Document

Performance Report - Existing Commitments

EC01: Guaranteed access to a GUM clinic within 48 hours of contacting a service

Accountability Period Submitted (1) (4)

EC01: Guaranteed access to a GUM clinic within 48 hours of contacting a service

31 Oct 2009

05 Jan 2010

Owner Rachel Spencer

Sponsor Judith Hooper

Key Achievements Since Last Report:

Both Genito Urinary Medicine (GUM) clinics offer a mixture of drop in and booked appointments at a variety of times.

Current Concerns: Performance for Kirklees is 100% offered for October. The take up of those appointments 'seen' is 98%

Reasons for Variance and Actions Taken:

STI Services are continuing to roll out in primary care. The sexual health programme is reviewing its plan for 2010/11. HIV prevention services are being retendered this year which will help support the prevention of STIs and HIV.

PI Due Date Planned (value)

Latest YTD

Variance (8) (9) Comments

Percentage: first attendances at a GUM service who were offered an appointment to be seen within 48 hours of contacting a service

Oct 09 31 Oct 2009

98 99.89 1.89 Not Set

Percentage: first attendances who were seen within 48 hours of contacting a GUM service

Oct 09 31 Oct 2009

80 98.21 18.21 Not Set

Percentage: people attending a GUM service who were offered an appointment to be seen within 48 hours of contacting a service

Oct 09 31 Oct 2009

100 100 0 Not Set

Department of Health GUM clinics waiting times collection (financial year 2009/10 (quarters 1 to 4))

This indicator relates to the offer of an appointment for the patient to be seen within 48 hours of contacting the service rather than an offer of an appointment that is made within 48 hours of contacting the service but to be seen at a later date. Contact is any request to be seen by the GUM service, whether by GP referral, self-referral in person, by letter or by phone.

Annual numbers of sexually transmitted diseases diagnosed in genito-urinary medicine (GUM) clinics in England rose by 43% between 1996 and 2002, with an overall increase in clinic workload of 79% for the same period. The white paper, 'Choosing health: making healthier choices easier' (Department of Health, 2004), included a number of commitments, including improved access to GUM clinics, and efficient and convenient screening services. Additional Information This indicator relates to the offer of an appointment for the patient to be seen within 48 hours of contacting the service rather than an offer of an appointment that is made within 48 hours of contacting the service but to be seen at a later date

CQC - 30th April 2009 HC - 18th June 2008


EC02: All ambulance trusts to respond to 75 percent of Category A calls within 8 minutes


EC02: All ambulance trusts to respond to 75 percent of Category A calls within 8 minutes

30 Nov 2009

05 Jan 2010

Owner Rachel Carter

Sponsor Carol Mckenna


November performance for NHS Kirklees was 66.7%, (May 72.2%, June 70.4%, July 65.9%, August 65.9%, September 67.0%, October 65.6%). In-month performance to 20th December was 60.1%. November performance for YAS was 70.9% (May 76.7%, June 74.6%, July 69.7%, August 70.1%, September 71.9%, October 70.2%). In-month performance to 20th December was 65.8%. April performance for Kirklees was 69.9%, and for YAS was 76.7%. May performance for NHS Kirklees was 72.2%, and for YAS was 76.7%. June performance for NHS Kirklees was 70.4%, and for YAS was 74.6%. July performance for NHS Kirklees was 65.9%, and for YAS was 69.7%. August performance for NHS Kirklees was 65.9%, and for YAS was 70.1%. September performance for NHS Kirklees was 67.0%, and for YAS was 71.9%. October performance for NHS Kirklees was 65.6%, and for YAS was 70.2%. November performance for NHS Kirklees was 66.7%, and for YAS was 70.9% Demand in April was higher than plan for both Kirklees (+0.7%) and YAS (+3.8%). Demand in May was lower than plan for Kirklees (-1.0%) but higher for YAS (+4.7%) Demand in June was higher than plan for both Kirklees (+2.1%) and YAS (+3.9%). Demand in July was higher than plan for both Kirklees (+3.5%) and YAS (+5.8%). Demand in August was lower than plan for Kirklees (-3.0%) but higher than plan for YAS (+2.9%) Demand in September was lower than plan for Kirklees (-2.2%) but higher than plan for YAS (+1.9%). Demand in October was higher than plan for Kirklees (+0.1%) and for YAS (+4.9%). Demand in November was higher than plan for Kirklees (+2.7%) and for YAS (+6.1%).

Current Concerns:

YAS is forecasting 72.1% Cat A performance for 2009/10 if its turnaround plan components are successful. I.e. YAS in now forecasting that it will not achieve the 75% cumulative annual performance requirement. There is significant variation in performance across different areas of Kirklees. In October, performance was best in Huddersfield North locality (78.0%) and worst in Denby Dale and Kirkburton locality (28.6%).


YAS is now formally in ‘Turnaround’ status with the SHA given its continued under achievement of national and locally contracted ambulance performance standards and limited progress with its performance improvement action plan, prepared in response to a Performance Notice issued on 25th September. In response to this, YAS has now prepared a ‘Performance Turnaround Plan’ Rob Cooper (SHA Director of Finance & Deputy CEO) is leading the performance management process and together with NHS Bradford and Airedale, as lead commissioner, meetings are scheduled on a weekly basis with YAS to review YAS compliance with and progress against this plan: a) Performance b) Demand c) Resource (Planned vs Actual hours produced and reasons for difference) d) Unit Hour Utilisation e) Total abstractions & Sickness absence levels and action f) Call Receipt / Activation times g) Ambulance turnaround times

h) National comparison (Demand / Performance / Turnaround) The reports, and background information, on these metrics are being scrutinised and challenged by the lead commissioner and SHA with weekly points for action being identified for the review meeting held at 9am every Wednesday. The plan identifies: 1 Major management concentration and action directed at reducing staff absence levels as YAS under-resourcing of operational shift hours has been clearly identified as the main reason for YAS’ performance under achievement. 2 Adjustment and expected improvement in several areas of YAS operation along the ambulance call cycle. 3 An assumption that demand on the ambulance service will continue at 4% above contracted level until the year end. Given year to date demand levels, this appears to be a reasonable assumption. 4 Given the current performance position, confidence is low that YAS will be able to recover its performance and deliver compliance to the Cat A 75% / 8 minute standard in year 5 Therefore, potentially performance inhibiting issues such as the West Yorkshire CAD change have been incorporated into the recovery plan to give as clear a possible opportunity for YAS to commence and continue achieving all national performance standards from April 2010. Summary YAS is forecasting 72.1% Cat A performance for 2009/10 if its turnaround plan components are successful. The success of the turnaround plan rests on YAS ability to adequately and consistently address the availability of adequate operational hours by dealing with the operational and organisational ‘culture’ issues around staff absence. Continued vigilance by associate commissioners in trying to reduce demand and turnaround will assist in this year’s ambulance performance standards achievement and also set up a favourable position for next year.


Latest YTD Variance (8) (9) Comments

1. Percentage of category A calls resulting in an emergency response arriving at the scene of the incident within 8 minutes

Nov 09 30 Nov 2009 75 72.5 -2.5 CQC measure.

2. Percentage of category A calls resulting in an emergency response arriving at the scene of the incident within 8 minutes. NHS Kirklees Monthly Performance mapped against YAS Monthly Performance

Nov 09 30 Nov 2009 66.7 YAS in-month performance 70.9%.

3. Percentage of category A calls resulting in an emergency response arriving at the scene of the incident within 8 minutes. NHS Kirklees Performance Year to Date

Nov 09 30 Nov 2009 67.2 Not Set

4. Percentage of category A calls resulting in an emergency response arriving at the scene of the incident within 8 minutes. YAS Monthly Performance mapped against local trajectory

Nov 09 30 Nov 2009 70.9 Monthly trajectory 75.2%


Apr 09 May 09 Jun 09 Jul 09 Aug 09 Sep 09 Oct 09 Nov 09 Dec 09 Jan 10 Feb 10 Mar 10

Actual 76.4 76.7 76 74.3 73.5 73.2 72.7 72.5

Profile 75 75 75 75 75 75 75 75 75 75 75 75


EC03: All ambulance trusts to respond to 95 per cent of Category A calls within 19 minutes.


EC03: All ambulance trusts to respond to 95 per cent of Category A calls within 19 minutes.

30 Nov 2009

05 Jan 2010

Owner Rachel Carter



November performance for NHS Kirklees had improved significantly to 97.5% (May 95.5%, June 94.1%, July 93.5%, August 94.5%, September 93.1%, October 92.1%). YAS performance in November had also improved to 96.5%,(May 96.1%, June 95.8%, July 93.6%, August 94%, September 94.8%, October 93.5%) against a trajectory of 96.5%. April performance for Kirklees was 94.8% against a trajectory of 93%; for YAS it was 96.4% against a trajectory of 96.5%. May performance for Kirklees was 95.5% against a trajectory of 93%; for YAS it was 96.1% against a trajectory of 96.5%. June performance for NHS Kirklees was 94.1% against a trajectory of 93.0%; for YAS performance it was 95.8% against a trajectory of 96.5%. July performance for NHS Kirklees was 93.5% against a trajectory of 93.0%; for YAS performance it was 93.6% against a trajectory of 96.5%. August performance for NHS Kirklees was 94.5%; for YAS performance it was 94.0%. September performance for NHS Kirklees was 93.1%; for YAS performance it was 94.8%. October performance for NHS Kirklees was 92.1%; for YAS performance it was 93.5%. November performance for NHS Kirklees was 97.5%; for YAS performance it was 96.5%.

Current Concerns:

Please see commentary for Cat A 8 minute target. YAS year-to-date performance (95.1%) has recovered to above the cumulative target of 95% (having fallen below this target for the first time in October). This represents a reversal of recent trends (4 months below target) and means that the annual target remains achievable if the improvement is maintained. Performance varies significantly in different parts of Kirklees. In October best performance was in Dewsbury and Mirfield locality (99.2%) and worst performance was in Denby Dale and Kirkburton locality (73.5%).


The 2009/10 contract includes a requirement to report exceptions against the A19 target. This applies to YAS performance for April to September and to individual PCT performance from October to March 2010.



1.Percentage of category A calls resulting in an emergency response arriving at the scene of the incident within 19 minutes

Dec 09 30 Nov 2009 95 95.1 0.1 CQC measure.

2. Percentage of category A calls resulting in an emergency response arriving at the scene of the incident within 19 minutes. NHS Kirklees Monthly Performance mapped against YAS Monthly Performance

Nov 09 30 Nov 2009 97.5 YAS monthly performance 96.5%

3. Percentage of category A calls resulting in an emergency response arriving at the scene of the incident within 19 minutes. NHS Kirklees Performance Year to Date

Nov 09 30 Nov 2009 94.4 Not Set

4. Percentage of category A calls resulting in an emergency response arriving at the scene of the incident within 19 minutes. YAS Monthly Performance mapped against local trajectory

Nov 09 30 Nov 2009 96.5 Not Set

KA34 ambulance services (financial year 2009/10)

This indicator measures performance in response to category A calls requiring transport. The Department of Health's requirement is that a minimum of ninety five per cent of category A calls (defined as ""immediately life-threatening"") that require transport should be met within 19 minutes of the request being made for a vehicle capable of transporting the patient. All PCTs will be aware that from 1 April 2008 the ‘clock’ for measuring the response times standards starts from the connection of the call to the ambulance control room, a change which formed one of the recommendations of the report 'Taking Healthcare to the Patient'. The category A 19 minute standard is measured from the time the request for transport is made; either when the initial responder makes a request for transport to the control room, or from the point the call is connected if the information received from the 999 caller indicates that transport is needed, whichever is the earlier. The category A 19 minute target is expected to be much less affected by the change than the category A 8 minute target.



Actual 96.3 96.1 95.4 95.1 95.1 94.8 95.1

Profile 95 95 95 95 95 95 95 95 95 95 95 95


EC04: All ambulance trusts to respond to 95 percent of Category B calls within 19 minutes


EC04: All ambulance trusts to respond to 95 percent of Category B calls within 19 minutes

30 Nov 2009

06 Jan 2010

Owner Rachel Carter



November performance for NHS Kirklees recovered to 89.4%, (May 86.9, June 85.3%, July 83.4%, August 85.5%, September 83.3%, October 81.1%). In-month performance to 20th December had dropped back to 85.9%. November performance for YAS improved to 90.5% (May 90.6%, June 90.1%, July 86.7%, August 88.3%, September 88.5%, October 86.8%). In-month performance to 20th December dropped back to 87.8%. April performance for Kirklees was 85.8% against a trajectory of 94.4%; for YAS it was 90.6% against a trajectory of 94.9%. May performance for Kirklees was 86.6% against a trajectory of 94.4%; for YAS it was 90.6% against a trajectory of 95.0%. June performance for NHS Kirklees was 85.3% against a trajectory of 94.6%; for YAS it was 90.1% against a trajectory of 95.0%. July performance for NHS Kirklees was 83.4% against a trajectory of 95.0%; for YAS it was 86.7% against a trajectory of 95.0%. August performance for NHS Kirklees was 85.5%; for YAS it was 88.3%. September performance for NHS Kirklees was 83.3%; for YAS it was 88.5%. October performance for NHS Kirklees was 81.0%; for YAS it was 86.8%. November performance for NHS Kirklees was 89.4%; for YAS it was 90.5%.

Current Concerns:

Please see also comments for Category A 8 minute target. YAS will not achieve the cumulative target of 95% for 2009/10. Performance varies significantly in different parts of Kirklees. In October best performance was in Spen locality (86.1%) and worst performance was in Denby Dale and Kirkburton locality (60.0%).



2. Percentage of category B calls resulting in an emergency response arriving at the scene of the incident within 19 minutes. NHS Kirklees Monthly Performance mapped against YAS Monthly Performance

Nov 09 30 Nov 2009 89.4 YAS monthly performance 90.5%

3. Percentage of category B calls resulting in an emergency response arriving at the scene of the incident within 19 minutes. NHS Kirklees Performance Year to Date

Nov 09 30 Nov 2009 95 85.1 -9.9 Not Set

4. Percentage of category B calls resulting in an emergency response arriving at the scene of the incident within 19 minutes. YAS Monthly Performance mapped against local trajectory

Nov 09 30 Nov 2009 90.5 Not Set

Percentage of category B calls resulting in an ambulance vehicle able to transport the patient arriving at the scene of the incident within 19 minutes

Nov 09 30 Nov 2009 95 89 -6 YAS YTD performance (CQC indicator)

KA34 ambulance services (financial year 2009/10)

This indicator measures performance in response to category B calls. The Department of Health's requirement is that a minimum of ninety five per cent of all category B calls (defined as ""serious but not immediately life-threatening"") should receive an emergency response at the scene of the incident within 19 minutes. All PCTs will be aware that from 1 April 2008 the ""clock"" for measuring the response times standards starts from the connection of the call to the ambulance control room, a change which formed one of the recommendations of the report 'Taking Healthcare to the Patient'. The change will make the response time targets more difficult to achieve, but the change in relation to the category B 19 minute target will have a considerably lesser impact than for the category A 8 minute measure, and therefore should not result in a significant change in reported levels of performance



Actual 90.4 89.5 89.3 89.1 88.8 89

Profile 95 95 95 95 95 95 95 95 95 95 95 95


EC05: All patients who need them, to have access to crisis services with delivery of 100,000 new crisis resolution home treatment episodes each year


EC05: All patients who need them, to have access to crisis services with delivery of 100,000 new crisis resolution home treatment episodes each year

31 Oct 2009 28 Oct 2009

Owner Vicky Dutchburn



Ongoing work with South West Yorkshire Mental Health Trust (SWYMHT) to try to meet the Intensive Home Base Treatment (IHBT) trajectories. The Trust, in partnership with its commissioners, has already worked hard to meet required targets. Additional IHBT episodes are been reported & there continues to be a positive move towrads the final trajectory .

Current Concerns:

QTR 2 Year to date figures: Number of Home Treatment Episodes = 562 Number of assessments made by Crisis Resolution (CR) teams = 769 Number of patients receiving home treatment = 370 ongoing progress and review of the agreed action plan for 09/10 will be monitored on a quarterly basis through the contract monitoring meetings.


The proposed Action Plan covers: -Data collection; To continue to review/refine assessment and treatment codes on RiO ,To set up additional ‘crisis centre location codes’ To increase the focus on the timely recording of discharge on RiO,To record the activity of all practitioners involved in joint visits. -Review of practice; To continue to explore the potential for community clinical teams (e.g. AOT, CMHTs) referring to the Crisis Teams when supporting the delivery of more clinically intensive care.To explore the potential of undertaking additional face to face contacts within the care pathway -Delivery of ageless services;To explore how work within current older peoples services could be included in IHBT figures. -General; To liaise with organisations currently meeting trajectories to share best practice. Penalty clause included within 09/10 contract



Number of separate episodes of home treatment provided by crisis resolution teams

Y/E 2008/09 31 Mar 2009 850 804 -46 Not Set

Number of separate episodes of home treatment provided by crisis resolution teams as a percentage of allocated national target

Jun 09 30 Jun 2009 213 210 -3 Not Set

Percentage of separate episodes of home treatment provided by crisis resolution teams of allocated national target

Oct 09 31 Oct 2009 562 on line to achieve annual trajectory

Percentage of separate episodes of home treatment provided by crisis resolution teams of locally agreed share of the national target

Oct 09 31 Oct 2009 66.12 Not Set

Community Mental Health Activities Collection (financial year 2009/10) Care Quality Commission special data collection (financial year 2009/10)

Crisis resolution services provide intensive support in the home for people in mental health crisis. The Priorities and Planning Framework (2003-2006) set out the following national target: 'Offer 24-hour crisis resolution to all eligible patients by 2005'. This target was based on the NHS Plan (2000) which envisaged 100,000 people being treated by crisis resolution/home treatment services each year once services were fully implemented. As set out in the 2009/10 Operating Framework, each PCT is required in each year after the target date to continue to deliver its allocated share of the 100,000.

CQC - 30th April 2009 HC - 25th February 2009 HC - 18th June 2008


Profile 213 425 738 850

Actual 44 210 562


EC06: Deliver 7,500 new cases of psychosis served by early intervention teams per year


EC06: Deliver 7,500 new cases of psychosis served by early intervention teams per year 30 Sep 2009

28 Oct 2009

Owner Vicky Dutchburn



For year 2 (Financial Year(FY) 08/09), the trajectory identifies total case load of 128, with 96 new cases – a higher delivery rate than the required 64, Full Year Investment into Southwest Yorkshire Mental Health Trust (SWYMHT)has ensured that this is achievable. The balance of the trajectory of 191 will be achieved in year 3 of the commissioning plan (FY 09/10), with a guaranteed delivery date by December 2010, though SWYMHT are working to an anticipated delivery date of End September 2010.

Current Concerns:

Quarter 2 year to date positon: New Early Intervention (EI) cases of psychosis served by EI teams = 78 Total EI patients being treated by EI teams (All patients receiving EI treatment at a point in time (All patients being treated will normally be engaged with services over three years)) = 146


Increased promotion of the service, including inclusion criteria is ongoing within the Kirklees community, across health, social care & other professionals, including police & schools etc AcFinancial penalty for under performance of this performance has been incorporated within the 09/10 contract



Number of people with newly diagnosed cases of first episode psychosis receiving early intervention in psychosis services

Qtr 2 09/10 30 Sep 2009 48 78 30 Not Set

Percentage of people with newly diagnosed cases of first episode psychosis receiving early intervention in psychosis services

Qtr 2 09/10 30 Sep 2009 78 on line to achieve year end target

Percentage of people with newly diagnosed cases of first episode psychosis receiving early intervention in psychosis services

Qtr 2 09/10 30 Sep 2009 81.25 Not Set

Community Mental Health Activities Collection (financial year 2009/10) Care Quality Commission special data collection (financial year 2009/10)

This is the planned number of cases to be taken on by early intervention teams for treatment and support between 1st April 2009 and 31st March 2010. Planned numbers of patients who are to be monitored for a limited period as suspected cases should be excluded.

Psychosis is a debilitating illness with far-reaching implications for the individual and his/her family. It can affect all aspects of life - education and employment, relationships and social functioning, physical and mental wellbeing. Without support and adequate care, psychosis can place a heavy burden on carers, family and society at large. The mean age of onset of psychotic symptoms is 22 with the vast majority of first episodes occurring between the ages of 14 and 35. The onset of this disease is therefore often during a critical period in a person’s development. Early treatment is crucial because the first few years of psychosis carry the highest risk of serious physical, social and legal harm. One in ten people with psychosis commits suicide - two thirds of these deaths occur within the first five years of illness. Intervening early in the course of the disease can prevent initial problems and improve long-term outcomes. If treatment is given early in the course of the

illness and services are in place to ensure long-term concordance (co-operation with treatment), the prospect for recovery is improved. There is evidence that early intervention can be helpful in reducing suicidal behaviour. Early intervention in psychosis services provide quick diagnosis of the first onset of a psychotic disorder and appropriate treatment including intensive support in the early years. A fully operational early intervention service typically serves a total of 450 people, but the caseload builds up over a 3-year period. (The service covers a population of 1 million, in that population there would be expected to be 150 new cases per year, and each person who is taken on by an early intervention service will remain on the books for 3 years.) As set out in the 2008/2009 NHS Operating Framework, each PCT is required to continue to deliver its locally agreed share of the 7,500 people to be taken on as new cases by early intervention services throughout England.

CQC - 30th April 2009 HC - 25th February 2009 HC - 18th June 2008

Qtr 1 2009/10

Qtr 2 2009/10

Qtr 3 2009/10

Qtr 4 2009/10

Actual 41 78

Profile 24 48 72 96


EC07: Data quality on ethnic group


EC07: Data quality on ethnic group

31 Oct 2009

21 Dec 2009

Owner Helen Bridges

Sponsor Peter Flynn


MENTAL HEALTH Data Quality Mental Health ethnicity data completeness continues to exceed the locally agreed stretch target. Benchmarking data taken from the Data Quality Dashboard also reveals performance of our main mental health provider SWYFT to be above the national average. ACUTE Data Quality Acute provider ethnicity data completeness continues to exceed the locally agreed stretch target.Benchmarking data taken from the Data Quality Dashboard (latest benchmarking available is as at September 09) allows us to review the performance of our two main acute providers CHFT and MYHT. CHFT is reported as having data completeness at 99.7%, which is excellent and MYHT is reporting data completeness at 94.6% ,against the national average of 97.9%.

Current Concerns: There are no current concerns. The below average MYHT performance has already been raised through the contracting route and a detailed recovery plan is in place at the Trust.


Latest YTD


(YTD) Percentage of care spells for inpatients (bed days greater than 0) recorded for the PCT (commissioner basis) on Mental Health Minimum Data Set (MHMDS) with valid 2001 census coding for ethnic category (excluding 'not stated' and 'not known').

Oct 09 31 Oct 2009

90 94.44 4.44 Only October data is available

as at 1st December 2009. As at October, the Q2 position is 94.44% which exceeds locally agreed stretch targets.

(YTD) Percentage of Finished Consultant Episodes (FCEs) for the PCT (commissioner basis) on Hospital Episode Statistics (HES) data with valid 2001 census coding for ethnic category (excluding 'not stated' and 'not known').

Oct 09 31 Oct 2009

90 97.01 7.01 As at October 2009, the Q3

position is 97.01% which exceeds locally agreed stretch targets. For our two main providers, CHFT is performing at 97.56% and MYHT at 95.47%. There are no concerns against either of these providers.

[Annual Health Check Indicator] Percentage of care spells for inpatients (bed days greater than 0) recorded for the PCT (commissioner basis) on Mental Health Minimum Data Set (MHMDS) with valid 2001 census coding for ethnic category (excluding 'not stated' and 'not known').

Aug 09 31 Aug 2009

85 93.61 8.61 As at August 2009, the

cumulative performance for mental health ethnicity coding is 93.61%

[Annual Health Check Indicator] Percentage of Finished Consultant Episodes (FCEs) for the PCT (commissioner basis) on Hospital Episode Statistics (HES) data with valid 2001 census coding for ethnic category (excluding 'not stated' and 'not known').

Oct 09 31 Oct 2009

85 96.38 12.01 As at October 2009, the

cumulative performance for acute ethnicity coding is 97.01%.

Hospital Episodes Statistics (April to December 2009) Mental health minimum data set (financial year 2009/10 (quarters 1 to 2))

HES data for the indicator will be sourced from Secondary Uses Service (SUS). We intend to use HES statutory obligation to promote greater equality and to prevent direct and indirect discrimination. In addition CQC – 6th October 2009 CQC - 30th April 2009 HC - 25th February 2009 HC - 18th June 2008


EC08: Delayed transfers of care to be maintained at a minimal level [NI131]


EC08: Delayed transfers of care to be maintained at a minimal level [NI131]

31 Oct 2009

03 Dec 2009

Owner Paul Howatson

Sponsor Sheila Dilks


Delayed discharges are being closely monitored to ensure that systems and processes are regularly reviewed to effect the timely discharge of all patients, as appropriate. To ensure consistency and accuracy of the data streams for the delayed discharge indicators, regular meetings have been established between colleagues from the two acute trusts and the local mental health trust with lead commissioners from NHS Kirklees.


Latest YTD


1. Number of patients (acute and non-acute, aged 18 and over) whose transfer of care was delayed (Month Average)

Oct 09 31 Oct 2009

0 10 10 Not Set

2. Percentage of patients (acute and non-acute, aged 18 and over) whose transfer of care was delayed (monthly Average)

Oct 09 31 Oct 2009

0 Not Set

3. The number of patients (acute and non-acute, aged 18 and over) whose transfer of care was delayed, averaged across quarter one to quarter four. (numerator) (Quarterly)

Qtr 2 09/10 30 Sep 2009

10 Not Set

GP registered populations (2009) Vital Signs monitoring return (financial year 2009/10 (quarters 1 to 4))

The numerator uses Vital Signs Monitoring Return data for the full financial year 2009/10, provided by the Department of Health. The denominator uses the Information Centre's 2009 GP registered populations for primary care trusts, reconciled to the Office for National Statistics 2008 mid-year population estimates.

This indicator measures the impact of community-based care in facilitating timely discharge from hospital and the mechanisms in place within the hospital to facilitate timely discharge. People should receive the right care in the right place at the right time and primary care trusts must ensure, with acute trusts and social services partners, that people move on from the acute environment once they are safe to transfer. The Community Care (Delayed Discharges, etc) Act 2003 facilitates joint working with social services and requires partners to identify the causes of delay, and implement the actions required to tackle delays within their local system. Although this is an all adult indicator the vast majority of those delayed are patients aged over 75 years. The 2008/2009 NHS Operating Framework reiterates that this target should continue to be maintained.

CQC - 30th April 2009 HC - 26th March 2009 HC - 18th June 2008


EC09: 100 percent of people with diabetes to be offered screening for the early detection (and treatment if needed) of diabetic retinopathy


EC09: 100 percent of people with diabetes to be offered screening for the early detection (and treatment if needed) of diabetic retinopathy

31 Oct 2009

09 Nov 2009

Owner James Williams



Latest YTD


AHC The percentage of patients with diabetes identified by practices in the PCT who were offered screening.

AHC 2008/09 31 Mar 2009

95 95.9 0.9 The Annual Health Check in

2008/09 uses the number offered screening for diabetic retinopathy for Q4 and divides in by Q3

The number of people with diabetes offered screening for the early detection (and treatment if needed) of diabetic retinopathy

Sep 09 30 Sep 2009

100 100 0 Not Set

The percentage of patients with diabetes identified by practices in the PCT who were offered screening

Sep 09 30 Sep 2009

100 100 0 The total number of people

with diabetes minus the number of exclusions / the number offered screening. (18541-683)/ 17858 = 100%

Vital Signs returns (financial year 2009/10 (quarters 1 to 4))

Validation criteria A record of clearly documented reasons for each patient excluded needs to be kept by each screening programme, recorded in the screening management software. If patients are excluded because they are already under Ophthalmology care, a record of a retinal examination in ophthalmology, with an NSC grading level of diabetic retinopathy, should be kept for each patient, recorded in the screening management software. All of the following validation rules will be applied to quarter 3 and quarter 4 data submissions. 1. Total number of people with diabetes in the past 12 months must be > = (more than or equal to) Number of people offered diabetic retinopathy screening in the past 12 months. 2. Number of exclusions in the past 12 months must be > (more than) 0 (Zero). 3. Number of exclusions from diabetic retinopathy screening must be < = (less than or equal to)15%. Services should be aware that failure of at least one of the three rules will result in a validation of 'data not returned' on the indicator, which equates to a 'fail' overall. Link to 'Further details on data quality and timelines'

National Standards, Local Action (Department of Health, 2004) stated that by March 2006 a minimum of 80% of people with diabetes should have been offered screening for the early detection (and treatment if needed) of diabetic retinopathy over the preceding 12 months as part of a systematic

programme that meets national standards, rising to 100% coverage of those at risk of retinopathy by December 2007. The operating framework for the NHS in England 2009/10 continues to retain the target to ensure delivery of the existing commitment, so that all eligible people with diabetes are offered screening for early detection (and treatment if necessary) of diabetic retinopathy. Where PCTs are failing to deliver this standard, they should agree recovery plans with their SHAs to ensure improvement. Additional Information Screening must be to national standards. The screening test must be digital photography. For further details on the national standards and what can be counted towards the diabetic retinopathy screening target, please follow the link to: http://www.retinalscreening.nhs.uk/standards. There are some people who will choose to opt out of screening or will not benefit from the offer of screening. Detailed information on whether or not individuals properly fall within the groups of people who can legitimately be excluded from the screening programme can be found in the document "Excluding patients from the NHS diabetic retinopathy screening programme temporarily or permanently" available on the website: http://www.retinalscreening.nhs.uk/exclusions. This year data validation rules will apply as stated below.

CQC – 30th October 2009 CQC - 30th April 2009 HC - 14th January 2009 HC - 18th June 2008


EC10: A maximum wait of 26 weeks for in-patients appointments


EC10: A maximum wait of 26 weeks for in-patients appointments 30 Nov 2009

06 Jan 2010

Owner Rachel Carter



The current waiting time guarantee for inpatient treatment is 26-weeks. There was 0 breaches of this target in November 2009, with the cumulative annual total remaining at 1. So far we are not aware of any breaches for December. The PCT breached this limit on 36 occasions in 2008/09. May 2009: 1 breach (Neuro, LTHT)



Number of inpatients waiting 26 weeks or more at the date of measurement (Year To Date)

Nov 09 30 Nov 2009 0 1 -1 Cumulative total = 1

Percentage of inpatients patients waiting 26 weeks or more for an elective (inpatient ordinary or daycase) admission at the date of measurement.

Nov 09 30 Nov 2009 0.03 0 0.03 Not Set

Monthly activity return (financial year 2009/10) Monthly monitoring return (financial year 2009/10)

The numerator applies to patients for whom English PCTs are responsible and awaiting NHS-funded treatment at providers in England. This description applies to provider and commissioner indicators. In DH central returns, providers are required to report upon all patients waiting. For performance assessment purposes, providers should then separately identify any patients for whom no English commissioner is responsible. For performance assessment purposes commissioners should separately identify patients waiting to be seen by a provider in Wales.

Public consultation prior to the production of the NHS Plan indicated that the public wanted to see reduced waiting times in the NHS. The NHS Plan (July 2000) set out the goal that from December 2005 the maximum wait for inpatient treatment is 26 weeks. Urgent cases would continue to be treated in accordance with clinical need. The maintenance of the 18-week referral to treatment target has subsequently become the most important waiting time priority for the NHS, however, this indicator remains as an existing commitment to be maintained as set out in the 2009/10 NHS Operating Framework.

CQC -30th April 2009 HC - 18th June 2008


Actual 0 1 1 1 1 1 1 1

Profile 0 0 0 0 0 0 0 0 0 0 0 0


EC11: A maximum wait of 13 weeks for an outpatient appointment


EC11: A maximum wait of 13 weeks for an outpatient appointment 30 Nov 2009 06 Jan 2010

Owner Rachel Carter



There were no 13 week breaches for the PCT in April, May, June July, August, September, October or November 2009 and current expectations are for none in December. There were a total of 18 breaches in 2008/09.



Numbers of outpatients waiting 13 weeks or more at the date of measurement (Year To Date)

Nov 09 30 Nov 2009 0 0 0 Not Set

Percentage of patients waiting 13 weeks or more for a first outpatient appointment following a GP written referral at the date of measurement

Nov 09 30 Nov 2009 0.03 0 0.03 Not Set

Monthly activity return (financial year 2009/10) Monthly monitoring return (financial year 2009/10)

The numerator applies to patients for whom English PCTs are responsible and awaiting NHS-funded treatment at providers in England. This description applies to provider and commissioner indicators. In DH central returns commissioners are required to report upon all patients waiting for whom they are responsible. For performance assessment purposes commissioners should separately identify patients waiting to be seen by a provider in Wales.

Public consultation prior to the production of the NHS Plan indicated that the public wanted to see reduced waiting times in the NHS. The NHS Plan (July 2000) sets out the goal that from December 2005 the maximum wait for an outpatient appointment is 13 weeks. Urgent cases would continue to be treated in accordance with clinical need. The implementation of the 18-week referral to treatment target has subsequently become the most important waiting time priority for the NHS, however this indicator remains as an existing commitment to be maintained as set out in the 2009/10 NHS Operating Framework.



Actual 0 0 0 0 0 0 0 0

Profile 0 0 0 0 0 0 0 0 0 0 0 0


EC12: Three month maximum wait for revascularisation


EC12: Three month maximum wait for revascularisation 31 Oct 2009

02 Nov 2009

Owner Alison Bragg



Target achieved as at September 2009 reporting.

Current Concerns:

Patients requiring this treatment should have the procedure performed within 13 weeks. The PCT has one patient who is waiting 11 to 12 weeks for which a status report has been requested. This procedure falls within the specialist services definition and the local teritary provider has expressed concerns regarding capacity to deliver this service within the waiting time.


This has been raised with the lead PCT so a status report can be gained on the patients surgery date. These waiting times will be monitored and issues will be raised through the contracting meeting. The specialist service group are aware that capacity issues will need to be addressed going forward. Other providers are being explored.


Latest YTD


Number of patients waiting greater than 13 weeks for CABGs

Sep 09 30 Sep 2009

0 Not Set

Number of patients waiting greater than 13 weeks for PTCAs?

Sep 09 30 Sep 2009

0 Not Set

Percentage of patients waiting less than 13 weeks for PTCAs or CABGs

Sep 09 30 Sep 2009

100 Not Set

Percentage of patients waiting more than 13 weeks. For either a coronary artery bypass graft (CABG (OPCS4 codes K40-46)) or percutaneous transluminal coronary angioplasty (PTCA (OPCS4 codes K49, K50.1 and K75)) .

Sep 09 30 Sep 2009

0.5 0 0.5 Not Set

Percentage of patients who have received either a coronary artery bypass graft (CABG (OPCS4 codes K40-46)) or percutaneous transluminal coronary angioplasty (PTCA (OPCS4 codes K49, K50.1 and K75)) waiting more than 13 weeks.

Sep 09 30 Sep 2009

0 Not Set

Monthly monitoring return (financial year 2009/10)

The National Service Framework for Coronary Heart Disease states that there is good evidence that many people with atheromatous plaques and narrowed coronary arteries can have their symptoms relieved and/or their risks of dying reduced by restoring blood flow through blocked coronary arteries -

revascularisation. The Government existing commitment was to deliver a maximum wait of three months for revascularisation by March 2005, this re-iterated in the 2009/10 NHS Operating Framework as a continuing commitment. Data are now collected in weekly timebands, and hence 13 weeks is now used in this indicator.



EC13: Thrombolysis “call to needle” of at least 68 percent within 60 minutes, where thrombolysis is the preferred local treatment for heart attack


EC13: Thrombolysis “call to needle” of at least 68 percent within 60 minutes, where thrombolysis is the preferred local treatment for heart attack

30 Sep 2009

02 Nov 2009

Owner Alison Bragg



Target has been achieved by acute trusts in Quarter 1. The Quarter 2 report has yet to be received.

Current Concerns:

The number of patients receiving this procedure is very low as thrombolysis is not the first line treatment for patients in West Yorkshire. Patients requiring emergency treatment for heart attack are treated using primary angioplasty at Leeds Teaching Hospital. There is a concern that if the flu pandemic affects the prmary angioplasty service, thrombolysis will become first line treatment once again and therfore local providers will have to be prepared to accommodate local patients. This has been noted at the West Yorkshire Cardiac Network Board.


The West Yorkshire Cardiac Network (WYCN) releases the data to PCTs on a quarterly basis and is discussed at the quarterly WYCN Board meeting. Information on both thrombolysis and primary angioplasty is reported. The Primary Angioplasty subgroup of the Board has been re-established to monitor the service at Leeds Teaching Hospital to ensure performance measures for primary angioplasty are acceptable as well as other outcomes. NHS Kirklees is represented at both the Board and the subgroup.


Latest YTD


Percentage of eligible patients with acute myocardial infarction who received thrombolysis treatment either by injection or by infusion within 60 minutes of calling for professional help

Jun 09 30 Jun 2009

100 Not Set

Myocardial Ischaemia National Audit (financial year 2008/09)

Cardiovascular disease (CVD) is a preventable disease that kills nearly 198,000 people in the UK every year. Approximately half of all deaths from CVD are from coronary heart disease and more than a quarter are from stroke. The Government is committed to reducing the death rate from coronary heart disease and stroke and related diseases in people under 75 by at least 40% (to 83.8 deaths per 100,000 population) by 2010. There are two treatment strategies for heart attacks, thrombolysis and primary angioplasty. To date the majority of patients have been treated using thrombolysis although this is increasingly changing as a result of a wider use of primary angioplasty to treat heart attack patients. Currently, 22% of all eligible patients are treated using primary angioplasty. The key to improving outcomes after heart attack is to re-establish coronary artery flow as quickly as possible and limit damage to the heart muscle. Thrombolysis, or treatment with thrombolytic drugs, helps reverse the effects of a heart attack by lysing blood clots blocking the coronary artery and returning blood supply to the affected part of the heart again. Thrombolytic treatment can be given up

to twelve hours after the onset of the symptoms of a heart attack but it is most effective when given within the first two hours. The CHD National Service Framework sets a standard to administer thrombolysis to all eligible patients within one hour of calling for professional help (60 minute call to needle).

HC -24th October 2008 HC - 18th June 2008


EC14a: 4-hour maximum wait in A&E from arrival to admission, transfer or discharge (Weekly for KPCT)


EC14a: 4-hour maximum wait in A&E from arrival to admission, transfer or discharge (Weekly for KPCT)

10 Jan 2010

12 Jan 2010

Owner Tony Cooke



There is ongoing pressure on both acute trusts in relation to performance. Of particular concern is MYHT, performance continues to fall and this needs to be addressed as an ongoing matter of urgency. Performance overall stands ar 98.19 after a poor christmas week. Dewsbury continues its slump, though Pinders and Ponte are worse. CHFT had a better christmas, though were slightly under target. Nevertheless performance at CHFT is more consistent without peaks and troughs and they should meet the overall 98% target. With MYHT there is an increasing risk that the target will not be met with the running average continuing to fall.

Current Concerns:

Sustaining performance at MYHT & CHFT throughout 2009/10. Issues have been escalated via performance team and SMT to CEO meetings, as concern about pressure from winter issues was justified over christmas


All actions taken are to support and maintain the delivery of the 4 hour standard whilst improving quality of care and the experience for the people of Kirklees. For MYHT there is a full and comprehensive actions plan we has been ratified by external support. We are working on our new out of hours contract and ensuring delivery of service, improved ambulance service delivery and implications of equitable access to maintain and exceed the 4 hour standard. In addition winter plans have been established to mitigate the potential effects of expected seasonal increases in activity. Further action has escalated the problem to CEO meetings and it is hoped that performance will meet targets in December after dips in the trajectory for the last couple of months.


Latest YTD


Year to Date Percentage of patients spending four hours or less in all types of A&E department - CHfT

10 Jan 10 10 Jan 2010

98 98.15 0.15 Not Set

Year to Date Percentage of patients spending four hours or less in all types of A&E department - MYHT

10 Jan 10 10 Jan 2010

98 98.1 0.1 Not Set

Year to Date percentage of patients spending four hours or less in all types of A&E department - NHS Kirklees

10 Jan 10 10 Jan 2010

98 98.31 0.31 Not Set

Year to Date Percentage of patients spending four hours or less in all types of A&E department - Walk In Centre

10 Jan 10 10 Jan 2010

98 100 2 Not Set


NPI01a: Percentage of patients seen within 18 weeks for admitted and non-admitted pathways (Weekly Unvalidated Data) (VSA04)


NPI01a: Percentage of patients seen within 18 weeks for admitted and non-admitted pathways (Weekly Unvalidated Data) (VSA04)

13 Dec 2009

18 Dec 2009

Owner Tony Cooke



Performance remains strong overall on 18 weeks, above target for CHFT and MYHT. The un-validated weekly October 2009 data (most recent un-validated data) position shows on average 95.4% Admitted patients treated within 18 weeks and 98.5% Non admitted treated within 18 weeks. Targets 90 and 95% respectively, so performance overall remains strong for MYHT and CHFT. Leeds is now (just) on target as well. This demonstrates a sustained position, with slight fluctuations week on week which will be closely monitored. Acute Trusts report that they are optimistic that they will achieve the standard throughout 2009/10. Not withstanding this there will be challenges in maintaining the 18 week standard.

Current Concerns:

For 2009/10 18 week performance will be measured by speciality level as well as an aggregated position for a trust. All specialties must achieve an 18 week standard by the final quarter of 2009/10. There remain two specialties that are not performing to target, though dermatology is now on track. These remain neurosurgery and also cardiothoracic. We are discussing internally freeing up some capacity to enable Sue Richardson to provide added support on this and ensure action in relation to specialties is co-ordinated.


Calderdale and Huddersfield Foundation Trust: Divisions have produce action plans to reduce risk, these are being monitored by the PCT on a weekly basis. The PCT continues to meet with the Trust on a weekly basis to support and monitor progress. Mid Yorkshire Hospitals Trust: Delivery on 18 weeks has two main components, ensuring that patients waiting over 18 weeks are treated over and above the activity that is required to maintain activity and not create further long waits. Both of these aspects are being monitored closely. Further modeling work and intensive support has been implemented for particular pressured specialties particularly Orthopaedics. An Orthopaedic action plan is currently being progressed.


Latest YTD


Percentage of eligible (*) admitted patients whose adjusted RTT clock stopped during the month who waited 18 weeks or less (<127 days)

13 Dec 09 13 Dec 2009

90 95.94 5.94 Not Set

Percentage of eligible (*) non-admitted patients whose RTT clock stopped during the month who waited 18 weeks or less (<127 days)

13 Dec 09 13 Dec 2009

95 98.02 3.02 Not Set

The NHS improvement plan (June 2004) set out the requirement that, by December 2008, there would be a maximum acceptable waiting time of 18 weeks from referral to start of hospital treatment. Providing fast, convenient access will reduce pain and anxiety for patients and ensure that waiting times for treatment are no longer the major issue for patients and the public. In 2008/2009 trusts will be expected to have achieved, by December 2008, a maximum waiting time of 18 weeks from referral to start of treatment for 90 per cent of admitted patients and 95 per cent of non-admitted patients. Trusts will be assessed on having maintained this performance during the final quarter of the year (January to March 2009). Trusts will also be expected to maintain high levels of data completeness.

HC - 24th July 2008

The NHS Improvement Plan and subsequent PSA targets set out that, by December 2008, no one waits more than 18 weeks from GP referral to the start of hospital treatment or other clinically appropriate outcome (for clinically appropriate patients who choose to start their treatment within 18 weeks). Reduction of diagnostic waiting times is central to delivering the 18 week pathway. “No local health system will be credible in claiming success on 18 weeks if it does not make excellent progress in tackling long waiting times affecting large numbers of its local population, including those waits that are technically outside the target.” Extract from the national audiology framework document “Improving Access to Audiology Services in England”, which is available at www.18weeks.nhs.uk.

National referral to treatment time data collection (January to March 2009)


NPI03: Primary dental services, based on assessments of local needs and with the objective of ensuring year-on-year improvements in the numbers of patients accessing NHS dental services (VSB18)


NPI03: Primary dental services, based on assessments of local needs and with the objective of ensuring year-on-year improvements in the numbers of patients accessing NHS dental services (VSB18)

30 Sep 2009

31 Dec 2009

Owner Clare Priestley



The waiting list now stands at approximately 1500 patients most of which are either asking for a specific practice not accepting NHS patients or refuse to travel a short distance to receive routine care. A proposal to change the way the PCT handle allocating patients to practices has been discussed and agreed in principle, however this needs to be taken through a formal process in the PCT. End of Year review information became available to the PCT in late July 2009 and this is currently being taken forward to address underachieved activity with a view to recovering overpayments and UDAs. The practices who are within the 4% tolerance will be expected to achieve any underperformance in 2009/10 or risk a reduction in contract value and UDA level, particularly if they have underachieved in previous years. Additional support has been identified to manage the 62 dental contracts in the PCT and this will enable a more robust approach to contract management.

Current Concerns:

Although it was anticipated that a newly developed purpose built dental practice would be created to support the access problems in the area of Dewsbury/Batley, due to the current PCT financial restrictions we have reviewed the need for this procurement. The PCT is confident that with robust contract management and a revised approach to waiting list management the PCT can meet the Mar 2011 target. The trajectory which we submitted to the SHA will need to be revised to reflect this change.


Latest YTD


Number of patient receiving NHS primary dental services located within the PCT area within a 24 month period

Qtr 2 09/10 30 Sep 2009

252803 253611 808 Not Set

According to guidelines issued by the National Institute for Clinical Excellence (NICE, 2004), the recommended longest period a patient over the age of 18 should go without an oral review is 2 years. However, many patients experience difficulty in accessing a NHS dentist, and recent figures show

that during the 24 months leading up to 31 March 2008, only 53.3% of the total population of England were seen by an NHS dentist (NHS Dental Statistics England, 2007/2008, published by the Information Centre). Of the remaining population, some patients will opt to receive private treatment, a proportion of which, in itself, is likely to be a direct result of difficulty accessing an NHS dentist. A recent survey commissioned by the Citizens Advice Bureau estimated that approximately 7.4m people in England and Wales say they would like to access NHS dentistry, but cannot. Of these, 2.7m say they are not able to access a dentist at all. Consultations by two SHAs have shown that the public consider this to be a major problem for the NHS to resolve. The Government has responded to this issue of access by increasing funding for NHS dentistry in England from April 2008, by 11 per cent, as part of the comprehensive spending review. The NHS 'Vital Signs' framework contains an indicator in the second tier (national priorities for local delivery) to measure improvements in access to primary dental care. PCTs will therefore be assessed on their performance in terms of access to NHS dental services using data compiled centrally by the Dental Services Division of the NHS Business Authority and the NHS Information Centre. PCTs will be expected to demonstrate improvement in 24-month access to a NHS dentist against a baseline of the two year period ending 31 March 2006, when the new dental contract system was introduced.

HC - 15th December 2008 HC - 18th June 2008

Measure is designed to focus benefits from new local commissioning strategy for NHS dentistry and increased funding over the planning period on tangible improvements in patient access. This improvement should be achievable through both more effective commissioning and management of contracts, and investment of extra resources included in PCT primary dental service allocations.

NHS Dental Statistics, England, financial year 2008/2009


NPI05a: A two-week maximum wait from urgent GP referral to first outpatient appointment for all urgent suspected cancer referrals


NPI05a: A two-week maximum wait from urgent GP referral to first outpatient appointment for all urgent suspected cancer referrals

31 Oct 2009 12 Jan 2010

Owner Loraine Turner



October 2009 Performance is 91.38% against a national operational target of 93%. Year to date we are 92%

Current Concerns:

Whilst we still need to achieve target of 93% unvalidated data for November demonstrates a rise to 96.65%


Since August 2009 MYHT have the support of a performance manager from the SHA who is tasked with ensuring the relevant information is made available to NHS Kirklees. We are assured detailed data will be available from November onwards. We have asurance that improved booking systems bringing appointments forward rather than delaying the appointment to a future date are now in place where patients are unable to attend. CHFT already use this system. Working in partnership with CHFT and MYHT we continue to share information and take a joint approach to resolving breaches. Case reviews, patterns and trends are being addressed together.



Percentage of patients first seen by a specialist within two weeks (14 days) when urgently referred by their GP or dentist with suspected cancer

Oct 09 31 Oct 2009 93 92.11 -1 Not Set

Cancer waits database (financial year 2009/10)

Performance will be calculated based on the managed population of the PCT, using the NHS number to link patients to their PCT. Patients who cannot be linked to a PCT are excluded from the indicator. This indicator includes all urgent referrals whether received within 24 hours or not, and whether or not referred using Choose and Book. The data quality for PCTs as commissioners of services will be assessed.

The NHS Cancer Plan set the ultimate goal that by 2008 no patient should wait longer than one month from an urgent referral for suspected cancer to the beginning of treatment except for good clinical reasons. A series of staged milestones and targets were set out between 2000 and 2005 including "a maximum two week wait from an urgent GP referral for suspected cancer to date first seen for

The publication of the Cancer Reform Strategy, in December 2007, set new, more ambitious standards for the NHS. Specifically for the two week wait, all referrals with breast symptoms, regardless of whether cancer is suspected, will be subject to a maximum two week wait, with full implementation expected by the end of December 2009. Within its scored assessments, the Care Quality Commission will retain its requirement for trusts to maintain the existing commitment on urgent referral to first outpatient appointment. PCTs will be assessed as commissioners.

CQC - 10th June 2009 HC - 24th October 2008


Actual 92.9 92 91.82 92.53 92.56 90.19 92.11

Profile 93 93 93 93 93 93 93 93 93 93 93 93


NPI05b: Proportion of patients with breast symptoms referred to a specialist who are seen within two weeks of referral (VSA08)


NPI05b: Proportion of patients with breast symptoms referred to a specialist who are seen within two weeks of referral (VSA08)

31 Oct 2009

12 Jan 2010




Current performance for October 2009 is showing as 33.57% Unvalidated data for November demonstrates 37.75% - CHFT 47.4% and MYHT 28.1%. Partial unvalidated data for December demonstrates 69.4% - CHFT 81.8% and MYHT 57%

Current Concerns:

This is currently a shadow target due to go live January 2010. CHFT are currently running at 3 week wait and will be increasing their clinic capacity in late November with the return of one of their breast surgeons. Assurances are given they will reach target in preparation for January 2010. There are concerns that MYHT are not reaching their projected targets and clinic capacity is currently being reviewed in preparation for the target going live.


Assurance has been sought through contract monitoring. A full report was be presented to SMT in October 2009 and the Board in December 2009 with recommendation for escalatation to CEO for action and acknowledgement of the shift in performance through unvalidated data.. CHFT are now providing fully completed data. At CHFT Audits are currently reviewing capacity and demand to determine if the real problem is lack of appointment space or inadequate use of outpatient capacity. Early indications show the latter and this has been resolved with additional clinics created and an additional breast surgeon appointed in December 2009 to reduce backlog and reduce the CWT. MYHT are taking similar action in reviewing their capacity and demand and are carving out appointment slots to accommodate patients within target. CHFT and MYHT continue to give verbal assurance that they will deliver the target as outlined in their remedial action plan. Cancer performance is now an agenda item for each MYHT board

meeting and they have received the improvement plans developed by the operational managers. Whilst this target still appears to be poor performance currently, the waiting time for symptomatic referrals is decreasing and, after the Urgent Suspected Cancer capacity, there is no further carve-out of appointment slots. This means that the continued reduction in waiting time can be managed in a relatively steady trajectory in relation to the waiting times (in weeks) element.


Latest YTD


Percentage of Patients referred for evaluation/investigation of "breast symptoms" by a primary care professional during a period (excluding those referred urgently for suspected breast cancer) who are FIRST SEEN within 14 calendar days (patient cohort to be defined by DSCN)

Oct 09 31 Oct 2009

93 32.98 -59.5 Not Set

Percentage of Patients referred for evaluation/investigation of "breast symptoms" by a primary care professional during a period (excluding those referred urgently for suspected breast cancer) who are FIRST SEEN within 14 calendar days (patient cohort to be defined by DSCN)

Sep 09 30 Sep 2009

93 33.57 -59.43 Not Set

HC - 24th October 2008

Currently cancer waiting times standards do not apply to all treatments or referral routes into acute services, which means that there are often delays for patients who are not identified early by GPs and/or who are awaiting subsequent treatments after they have received their first definitive treatment. This extension to the standard will ensure that more of the patient pathway will be carried out at a faster pace thus providing a better patient experience and improving survival and mortality rates.


NPI06a: A maximum waiting time of one month from diagnosis to treatment for all cancers


NPI06a: A maximum waiting time of one month from diagnosis to treatment for all cancers

31 Oct 2009 12 Jan 2010




In October 2009 we achieved 95.35% against a national target of 96%. Year to date we have achieved 94.24%

Current Concerns: Small numbers of breaches affect this target. Unvalidated data for November demonstrates a rise to 99%



[Annual Health Check Indicator] Percentage of patients receiving their first definitive treatment within one month (31 days) of a decision to treat (as a proxy for diagnosis) for cancer

Oct 09 31 Oct 2009 96 94.41 -1.77 Not Set

Percentage of patients receiving their first definitive treatment within one month (31 days) of a decision to treat (as a proxy for diagnosis) for cancer

Sep 09 30 Sep 2009 96 94.24 -1.76 Not Set


Performance will be calculated based on the managed population of the PCT, using the NHS number to link patients to their PCT. Patients who cannot be linked to a PCT are excluded from the indicator. The data quality for PCTs as commissioners of services will be assessed. Services should be aware that if data are not of sufficient quality they will be penalised. Please note that for subsequent treatments this assessment will cover all treatment modalities including radiotherapy.

The NHS Cancer Plan sets the ultimate goal that no patient should wait longer than one month (31 days) from diagnosis of cancer to the beginning of treatment, except for good clinical reasons. The publication of the Cancer Reform Strategy, in December 2007, set new, more ambitious standards for the NHS. Specifically for the one month wait, the standard will be widened to cover all cancer treatments, including second or third treatments and treatment for recurrence of cancer, with achievement of this for all patients receiving surgery or drug treatment required by December 2008. The financial year 2008/09 will be a year during which trusts will be required to update systems and ensure capacity is available to meet the new standard, maintain existing commitments throughout the year and achieve the new standard for patients receiving surgery or drug treatment in the fourth quarter of the year. PCTs will be assessed as commissioners

CQC - 10th June 2009 HC - 26th March 2009 HC - 24th October 2008


Actual 98.3 96.5 96.7 97.38 97.47 94.24

Profile 96 96 96 96 96 96 96 96 96 96 96 96


NPI06b: Proportion of patients waiting no more than 31 days for second or subsequent cancer treatment (surgery and drug treatments) (VSA11)


NPI06b: Proportion of patients waiting no more than 31 days for second or subsequent cancer treatment (surgery and drug treatments) (VSA11)

31 Oct 2009 12 Jan 2010




We have achieved Year to Date 95.16% for Surgery against a target of 94%. We have achieved Year to Date 100% for Drug Treatments against a target of 98%.

Current Concerns: This target is affected by small numbers.



Percentage of patients receiving subsequent/adjuvant treatment within a maximum waiting time of 31-days during a given period, including patients with recurrent cancer (Drug Treatments)

Oct 09 31 Oct 2009 98 100 2 Not Set

Percentage of patients receiving subsequent/adjuvant treatment within a maximum waiting time of 31-days during a given period, including patients with recurrent cancer (Drug Treatments)

Oct 09 31 Oct 2009 98 100 2 Not Set

Percentage of patients receiving subsequent/adjuvant treatment within a maximum waiting time of 31-days during a given period, including patients with recurrent cancer (Surgery)

Oct 09 31 Oct 2009 94 96.55 1.17 Not Set

The NHS Cancer Plan set the ultimate goal that no patient should wait longer than one month (31 days) from diagnosis of cancer to the beginning of treatment, except for good clinical reasons. The publication of the Cancer Reform Strategy, in December 2007, set new, more ambitious standards for the NHS. Specifically for the one month wait, the standard was widened to cover all cancer treatments, including second and subsequent treatments and treatment for recurrence of cancer, with achievement of this for all patients receiving surgery or drug treatment required by December 2008. The expansion of the standard to incorporate radiotherapy treatment is required to be achieved by December 2010, and therefore during 2009/2010 trusts will need to continue to work to ensure that capacity is in place to achieve this. PCTs will be assessed as commissioners.

CQC - 10th June 2009 HC - 26th March 2009 HC - 24th October 2008 HC - 18th June 2008

Currently cancer waiting times standards do not apply to all treatments or referral routes into acute services, which means that there are often delays for patients who are not identified early by GPs and/or who are awaiting subsequent treatments after they have received their first definitive treatment. This extension to the standard will ensure that more of the patient pathway will be carried out at a faster pace thus providing a better patient experience and improving survival and mortality rates



Actual 100 100 100 100 100 100 100

Profile 98 98 98 98 98 98 98 98 98 98 98 98


Actual 100 95.12 98.46 95.96 94.66 100 96.55

Profile 94 94 94 94 94 94 94 94 94 94 94 94


NPI06c: Proportion of patients waiting no more than 31 days for second or subsequent cancer treatment (radiotherapy treatments) (VSA12)


NPI06c: Proportion of patients waiting no more than 31 days for second or subsequent cancer treatment (radiotherapy treatments) (VSA12)

30 Sep 2009

12 Jan 2010




In October 2009 we achieved 84.62% against a new target of 94%. Year to date we achieved 80.33% against a 94% national standard target

Current Concerns: This is currently a shadow indicator target and consequently work is progressing towards achieving the national standard.



Percentage of patients receiving subsequent/adjuvant radiotherapy treatment within a maximum waiting time of 31-days during a given period, including patients with recurrent cancer

Sep 09 30 Sep 2009 94 84.72 -9.33 Not Set

Percentage of patients receiving subsequent/adjuvant radiotherapy treatment within a maximum waiting time of 31-days during a given period, including patients with recurrent cancer

Sep 09 30 Sep 2009 94 84.62 -9.38 Not Set

The NHS Cancer Plan sets the ultimate goal that no patient should wait longer than one month (31 days) from diagnosis of cancer to the beginning of treatment, except for good clinical reasons. The publication of the Cancer Reform Strategy, in December 2007, set new, more ambitious standards for the NHS. Specifically for the one month wait, the standard will be widened to cover all cancer treatments, including second or third treatments and treatment for recurrence of cancer, with achievement of this for all patients receiving surgery or drug treatment required by December 2008. The financial year 2008/09 will be a year during which trusts will be required to update systems and ensure capacity is available to meet the new standard, maintain existing commitments throughout the year and achieve the new standard for patients receiving surgery or drug treatment in the fourth quarter of the year. PCTs will be assessed as commissioners

HC - 24th October 2008 HC - 18th June 2008




Actual 69.57 75 79.61 83.42 83.84 84.72

Profile 94 94 94 94 94 94 94 94 94 94 94 94


NPI07a: A maximum waiting time of two months from urgent referral to treatment for all cancers


NPI07a: A maximum waiting time of two months from urgent referral to treatment for all cancers

31 Oct 2009 12 Jan 2010




In October 2009 we achieved 74.47% against a national target of 85%. Year to date position is 82.25%

Current Concerns:

Unvalidated data for Novemner 2009 demonstrates a rise to 83.25% against a target of 85%


In September/October MYHT performance was escalated through the senior management team as a serious risk and raised through contract monitoring in order to monitor and action breaches with full knowledge of the reasons and the appropriate action required. MYHT are now responding to this challenge with improved data analysis, systems and processes. MYHT have provided some assurance by way of reviewing their systems, performance and tracking of breaches. The SHA are supporting MYHT with a senior performance manager 1 day a week. Cancer services are to be managed by the Chief Operating Officers directorate and an experienced lead cancer manager has been brought in for 2 days a week to provide clear guidance and support the delivery of improved cancer services. The recruitment process to replace the Lead cancer manager/nurse is underway.



Percentage of patients receiving their first definitive treatment for cancer within two months (62 days) of GP or dentist urgent referral for suspected cancer

Oct 09 31 Oct 2009 85 82.46 -2.72 Not Set

Percentage of patients receiving their first definitive treatment for cancer within two months (62 days) of GP or dentist urgent referral for suspected cancer

Oct 09 31 Oct 2009 85 82.25 -2.75 Not Set

Cancer waits database (financial year 2009/10))

Performance will be calculated based on the managed population of the PCT, using the NHS number to link patients to their PCT. Patients who cannot be linked to a PCT are excluded from the indicator. Services should be aware that if data are not of sufficient quality they will be penalised. The data quality for PCTs as commissioners of services will be assessed.

The NHS Cancer Plan sets the ultimate goal that no patient should wait longer than two months (62 days) from a GP urgent referral for suspected cancer to the beginning of treatment, except for good clinical reasons. The publication of the Cancer Reform Strategy, in December 2007, set new, more ambitious standards for the NHS. Specifically for the two month wait, the standard will be widened to cover both referrals from the national screening programmes and from consultants where they request that the patient is managed on the two month pathway. The financial year 2008/09 will be a year during which trusts will be required to update systems and ensure capacity is available to meet the new standard, while continuing to meet the existing commitment throughout the year. PCTs will be assessed as commissioners.

CQC - 10th June 2009

HC - 26th March 2009 HC - 24th October 2008


Actual 82.2 84.8 82.1 83.61 83.33 82.25

Profile 85 85 85 85 85 85 85 85 85 85 85 85


NPI07b: Proportion of patients with suspected cancer detected through national screening programmes or by hospital specialists who wait less than 62 days from referral to treatment (VSA13)


NPI07b: Proportion of patients with suspected cancer detected through national screening programmes or by hospital specialists who wait less than 62 days from referral to treatment (VSA13)

31 Oct 2009

12 Jan 2010




We continue to achieve 100% for CRS 62 Day Upgrade Standard (Tumour)for October 2009

Current Concerns: Low patient numbers influence this target and as a consequence it is easy to underachieve against target. There were no breaches in October 2009


Latest YTD


Percentage of patients receiving first definitive treatment for cancer within 62-days of a consultant decision to upgrade their priority status

Oct 09 31 Oct 2009

100 Not Set

Percentage of patients receiving first definitive treatment within 62-days following referral from an NHS Cancer Screening Service during a given period

Aug 09 31 Aug 2009

90 89.01 -0.99 Not Set

Percentage of patients receiving first definitive treatment within 62-days following referral from an NHS Cancer Screening Service during a given period

Oct 09 31 Oct 2009

90 100 10 Not Set

The NHS Cancer Plan set the ultimate goal that no patient should wait longer than two months (62 days) from a GP urgent referral for suspected cancer to the beginning of treatment, except for good clinical reasons. The publication of the Cancer Reform Strategy, in December 2007, set new, more ambitious standards for the NHS. Specifically for the two month wait, the standard was widened to cover both referrals from the national screening programmes and from consultants where they request that the patient is managed on the two month pathway. Both these enhancements to the target were due to be met by December 2008. In 2009/2010 trusts will be assessed on maintaining achievement of the new enhancements while continuing to meet the existing commitment on GP urgent referrals. PCTs will be assessed as commissioners.

CQC - 10th June 2009 HC - 26th March 2009 HC - 24th October 2008 HC - 18th June 2008



NPI09 VSB09: NI55: NI56 Obesity among primary school age children


NPI09 VSB09: NI55: NI56 Obesity among primary school age children

31 Mar 2010

06 Jan 2010

Owner Liz Messenger



The results from the 2008/09 National Child Measurement Programme have been published. Nationally between 2007/08 and 2008/09 there were no significant changes in the prevalence rates for underweight, overweight or obese children for both age groups. In Kirklees levels of childhood obesity are similar to the national picture: • In Kirklees more than one in five (21%) of the reception aged children measured were either overweight or obese. • In year 6 approximately one in three (30%) of the children measured were either overweight or obese. The full data set has been requested from the Y&H Public Health Observatory which will enable additional analysis to be carried out. Planning has started for collection of 09/10 data. Concerns raised regarding the quality of ethnic coding have been addressed with School Nursing Teams and Child Health. Two localities have been identified to pilot routine feedback to parents: • Spen - parents of reception aged children attending schools located in Spen will receive feedback • Huddersfield South - parents of Year 6 pupils attending schools in Huddersfield South will receive feedback

Current Concerns:

We will be implementing routine feedback to parents this academic year; this raises concerns about the capacity of current weight management provision via MEND and Start. The pilot project will enable us to access the demand for services and plan accordingly.


Latest YTD


Percentage of children in Reception with height and weight recorded

Y/E 2008/09 31 Mar 2009

100 Not Set

Percentage of children in Reception with height and weight recorded who are obese.

2009/10 31 Mar 2010

10 9.3 0.7 Not Set

Percentage of children in Year 6 with height and weight recorded

Y/E 2008/09 31 Mar 2009

94 Not Set

Percentage of children in Year 6 with height and weight recorded who are obese.

2009/10 31 Mar 2010

17 16.4 0.6 Not Set

Almost two thirds of adults and a third of children are either overweight or obese (NHS Information Centre, Health Survey for England 2006 Latest Trends, January 2008), and work by the Government Office for Science's Foresight programme suggests that, without clear action, these figures will rise to almost nine in ten adults and two thirds of children by 2050. The impact of being overweight or obese can be severe on an individual's health - both are associated with an increasing risk of diabetes, cancer, and heart disease among others - and the risks get worse the more overweight people become. The pressure such illnesses put on families, the NHS and society more broadly, with overall costs to society forecast to reach £50 billion per year by 2050 on current trends. In October 2007, the Government announced its ambition on obesity, which forms part of the Public Services Agreement (PSA) 12: to improve the health and wellbeing of children and young people. Healthy Weight, Healthy Lives - A Cross Government Strategy for England, published in January 2008, sets out the first steps to meeting the challenge of excess weight in the population, and will be followed with a one-year-on report in Spring 2009.

CQC - 30th April 2009 HC - 14th January 2009 HC - 24th October 2008 HC - 18th June 2008

Childhood obesity is closely linked with early onset of preventable disease, including diabetes. In October 2007, the Government set a new long-term ambition to tackle obesity. Our ambition is to reverse the rising tide of obesity and overweight in the population, by enabling everyone to achieve and maintain a healthy weight. Our initial focus will be on children: By 2020, we aim to reduce the proportion of overweight and obese children to 2000 levels. At a national level, progress towards this aim will be measured with obesity prevalence data from the Health Survey for England. Local progress towards this aim is measured with NCMP obesity prevalence data. PCTs and SHAs should develop robust and effective care pathways to prevent and tackle obesity in children. Additionally, although the focus of the indicator is on obesity, PCTs and SHAs should be aware that future plans will need to encompass overweight as well as obese children, as part of meeting the long-term ambition to ensure that everyone can maintain a healthy weight. SHA plans should reflect the aggregate of local PCT plans. For comparisons to be made between years and between PCTs with sufficient confidence, it is important that a high percentage of children participate to reduce the risk of non-participation bias in the figures.

National Childhood Measurement Programme 2008/09 school year Vital signs plan for 2008/09


NPI10: Prevalence of Chlamydia (VSB13) [NI113]


NPI10: Prevalence of Chlamydia (VSB13) [NI113] 30 Nov 2009 05 Jan 2010




C Card scheme –Training sessions are continuing and the number of venues offering delivering the scheme is 30 LES for sexual health in pharmacies – Programme is continuing with a further 20 pharmacies looking at delivering the service. Brunswick Centre is continuing screening in S Kirklees providing outreach in pubs and clubs and has now been commissioned for North Kirklees. Kirklees Active - Dump Bins have been ordered to begin screening in Kirklees Active leisure centers. CSO are arranging training and screening events with all K.A. Staff. This is ongoing waiting for the arrival of the bins mid January. CSOs are contacting all interested sports venues in order to begin screening. GPs - 46 GP practices signed up to LES. Refresher seminar took place in September – CSO follow up support visits are underway and almost complete. Patient warnings re Chlamydia to appear on GP computer screen – imminent. Card system has been introduced in CASH to support uptake of training. Attending PBC meetings on request by GPs. Schools – Letter has been sent out to all Secondary schools via Healthy Schools Team and requests are being forwarded to CSOs. Discussions taking place with PHSE lead for Kirklees to formalize working between CSO and schools. Drop in at Batley Girls’ High set up; other negotiations underway. Sexual Health Youth Workers – SHWs have met with CSOs and agreed a series of screening events that will take place between Dec 09 and March 10. F.E. – Meeting took place between commissioners, Huddersfield Technical College (Glynn Collins) and Vivien Thompson (CSO coordinator North Kirklees) in order to support the work already taking place in college to increase screening. It was agreed that CSO will support RASH tutorials and provide merchandise for Young people to increase uptake. A number of dates and events have been agreed between Dec 09 and March 10. Commissioners are communicating directly with Provider Service Management in WCHCS in order to improve Performance of screening in North Kirklees.

Current Concerns:

The PCT is not currently meeting the November trajectory of 9349 Screens. The total number of screens performed to date is 5823 (inclusive of those screens obtained direct from the lab) Screening in CaSH is now being given on an opt out basis, however according to their last quarterly report only 57% patients are offered screens of which 37% take up.


The following actions are taking place to obtain the additional screens needed to meet the trajectory of 14,024 screens by March 2010.

Each of the following actions has been updated where appropriate… Sports and Leisure organisations – CSOs to contact all sports organisations that registered an interest in screening. Waiting for order of dump bins to arrive mid January 10 these will be distributed to all Kirklees Active Leisure centers to operate postal screening. Review quality performance report provided by KCHS to improve qualitative reporting. Support NHS Wakefield to get service specification for CSO finalised and work with WDCHS to receive better performance information. Continue to have monthly meetings with each provider to performance manage programmes LES for sexual health in pharmacies, 20 sites will come on stream after CRBs completed. All pharmacies will continue to be offered refresher training via CSOs as soon as they are operational. . Sexual health youth workers and CSOs to provide a number of joint screening events between December 09 and March 10 in order to increase uptake with in the Youth Service. Schools – Engage with Head teachers in order to increase screening across all schools in Kirklees, collate information gathered from Healthy Schools. GPs – All GPs will be asked to create a pop up on their administrative system to remind practitioners to offer Chlamydia screening. Data will be sent out to all practices providing the percentage of target group that have screened and highlighting the numbers needed in order to receive bonus payments



Number of the population aged 15 - 24 screened or tested for chlamydia

Nov 09 30 Nov 2009 9349 5823 -3526 Not Set

Percentage of the population aged 15 - 24 screened or tested for chlamydia

Y/E 08/09 31 Mar 2009 17 6.57 -10.43 Not Set

Chlamydia is the most common sexually transmitted infection (STI) and there is evidence that up to one in 10 young people aged under 25 may be infected. It often has no symptoms, but if left untreated can lead to pelvic inflammatory disease, ectopic pregnancy and infertility. Chlamydia is very easily treated. The national chlamydia screening programme (NCSP) has a community focus and concentrates on opportunistic screening of asymptomatic sexually active men and women under the age of 25 who would not normally access, or be offered a chlamydia test, and focuses on screening in non-traditional sites. The 2009/10 NHS Operating Framework contains an existing commitment to nationally roll out the chlamydia screening programme. In 2009/10, all chlamydia tests undertaken outside of genitourinary medicine clinics (GUM) on 15-24 year olds will count towards calculating screening coverage in residents of each Primary Care Trust (PCT). It is the responsibility of each PCT to ensure that the data submitted reflects the activity within their community.

CQC - 30th April 2009 HC - 24th October 2008 HC - 18th June 2008

The public health White Paper, Choosing Health: Making healthy choices easier, identified sexual health as a new priority area. Unacceptably high levels of sexually transmitted infections, particularly chlamydia, require a step change in the way sexual health services are organised and delivered, building on the recommendations in the Government’s National strategy for sexual health and HIV launched in 2001. The Choosing Health White Paper indicated that the final phase of the rollout of the national chlamydia-screening programme would be achieved by 2007. The more recent health and social care White Paper, Our health, our care, our say, has also highlighted that access to health services needs to be faster. Increases in the demand for sexual health services mean it is no longer sensible or economic to deliver sexual health care only in hospital-based specialist services. To meet the needs and preferences of service users, PCTs should commission a full range of services, which provide different levels of sexual health care in a variety of settings. There is considerable evidence indicating a high prevalence of chlamydia and subsequent disease burden in young people aged under 25, with up to one in ten found to be infected. Approximately 50% men and 70% women with chlamydia do not have any symptoms. If left untreated, genital chlamydial infection can lead to pelvic inflammatory disease, ectopic pregnancy and infertility.

Due to the high proportion of asymptomatic infection, the National Chlamydia Screening Programme (NCSP) offers opportunistic screening for chlamydia, with the aim of detecting asymptomatic infection in sexually active men and women under the age of 25 who would not otherwise access, or be offered a chlamydia test. The NCSP is delivered in community-based settings and focuses on screening in non-traditional sites (youth services, military bases, universities, contraception services, primary care). Since the NCSP started in 2003 over 180,000 screens have been performed with a 10% positivity rate. There has been a steady increase in the number of tests reported each quarter. Additional information on planning and delivery of the NCSP is provided through the Further Information links provided below. National guidance has been provided on the framework for targeting at risk individuals, data collection, access to results, treatment and notification. There is evidence from the United States and Sweden that those areas that achieved high volumes in their screening programmes had the highest reductions in chlamydia prevalence.

Chlamydia screening programme returns (financial year 2009/10) Vital Signs plans (financial year 2009/10)


Actual 706 1283 2011 2737 3616 4494 5187 5823

Profile 1169 2337 3506 4675 5843 7012 8181 9349 10518 11687 12855 14024


NPI11: Effectiveness of Children and Adolescent Mental Health Service (CAMHS) (percentage of PCTs and Local Authorities who are providing a comprehensive CAMHS). (VSB12) [NI51]


NPI11: Effectiveness of Children and Adolescent Mental Health Service (CAMHS) (percentage of PCTs and Local Authorities who are providing a comprehensive CAMHS). (VSB12) [NI51]

31 Dec 2009

07 Jan 2010

Owner Debi Hemingway



Key achievements for this period include a very positive visit from Dame Jo Williams from the CAMHS National Advisory Council who was very impressed with the range of comprehensive CAMH services and innovations being delivered across Kirklees. In November Kirklees also had a visit from the DCSF who were researching NI 50 developments, activities and impacts in the delivery of services to meet the emotional health of children and young people in the district. The report from the DCSF was again impressive for Kirklees and stated, "it has been a great priviledge to discover this area of good practice" Other achievements include the completion of the ADHD service specification and the development of the new service model which has been heavily influenced by service user and carer consultation and active participation by families using the service. A multi-agency steering group has been established, following the mapping excercise, to develop an integrated pathway for children with learning disabilities and mental health problems. Partnership work with Adult Mental Health Services providers and commissioners is progressing towards the development of age appropriate services for 16/17 year olds and by March 2010 this will be rated from a score of 3 to 4

Current Concerns: A full range of CAMH services for children and young people with learning disabilities has not been fully commissioned.


Latest YTD


Are arrangements in place for the council area to ensure that 24 hour cover is available to meet urgent mental health needs of children and young people and for a specialist mental health assessment to be undertaken within 24 hours or the next working day where indicated (rate 1-4)

Qtr 3 09/10 31 Dec 2009

4 4 0 Not Set

Do 16 and 17 year olds from the council area who require mental health services have access to services and accommodation appropriate to their age and level of maturity? (rate 1-4)

Qtr 3 09/10 31 Dec 2009

4 3 -1 Not Set

Has a full range of CAMH services for children and young people with learning disabilities been commissioned for the council area? (rate 1-4)

Qtr 3 09/10 31 Dec 2009

4 2 -2 Not Set

Is a full range of early intervention support services delivered in universal settings and through targeted services for children experiencing mental health problems commissioned by the Local Authority and PCT in partnership? (Indicator in Development (rate 1-4)

Qtr 3 09/10 31 Dec 2009

3 2 -1 Not Set

Mental health problems in children are associated with educational failure, family disruption, disability, offending and antisocial behaviour, placing demands on social services, schools and the youth justice system. Untreated mental health problems create distress not only in the children and young people but also for their families and carers, continuing into adult life and affecting the next generation. The National Service Framework for Children, Young People and Maternity Services set out the standards and milestones for improvement in child and adolescent mental health services, including year on year improvements in access. The 2009/10 NHS Operating Framework and the 2007 Public Service Agreement 'Improve the health and wellbeing of children and young people' describe four proxy measures for a truly comprehensive child and adolescent mental health service: * 24 hour/seven days a week cover to meet the urgent mental health needs of children and young people * a full range of CAMHS for children and young people who also have a learning disability * a full range of CAMHS for 16 and 17 years olds, appropriate to their age and level of maturity * a full range of early intervention support services jointly commissioned by the Local Authority and PCT in partnership


The maintenance of a set of proxy measures for the delivery of comprehensive CAMH service has broad acceptance amongst health commissioners and providers at local and national levels. It is clear, from feedback received from commissioners, and those involved in delivering a support/challenge role (National CAMHS support service for example) of the significant impact that the current PSA service development measure for CAMHS has had on stimulating and promoting the recent improvements in CAMHS (ie services for 16/17 year olds; comprehensive CAMHS for children and young people with learning disabilities and the delivery of 24 hour emergency services.) Without such a focus, there is a substantial risk that recent improvements in services will not be sustained; with services for vulnerable groups such as children with disabilities, and looked after children, where developments have been from such a low starting point in many areas, being most at risk.

Vital Signs Monitoring Returns (financial year 2009/10 (quarter 3 - as at 31 December 2009))


NPI13: Smoking prevalence among people aged 16 or over and, aged 16 or over in routine and manual groups (quit rates locally 2008) (VSB05) [NI123]


NPI13: Smoking prevalence among people aged 16 or over and, aged 16 or over in routine and manual groups (quit rates locally 2008) (VSB05) [NI123]

31 Oct 2009 05 Jan 2010




Kirklees Tobacco alliance is being refreshed; sub groups for WOCBA/pregnancy and Routine & Manual workers have met and developing action plans to meet the cessation needs of these populations. The Smoke Free Homes project(Queens Nursing Institute award funded) has now engaged with 10 families, impacting on 32 children. The project is being communicated to all PCT staff at the celebrating the talent event. A smoking cessation pilot project targeting Routine and Manual workers is moving forward following social marketing insight work. Customer journey maps have been completed, designated Routine and Manual advisors from the specialist service, outside speakers and ex-service users are involved in programme delivery. The groups will begin in January 2010.

Current Concerns: The current position for October is 1364 quitters against a target of 1281. It is anticipated that the target will be met at year end.


Following the publication of the JSNA 6 key target groups have been identified which the tobacco programme will target this year, these are Women of child bearing age; pregnant women; people suffering from a long term condition; routine and manual workers; BME groups and young people. The Stop Smoking Service is working with public health and wider partners to develop action plans to target these six groups as part of the refreshed Kirklees Tobacco Alliance. Kirklees was well represented at a regional conference in September to look at how we move from the 4 week quitter measure to a measure of prevalence. More work is needed to ensure prevelance can be reported for 2011. The LES 2009/10 will include new revised targets for GP practices that not only focus on the size of the practice population but the prevalence of smoking in that area to make sure that we are prioritizing areas of greater need according to annual quitter targets. The monitoring form is also being revised in relation to occupation status to allow for greater accuracy of reporting from the Intermediate network as well as the specialist service



Number of 4-week smoking quitters who attended NHS Stop Smoking Services

Oct 09 31 Oct 2009 1281 1364 83 Not Set

Population aged 16 and over

Qtr 3 09/10 31 Dec 2009 322500 322500 0 Not Set

Smoking is the single greatest cause of preventable illness and premature death in the UK (http://www.dh.gov.uk/en/Publichealth/Healthimprovement/Tobacco/index.htm). The effects on health from smoking have been known for many years and are well documented with 80% of the deaths from lung cancer being related to smoking. There has been a steady decline in the number of people who smoke in England over the last three decades. For smokers who give up, the chances of developing serious conditions or diseases are greatly reduced. This indicator is crucial to securing improvements in public health. There are many approaches to tobacco control and treatments to help people quit smoking are constantly evolving. The NHS Stop Smoking Services are implemented by targeting smokers and supporting them to quit within four weeks. The monitoring of the progress made within this programme provides a proxy for the level of performance on reducing smoking prevalence in the population.


Stop Smoking Services are a key NHS intervention to reduce smoking in all groups, with particular focus on routine and manual groups. They are currently monitored through assessment of 4-week smoking quitters. The NHS Stop Smoking Services are part of a programme of action needed to meet the national target to tackle the underlying determinants of ill health and health inequalities by reducing smoking rates to 21% or less by 2010, with a reduction in prevalence among routine and manual groups to 26% or less. In planning and monitoring delivery, SHAs may wish to consider PCT level plans for targeting smokers in routine and manual groups and the information required to monitor this. As recommended in the NHS Smoking Cessation Guidance 2001-02, longer term success can be measured in local audits, including 52 week follow-up.

Stop smoking services return (financial year 2009/10) Vital Signs plans (financial year 2009/10)


Actual 82 308 652 732 958 1238 1364

Profile 180 360 565 770 950 1130 1281 1432 1583 1822 2042 2267


NPI14: Rates of Clostridium Difficile (Commissioner NHS Kirklees) VSA03a


NPI14: Rates of Clostridium Difficile (Commissioner NHS Kirklees) VSA03a

30 Nov 2009

21 Dec 2009

Owner Jane O'Donnell



Latest YTD


1a. Kirklees - Number of C.Difficile Infections

Nov 09 30 Nov 2009

25 7 18 Not Set

1b. Kirklees - Number of C.Difficile Infections (YTD)

Nov 09 30 Nov 2009

195 100 95 Not Set

2a. CHFT - Number of C.Difficile Infections

Nov 09 30 Nov 2009

13 4 9 Not Set

2b. CHFT - Number of C.Difficile Infections (YTD)

Nov 09 30 Nov 2009

118 74 44 Not Set

3a. MYHT - Number of C.Difficile Infections

Nov 09 30 Nov 2009

20 12 8 Not Set

3b. MYHT - Number of C. Difficile Infections (YTD)

Oct 09 31 Oct 2009

140 85 55 Not Set

Tackling healthcare-associated infections, such as Clostridium difficile (C. difficile), continues to be a key patient safety issue and is a priority for the NHS, as set out in the 2009/10 NHS Operating Framework and the 2007 Public Service Agreement ‘Ensure better care for all'. Mandatory surveillance of C. difficile was introduced in England in January 2004 with all acute and specialist NHS trusts in England required to report all diarrhoeal samples (defined as those that take the shape of their container) from people 65 years of age or older who have not been diagnosed with C. difficile infection (CDI) during the preceding four weeks. Trusts are required to report all positive results, including those received from people in the community. Since 1 April 2007, trusts were required to expand this reporting to include all positive results in patients aged two years and over. The national target (a 30% reduction nationally in 2010/11 compared with the 2007/08 baseline figure) requires effective working across health communities to tackle infections in both healthcare settings and the community. Primary care trusts (PCTs) are therefore expected to work effectively with acute trusts to tackle C. difficile infections. As such, PCTs are expected to set interim targets each year (between 2008/09 and 2010/11) with their strategic health authorities (SHA) to help achieve the national target overall by 2010/11.


Reduction in healthcare associated infection is a priority for the NHS, as set out in the Operating Framework 2009/10 and PSA Delivery Agreement 19. CDI is a significant patient safety issue with over 55,000 cases in 2007/08 in England. Along with other healthcare associated infections, it can cause illness and, in some cases, death. It can be very distressing for patients who acquire an infection, for their family and friends and for staff who treat them. It is also increasingly a key issue for public confidence in the NHS. Reducing CDI will lead to significantly improved patient outcomes as well as cost savings for the NHS. Organisations need to take particular action to ensure progress in reducing CDI at the same time as maintaining performance on MRSA - an infection also of key concern to the public.

Health Protection Agency (financial year 2009/10) Trajectories for C. difficile reduction (financial year 2009/10)


NPI16: Number of drug users recorded as being in effective treatment. (VSB14) [NI40]


NPI16: Number of drug users recorded as being in effective treatment. (VSB14) [NI40]

31 Aug 2009

09 Nov 2009

Owner Tony Cooke



Latest YTD


The number of drug users using crack and/or opiates recorded as being in structured drug treatment in a financial year who were discharged from treatment after 12 weeks or more, or who were discharged from treatment in a care planned way.

Jul 09 31 Jul 2009

1537 1577 40 Not Set

The percentage of drug users using crack and/or opiates recorded as being in structured drug treatment in the financial year who were discharged from treatment after 12 weeks or more, or that remain in treatment for 12 weeks or more, or who were discharged from treatment in a care planned way.

Jul 09 31 Jul 2009

3 90.27 87.27 Not Set

An estimated 3.764 million people in England and Wales use at least one illicit drug each year (British Crime Survey), and around one million people use at least one of the most harmful drugs (such as heroin and cocaine). For most people this will be a passing phase and they will not continue to take drugs or require any special treatment in order to deal with it. The Home Office however estimate that approximately 330,000 people in England experienced a serious drug problem involving crack and/or opiates in 2005/06 (homeoffice.gov.uk/rds/pdfs06/rdsolr1606.pdf (PDF, 55KB, Opens in a new window). Drug use causes a wide range of health and social harms. It causes short and long-term damage to physical and mental health, it affects unborn babies and it exposes drug users to risk of death from overdose and blood borne viruses. Drug use also causes wider public health risks as a result of discarded drug paraphernalia, drug driving and unprotected sex. Drug use also limits the ability to work, to parent and to function effectively in society. It contributes to social exclusion and makes it difficult for people to play full and active roles in society. The government's ten-year drug strategy 2008-2018 (http://drugs.homeoffice.gov.uk/drug-strategy/overview/) aims to restrict the supply of illegal drugs and reduce the harm caused by illicit drug abuse by reducing the demand for them. A major strand of the new National Drug Strategy is the provision of effective and high quality drug treatment. The Drug Strategy recognises that providing effective treatment for drug users not only reduces rates of individual harm (e.g. the spread of blood borne viruses and accidental death through overdose) but also contributes significantly to reducing wider social harms such as rates of acquisitive crime. This aim is also reflected within PSA 25: Reduce the harm caused by alcohol and drugs (hm-treasury.gov.uk/media/B/1/pbr_csr07_psa25.pdf (PDF, 55kb, Opens in a new window).

CQC – 30th October 2009 CQC - 10th June 2009 HC - 14th January 2009 HC - 24th October 2008 HC - 18th June 2008

This indicator will drive a reduction in harm caused by the misuse of those drugs known to case the highest harm to individuals, their families and the communities in which they live. It focuses attention on meeting both the demand for and the effectiveness of drug treatment and reinforces the gains made in the last drug strategy in improving the capacity and the quality of drug treatment. Progress on this indicator will have a wider impact on ill health, crime and social cohesion.

National Drug Treatment Monitoring System (National Treatment Agency) (financial year 2009/10) Vital Signs returns (financial year 2009/10)


NPI17: Percentage of infants breastfed at 6-8 weeks. (VSB11) [NI53]


NPI17: Percentage of infants breastfed at 6-8 weeks. (VSB11) [NI53]

31 Dec 2009

02 Dec 2009

Owner Jayne Heley



Continuing to support GP practices with data collection systems. Actioned a quarterly breakdown and targeted practices accordingly.There has been an improvement in data quality and some practices have made improvements in returning data in a timely way. Action to continue raising awareness of present systems through consistent messages with GP Practices. Actioned an administrator role to contact GP Practices on a regular basis to support practices to return 6-8 week breastfeeding data in a timely and consistent way. Actioned Child Health in North and South to send all practices a letter reminding all GP practices to send in breastfeeding data. Actioned Child Health in North to send out an extra pad of forms enabling GP practices to return data back to Child Health if run out.

Current Concerns:

A minority of practices are still not following the process in both North and South Kirklees. Some GP Practices are returning the forms without a feeding status. This is a data quality concern. Some GP Pracices are not returning any breastfeeding data at all.


Targeting of individual GP Practices on a monthly basis to encourage the practices to use the systems that are being developed and put in place. Some GP Practices are still not returing breastfeeding data because of a lack of awareness and uncertainty around which health professional returns the data back to Child Health.Incomplete forms are being returned to GP practices for further completion.


Latest YTD


Coverage: The number of children with a breastfeeding status recorded as a percentage of all infants due for a 6–8 week check.

Qtr 2 09/10 30 Sep 2009

90 73.21 -16.79 Not Set

Prevalence; The number of infants recorded as being totally breastfed at 6-8 weeks plus the number of children recorded as being partially breastfed (receiving both breast milk and infant formula) at 6–8 weeks as percentage of the number of infants due for a 6–8 week check.

Qtr 2 09/10 30 Sep 2009

44.3 32.62 -11.68 Not Set

The number of children being recorded as not at all breastfed at 6-8 weeks during quarter 4.

Qtr 2 09/10 30 Sep 2009

624 585 -39 Not Set

The number of children recorded as being partially breastfed (receiving both breast milk and infant formula) at 6-8 weeks during quarter 4.

Qtr 2 09/10 30 Sep 2009

241 159 -82 Not Set

The number of infants due for a 6-8 week check during quarter 4.

Qtr 2 09/10 30 Sep 2009

1365 1441 76 Not Set

The number of infants recorded as being totally breastfed at 6-8 weeks during quarter 4.

Qtr 2 09/10 30 Sep 2009

364 311 -53 Not Set

The operating framework 2009/10 highlights breastfeeding a tier 2 national priority, as a key area in keeping adults and children well, improving their health and reducing health inequalities. There is clear evidence that breastfeeding has positive health benefits for both mother and baby in the short-and longer-term (beyond the period of breastfeeding). Breast milk is the best form of nutrition for infants and exclusive breastfeeding is recommended for the first six months (26 weeks) of an infant's life. For infants, it reduces the incidence of gastrointestinal and respiratory infections, otitis media and recurrent otitis media, and reduces the risk of allergies. There is also some evidence that it reduces the risk of auto-immune disease, such as diabetes mellitus type i, and of adiposity later in childhood. For mothers, it promotes maternal recovery from childbirth, reduces the risk of pre-menopausal breast cancer and possibly of ovarian cancer, accelerates weight loss and a return to pre-pregnancy body weight and prolongs the period of postpartum infertility; see WHO Regional Publications, European Series, No.87 on Feeding and Nutrition of Infants and Young Children).

CQC – 30th October 2009 CQC - 10th July 2009 HC - 15th December 2008 HC - 24th October 2008 HC - 18th June 2008

There is clear evidence that breastfeeding has positive health benefits for both mother and baby in the short- and longer-term (beyond the period of breastfeeding). Breastmilk is the best form of nutrition for infants and exclusive breastfeeding is recommended for the first six months (26 weeks) of an infant's life. For infants, it reduces the incidence of gastrointestinal and respiratory infections, otitis media and recurrent otitis media and reduces the risk of allergies. There is also some evidence that it protects against neonatal necrotizing enterocolitis, respiratory and urinary tract infection, and that it reduces the risk of auto-immune disease, such as diabetes mellitus type I, and of adiposity later in childhood. For mothers, it promotes maternal recovery from childbirth, reduces the risk of pre-menopausal breast cancer and possibly of ovarian cancer, accelerates weight loss and a return to pre-pregnancy body weight and prolongs the period of postpartum infertility. (See WHO Regional Publications, European Series, No.87 on Feeding and Nutrition of Infants and Young Children.) There is evidence indicating that the longer the duration of breastfeeding, the greater the health benefits in later life. Breastfeeding initiation rates have been improving over the last 10 years and, in 2005 , 78% of mothers in England initiated breastfeeding. However, only 50% of all mothers who initiated breastfeeding were continuing to breastfeed at 6 weeks and 26% continued some breastfeeding at six months. There is clear evidence that adequate support to breastfeeding mothers in the first few weeks is likely to increase the duration of breastfeeding. Breastfeeding has an important contribution to make towards reducing infant mortality, childhood obesity and health inequalities.

Vital Signs plans (financial year 2009/10) Vital Signs returns (financial year 2009/10)


NPI20: Mortality Rate from all circulatory diseases (CVD) under 75 per 100,000 population (VSB02) [NI121]


NPI20: Mortality Rate from all circulatory diseases (CVD) under 75 per 100,000 population (VSB02) [NI121]

31 Dec 2009

05 Aug 2009

Owner Alison Bragg


Current Concerns: Clarification is being sort on the trajectory for this target due to a potential discrepancy in the population figures.


The directive from the Department of Health to introduce health checks for 40 to 75 year olds and a recall system every five years has resulted in NHS Kirklees submitting a business case to achieve the directive which is seen as a significant opportunity to achieve this indicator. The business case has been approved but will now progress to a prioritising process as the level of financial investment is significant. Initiatives continue in other areas and NHS Kirklees has secured a road show from the British Heart Foundation to raise public awareness about the health checks. The road show will begin in August. There are also a number of Health Improvement teams (HITs) who's agendas will also be impacting on this indicator and the cardiology HIT is looking to explore those agendas to highlight specific areas which are having positive impacts.


Latest YTD


Cardiovascular disease is the biggest cause of preventable death in the UK. Nearly 198,000 deaths are caused by CVD each year which accounts for over a third of all deaths annually. Of these deaths approximately a half are from coronary heart disease and a over a quarter are from strokes (British Heart Foundation, 2008). All PCTs experience health inequalities in their population. PCTs should be addressing these inequalities through their service planning and, as such, this indicator measures actual performance in relation to planned performance. The Government has given a commitment to faster improvement on life expectancy, cancer, cardiovascular disease, stroke and related diseases in the fifth of areas with the worst health and deprivation indicators.


Cardiovascular disease is the biggest cause of preventable death in England. 300,000 people have a heart attack each year and hundreds of thousands of people are living with angina or heart failure. Thousands die or experience severe disability due to stroke. These diseases are also a major clinical cause of health inequality, England has higher rates of the disease relative to comparable countries and, with cancer, it is one of the public’s top priorities for health. CHD alone is estimated to cost the UK more than £7 billion each year. Inequalities focus The White Paper on improving health, Choosing Health, recognises that taking effective action to tackle health inequalities is a top priority and one that will be very challenging. The planning round is a key mechanism to make the vision of narrowing health inequalities a reality, embedding the principles of delivering equity and closing service gaps into mainstream planning and commissioning

of services, and this should be the aim in every PCT. Tools such as the Health Poverty Index can be used to support local priority setting within the NHS and in conjunction with partners, and Health Equity Audits can be used to level up service provision in areas of high need. All PCTs have inequalities in the health status and experience of their population. Within their communities, all PCTs should be effectively addressing these through their service planning. Nationally, some areas suffer from inequalities and worse health indicators on a greater scale than others, and the Government has given a commitment to faster improvement on life expectancy, cancer, cardiovascular disease, stroke and related diseases in the fifth of areas with the worst health and deprivation indicators.

Local delivery plan (calendar year 2008) Office for National Statistics (calendar years 2007, 2008, 2009)


NPI21: Stroke Care. (VSA14)


NPI21: Stroke Care. (VSA14) 30 Sep 2009

03 Nov 2009

Owner Hayley Haycock



There is a national Vital Signs requirement that 65% of patients who are admitted with a stroke should receive their care in a recognised stroke unit for 90% of their time in hospital. Performance for Quarter 2 showed that we were status RED at 57.5%. Calderdale and Huddersfield Foundation Trust (CHFT) 60.4% and Mid Yorkshire Hospital Trust (MYHT)55.5%. CHFT provided a progress report to the Clinical Quality Board around issues raised at the meeting in September. CHFT conducted an audit of all patients who breached the 90% target, which highlighted some coding and data errors. These have now been rectified. They are continuing to keep a record of all breaches, to inform data quality and performance. Also, a new acute stroke pathway has been developed, to aid a speedier admission for Kirklees patients to acute stroke care provided at Calderdale Royal Hospital (CRH). A pathway nurse has been appointed to help facilitate implementation of the pathway and improve the patient journey through the acute stroke phase. We should start to see an improvement in performance against the 90% target. MYHT, Dewsbury Hospital site are also underperforming against target. We have now managed to secure management representation on the Stroke Health Improvement Team (HIT), and we have escalated key clinical quality of care issues to the Clinical Quality Board, which are contributing to the underperformance in stroke care. MYHT are piloting a tracker system for people admitted with stroke, which will help to identify people sooner and aid speedier admission to the acute stroke unit. MYHT are also now starting to collect and submit TIA data, and we are now able to start reporting against the TIA Vital Signs indicator Work has progressed in exploring the options for future acute, hyperacute (including thrombolysis) and stroke rehabilitation services in Kirklees. The focus of the study has been around the ability to deliver patient outcomes rather than location of services and an update will be presented to the Senior Management Team at NHS Kirklees later this month. To support the planning and delivery of future stroke services, the Strategic Health Authority (SHA) has produced a Stroke Assurance Framework for PCTs to be submitted by 18th December. The purpose of this exercise is for PCTs to demonstrate how they intend to commission stroke services in line with core service standards and to indicate their plans to meet developmental service standards. The trajectories for developmental standards are recommendations made by clinicians endorsed by the stroke networks and PCT Chief Executives

Current Concerns:

Although we have now started to report against the Vital Signs TIA indicator, the data received from both acute trusts is estimated and therefore not robust. Also, the current care pathway for referring and treating high risk TIA’s within 24 hours is not working effectively. Patients are being referred to the TIA weekly clinic, which is not sufficient to be able to deal with demand and treat those patients who are high risk of full stroke. This is resulting in some patients who have high risk TIA being admitted to hospital Current lack of medical cover is impacting on delays in admissions and discharges and key medical decision-making such as ordering diagnostics. This is impacting on patient care and performance against the 90% indicator and is more apparent at MYHT.


Stroke is currently on the agenda of the Clinical Quality Boards with both acute trusts. CHFT have developed a plan to address some of the performance and care quality issues and will be updating the board in January on progress. Stroke will be discussed at the MYHT Clinical Quality Board in December, where Clinical Directors will be present. Stroke performance was discussed at the SMT on 27th October, where concerns were acknowledged and issues escalated. Performance is integral to the stroke programme and have secured the support of the Assistant Director of Performance at the Stroke HIT meetings to help embed performance management as a core function of the HIT. CHFT and MYHT have started work on their implementation plan for the SHA Stroke Assurance Framework, deadline 30th November. This will demonstrate how they will deliver core stroke services, including direct admission to the acute stroke unit and urgent access to diagnostics.


Latest YTD


Proportion of people who have a TIA who are scanned and treated within 24 hours

Qtr 2 09/10 30 Sep 2009

25 0 -25 Not Set


Qtr 2 09/10 30 Sep 2009

25 0 -25 Not Set

Proportion of people who spend at least 90% of their time on a stroke unit

Qtr 2 09/10 30 Sep 2009

65 57.5 -7.5 Not Set


Qtr 2 09/10 30 Sep 2009

65 57.5 -7.5 Not Set

A stroke is caused by a disturbance to the flow of blood to the brain by one of two main means, either as a result of a clot that narrows or blocks blood vessels or where blood vessels burst causing bleeding into the brain.

Driving up standards of care to reduce mortality and morbidity through implementation of the National Stroke Strategy continues to be an important activity for PCTs, supported by their local stroke care networks (Operating Framework for the NHS in England 2009/10). Every year 110,000 people have a stroke, 20% - 30% of whom die within 1 month. 11% of all deaths in England occur as a result of a stroke, making it the third largest cause of death in the country, and 300,000 people live with a moderate to severe disability as a result of a stroke making it the largest cause of adult disability in England. The 2005 National Audit Office report found that, compared to other countries, England has a higher rate of mortality and disability caused by strokes, despite stroke care being among the most expensive internationally. The National Stroke Strategy, 2007, sets out 20 quality markers which define excellent care at different stages in the pathway, to help local services make improvements to stroke services. These definitions include the treatment of stroke patients within specialist stroke units and the provision of rapid access to services for people who have had a minor stroke or transient ischemic attack (TIA).

CQC - 10th June 2009 HC - 24th October 2008 HC - 18th June 2008

110,000 people have a stroke each year, around a third of whom die. Stroke is the largest single cause of adult disability – there are around 300,000 people in England living with moderate to severe disabilities as a result of a stroke. Good care on a dedicated stroke unit is the single most effective way to improve outcomes for people with stroke. Early initiation of treatment for Transient Ischemic Attacks (TIAs) or minor stroke can reduce the number of people going on to have a major stroke by 80%. Higher risk TIA cases are defined as those with an ABCD2 score of 4 or above. These indicators are a good proxy for reducing disability and death due to stroke. Current Performance: Neither of these are currently measured, however, 56% of people with stroke spend the majority of their time in a stroke unit, 35% of people with TIAs are treated in 7 days. Expected Position by the end of 2010/11: 80% of people with stroke spend at least 90% of their time on a stroke unit and 60% of higher risk TIA cases are treated within 24 hours by 2010/11. National Stroke Strategy and other related information (including Action on Stroke Services Toolkit) can be found on www.dh.gov.uk/stroke

Vital Signs returns (financial year 2009/10)


NPI21: Stroke Care. (VSA14)


NPI21: Stroke Care. (VSA14) 30 Sep 2009

03 Nov 2009

Owner Hayley Haycock



There is a national Vital Signs requirement that 65% of patients who are admitted with a stroke should receive their care in a recognised stroke unit for 90% of their time in hospital. Performance for Quarter 2 showed that we were status RED at 57.5%. Calderdale and Huddersfield Foundation Trust (CHFT) 60.4% and Mid Yorkshire Hospital Trust (MYHT)55.5%. CHFT provided a progress report to the Clinical Quality Board around issues raised at the meeting in September. CHFT conducted an audit of all patients who breached the 90% target, which highlighted some coding and data errors. These have now been rectified. They are continuing to keep a record of all breaches, to inform data quality and performance. Also, a new acute stroke pathway has been developed, to aid a speedier admission for Kirklees patients to acute stroke care provided at Calderdale Royal Hospital (CRH). A pathway nurse has been appointed to help facilitate implementation of the pathway and improve the patient journey through the acute stroke phase. We should start to see an improvement in performance against the 90% target. MYHT, Dewsbury Hospital site are also underperforming against target. We have now managed to secure management representation on the Stroke Health Improvement Team (HIT), and we have escalated key clinical quality of care issues to the Clinical Quality Board, which are contributing to the underperformance in stroke care. MYHT are piloting a tracker system for people admitted with stroke, which will help to identify people sooner and aid speedier admission to the acute stroke unit. MYHT are also now starting to collect and submit TIA data, and we are now able to start reporting against the TIA Vital Signs indicator Work has progressed in exploring the options for future acute, hyperacute (including thrombolysis) and stroke rehabilitation services in Kirklees. The focus of the study has been around the ability to deliver patient outcomes rather than location of services and an update will be presented to the Senior Management Team at NHS Kirklees later this month. To support the planning and delivery of future stroke services, the Strategic Health Authority (SHA) has produced a Stroke Assurance Framework for PCTs to be submitted by 18th December. The purpose of this exercise is for PCTs to demonstrate how they intend to commission stroke services in line with core service standards and to indicate their plans to meet developmental service standards. The trajectories for developmental standards are recommendations made by clinicians endorsed by the stroke networks and PCT Chief Executives

Current Concerns:

Although we have now started to report against the Vital Signs TIA indicator, the data received from both acute trusts is estimated and therefore not robust. Also, the current care pathway for referring and treating high risk TIA’s within 24 hours is not working effectively. Patients are being referred to the TIA weekly clinic, which is not sufficient to be able to deal with demand and treat those patients who are high risk of full stroke. This is resulting in some patients who have high risk TIA being admitted to hospital Current lack of medical cover is impacting on delays in admissions and discharges and key medical decision-making such as ordering diagnostics. This is impacting on patient care and performance against the 90% indicator and is more apparent at MYHT.


Stroke is currently on the agenda of the Clinical Quality Boards with both acute trusts. CHFT have developed a plan to address some of the performance and care quality issues and will be updating the board in January on progress. Stroke will be discussed at the MYHT Clinical Quality Board in December, where Clinical Directors will be present. Stroke performance was discussed at the SMT on 27th October, where concerns were acknowledged and issues escalated. Performance is integral to the stroke programme and have secured the support of the Assistant Director of Performance at the Stroke HIT meetings to help embed performance management as a core function of the HIT. CHFT and MYHT have started work on their implementation plan for the SHA Stroke Assurance Framework, deadline 30th November. This will demonstrate how they will deliver core stroke services, including direct admission to the acute stroke unit and urgent access to diagnostics.


Latest YTD



Qtr 2 09/10 30 Sep 2009

25 0 -25 Not Set


Qtr 2 09/10 30 Sep 2009

25 0 -25 Not Set


Qtr 2 09/10 30 Sep 2009

65 57.5 -7.5 Not Set


Qtr 2 09/10 30 Sep 2009

65 57.5 -7.5 Not Set

A stroke is caused by a disturbance to the flow of blood to the brain by one of two main means, either as a result of a clot that narrows or blocks blood vessels or where blood vessels burst causing bleeding into the brain.

Driving up standards of care to reduce mortality and morbidity through implementation of the National Stroke Strategy continues to be an important activity for PCTs, supported by their local stroke care networks (Operating Framework for the NHS in England 2009/10). Every year 110,000 people have a stroke, 20% - 30% of whom die within 1 month. 11% of all deaths in England occur as a result of a stroke, making it the third largest cause of death in the country, and 300,000 people live with a moderate to severe disability as a result of a stroke making it the largest cause of adult disability in England. The 2005 National Audit Office report found that, compared to other countries, England has a higher rate of mortality and disability caused by strokes, despite stroke care being among the most expensive internationally. The National Stroke Strategy, 2007, sets out 20 quality markers which define excellent care at different stages in the pathway, to help local services make improvements to stroke services. These definitions include the treatment of stroke patients within specialist stroke units and the provision of rapid access to services for people who have had a minor stroke or transient ischemic attack (TIA).

CQC - 10th June 2009 HC - 24th October 2008 HC - 18th June 2008

110,000 people have a stroke each year, around a third of whom die. Stroke is the largest single cause of adult disability – there are around 300,000 people in England living with moderate to severe disabilities as a result of a stroke. Good care on a dedicated stroke unit is the single most effective way to improve outcomes for people with stroke. Early initiation of treatment for Transient Ischemic Attacks (TIAs) or minor stroke can reduce the number of people going on to have a major stroke by 80%. Higher risk TIA cases are defined as those with an ABCD2 score of 4 or above. These indicators are a good proxy for reducing disability and death due to stroke. Current Performance: Neither of these are currently measured, however, 56% of people with stroke spend the majority of their time in a stroke unit, 35% of people with TIAs are treated in 7 days. Expected Position by the end of 2010/11: 80% of people with stroke spend at least 90% of their time on a stroke unit and 60% of higher risk TIA cases are treated within 24 hours by 2010/11. National Stroke Strategy and other related information (including Action on Stroke Services Toolkit) can be found on www.dh.gov.uk/stroke

Vital Signs returns (financial year 2009/10)


NPI23: Percentage of women who have seen a midwife or a maternity healthcare professional, for assessment of health and social care needs, risks and choices by 12 completed weeks of pregnancy. (VSB06) [NI126]


NPI23: Percentage of women who have seen a midwife or a maternity healthcare professional, for assessment of health and social care needs, risks and choices by 12 completed weeks of pregnancy. (VSB06) [NI126]

31 Dec 2009

11 Jan 2010

Owner Keith Henshall



Currently awaiting data from both trusts (due 25.01.10). Both trusts have submitted responses to the draft service specification, RAG rating areas where they are already delivering (green), where some changes are needed to deliver (amber) and where they cannot deliver without significant investment (red). These responses are being analysed currently. Discussions are ongoing around agreeing a dashboard of information required for strategic planning of services covering Kirklees population and being consistent with Wakefield and Calderdale commissioning requirements.

Current Concerns: Community midwifery capacity still seems to be an issue particularly in north Kirklees. Some recruitment has taken place but there is still a shortfall relative to the Safer Childbirth guidance of 1 midwife to 28 births (35 midwives per 1000 births).


The shortfall may be due to the time lag between income from tariff and maternity services obtaining the required investment. Commissioners are calculating the amount of extra investment since tariff changes came into effect and challenging providers through the contracting process.



The percentage of women in the relevant PCT population who have seen a midwife or a maternity healthcare professional, for health and social care assessment of needs, risks and choices by 12 weeks and six days of pregnancy.

Qtr 2 09/10 30 Sep 2009 85.7 Not Set

The percentage of women in the relevant PCT population who have seen a midwife or a maternity healthcare professional, for health and social care assessment of needs, risks and choices by 12 weeks and six days of pregnancy.

Qtr 2 09/10 30 Sep 2009 80 85.74 5.74 Not Set

The 'Vital Signs', published as part of the 2008-2011 planning cycle for the NHS and reiterated in the 2009/10 NHS Operating Framework, include an indicator on the percentage of women who have seen a midwife or maternity healthcare professional, for assessment of health and social care need, risks and choices, by 12 completed weeks of pregnancy (which is defined as 12 weeks and 6 days). This indicator also appears as a PSA target indicator as part of the 2007 Comprehensive Spending Review. This requirement is also included in the Department of Health document 'Maternity Matters' (2007) as a key element in delivering maternity choice. The indicator assesses the number of maternities where the first maternity appointment occurs within the first 12 completed weeks of pregnancy.

CQC - 10th June 2009 HC - 26th March 2009 HC - 18th June 2008

All women should access maternity services for a full health and social care assessment of needs, risks and choices by 12 weeks and 6 days of their pregnancy to give them the full benefit of personalised maternity care and improve outcomes and experience for mother and baby. Reducing the percentage of women who access maternity services late through targeted outreach work for vulnerable and socially excluded groups will provide a focus on reducing the health inequalities these groups face whilst also guaranteeing choice to all pregnant women. Completion of the assessment empowers women, supporting them in making well informed decisions about their care throughout pregnancy, birth and postnatally. The national choice guarantees:

• choice of how to access maternity care; • choice of type of antenatal care; • choice of place of birth; • choice of place of postnatal care. The aim is an increase in the percentage of women who have seen a midwife or a maternity healthcare professional for assessment of health and social care needs, risks and choices by 12 weeks and 6 days of pregnancy. This indicator promotes provision of accessible services.

Vital Signs monitoring return (financial year 2009/10) Vital Signs plans (financial year 2009/10)

Qtr 1 2009/10

Qtr 2 2009/10

Qtr 3 2009/10

Qtr 4 2009/10

Actual 74.62 85.74

Profile 80 80 80 85


OPI01: MRSA number of infections VSA01


OPI01: MRSA number of infections VSA01 30 Nov 2009 21 Dec 2009

Owner Jane O'Donnell




CHFT - Number of infections in period

Nov 09 30 Nov 2009 13 8 5 Not Set

MYHT - Number of infections in period

Nov 09 30 Nov 2009 28 15 13 Not Set


Actual 3 4 8 10 11 1 13 15

Profile 3 6 9 14 17 20 25 28 31 37 40 43


Actual 0 2 3 5 7 0 8 8

Profile 1 3 4 7 8 9 11 13 14 16 17 19


OPI02: Supporting measures: Extended opening hours for GP practices, Increased capacity in primary care, Patient reported access to out-of-hours care (indicator to be developed) (VSA07)


OPI02: Supporting measures: Extended opening hours for GP practices, Increased capacity in primary care, Patient reported access to out-of-hours care (indicator to be developed) (VSA07)

30 Nov 2009

23 Nov 2009

Owner Mark Jenkins



62 practices out of 73 85% are offering extending opening hours at GP Practices.

Current Concerns: None


Latest YTD


The percentage of GP practices in the PCT offering extended opening in compliance with Department of Health guidelines

Jun 09 30 Jun 2009

51 85.14 34.14 Not Set

The percentage of GP practices in the PCT offering extended opening in compliance with Department of Health guidelines

Jun 09 30 Jun 2009

85 Not Set

This measures available extended opening in each PCT on an agreed common basis.


OPI05: Patient reported measure of choice of hospital. (VSC16)


OPI05: Patient reported measure of choice of hospital. (VSC16)

31 Mar 2010

06 Jan 2010

Owner Rachel Carter



No further update in November. The March - May 2009 survey was the last of its kind. There is a current intention to run a one-off additional survey in March 2010. The need for a local survey in the meantime is being considered. This measure records the proportion of patients that were able to attend the hospital of their choice, or had no preference about which hospital they wished to attend. According to the last available data, NHS Kirklees performance was slightly below both SHA and National performance. March - May 2009: Kirklees Performance 87% (SHA 89%, National 90%)


Latest YTD


Percent of patients who went to the hospital they wanted, or had no preference

Y/E 08/09 31 Mar 2009

87 Not Set

To measure patient experience of choice in the NHS


OPI06: Number of emergency bed days per head of weighted population. (VSC20) [NI134]


OPI06: Number of emergency bed days per head of weighted population. (VSC20) [NI134]

31 Oct 2009

26 Nov 2009

Owner Pat Andrewartha



Whilst numbers of emergency bed days continues to be high the numbers have continued the slight decrease when compared to last year, this decrease overall is 4.7%. Work continues to reduce emergency bed days through such as YAS frequent callers; developemtn of pathways to prevent attendance at A&E, work with GP practices on inappropriate (in hours) attenders. Refer to VSC21 Ambulatory Care Sensitive Conditions - actions may refer to both accountabilities. Generic Workers are now inplace within the rapid response teams providing direct support to individuals with low level health and social care needs to prevent hospital admission and facilitate early and timely discharge Early supported discharge for COPD will commence in July and will affect performance against this target. Procurement of the predictive risk tool is not yet completed - expected late summer/early autumn, once in place this will enable us to identify people at risk of admission and allocate resources appropriately to manage risk. The work of the complex discharge team at CHFT continues to be developed in order to support and improves patient flow Increased investment and development in primary care streaming service within accident and emergency services has supported achievement of the emergency service targets – this alongside other investments in ambulatory care management will impact on unplanned admissions and overall bed day usage. Partnership work between Community Matrons and Yorkshire Ambulance service on the people who frequently call the ambulance service is helping to identify and reduce inappropriate use and transportation to accident and emergency departments for assessment

Current Concerns:

Activity continues to be high with the continued threat of swine flu and winter posing a significant threat. Ongoing analysis of the data continues to better understand the reasons for increases along with more detailed analysis of service utilization across care pathways and further development work to existing services; this is being undertaken across many areas (older people, long term conditions etc) to provide a more complete picture of the reasons for the EBD continued increase. The introduction of the Predictive Risk Tool will help identify and manage this group of patietns once it is up and running.


Proposed investment and service redesign in Long Term Conditions, emergency care and intermediate care has not all been completed and realised but with acute beds remaining in the system, to demonstrate that patients have been diverted via, for e.g. intermediate care does not stop the bed being utilised by another patient. Recruitment of additional community matrons is complete but staff continue to not be fully operational until the training and development programme has been completed. Training will be complete by September 2010. Further work to establish high intensity service usage including the use of predictive risk tools are vital to intelligent commissioning that will directly impact on this target.


Latest YTD


Number of Emergency Bed Days

Sep 09 30 Sep 2009

87486 105566 -18080 Not Set

This is a measure of improved pro-active care of patients, particularly those with chronic conditions. Reducing the number of emergency bed days requires input from range of stakeholders to avoid admissions and to ensure appropriate time in hospital. There is a clear measure of success and requires improvements in performance from a range of organisations in health and social care to achieve it.


OPI07: Rates of hospital admissions for ambulatory care sensitive conditions per 100,000 population. (VSC21)


OPI07: Rates of hospital admissions for ambulatory care sensitive conditions per 100,000 population. (VSC21)

31 Oct 2009

07 Jan 2010

Owner Joanne Crewe



People with Long term Conditions being supported by Community Matrons or Specialist Nurses are being identified as suitable for telehealth monitoring - this should reduce reliance on secondary care and prevent future avoidable admissions. Generic workers are available 24 hours per day 7 days per week via a single point of access and can support people with health or social needs at home to prevent hospital admission or facilitate early discharge. Community Matron service is fully staffed and are managing a higher number of people with high intensity health or social care needs to prevent hospital admissions or reduce length of hospital stay. There is a significant reduction in activity and bed days for people who are managed by this service. Community Matrons and Generic workers are assigned to a practice unit and as such should proactively identifying people at risk of future avoidable hospital admissions. Predictive risk tool contract was signed with the provider on 28th September – work is underway to recruit practices to share their practice data. The first reports for the PCT and practices should be available by the end of February 2010.

Current Concerns:

Rate of hospital admissions for the ambulatory conditions not showing significant reduction. Procurement of provider for the community specialist respiratory services has reached final negotiations with no agreement. Length of stays in Holme Valley hospital and under utilization of care homes for end of life care.


Early identification of those at risk of admission not being identified early enough and therefore opportunities to proactively manage to prevent admission not being realised. The predictive risk tool will enable clinicians and the PCT to identify current and future resource/service utilaisation

Last Report: Matrons or Specialist Nurses are being identified as suitable for telehealth monitoring - this should reduce reliance on secondary care and prevent future avoidable admissions. Generic workers are available 24 hours per day 7 days per week via a single point of access and can support people with health or social needs at home to prevent hospital admission or facilitate early discharge. Community Matron service is fully staffed and are managing a higher number of people with high intensity health or social care needs to prevent hospital admissions or reduce length of hospital stay. There is a significant reduction in activity and bed days for people who are managed by this service. Community Matrons and Generic workers are assigned to a practice unit and as such should proactively identifying people at risk of future avoidable hospital admissions. Predictive risk tool contract was signed with the provider on 28th September – work is underway to recruit practices to share their practice data. The first reports for the PCT and practices should be available by the end of February 2010.

Current Concerns:

Rate of hospital admissions for the ambulatory conditions not showing significant reduction. Procurement of provider for the community specialist respiratory services has reached final negotiations with no agreement. Length of stays in Holme Valley hospital and under utilization of care homes for end of life care.


Early identification of those at risk of admission not being identified early enough and therefore opportunities to proactively manage to prevent admission not being realised. The predictive risk tool will enable clinicians and the PCT to identify current and future resource/service utilaisation


Latest YTD


PCT population estimates for the respective calendar yearsMonth 7 31 Oct 404945 404945 0 Not SetRate of hospital admissions for ACS conditions per 100,000 populationMonth 5 31 Aug 550 364.25 185.75 Not SetTotal number of hospital admissions for ACS conditionsMonth 7 31 Oct 3122 3418 -296 Not Set

Avoidable hospitalisations are those conditions that could have been avoided if proper ambulatory care had been received and can thus be seen as a measure of access to appropriate care. The rate of ambulatory care sensitive hospitalisation is considered a measure of access to adequate primary care and quality of chronic disease management to prevent complications. A disproportionately high rate is presumed to reflect problems in obtaining access to primary care.

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