NHS Norwich CCG Performance and Operational Management Report

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NHS Norwich CCG Performance and Operational Management eport Measurement Target Provider Month Performance Graph Acute Cancer performance 31 day first definitive treatment 96% NNUHT April 31 day subsequent treatment - surgery 94% NNUHT April 31 day subsequent treatment - drug 98% NNUHT April 31 day subsequent treatment - radiotherapy 94% NNUHT April 62 day standard 85% NNUHT April 62 day screening 9% NNUHT April 62 day upgrade 9% NNUHT April 2 week wait 93% NNUHT April Breast symptom 2 week wait 93% NNUHT April A/ performance A& waits <4h 95% NNUHT April Stroke performance % spending 9% of time on Stroke unit % NNUHT April Higher risk TIAs treated within 24hrs % NNUHT April 18 Weeks performance TT Admitted 9% NNUHT April TT Non-admitted 95% NNUHT April TT Incompletes 92% NNUHT April MSA TBC NNUHT April Cdiff TBC NNUHT April VT 9% NNUHT April Mixed Sex Accommodation NNUHT April DTOC TBC NNUHT April Ambulance Ambulance Cat A (8mins) Norfolk Performance TBC AST April Ambulance Cat A (8mins) Trust Target 75% AST April Ambulance Cat A (19 Mins) Norfolk Performance TBC AST April Ambulance Cat A (19mins) 95% AST April Ambulance Turnaround 15 minutes clear 85% AST April Ambulance Turnaround 3 minutes clear TBC AST April Ambulance Turnaround mins plus TBC AST April Community CN&T - Access performance Category A (same day) 95% NCH&C April Category B (within 24 hours) % NCH&C April Category C (planned and agreed within 1 days of referral) 85% NCH&C April Pledge 2 (18 weeks) performance MSK Physiotherapy 95% NCH&C April Adult Speech and Language Therapy 95% NCH&C April Wheelchair Clinics 95% NCH&C April Podiatric surgery 95% NCH&C April Continence management TBC NCH&C April MSA TBC NCH&C April Cdiff TBC NCH&C April Pressure Ulcers TBC NCH&C April Bed Occupancy (Alder Ward at NCH) TBC NCH&C April Mixed Sex Accommodation NCH&C April Mental Health IAPT - % entering treatment N/A NSFT April IAPT - % of people moving to recover 5% NSFT April Crisis team access TBC NSFT April Mixed Sex Accommodation NSFT April MSA TBC NSFT April Cdiff TBC NSFT April OOH/111 NQ's (OOH) performance Call back within 2 mins (urgent) 95% AST April Call back within mins (non urgent) 95% AST April PCC seen within 1 hour (urgent) 95% AST April PCC seen within 2 hours (non- urgent) 95% AST April Home Visit seen within 1 hour (urgent) 95% AST April Home Visit seen within 2 hours (non- urgent) 95% AST April 111 performance Warm transfer to clinican 95% AST April % 111 triggered ambulances transporting patient Nil AST April 111 dispositions: % Ambulance dispatches Nil AST April 111 dispositions: % ecommended to attend A& Nil AST April OOH/111 Shift coverage TBC AST April

Acute Provider NNUH National Target 31 day first definitive treatment G N 15 95 9 85 75 7 65 31 day first definitive treatment 211/12 96.94 95.32 97.89 97.33 98.4 96.85 95.11 97.75 99.25 96.7 97.48 97.54 97.11 212/13 97.27 99.8 98.23 98.32 98.81 97. 98.2 97.2 96. 98. Commentary last updated

Acute Provider NNUH National Target 31 day subsequent treatment - surgery 12 31 day subsequent treatment - surgery D 2 211/12 95.5 96.61 96.99 95.4 98.6 94. 95.7 96.35 98.77 93.2 95.7 93.55 95.77 212/13 94. 96. 9.82 95.24 86.89 93.3 96.5 91.1 91. 95.1 Commentary last updated on: 3th November 212 A Contract Query notice has been issued to the NNUH regarding this 31 day subsequent treatment - surgery. The NNUH has issued a excusing notice to the PCT, to which the PCT is formally considering its response. This will be discussed at the Service and Performance eview Group meeting on 5 December.

Acute Provider NNUH National Target 31 day subsequent treatment - drug.5 31 day subsequent treatment - drug G N 99.5 99 98.5 98 97.5 97 211/12......... 99.24.. 99.94 212/13....... 98.. 99. Commentary last updated on:

Acute Provider NNUH National Target 31 day subsequent treatment - radiotherapy 12 31 day subsequent treatment - radiotherapy G N 2 211/12 99.28 98.6 98.56 99.46 97.74 96. 97.81 98.85 99.38 98.27. 98.45 98.35 212/13 98.14 98.92 96.77 96.75 97.37 98.7 97... 98.1 Commentary last updated on:

Acute Provider NNUH National Target 62 day standard G N 9 7 5 3 2 1 62 day standard 211/12 92.51 86.45 85.33 88.18 86.52 84.82 76.45 83.83 92.89 87. 83.9 91.61 86.61 212/13 88.11 86.32 89.88 81.8 84.66 85.5 87.7 86. 87. 86.3 Commentary last updated on:

Acute Provider NNUH National Target 62 day screening 12 62 day screening D 2 211/12 93.48 95.45 89.74 91.89 94.44 91.53 88.33 9.24. 92.73 91.3 96.3 92.66 212/13 92.31 91.67. 93.33 88.24 95.7 95.5 95. 89.7 93.9 Commentary last updated on:

Acute Provider NNUH National Target 62 day upgrade 12 62 day upgrade G N 2 211/12 66.67.. 83.33. 66.67... 75... 88.64 212/13......... 88.9

Acute Provider NNUH National Target 2 week wait 12 2 week wait G N 2 211/12 96.92 95.93 95.54 96.72 95.19 95.7 97.6 96.25 97.54 97.84 97.27 98.7 96.72 212/13 97.2 96. 95.76 95.81 96.38 95.9 95.9 96.5 96.7 96.3 Commentary last updated on:

Acute Provider NNUH National Target Breast symptom 2 week wait 12 Breast symptom 2 week wait G N 2 211/12 96.61 96.79 93.13 98.53 99.34 98.85 98.58 97.42 97.93 98.33 97.34 98.15 97.61 212/13 97.14 98.6 98.7 98.74 99.41 98.5 99. 99.5 97. 98.5 Commentary last updated on:

Acute Provider NNUH National Target A& waits <4h G N 98 96 94 92 9 88 86 84 82 A& waits < 4hrs 211/12 95.97 96.62 96.47 96.83 96.19 94.36 97.47 96.44 95.17 91.32 88.38 93.91 94.91 212/13 96.89 96.94 96.27 96.97 96.96 94. 93. 95.94 96. 95.33 93.67 95.65 Commentary last updated on: 3th November 212 A & performance can now to be reported in a more timely manner. NHS Norwich CCG have issued a performance notice to the NNUHFT for their A& performance in September and now October 212. The Trust have responded by issuing an excusing notice stating that demand is not being managed hence the performace. We have sent a further notice back stating that activity volumes in May/Jun /July were actually greater and the trust was green for A& performance. We await a reply. This will be picked up at the Service & Performance eview Group meeting on 5 December.

Acute Provider NNUH National Target % spending 9% of time on Stroke unit D 9 7 5 3 2 1 % spending 9% of time on Stroke unit 211/12 64.77 73.8 68. 7.37 73.8 81.69 78.41 79. 81.82 82.2 77.92 77.78 75.69 212/13 74.36 87.3 77.2 74. 78.9 71.3 74. 7. 78. 76.1 Commentary last updated on: 3th November 212 NNUH continue to have medical outliers in the stroke beds which effects flow in these beds. Contract manager for the CCG now seeing the dashboard with the information behind these figures. Board to note the numbers behind September performance 76 patients with 59 achieving the standard. CCG will be monitoring how this performance could be effected by the winter period.

Delivery Unit: NNUH KPI Title: Higher risk TIAs treated within 24hrs G N 9 7 5 3 2 1 Higher risk TIAs treated within 24hrs 211/12 75.. 46.67... 66.67 42.86.. 33.33 75. 62.73 212/13. 76.92 64.3 58.97 9.63 7. 75. 54.2 84. 7.7 Commentary last updated on: 3th November 212 The target remains green although a drop from August performance, the numbers behind these figures are there were patients with 28 being treated within the 24 hours.

Acute Provider NNUH National Target TT Admitted G N 9 7 5 3 2 1 TT Admitted 211/12 89.77 88.86 92.32 9.34 89.27 9.65 91.51 91.56 88.75 83.68 82.14 78.34 88.51 212/13 87.5 85.9 85.5 91. 89.2 9.2 91. 9.5 91. 89.2 Commentary last updated on: 3th November 212 NNUHFT have gone into green for this target. Team will be closely monitoring this in terms of winter pressures and potential cancellations to surgery. Will also be watching with regard to contractual levers if needed.

Delivery Unit: NNUH KPI Title: TT Non-admitted 12 TT Non-admitted G N 2 211/12 98.14 98.34 97.71 97.67 97.56 97.79 97.37 97.23 96.96 96.86 96.57 97. 97.42 212/13 97.11 97.48 97. 97. 96. 96.1 97. 97.2 97.5 97.2 Commentary last updated on: 3th November 212 NNUH non admitted TT still continues to be green although a slight drop from last month; contracts team will be regularly me eting with the contracts team at the CSU to monitor performance.

Ambulance Provider ast of ngland Ambulance Service National Target Ambulance CAT A8 minutes- Norfolk performance D 75 7 65 55 5 45 35 3 Ambulance CAT A 8 minutes Norfolk Performance 211/12 64.9 65.91.66 61.35 67.77 69.23 71.3 61.91 59.99 61.31 59.59 63.83 63.79 212/13 64.25 64.71 65.26 66.72 64.96 59. 63.5 62.5 59. 58.3 62.2 Commentary last updated on: 3th November 212 The trust continue to struggle to hit this target across Norfolk. We are still awating this at a CCG level. It is worth notin g that performance is monitored on where the ambulance crew collect a patient from and not where the patient is registered. Operation domino continues to work on addressing the urgent care system and is now in phase 4 (implementation). The ast Anglia LAT are also reviewing Ambulance performance and the CCG is involved with this as well.

Ambulance Provider ast of ngland Ambulance Service National Target Ambulance CAT A- 8 minutes Trust D 75 7 65 55 5 45 35 3 Ambulance CAT A8 minutes Trust Target 211/12 75.54 75.22 75.12 74.79 76.92 76.11 77.59 75.26 73.21 76.5 72.69 76.21 75.39 212/13 75.31 74.61 74.42 78. 77.1 72.7 73.9 74. 69.2 71. 73.7 Commentary last updated on: 3th November 212 The trust has continued to report green on the 75% standard. They are still working on design of services to ensure that the performance continues to be maintained.

Provider ast of ngland Ambulance NHS trust KPI Title: Ambulance CAT A19 minutes D 9 7 5 3 2 1 Ambulance CAT A19 minutes 211/12 91.27 91.43 88.51 87.98 89.52 9.93 9.83 88.27 87.74 87.74 85.37 89.29 89.6 212/13 89.11 88.62 88.42 88.99 88.9 84.26 86.42 86.42 85.93 83.27 86. Commentary last updated on: 3th November 212 The above number continue to represent the Norfolk figure. AST continue to be on amber overall for delivery of this target as well. AST have confirmed that the current level of investment from commissioners is enough to meet the A19 target were hospital turnaround not an issue. This is not the case in Norwich at the moment (see Ambulance turnaround). The Trust are implementing their rota redesign plans ahead of winter to ensure performance gets to green overall The trust also sit within the winter planning team, which includes representation from Norwich CCG.

Ambulance Provider ast of ngland Ambulance Service National Target Ambulance Turnaround D 75 7 65 55 5 45 35 3 Ambulance Turnaround Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 YTD 212/13 58. 61. 58. 58. 57. 57. 56. 52. 55. Commentary last updated on: 3th November 212 The Trust had agreed an 85% of Ambulances turned around in 15 minutes target by the end of October 212, and they have not ac hieved this. Norwich CCG had led Operation Domino which is now in phase 4 (implementation). ast Anglia LAT also doing a system wide review related to Ambulance performance and turnaround. C CG has asked the PCT to clarify what is included in the contract, and therefore what contractual levers can be used to drive up this performance.

CN&T Access Provider NCH&C National Target CN&T 75 7 65 55 5 45 35 3 CN&T 13 212/13 Commentary last updated on:

Pledge 2 (18 weeks) Provider NCH&C National Target Pledge 2 (18 weeks) 75 7 65 55 5 45 35 3 Pledge 2 (18 weeks) 13 212/13 Commentary last updated on:

Acute Provider Norfolk and Suffolk FT National Target IAPT - Number of people entering treatment N O S T A T U S 9 7 5 3 2 IAPT - Number of people entering treatment Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 YTD 212/13 653 753 75 928 772 822 132 923 563 627 7823 Commentary last updated on: 3th November 212 The above performance is based on a Norfolk target as per the current IAPT tar get indicators. The target is a rising cumulative figure that is based on national guidelines using the Psychiatric Morbidity Survey. Norfolk is expected to acheive an overall figure of 1164 people entering treatment by the end of 212/13, the service is currently ahead of target to acheive this indicator.

Delivery Unit: Norfolk and Suffolk FT KPI Title: IAPT - % of people moving to recover IAPT - % of people moving to recover.6.5 D.4.3.2.1 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 YTD 212/13 5.6% 54.3% 51.5% 53.6% 49.2% 44.3% 47.7% 52.9% 49.2% 45.8% 49.9% Commentary last updated on: 3th November 212 The above performance is Norfolk based as the current target is set on a Norfolk basis. The actual performance for Norwich CC G is 46%, against a Norfolk wide performance of 44%. There is evidence that DNA's have negatively affected the service and Norwich has been particularly affected, NSFT are implementing a more proactive chasing system to try an improve this situation. A lack of capacity in the Primary Care Mental Health Teams (Link Worker Pathway) is negatively affecting the recovery rate. NSFT reports patients who are too severe for IAPT are still being seen, as there is not capacity in the Link Worker Pathway, and subsequently the IAPT recovery rate is being lowered. This has been raised at contract level and mitigat ing actions have been requested.

OOH/111 Provider AST National Target Warm transfer to clinician 75 7 65 55 5 45 35 3 Warm transfer to clinician 13 212/13 Commentary last updated on: