NHS GRAMPIAN

PERFORMANCE REPORT –june 2012

This Performance Report is to provide Board members with assurance on key performance topics as discussed at the Performance Governance Committee (PGC) meeting on18th May2012.

The first part of the meeting, termed Healthstat, reviewed the documentation and outcomes from the cross system performance review (CSPR) held on 17th April 2012and sought assurance from the Chief Operating Officer, Director of Finance and Medical Director about performance improvement.

HealthStat / Discussion/Assurance
Better Care Without Delay: Access Targets / PGC was advised that the final report of the Better Care Without Delay programme had been presented at the CSPR. This provided a comprehensive picture of the range of activity which had been supported by the programme and made recommendations for the next steps. The programme had been in place for 4 years and had taken a whole system approach which had proven to be the correct one. The 90% within 18 weeks referral to treatment target had been delivered one month early in November 2011 and had been sustained since then. The programme had worked with individual specialties to improve pathways and had initiated the Clinical Guidance Intranet. It was now important that the activity continued and was appropriately embedded within operational units and through the strategic modernisation agenda.
PGC discussed in some depth the Grampian approach to delivering 18 weeks referral to treatment. Pauline Strachan advised that patients’ interests and wellbeing were central to the approach. On occasions where care was not likely to be available within the target period, contact was made with patients and a reasonable offer of treatment elsewhere in Grampian or at Stracathro or Golden Jubilee was made. If accepted then all travel and accommodation costs for patients and a companion were paid. Where patients chose to wait longer for treatment locally then the unavailability code was applied in accordance with the current guidance. There had been external scrutiny of the Grampian approach by Scottish Government and Information Services Division. NHS Grampian had been assured by thisscrutiny that the national guidance on availability was being followed appropriately. Pauline Strachan stressed it was important not to be complacent as inevitably there remained areas where improvement could be made. She advised PGC that an internal audit had beencommissioned to provide furtherscrutiny and Audit Scotland was to similarly undertake a Scottish wide audit.
PGC was also made aware of the recently published report on the culture within NHS Lothian which made a large number of recommendations. The Board Executive Team was examining the report in detail and the recommendations would be considered for applicability. At the CSPR Richard Carey had stressed that all NHS Grampian staff should be aware and supported to identify any problem areas with their manager in the first instance and no-one should feel under any pressure to hide or manipulate data in order to deliver targets. The culture as described in the report was not recognised in Grampian.
Ambulatory Care Toolkit / PGC was advised that the ambulatory care toolkit was a national tool which provided information on where efficiencies could be delivered through adopting best practice in unscheduled care. The recent issue identified Grampian as the Board with least scope for delivering further improvement in Scotland and also demonstrated that emergency admissions for a number of procedures had reduced. PGC was assured that this benchmarking information was utilised to guide continued improvement.
Performance Management Framework / PGC heard that CSPR had spent some time reviewing current performance management processes. The performance management framework had been updated to reflect the Chief Operating Officer position and the sector performance reviews that were now in place. It had been agreed to ensure future CSPR focussed on cross system issues and also on the modernisation priorities as well as public health and integration. The corporate functions would also be brought on Board with one being the focus of review at each meeting. Alan Gray advised that he was also refocusing the work of the Asset Management Group and Budget Steering Group to provide clearer performance information. Outcomes from this would be reported to PGC.

The second part of the meeting considered Assurance Reports submitted to PGC by other Board Governance Committees and the Community Health Partnership Committees. These reports consist of a template which documents the business discussed at the committees relating to performance issues which might impact on delivery of one or more of NHS Grampian Strategic Objectives or Themes and the actions put in place to mitigate these risks. At the May meeting six written reports were available covering a range of topics including:-

  • Importance of responding to the consultation on Charter of Patient Rights and Responsibilities (Patient Focus and Public Involvement Committee)
  • Delivery of the new Patient Advice and Support Service (Patient Focus and Public Involvement Committee)
  • Plans and performance of Change Fund initiatives (Moray CHSP)
  • Progress with national pilot on patient safety in primary care (Moray CHSP)
  • Progress with PMS data submission and mental health implementation (eHealth Committee)
  • The need to ensure co-ordinated approach to Designing Assisted Living at Scale (DALLAS) and support eHealth to support clinicians (eHealth Committee)
  • Reshaping care for older people – local Change Plans (Aberdeen City CHP)
  • Draft CHP Committee structure (Aberdeen City CHP)
  • Update on Maternity Services Review (Aberdeenshire CHP)
  • Consideration of an end of term report for the CHP (Aberdeenshire CHP)
  • Concerns re completeness of eKSF (Staff Governance Committee)
  • Update on ongoing work on Health and Safety (Staff Governance Committee)

The thirdpart of the meeting considered progress against the Strategic Themes and Objectives aligned to the Balanced Performance Framework. The overall performance position was presented followed by more in depth consideration of key topics. These included:-

Strategic Theme

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Topic

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Discussion

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Risk Rating

Improving the Public’s Health and Reducing Inequalities / Detecting Cancer Early (DCE) / Dr William Moore attended PGC to provide an update on the Detecting Cancer Early programme. It was noted that the local Steering Group had produced a highlevel implementation plan which was to be presented to the Operational Management Team and thereafter submitted to Scottish Government. There continued to be a high degree of uncertainty around the programme and work was ongoing nationally to firm up on definitions etc. Funding had been allocated to Boards but given the difficulty of assessing likely impact of the programme on referrals, cancers detected etc it was not known what additional local resource would be required to enhance this.
The NHS England DCE campaign had started and this, in association with a change in screening tests, was leading to increased colorectal referrals in Scotlandwith consequent impact on access times. Pauline Strachan advised that In Grampian there had been 100% increase in urgent suspected cancer colorectal referrals since December. This was impacting on current performance against the 31 day and 62 day cancer targets as priority was given to these over routine referrals. She assured PGC that action was in hand to address the issue and the 31 day target was back on track. However work was required across the patient pathway to ensure the right referrals at the right time. The local DCE Steering Group was taking a cross system approach which facilitated such discussion and action across the whole patient pathway. PGC commended William Moore for the work he was leading in this particularly complex area. / amber / high
Delivering Safe, Effective and Timely care in the Right Place / Media Report / PGC received its regular report on print media from Laura Gray. There had been fairly balanced coverage of the Maternity Services Review. The Princess Royal opening ChalmersHospital had featured widely and there had been a number of staff focused positive stories. There had also been some inaccurate stories which the Board had sought to put right. In this respect PGC learned of the growing use of social network sites, particularly Twitter, which allowed full statements to be put out immediately to the growing number of NHS Grampian ’followers’. Car parking, infection control and waiting times remained a recurring theme. / green / medium
Improving Efficiency, Productivity and Sustainability / Financial Position / Alan Gray reported on the overall financial position at the end of March 2012. Subject to audit the three financial targets had been delivered which was a very good position given the challenges faced by sectors throughout the year. Budgets for 2012/13 were now being set. The impact of incremental drift was being looked at closely and addressed where possible. The areas of ongoing financial risk were energy costs and GP prescribing costs although it was noted that in 2011/12 a number of drugs came off patent resulting in a fall in price. / green / medium

Anne Ross

Head of Performance and Quality Improvement

May2012

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