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Agenda Item No. 3.1 Agenda Item No. 3.1 Manchester Health and Care Commissioning Board Meeting Agenda Item 3.1 Date 27 March 2019 Report Title Performance and Quality Improvement Report Report Author The Performance and Quality Improvement Team This report summarises the quality and performance highlights to be brought to the attention of Manchester Health and Care Commissioning (MHCC). The report covers Summary national, regional and local key performance indicators as set out in the annual planning guidance and those embedded as requirements in provider contracts. Improve the health and wellbeing of people in Manchester Strengthen the social determinants of health and promote Strategic healthy lifestyles Objectives Ensure services are safe, equitable and of a high standard considered in this with less variation report Enable people and communities to be active partners in their health and wellbeing Achieve a sustainable system Risks identified in this report are included in the organisational risk register. 749 Local Care Organisation Risks considered in 750 Single Hospital Service this report 752 Service capacity 753 Care Pathways 757 Provider Service Delivery 758 Strategic Partnerships Agenda Item No. 3.1 Yes - the Performance, Quality and Improvement (PQI) team have undertaken an Equality Impact Analysis (EIA) on their Confirmation that PQI Framework released for 2018/19. Alongside the 9 equality analysis protected characteristics the team has identified sub- has been fully categories that are important to capture to better facilitate our considered in the work, these include: homelessness, carer status, dementia, preparation and learning disabilities, asylum/refugees, looked after children design of the and employment status. Where we undertake a breach reported policy, analysis or deep dive a review of protected characteristics is plan or strategy. undertaken as a matter of course and will be reported accordingly to committees and boards. Financial N/A Implications Public Engagement N/A The Board is recommended to: Recommendations 1. Support the actions being undertaken to improve the quality and performance of services commissioned for the population of Manchester. Agenda Item No. 3.1 EXECUTIVE SUMMARY Urgent Care Accident and Emergency (A and E) 4hr performance continues to be challenging across all Manchester hospitals with all sites reporting performance short of the agreed monthly and quarterly sustainability and transformation fund (STF) trajectories in January. Following significant underachievement in December, North Manchester Care Organisation (NMCO) reported an improving position, with Manchester Royal Infirmary (MRI) and Wythenshawe reporting a deterioration of performance month on month. A weekly 4 hour performance improvement trajectory has been agreed with acute providers, with MFT to achieve 85.5%, and NMCO to achieve 81.2%, by the end of March. Achievement of the 30 minute ambulance handover turnaround target remains a challenge. In January MRI, Wythenshawe and NMCO sites did not meet the required standard. However the North site only narrowly missed the 30min target achieving 30minutes and 56 seconds MRI site continues to achieve the 3.3% delayed transfers of care (DTOC) target with Wythenshawe and NMGH sites failing to achieve this target Elective Care Diagnostic and RTT incomplete performance was below trajectory at all sites in December and performance remains challenged. There has been a slight decrease in the numbers of patients on incomplete pathways between March and December 2018. At MFT, a significant improvement has been made in the over 52 week waiters with deep inferior epigastric perforators (DIEP) procedures expected to hit the trajectory of reducing breaches by 50% by the end of the year. PAHT continue to work towards delivering no 52 week waiters by the end of the year, although bed pressures present a risk. Cancer All Trusts are engaging with MHCC and have improvement trajectories for underperforming specialities, with recovery of the 62-day standard expected in quarter 4 for both providers. Investigations are completed for breaches and lessons Agenda Item No. 3.1 learnt are shared to improve performance. Risks continue to be monitored and escalated as appropriately. Quality Quality exceptions are presented for both MFT and PAHT in relation to complaints, staff training, medicines management and mixed sex accommodation breaches. Service Delivery Improvement Plans (SDIP) for 19/20 will be in place with providers for the following KPIs: Medicines at PAHT – this will be led by the MHCC Medicines Management team. The ambition is to align the KPIs and targets to those in the MFT contract so these are aligned prior to North Manchester moving into the single hospital. Complaints at MFT PQI will seek assurance from providers regarding the other quality KPI exceptions in quarter 4. Children and Family Health An update on maternity KPI exceptions is provided. MHCC will meet with both providers to identify any data quality issues and have a plan in place to resolve these and provide positive assurance in quarter 4. Mental Heath The number of people receiving psychological therapy continues to increase. MHCC is confident in delivering the access target of ensuring 4.75% of people with a mental health condition enter treatment in quarter 4 and the 18 week waiting time standard. Achievement of the 6 week waiting time and the recovery standard are forecast to be achieved in quarter 1 of 19/20. A summary of the quality walkround at Redwood Ward in the Park House Unit, situated in North Manchester General Hospital is included. Manchester Local Care Organisation KPI exceptions are presented in relation to RTT, Learning Disabilities, staff training, complaints, looked after children and health visiting. The community paediatrics service has an action plan in place to improve RTT performance. There are also improvement plans in place regarding complaints and staff training. Formal escalation is in place regarding delays in notifications for LAC assessments and there are plans to recruit additional health visitors. Service leads and health and social care commissioners are in the process of mapping out whole scale service re- design in relation to the LD services (both health and social care). The aim is to design an integrated service model based on the new service specification, which will also address the waiting time issues in the longer term. Agenda Item No. 3.1 Primary Care Quality and Performance of general practice is highlighted in this section with exception reports for practices requiring intensive support. There have been no changes to CQC inspection ratings since the last report. Building on the success of the past year, the PQI team are now working towards developing a visit toolkit to use with practices to help proactively identify any areas requiring support at an early stage. Adult Social Care Quality and Performance of nursing and care homes is highlighted in this section with exception reports for homes requiring intensive support. There have been no changes to CQC inspection ratings since the last report. Smaller Providers An update is provided on those providers which remain a cause of concern to the team due to quality and/or performance issues. Those providers are: • Alliance Medical – Magnetic Resonance Imaging (MR) • Concordia – Dermatology • Mediscan – Non Obstetric Ultrasound (NOUS) and MR • PRIMO – Musculoskeletal service Issues are being managed via contract review meetings CCG Improvement and Assessment Framework The latest iteration of the CCGIAF dashboard was published on the 13th February 2019. This is the 5th dashboard that has been produced on the Manchester footprint. Within the Better Health / Better Care sections there are 43 reported indicators for Manchester. 3 indicators are in the top quartile, these are: IAPT Access Estimated diagnosis rate for people with dementia Choices in maternity services Contract Planning A final version of the national contract was published in February. The PQI team have reviewed the national publications and ensured any updates are reflected in the relevant quality schedules and KPIs. The deadline for agreeing contracts is 21 March 2019 and final meetings are being held with providers. The CQUIN guidance has not yet been published; this was expected before the end of January but now looks likely to be published in March at the earliest. It has been indicated in the contract consultation that the value of CQUIN will reduce from 2.5% of the value of the contract to 1.25%. A service development improvement plan (SDIP) has been agreed with MLCO covering 4 key areas: Agenda Item No. 3.1 Integrated Neighbourhood Teams – develop a suite of metrics that will demonstrate the benefits of implementing the new models of care. This will build on the theory of change work and the benefits articulated through business cases and service specifications. Elective access and non-consultant waiting lists – to ensure waiting times for community services are subject to the same scrutiny as secondary care services. Quality assurance – to work together to enhance the current regime of quality assurance. Children and Young People’s Transition – to develop small number of metrics that demonstrate the smooth transition from children to adult’s services. 1.0 Introduction 1.1 This report summarises the quality and performance highlights to be brought to the attention of Manchester Health and Care Commissioning (MHCC). The report covers national, regional and local key
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