Performance Report For the governing body of South Gloucestershire CCG, to be tabled on 24 April 2013 1 Purpose The purpose of this report is to inform the board current performance of the services commissioned by South Gloucestershire CCG against key access and quality standards. The majority of the standards in this document show performance to February 2013 i.e. month 11 of the 2013/14 financial year, with the exception of urgent care performance standards which are shown to week ending 31 March 2013. The report is intended to provide a variety of level of details. The executive summary below details the current main performance concerns of the South West Commissioning Support Unit Performance Team and is therefore provides a quick overview of current issues. There is also a scorecard attached which shows current progress against all key standards. For a more in depth commentary on performance, the sections of this report will summarise the detail of performance against key standards for: Urgent Care Planned Care Cancer Stroke/TIA Quality indicators e.g. healthcare associated infections The Governing Body is asked to note the contents of the report. Executive Summary The main current areas of concern are shown in the table below: Area Standard Current Commentary Performance Urgent 4hrs: 95% of all As at week The whole health system has been experiencing severe Care patients to be ending 31/03/13: pressure for a number of months and this has been seen, treated, maintained recently, as is demonstrated by performance admitted or 4hrs: against urgent care standards. discharged NBT: 85.76% within 4hrs of UHB: 91.48% Patient flow remains at the core of the problem, although arrival at A&E recently an increase in activity due to issues with the launch of the NHS 111 system has increased pressure Ambulance Handovers: further. Both Bristol trusts as well as community and social Handover: No NBT: 43% care providers are working together to improve the more than 10% UHB: 34% timeliness of discharge and the Trusts are anticipating that of ambulance performance will be recovered by Summer 2013. Please handovers to see the Urgent Care section for more. be completed in more than 15 minutes Planned No more than February 2013: Both Bristol Trusts have reported high levels of elective Care 0.8% of cancellations, which are the direct cause of current bed operations to UHB: 1.2% pressures. There were 56 cancellations at NBT and 82 at be cancelled at UHB in February 2013. Reductions in the level of last minute (i.e. NBT: 1.6% cancelled operations are linked to the ongoing work to on day of improve patient flow and therefore availability of beds. arrival at hospital for 2 surgery) for non-clinical reasons Diagnostics 99% of patients February 2013: Failure to meet the target is an ongoing problem. The to receive cause of the continued underperformance is a diagnostic test South longstanding backlog in gastroenterology investigations within 6 weeks Gloucestershire due to capacity issues in 2012/13. of referral CCG: 98% The size of the backlog is such that the Trust is not UHB: anticipating achieving the 99% standard until June 2013. It 92.04% should be noted that, month on month, progress against the standard is being made now that additional clinicians UHB YTD: and endoscopy rooms have been made available. 89.20% Cancer 90% of patients February 2013: As at February 2013 North Bristol NHS Trust are reporting with urgent a provisional position of 33% against the 90% urgent referral from NBT: 33% referral to treatment from national screening programme National standard. Screening Programme to Commissioners are investigating this at present. It is be treated essential to note that this is a provisional position and may within <62 days change on validation; an update will be provided verbally of referral at presentation of this report. Independent verification of this position is not possible at the time of writing as South West Commissioning Support Unit staff do not currently have access to the Open Exeter system which stores cancer waiting times information following the national transition process. Nationally, work is ongoing to resolve this. Healthcare UHB Target: Year to date: With a further case of MRSA in February 2013 UHB have Associated Max incidence had 9 cases of MRSA in 13/14 against a plan of 2. Infections of MRSA 2 9 cases cases The Health Protection Agency has coordinated a point prevalence survey that was undertaken in February 2013 to look at cannula management and insertion. Results are currently being analysed and will be shared in the next report. 3 Detailed Performance Overview – Urgent Care South Western Ambulance Service NHS Foundation Trust Red 1 Calls (Target 75% within 8 minutes): 74.9 % February 2013; 76.4% year to date. The Trust has underachieved the 75% standard in February 2013 but continues to achieve year to date. Red 2 (Target 75% within 8 minutes): 75.8% February 2013; 76.7% year to date. The Trust continues to achieve this target both in the month and for the year to date. Accident and Emergency waiting Times > 4 hours (Target 95%) North Bristol NHS Trust – 94.0% February 2013; 93.4% year to date. University Hospitals Bristol NHS Foundation Trust – 93.0% February 2013; 94.2% year to date. Ambulance Handover Performance Overall Ambulance Handover Breach Rate (Target Max 10% of all Ambulance Handovers >15 minutes) Overall in Bristol, North Somerset and South Gloucestershire, the rate of ambulance handover breaches remains higher than the target maximum of 10%. This is a worsening position and the South Western Ambulance Service NHS Foundation Trust has been reviewing their Standard Operating Protocol for handovers to Trusts in response to this decline in performance. 4 North Bristol NHS Trust Handover Performance – 2012/13 average 38%; w/e 31/03/13 43% North Bristol NHS Trust Ambulance Handover breach rates remain higher than the target. Weekly performance management teleconferences are in place to monitor provider performance against urgent care standards including ambulance handover. Commissioners have stressed the importance of ensuring that sufficient senior representation is available from the Trusts for escalation teleconferences. The main reason for breaches continues to be slow patient flow due to a lack of beds. North Bristol NHS Trust is carrying out a number of actions to address these issues further details of which are in this document under four hour performance. 5 University Hospitals Bristol NHS Foundation Trust Handover Performance – 2012/13 average 28%; w/e 31/03/13 34% University Hospitals Bristol NHS Foundation Trust handover performance has continued to worsen in recent weeks, in line with wider operational and patient flow problems. Similar to North Bristol NHS Trust, due to not being able to access data for handover delays below 20:00 minutes, the Trust is focussing on data quality to eliminate discrepancies between the Trust and ambulance service data sources. The Trust holds fortnightly handover meetings to monitor progress towards 90%. Actions being undertaken to improve patient flow and therefore improve the handover process are detailed as part of the section below on 4 hour performance. 6 Accident and Emergency 4 Hour Performance North Bristol NHS Trust 4 hour Performance – 2012/13 92.15%; w/e 31/03/13 85.76% The above graph presents performance against the 95% 4 hour standard. The Trust has been unable to maintain performance to the required standard with March 2013 and into April 2013 being particularly challenging. As reported in the previous month, the Trust has shared a recovery plan with commissioners and delivery of the 4 hour standard is planned for by the end of Q1 2013/14. The action plan sets out a package of measures to improve patient flow and recover performance. In addition to the action plan, commissioners have been negotiating with the Trust to define a CQUIN for 2013/14 which will provide a robust framework for supporting and monitoring the Trusts delivery of recommendations in the Emergency Care Intensive Support Team report. Identified actions that were strongly recommended include: improving internal surge management through use of a ‘full capacity protocol’; improvements to the internal ‘take’ system; and improving patient flow through a number of initiatives, for example, reviewing weekend medical cover, daily consultant-led board rounds and multi professional discharges. 7 University Hospitals Bristol NHS Foundation Trust 4 hour Performance – 2012/13 94.00%; w/e 31/03/13 91.48% In February 2013, University Hospitals Bristol NHS Foundation Trust has struggled with capacity with a significant number of breaches over the 4 hour standard. As with all providers, the Trust has been in close liaison with commissioners, other providers and the ambulance service to ensure the whole community understand the pressure points. The main contributory factors to failing against the standard in February 2013 were significant bed pressures associated with Norovirus related bed closures, an increase in the number of emergency admissions in comparison to the same period last year and the community being unable to quickly accommodate delayed discharge patients. In addition to delivery of the recovery plan, the Trust has a joint patient flow project with KPMG with workshops established to prioritise the work to be undertaken. NHS 111 The full launch of NHS 111 whereby the current NHS Direct service would be discontinued and their calls transferred to the new 111 service was delayed until after Easter 2013. Performance in the first month of operation during the ‘soft launch’ has not been as expected. The main concerns has been an inability of Harmoni to hit their key performance target of answering calls 95% of the time within 60 seconds and there is also concern that a high number of calls are abandoned.