Quarterly Joint Commissioning Team (Jct)

JOINT COMMISSIONING PARTNERSHIP BOARD

WEDNESDAY 15 JULY 2009 AT 10 A.M.

QUARTERLY JOINT COMMISSIONING TEAM (JCT)

SUMMARY PERFORMANCE REPORT

Authors: Mark Jordan, Head of Joint Commissioning;

Melanie Parker, Finance Manager Adult Care Services;

Wayland Lousley, Planning and Commissioning Manager - Working Age Mental Health;

Judith Jackson, Planning and Commissioning Manager – Learning Disabilities;

Steve Malusky, Planning and Commissioning Manager – Mental Health Services for Older People;

Sue McRitchie, Planning and Commissioning Manager – Drug and Alcohol.

Tel: 01438 843232

Purpose of report

To present a high level quarterly performance overview of the partnership in relation to finance and key targets.

2.Summary

The Joint Commissioning Partnership Board ( JCPB) contains the following:

A ‘Traffic Light’ summary of key performance indicators for each care group within the partnership.
A Financial summary presenting the partnership’s revenue monitor.
A ‘Background Information’ section containing reports from each care group presenting any significant areas of note in relation to performance and finance.
Conclusions / Recommendations.
Appendices containing:
Financial tables (Appendix 1)
The partnership risk register (Appendix 2)
The JCPB forward agenda and workplan (Appendix 3)

Key performance issues are highlighted in each of the specific care group sections. In particular we would draw the Board’s attention to progress made in relation to Working Age Mental Health Crisis Teams and Psychological Therapies performance targets andSubstance Misuse numbers in treatment targets.

Because it was recommended that the proposed performance scorecards presented to May JCPB be further simplified we are continuing to use the previous ‘traffic light’ summary report until the new revised format can be agreed.

A number of other pieces of work relating to the improvement of the Joint Commissioning Team’s performance monitoring and performance management arrangements are also continuing including:

The establishment of a data quality policy.
The findings of the external review of clinical governance arrangements that has been taking place.
The findings of the survey of service user-carer experience of care and treatment.

Together these pieces of work will help shape our future approach to performance monitoring and performance management, including the structures we adopt for the next Foundation Trust contract.

General updates on developments and other matters of interest are not included in JPCB reports but instead are included in a new quarterly partnership newsletter. Copies of this will be available at board and public meetings and through the partnership website (

090715 04 Item 4 Report on Quarterly Performance

2.1 Quarterly Summary Headline Indicator Report

Below are summarised this year’s proposed headline performance indicators for each commissioning care group along with associated information under the following headings:

Indicator Description

This describes the nature of the indicator, what it is about and how it is measured.

Reported to / on behalf of

This indicates which national regulators this is reported to and which partner organisations ratings are affected by the performance against it.

Target for year

Identified here are the target numbers to be achieved for the current year. (NB some will not yet be available for the current year.)

Current position

Identified here is our performance so far and the date of this latest information.

Traffic Light

This traffic light rates performance against this indicator as:

Red: Significant risk at present of missing target

Amber: As yet unsure of achieving annual target

Green: Currently confident of achieving target

Comment / Actions

Description of any measures in place to address any performance issues plus any other key comment regarding the indicator.

Adult Learning Disability

Indicator Description

Reported to / on behalf of

Target for year

Current position

Traffic Light

Comment / Actions

Number of people with individual budgets

ACS

100

176

Green

Target exceeded

Number of people who meet DH campus definition who have moved to community settings

PCT

Green

Target hit

Number of new housing and support places developed

JCT/ACS

Amber

/ Some delays as housing associations have had to rework financial models to reflect current state of property market and gain the necessary approvals from their Boards.

Working Age Mental Health

Indicator Description

Reported to / on behalf of

Target for year

Current position

Traffic Light

Comment / Actions

Seven Day Follow up post discharge

HCC / PCT

100% DH, 95% Monitor

97.6%

Green

Although the target is 100% monitor are only asking for 95% this year which is the target HPFT are working to.

Early Intervention in Psychosis- New Cases

HCC / PCT

150

182 as at q4

Green

375 figure currently behind projected caseload figures needed to meet target of 450 by July 09

Number of high intensity workers and low intensity workers in West Herts as part of the Improving Access to Psychological Therapies roll-out

/ SHA on behalf of PCT & HPFT / for 08/09 required36.3 HI & 21.6 LI workers / 22 HI and 13 LI 01/10/08 /

Amber

HPFT are having difficulty filling vacancies, but mitigating action underway to establish full 80% workforce.

Further work being done with counseling services re potential for redesign to establish remaining workforce numbers. Target is to match fund full workforce by March 2010 Total workforce =

44 High Intensity (HI) 26 Low Intensity (LI)

Older People’s Mental Health

Indicator Description

Reported to / on behalf of

Target for year

Current position

Traffic Light

Comment / Actions

Older Peoples Assessment Waiting Times

Contacted within 2 Days
Assessed within 4 weeks
Combined score

CSCI / ACS

/ 100%
68.9%
84.4% / No longer recorded
80.5% /

Green

/ MH Data taken from Carenotes. Target is for all client types and not just for MH. The combined score could not be achieved as the revised national targets do not record 2 day waiting times on care notes. More details in the report Appendix 4

% Receiving provision of all services in a care package within 4 weeks of completion of assessment.

(PAF D56) /

CSCI / ACS

/ 93% / 91.7% /

Amber

/ Numbers for Mental Health records remain low on Iris and Care Notes.
ACS reported that 69.3% are having a completed assessment within 2 weeks and 37.4% are completed before day 2

Direct Payments to Mental Health Service Users

CSCI / ACS

/ 37 / 35 /

Amber

/ 35 Cases recorded as at 31st March. The WGC/Hatfield and Decorum Pilots showed slow early take up but has improved in Q3 & Q4

Equipment Delivered to Service Users within 7 days.

CSCI / ACS

/ 88% / 89.4% /

Green

Substance Misuse

Indicator Description

Reported to / on behalf of

Target for year

Current position

Traffic Light

Comment / Actions

Numbers of Heroin and Crack users in Effective Treatment

NTA & HCC / PCT & ACS

1652

1590

Red

/ Further detail with action plan to address in report. Latest available position to 31.12.2008 shows reduction in the deficit
DIP numbers commencing treatment / Government office/HCC / 389 / 660 /

Green

Target set at growth rate for 2008/9

Provisional position to Mar 09

Alcohol Detox waiting times

/ NDTMS/PCT & ACS /

6 weeks

3 weeks or under

Green

Introduction of initiatives to reduce waiting times

DRR Commencements / Probation service / HCC/PCT /

180

225

Green

Position at end March 09

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3. Background Information

3.1Finance (see also Appendix 1)

The summary text below relates to the financial year 2008/9 as revenue monitor information for 2009/10 is not yet available.

Appendix 1a provides a summary of the JCPB budget for 2008/09, and the outturn revenue monitor for 2008/09.

Appendix 1b provides a summary of actual investment ofthe Primary Care Trust (PCT)growth monies in 2008/9.

Appendix 1c (to follow) summarises provisional budgets for 2009/10.

Also attached in the Memorandum Account for the Pooled Budget 2009/10.

Overview

The budgets managed by the partnership on an agency basis were underspent by £932,000 on service level agreements, with an underspend of £289,000 on other services.

The two main providers both reported internal overspends at the year end, with Hertfordshire Partnership Foundation Trust (HPFT) projecting an overspend of £1,248,000 on the services commissioned by JCPB, and Adult Care Services (ACS) reporting an overspend of £2,509,000 on JCPB commissioned learning disability services. These budgets are managed at risk to the providers and do not directly affect partnership budgets.

Detailed financial monitoring information was presented to each of the Strategic Commissioning Groups. More detailed explanations beyond that presented here is included in the performance report for each care group where relevant.

3.1.2Partnership Finances

a)Joint Commissioning Team

The variance on the Joint Commissioning Team was £8,000 overspent. This has arisen from the cost of staff to cover sick leave.

b)Learning Disability

The budget for specialist placementsunderspentby £241,000. This compared to £230,000 underspend reported in May 2009.

c)Working Age Mental Health

The underspend increased to £485,000 from £430,000 reported in May 2009, due to delays in setting up the Personality Disorder service and includes an underspend of £29,000 on services at the Mount Prison.

d)Mental Health Services for Older People

The underspend was £206,000. This has arisen from delays in implementing new services.

e)Drug and Alcohol

No significant variances projected on drug and alcohol services.

f)Contracts with Voluntary Organisations (ACS)

Grants to voluntary organisations for adult mental health services overspent by £133,000. This was an increase from £104,000 reported in May 2009, due to further commitments made at the end of the year. The overspend was funded from the underspend on S28a budgets.

There was no variance on learning disability voluntary organisation contracts.

g)S28a Mental Health

Mental Health S28a underspent by £289,000 in 2008/09.

3.1.2Provider Finances

The variances reported by the providers are the responsibility of the provider. They do not affect the amount JCT will pay the provider but they do indicate where more or less services are being provided than were budgeted for at the start of the year.

a)Hertfordshire Partnership Foundation Trust.(HPFT)

HPFT reported an overspend of £1,248,000 at the year end for services commissioned by JCPB. This was made up of a projected overspend of £3,172,000 on working age mental health external placements, offset by underspends on community services across all care groups.

b)HCC Adult Care Services

ACS learning disability services reported an overspend of £2,509,000 for 2008/9.

The overspend on ACS LD services have arisen from:

Purchasing budgets were £2,564,000 overspent. The purchasing budget was set at the start of the year using assumptions about the number of people who would be placed during the year, and the cost and timing of those placements. These assumptions proved to be incorrect and understated the number of people who would need to be placed and the cost of the new placements.
The in-house supported living service reported an overspend of £99,000 due to additional staffing being required to meet the needs of higher dependency clients. This was partly offset by projected underspends on day services of £51,000 resulting from the difficulties in recruiting suitable staff, which gave a net projected overspend of £48,000.
Learning Disability Development Fund (LDDF), was underspent by £103,000. ACS had made plans to fully spend the LDDF allocation in 2008/9, taking forward the Government's "Valuing People Now" agenda. However the Government agenda paper was not published until the end of January 2009 and the implementation guidance issued even later than this, and as a result the planned expenditure slipped into 2009/10.

3.2 Working Age Mental Health

3.2.1Improved Access to Psychological Therapies (IAPT) delivered by the Enhanced Primary Mental Health Service (EPMHS)

At the same time as implementing IAPT in the West Herts area Hertfordshire Partnership Foundation Trust (HPFT) started recruiting for the second wave expansion across East andNorth Herts. As of April 2009 HPFT have recruited and started training 24 of the 34new trainees. HPFT have only been able to recruit to one High Intensity trained worker post prior to starting the service on 1st April. HPFT have utilised experienced Psychologists, Community Psychiatric Nurses, Occupational Therapists and Social Workers as supervisors and team managers as an interim measure to support the new trainee workforce both through supervision and day to day working. HPFT have a rolling recruitment programme in place advertising in national and local papers as well as the NHS job recruitment website and recently recruited 3 of the 4 lead psychology posts to start in July-September 2009.

The inability to recruit trained workers is a nationwide issue for which commissioners and HPFT in consultation with East of England Strategic Health Authority (EoE SHA) have done everything possible to resolve. In October 2009 Hertfordshire will have the first cohort of trained staff in place and plans to continue training more workers in an effort to grow the workforce locally. HPFT are also looking at a variety of ways to retain this newly trained workforce and commissioners are hopeful that HPFT will be able to achieve and maintain the required performance levels. However, so as to manage the risk of their not so doing, commissioners are also undertaking a feasibility study with regard to tendering out IAPT services. The results of this feasibility study will be available in the autumn and reported to JCPB whose approval will be sought should tendering be recommended.

Despite the ongoing workforce issues which will continue to hamper performance throughout 2009/10, the EPMHS in West Herts delivered 4,174 sessions having received approximately 2,200 referrals with 1,000 people entering into psychological therapy, 453 completing treatment and 22 moving off sick pay or benefits. This is a good start towards achieving the final targets of 14,362 completed treatments and 383 moving off sick pay or benefits by the end of March 2011. It is worth noting that throughout this programme development there have been constant changes to outcome parameters set by the Department of Health and as a result there is ongoing discussions regarding the appropriateness of these targets.

3.2.2Early Intervention in Psychosis Service

The Early Intervention in Psychosis Service has continued to provide support to people suffering from first episode psychosis. The position at the end of the year was a total caseload of 375 against an interim target of 410. The expected caseload is a rolling caseload of 450 which should be in effect by June 2009, however it is anticipated that this target will not be reached until later in the summer.

3.2.3Crisis Assessment and Home Treatment (CATT)

Following clarification on the targets, counting has been adjusted, demonstrating as previously reported that in 2008/9 we did not meet the 1,636 new episodes target. Since then CATT has been reviewed and local targets for each team are now measured on a monthly basis and there have been changes in practice such as increased in-reach to facilitate inpatient discharge. These changes mean that we are confident of the target being achieved this year.

3.2.4Care Programme Approach (CPA) 7-Day follow up

The target of 100% of all admissions requested by the Department of Health is the ideal that HPFT is working towards but the key target of 95% is set by Monitor and we are performance managed against. CPA 7 day follow up relates to the timely post discharge follow-up of ‘at risk’ service users and continues to be closely monitored by HPFT and the JCT.

3.3Drug and Alcohol

3.3.1 Drug Numbers in Treatment

Background

The figure on which future growth projections were based have, historically, been affected by numbers of clients previously reported but not discharged by a now decommissioned service – Chrysalis. Data quality had been poor for sometime before the decision was taken to decommission the service in 2007. A closure strategy was agreed with the National Treatment Agency (NTA) and the Regional Drugs Health Information Unit (RDHIU) and all Chrysalis clients were discharged in the November 2007 submission to the National Drugs Treatment Monitoring System (NDTMS) with a discharge date of 30th September 2007. This discharge date solution was agreed with Joint Commissioning, the Regional and Central NTA as the best solution in the circumstances and in order to minimise impact on 2007/8 performance against targets.

A new measure of numbers in effective treatment was introduced in April 2008 although details of how it was to be calculated and the use of a rolling 12-month period were only available some months after that. As this change only came into effect some six months after Chrysalis had been decommissioned the retrospectiveimpact on 2008/9 performance ratings was significant. Therefore the NTA agreed that the adjusted figures should not impact on the PCT’s overall performance rating. However, this retrospective adjustment in figures will continue to affect reporting into the future thus significant increases in performance have to be achieved 2009-11 if targets are to be met.

Problem Drug Users (PDUs) (Heroin and Crack) Numbers in Effective Treatment Target

The target for 2008/9 was 1652. Following the data cleansing in September 2007 PDUs reported as in effective treatment at September 2008 stood at 1554 which indicated that Hertfordshire would be between 1% and 8% short of target at year end March 2009.

Latest available PDUs in Effective Treatment at December 2008 stand at 1590 reducing the deficit to 62 clients which indicate that Hertfordshire would be between 1% and 4% short of target for 2008/9. We anticipate further potential improvements to numbers including additional clients entering treatment in respect of the Practice Based Commissioning Service based at Stevenage and from Tier 3 services at a Hertford based non-statutory provider and are working with them and all providers to ensure all clients are captured.

●If the target shortfall is 1% we would potentially meet 2008/9 target late April 2009/May 2009 between 2 and 3 months late. We should hit the 2009/10 target mid-year at latest and potentially June 2009.

●If numbers come in 4% under target we would potentially meet the target September 2009/October 2009 – 6 to 7 months late and the 2009/10 target November 2009.