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Transcript of meeting (held in public) - Bexley CCG body... · Bexley CCG Outcomes data weekly. cover Source: Ref...
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DATE: 24 March 2016
Title
Integrated Quality, Safety and Performance Report March-16
This paper is for Information
Recommended action for the Governing Body
That the Governing Body: Note Integrated Quality, Safety and Performance Report March-16
Potential areas for Conflicts of interest
None.
Executive summary
Outcome data: Nov-December 15 • 72 cases of C.Diff reported from Apr-Dec15 (target 37, annual target 56)
newly appointed Infection prevention nurse now in post to identify gaps and possible solutions to reduce incidents.
• A&E target not achieved –all providers have action plans in place to mitigate risks to patients
• Cancer 62 day’s great improvement and targets met in December 2015 • RTT: 18 weeks not met – additional fund given to LGT by Lewisham CCG • Improving Access to Psychological Therapies (IAPT) still below target • Safeguarding children training improved across the providers • Oakwood House closed 29/02/2016
How does this paper support the CCGs objectives?
Patients: Improve the health and wellbeing of people in Bexley in partnership with our key stakeholders.
People: Empower our staff to make NHS Bexley CCG the most successful CCG in (south) London.
Pounds: Delivering on all of our statutory duties and become an effective, efficient and economical organisation.
Process: Commission safe, sustainable and equitable services in line with the operating framework and which improves outcomes and patient experience.
What are the Organisational implications
Key risks
N/A
Equality No Equality and Diversity issues identified.
ENCLOSURE: Q(i) Agenda Item: 41/16
Governing Body meeting (held in public)
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Financial
N/A
Data
N/A
Legal issues
N/A
NHS constitution
Paper supports the NHS constitution.
Engagement
Audit trail
Comms plan None
Author: Ina Herridge Sue Higgins
Clinical lead: Dr Sonia Khanna-Deshmukh Frognal Locality Representative
Executive sponsor: Simon Evans-Evans Director of Governance and Quality
Date 14 March 2016
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Excellent healthcare – locally delivered
Integrated Quality,
Safety and
Performance Report
March 2016
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Contents Page No.
Patient stories 3
CCG Outcomes Data 4
Quality Strategy - priorities for 15/16 6
- Assurance visits & audit plan 8
CQUINS 9
Quality Premium 12
Safeguarding Children 13
Safeguarding Adults 15
Serious Incidents 19
Quality Alerts (GP) 20
Lewisham & Greenwich NHS Trust 21
Dartford & Gravesham NHS Trust 24
Kings College NHS Foundation Trust 26
Guy‟s & St Thomas‟ NHS Foundation Trust 29
Oxleas NHS Foundation Trust 32
Other Contracts - Care Homes, UCC 35
Engagement Activity 37
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3
Patient Stories
Non emergency transport services
Concern: Travel & Access to appointment out of area. Relative concerned at elderly husband has prostate
cancer and needs to attend hospital Mon – Fri for treatment over several weeks. Although seen at DVH treatment
is provided Maidstone Hospital. The relative was very concerned at the impact of the journey as neither drive and
have no close family nearby to assist with travel.
Outcome: The CCG liaised with GP surgery, who agreed it would be difficult for the patient to access treatment at
Maidstone without support. Consequently, arrangements were made for Non Emergency Transport services.
Patient and family advised of outcome and grateful for assistance – they did not realise they may be entitled to help
with transport to access care .
MSK Kings College Hospital
Concern: Access to services & Patient Choice. Following trauma to hand and operation at PRUH patient
advised would need Physio. Call received from Physio several days later advising patient to attend Beckenham
Beacon for treatment. Patient advised this would be a very difficult and long journey (involving at least two buses)
– a request was therefore made to attend QMH as this is much nearer. Patient was then advised this service is not
provided at QMH.
Outcome: After liaising with Commissioners and Musculoskeletal (MSK) managers at KCH it was confirmed that
the patient could access Physio at QMH. Consequently, an appointment was swiftly arranged. The MSK manager
has also agreed to speak to staff at Beckenham Beacon to re-educate them and ensure they are aware services
can be accessed on the QMH site.
Patient subsequently contacted Patient Engagement Team (PET) to personally thank staff (DH) for assistance in
resolving and to enable patient to access services at hospital of choice.
Source: Patient Engagement Team, Bexley CCG Feb-16
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Bexley CCG Outcomes data
Source: South London CSU, Bexley CCG Pack Month 9 captured on 16/02/2016
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Ref. Indicator Target Oct Nov Dec Comments
1 C Difficile
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Bexley CCG Outcomes data
Source: Ref 09-18 South London CSU, Bexley CCG Pack Month 9 captured on 16/02/2016
Source: Ref 19-20 ICT IAPT Reporting Dashboard from MIND in Bexley, received 9/02/16
Source: Ref 21 NHS England, National Clinical Director for Dementia and Older People‟s Mental Health, received January 2016
Source: Ref 22 Oxleas Business Manager, Children and Young People's Directorate, received 23/02/16
9 Cancer subsequent treatment 31 days, radiotherapy (m) 94% 100.0% 92.1% 97.1%
10 Cancer composite, 62 days first treatment plus rare cancers (m) 85% 72.7% 78.3% 88.6%
11 Cancer first treatment 62 days, Screening (m) 90% -- 100.0% 100.0%
12 Cancer first treatment 62 days, Consultant upgrade (m) -- 100.0% 100.0%
13 RTT 18 weeks (admitted patients) 90% 87.9% 86.3% 86.4%
At KCH the Trust has an agreed derogation of reporting to Apr-16. CCG reporting therefore does not reflect KCH data for this period.
14 RTT 18 weeks (non admitted patients) 95% 94.7% 94.0% 94.3%
15 RTT 18 weeks (incomplete pathways) 92% 92.9% 93.1% 92.6%
16 RTT 52 weeks (admitted patients) 0 1 2 1
17 RTT 52 weeks (non admitted patients) 0 0 1 1
18 RTT 52 weeks (incomplete pathways) 0 1 1 0
19 IAPT-Patient numbers as % population with depression etc. 1.1% 1.4% 1.40% 1.14%
20 IAPT - Proportion moving to recovery 50% 45% 45% 45% Provider given opportunity to improve by end Q4 and CCG monitoring performance weekly.
21 Estimated diagnosis rate for people with dementia 66.7% 66.9% 66.3%
22 Health visitors (WTE) 39.59 36.86 37.26 35.86 Recruitment to vacancies is underway with cover in place from agency/bank staff
23 Transforming care - Bexley have three mental health patients meeting this criteria, all had care and treatment reviews in Nov-15 with discharge planning in place for discharge before Mar-16 (Source: Transforming Care spread sheet Mthly, Oxleas – Jan-16)
There has been one admission into the assessment and treatment unit at Atlas House following a community clinical treatment review (CTR) on 10/02/16 (Source: Transforming Care spread sheet 2wkly, Oxleas – Feb-16)
There has also been one admission onto acute Mental Health(MH) wards for an ‘in scope’ patient who is currently being titrated for
medication. A CTR is planned for 04/03/16 (Source: Ref Transforming Care spread sheet Mthly, Oxleas – Jan-16)
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Quality Strategy - priorities for 15/16 6
GENERAL
To embed learning from incidents, complaints and patient feedback, thereby reducing the potential for
incidents.
Assurance provided via embedded learning events at LGT and Oxleas
Supporting Quality improvement through greater collaboration between hospital and community
services.
Pressure ulcer panels at Oxleas and LGT
A better understanding around the prevention of inequality for the vulnerable groups and their access
to treatment.
Learning Disability nurse in post at LGT and DVH
Improvement in the quality of information between secondary, primary and community care.
Development of dashboard for CQRG
Safeguarding Children and Vulnerable Adults (see Safeguarding Strategy).
Qtr2 deep dive with NHSE
Source: Quality & Performance Manager, Bexley CCG Jan-16
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Quality Strategy - priorities for 15/16
SPECIFIC
Quality Improvement in: Care Homes
Care homes forum established with CQC liaison
District Nursing
Joint strategy in place
The Quality Premium
See separate slide
C.Diff performance
The local authority have recruited an infection control nurse who joined the team in Feb-16.
London Quality Standards
LGT undertaking an audit
The quality of maternity provision for the women of Bexley
Business case in progress
The quality of care at Queen Elizabeth Hospital A&E
Continuous review through CQRG
End of Life Care/ linking work through Care Home Forum
recruited interim safeguarding adults & quality lead in post since 15/02/16, objective to liaise with Older Persons
Commissioner to support end of life work stream.
Small Contracts Assurance Process
PAMS business case to go to FSC
Delivery Improving Cancer services (especially 62 day waits at L&G).
Plan in place
Source: Quality & Performance Manager, Bexley CCG Jan-16
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Quality Strategy (assurance visits & audit plan) 11
1 Older People discharge into care homes (completion by end of Q3). Report has been completed, action plan is being developed.
2 District Nursing audit of care plans (completion by end of Q4).
This has been superseded by impending CQC inspection
3 AQP Service Community Gynaecology Services (completion by the end of
Q4).
All AQP quality measures being reworked with new contracts in
place with the aim to have annual CQRG with each
provider/group of providers
4 End of Life Care - a hospice specific audit (completion by the end of Q4).
The CCG carried out an assurance visit to the hospice in December 2015,
draft report in progress
Source: Bexley CCG Quality team Feb-16
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CQUINS (Q2) Lewisham and Greenwich NHS Trust 2015/16 Q3 data has not been finalised
Source: South East CSU, Feb-16
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No CQUIN Overview % weighting
available in Q2 Description of CQUIN indicator
Final RAG
% weighting
achieved
1
Acute Kidney Injury 3.50% Trust to provide a further cleansed baseline by Sep 2015
Q2 meeting with commissioners to review revised baseline and target setting.
20% of whole-year AKI CQUIN value awarded if locally agreed Q2 target of improvement from
baseline achieved.
3.50%
2a
Sepsis Screening 2.20% Trust to sample again using July admissions data, identifying patients with a sepsis diagnosis, as
well as a sample of arrival to treatment times for patients whose trigger for sepsis was on arrival
at the Trust. 10% of whole-year sepsis CQUIN value awarded if locally agreed Q2 target of
improvement from baseline achieved.
2.20%
2b
Sepsis Antibiotic
Administration
2.20% Establish baseline of patients receiving antibiotics for sepsis using the Trust protocol.
Protocol to be shared with Commissioners.
10% of whole-year sepsis CQUIN value awarded if baseline data collection established.
Q3 target to be agreed and set as soon as possible after Q2 ends using data from Q2
2.20%
3a
Dementia - Find, Assess,
Investigate, Refer & Inform
1.75% Quarterly download of dementia patents identified sent to BGL GPs.
Provider achieves 90% or more for each element of the indicator for Quarter 2 of 2014/15,
taken as a whole
1.75%
3b Dementia - Staff training 0.00% No milestone actions this quarter 0.00%
3c Dementia - Supporting
Carers of people with
dementia
0.75% Provider to undertake monthly audit of carers of people with dementia to test whether they
feel supported with results reported to the Trust Board
0.75%
4 Reducing the proportion of
avoidable emergency
admissions to hospital.
1.00% Trust to establish 'cleansed' baseline level of avoidable emergency admissions in 2014/15 by
case note review of top ambulatory sensitive conditions (ie those with more than 100 avoidable
admissions) and meet with commissioners to agree targets.
1.00%
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CQUINS (Q2) Lewisham and Greenwich NHS Trust 2015/16 (cont‟d)
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Source: South East CSU, Feb-16
No CQUIN Overview
% weighting
available in
Q2
Description of CQUIN indicator
Final RAG
% weighting
achieved
5a
Maternity - Development
of a maternal obesity
service
1.00% Trust to amend questions based on Public Health England guide to evaluating weight
management interventions.
Post natal outcomes to be included covering complications, mode of delivery, feeding and
birth weight.
Report on motivational interview training.
Completion of Project Plan to set up new service to include training requirements.
Plans and progress on QE clinics reported within Q2
1.00%
5b Maternity - Joint
Vulnerability Assessment
1.00% Commence plans to develop a dynamic resource perhaps on their Trust intranet whereby
midwives can check what local support is available for individual women.
Trust to commence planning to develop an internet resource for women on sources of local
support.
1.00%
6 Supporting Integration 1.00% Trust to provide updated draft implementation plan including re-costing of estates plans.
Trust to submit first stage report on 'shifts in care'
Meet with Commissioners to agree priorities and models
0.00%
7a Improving quality and
effectiveness of care for
children with complex
needs through better
identification and
coordination
1.00% • Undertake audit to establish baseline recording of functional coding of children with a
known diagnosis
• Agree and establish format of stakeholder feedback
1.00%
7b Clinical Pathway
Development – Community
Children Nursing
1.00% Develop a series of events with stakeholder’s and service users (CYP and their families) to
ensure the local approach to pathway redesign meets children’s needs but also reflects the
strategic and partnership priorities for community services for children and young people.
Events to be undertaken by the end of Q2 to inform Q4 piloting of pathways.
1.00%
Total 16.4% 15.4%
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CQUINS (Q3) Oxleas
Source: please add the source of data and the date it was received/retrieved
Source: Oxleas NHS Trust quarterly reporting received February 2016
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Quality Premium
Source: No. 1 HSCIC 23/02/16 No. 4a+b PCIF report 19/02/16 No. 5a Oxleas NHSFT 23/02/16
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2015/16 measures Latest actual Target Period Forecast
end R/G
1 Reducing potential years of lives lost through causes considered amenable to
healthcare (10%).
DSR 1785.00
2012
DSR 2008.3
2014
1.2%
reduction
2012 -
15
2012 - 2015
data due
June 2016
2
Urgent and
Emergency
Care
(30%)
Avoidable emergency admissions (30%). Either a) a reduction, or a zero per cent change, in the annualised
trended change in the Indirectly Standardised Rate of
emergency admissions for these conditions over the 4
years 2012/13 to 2015/16 ; or
b) the Indirectly Standardised Rate of admissions in 2015/16
at less than 1,000 per 100,000 population
Outcome
data for
2015/16 will
be available
June 2016.
3 Mental
Health
15% each
Increase in the proportion of adults in contact with secondary mental health services
who are in paid employment 29% Increase Q3
Increase
from 24% in
Q2
Improvement in the health related quality of life for people with a long term mental
health condition
Seeking data None
available
4
Improving
antibiotic
prescribing
in primary
and
secondary
care (10%)
Reduction in the number of antibiotics prescribed in
primary care (5%) antibacterial items per STAR PU 0.267 0.23 Q3
Reduction in the proportion of broad spectrum
antibiotics prescribed in primary care (3%) 14.8%
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Safeguarding Children
No.1 Data Source: Oxleas NHS Trust quarterly reporting received February 2016
No 2 Data source: D&G Trust, L&G NHS Trust quarterly reporting received February 2016
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Subject Detail Action Latest position
1. Child
Protection
medicals
Good practice requires a child protection
medical to be completed within 24hrs of a
request being received from children‟s social
care for acute presentations.
Actions put in place have enabled a
much improved position.
Qtr. 3– 94%
(Qtr2 - 80%).
2. Acute
providers
safeguarding
training
compliance at
level 3
All providers are expected to achieve 80%
compliance with safeguarding children
training at 3 levels. The level expected will
depend on the responsibilities and contact
with children/carers. Acute providers remain
non-compliant. It is particularly important that
children‟s areas; obstetrics & gynaecology,
maternity and accident & emergency (A&E)
department achieve compliance at Level 3.
D&G Trust
• Revised training needs analyses
identifies a total of 578 staff requiring
Level 3 training.
• Additional training sessions scheduled.
• Projected compliance by end of Qtr 4
will be in the region of 87.5%.
L&G Trust
• Directorates less than 60% compliant
are required to complete an exception
report, to include any action plans to
improve compliance Directorate
General Managers, will be asked to
attend Trust Safeguarding Committee
to deliver/discuss their exception
report.
Qtr 3 level 3:
74%
Qtr 3 level 3:
65%
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Safeguarding Children (cont‟d)
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Source:Bexley Safeguarding Children Board 2015
No 3.Data Source: Oxleas NHS Trust quarterly reporting received February 2016
No 4. Data Source: Bexley Safeguarding Children Board CDOP 2015
Subject Detail Action Latest position
3. Looked
after children
initial health
assessments
This is a health indicator but Oxleas are entirely
dependent of children‟s social care providing
notification and consent. Delays in receiving
documentation and consent have meant health
assessments are delayed beyond 28 day
timescale.
Escalated to Assistant Director
children‟s services London Borough
Bexley (LBB) and Bexley Safeguarding
Children Board. Compliance achieved.
Qtr 3 – 81%
(Qtr. 2 - 75%)
4. Suicides
In Bexley there has been a cluster of suicides:
2014/15 1 young person took his life and 1 near
miss.
2015/16 2 young people have taken their lives
A cluster of suicides is a rare event. Suicide cluster
is defined as a series of three or more closely
grouped deaths. In the absence of transparent
social connectedness, evidence of space and time
linkages are required to define a cluster (Larkin&
Beautrais 2012)
Suicide Summit across South East
London held February 2016 agreed
group actions.
Bexley LSCB also plans to commission
workshops for teachers and GP‟s and
exploring options for delivery of keep
safe work with young people. (agenda
item)
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Safeguarding Adults (SA) – Compliance Q3
Subject Detail
Lewisham &
Greenwich
Trust
Lewisham and Greenwich Trust:
Safeguarding Adults Training
• level 1 is at 100%,
• level 2 is 82% it is anticipated that 85% will be reached in quarter 4.
Mental Capacity Act and Deprivation of Liberties
PREVENT:
• 2497 staff have received full PREVENT training (WRAP 3)
• A prevent Duty Gap analysis has been completed which indicated significant progress.
• Action plan is in place to progress this work further.
Adults with learning disabilities
• Liaison with partner agencies is on-going to explore the possibility of sharing the registers of service users with
QEH so that known adults with a learning disability can be proactively flagged on I-Care.
• The Trust is now signed up to the Mencap Patients Charter.
Domestic Violence
• 13 referrals made from the QE site.
• 8 referrals from the Lewisham Site
• Independent domestic violence advocate is now in place on both sites.
• Pathway to support people through A&E is being developed.
Quality Audit at QEH
• Both sites are now able to flag adults with a learning disability.
• The Quality lead has agreement to flag all individuals known to the Bexley and Greenwich Learning Disability
teams.
• Service user forum has been set up on the Lewisham site. QE Lead has met with local groups.
• Videos are being created to demonstrate procedures.
RESTRAINT – No data available
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Safeguarding Adults (SA) – Compliance Q3
Source: SA Assurance Monitoring System 2015/2016 Oxleas NHS Foundation Trust - Email from ADQ&G 29/01/2016
Subject
Oxleas
NHSFT
Training:-
Safeguarding Adults
98% for level 1.
No data available for levels 2 and 3
Local Authority offer multiagency level 2 and 3 training. 8 staff undertook this in January 2016.
Action: To be taken to Training SA sub group
Mental Capacity Act and Deprivation of Liberties - 93%
PREVENT – No data available
Domestic Violence Training – No data available
Safer Recruitment training – 93%
Complaints – 162 issues from 71 complaints 44% upheld or partially upheld.
Action: Clarity to be found on when a complaint becomes a safeguarding referral
Section 42 ENQUIRIES Concerns to LA – 23 Enquiries -10
Action: For audit in case of inappropriate referrals
Deprivation of Liberties Applications – 0 in quarter 3
Domestic Violence referrals – No Data available
Action: To discuss in SA sub groups
Discloser and Barring Service – 100%
Antipsychotic Prescribing – Audit carried out. Lowest prescribing of any other Trust. Consistent with NICE
guidelines.
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Safeguarding Adults – Compliance Q3
Source: SA Assurance Monitoring Systems Q4 – Dec 15 Emailed by SA lead for DVH - received 16/02/2016
Subject Detail
Darent Valley
Hospital
Training:-
SA – level 1 – 92%
Level 2 - 92%
Mental Capacity Act and Deprivation of Liberties -The training is not mandatory and therefore is not reported
as a compliance figure. Legal Awareness training in Oct 2015.
Nine staff attended MCA training and 22 DoLS Training
PREVENT – 18 people trained as WRAP 3 trainers – Police provided training
Domestic violence Training – Maternity Department only
Safer Recruitment training – Not reported on
Complaints –
Section 42 ENQUIRIES
DoLS Applications – 5
Section 42 - SA concerns raised 6 enquiries 6
DV referrals – 0
DBS Compliance – 100% for New Staff (Not reported on for existing staff?)
Action: To find out when DBS compliance figure will be collated
Restraint – 13 in Q3 (YTD 18) possibly due to staff being told to report as a datix –using incident reporting
system
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Safeguarding Adults
Subject Detail
Emerging quality
issues and good
practice
Domestic violence reporting and training
DBS figures and compliance for existing staff
Criteria for a Section 42 concern and relationships with Serious Incidents and complaints
Action: Issues to be taken to the SA sub groups
Positive learning from all sites to be shared
Restraint – reporting inconsistent
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Serious Incidents • There were 9 Serious Incidents affecting Bexley patients in Dec-15 to Jan-16, none were „never events‟.
• The types of incident reported were:-
2 Delayed diagnosis meeting SI criteria
2 Apparent/actual/suspected self-inflicted harm meeting SI criteria
2 Surgical/invasive procedure incident meeting SI criteria
1 Pressure Ulcer meeting SI criteria
1 Treatment delay meeting SI criteria
1 Slips/trips/falls meeting SI criteria
Source: STEIS national reporting system , reviewed on 23/02/16
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Quality (GP) Alerts
33 alerts received in Qtr3
A small increase on previous quarter (18%)
Organisation alert is related to
37% Oxleas
33% Lewisham & Greenwich NHS Trust
18% Darent Valley & Kings (9% each)
12% Hurley, LAS, LBB & Care Home (3% each)
Themes (top 3)
24% Insufficient info/poor discharge / poor communication
12% Delay in treatment
30% Poor Communication
Risk rating
23 Amber (response required from provider)
7 Green (provider informed for learning, no response required)
2 alerts unrated – awaiting further information to risk rate
1 contact not an alert and has been appropriately redirected
Source: Quality Alert Management System (QAMS) Oct – Dec 2015
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Lewisham & Greenwich NHS Trust
Source: South London CSU, Lewisham & Greenwich Trust Scorecard Month 9 captured on 16/02/2016
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Monthly Performance
Target Oct Nov Dec Comments
RTT 18 weeks (admitted patients) 90.00% 86.4% 85.6% 83.8% Following on-going discussions with CCG's Lewisham CCG has made £600k additional funding available to LGT for Orthopaedic patients. The Trust will present an activity plan for this funding at February Contract Management Board.
RTT 18 weeks (non admitted patients) 95.00% 94.6% 93.0% 92.4%
RTT 18 weeks (incomplete pathways) 92.00% 92.5% 92.4% 92.6%
Diagnostic tests waiting time 99.00% 99.8% 99.8% 99.8%
A and E waiting times 95.00% 91.3% 89.7% 91.5%
QEH has seen an increase against plan in A&E with weekly averages at 2980 against a plan of 2850. The increase has been mainly in admitted patients which has in turn resulted in extended waits for admission and DTAs in the morning in A&E. QEH has also seen an increase in the number or London Ambulance Service arrivals above the weekly average prediction of 616 arrivals with outcomes of 628, 622, 640 in recent weeks. Recovery plans in place.
Cancer two weeks (monthly) 93.00% 89.2% 93.8% 95.7%
Breast symptoms two weeks (monthly) 93.00% 98.5% 82.9% 89.5%
The Trust failed to meet the delivery of the Breast Symptomatic pathway for Dec-15. An investigation into the cause has been conducted.
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Lewisham & Greenwich NHS Trust
Source: South London CSU, Lewisham & Greenwich Trust Scorecard Month 9 captured on 16/02/2016
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Monthly Performance
Target Oct Nov Dec Comments
Cancer first definitive treatment 31 days (monthly) 96.00% 97.5% 98.6% 98.8%
Cancer subsequent treatment 31 days, surgery (monthly) 94.00% 100.0% 100.0% 90.9%
Cancer subsequent treatment 31 days, drug (monthly) 98.00% -- 100.0% 100.0%
Cancer subsequent treatment 31 days, radiotherapy (monthly) 94.00% -- -- --
Cancer composite, 62 days first treatment plus rare cancers (m) 85.00% 73.7% 75.2% 84.6%
Cancer first treatment 62 days, Screening (monthly) 90.00% 83.3% -- 100.0%
Cancer first treatment 62 days, Consultant upgrade (monthly) 100.0% -- 100.0%
RTT 52 weeks (admitted patients) 0 12 7 6
RTT 52 weeks (non admitted patients) 0 0 0 0
RTT 52 weeks (incomplete pathways) 0 4 3 2
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Lewisham & Greenwich NHS Trust
Source: Ref 1 – CCG Patient Experience Team
Ref 2 – Mystery Shopper feedback – Oct – Dec 2015
Ref 3 – NHS Choices – Oct – Dec 2015
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Ref Patient Experience
1 Complaints
In Q3 the CCG did not receive any formal complaint regarding services provided by
Lewisham & Greenwich NHS Trust
2 Mystery Shopper
93 feedback forms received regarding L> services
87% positive / 13% negative
Positives = Phlebotomy (QMH site), Midwifery (antenatal care) & A&E at QEH
Negatives = General surgery & colorectal surgery (delays)
3 NHS Choices headlines
A total of 30 comments for LGT were recorded on NHS Choices in Q3.
18 (60%) of comments reported a good experience
10 comments regarding A& E services ( 6 reported good experience)
5 related to Obstetrics – of which four reported a good experience
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Dartford & Gravesham NHS Trust
Source: South London CSU, Dartford & Gravesham Trust Scorecard Month 9 captured on 16/02/2016
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Indicator Monthly Performance
Target Oct Nov Dec comments RTT 18 weeks (admitted patients) 90.0% 83.7% 83.8% 84.9%
RTT 18 weeks (non admitted patients) 95.0% 97.0% 96.8% 96.7%
RTT 18 weeks (incomplete pathways) 92.0% 96.1% 95.5% 94.7%
Diagnostic tests waiting time 99.0% 99.8% 99.8% 99.8%
A and E waiting times 95.0% 89.2% 80.3% 83.1%
A&E Performance was 91.22% for year to end of December. The Trust reported that it declared Black status on 2 occasions and was supported by a divert to Medway on one of these occasions. The divert was a result of high occupancy.
Cancer two weeks (monthly) 93.0% 95.1% 96.2% 95.9%
Breast symptoms two weeks (monthly) 93.0% 97.0% 94.4% 93.5%
Cancer first definitive treatment 31 days (monthly) 96.0% 98.2% 98.4% 98.2%
Cancer subsequent treatment 31 days, surgery (monthly) 94.0% 100.0% 100.0% 100.0%
Cancer subsequent treatment 31 days, drug (monthly) 98.0% 100.0% 100.0% 100.0%
Cancer subsequent treatment 31 days, radiotherapy (monthly)
94.0% -- -- --
Cancer composite, 62 days first treatment plus rare cancers (m)
85.0% 85.1% 85.7% 90.9%
Cancer first treatment 62 days, Screening (monthly) 90.0% -- 100.0% 100.0%
Cancer first treatment 62 days, Consultant upgrade (monthly)
-- -- --
RTT 52 weeks (admitted patients) 0 0 0 0
RTT 52 weeks (non admitted patients) 0 0 0 0
RTT 52 weeks (incomplete pathways) 0 0 0 0
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Dartford & Gravesham NHS Trust (cont‟d)
Source: Ref 1 – CCG Patient Experience Team
Ref 2 – Mystery Shopper feedback – Oct – Dec 2015
Ref 3 – NHS Choices – Oct – Dec 2015
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Patient Experience
1 Complaints No formal complaints relating to DGT services were received by the CCG in
Q3.
2 Mystery Shopper
45 feedback forms received
76% positive / 24% negative
Positives = Radiology (QMH), Cardiology (outpatient care)
Negatives = Mottingham Ward (admission), A&E (clinical treatment)
3 NHS Choices headlines
24 comments were recorded on NHS Choices in Q3, 13 (54%) of them reported a
good experience
A&E - Five reported poor clinical treatment
Obstetrics – Three reported good customer care but two highlighted poor
clinical treatment
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King‟s College NHS Foundation Trust
Source: South London CSU, Kings College Trust Scorecard Month 9 captured on 16/02/2016
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Monthly Performance
Target Oct Nov Dec Comments
RTT 18 weeks (admitted patients) 90% RTT reporting suspension is currently in place, the Trust intends to return to national RTT reporting of January 2016 performance in February.
RTT 18 weeks (non admitted patients) 95%
RTT 18 weeks (incomplete pathways) 92%
Diagnostic tests waiting time 99% 98.6% 98.6% 93.2%
The number of breaches increased by 500 cases reported at the end Dec-15 to 630, 6.8% of the total number of patients waiting. Main breach areas are non-obstetric ultrasound mainly on the Denmark Hill (DH) site and MRI again mainly on the DH site. An action plan is being produced to reduce the backlog.
A and E waiting times 95% 91.7% 88.8% 87.4%
Four hour target, all types of
attendance performance worsened on
the PRUH site from 89.9% in Nov-15 to
86.1% in Dec-15, and performance for
type 1 attendances in A&E worsened
from 91.2% to 89.3%. Attendances
increased in A&E by 6.7% in Q3
compared to Q2 this year,
with all types attendances increasing by
2.1%. Despite the reduction in
performance reported in Dec-15, it is
10% higher than Dec-14 at 75.9%.
Cancer two weeks (monthly) 93% 95.2% 94.1% 96.3%
Breast symptoms two weeks (monthly) 93% 100.0% 99.0% 97.6%
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King‟s College NHS Foundation Trust
Source: South London CSU, Kings College Trust Scorecard Month 9 captured on 16/02/2016
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Monthly Performance
Target Oct Nov Dec Comments
Cancer first definitive treatment 31 days (monthly) 96% 100.0% 99.0% 98.9%
Cancer subsequent treatment 31 days, surgery (monthly) 94% 100.0% 98.4% 100.0%
Cancer subsequent treatment 31 days, drug (monthly) 98% 100.0% 100.0% 100.0%
Cancer subsequent treatment 31 days, radiotherapy (monthly) 94% -- -- --
Cancer first treatment 62 days, excludes rare cancers, GP Referral (m) 85% 91.0% 82.5% 86.0%
Cancer first treatment 62 days, Screening (monthly) 90% 93.9% 95.7% 100.0%
Cancer first treatment 62 days, Consultant upgrade (monthly) 100.0% 96.2% 100.0%
RTT 52 weeks (admitted patients) 0 RTT reporting suspension is currently in place, the Trust intends to return to
national RTT reporting of January 2016
performance in February.
RTT 52 weeks (non admitted patients) 0
RTT 52 weeks (incomplete pathways) 0
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Kings College NHS FT (cont‟d)
Source: Ref 1 – CCG Patient Experience Team
Ref 2 – Mystery Shopper feedback – Oct – Dec 2015
Ref 3 – NHS Choices – Oct – Dec 2015
28
Patient Experience
1 Complaints
In Q3 the CCG did not receive any formal complaint regarding services provided by Kings
College Hospital
2 Mystery
Shopper
224 feedback forms received regarding Kings services
85% positive / 15% negative
Positives = MSK (Physio), Ophthalmology (Clinical care), Dental/Maxillo Facial and
Rheumatology
Negatives = Ophthalmology (communication & appointment administration)
3 NHS Choices
headlines
33 comments were recorded on NHS Choices in Q3, of these 20 (60%) reported a good experience
A&E - Four reported a good experience, although three were unhappy about staff attitude and
clinical care received
Obstetrics - Three out of five reported a good experience
Wards – Three out of four were not happy with their treatment on wards and attitude of nursing
staff (unfortunately the wards in question are not identified in the feedback )
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Guy‟s & St Thomas‟ NHSFT
Source: South London CSU, Guy‟s & St Thomas‟ Trust Scorecard Month 9 captured on 16/02/2016
Source: South London CSU, GSTT Trust Scorecard Month 9 captured on 16/02/2016
29
Monthly Performance
Target Oct Nov Dec Comments
RTT 18 weeks (admitted patients) 90% 85.1% 82.6% 84.6% The backlog of patients waiting beyond 18 weeks has grown during 2015/16. There are a number of services with increased demand and limited alternative provision which are of particular concern. The Trust has contacted the national PMO regarding additional outsourced capacity and is maximising its own internal capacity . The Trust has been asked to complete demand and capacity modelling to the level of activity required to deliver the RTT incomplete target. The Trust have also employed additional validators to ensure the PTL is fully validated for all patients waiting beyond 18 weeks.
RTT 18 weeks (non admitted patients) 95% 91.9% 93.0% 92.2%
RTT 18 weeks (incomplete pathways) 92% 92.3% 92.1% 91.3%
Diagnostic tests waiting time 99% 98.7% 98.6% 98.0% Despite the target not being met there has been an improvement 2014/15
A and E waiting times 95% 93.5% 93.1% 92.8%
The Trust has been focussing on improvements both within A&E and across the emergency pathway. These include better outflow processes to admitting wards, improving escalation process and review of the Emergency Medical Unit.
Cancer two weeks (monthly) 93% 95.1% 93.6% 92.0% The Trust continue to monitor our out-patient capacity to ensure we respond to seasonal variations in referral rates Breast symptoms two weeks (monthly) 93% 97.6% 94.9% 91.8%
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Guy‟s & St Thomas‟ NHSFT
Source: South London CSU, Guy‟s & St Thomas‟ Trust Scorecard Month 9 captured on 16/02/2016
30
Monthly Performance
Target Oct Nov Dec Comments
Cancer first definitive treatment 31 days (monthly) 96% 95.1% 93.2% 95.0%
Cancer subsequent treatment 31 days, surgery (monthly) 94% 92.0% 89.8% 90.4%
The surgery breaches were due to a combination of medical, capacity and patient choice. The Directorates analyse these breach reasons to ensure that they can respond to the trends and themes to correct these in future months.
Cancer subsequent treatment 31 days, drug (monthly) 98% 98.8% 98.9% 98.1%
Cancer subsequent treatment 31 days, radiotherapy (monthly) 94% 97.3% 94.4% 95.8%
Cancer first treatment 62 days, excludes rare cancers, GP Referral (m)
85% 63.5% 70.9% 76.5%
The main factor in our failure to meet the overall target relates to the external referrals into the Trust for treatments. The Trust is recruiting two inter Trust co-ordinators to ensure that patients are referred in timely manner and placed on correct pathways.
Cancer first treatment 62 days, Screening (monthly) 90% 90.0% 100.0% 100.0%
Cancer first treatment 62 days, Consultant upgrade (monthly) 87.5% 95.5% 69.0%
RTT 52 weeks (admitted patients) 0 0 0 4 There has been significant focus on RTT, with additional assurance on activity and actions to actively reduce the backlog. The trend of a rising backlog has since been halted since August and is now slowly reducing, however the overall size of the waiting list remains a concern and we continue to work with commissioners of demand management options.
RTT 52 weeks (non admitted patients) 0 21 15 10
RTT 52 weeks (incomplete pathways) 0 4 6 3
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Guy‟s & St Thomas‟ NHSFT (cont‟d)
Source: Ref 1 – CCG Patient Experience Team
Ref 2 – Mystery Shopper feedback – Oct – Dec 2015
Patient Experience
1 Complaints One formal complaint about GSTT services was received by the CCG during Q3, which
relates to community cardiology services and administrative delay / communication delay.
2 Mystery
Shopper
Four feedback forms received regarding GSTT services, these relate to Cancer services,
Physiotherapy, Cardiology
Positives = clinical care in cardiology
Negatives = delays (physio), location of services(cancer)
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Oxleas NHS Foundation Trust
Source: Ref 1 – CCG Patient Experience Team
Ref 2 – Mystery Shopper feedback – Oct – Dec 2015
Ref 3 – NHS Choices – Oct – Dec 2015
32
Patient Experience
1 Complaints The CCG has not received any formal complaints about Oxleas services in Q3.
2 Mystery Shopper
Thirty-three mystery shopper comments received in Q3. 79% negative / 21%
positive. The majority of feedback relates to QMH site (car parking, buildings,
estate etc.). However, negatives comments have also been noted around attitude
of staff in Meadowview Ward and lost property.
3 NHS Choices headlines
NHS Choices had six comments in relation to Oxleas services (all negative). Four
of the comments relate specifically to mental health rehabilitation and highlight
poor attitude from medical staff.
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Oxleas NHS Foundation Trust (cont‟d)
Source: Oxleas CQRG papers Feb-16
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Patient Safety
Pressure ulcers
Reporting themes Quarter 3, 2015/16
• There have been no avoidable grade 4 pressure ulcers acquired in Oxleas care in Q3.
• There are less grade 3 pressure ulcers in Q3 compared to Q2
• There have been 12 avoidable pressure ulcers in 2015/16 to date (Q3 decisions are yet to
be made at January panel).
• There are similar numbers of grade 2 PUs in Q3 2015/16 and 2014/15
• There are 6 more grade 3 PUs in 2015/16 compared to 2014/15 but DNs report that
caseload sizes have increased and these patients have more complex needs and unusual
sites for pressure ulcers eg ear, leg.
Continence Survey
Recommendations following patient survey
• The Continence Team to review all patients receiving products within next 6 months and
give advice / make changes as necessary. They continue to promote continence and the
provision of pads is the last resort following full assessment. This will be made clear to all
patients who are assessed.
• Re-survey in six months
• Continence service continues to hold quarterly meetings with the pad manufacturer
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Oxleas NHS Foundation Trust (cont‟d)
Source: Oxleas CQRG papers Feb-16
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Clinical Effectiveness
Mental Capacity
Act Audit
The audit showed that improvements could be made in relation to
• Consistency in demonstrating that individuals consent to the care they receive
(admission/treatment/observation)
• Evidencing the authority staff rely on to authorise the care of patients, especially
where it is unclear whether individuals have consented to their care.
• Evidencing in records that patients under continuous control and supervision had
consented to such arrangements or that such care plans were authorised through the correct process.
Recommendations and Next Steps
• The Trust will continue to provide various learning platforms to afford staff adequate
understanding and knowledge of the Mental Capacity Act. The Trust will also continue to make available
relevant tools and “monitoring systems” to aid staff in their understanding
and compliance with expectations of the MCA in their daily practice.
• Front line managers will be asked to include as a matter of routine during supervision
sessions, discussions and reflections on instances where staff observed the principles/provisions of the
MCA in their daily practice.
• The aim is for staff to as a matter of routine, carry out capacity assessments where
appropriate and apply best interests decision-making processes where relevant i.e. if the
patient lacks the relevant decisional capacity. Staff will also be encouraged to consistently
ask themselves “what authority they have to proceed with patient care i.e. is it with the
patients consent or is it by using provisions of the relevant health legislation (Mental Health
Act/Mental Capacity Act) or perhaps in certain cases in compliance with a court order or
more remotely common law.
• The Trust Clinical Lead for MCA will explore the possible creation of a system whereby MCA related
incidents are subject of reflective practice sessions across the Trust and subject of embedded learning
events.
• The Trust will also continue to carry out audits and surveys to monitor and promote the
compliance of practice within Oxleas NHSFT with MCA principles and provisions.
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Other Contracts - Care Homes
Source: Bexley CCG Adult Safeguarding Lead, Feb-16
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Subject Detail
Maples Care Home • Maples is no longer in special measures. CQC are removing the imposed conditions and the provider has
given a written plan for gradual planned new admissions. (Source: Email from Julie Burgess CQC 12/02/2016)
Sidcup Nursing and
Residential Care Home
• Feedback from CHC team is that the home is currently refusing CHC residents. (Source: Bexley CCG, CHC Manager – Verbal 16/02/2016)
• Barnard Medical Practice has raised the issue of out of hours GPs calling relatives and persuading them
that their relative should go to A&E. (Source: Contract meeting with Barnard Medical Centre 22/02/2016)
Northbourne Court
Care Home:
• CQC inspection with verbal feedback indicating that the overall outcome will be good.
• A specialist in falls was part of the team and found that the risk assessments and risk management
plans were adequate. (Source: Heather Brimm – Service Director based on brief written feedback from CQC)
St Aubyns • Issue raised of a need for training for nurses in providing subcutaneous fluids. (Source: Contract meeting
with Barnard Medical Practice and St Aubyns 22/02/2016)
St Marys • Quality issues raised at CQC Inspection
Care plus Partnership • Oakwood House closed on 29 February 2016. A Safeguarding Adults review will take place and is likely
to be led by Lewisham. Daily visits carried out in final week of business (Teleconference 22/02/2016 led by Elaine Ruddy NHS England)
QAMS: Quality Alerts
Monitoring System
• The homes have not been engaging with this process. The Quality Monitoring Officers in LBB have
been informed and will be working with the homes to encourage them to participate. (Source: Email from David Parker 22//02/2016)
Training to Care
Homes
• LBB provides multiagency level 3 safeguarding training. Training provided to 8 staff from Oxleas Mental
Health Intake Team. (Source: LBB Training Spread sheet 10/02/2016)
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Other Contracts – Hurley Group
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Patient Experience
1 Complaints No formal complaints regarding Hurley Group were received in Q3.
2 Mystery Shopper Mystery shopper feedback 90% positive / 10% negative. Areas of poor feedback
relate to clinical treatment.
3 NHS Choices headlines
NHS Choices highlighted 18 contacts regarding Hurley services at QMH and Erith
Hospital.14 of which recorded a positive experience. Negative feedback relates to
attitude of staff, waiting time and clinical treatment.
Source: Ref 1 – CCG Patient Experience Team
Ref 2 – Mystery Shopper feedback – Oct – Dec 2015
Ref 3 – NHS Choices – Oct – Dec 2015
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Engagement Activity
Source: Ref 1 Patient Council meeting minutes Oct – Dec 15
Ref 2 Patient feedback Oct – Dec 15
Ref 3 Patient engagement team
37
1 Patient Council Two meetings of the Patient Council took place during Q3 (November and December). Agenda
items included „Our Healthier South East London‟, Primary Care Development, and updates on
progress at Queen Mary‟s Hospital.
2 CCG activity
Five formal complaints have been received about CCG services/decisions in Q3. All five relate to
Continuing Healthcare/ retrospective review funding decisions.
The Head of Patient Experience has been working closely with the commissioning and contracting
team and is supporting engagement activities with several redevelopment projects.
Patient representatives have also been recruited and are supported in attending contract monitoring
meetings, including MSK services, Ophthalmology, Palliative Care, Cardiology and Physical
Disability re-procurement.
3 Engagement
• Older People Day – national campaign awareness and event
• Community engagement stand at QMH
• Health bus – community information stand at Bexleyheath Broadway
• Launch Youth Health Ambassador Scheme
• Erith Town Forum
• Equality Steering Group
• Hosted Patient and Public Voice – training for Patient Council and PPG representatives
• MSK – Walk my shoes experience at Orpington Hospital
• Big Health Check event for People with Learning Disabilities
• South East London Stakeholder Reference Group
In addition to the above the PET attended service provider AGMs including Age UK Bexley and
Mencap. We have also attended contract monitoring meetings with patient champions regarding
MSK, QMH site development, Ophthalmology, Cardiology, UCC and Primary Care Services
Development
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This report provides a summary of quality, safety and performance. Further information can be obtained from the Quality and Patient Experience teams.
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Enc Q(i)(a) FS QSP report MAR16Enc Q(i)(b) QSP Mar-16 Final for GB