Board Report - Performance December 2009 Produced by Business Intelligence

1. Board Report - Performance December 2009 Produced by Business Intelligence

2. Cleanliness and HCAI – Nursing Homes/General Practice The PCT has reduced the overall number of cases of C.Difficile by 46% compared to the same time last year. This comparison is in line with national statistics where the rate of decrease has been greatest among Acute Trust apportioned cases ( 61%) and 40% in all other episodes. The rate of decrease on Acute hospital sites may reflect stricter regimes of prescribing and rapid isolation of presenting index cases. The largest rates occur in the over 65 year olds, Data suggests this may be reflecting specific differences in the epidemiology of the disease within this age group and requires a particular focus upon how these patients are managed in different settings. Providers are ahead of target except Community Primary care/Nursing homes where they are 25 cases above their stretch target. Community does not include West Sussex health who are within target. Lead: Mona Walker – Interim Director of Quality health and wellbeing, for life

3. Emergency Care – 4 hour A&E Wait Although individual Trust A&E performance has taken a dip across the board, it is the Surrey & Sussex Healthcare (SASH) performance failure in October that has pushed the PCT Commissioner position below the 98% target. SASH performance is not as low as July when they were issued a performance notice by Surrey PCT, although the numbers of attendances have risen sharply for month 7 contributing to the current position. SaSH have received assistance from the Emergency Care Intensive Support Team and they are now working through implementation of agreed action plans to address their performance. From the first six months of 2007/08 to the first six months of 2008/09, the total A&E attendances for NHS West Sussex increased by 2.4% and from 2008/09 to 2009/10, this has increased by 7.3%. For BSUH the increase was 6.8% and 8.3%, SASH was 2.3% and 12.2% and Western Sussex Hospitals was 1.3% and 6%. Lead: Paul Goddard – Head of Acute Contracting health and wellbeing, for life

4. Emergency Care – Ambulance Response Times SECAmb continue to perform at levels below the contracted requirement for West Sussex and for SEC as a whole. SECSCG have been seeking to manage this with the provider. Proposals from SECSCG have been made to all PCTs in this respect with a choice provided to continue to manage performance through contractual process (including the application of penalties) or to vary the level of expected performance to a level below national standard and seek a small reduction in contract value. The majority of commissioners (accounting for over 73% of the investment) wanted to vary the contract and manage the financial risks for 2009/10. NHS West Sussex does not support this position and has expressed a wish to apply contractual process. Confirmation as to the agreed course of action has yet to be received. Lead: Tina Wilmer / Dominic Ellett health and wellbeing, for life

5. 18 weeks In October there were 7 breaches of the 6-week diagnostic target: 1 at BSUH for audiology – an onward referral to a clinic open once a month that did not have capacity – now rectified 3 at Guys – 1 in each of sleep studies, urodynamics and cyctoscopy. The Trust are having problems with data submissions and have estimated these figures. 1 at Portsmouth – patient choice 2 at Park Surgery – for 1, the GP had requested a time outside the 6 weeks Lead: Bianca Kokkolas – Head of Performance and Programme Management health and wellbeing, for life

6. 18 weeks Both the Inpatient and Outpatient breaches in October occurred at Brighton & Sussex University Hospitals Trust. The Outpatient breach was at 13 weeks and was in Elderly Medicine. There was a three week delay in consultant triage of the referral prior to arranging the appointment. The Service Manager was not notified that an appointment was not available within 13 weeks. BSUH have reviewed their process for triaging referrals in elderly medicine and escalation processes. The Inpatient breach was in T&O and was at 29weeks. The patient declined the original operation date offered. Surgery was then cancelled twice: the first time due to the patient needing to be treated by a particular consultant who was unavailable and the second time due to ward closure because of an MRSA infection outbreak. Year to date, NHS West Sussex is achieving the Inpatient waiting times target as the current percentage is at 0.01% against a target of less than 0.03%. Based on an estimated final year activity figure of 77,232, as long as there are less than 23 breaches in total, we should achieve the target. NHS West Sussex is currently underachieving on the Outpatient waiting times target. Based on an estimated final year activity figure of 127,202 as long as the number of breaches do not exceed 190, then we should still under achieve rather than fail this target. Lead: Bianca Kokkolas – Head of Performance and Programme Management health and wellbeing, for life

7. Sexual Health The chlamydia trajectory continues to form one of the areas of contention within the contract variation with WSHT, this continues to be worked on by the PCT Programme Manager. The Performance notice is also a barrier to the contract variation being signed, the contracting team and SACS are working on this The IT system is now operational and existing data is being entered into the system, which will make interrogation of the system much easier. The LES is completed but is yet to be signed off. Lead: Paul Woodcock Public Health Programme Manager health and wellbeing, for life

8. Cancer Targets • 2 week wait – Patients choosing to cancel or change their appointment continues to be an issue. However this month we have met the 93% target for the first time since the new methodology was introduced. Year to date we are still slightly under target at 92.2 % • Consultant Upgrades – There were 3 breaches; reasons given by the trusts were: • Longer than usual diagnostic pathway requiring two MDT's discussion prior to treatment decision and delay to treatment planning following inter-trust referral • Delay to treatment planning (chemo) • Delays in pathway due to patient choice Lead: Alison Hempstead Programme Director Cancer health and wellbeing, for life

9. Performance Notices health and wellbeing, for life

10. Performance Notices (previous slide) Two Performance Notices were issued by Surrey PCT to Surrey and Sussex NHS Trust in relation to concerns around performance in both Stroke Care and Caesarian Sections Lead: Bianca Kokkolas, Head of Performance and Programme Management health and wellbeing, for life