GOVERNING BODY

Agenda Item No. 13

Reference No. IESCCG 19-30 Date. 21 May 2019

Title Integrated Performance Report

Lead Chief Officer Chief Officers

Author(s) Alex Briggs, Head of Corporate Intelligence

Purpose To provide members with a summary of performance against national targets, contractual targets, clinical quality and patient safety issues, financial position and workstream activity.

Applicable CCG Clinical Priorities: 1. To promote self-care  2. To ensure high quality local services where possible  3. To improve the health of those most in need  4. To improve health & educational attainment for children & young people  5. To improve access to mental health services  6. To improve outcomes for patients with diabetes to above national averages  7. To improve care for frail elderly individuals  8. To allow patients to die with dignity & compassion & to choose their place  of death

Action required by Governing Body:

To note the position regarding financial and service performance; review actions being taken with regard to patient safety and clinical quality issues; and any actions to mitigate risks or poor performance.

Integrated Performance Report

May 2019

1 Part 1 –Clinical Quality & Patient Safety ………………………………………………………… 3-20

Part 2 – Finance………………………………………………………….. 21-24

Part 3 – Transformation / PMO……………………………………………………………………………………. 25-29

Part 4 – Contractual Performance by Provider………………………………………………. 30-31

Part 5 – Primary Care……………………………………………………………….. 32-33

Part 6 - National Reporting Measures ……………………………………………………… 34-37

2 Clinical Quality & Patient Safety Report

May 2019

3 CONTENTS

Slide 3 EXECUTIVE SUMMARY

Slides 4 - 9 PROVIDERS ON A PAGE / QSAF UPDATES (APRIL 2019)

Slide 10 CONTINUING HEALTHCARE (CHC)

Slide 11 CARE HOMES

Slides 12 - 14 MATERNITY

Slides 15 - 16 SPECIALIST SERVICES – TRANSFORMING CARE

Slides 17 - 18 SPECIALIST SERVICES – INDIVIDUAL FUNDING REQUESTS (IFR)

4 EXECUTIVE SUMMARY

This version of the integrated performance report has been produced following the CNO’s inaugural Quality Scrutiny and Assurance Forum (QSAF).

This forum has been established in line with the CNO’s new Quality Assurance Framework and consists of Clinical Quality, Patient Safety, Patient Experience, Safeguarding, Care Homes, Specialist Services, CHC and Infection Prevention and Control. Therefore,

This IPR pack is the first iteration following the forum and in turn will be a process to be improved upon. These slides endeavour to provide an overarching view of key providers based upon the five key domains; Safe, Effective, Caring, Responsive and Well-Led.

Where there are concerns, the slides aim to provide assurance around the actions being taken to mitigate against the risks highlighted.

5 PROVIDERS ON A PAGE / QSAF UPDATES

Care UK

CCG Rating: Level 2 CQC rating: May 2017: Good

Month Apr-19 QSG surveillance rating: Quality Issues / Concerns / Comments Actions / Progress Domains 1. Assurance required RE CAS queue and comfort calls/breaches. 1. A CCG unannounced visit has been scheduled for 27/04/2019 (to include: Safe 2. 3 SI's being reviewed by CCG. Clinical Quality, Contracts, Transformation and GP involvement).

1. Concerns relating to the OOH's service (2 hour and 6 hour KPI) around patients 1. A CCG unannounced visit has been scheduled for 27/04/2019 (to include: receiving call backs. Clinical Quality, Contracts, Transformation and GP involvement). Effective 2. Significant concerns around the CAS and OOH's service across the CCG around 2. Being followed up through the RAP and QCPM in order to gain assurance. performance and safety of the service.

1. 1 x complaint relating to communication. 1. Four star ratings on NHS choices and Healthwatch. Clinical Quality Team Caring to obtain a better understanding of Care UK's complaints process (either via the upcoming unannounced visit or a future QCPM). 1. 2 Recent SI's related to pathways including the use of and escalation from a Health 1. Follow up through the QCPM and the RAP. Advisor to a Clinical Advisor. Responsive

1. Significant loss of staff at the end of last year including GP's, Health advisors and 1. Robust recruitment strategy in progress which is starting to show a Clinical advisors. The move to an IUC has coincided with the staff losses. positive improvement. Well led

6 PROVIDERS ON A PAGE / QSAF UPDATES

EEAST March 2018: Requires CCG Rating: Level 2 CQC rating: Improvement Month Apr-19 QSG surveillance rating: Quality Issues / Concerns Actions / Progress Domains 1. 2 x SI's; 1 x attending a fall - fractured neck and femur - full report pending, 1 x fall 1. CCG is setting up a Regional SI Learning Group with the Trust. This will attended - called back the following day due to a bleed. allow learning and themes to be shared at regional level. 2. 80 x SI's reported for 2018-19 - an improved position compared to the previous year 2. No Never Events reported for 2018-19. Safe (risk summit), with treatment delay remaining the highest category - identified as an 3. Quality leads will continue to seek assurance from the Trust around their early trend. vehicle decontamination schedules. A planned visit is also scheduled for 3. Vehicle Decontamination - Our STP has been highlighted as the lowest-performing mid-May. across EEAST. 1. ACQIs have been refreshed for this financial year; Clinical quality lead will provide 2. Stroke is a known difficulty in due to it's rurality. EEAST is an update at each QSAF. exploring in detail stroke cases, looking at response time, care bundles and Effective 2. Strong performance reported for February across ACQIs, with the exception of time to transport to hospital. Stroke 60. 1. Issues present around capacity and logging compliments onto Datix. 1. Clinical Quality Lead will be accompanying Healthwatch on a visit to 2. FFT results remain positive and continue to have a high response rate. Bedfordshire, with a view to Healthwatch supporting the Trust to collate Caring 3. Healthwatch and NHS Choices Ratings are four stars and 4.5 stars respectively. patient feedback.

1. On balance, Care Bundles (Stroke) are reported at 99-100%, this is significantly 1. A planned visit is also scheduled for mid-May where this will be discussed above the national average. with staff. 2. Hospital Delays - HALO's are continuing at both sites into this financial year. Responsive 3. E-PCR - low compliance (use) reported for Suffolk - this is attributed to fleet issues (docking stations). 4. Response Times - the Trust has work in-train with Lighthouse Analytics, looking at statistical variants across semi-rural/rural areas. 1. CCG is mindful of the high volume/s of referrals into the Suffolk MASH. 1. Safeguarding (skeleton) reporting for the contract has been agreed. 2. CCG consensus is that the focus has been on regional reporting and that there 2. Each STP Area does want slight variations in information. needs to be more of a focus locally. 3. A Task and Finish Group will be working on this for the first two quarters of 3. The Trust's lack of response to recent Compassionate Conversations Training has this year, with the Suffolk Safeguarding Team leading for the region. been noted. 4. Clinical Quality will continue to monitor training compliance and seek Well led 4. Mandatory Training Compliance achieved for March, with the Professional Updates assurance around non-compliance. (18-month cycle) due to complete in September. There is an associated risk identified - training is suspended during winter / periods of surge. 7 5. Recruitment/retention remains a significant risk, with the service moving to a local model; there is a delay for the Local Recruitment Specialist for this area. PROVIDERS ON A PAGE / QSAF UPDATES

E-ZEC

CCG Rating: Level 3 CQC rating:

Month Apr-19 QSG surveillance rating: Quality Issues / Concerns Actions / Progress Domains 1. Poor performance can impact on patient safety (medications, access to appointments). Safe

1. The service is failing to meet its KPI's, fluctuating between 55-60%. 1. A further red to green week is scheduled (7th May) whereby contracts and 2. Potential culture issues have been identified in respect of bullying. clinical quality will assess the provide against the actions agreed at the last red to green week. Clinical quality will also explore the areas raised in relation to the culture in the organisation and the issues raised as part of the Effective complaints process.

Caring

Responsive

1. The service has lost 85% of its staff and there has been continued challenges around returning to establishment. New starters have a period of induction and training and therefore impacts their ability to start immediately. Well led 8 PROVIDERS ON A PAGE / QSAF UPDATES

ESNEFT

CCG Rating: Level 3 CQC rating: Month Apr-19 QSG surveillance rating: Quality Issues / Concerns Actions / Progress Domains 1. Significant concerns raised around ED and the timeliness of interventions, as well as 1. Quality visits have scheduled across both ESNEFT sites in collaboration sepsis compliance, infection control and onward referrals. with North East Essex CCG, including ED and Maternity. 2. A higher number of falls reported for the Site - Colchester Site has a Falls 2. CCG Quality Team will explore this further as part of the planned visits. Safe Lead. 3. This is partly attributed to vacancies within practice education in the 3. Pressure Ulcers - significant concerns around the Community Hospitals numbers. community (staff moving to the West) - CCG has requested workforce data in connection with staff surveys for the next QCPM. 1. Readmissions remains an area of concern. 1. Work is ongoing around readmissions and the Quality Team will review 2. Trust is deemed not to be on top of its SI's (i.e. 60-day reports). As a consequence, regularly as part of the PQRM. CCG does not have assurance that (appropriate) actions are being taken, with 150 x 2.CCG is currently working on a new plan to hold ESNEFT to account on a action plans overdue. monthly basis, with involvement from their governance managers Effective 3.157 x SI's reported for 2018-19 (a proportion were pre-merger) 3. All SI's now follow the new process of review set up within the CNO 4. 6 x Never Events reported for 2018-19 (all theatre-related) Directorate 5. SHMI - ESNEFT is two deviations higher than expected and sits as a regional 4. All SI's/Never events follow a process of review which enables themes to outlier. be highlighted and reviewed. 1. The Trust is not deemed to be on top of its complaints in terms of timely responses. 2. 2 x complaints: 1 x A & E Staff being rude, 1 x Concern raised prior to fathers death. Caring 3. GP Issues Log - backlog remains in respect of responses. 4. Healthwatch and NHS Choices ratings are four stars and 4.5 stars respectively. 1. CCG is not sighted on the community safeguarding for adults - the Community 2. CCG Safeguarding Team liaise with the CCG care homes team to allow Safeguarding Practitioner is working closely with WSHFT, including joint action the sharing of intelligence to enable support to be provided alongside the planning around community safeguarding. This however is not being mirrored in the community services. Responsive East. 2. Community Healthcare has raised safeguarding concerns in respect of care homes and pressure sores - there is a lack of recognition that these sit with the District Nurses, i.e. care plans not being shared. 1. Issues identified around the harmonisation of Ipswich and Colchester structures. 2. Safeguarding training and competencies - the Trust is continuing to align and roll these out. Well led 3. ESNEFT is compliant in terms of PREVENT. 4. IHA's - Issues present in terms of the North East Essex element, being 9 commissioned in Ipswich Hospital. PROVIDERS ON A PAGE / QSAF UPDATES

NSFT

CCG Rating: Level 3 CQC rating: Inadequate Month Apr-19 QSG surveillance rating: Quality Issues / Concerns Actions / Progress Domains 1. Significant concerns around CYP services. The EWB Hub waiting list was 1. CNO team members were recently in situ at the EWB Hub to offer previously in excess of 1,300 patients awaiting contact - this has since reduced to support and clinical leadership, in light of report findings into the EWB 900 and business as usual should be able to meet demand. Hub; this has since been stepped back. Clinical Quality also attends the Safe Weekly Oversight Group and the EWB Board. There remains concerns in terms of clinical leadership and skill mix, and questions raised around decision making within teams. 1. Care Plans - concerns around keeping these up to date, as well as clinical record 1. Care planning and care plans are being reviewed as part of the keeping, particularly within CYP services and crisis. Significant reduction seen in service line reviews taking place. terms of care plan compliance - thought to be largely attributed to staffing. 2. CCG Safeguarding Team is working closely with the NSFT 2. The lack of NSFT representation at safeguarding forums has been noted along safeguarding colleagues to encourage representation and support with adult reporting being very limited in information. reporting where deficient. Effective 3. Children - Level 3 training compliance is sitting at 74% (red-rating). 3. Escalated to the Trust Deputy Director of Operations. 4. 42 x SI's reported for 2018-19, with the majority relating to self-inflicted harm. 4. Table top review arranged of the 32 SI's relating to 5. There has been a significant increase in the number of extensions for 60-day apparent/actual/suspected self-inflicted harm - review will look for reports, which is another indicator of the staffing issues. themes and learning.

1. 1 x complaint relating to ADHD - issue around MP letters and timeliness of Caring responses from the Trust - NHS Choices Rating of 2.5 stars. 1. Downgrading of referrals. 1. Clinical Quality will be meeting with Mike Seaman, Deputy Chief 2. Out Of Area (appropriate) - 15 x patients - CCG trajectory of 250 x bed nights Nurse for the Trust, in May, for the purpose of undertaking a joint audit. has been significantly exceeded, currently sitting at 407 - this is attributed to Acute. 2. Clinical Quality has expressed disappointment at there being not Responsive OOA for CYP - 17 x children are currently in Tier 4 provision. home treatment function for children, and will be looking to be actively involved in that piece of work moving forwards.

1. Significant concerns raised around youth pathways, IDT staffing levels and 1. This is being escalated at Director Level as progress has not been waiting lists. Indications are of increased attendances at A & E for CYP. The seen. reduction in school nursing is also directly attributing to this. 2. Staffing levels and recruitment are routinely monitored via the QCPM. Well led 2. Staffing and retention remain of significant concern. 3. The CCG is currently exploring the options for commissioning 10 3. ADHD - significant concerns around the operational side of the service. additional support via NSFT in the short term. PROVIDERS ON A PAGE / QSAF UPDATES

WSHFT

CCG Rating: Level 1 CQC rating: Outstanding Month Apr-19 QSG surveillance rating: Quality Issues / Concerns Actions / Progress Domains 1. Neutropenic sepsis door to needle time remains an area of focus for improvement. 1. Sepsis and neutropenic sepsis meetings are being brought together within the 2. Nutrition is an area that is being focused on across the wards due to poor performance. Trust in May with an update expected at the QCPM in June. 3. C-Diff case noted which has indicated some cross contamination. 2. Focus is being given to nutrition throughout the hospital as they seek to Safe improve compliance in this area. 3. This is being thoroughly investigated by the IPC team at WSHFT. The ward as part of movements with escalation beds is also being closed for a complete deep clean. 1. High volumes and acuity have resulted in the use of escalation beds for longer than 1. Assurance has been sought from QCPM that the use of escalation areas are anticipated in recent months. being monitored and reduced where appropriate. Re-modelling for next winter is 2. 55 X SI's reported for 2018-19 (a noted reduction) - this is due to a change in classification already taking place, taking in to account the changes seen this year. for G3 pressure ulcers. 3. These are being monitored via the SI route to inform themes and learning that 3. Increased number of IG breaches noted. is being implemented as a result of findings. Effective 4. 2 x recent never events experienced by the Trust. 4. CCG Clinical Quality and Patient Safety are seeking assurance around the 5. Poor performance noted in terms of NRLS due to not reporting differently to other areas. learning, immediate and long term actions that have and will take place to prevent reoccurrence.

1. 3 x complaints; 1 x delay and treatment and 2 Community Children's Service - Lisa Nobes is aware and liaising with Rowan Proctor Caring directly 2. Issues present around getting responses from the WSHFT Complaints Team. 3. CCG is currently leading on 2 x multiagency complaints which have had significant delays.

1. There are on-going issues with discharge summaries particularly from ED. 1. This is now being monitored closely by the Chief Operating Officer who is 2. CiC Pathway - increased numbers noted four months ago, this was thought to be due to contacting departments and specific clinicians who are repeatedly not completing Responsive the inspection at that time, but numbers have since reduced again. the process. 2. The team is currently trialling a six-month GP pathway (IHA'S) (East) - indications are that the 15 W/D deadline is still not being met. 1. Difficulties in employing registered nurses is being seen across the county and as a 1. Trust has remodelled its staffing ratios to counteract the availability of national picture. registered nurses. 2. Mandatory training has seen a reduction in completion over the winter period with WSHFT 2. Mandatory training is being monitored closely at the QCPM in order to highlight Well led having an amnesty in January. if performance does not return to an acceptable position. 11 3. Concerns remain around PREVENT training and the Trust's non-compliance to the 3. CCG Safeguarding Team is working closely with the Trust to monitor their expected standard. performance against the national standard. CLINICAL EFFECTIVENESS

Continuing Healthcare (CHC)

Performance Finance/Activity – Month 12 March

RAG Indicator Comments Change YTD Budget £’000 YTD Actual £’000 Variance £’000 80% eligibility decisions Staffing and social work availability, NOK availability, patient (under) / over made within 28 days from illness, impacted performance. November and December CHC 10956 10024 -931 receipt of Checklist performance will be below target, improvement plan in place. (Feb 89%) 80% Mar FNC 2741 2717 -24

PuPOC 253 97 -157 % DSTs completed in acute Achieved in IHT for 15 consecutive months setting less than 15% Clinical Quality 0% Mar (Feb 0%) Performance Indicator Jan Feb Mar Change Comments mth on mth Number of formal complaints Updates 0 1 1 • 28 days - target met Q4 Appeals – number of new • CHC Discharge to Assess working well, no assessments in IHT 0 2 3 ↑ • Appeals – 1 case heard at stage proceeding to stage 2, 5 cases heard at stage 2 – all not eligible, delay appeals received in cases being heard at IRP (NHSE delay) Appeals – Stage 1 0 0 1 • Work has commenced on retrospective cases • PHBs being put in place at eligibility for new referrals in their own home, and at review for existing home Appeals - Stage 2 Cases progressing care caseload 7 8 6 though stage 2 • 3.6 wte Nurse Co-ordinators appointed – will commence in post April and May 2019 • 4.19 wte clinical vacancies across the team, recruitment ongoing Appeals Stage 3 (IRP) IRP arranged by NHSE, delay due to number of 6 6 7 cases going to IRP What are the top 3 risks and issues? across region

Rank Risk Owner Likelihood Impact Mitigation Personal Health Budgets: deadline for expanding PHBs as the default model of delivery for • Band 6 commenced in post all CHC Domiciliary Care packages brought forward to 1/4/19, one year ahead of the original • Extensive mandatory in-house training programme completed by all staff plan. This involves a significant amount of work, including care planning, support planning, • Band 4 administrative support in post 1 and additional assessments and visits. A plan is in place to achieve this which includes CHC Medium Medium • PHBs being embedded at review and at commencement of eligibility additional staffing. NHSE have confirmed that for existing patients PHBs should be • Bank Band 6 nurse supporting PHB team explored at review which means that not all existing patients need to be transitioned to a • Additional 1:1 support being offered to Nurse Co-ordinators by PHB Clinical Lead PHB (direct budget or notional) by 31 March 2019.

PUPoC (retrospective) – the Ombudsman has overruled PCT/NEL decision regarding three • Staff from appeals/retrospective team have commenced retrospective work, commencing cases in receipt of RNCC and instructed these are assessed, the team is receiving with cases raised by Ombudsman 2 complaints in respect of the delay in assessing retrospective cases. CHC High Medium • Fixed term additional resource approved to support retrospective cases (experienced in retrospective work) to commence in post 3/4/19 • Experienced p/t Nurse Co-ordinator being rotated into team April 2019

Delivery of 28 day performance at risk due to social work availability, NOK availability, • Staff across the team being used flexibly to support 28 day process patient illness, the impact of new NHSE instructions regarding the process and treatment of • CHC Social worker team lead to support as SW as a last resort 3 CHC Medium High referrals with missing or incomplete paperwork, including consent. • Incomplete/missing paperwork to be chased with referrer • Interim Social Worker commenced February 2019 CLINICAL EFFECTIVENESS

Care Homes

CQC ratings distribution Information from Regulator (CQC)

Ratings: Outstanding: 18 Inadequate: 0 Requires Improvement: 17 18, 15% 0, 0% Good: 86 Unrated: 6 Total homes captured: 126 Updated: 26 April 2019 17, 14% Total reflects the (nursing) care homes which have not been inspected 86, 71% Risk Ratings: No risk identified: 98 Risk rating 1: 8 Risk rating 2: 18 Risk rating 3: 2 Emerging/Potential risks: 2 Outstanding Inadequate Requires Improvement Good Total homes captured: 126 Updated: 26 April 2019

Board CCG/SCC Risk Ratings Homes rated Outstanding: 2, 2%2, 2% 1. Baylham Care Centre 2. Bucklesham Care Centre 3. Foxgrove Residential Home 18, 14% 4. Jubilee House 5. Montrose House 8, 6% 6. Prince of Wales House 7. Cleves Place 8. Ford Place 98, 76% 9. Mellish House 10. Mildenhall Lodge 11. Montana Care Home 12. Risby Hall 13. Risby Park No risk identified 14. St Peter’s House RR1 - minor issues, for observation/embedding improvement 15. The Martins RR2 - minor to moderate issues with planned work going ahead ACS/CCG teams 16. Brandon Park RR3 - serious concerns and regular support 17. Stowlangtoft Hall 13 Emerging/Potential risks 18. Asterbury Place CLINICAL EFFECTIVENESS

Maternity

LMS: Suffolk & North East Essex DCO Area: Submission date: 22/02/19 Highlight Report

Maternity Core Deliverables Overall RAG X097 X098 X099 X100 X101 MTP1 MTP2 MTP3 MTP4 MTP5 MTP6

Milestones

Ref Critical Milestones (Rolling) Due Date Current Assessment

LMS to evidence that mechanism for being able to record the number of women who have been MTP3 - 1 30/01/19 informed of their choice offer is in place.

Mechanism in place for being able to record the number of women who have a PCP (electronic or paper X101 - 2 30/01/19 based)

MTP1 - 2 Progress against CNST 10 point action plan check-point March 19 ( 31 March 19) 31/03/19

MTP6 1 The LMS has sufficient core staffing, and clear governance and reporting processes in place Ongoing

MTP6 -2 LMS core staffing in place with clear reporting mechanisms (ongoing) Ongoing

MTP2 - 1 LMS engaged with NHSI & NQI programme (ongoing) Ongoing

Wave 1 & 2 sites to continue to deliver against agreed plan for access to specialist perinatal mental X100 - 5 Ongoing health service

Establish clear strategic plans for specialist perinatal mental health services engaging with the regional X100 - 6 Ongoing 14 perinatal mental health network CLINICAL EFFECTIVENESS

Maternity

Risks Rating Rating Ref Top Risks & Issues Mitigation (Pre) (Post) LMS to evidence that mechanism for being able to record the MTP3 - number of women who have been informed of their choice offer is Mechanism under development but not yet fully implemented 1 in place.

X101 – Mechanism in place for being able to record the number of women 2 Mechanism under development but not yet consistent across the LMS who have a PCP (electronic or paper based)

Increase the number of women receiving continuity of the person Women have started to be booked onto the pathways, and women who X100 caring for them during pregnancy, birth and post-natally so that by are 12 wks+ gestation have been identified to move across onto the March 2019, 20% of women booking receive continuity pathway. However, this constitutes less than the 20% target

Activities

Key activities this reporting period Key activities next reporting period Identification of women to move onto CoC Pathways Continue to roll CoC early implementer pathways out and measure activity Additional resource moving into Maternity based smoking cessation Digital strategy approval from LMSB and system PCP core elements to inform digital planning PCP template design and digital tool testing Digital strategy recommendations Service user surveys finalised SBL clinical audit collation and action planning Attain action planning

Challenges, Learning & Good News

Further good news Comments

15 CLINICAL EFFECTIVENESS

Maternity

Core Deliverables

No. Ref Type Deliverable

Deliver improvements in safety towards the 2020 ambition to reduce stillbirths, neonatal deaths, maternal death and brain 1. X097 Next Steps injuries by 20% and by 50% in 2025, including full implementation of the Saving Babies Lives Care Bundle by March 2019.

Deliver full implementation of the Saving Babies Lives Care Bundle by 31 2. X098 Next Steps March 2019.

Deliver improvements in choice and personalisation through Local 3. X099 Next Steps Maternity Systems so that by March 2021 all women have a personalised care plan.

Increase the number of women receiving continuity of the person 4. X100 Next Steps caring for them during pregnancy, birth and postnatally so that by March 2019, 20% of women booking receive continuity.

Deliver improvements in choice and personalisation through Local Maternity Systems so that by March 2021 more women are 5. X101 Next Steps able to give birth in midwifery settings.

All services are investigating and learning from incidents, and share this learning through their LMS and with others by March 6. MTP1 System Ask 2021

All services are fully engaged in the development and implementation of the NHS Improvement Maternity and Neonatal Quality 7. MTP2 System ask Improvement programme by March 2021

All women are able to make choices about their maternity care, during 8. MTP3 System ask pregnancy, birth and postnatally by March 2021

The LMS is engaging with Operational Delivery Networks to deliver safe and sustainable models of neonatal care across 9. MTP4 Oversight by March 2021

The LMS has a credible plan for how its financial allocation (Transformation funding) will be spent, and is it on track to spend in 10. MTP5 Oversight year.

16 11. MTP6 Oversight The LMS has sufficient core staffing, and clear governance and reporting processes in place by March 2021 SPECIALIST SERVICES

Transforming Care

Transforming Care There were 2 patients in the IESCCG cohort at the end of March 2019, plus 3 for WSCCG Both IESCCG patients are officially classed as “Delayed Transfer of Care” as they are ready for discharge

IESCGG 2018 - 2019 Transforming Care 14 Inpatients vs Trajectory

12

10

8 7 7 7 7 6 6 6 6 6 5 5 5 5 4 4 4 4 4 4 4 4 4 4 4

2 2

0 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Inpatients Trajectory

IESCCG Transforming Care Admissions & Discharges (by financial year)

18 16 14 12 10 8 Number of of Patients Number 6 4 2 0 2015/16 2016/17 2017/18 2018/19 Admissions 11 13 10 6 Discharges 8 17 16 10 Inpatients 16 12 6 2 17 SPECIALIST SERVICES

Transforming Care

Specialised Community-Funded Suffolk Inpatients 2018 - 2019 Performance Vs Trajectory

Combined IESCCG and WSCCG Adults and CYP 14 12 11 11 11 11 11 12 10 4 4 5 4 3 4 3 8 4 6 2 2 2 2 4 8 8 8 8 6 7 7 7 2 5 4 4 4 0 Apr May Jun Jul Aug Sept Oct Nov Dec Jan-19 Feb Mar

Spec Comm Adult Inpatients Spec Comm CYP Inpatients Spec Comm Trajectory

18 SPECIALIST SERVICES

Individual Funding Requests (IFR)

Individual Funding Requests (IFR) (1 April 2018 - 31 March 2019)

545 referrals were received during the period

A total of 184 referrals from Ipswich and East Suffolk were considered by the Individual Funding Panel (including Triage Group)

Total Number of Referrals Received 1 April 2018 - 31 March 2019 Percentage of Spend per CCG 1 April 2018 - 31 March 2019

215

£105,290.54, 330 30%

WSCCG IESCCG

Summary of Decisions of IFR Panel £244,244.50, for Ipswich and East Referrals 70% 1 April 2018 - 31 March 2019

WSCCG IESCCG 200 184

150

100 80 50 40 50 14 0 TOTAL APPROVED NOT APPROVED DEFERRED REDIRECTED 19 SPECIALIST SERVICES

Individual Funding Requests (IFR)

Types of Procedures Approved WSCCG IESCCG 1 April 2018 - 31 March 2019

6 5 4 3 2 1

0

IVF

Skin Tag Skin

Cataracts

Labiaplasty

(Female)

Apronectomy

Abdominplasty

Varicose Veins Varicose

Septhoroplasty

Transplantation

Breast Reduction Breast

IVF Egg donation Egg IVF

Meniscal allograft Meniscal

and lower legs lower and

Seroma Capsule Seroma

Vasectomy under Vasectomy

Laser hair removal hair Laser thigh from removal

Clinic Assessment Clinic

general anaesthetic general

with apronectomy with

Specialist Spina Bifa Spina Specialist

Liposuction to thighs to Liposuction

Breast Augmentation Breast

ICANHO Assessment ICANHO

IVF with sperm donor sperm with IVF

Breast Reconstruction Breast

Umbilical hernia repair hernia Umbilical

Gynaecomastia (male) Gynaecomastia pathway) (excellerated

Breast implant removal implant Breast Rehabilitation ICANHO

Type of Drugs Approved WSCCG IESCCG 1 April 2018 - 31 March 2019 15

10

5

0

Sativex

Abtacept

Adalimab

Rituxmab Infliximab

Sorolimus

Tofacitinib

Plenadren

Verteporin

Baracitinib

Tacrolimus

Appremilast

Teriparatide

Gammacore

Ustekinumab

Certolizumab

Ethanerecept

Secukinumab

Electrombopog

Botulinum Toxin Botulinum Growth Hormone Growth

20 Finance

May 2019

21 Finance - Headlines

Month Ending 31st March 2019

Key Metric Value Rating Movement Headlines

At Month 12, the CCG achieved its revised target of £3m in year surplus. Variance from Plan £0.0m 1 1 h l Variance against plan for the main spend areas are highlighed in the chart below and explained in detail overleaf. This indicator adjusts the forecast surplus by removing the impact of non-recurrent costs and allocations and the full Underlying Surplus / (Deficit) £11.9m 1 1 h year effect of in year adjustments in order to show the recurrent position. Key adjustments include adjusting for in-year l non recurrent allocations and other non recurrent/full year adjustments. At the end of Month 12, the CCG delivered £19.7m of its savings plan (QIPP) against a target of £16.5m (119% delivery) QIPP Delivery 119% i h h l mainly due to over delivery of QIPP on CHC, Prescribing, Other Acute Contracts and Running Costs.

Rating Key Movement Key l On or better than target h Improvement l Below target 1 No Change l 95% -99% of target (QIPP only) i Deterioration 22 Finance – Key Variances

Month Ending 31st March 2019

Category Variance £m % Rating Commentary

Mainly due to lower level of YTD prescribing spend, under spend on GP+ contract and release of Primary Care £2.3m 3.2% l Primary Care contingency which partially offsets overspend on Primary Care Delegated budgets.

Mainly due to NR investment costs charged against the General Reserve, additional expenditure Other Programme (£6.7m) (35.0%) in Ambulance Patient Transport Services for critical care and additional journeys. This also l includes the impact of realignment of corporate costs.

Primary Care Mainly due to revised rates for GMS global sum & PMS contract value, growth in list sizes and Delegated (£0.7m) (1.2%) increase in locum costs. Commissioning l

Mainly due to underspend on Nursing & Residential Home Package care costs and PUPOC 2 Continuing Care £1.6m 6.3% l claims, partly offset by Fast Track and PHB package costs.

Mainly due to realignment of corporate costs across STP and underspend in pay costs due to Running Costs £0.7m 8.9% l delays in recruitment.

23 18/19 QIPP - Finance

Month Ending 31st March 2019

24 Transformation / PMO

May 2019

25 Integrated Care East Programme Dashboard

Overall Programme Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 RAG GREEN Programme Status: This programme is green for April due to all projects being on track. Project RAG Update/Action Required in Red or Amber Project RAG Update/Action Required in Red or Amber REACT Phase 2 is on track and has started with the integration and co-location of DIST This project workstream sits within the wider 'Community Transformation' programme of ICE 01 Admissions to create a fully integrated, community based admission avoidance hub. Three admission ICE 07 Integrated Therapies work. Therapies integrated pathways re-design is a three year project and we are in the On Track On Track Avoidance avoidance bids are currently being drafted ready for submission to Alliance for agreement Pathways Re-design scoping phase at present with key individuals/therapy leads from across health and care by June 2019. system.

Monthly Community Transformation Board established. Inaugural meeting held with ICE 02 Community community providers to identify scope of projects to review how we can manage referrals ICE 08 Responsive Home Programme on track and East Delivery Group meeting regularly to develop Responsive On Track On Track Transformation differently at a local level. Task and Finish Group members identified and further meeting Care Homecare model. schedule in June 2019 to take this forward.

On track to become business as usual by end June 2019. However acknowledged that ICE 09 Falls and Fragility Project on track - Decision taken to stand down Pan Suffolk Group and to progress Falls ICE 03 D2A On Track On Track some work still to do within the hospital on Pathway 0. Fractures work locally and in localities with joined up activity as appropriate.

Overall programme on track. My Care Wishes review completed and roll out of new Project on track- Trusted Assessment steering group met on 3/5/19 to review activity and ICE 04 EOL On Track tools. End of life care review underway with a view to sharing interim report and ICE 10 Trusted Assessment On Track SRO Paul Little will be providing update to Ipswich and East Suffolk Integrated Care recommendations in July 2019. Programme Board on 14th May 2019.

Draft service specification written for Frailty Clinic as part of Frailty Offer. Review of Baseline data agreed and data dashboard being developed to monitor/report on HIU ICE 05 Proactive Felixstowe Community Hospital capacity undertaken on 2nd May 2019 to ascertain ICE 11 High Intensity Users On Track On Track initiative. Embedding HIU framework in Integrated Neighbourhood Teams (INTs), based Frailty Service options for clinic and future co-location. Currently identifying medical resource of Urgent Care on the location of the HIU cohort and development of individual INTs. requirements/roles for the new service.

ICE 06 Care Homes Demand The Care Homes programme is on track. Working closely with ESNEFT to initiate On Track Management recruitment into new posts to support Care Home programme. IntegratedIntegrated Care KeyCare Performance Key Performance Indicators Indicators - Programme - Programme Levels Levels Emergency Admissions @M12 A&E Attendances @M12 View KPIView MetricKPI Description Metric Description MeasurementMeasurement Metric Metric KPI TargetKPI Target LatestLatest data data CurrentCurrent Month Month LastLast Month Month YTDYTD IHT 4hrIHT ED percentage4hr ED percentage 92% 4hr 92%ED by 4hr Sept ED by18, Sept upward 18, upward trajectory trajectory to meet to 95%meet by 95% Mar by 19 Mar – IHT 19 – IHT 92% Sept92% Sept 18 95% 18 95% Mar Mar 19 19 MarMar 89.8%89.8% 86.4%86.4% 89.3%89.3% Year to date 2017/18 2018/19 Variance % Var Year to date 2017/18 2018/19 Variance % Var

All ambulance handovers completed within 30 minutes by IHT Ambulance handover delays All ambulance handovers completed within 30 minutes by 0 Mar 145 148 1,849 IHT Ambulance handover delays September 2018 at IHT 0 Mar 145 148 1,849 A&E Attends 81,152 83,058 1,906 2.3% September 2018 at IHT Activity 30,878 32,354 1,476 4.8% 410 reduction in emergency admissions at IHT compared to 2018/19 IHT Reduction in emergency admissions410 reduction in emergency admissions at IHT compared to 2018/19 (410 By 31/03/19) Mar 97 20 190 IHT Reduction in emergency admissions plan (410 By 31/03/19) Mar 97 20 190 GP Streaming 5,085 5,085 plan Plan Position Plan 2018/19 Variance % Var IHT Reduction in ED attendances 870 attendance reduction in ED at IHT compared to the 18/19 plan (870 By 31/03/19) Mar 100 83 435 Total 81,152 88,143 6,991 8.6% IHT Reduction in ED attendances 870 attendance reduction in ED at IHT compared to the 18/19 plan (870 By 31/03/19) Mar 100 83 435 50% of calls triaged to have a clinical contact by March 2018 and YTD @M12 31,598 32,354 756 2.4% Suffolk 111 calls triaged by a Clinical Adviser 50% Mar 53.9% 51.85% 55.44% 50% of callsmaintained triaged throughoutto have a clinical 18/19 contact by March 2018 and Suffolk 111 calls triaged by a Clinical Adviser 50% Mar 53.9% 51.85% 55.44% Plan Position Plan 2018/19 Variance % Var maintained throughout 18/19 Reduction of 15% by March 2019 Reduction in number of deaths in (Reporting actual variance IHT Reduction in number of deaths in IHT compared to 2017/18 Reduction of 15% by March 2019 Mar -33 (24.4%) -20 (15.3%) -139 (10.11%) M11 A&E data is incomplete from IHT hospital month on month 18/19 actual vs A&E Attends 79,953 83,058 3,105 3.9% Reduction in number of deaths in (Reporting actual variance IHT Reduction in number of deaths in IHT compared to 2017/18 17/18 actual) Mar -33 (24.4%) -20 (15.3%) -139 (10.11%) hospital month on month 18/19 actual vs High level figure from IHT used for Feb 19; Mar 19 data also Increase to 59% of deaths occurring in home, care home or hospice IESCCG Out of hospital mortality 17/18 actual)59% Nov 50.6% 58.6% 57.7% GP Streaming 5,526 5,085 -441 -8.0% for IESCCG appears low but unable to quantify Increase to 59% of deaths occurring in home, care home or hospice IESCCG Out of hospital mortality % of over 75 year olds that are readmitted to Acute care at IHT within 59% Nov 50.6% 58.6% 57.7% IHT People readmitted to Acute carefor IESCCG 17% Mar 18.5% 20.9% 18.9% 30 days Total 85,479 88,143 2,664 3.1%

% of overAverage 75 year number olds that of arepatients readmitted per day to staying Acute in care IHT forat IHT more within than 14 IHT PeopleIHT readmittedStranded patient to Acute metrics care 110 By Oct1817% & 105 By Mar19 MarMar 18.5%103.77 20.9%100.25 18.9%108.33 30 days days

AverageAverage number number of patients of patients per day per staying day staying in IHT infor IHT more for morethan 14than 21 IHT StrandedIHT patientStranded metrics patient metrics 110 ByNHSE Oct18 ambition & 105 By for Mar19 IHT of 87 MarMar 103.7755.71 100.2551.04 108.3363.33 days days

Average number of patients per day staying in IHT for more than 21 IHT StrandedIHT patientAcute Delayed metrics transfers of care Maximum of 3.5% DToCs at IHT by 30th Sept 2018 NHSE ambition3.50% for IHT of 87 MarMar 55.713.21% 51.043.03% 63.33 days Maximum of 3.5% DToCs at East community hospitals by 30th Sept IESCCG Community Delayed transfers of care 3.50% Mar 13.7% 11.3% IHT Acute Delayed transfers of care Maximum2018 of 3.5% DToCs at IHT by 30th Sept 2018 3.50% Mar 3.21% 3.03% 26 Note - Reductions in Emergency admissionsMaximum and ED attendances of 3.5% DToCs include at East Paeds community QIPP hospitals by 30th Sept IESCCG Community Delayed transfers of care 3.50% Mar 13.7% 11.3% 2018

Note - Reductions in Emergency admissions and ED attendances include Paeds QIPP Elective Care EAST Programme Dashboard

Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Overall Programme RAG GREEN

Programme Status: All projects are either on track or under development Project RAG Update/Action Required in Red or Amber Project RAG Update/Action Required in Red or Amber IESCCG (transformation & quality teams) are conducting an external review of Urology as requested by ESD service specification and options completed and waiting Governing Body approval May 2019 to Stroke On Track Urology PID in development ESNEFT. Urology is a challenged specialty but one of the key 6 specialties identified for priority review allow procurement to commence. in 19/20.

Implementation of Fibromyalgia, streamline process fro DEXA reporting and administration of Biologics All Key milestones are still in draft form and are being discussed and agreed at the Respiratory as well as taking forward actions arising from the R2G Action Plan. Next steps include: links with On Track On Track Operational Group on 14th May 2019. Elective Care Programme Board (ECPB) has received a deep MSK ICS/PCNs, development of Opioid tapering support, close links with Mental Health Teams and further Respiratory (Rightcare) dive presentation as part of quarterly review process. development / rollout of Pain Management Classes

Glaucoma pathway completed and awaiting LOC approval. LOT 1 mobilisation in progress. Alternative NEECCG awarded community Dermatology Contract to ESNEFT. This means a clinical lead will be in options for LOT 2 service development are under consideration with ESNEFT. This service will have situ who will help to develop the specialty. Service delivery at Ipswich is reliant on x2 locum consultants, On Track Dermatology Ophthalmology considerable capacity issues in year, no demand and capacity modelling is available for 19/20, PID in development so the long term sustainability of the service is tenuous. Elective Care Programme Board receive insufficient consultant capacity to support timely treatment. Milestones to be reset. regular updates on status.

Year 2 has now completed resulting in increased number of patients attending SE, pilot of a digital The planned five year transformation of Gastroenterology services (new model of care) across IES is Diabetes App, more consultant visits to practices, embedding of our enhanced lifestyle dietitian and now underway. The Gastro Steering Board has met several times and is beginning to implement actions Gastroenterology (Rightcare) On Track Diabetes (ICS) On Track diabetes mental health link worker. Unfortunately the roll out of Eclipse software has proven frustrating agreed in the sub-groups. The public launch and communication will be issued May. All MOUs and with only 5 or 40 practices so far having taken it up. We are currently planning for year 3 which has a contracts now signed. reduced funding from NHSE.

National KPIs for constitution targets and Planning Requirements to be included for in year delivery. Self-care PID in development Elective Demand Management PID in development Key areas of focus are reduction in year of 3% 1st outpatients and 3% follow-ups, clearance of backlog, reducing size of waiting list.

Elective Admissions - Summary @ M12 OutpatientsEmergency vs Plan Admissions Notes: Year to Date Plan 2018/19 Variance % Var * First and Follow Up Outpatient KPIs are set internally by IHT using their own numbers and are not a CCG view Plan Position Plan 2018/19 Variance % Var First 105,125 101,742 -3,383 -3.2% ** Cancer metrics currently not supplied for IHT site - so total ESNEFT shown from July Daycase 35,720 34,437 -1,283 -3.6% All other metrics are for IHT Follow-Up 225,320 216,995 -8,325 -3.7% Elective 5,614 4,927 -687 -12.2% Total 330,445 318,737 -11,708 -3.5% Elective Care Key Performance Indicators - Programme Levels at March 2019 YTD @M12 41,334 39,364 -1,970 -4.8% View KPI Metric Description Measurement Metric KPI Target Current Month Last Month YTD Outpatients by POD Year to Date 2017/18 2018/19 Variance % Var Incomplete – Referral to Treatment % waiting treatment POD 2017/18 2018/19 Variance % Var IHT 18 week referral to treatment standard 92% 88.7% 89.7% 90.9% <18 weeks First Attendance 69,264 71,262 1,998 2.9% Daycase 33,672 34,437 765 2.3% FU Attendance 141,635 142,382 747 0.5% Incomplete – Referral to Treatment Number waiting IHT 52 week plus waits 0 0 1 4 over 52 weeks Elective 5,339 4,927 -412 -7.7% First Telephone 3,960 3,268 -692 -17.5% FU Telephone 24,684 25,907 1,223 5.0% Number of incompletes - change from last month Total 39,011 39,364 353 0.9% IHT Incomplete – Referral to Treatment 18 week Reduction 970 613 Procedure 76,068 75,918 -150 -0.2% Total 315,611 318,737 3,126 1.0% Outpatients First Appointments 3% Reduction 'Negative IHT Number of first outpatient appointments * 3% -9.2% -7.6% Allowance included for Mar 19 uncoded UZ activity values show performance is not meeting the target' Outpatients Follow Up Appointments 3% Reduction Notes:- IHT Number of Follow up outpatient appointments * 'Negative values show performance is not meeting the 3% 8.2% 10.4% target' The First and Follow Up outpatient KPI's in the table above are NOT the same as the IHT Outpatient backlog Follow-up trajectory - trust wide follow-up backlog 550 Patients 6,166 5,644 67,858 CCG QIPP - The CCG Demand Management QIPP measures a restricted list of specialties for IESCCG patients only at IHT. Diagnostic breaches > 6 weeks Number of patients The KPI's above measure total IHT performance for all patients and all specialties - we IHT Diagnostic waiting times 1% 7.6% 2.4% 2.2% waiting more than 6 weeks are waiting for detail from IHT on how the baseline was calculated for their plan. This also applies to the table on the right - these show an internal CCG view of total ESNEFT Cancer - 2 week waits ** Cancer 2WW to be at 93% from July 2018 93% from July 86.9% 88.1% 92.3% outpatient activity for IESCCG patients only and will not match the numbers within the KPIs. ESNEFT Cancer 62 Day Target ** 62 days from GP referral to first treatment 85% 77.7% 74.7% 74.9% 27 Children and Young People Programme Dashboard

Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Overall Programme RAG GREEN Programme Status: This programme is green for April due to all projects being on track. Project RAG Update/Action Required in Red or Amber Children’s Emotional Health and Progress continues with the Mental Health transformation priorities of the Children's Emotional Wellbeing Group and preparation for the MCP process including producing the service specification and ensuring Alliance partners have plans in place to support On Track Wellbeing Plan. the dialogue sessions.

Special Educational Needs and The Specialist Education programme is progressing well having secured capital funding. The health and social care implications are now being worked through to form the sufficiency plan. There is some risk to the Sensory Integration pilot as ICPS are On Track Disability (SEND). having difficulty recruiting the expertise to fulfil the scope agreed. Speech and Language Therapy On Track Progress continues with the implementation of the new SLC model and the consultation to inform the decision making for the SLU has been completed. and Communication Neurodevelopmental and The Neurodevelopment and Behaviour Steering Group has focussed on developing proposal for early implementation and are in the process of refining these to form an early implementation plan alongside ongoing work to develop a business case for the On Track Behaviour Pathway future model of delivery. Children and Young Peoples On Track A scoping meeting has been held to inform the TOR for the review of ICPS. Community Health Services. Agreement of Acute/Emergency PID in development Paediatric Pathway. On the 20th and 21st of May 2019 Leeds Beckett University in partnership with Suffolk County Council will be hosting a team from Amsterdam to discuss their success in reducing childhood obesity and discussing how Suffolk can learn from their example to Childhood Obesity. On Track reduce our rates. CYP Key Performance Indicators - Programme Levels

KPI Metric Description Measurement Metric KPI Target Latest data Area Type IES CCG -32% of CYP (0-18) with a mental health diagnosis are receiving NHS funded treatment Numerator 1,360 -Treatment is defined as a child having had 2 or more contacts relating to the same referral in a 12 month period (this can be direct or indirect (e.g. advice based on rolling 12 Denominator 7,347 CYP Access Standard 32% Jan-19 to carers etc.)) month position Rate 18.51% -Only treatments recorded in the Mental Health Services Data Set (MHSDS) count towards the target Plan 75.0% Q3 1819 Routine -Progress towards target of 95% of patient receiving first definitive treatment within four weeks for routine cases Actual 60.0% Community Eating Disorders Services (CEDS) 95% by 2020 -Progress towards target of 95% of patients receiving first definitive treatment within one week for urgent cases. Plan 50.0% Q3 1819 Urgent Actual 0.0% Plan 54.5% Q3 1819 60% of people by 2020/21 receiving treatment in 2 weeks in line with NICE recommendations for requiring early intervention for psychosis including Actual 66.7% EIP 60% children Plan 58.1% YTD Actual 63.9% Perinatal -Increase access to evidence-based specialist perinatal mental health care (pending information) TBC TBC TBC TBC TBC Crisis KPI to be established as part of the pilot model and evaluation TBC TBC TBC TBC TBC A&E Planned Saving Plan Saving 0 IES CCG 0 Mar-19 A&E Actual Saving 0 WS CCG 207 Acute emergency paediatric pathway Pathway to be established once priority scoped Emergency Admission Plan Saving 45 Planned Saving Mar-19 Emergency Admissions IES CCG 45 Actual Saving -264 WS CCG 207

28 Mental Health Programme Dashboard

Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Overall Programme RAG GREEN Programme Status: Work has commenced to implement the i) Improving Access to Psychological Therapies (IAPT) Long Term Conditions and the ii) Crisis Resolution Home Treatment Team (CRHTT) business case(s). A Crisis implementation group has re-convened which will meet monthly to oversee the roll out. A Physical and Mental Health Implementation Group has also convened which will oversee the recruitment of new staffing and the development of pathways with Ipswich/ Hospitals for Diabetes, COPD and Cardiology. Living Life to the Full (LLTTF) is now available to all East GP Practices. A successful promotion session was held at Ipswich Hospital in March Project RAG Update/Action Required in Red or Amber Project RAG Update/Action Required in Red or Amber P1 Mental Health Model On Track Development of Mental Health & Emotional Wellbeing service specification continues. P9 Early Adopter Site: Ipswich On Track First meeting for this project scheduled to take place on 28th May.

P2 Increasing Access to Recruitment to additional 43 IAPT LTC posts underway. Suffolk Wellbeing manager post to be created. Meeting held with DoN P10 SMI Patient: Individual On Track On Track 19/20 funding confirmed by NHSE. Implementation underway with EPUT and NSFT Suffolk colleagues. Psychological Therapies for ESNEFT regarding project planning for new IAPT LTC pathways to agree Project Plan for 2019/20. Placement Support (IPS) LLTTF available to all East GP Practices. Launch of the materials has happened at IHT and Professor Chris Williams did a tour to March 2019 rate was 68.3% in East (stepped improvement of 1.1% from February 2019)- meeting NHSE recovery P3 Living Life to the Full On Track various departments to raise awareness in April. IHT to systematically roll out to departments with support from CCG. P11 Dementia Programme On Track trajectory. Roll out of Dementia Together Primary Care Navigators underway in East.

P4 Severe Mental Illness National Technical Guidance now released. EMIS data extraction software has been authorised for purchase by the CCGs and Recruitment of staff for phase 2 of business case has begun with a Consultant post and a nurse position currently being the order has been placed. IT are progressing this and will roll this out to all EMIS practices across East (timescale tbc). This will P12 Early Intervention in (SMI): Physical Health On Track On Track advertised. Space issue of team to cater for newly recruited staff at Haymills, escalated to NSFT COO. avoid the need to make assumptions about the missing data, and can also be used to support other workstreams/projects. Psychosis Checks P13 System Wide Crisis P5 GP Education 3 East sessions successfully delivered: personality disorder; Suffolk needs met and consultation skills; treatment of anxiety and Response Service Crisis Implementation Group met for first time on 16.04. Costings for potential call centre received from Care UK and On Track depression and Wellbeing. Further 4 sessions confirmed: dementia; CYP mental health, EIP and 10 minute CBT. October and On Track requested from NSFT. Task & Finish Groups to be set up to support HR, process and pathways, call centre location, Programme December sessions to be confirmed. comms and finance and contracts.

P14 Serenity Intensive Two posts (East/West) successfully recruited to. Work taking place to develop the operating policy for the service and Contracts have been signed and finance being paid across to Suffolk Mind for extension of Waves and Suffolk Night Owls. Initial Monitoring & High Intensity the cohort of patients being reviewed at end of May. Training for the new posts to take place 29/30/31 July so recruits P6 Personality Disorder On Track meeting held with Lulu Preston on 30.04 to discuss current approaches to PD within NSFT. On Track networks to be in post shortly before then hosted by NSFT.

P8 Early Adopter Site: Two week scoping (29.04-10.05) of demand underway at two Haverhill Practices. Link workers have been working with the On Track practices to audit the referrals coming in to services to understand the needs and demands of the locality to help inform the model Haverhill moving forward. Haverhill Alliance workshop planned for 05.06. Suffolk MIND about to advertise PM post to support.

Mental Health Key Performance Indicators - Programme Levels

KPI Metric Description Measurement Metric KPI Target Latest data Type IES CCG Dementia 66.7% Dementia Diagnosis 66.7% Mar-19 Rate 68.3% Age-standardised suicide rates per 100,000 Suicide Prevention 10% Reduction in Suicides 10% reduction on 17/18 2015/17 9.8 population Plan 4.2% Q3 1819 National Actual 6.81% based on published NHSD monthly file for all providers Local Actual 6.80% based on latest NSFT report IAPT Intervention Rate: 19% Access Rate for IAPT 19% at March 2019 (Q4) Plan 12.6% YTD National Actual 16.19% Local Actual 16.16% Plan 50.0% Q3 1819 National Actual 49.74% Local Actual 50.42% IAPT 50% Recovery Rate for IAPT 50% at March 2019 Plan 50.0% YTD National Actual 50.16% Local Actual 50.46% IAPT Long Term Conditions Approaches TBC TBC TBC TBC Plan 54.5% Q3 1819 60% of people by 2020/21 receiving treatment in 2 weeks in line with NICE recommendations for requiring Actual 66.7% EIP 60% early intervention for psychosis Plan 58.1% YTD Actual 63.9% 60% of SMI register (50% of SMI register receiving in primary care; 10% of SMI register receiving in secondary 12 months to end Q3 SMI: Physical Health Checks 60% at 31Mar19 Achievement 21.1% care) 1819 25% increased access to Individual Placement and Support (IPS) services in 2018/19 (for services in Wave 1 SMI: IPS 0% TBC TBC TBC pilots) Crisis Resolution Home Treatment Ensure that teams are able to offer 24/7 community crisis response, including rapid response for people with 0% TBC TBC TBC 29 Teams (CRHTT) urgent and emergency needs Contracts

May 2019

30 Contracts headlines

Contract Current Month Previous 6 months (most Headlines recent on left)

• A&E performance at the Ipswich site was 86.2%, below the 95% requirement. All actions to improve performance are managed through the A&E delivery board. • 18 weeks: Performance was 88.8% against 92% requirement. 5 specialities are non compliant. A Ipswich Hospital Site recovery plan is in place. (ESNEFT) March ↓ • 62 day cancer target was not achieved at (un validated) 77% which is in line with the agreed recovery trajectory. The Trust have resubmitted an improvement plan, currently forecasting recovery to 85% by May/June 2019. • Diagnostic Tests within 6 weeks was 97.4% against 99% target.

• A&E performance 84.8% in March (down from 87.9%). All actions to improve this performance are managed through the A&E delivery board and a recently updated recovery plan has been shared. West Suffolk Hospital NHS • 18 weeks: Performance was 84.8% in March (up from 84.7%) against 92% target. Foundation Trust March ↔ • 2 patients breached 52 weeks in March (7 in February) • 62 day cancer target was achieved at 88.9% (up from 82.5%). Revised weekly PTL monitoring implemented.

• CQC rated NSFT Inadequate in November 2018 • Early Intervention in Psychosis performance, 100% in 14 days in February (March 100% un-validated - target 53%) Norfolk and Suffolk NHS March ↔ • Routine referral to assessment within 28 days performance fell to 53% in February from 69% for children, Foundation Trust recovery action plan being redrafted. • NSFT met the Improving Access to Psychological Therapies recovery rates in WS and IES at 53.4% and 52.5% respectively against 50% standard.

• Community services (was Achieved response times for referrals; 4hrs, 72hrs. Did not achieve 18 weeks for adult speech and language therapy in the east. Suffolk Community March ↔ • Children in Care Initial Health Assessments completed within 15 days of service receiving completed Healthcare) paperwork was 55% against 95% target in IESCCG and 25% in WSCCG.

• The service did not meet response standards and an improvement action plan is in place. Handover Out Care UK: GP Out Of Hours March ↔ of Hours provision to Suffolk GP Fed on 24 April

• The 60 second response standard was not achieved at 87.68%. Improvement plan has been agreed, although performance is below plan. Revised improvement plan requested. Care UK: 111 March ↑ • 51.62% of Cat 3/4 calls were validated against a trajectory of 80%. • ED referrals were 8.6% against a trajectory of 8%

East of England Ambulance • A recovery plan is agreed between EEAST and CCG consortium. Service NHS Trust March ↑ • Performance and recruitment is being monitored at the bi-weekly Operational Performance Group.

Key Improvements and/or continued good performance – no major concerns/risks noted Slight deteriorations on performance – some concerns/risks noted 31 Considerable deteriorations on performance – major concerns/risks noted Primary Care

May 2019

32 Dementia Coding Above target and improving Primary Care Qof 17/18 Overall Achievement Best in STP and well above national figure Qof 17/18 Achievement Mental Health Well above national figure Qof 17/18 Achievement COPD Best in STP and well above national figure Practice *Dementia Compared to CQC 82% of practices good or outstanding - but number has fallen Coding Mar 18 List Closures No list closures Mar 19 (target 66.7%) CCG @ 68.3% CCG @ 66.9% Hawthorn Drive 119.0% 9.4% Holbrook 93.1% 2.4% Combs Ford 90.1% 7.9% Drs Solway & Mallick 89.6% 15.6% Haven Health 84.6% -3.7% *Practice list closures StowHealth 82.4% 1.7%  None planned Derby Road 80.9% -0.2% Barrack Lane 79.9% 10.1% Eye 79.9% -0.1% *CQC Update Norwich Road 79.0% -8.4% Two Rivers 78.6% 15.7% 77.8% 6.0% Recent Inspections: Martlesham 77.0% -5.1%  Constable Country Walton 76.9% 2.4%  Stowhealth Ravenswood 76.6% -2.4% Wickham Market 75.6% -0.7% Upcoming Inspections: Burlington Road 74.1% -7.0% Note: CQC are transitioning to Howard House 72.7% 8.9% inspections by telephone. The 70.1% 2.0% CCG are told which practices Chesterfield Drive 67.5% -14.3% 67.4% -1.6% are being inspected but not Ivry Street 65.5% -10.7% when The Birches 65.2% 0.7%  Howard House Hadleigh 64.9% 0.6%  Needham Market Orchard Street 60.5% -4.5%  Leiston Fressingfield 59.4% 6.6%  Walton 58.0% 0.6% Ixworth 57.1% 0.5% Little St John's St. 56.5% 0.6% Bildeston 55.2% 4.3% Debenham 55.2% 0.6% Grove Surgery 53.9% -3.8% 53.7% -1.1% Deben Road 49.7% -2.4% Framfield House 49.3% 4.0% Constable Country 47.3% 7.5% Barham & Claydon 45.7% -11.4% Felixstowe Road 45.3% 3.2% Alderton 42.9% -5.6% Mendlesham 41.1% 3.5%

* Patients coded with Dementia as a % of estimated prevalence. LEGEND - RED: < 50% 33 AMBER: = > 50% and < 66.7% GREEN: = > 66.7% National Reporting Measures

May 2019

34 National Reporting Measures

CCG performance, unless otherwise stated

35 National Reporting Measures

CCG performance, unless otherwise stated

36 National Reporting Measures CCG performance, unless otherwise stated Quarterly metrics only

37