thequarter. Quarter 3 2012/13 An update from David Flory, Deputy NHS Chief Executive Index 01 Introduction 03 Quality 03 HCAI Introduction 04 Patient experience 09 Referral to The quarter provides the defi nitive account of how the NHS is treatment 14 A&E performing at national level against the requirements and indicators 15 Ambulance set out in the NHS Operating Framework 2012/131. This edition of 17 Cancer 19 Long-term the quarter covers the period from October to December 2012, conditions 19 Mental health quarter three (Q3) of the 2012/13 performance year. 23 Emergency highlighted the positive achievements of the admissions This latest publication comes at a key moment 24 Stroke for the NHS as the system prepares to move NHS on aggregate, we have always been 24 Dentistry formally to the new organisational structures clear that beneath the headline fi gures, there that have been developing over the last year. are a number of organisations who present a 25 Innovation signifi cant challenge. The challenging fi nancial Progress to date is the result of signifi cant 28 Productivity context and the future demand pressures which efforts on an unprecedented programme 28 Finance will continue beyond the quality, innovation, of change, in particular the preparation for 32 Activity productivity and prevention (QIPP) period mean new organisations ready to discharge their 34 Workforce that the response to the Francis report needs to responsibilities whilst retaining the strategic 37 Prevention be embedded in the approach to NHS delivery health authority (SHA) and primary care trust 37 Health visitors in future and success will be dependent on the (PCT) architecture to continue to focus on 38 Maternity and actions of staff at all levels of the system. newborn in-year delivery. 38 Breastfeeding We have been under no illusions that the Continued strong 38 Smoking transition has represented one of the most 39 Screening (venous performance thromboembolism, signifi cant challenges to the NHS in recent years The majority of key performance standards breast, cervical, and we have been clear that our fi rst priority were maintained in Q3 in spite of a challenging bowel, diabetic has been the delivery of a strong legacy at retinopathy) 1 April 2013. start to the winter period. 40 Immunisation The publication of the Francis report following • MRSA bacteraemia were 19 percent lower 40 NHS health checks the Mid Staffordshire NHS Foundation than during the same quarter last year and 41 Reform Trust Public Inquiry shows the extent of the C.diffi cile infections were 13 percent lower. 41 Choice challenge that we face in the future. The • Access to services continued to be maintained 45 Provision recommendations apply to the whole health with the NHS delivering above the standards 45 Commissioning system and it will take time to fully consider that demonstrate achievement of the NHS 47 Public health the wide ranging implications and respond to constitutional rights to treatment within 48 Annexes them formally. Whilst the quarter has always 18 weeks of referral. 1 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_131360 Gateway reference number 18845 Quarter 3 2012/13 Enter thequarter. • The number of breaches of mixed sex Final arrangements in place accommodation remained stable with a breach rate of 0.2 per 1,000 episodes. for transition • Key cancer standards continue to be achieved Progress against the reform agenda has across all eight performance measures. continued and we are now entering the critical handover phase. The CCG authorisation process • A&E access performance remained above the has made signifi cant progress in preparing 95 percent operational standard. clinical commissioning groups (CCGs) for their Ambulance performance towards the end of future roles and the publication of Everyone 2 the quarter was disappointing and the decrease Counts: Planning for Patients 2013/14 in in the headroom above the A&E 95 percent December initiated the planning round that standard in comparison with previous years is currently progressing with the preparation refl ects the reality of the challenges the system and agreement of operating plans for the faced towards the end of December. forthcoming year. In addition, the NHS Trust Development Secure fi nancial position Authority (NHS TDA) has been working with The NHS has further consolidated its healthy the legacy NHS organisations and NHS trusts fi nancial position reported at quarter two and has published its own planning guidance in 3 (Q2), with SHAs and PCTs forecasting an overall readiness for the transition . surplus of £1,433 million at the end of Q3. In addition, NHS trusts, excluding foundation Conclusion trusts (FTs), are forecasting an overall surplus of The fi rst months of the new system will be a £90 million. The total surplus represents a solid challenge to all involved as we fully embed fi nancial platform to support transition to the the new organisations, benefi ting from the new commissioning landscape in 2013/14. preparations made over the transition period. The Q3 fi nancial reports also show that the The engagement to date and the positive NHS has delivered a further £1.2 billion of QIPP performance picture means that the NHS is in a effi ciency savings. This builds on the £2.45 solid position to meet this challenge and future billion reported at Q2, resulting in a year to challenges. date achievement of £3.7 billion, which is 72 The dedication of staff through this period of percent of the Q3 forecast £5.1 billion savings signifi cant personal uncertainty is testament for 2012/13. to the capacity which the NHS retains for the future to continue to deliver high quality care for patients. 2 http://www.commissioningboard.nhs.uk/everyonecounts/ 3 http://www.ntda.nhs.uk/2012/12/21/nhs-tda-publishes-planning-technical-guidance-for-201314/ 2 Quarter 3 2012/13 thequarter. HCAI4 Performance status: improved MRSA MRSA bloodstream infections were 19 percent In Q3, a total of 217 MRSA bloodstream lower and C. diffi cile infections were 13 percent infections were reported, a 19 percent lower than the same quarter last year. reduction on the same quarter last year and in the 12 months to December 2012, there For 2012/13, the NHS Operating Framework were 30 trusts with zero trust apportioned continues to prioritise the achievement of the MRSA cases. MRSA and C. diffi cile objectives. This requires NHS commissioners and providers to identify However, although performance in MRSA and agree plans for reducing infections in line bloodstream infections continues to improve, with national objectives. there are some organisations who are facing a more challenging situation and who will need to focus on lowering their number of infections Quality if the national MRSA objective is to be achieved. Figure 1: MRSA bacteraemia: quarterly totals between April 2007 and December 2012 1,600 1,200 800 Quarterly MRSA totals 400 Quarterly pro-rata ambition for 2012/13 0 Jul-Sep Jul-Sep Jul-Sep Jul-Sep Jul-Sep Jul-Sep Apr-Jun Apr-Jun Apr-Jun Apr-Jun Apr-Jun Apr-Jun Oct-Dec Oct-Dec Oct-Dec Oct-Dec Oct-Dec Oct-Dec Jan-Mar Jan-Mar Jan-Mar Jan-Mar Jan-Mar 2007/8 2008/9 2009/10 2010/11 2011/12 2012/13 Based on data published by Health Protection Agency on 6 February 2013 4 http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/HCAI/ LatestPublicationsFromMandatorySurveillanceMRSACDIAndGRE/ 3 Quarter 3 2012/13 thequarter. C. diffi cile The NHS is on track to meet the national For C. diffi cile, 3,746 infections were reported C. diffi cile objective, although a small number in Q3, a 13 percent improvement on the same of individual organisations will need to focus quarter last year. on lowering infection rates if they are to deliver their local C. diffi cile objectives. Figure 2: C. diffi cile cases aged two or more: quarterly totals between April 2007 and December 2012 20,000 15,000 10,000 5,000 Quarterly pro-rata ambition for 2012/13 Quarterly CDI cases aged 2+ 0 Jul-Sep Jul-Sep Jul-Sep Jul-Sep Jul-Sep Jul-Sep Apr-Jun Apr-Jun Apr-Jun Apr-Jun Apr-Jun Apr-Jun Oct-Dec Oct-Dec Oct-Dec Oct-Dec Oct-Dec Oct-Dec Jan-Mar Jan-Mar Jan-Mar Jan-Mar Jan-Mar 2007/8 2008/9 2009/10 2010/11 2011/12 2012/13 Based on data published by Health Protection Agency on 6 February 2013 with the national defi nition, or face fi nancial Patient experience penalties. From this date, fi nes of £250 for every breach were introduced. This money is Eliminating mixed sex reinvested into patient care. 5 accommodation Reporting requires all breaches of sleeping Performance status: maintained accommodation to be captured for each patient affected. Figures are revised every six months The overall trend of steadily reducing breaches following validation with commissioners. Two was interrupted in Q3 with the total number of years’ worth of data is now available. There has breaches 136 higher than in Q2. The evidence been a steady reduction in the breach rate as suggests that this increase was due to one-off shown in Figure 3 (Q3 fi gures in shaded boxes). circumstances at a small number of sites. *Asterisked fi gures are unrevised. Overall, the number of breaches for Q3 in The reporting arrangements ensure a higher 2012/13 (727) was signifi cantly lower than degree of scrutiny and transparency to eliminate the corresponding period in 2011/12 when mixed sex accommodation. Breaches of guidance 3,080 breaches were reported. Breach data relating to bathrooms, WCs and day areas in has now been submitted for two complete mental health units are monitored locally through calendar years during which time the number usual contract arrangements.