Delivering for Quality
Integrated Performance Report
August 2016
Contents
Executive Summary 3
Section A: HAI / SABS 8
Section B: Complaints 10
Section C: Scottish Patient Safety Programme (SPSP) 14
Section D: Local Delivery Plan Performance
1. Performance Summary 23
2. Targets and Standards
2.1 On Track 26
2.2 Recent Adverse Movement 26
3. Performance Escalation
3.1 NHS Acute Division 28
3.2 Board Wide 35
3.3 Health & Social Care Partnership 40
Section E: Capital Programme 47
Section F: Financial Position 54
Section G: Freedom of Information (FOI) Requests 61
Executive Summary
INTRODUCTION
The purpose of the Integrated Performance Report (IPR) is to provide assurance to the Board on NHS Fife’s performance relating to National Standards, local priorities and significant risks.
The Executive Directors Group reviews the IPR prior to its consideration by the Board. This process is supported by scrutiny from colleagues in the Acute Services Division and Integration Joint Board.
SECTION A: HAI /SABS (see page 8)
We will achieve a maximum rate of SAB (including MRSA) of 0.24
Not achieved
For the 12 month period ending August, the rate was 0.38. There were 8 SAB cases in August, the same as in July but 4 less than in August 2015.
Hospital acquired SABs are increasing with vascular access devices being identified as the predominant primary cause. A multi-disciplinary focused improvement programme in cardiology is now complete and has provided the project team with baseline data for further improvement. The project will now move into Phase 2 which will support continued improvement in cardiology while also looking for opportunities for improvement in other wards and departments in the acute division.
The various improvements are expected to achieve a steadily decreasing infection rate throughout 2016-17, with the Standard being met by March 2017.
SECTION B: COMPLAINTS (see page 10)
The target to be achieved is that 75% of complaints are completed within 20 working days of receipt.
The completion rate in July was 66%, with 23 out of 35 complaints received being completed on time. This is a small improvement on the June performance and the completion rate remains below the planned performance for 2016-17 of 75%. The number of open complaints increased in the month (after a sharp fall in June), with delayed statements and complex complaints (including Significant Adverse Effects Reviews, SAERs) presenting the main challenges.
Just under 95% of complaints were acknowledged within 3 days.
SECTION C: SCOTTISH PATIENT SAFETY PROGRAMME (SPSP) (see page 14)
In June, the Cabinet Secretary for Health and Wellbeing announced a new aim for Hospital Standardised Mortality Rate (HSMR), to reduce it by 10% in relation to a new baseline period of January 2011 to December 2013. The current NHS Fife rate (for the first quarter of 2016) is 1.01.
SECTION D: NATIONAL LDP TARGETS AND STANDARDS
There are currently 6 standards/targets which are consistently met and not therefore included in this part of the report; they can be reviewed in sub section 2.1. The remainder are included below with those usually met but showing recent adverse movement, discussed further in sub section 2.2. Those undergoing performance escalation are included in sub section 3.
NHS ACUTE
a) 18 Weeks Referral to Treatment (RTT) (see page 28)
At least 90% of planned/elective patients will commence treatment within 18 weeks of referral
Achieved
This standard is on a positive trajectory with 92.0% of patients treated within 18 weeks in July. Work is ongoing to sustain demand/capacity match across specialities.
b) Patient Treatment Time Guarantee (TTG) (see page 29)
We will ensure that all eligible patients receive Inpatient or Day Case treatment within 12 weeks of such treatment being agreed
Not achieved
In August, 97.3% of patients were seen within 12 weeks, a slight fall in comparison to July. More than half of the breaches were in the Oral/Maxillofacial specialty and the majority caused by gaps in small numbers of specialities. .
We anticipate that through ongoing discussions on resilience with the Scottish Government, we will achieve low numbers of patient breaches regularly from December.
c) Outpatient Waiting Times (see page 30)
At least 95% of patients (stretch target of 100%) will receive their first outpatient appointment within 12 weeks of referral
Achieved
Performance in August remained above the standard, at 95.3%. The overall number of patients on the waiting list fell by over 1,200 in comparison to July.
d) Cancer 62 Day Referral to Treatment (RTT) (see page 31)
At least 95% of patients urgently referred with a suspicion of cancer will start treatment within 62 days
Not achieved
In July, performance against the standard rose slightly in comparison to June (from 83.3% to 85.7%). This equates to 7 breaches from 49 patients treated.
Additional radiology support has been secured from neighboring boards which should deliver improvements in CT waiting times in Q3, a solution is in place for radiology input to the Urology MDT and additional non recurring funding has been provided by Scottish Government to facilitate improvements in waiting times.
We anticipate that we will achieve the Standard consistently from the start of 2017.
f) Cancer 31 Day Decision to Treat to Treatment (DTT) (see page 32)
We will treat at least 95% of cancer patients within 31 days of decision to treat
Not achieved
In July, performance against the standard was 89.5% (94.5% in June). This equates to 9 breaches (all Urology) out of 86 patients treated.
We anticipate that we will achieve the Standard consistently towards the end of 2016, although a national issue with a shortage of Urology Consultants will remain a threat.
g) A&E 4 Hour Waiting Time (see page 33)
At least 95% of patients (stretch target of 98%) will wait less than 4 hours from arrival to admission, discharge or transfer for Accident and Emergency treatment
Achieved
The annually measured performance (96.3%) is above the standard. In August, 96.5% of the patients attending A&E or a Minor Injuries Unit were treated within 4 hours of arrival, equating to 284 breaches. The number of 8 hour breaches (11) was higher than in the previous month, but there were no 12 hour breaches for the fourth successive month.
h) Diagnostic Waiting Times Waiting (see page 26)
No patient will wait more than 6 weeks to receive one of the 8 Key Diagnostics Tests
Not achieved
At the end of July, 406 patients had breached the standard (all for one of the Imaging tests) an increase from 320 at the end of June. It is anticipated that this pressure will continue throughout 2016-17.
Actions are being taken locally to outsource reporting and with regional partners to source additional capacity, but we anticipate that we will not consistently achieve the Standard until the start of FY 2017-18.
BOARD WIDE
a) Sickness Absence (see page 26)
We will achieve and sustain a sickness absence rate of no more than 4% (measured on a rolling 12-month basis)
Not achieved
Note: We are measuring performance on an annual basis to eliminate monthly/seasonal variations, however supporting text focuses on month to month performance. The overall average sickness absence rate for the 12 months to July fell to 4.96%, the lowest it has been since October 2014. The Clinical Access and Support Directorate was below 4% for the third successive month.
Consistent implementation of our absence management policies across all areas are expected to ensure our sickness rate reduces to 4.5% for the whole financial year.
HEALTH AND SOCIAL CARE PARTNERSHIP
a) Delayed Discharge (see page 40)
No patient will be delayed in hospital for more than 2 weeks after being judged fit for discharge
Not achieved
At the August census point, there were 96 patients in delay, 50 of whom had been in delay for more than 14 days. Both figures are unchanged from the July census, and they include 16 patients who were due to be discharged within 3 days of the census and would, prior to the July changes in census guidance, have been discounted from the report.
The partnership continues to rigorously monitor patient delays and enhance facilities for earlier discharge from hospital, with the intention of eradicating delays greater than 14 days by the end of FY 2016-17.
b) Smoking Cessation (see page 42)
In FY 2016-17, we will deliver a minimum of 779 post 12 weeks smoking quits in the 40% most deprived areas of Fife
Behind delivery trajectory
Local management information shows that 80 people who attempted to stop smoking in the first two months of FY 2016-17 had successfully quit at 12 weeks, below the delivery trajectory of 130 and worse than at the same stage last year (when the annual target was less than for this year.
Regular management meetings continue to focus on actions to target the areas where deprivation and smoking prevalence are highest, but it will be a major challenge to deliver the full-year target.
c) Alcohol Brief Interventions
In FY 2016-17, we will deliver a minimum of 4,187 interventions, at least 80% of which will be in priority settings
Behind delivery trajectory
The number of interventions delivered in the first quarter was 9% below the plan. The number of interventions delivered by the 3rd sector was unavailable when the data was submitted to ISD and is likely to have resolved the shortfall.
We anticipate that the number of interventions delivered by the end of Q2 of FY 2016-17 will be above the trajectory when the figures for all delivery areas are available.
d) Child and Adolescent Mental Health Service (CAMHS) Waiting Times (see page 45)
At least 90% of clients will wait no longer than 18 weeks from referral to treatment for specialist Child and Adolescent Mental Health Services
Not achieved
Note: Performance is measured on a 3 month average basis.
Performance against the CAMHS standard continues to improve with the percentage of patients starting treatment within 18 weeks of referral increasing to 88.1% for the 3-month period ending July.
A continuation of the current approach to delivering treatment and the use of additional Scottish Government finance aims to achieve the Standard by the end of 2016.
e) Psychological Therapies Waiting Times (see page 46)
At least 90% of clients will wait no longer than 18 weeks from referral to treatment for Psychological Therapies
Not achieved
Note: Performance is measured on a 3 month average basis.
For the 3-month period ending July, the percentage of patients starting treatment within 18 weeks of referral was 75.0%, a slight increase in comparison to the previous month.
Improvements to IT systems and the availability of additional clinic space, backed up by additional Scottish Government funding, is expected to see us achieve the Standard by the end of FY 2016-17.
SECTION E: CAPITAL (see page 47)
At the end of August, expenditure of £4.1m has been incurred against the planned capital programme, in line with the planned trajectory for the period.
SECTION F: FINANCIAL POSITION (see page 54)
There is a reported £7m overspend on the revenue resource limit at the end of August; this compares with a trajectory of £6.7m for the period.
The key driver of the reported position is the impact of the residual financial plan gap of £9.4m, coupled with an overspend in GP prescribing expenditure, linked to both an increase in cost per item and average number of items prescribed. The most notable movement from the position reported in July is the recognition of wider slippage on savings, including both GP and secondary care prescribing; service change and redesign projects; and national initiatives.
An initial assessment of the likely year end outturn has been undertaken. This recognises a range of factors including: the in year operational budget performance; a review of the planned efficiency projects; existing commitments and anticipated allocations; and other management actions identified to mitigate any further pressures. Work underway with Scottish Government and NHS National Services Scotland on a transformation programme, with tailored support, will also continue to inform the review of the in year position over the coming weeks and months, as well as the longer term financial strategy to deliver a recurring break even position. The transformation programme is considered as a separate agenda item.
SECTION G: FREEDOM OF INFORMATION (FOI) REQUESTS (see page 61)
There were 42 FOI requests received in August compared to 51 received in the same month last year. Of these, 24 have been responded to, 1 of which missed the laid down 20 working day deadline. Of the remaining 18, 4 have missed the 20 day deadline.
Section A: HAI / SABS
We will achieve a maximum rate of SAB (including MRSA) of 0.24
Key Concerns & Risks
The actions described will support the reductions in preventable (hospital acquired) SAB numbers being increased. Infections related to invasive devices such as peripheral venous cannulae (PVC) constitute the single biggest preventable cause and are a particular area of focus.
The trend in the relative rate of SABs acquired in a hospital environment as opposed to arising spontaneously in the community, over the last 12 months, is shown below.
Recovery Plan
Situational Analysis
Various improvement initiatives are in place to address areas of concern in relation to the incidence of SAB infections board wide. It is hoped that these will result in reduced infections during the later months of 2016.
Hospital acquired SABs are increasing with vascular access devices being identified as the predominant primary cause. A multi-disciplinary focused improvement programme is established in cardiology with external support from Health Improvement Scotland to refocus on safe harm free care related to vascular access device management. This 6-week intensive project is now complete and has provided the project team with baseline data for further improvement. The project will now move into Phase 2 which will support continued improvement in cardiology i.e. embed, sustain and achieve reliable systems and processes to enable staff to deliver safe harm free care to “every patient every time” while also taking into consideration the impact of non-compliance with line management and the opportunities for improvement in other wards and departments in the acute division.