Delivering for Quality
Integrated Performance Report
February 2016
Contents Page(s)
Executive Summary 3 - 4
Section A – LDP Standards Performance Summary 5 - 7
Targets on Track Short Report 8
Chief Executive’s Performance Escalation
Colour Coding Key 9
Cancer 62-Day RTT 10 - 12
18 Weeks RTT 13
Patient TTG 14 - 15
Outpatient Waiting Times 16 - 17
A&E 4-Hour Waits 18
HAI Sabs 19
Sickness Absence 20 - 23
Dementia 24 - 26
Delayed Discharge 27 - 28
Smoking Cessation 29
Alcohol Brief Interventions 30
CAMHS Waiting Times 31
Psychological Therapies Waiting Times 32 - 33
Section B - Capital Programme 35 - 42
Section C - Financial Position 43 - 48
Section D - Scottish Patient Safety Programme 49 - 56
Section E - FOI 57 - 58
Section F - Complaints 59 - 61
Section G - Programme Management Initiatives 62 - 64
EXECUTIVE SUMMARY
OBJECTIVE OF THE REPORT
The object of the Integrated Performance Report (IPR) is to provide assurance to the Board on the overall performance of NHS Fife against the corporate aims relating to National Standards (as described in the Local Delivery Plan), local priorities and significant risks.
INTRODUCTION
This report is comprised of Sections A to G as per the Contents page.
In compiling this report, the most up to date information is used to populate the various sections. Due to different reporting timetables, the most current month’s information is not always available.
The Executive Directors Group reviews the Board’s performance every month prior to presentation to the Board or Finance and Resources Committee. This process is further supported by the scrutiny undertaken by the Acute Services Division and Health and Social Care Services.
The Healthcheck, which is presented at each Board Meeting, contains some areas of duplication, and a review of this is in progress, with a view to producing an overarching Quality Report in its place.
KEY PERFORMANCE OBSERVATIONS
In considering the February performance, the following areas for highlighting have been noted:
Section A – LDP Standards:
· The continued sustainment of A&E Waiting Times performance above the 95% target is being sustained (rolling 12 month average). However the day to day performance in the current weeks has proved to be particularly challenging
· The % of patients treated within 18 Weeks of referral is remaining just under the 90% standard (89.9% and 89.3% in January and February, respectively)
· After a slight deterioration in Outpatients Waiting Times in January (91.8% of patients waiting no more than 12 weeks for their first appointment), performance rose again in February to 94.2%, the highest we have achieved under this measure; in addition, the overall waiting list numbers continued to decrease
· The number of patients waiting more than 6 weeks for a Diagnostic MRI test recovered in February to only a single breach compared to 161 in January.
· There is a continuing small improvement against the CAMHS Waiting Times standard, with the % of patients starting treatment within 18 weeks of referral increasing to 83.0% (from previous months of 82.9% and 80.7%)
· There is a continuing small improvement against the Psychological Therapies Waiting Times standard, with the % of patients starting treatment within 18 weeks of referral increasing to 72.2% in January (against 71.1% in December)
· The current monthly performance against both Cancer Treatment measures deteriorated with 86.2% of patients starting treatment within 62 days of an urgent referral and 91.9% of patients starting treatment within 31 days of a decision to treat; the performance against the latter measure was the first time we had failed to meet the 95% standard in this Financial Year .
A breakdown By Specialty for all Cancer Treatment is supplied on Page 12 to show the performance across the different clinical specialties
· There has been a further fall in the number of patients in delay for over 14 days, from 43 at the January Census to 37 at the February Census
· There has been a further small increase in the number of patients failing to meet the 12 week TTG target, from 15 in December and 19 in January to 23 in February
· The increase in the HAI Sabs infections rate has continued, from 0.40 in January to 0.43 in February
· The locally produced sickness absence figure for NHS Fife for January was 5.21%, a reduction of 0.31% on the December figure. The average for the 12-month period ending January was 5.11%, the lowest since December 2014. Particular improvement challenges remain within the Fife West and Fife East Health and Social Care Divisions.
Section B – Capital:
The overall programme continues to be in line with the plan to deliver the target against the CRL.
Section C – Financial Position to 29 February 2016:
The in-month position has improved with an overspend of £0.489 to the end of February with the level of outstanding efficiency savings also reducing. The year-end outturn forecast to deliver a break even position continues to be challenging but has improved in the current month to a more optimistic position
Section D – SPSP:
The Charts in this section of the report now cover NHS Fife as a whole, having previously only reported on activity within the Acute Services Division.
Section F – Complaints:
There has been a further improvement in the 20-day complaints closure rate from 60% in December to 76% in January.
The IPR does not include the Hospital Associated Infection Reporting Template (HAIRT). This information is reported through the Infection Control Committee and the Clinical Governance Committee.
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SECTION A: LDP STANDARDS PERFORMANCE SUMMARY
The source of data in the IPR is either from validated published sources or is local management information from a variety of internal sources. It is important to note that whilst local management information provides a more up to date position, data validation processes may not have been completed and this information may therefore be subject to change.
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TARGETS ON TRACK
NHS Fife continues to meet or perform ahead of the following National Targets and Standards:
Antenatal Access: at least 80% of pregnant women in each SIMD quintile will book for antenatal care by the 12th week of gestationLocal management information shows that NHS Fife has continued to record a performance level of over 80% in all SIMD quintiles. The lowest-performing quintile for the final quarter of 2015 was Quintile 3 (Quintile 1 is most-deprived, Quintile 5 is least-deprived), with a figure of 86.3%. The highest-performing quintile was Quintile 5 (95.7%), while the overall NHS Fife figure was 91.0%.
HAI: we will achieve a maximum rate of C diff infection in the over 15s of 0.32
Local management data for the year ending February indicates a C difficile rate of 0.26, better than the standard of 0.32.
IVF: no eligible patient will wait longer than 12 months for screening following referral from Secondary Care
All NHS Fife patients continue to be screened within 12 months, via the service run by NHS Tayside, with 75 patients having been screened in 2015-16 up to the end of January. The latest management information showed that 23 patients were on the waiting list, none of whom had waited more than 12 months.
Cancer Waiting Times - we will treat any cancer patient within 31 days of decision to treat
Local management information shows that January performance dipped to 91.9% due to surgical capacity within Gynaecology and Urology. Prior to this, NHS Fife had exceeded the 95% standard in every month of 2015-16. It is anticipated that performance will recover in February.
Drug and Alcohol Waiting Times: at least 90% of clients will wait no longer than 3 weeks from referral to treatment
The December ISD publication showed that 98.6% of patients were seen within 3 weeks of referral for treatment between July and September. This remains significantly above the 90% standard, a position NHS Fife has sustained since the start of 2013. We remain in the top quartile of Health Boards as far as performance against this standard is concerned, despite first appointments increasing year-on-year by around 20%. For Drugs alone, the increase was almost 40%.
Diagnostics Waiting Times: No patient will wait more than 6 weeks to receive one of the 8 key diagnostic tests - barium studies, non-obstetric ultrasound, CT, MRI, upper endoscopy, lower endoscopy, colonoscopy, cystoscopy
Local Management information shows that 161 patients were waiting more than 6 weeks for an MRI at the end of January having had no patients waiting over 6 weeks for the previous 3 months. This was due to a spike in referrals for MRI associated with additional outpatient activity and a reduction in capacity due to vacancies in MRI. Additional activity was undertaken in February and only a single breach (for Cystoscopy) was recorded at the end of that month.
Detect Cancer Early: at least 29% of cancer patients will be diagnosed and treated in the first stage of breast, colorectal and lung cancer
The measure for this target covers a rolling 2-year period, and the NHS Fife target of 29% covers 2014 and 2015. Local management information for the 2-year period ending September 2015 shows that we remained slightly behind plan, though improving in both Breast and Lung specialties since the last update. The Stage 1 Detection Rate for Lung Cancer was 20.1%, more than twice the measurement at the base time of December 2011.
CHIEF EXECUTIVE’S PERFORMANCE ESCALATION
In the following sections, cells in the Recovery Trajectory tables and Recovery Plan charts are shaded as follows:
Recovery Trajectory
Recovery Plan
ACUTE SERVICES
CLINICAL ACCESS & SUPPORT
CANCER 62 DAY REFERRAL TO TREATMENT
At least 95% of patients urgently referred with a suspicion of cancer will start treatment within 62 days
Key Concerns & Risks
As described in previous reports, there are a number of areas of risk in achieving this target, namely around Urology and Gynaecology. Gynaecology waits are improving, however, there are capacity issues for outpatients and surgery. Head & Neck and Lung cancers remain at risk due to complexity, liaison with tertiary providers, visiting oncology capacity and surgical capacity.
Performance against the 62-day target remains a significant challenge.
Recovery Trajectory
Recovery Plan
Situational Analysis
In the recovery plan for this target there are 8 actions which have a Red or Amber RAG status.
Challenges with vacancies in Respiratory medicine continue with interim arrangements in place to release capacity to enable urgent outpatient slots to be maintained. A locum has been appointed and targeted additional activity continues which has resulted in improvement in waits to 1st appointment. Two Respiratory posts have now been recruited to. The actions taken have moved the status from Amber to Green.
The review of EBUS provision in NHS Fife has been delayed until the current vacancies are filled.
A draft Outline Business Case for Robotic Assisted Laparoscopic Prostatectomy within SEAT has been developed. This is being taken forward at a regional Level and a Fife based consultant has been identified to be trained to undertake these procedures. This has moved this status from Red to Amber.
A new administrative support structure has been implemented in Urology. Whilst there are still challenges the new process has resulted in timely information to facilitate waiting list management. It is anticipated that these actions will move the status for action 2.6 from Amber to Green
Patients who have been delayed in the initial part of their pathway are now progressing to treatment however this together with the increased throughput of general urology outpatients has resulted in increased demand for surgery. This will result in deterioration in performance in the next few months. The status remains at Amber for surgical capacity.
Waits for Urology oncology appointments continue to be a challenge. The review of oncology provision as a whole is underway and additional capacity is being provided when possible. Recruitment of a second Acute Oncologist with an interest in Uro-Oncology is currently at advertisement.
A solution to allow electronic referrals between Boards has been investigated and is unlikely until a replacement PAS system is implemented in 2017. An alternative solution has improved the speed of communications and has moved this status from Red to Amber.
The GP direct access to imaging is a national project; there has been a delay at national level and there is no revised timescale available. This has moved from Amber to Red.
Two new actions have been added for Gynaecological cancer, 4.1 and 4.2 with the aim of improving performance for this cancer site.
Cancer Performance Trend by Specialty
The Performance Trend for both Cancer Treatment measures, broken down by Specialty, is shown in the tables below. (In certain specialties the numbers are very low ie <5 so are not disclosed as actual numbers)
62-Day RTT
31-Day DTT
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18 WEEKS REFERRAL TO TREATMENT
At least 90% of planned/elective patients will commence treatment within 18 weeks of referral
Following three successive months when performance was above trajectory, we slipped behind plan in August, and have remained behind since, albeit with a narrowing gap.
Key Concerns & Risks
The key specialties currently at risk of not meeting 18 weeks RTT are Urology, Oral Surgery, General Surgery, Vascular Surgery and Neurology. This is driven by vacancies, increasing demand and an ongoing demand-capacity gap.
Additional activity continues to be undertaken to improve and sustain Outpatient, Diagnostic and Inpatient / Day Case waiting times, and the positive impact of this was seen in January. NHS Fife continues to meet with Scottish Government regarding resilience around this target and work is being undertaken to review the size and resourcing of the demand-capacity gap.