Board Exception Report - Performance February 2010 (December 2009 data presented)

1. Board Exception Report - Performance February 2010 (December 2009 data presented) Produced by Business Intelligence

2. Index • Health Care Associated Infections (HCAI) • Emergency Care • Access • Cancer • Primary Care • Cardiac • Sexual Health • Health Improvement • Stroke & Transient Ischaemic Attacks (TIA)

3. Cleanliness and HCAI • Headline: NHS West Sussex [Nursing Homes and General Practice] had 17 cases of Clostridium difficile (C.Diff) in December ’09 which brings the total YTD to 161. Whilst this is below the community cumulative Department of Health target, it exceeds the Strategic Health Authority (SHA) stretch target by 18 cases. • Current Actions: Several pieces of work have commenced to continue with efforts to reduce incidents of C.Diff, including:- • sign up of a third of GP practices to the HCAI Local Enhanced Scheme (LES) • an information crib sheet to all the GPs re-issuing the antibiotic guidance • an HCAI newsletter. • Future Actions: The Quality Directorate are in the process of arranging 3 sessions for the prescribing leads for each practice across the patch. They will not be infection control sessions but will be learning sets with a microbiologist, a pharmacist and one of the Quality team advising lessons learnt from the Root Cause Analyses. The bid to the SHA for an antibiotic pharmacist did not receive approval but we are exploring whether there are alternative routes of funding. • Other: On a positive note, MRSA cases are at 17 against a target of 19 and C.Diff for Acutes is also within DH tolerances. Overall NHS West Sussex is green against all the DH HCAI targets. • Lead: Julia Dutchman-Bailey, Director of Quality health and wellbeing, for life

4. Emergency Care - A&E 4 hour wait • Headline: Overall the NHS West Sussex position is red for the A&E 4 hour wait for December mainly due to adverse weather conditions affecting all Sussex Trusts. The position split by Trust is as follows: • BSUH = 75 breaches • SASH = 260 breaches • WSHT = 203 breaches • Current Actions: Contract managers are aware of the reasons for the breaches and are working with the Acute Trusts to plan more effectively for winter pressures. Surrey PCT have issued a performance notice against SASH for an unacceptable level of performance for A&E 4 hour waits. • Future Actions: Performance will be monitored closely on a monthly basis and any deviation from plan will be picked up by the contract managers and remedial action plans put in place • Other: The position against the target has remained steady throughout the year. The current cumulative position at December 2010 is 98.39% for the Commissioner target so the indication is that this will be rectified by year end. • Lead: Tina Wilmer, Programme Director Unscheduled care health and wellbeing, for life

5. Emergency Care - Ambulance Response Times Headline: Performance for Cat A <8 minutes has dropped below target for the first time since July 2009, due to adverse weather conditions, combined with exceptionally high activity in emergency care, particularly during the first weekend of snow.  Whilst Cat A <8 minutes was not achieved during the month,  it remained above 75% for the year to date.  The Cat A <19 minute target was maintained above 95% during the month, which was a significant achievement bearing in mind the weather conditions. Current Actions: No remedial action at this stage. Continued monitoring of performance by SECSCG. Future Actions: Possible application of contractual framework to be determined by SEC SCG. Other: Continued monitoring of performance to ensure compliance Lead: Dominic Ellett, Assistant Director Acute Contracting health and wellbeing, for life

6. Emergency Care - Ambulance Response Times Headline: SECAmb continue to perform at levels below the contracted requirement for West Sussex and for South East Coast as a whole. Poor weather conditions in December have contributed to further deterioration. Overall activity is 2.5% above baseline for YTD. Current Actions: Contractual framework and penalty applied for non-performance. Future Actions: No further action at this stage. Subject to review by SECSCG. Other: The performance notice issued to SECAmb in relation to consistent underachievement against this target was removed in December as a penalty was imposed as per contracting performance criteria. Lead: Dominic Ellett, Assistant Director Acute Contracting health and wellbeing, for life

7. Access – Diagnostic Test Waiting Times Headline: There were 206 breaches of the 6 week target in December. BSUH were responsible for 116 of these; Flexi-Sigmoidoscopy (38) and Gastroscopy (66) due to job planning and capacity issues. There has been a complete review of the entire booking process at the hospital and additional clinics have been added. Further breaches are expected at the end of January 2010 due to the size of the issue and the Board have been briefed on this. Other contributors include West Sussex Health with 55 audiology assessment breaches and Western Sussex Hospitals with 34 breaches (mostly non-obstetric ultrasound and Gastroscopy). Current Actions: Action plans have been received and contract managers are managing the situation. We are in contact with Brighton & Hove City PCT and the provider to implement the trust remedial action plan as a matter of urgency. Future Actions: West Sussex Health have assured the Trust that appointments are always offered when cancellations occur and communication will be improved to ensure management are able to address issues as soon as they arise and flag them up through the risk management process. Other: Continued workwith Providers has kept the breaches to a minimum throughout the year and the current issue at BSUH should be rectified by next month. Lead: Debra Wheeler, Head of Market & Capacity Management health and wellbeing, for life

8. Access – Stage of Treatment Waiting Times • Headline: SASH were responsible for the two 13 week waiters (one in Ophthalmology, one in Paediatric medicine). Both patients have now been seen. The 26 week breach was at Western Sussex Hospitals in Ophthalmology due to a TCI (to come in) card being filed within a patient’s notes. Current Actions: Root Cause Analyses (RCA) and breach reports have been received and action plans are in place at both providers • Future Actions: Execution of the action plans will be monitored to ensure learning from RCAs is implemented. • Other: Indicative tolerances are set at: Achieving <=0.03%, Underachieving <=0.15% and Failing >0.15%. Overall NHS West Sussex are YTD at: • 13 week at December is 0.08% underachieving in relation to numbers of patients seen overall. • 26 week at December is 0.017% and therefore achieving the target in relation to numbers of patients seen overall. • Lead: Debra Wheeler, Head of Market & Capacity Management health and wellbeing, for life

9. Access – GP Referrals Headline: GP referrals continue to run above planned levels but decreased in month as per the seasonal trend Current Actions: Contract managers are working with each Acute Trust and Practice Based Commissioning (PBC) Group in order that trends are identified and understood. Peer review within PBC localities using benchmarked data is being used to inform the debate. Other referrals have decreased against previous years although still running ahead of plan. Data from Western Sussex Hospitals Trust new PAS system is being validated as activity is being double counted but not double charged Future Actions: The new head of planned care Debra Wheeler (Head of Market and Capacity Management) will work with PBC and Programme Manager to continually review the position. Other: 2010/11 contracts are being set at outturn. Lead: Debra Wheeler, Head of Market & Capacity Management health and wellbeing, for life

10. Primary Care - Dental Headline: Department of Health Access target for end March 2011 – 58% (465,000) of West Sussex Residents to access NHS Dental Services Current Actions: A tender exercise to consolidate and further increase general dental access throughout the county for 2010/11 is in process.  Following issue of Invitation To Tender (ITT) documentation, bids have been received from twenty-five Dental Providers, covering various locations across West Sussex and are currently being evaluated. There is a timeline in place but there is currently a delay and the implications in relation to its exact effect on evaluation are not yet clarified. Future Actions: Dental contracts have been extended within 2009/10 to manage capacity. Other: Specialist Dental services; orthodontics, sedation, minor oral surgery, community dental and emergency dental being reviewed alongside general dental access. Lead: David Grant, Contract Manager Dental Services health and wellbeing, for life

11. Cancer - 2 week wait Headline: The number of breaches has increased again this month and analysis of the reasons given by trusts shows that the vast majority are due to patient choice i.e. a patient has declined an offer of an appointment which was within a 2 week window as specified within policy. This was made worse by patients not wanting to attend before the Christmas period and due to the adverse weather conditions. Current Actions: Working with Cancer networks and acute trusts to ensure issues are not related to capacity. All GP practices provided with patient leaflets and information. Future Actions: Continue to monitor and work with GPs to ensure patients informed of the reasons why a 2 week appointment is being offered. Other: National thresholds may change over time.Lead: Alison Hempstead, Cancer Programme Director health and wellbeing, for life

12. Cardiac - Thrombolysis Headline: Last quarter thrombolysis figures dropped dramatically.  It would appear that this can largely be attributed to a decrease in data collection around the St Richard's site. The % dropped from 75% in Q2 to 20% in Q3. Overall our performance is 66% YTD. Current Actions: The trust have plans in place to ensure data quality and data collection is improved through additional resource and will be actioned imminently. Future Actions: NHS West Sussex will continue to review the data on a monthly basis. Overall the target has been achieved and this appears to be a data issue which should now be resolved. Other: NHS West Sussex has now recruited to a Cardiac Programme Manager and their role will be to review and performance monitor Providers to ensure compliance Lead: Tina Wilmer, Programme Director Unscheduled care health and wellbeing, for life

13. Sexual Health - Chlamydia 25% target Headline: There has been a significant increase in numbers screened for Chlamydia in December 2009, almost reaching the YTD highest position which was in September. Current Actions: NHS West Sussex have issued a performance notice against West Sussex Hospitals for poor performance against chlamydia screening within the contract. Future Actions: The Local Enhanced Scheme has been through Executive Team at NHS West Sussex and approved, however funding is not yet released. Next steps are to implement plans to mail out to all 21-24 year olds about screening as there is good evidence that this will increase up-take of screening in other counties. Other: Significant improvements in numbers screened demonstrate that the work carried out by the Programme have been successful. Lead: Paul Woodcock, Programme Manager Sexual Health health and wellbeing, for life

14. Health Improvement - Immunisations Headline: The data for the recent quarter is preliminary. We have seen the expected decline in performance in Q3 owing to the additional burden of the swine flu vaccination programme in GP practices. Current Actions: DTP/IPV aged 1 - There has been a small decline in Q3 however this is very close to target and to achieve this would require 16 more children to complete their primary course. Hib/MenC at age 2 - There has been a decline in Q3, however NHS West Sussex may not achieve the target set by the end of 2009/10 as further 165 children would need to be immunised. Future Actions: Work is ongoing with the HIS to address inaccuracies in the records held by Child Health Bureau. The Director of Public Health is being approached to approve the funding (from within the PH directorate) to continue the data reconciliation exercise. This should result in improved statistics describing immunisation coverage for the cohorts in question. Others: Work by the Immunisation Co-ordinator is on-going with the Practices to encourage take-up Lead: Nick Kendall, Consultant in Public Health health and wellbeing, for life

15. Health Improvement - Immunisations Headline: MMR vaccine dose 1 at age 2 - The MMR coverage has shown a very small decline this month. It is unlikely that the PCT will achieve the 92% coverage target for the year 2009/10. Another 91 children would have to be immunised by the end of March. MMR dose 2 aged 5 - This year’s target is green, although the achievement of the 95% target for 2010/11 is doubtful (representing a step change from 84% to 95% in one year). Current Actions: Children under 5 are now being called into the surgeries for their swine flu vaccines until the end of February 2010. There will be the opportunity to persuade parents who have not decided, about the safety and efficacy of other childhood vaccines (parents may prefer to come back to have their child immunised at a separate appointment). The Immunisation co-ordinator will draw this to the attention of the practice managers. Future Actions: The latest Immform data show 85% coverage of dose 1 of the school based immunisations. The current programme is set to recover and the PCT should meet this year’s target. There is a detailed project plan held by NHS West Sussex. Other: For the month of January 2010, the school based immunisations have been set back owing to the closure of schools during the bad weather. Lead: Nick Kendall, Consultant in Public Health health and wellbeing, for life

16. Health Improvement – Breastfeeding 48% Target Headline: The targets for prevalence and coverage have not been met Current Actions: The backlog of data entry has now been completed and NHS West Sussex has recently submitted revised figures.  An action plan is being implemented by West Sussex Health to address data cleansing issues. This will improve the achievement, however we are unlikely to meet the 2009/10 target. Future Actions: The new manager for the Child Health Bureau is now in place and has been tasked with prioritising this indicator to improve the current systems Other: For clarification, prevalence is the number of babies actually recorded as being breastfed against the number of babies due their 6/8 week check and coverage is the number asked. Lead: Catherine Scott, Programme Director, Health and Wellbeing health and wellbeing, for life

17. Health Improvement - Diabetic Retinopathy Headlines: Brighton & Sussex University Hospitals NHS Trust Diabetic Retinopathy Screening (DRS) service has indicated it expects to experience some capacity issues in the last quarter of 09/10, however the Programme envisages meeting the Annual Health Check (AHC) target for 2009/10. Western Sussex NHS Trust DRS service continues to perform ahead of the planned trajectory submitted in the in-year recovery plan and is confident it will meet the AHC target by the end of 2009/10. Current Actions: Western Sussex Hospitals Trust has seen dramatic increases in the uptake of screening and the trajectory is indicating that they will achieve green status by year end. Future Actions: Work is on-going with Western Sussex Hospitals Trust to ensure the continued improvements in uptake. Other: The joint working carried out by NHS and West Sussex Hospitals Trust has been a very positive step in improving the target. Lead: Viv Mussell, Programme Manager Screening health and wellbeing, for life

18. Stroke & TIA Headline: There remains an issue with the recruitment of stroke nurses within NHS West Sussex and this has impacted on the targets. Current Actions: Patients at Surrey and Sussex NHS Healthcare Trust (SASH) are currently diverted to Guildford or Brighton out of hours. The Sussex-wide position is to implement tele-medicine which should improve the current situation. Surrey PCT have issued a performance notice against SASH in relation to stroke performance consistently falling below target. Future Actions: Western Sussex Hospitals have recently installed a new information system and are currently reviewing quarter 3 numbers as part of a data quality exercise and looking to re-submit at year end based on improved data capture. Other: The current position should improve by the next quarter due to the actions taken by the Programme stated above. Lead: Tina Wilmer, Programme Director Unscheduled care health and wellbeing, for life