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10. Integrated Performance & Quality Report

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10. Integrated Performance & Quality Report I n t e g r a t e d Performance & Quality report Produced February 2021 NHS Highland NHS Gaidhealtachd Page 1 Introduction The purpose of the Integrated Performance and Quality Report (IPQR) is to provide assurance on NHS Highland’s performance relating to the Remobilisation Plan agreed with the Scottish Government and the National Performance Standards. The report provides information on: a. Agreed Plans with the Scottish Government as part of the Remobilisation Plan b. Clinical Governance c. Acute Services Performance d. Financial Outturn e. Staff Governance f. Ministerial Strategic Indicators and Performance against national standards Each report contains data, displaying trends and highlighting key problem areas, as well as information on current issues with corresponding improvement actions. AOP (also known as LDP) Standards and local Key Performance Indicators (KPIs) These have been fully reinstated in the report and provides the Board with a Balanced Scorecard which shows current, previous and (where appropriate) ‘Year Previous’ performance as well as benchmarking against other NHS Boards. This IPR also includes data on Ministerial Strategic Indicators for Health & Social Care. Page 2 I. Executive Summary This section of the IPQR provides a summary of performance against the Remobilisation Plan indicators as agreed by the Scottish Government for August 2020 to March 2021. NHS Highland Targets Remobilisation To 14 Feb 2021 Exceeds plan by >= 20% Meets plan or exceeds plan <20% Behind (but within 10% of) the plan More than 10% behind the plan Activity Location Plan Actual Variance Raigmore 9530 7521 -2009 Belford 261 272 11 TTG Inpatient & Day Case Activity (All Caithness 638 898 260 Elective Admissions) North Highland 10429 8691 -1738 Lorne & Is. (A&B) 290 212 -78 NHS Highland 10719 8903 -1816 SCOPES - Elective Colonoscopy NHS Highland 1412 975 -437 SCOPES - Elective Cystoscopy NHS Highland 531 286 -245 SCOPES - Elective Lower Endoscopy NHS Highland 666 524 -142 SCOPES - Elective Upper Endoscopy NHS Highland 909 1219 310 IMAGING - Barium Activity NHS Highland 145 202 57 IMAGING - CT Activity NHS Highland 6088 5489 -599 IMAGING - MRI Activity NHS Highland 4060 2772 -1288 IMAGING - US Activity NHS Highland 10026 9389 -637 Raigmore 34568 23626 -10942 Belford 841 587 -254 Caithness 1392 830 -562 New OP Referrals Received (Acute North Highland 36801 25043 -11758 Specialties only) Lorne & Is. 3248 2250 -998 A&B Other 2349 1689 -660 A&B 5597 3939 -1658 NHS Highland 42398 28982 -13416 Raigmore 18154 19683 1529 Belford 522 477 -45 Caithness 986 669 -317 New OP Activity (inclu.Virtual - North Highland 19662 20829 1167 telephone, NHS Near Me) Lorne & Is. 2378 2340 -38 A&B Other 1711 1487 -224 A&B 4089 3827 -262 NHS Highland 23751 24656 905 Raigmore 20706 15636 -5070 Belford 5481 3670 -1811 Caithness 4698 3908 -790 A&E Attendance North Highland 30885 23214 -7671 A&B 2958 3611 653 NHS Highland 33843 26825 -7018 Raigmore 98% 90% -8% Belford 98% 93% -5% A&E 4hr Performance (W/E 14 Feb 21) Caithness 98% 87% -11% A&B 91% 7% -84% NHS Highland 98% 90% -8% Raigmore 10382 9348 -1034 Belford 841 775 -66 Caithness 986 912 -74 North Highland 12209 11035 -1174 Emergency Admissions Lorne & Is. 1073 1032 -41 A&B Other 0 0 0 A&B 1073 1032 -41 NHS Highland 13282 12067 -1215 Page 3 NHS Highland Targets (Cont) Remobilisation To 14 Feb 21 Exceeds plan by >= 20% meets/exceeds plan behind (but within 10% of) the plan more than 10% behind the plan Activity Location Plan Actual Variance Urgent Suspicion of Cancer - Referrals Received (SG Management NHS Highland 1281 3521 2240 Information) 31 Day Cancer - First Treatment NHS Highland 534 577 43 (Definitions as per published statistics) NH CAMHS 141 188 47 NH PMHW 176 187 11 CAMHS (based on National Reporting North Highland 317 375 58 Definitions of Referral to Treatment, A&B CAHMS 0 0 0 Not Attendances) A&B PMHW 0 39 39 A&B 0 39 39 NHS Highland 317 414 97 b. Assessment 1. Remobilisation Overall numbers of referrals continue to be lower than that planned. The A&E 4 hour “stretch” target is 98%, with an interim target of 95%. The 95% target is not being met. The national average is 89.6 (Indicator 16 in the NHS Highland Annual Operational Plan Standards section of this report). Scopes are also below target. Further information is given in the Finance, Resources and Performance section of the report. 2. Clinical Governance (CG) This section includes a new performance measure previously requested by the Clinical Governance Committee – Emergency Readmission Rates within 28 days of discharge. The data is in the CG section and the CG Committee may wish to consider whether the data provided meets their needs. No accompanying narrative was available at report publishing date. 3. Staff Governance Performance regarding staff governance continues to be absence rates only. The Staff Governance Committee may wish to consider what additional performance information on Staff Governance should be included in the IPR. Potential additions considering the absence narrative and recent events could include greater detail (numbers, challenges, actions) on the number of Page 4 longer term absences due to mental health issues or performance on the completion of the organisation’s training regarding Data Protection and Safe Information Handling. 4. Data Packs The Ministerial Strategic Performance data has been updated to the latest available. In the last IPR, it was not possible to fully update the Annual Operational Standards scorecard due to delays in the submission of data by all Boards in the early days of the COVID pandemic. That data is now available and, coupled with the outcome of the biennial Health & Care survey, every indicator has been updated (and the trend graphs have been reinstated). One point to note is that the Early Access to Antenatal Services (Indicator No. 8 – an annual indicator, 2019/20 is the lasts available) has dropped to 71.4%. NHS Highland achieved or exceed the 80% government target for this area from 2011/12 to 2018/19. 5. Resilience Update The newly formed NHS Highland Resilience Committee met on 16 December 2020, chaired by the Executive Lead for Resilience, David Park. The Resilience Management Framework Policy has been approved, which sets out important changes in the governance, leadership and resourcing of resilience within NHS Highland, including the re-allocation of resources to form a small Resilience Team reporting directly to the Executive Lead for Resilience. One of the key tasks of NHS Highland Resilience Committee will be to oversee completion of the Audit Implementation Plan, to address the many issues raised during Business Continuity Audit Reports in recent years. The majority of the actions have been completed and the remainder are due for completion in the next quarter. Work also continues to develop the high-level dashboard to monitor and record the work of the Resilience Committee and report accordingly. Page 5 Clinical Governance Standard/ Last Target Current Local Achieved 2020/21 Performance Target Major & Extreme Events TBA TBA TBA Jan-21 6 The adverse event policy and procedures was updated and will be finalised at the end of November 2020. Training guides are being updated and teams training delivered as requested. All major and extreme adverse events are discussed at weekly check in meetings in each operational unit to determine the appropriate investigation route. Plans are being made for SAER training session over the coming months. New performance measures will be included from next financial year. HSMR If value is less than 1, number of deaths is fewer than predicted. TBA TBA TBA Sep-20 0.99 If value is more than 1 , number of deaths is more than predicted. All hospitals are within acceptable range and there are no concerns. Inpatient Falls With Harm Number of falls with harm in month TBA TBA TBA Jan-21 35 A target set in 2014 for 25% reduction in falls was achieved in 2018. There has been further improvement with sustained performance to date. Tissue Viability/Pressure Ulcers TBA TBA TBA Jan-21 45 The prevention of pressure ulcers in hospital and care homes is a priority work stream for NHSH. NHSH has achieved a sustained reduction in the development of grade 2 to 4 pressure ulcers. Complaints (Stage 2 Performance) NA NA NA Dec-20 46% Complaints performance for December 2020 has increased from the previous month. Performance against the 20 working day target is variable. Each of the Operational Units and detailed reports are being issued weekly to track performance. Over the last couple of months there has been a steady increase in the number of stage 2 complaints being received. SAERs (date declared) NA NA NA Jan-21 2 Progress with SAER investigations are monitored by each operation unit.through their respective Quality and Patient Safety Groups. Concluding investigations within the 26 week target has been a challenge and work is being undertaken to improve this. A paper is being taken to the Clinical Governance Committee in January 2021 to consider performance against time taken to complete SAERs and outstanding actions. Performance against the 26 weeks is now included in the IPR. Freedom of Information NA NA NA Jan-21 52% The CGST support team took over responsibility for FOI in July and have undertaken a review. Foi requests are now recorded on datix which enables closer monitoring. Performance has improved significantly, however over the last couple of months performance has slipped. Escalation of outstanding FOIs is now in place. Emergency Readmission Rates New IPR indicator Readmission rates are being monitored throughout the pandemic for any changes. Page 6 Finance, Resources & Performance Standard/ Last Target Current Local Achieved 2020/21 Performance Target 4-Hour Emergency Access 95% of patients to wait no longer than 4 hours from arrival 95% Jul-20 95% Jan-21 90.0% to admission, discharge or transfer for A&E treatment Numbers of attendances are starting to return to precovid numbers.
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