Board Report - Performance

November 2008

Produced by Business Intelligence (Performance)

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RWSx 11 6 11 7 11 5WASH 25 14 16 13 9 12QV 0 0 1 1 0 0BSUH 7 3 9 6 2 2SASH 4 8 11 2 4 2Community 34 36 24 25 21 16Cumulative Actual 83 156 231 287 337 377Cumulative Trajectory 70 139 207 270 333 401 469 543 617 691 764 834

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RWSx WASHQV BSUHSASH Cumulative trajectory (Trust Only)YTD Actual C.diff Infections (Trust Only) Cumulative Community ActualsCumulative Community trajectory

West Sussex PCT Cleanliness and HCAI - Commissioner Clostridium difficile infections 2008-09

Performance Traffic Light

C. Diff - September year to date sees the first time our infection rate is lower than plan. For RWSx: Compliance with the High impact Intervention bundle has improved greatly. WASH: All gastrointestinal inpatients are now to have routine stool sampling to ensure early detection. Matrons are reviewing the care plans of patients experiencing a relapse of symptoms to ensure that the level of care received was not a cause of the relapse. Wards at Worthing Hospital which do not have single rooms are now receiving daily rounds from the infection control team to heighten awareness of their high risk patients.

MRSA - The PCT will take steps to improve urinary catheter care and the management of wounds in the community. Standardise data collection for RCA audits will assist with the investigation process, in line with DH recommended best practice. The PCT will continue to seek improvements in the recording of HCAI risk status in GP information systems and to improve the quality of information on transfer of patients between institutions.

Cleanliness and HCAI

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QV 1 0 0 0 0 0RWSx 1 0 1 2 2 1WASH 5 2 3 2 1 2YTD MRSA Infections 7 9 13 17 20 23Cumulative Trajectory 2 4 6 8 10 13 15 17 20 22 24 27

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QV RWSx WASH Cumulative trajectory YTD Actual MRSA Infections

Performance Traffic Light

West Sussex PCT

Cleanliness and HCAI - MRSA infections 2008-09

0500

1000150020002500

30003500400045005000

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Ambulance Response times to Cat A - % within 8 minutes

Performance Traf f ic Light

75 %75% target

The above charts relate to West Sussex PCT. For the Annual health check we are measured against SECAmb performance, based on our score for March 09 YTD. For Category A - % within 8 minutes September month performance is above the 75% target required, at 78.6%. This gives a year to date performance of 72.8%. To achieve the target set, performance will need to be above 77.7% every month till March 09 (except for December 08 where its 75%). Both Category A 19 and B 19, performance are both above target for the month and year to date. See Appendix A - SECAmb Cat A (8 min) Performance MIS Package - September 08 for details of local performance.

Emergency Care

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Ambulance Response times to Cat B - % within 19 minutes

Performance Traf f ic Light

95% target

Emergency Care - Focused Wards: Cat A (8 min) CallsWards with >100 calls (Jan-Sep) and <50% Performance

The above table is an addition to the SECAmb Cat A (8 min) Performance MIS Package, which will be produced monthly this will help to identify those Wards with high calls and low performance. This information will be shared with Contract Managers and taken into account when developing specific schemes to improve performance. See Appendix A - SECAmb Cat A (8 min) Performance MIS Package - September 08 for details of local performance.

Emergency Care - Focused Wards: Cat A (8 min) CallsWards with >100 calls (Jan-Sep) and <50% Performance

See Appendix A - SECAmb Cat A (8 min) Performance MIS Package - September 08 for further details.

Breach reports for non-obstetric ultrasound scans at Park Surgery are currently being validated, but it is clear a proportion of the breaches are genuine. Work is continuing to ensure the surgery complies with reporting and waiting time standards. All other diagnostic waits including audiology assessments now at 6 weeks.

The diagnostic return for October will include numbers of patients breaching the 6 week target, which have not previously been visible via this statutory return. This is due to numbers being included in the West Sussex Health 18 week RTT Provider return and were included with other paediatric services rather than being reported separately under the audiology and / or diagnostic pathways.

Numbers attributable to the West Sussex Health Paediatric Audiology Services are as follows:•115 patients were treated in October, of which 86 waited 6 weeks or longer (69 from Crawley and 17 from Haywards Heath) •166 patients were still waiting at the end of October, of which 57 had already waited  6 weeks or longer (43 from Crawley and 14 from Haywards Heath). There is an Action Plan to address the backlog of patients waiting 6 weeks or longer; Haywards Heath by end of November and Crawley by December.

18 Weeks

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Patients waiting > 6 weeks for 15 key diagnostic tests (monthly data) 21 7 59 46 43 21Patients Waiting 6+ Weeks for all other diagnostic tests on Quarterly Census 0 0 2 0 0 0

Total 21 7 61 46 43 21Target 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

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Non-obstetric ultrasound Audiology - Audiology Assessments Cardiology - echocardiography Colonoscopy Cystoscopy Other Quarterly data

West Sussex PCT 18 weeks - diagnostic tests

There has been an increase of all referrals of 0.8% against last year. This can be broken down into General & Acute (G&A) and Non G&A. G&A referrals as at September YTD have increased by 1.6% from 2007/08, this is made up of GP (11.8% growth) and Other (12.2% reduction). For Non G&A referrals there has been a reduction of 50% since last year.

DemandWest Sussex PCT

GP Referrals (G&A)

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2008/09 Plan

West Sussex PCTOther Referrals (G&A)

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Patients seen in previous 24 months March 2006

Patients seen in previous 24 months March 2008Patients seen in previous 24 months of June 2008Patients seen in previous 24 months of Sept 2008Patients seen in previous 24 months of Dec 2008Patients seen in previous 24 months of Mar 2009

Annual Target

403,603

439,702

No. Patients

420,767

403,641

403,369

92%

96%

4.) No. patients receiving NHS primary dental services located in the PCT area in a 24 month period

92%

92%

% annual target achieved

Dental services – The Oral health needs assessment is now complete and informing to the commissioning plan. New services will be tendered in areas of greatest need to improve access for patients.

Primary care Access – In 2007 08 the PCT under achieved this indicator despite year on year improvements in the PC Access survey score. This indicator was made up of two parts – Access to a GP (under achieved) and Access to a primary care professional (Achieved). The former was based on the GP patient survey and the latter on actual recorded data. Its important to point out that targets have to be met for both sub indicators to achieve the required score, and that the difference between the two scores was also taken into account. In 2008/09 the PCT has made good progress in offering extended hours in Primary Care.

Primary Care

A meeting has been arranged for the DH in December to review the Chlamydia screening programme to seek improvements. From October screening will be offered by GPs at the same time as HPV vaccine and postal kits are to be sent out daily.

Sexual Health

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No. 15 - 24 year old persons screened or tested for Chlamydia 282 284 252 201 226 510target 1,270 1,270 1,270 1,270 1,270 1,270 1,270 1,270 1,270 1,270 1,270 1,270Annualised Screening or testing 3,384 3,396 3,272 3,057 2,988 3,510The population aged 15 - 24 years 89,663 89,663 89,663 89,663 89,663 89,663 89,663 89,663 89,663 89,663 89,663 89,663Actual % population aged 15 - 24 screened or tested for chlamydia 3.8% 3.8% 3.6% 3.4% 3.3% 3.9%Target % population aged 15 - 24 screened or tested for chlamydia 17.0% 17.0% 17.0% 17.0% 17.0% 17.0% 17.0% 17.0% 17.0% 17.0% 17.0% 17.0%

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West Sussex PCT

% of population 15-24 screenedTarget

Number of pateints screenedTarget number of patients screened

Sexual Health - Screening for Chlamydia

The criteria for measurement for the Annual Health Check is based on performance in 2007 08, those numbers have been collected and we have achieved this target. The above numbers will be published on the National Child Measurement Programme website in December.

Health Improvement – Obesity amongst school age children

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

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2006_07 2007_08 2008_09 2009_10

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Actual - Obese Target - Obese Actual - Recorded Target - Recorded

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

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Actual - Obese Target - Obese Actual - Recorded Target - Recorded

Health Improvement

Actions planned include:•Working with GP practices to improve data collection•Pfizer mail shot project in Burgess Hill to be rolled out if successful•Poster and publicity campaign in LNIA areas•Pharmacy Enhanced Service to launched on 10th November•New communications plan being developed with Public Health•Letter to dentists and acute medical directors to encourage referral to smoking cessation services

There has been an improvement in performance in Q2, but still below target. Plans are in place to improve data collection through health visitors from January 2009 onwards.

Health Improvement

Prevalence of Breastfeeding at 6-8 weeks

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Jun-08 Sep-08 Dec-08 Mar-09 Mar 09 Target

Prevalence - No. of infants at 6-8 weeks who are breastfed against the no. that are due for checks during q4

Coverage: No. of children with a breastfeeding status recorded as a % of all infants due for a 6–8 week check during q4

Health Improvement – Child Immunisation rates

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Children aged 1 immunisedfor DTaP/IPV/Hib

Children aged 2 immunisedfor PCV

Children aged 2 immunisedfor Hib/MenC

Children aged 2 immunisedfor MMR

Children aged 5 immunisedfor DTaP/IPV

Children aged 5 immunisedfor MMR

Jun-08

Sep-08

Dec-08

Mar-09

Mar-09 Target

West Sussex PCT Health Im provem et - Im m unisation rates 2008-9

There are plans in place to carry out a benchmarking exercise between GPs on a 6 monthly basis and provide GPs with performance reports, to identify areas of under performance. Currently there is a possibility that some vaccinations are not been counted. A data cleansing exercise will take place over the coming months to ensure GP records are in line with the Child Health System. To improve awareness of this service, health visitors will be encouraged to promote the availability of this service to children.

Other reasons for the drop in performance relate to; staffing issues at the Child Health Bureau, which have been resolved, the low availability of vaccinations which resulted in a backlog which they are currently resolving.

WASH national re-visit is now taking place in November. Q2 performance worsened as predicted.

The cumulative achievement for both providers (BSUH and WASH) against 100% target for quarter 4 is estimated to be 83%. Whilst BSUH expects to maintain the 100% target, WASH will not be in a position to meet it by the end of the 4th quarter. Throughout January to March 09 WASH will have in place sufficient screening appointments and staffing capacity to meet and sustain a screening level of 2000 patients per month which will enable that service to achieve the 100% target throughout 2009/10. The English National Screening Programme for Diabetic Retinopathy (ENSPDR) Quality Assurance visit to the WASH Diabetic Retinopathy service takes place on December 2nd.

Health Improvement

9) Diabetic Retinopathy      

         

 No offered screening for diabetic retinopathy

Total no. with diabetes, less those exclusions from screening) % achievement % Target

Jun-08 25,912 27,866 93% 100%

Sep-08 23,924 28,888 83% 100%

Dec-08        

Mar-09        

An Acute Stroke Data Group has been set up and meet on a monthly basis, the aim is to ensure robust data can be collected, to meet the required targets which have been set. At present all acute trusts are reviewing the data and will collect a sample set for review in quarter 4.

Stroke

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6% 5% 0% 0%5.0% 5.0% 5.0% 65.0% 65.0% 65.0% 65.0% 65.0%

No. people who spend at least 90% of their time on a stroke unit% people who spend at least 90% of their time on a stroke unitTarget %

No. people who have a stroke who are admitted to hospital

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Performance Traffic Light

West Sussex PCT

Stroke - time on a stroke unit

% patients who spend 90% of time on a stroke unitPatients admitted for stroke who spend > 90% of time on a stroke unit

Patients admitted for stroke who spend < 90% of time on a stroke unit

Appendix A

• SECAmb Cat A (8 min) Performance MIS Package - September 08