HSC BOARD PERFORMANCE REPORT 2014/15 (Month 11 ... BOARD...1 HSC BOARD PERFORMANCE REPORT –...

1

HSC BOARD PERFORMANCE REPORT – 2014/15 (Month 11 – February 2015)

Purpose

This paper provides Board members with an assessment of performance against the 2014/15

standards and targets set out in the Minister’s Commissioning Plan Direction (Northern Ireland)

2014. The position regionally and by Trust at the end of February 2015 for the targets and

standards that the Board is responsible for monitoring and where monitoring information is

currently available is set out in Annex A.

Introduction

The key performance challenges, including the reasons for the current performance and the

actions being taken to address these, remain as reported at the March Board meeting. Given

that the performance trends remain broadly unchanged from last month, this report provides a

brief update on performance only for these areas and the remainder of the report provides a

more detailed update on psychological therapies (Annex B), as requested at the March Board

meeting.

Full details of performance across all target areas are provided in Annex A.

1. Elective Care (including Diagnostics)

There has been a slight increase in the number of patients waiting longer than nine weeks

for a first outpatient appointment or 13 weeks for inpatient/daycase treatment compared to

the position at the end of January 2015 – at the end of February 2015, 104,363 outpatients

were waiting longer than nine weeks and 27,475 patients were waiting longer than 13

weeks for treatment. There has however, been a reduction in the number of patients

waiting longer than nine weeks for a diagnostic test – at the end of February 2015, 20,132

patients were waiting longer than nine weeks, a reduction of 2,167 from end of January.

2

26,937

34,103 32,43236,350

42,084

29,915 31,91334,766

38,261

47,78243,824

39,768

49,528

58,761 56,08764,648

75,595 73,61178,864

85,588

95,437

103,156 104,363

0

20,000

40,000

60,000

80,000

100,000

120,000

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

Outpatients - Number waiting > 9 weeks

2013/14 2014/15

8,829

8,701 8,747 8,7268,085

6,3365,818 5,732

7,484

8,8318,069 7,837

10,201

11,55911,063

12,61813,636 13,170

14,086

15,887

20,284

22,299

20,132

0

4,000

8,000

12,000

16,000

20,000

24,000


Diagnostics waiting > 9 weeks(Imaging and Physiological Measurement)

2013/14 2014/15

16,01317,184 16,887 16,887

18,49317,464

15,18314,256

15,91517,391 17,254

16,356

17,34118,781

17,62418,544

19,879 20,08220,688 20,786

23,393

26,04927,475

0

5,000

10,000

15,000

20,000

25,000

30,000


IPDC - Number waiting > 13 weeks

2013/14 2014/15

Apart from diagnostics, where the position is expected to continue to improve as a result of

the funding allocated for additional activity in quarter four, elective waiting times will

increase due to the lack of funding for additional outpatient and inpatient/daycase treatment

in the second half of this year in specialties where there is a gap between funded capacity

and patient demand.

3

2. A&E (4-hour and 12-hour standards)

As indicated at the March Board meeting, 642 patients waited longer than 12 hours during

February 2015 – this represents an increase compared with January 2015 (380) and with

the same month last year (268). The majority of the breaches of the 12-hour standard

during February 2015 were in the Belfast (323) and South Eastern (229) Trusts. It should

be noted that no patients waited longer than 12 hours in the Southern Trust during

February.

Four-hour performance regionally also deteriorated from 75% in January 2015 to 71% in

February.

998

294

244

191150

76 77 82

165 156

268

408241

204

294

40142

260

141 12592

380

642

0

200

400

600

800

1000

1200


A & E - Number waiting >12 hours

2013/14 2014/15

72%

80% 82% 80% 80% 80% 81% 80%76% 76% 75% 75%

77% 77% 79%82%

79% 79% 79% 80% 77% 75%71%

0%

20%

40%

60%

80%

100%


A & E - % within 4 hours

2013/14 2014/15

In relation to the deterioration in performance during February, it should be noted that

regionally there was a 5% increase in attendances and a 5% increase in admissions

compared with the same month last year. Furthermore, during February 2015, Trusts

experienced a 14% increase in the number of attendances by patients aged 80 or over and

an 8% increase in the number of patients who were triaged as category 2 (very urgent) or 3

4

(urgent). All of these factors combined will have contributed to the increased pressures

experienced by Trusts in February.

3. Cancer Services

Regionally during February 2015, performance against the 14-day breast cancer standard

has deteriorated compared to the previous month – 90% of urgent referrals were seen

within 14 days compared to 94% in January 2015. This is due to performance in the Belfast

Trust which has deteriorated in February to 55% however, it should be noted that all other

Trusts achieved 100% during February. The Board is working with Belfast Trust to develop

increased flexibility in the service to take account of peaks and troughs in demand and the

Trust expects performance to improve during quarter one with additional clinics coming into

effect from mid-April. In addition, there are a number of recording issues which are

currently being addressed.

97% 99%

89% 88%

97%

85%89%

81%

80%76% 74%

53%61%

56%60%

46%

87%

99% 100%97% 96% 94%

90%

0%

20%

40%

60%

80%

100%

April May Jun Jul Aug Sept Oct Nov Dec Jan Feb March

Breast Cancer - % Seen within 2 weeks

2013/14 2014/15

Regionally during February 2015, 96% of patients diagnosed with cancer received their first

definitive treatment within 31 days of a decision to treat.

Performance against the 62-day standard has reduced compared with the previous month –

during February 2015, 69% of patients urgently referred with a suspected cancer began

their first definitive treatment within 62 days.

5

80%86%

82% 85% 83% 82%78%

86%82%

78% 78% 79%

77%73%

77%73%

76%

66%70%

74% 74% 72%69%

0%

20%

40%

60%

80%

100%


Cancer - % treated within 62 days

2013/14 2014/15

Trusts are continuing to focus on treating the longest waiting patients and, as performance

against the 62-day cancer access standard is based on completed waits in month, the pace

of progress towards achievement of the 95% standard is as expected as it reflects that a

higher proportion of patients treated in month were the longer waiters. This position is

evidenced by the significant reduction in the number of patients actively waiting longer than

62 days on the urological cancer pathway since January – in Belfast Trust, the number of

patients has reduced from 70 to 29 and, in Northern Trust, the number has reduced from 46

to seven.

Performance against the 95% standard in the Western and Southern Trusts remains strong

– 91% and 89% respectively during February. However, performance in the South Eastern

Trust continues to be well below the required level – during February 2015, 55% of patients

began their first definitive treatment within 62 days and 130 patients were actively waiting

longer than 62 days (44% of the regional total). This performance issue is the subject of

ongoing discussion between the Board and Trust.

4. Psychological Therapies

The number of patients waiting longer than 13 weeks to access psychological therapies has

continued to increase during 2014/15 – 854 patients were waiting longer than 13 weeks at

the end of February 2015.

6

274312

352406

481525

460414

535 511 526

426438495

551 575610

678 688 700

830 831 854

0

200

400

600

800

1000


Psychological Therapies - Numbers Waiting >13 Weeks

2013/14 2014/15

The majority (75%) of patients waiting longer than 13 weeks to access psychological

therapies at the end of February 2015 were in Belfast (183) and South Eastern (460) Trusts.

Trust

Adult Mental

Health

Adult Health

Psychology

Children's

Psychology

Adult &

Children's

Learning

Disability

Psychosexual

ServicesTOTAL

Belfast 55 82 14 32 183

Northern 84 2 3 89

South Eastern 347 104 9 460

Southern 41 1 42

Western 60 1 2 15 2 80

Total 587 189 16 60 2 854

A paper providing a detailed update on psychological therapies is attached at Annex B.

Conclusion

More detail on the actions being taken in relation to these and other performance areas will be

provided by the relevant Directors at the Board meeting.

Michael Bloomfield Director of Performance and Corporate Services April 2015

7

Annex A SUMMARY OF PERFORMANCE AGAINST 2014/15 COMMISSIONING PLAN DIRECTION STANDARDS AND TARGETS

STANDARD (from April 2014) TARGET (by March 2015 unless stated

otherwise) Trend Analysis Comments

To improve the quality of services and outcomes for patients, clients and carers, through the provision of timely, safe, resilient and sustainable services in the most appropriate setting. Hip Fractures (Standard) – from April 2014, 95% of patients, where clinically appropriate, wait no longer than 48 hours for inpatient treatment for hip fractures.

Dec-14 Jan-15 Feb-15 14/15 Cum

Belfast 89% 100% 95% 88%

Northern

South Eastern 93% 78% 89% 79%

Southern 92% 100% 100% 90%

Western 89% 90% 85% 89%

Region 90% 95% 92% 87%

TrustFracture NoF- % within 48 hours

Regionally during February 2015, 92% of patients, where clinically appropriate, received inpatient treatment for hip fractures within 48 hours.

Cancer care services 1 (Standard) – from April 2014, all urgent breast cancer referrals should be seen within 14 days.

Regionally during February 2015, performance against the 14-day breast cancer standard has deteriorated compared to the previous month – 90% of urgent referrals were seen within 14 days compared to 94% in January 2015. This is due to performance in the Belfast Trust which has deteriorated in February to 55% however, it should be noted that all other Trusts achieved 100% during February. The Board is working with Belfast Trust to develop increased flexibility in the service to take account of peaks and troughs in demand and the Trust expects performance to improve during quarter one with additional clinics coming into effect from mid-April. In addition, there are a number of recording issues which are currently being addressed.

8




Belfast 83% 79% 55% 89%

Northern 100% 100% 100% 68%

South Eastern 100% 100% 100% 65%

Southern 100% 100% 100% 81%

Western 100% 98% 100% 99%

Region 96% 94% 90% 81%

TrustCancer Services (Breast) - % within 14 days

Cancer care services 2 (Standard) – from April 2014, at least 98% of patients diagnosed with cancer should receive their first definitive treatment within 31 days of a decision to treat.

98% 97% 97% 97% 97% 96% 95% 97% 96% 95% 94% 96% 96%

0%

20%

40%

60%

80%

100%

13/14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 14/15Cum

Cancer - % treated within 31 days


Belfast 91% 89% 91% 93%

Northern 99% 100% 100% 99%


Southern 100% 99% 100% 99%

Western 100% 100% 100% 100%

Region 95% 94% 96% 96%

Cancer Services - %

9




Belfast 74% 62% 64% 67%

Northern 68% 68% 62% 68%


Southern 91% 91% 89% 84%

Western 94% 94% 91% 92%

Region 75% 72% 69% 73%

TrustCancer Services - %

10




Belfast 45 85 323 1,449

Northern 1 42 80 469


Southern 1 9 0 13

Western 0 7 10 17

Region 92 380 642 2,561

TrustA&E - No. treated within 12 hours

Unscheduled care 3 (Target) – by March 2015, 72.5% of Category A (life threatening) calls responded to within eight minutes, 67.5% in each LCG area.

64%69% 70% 68% 69% 71%

72% 70%65% 66% 64% 65%

67% 66% 63%59% 58% 59% 59% 57%

51% 53% 50%

0%

20%

40%

60%

80%

100%


NIAS - % Cat A calls

11



Hospital readmissions (Target) – by March 2015, secure a 5% reduction in the number of emergency readmissions within 30 days (using 2012/13 data as the baseline).

Profile

Reduction

(April - Nov

2014)

Actual (April -

Nov 2014)

Variance

(Actual vs

profile)

% Variance

(Actual vs

profile)

Belfast 3,600 5,564 1,964 55%

Northern 2,629 3,139 510 19%

South Eastern 3,015 3,430 415 14%

Southern 2,668 3,018 350 13%

Western 2,844 3,633 789 28%

Region 14,757 18,784 4,027 27%

Trust

Emergency Readmissions (5% reduction within 30 days)

Trusts are permitted three months to complete clinical coding. Cumulatively in the year to end of November 2014, there have been 18,784 emergency readmissions within 30 days against a reduction profile of 14,757.

Elective care 1 (Outpatients) (Standard) – from April 2014, at least 80% of patients wait no longer than nine weeks for their first outpatient appointment and no patient waits longer than 15 weeks.

30.11.14 31.12.14 31.1.15 28.2.15

Belfast 43% 40% 35% 37%

Northern 50% 46% 42% 44%


Southern 53% 48% 46% 47%

Western 60% 55% 53% 53%

Region 49% 44% 41% 42%

Trust Outpatients - % waiting

12



30.11.14 31.12.14 31.1.15 28.2.15

Belfast 39,216 43,520 45,903 46,462

Northern 11,957 12,157 14,182 14,018

South Eastern 14,908 17,057 19,114 19,641

Southern 12,184 13,875 14,963 15,086

Western 7,323 8,828 8,994 9,156

Region 85,588 95,437 103,156 104,363

Trust Outpatients - No. waiting >9 weeks

13



30.11.14 31.12.14 31.1.15 28.2.15

Belfast 27,110 30,667 33,168 35,385

Northern 7,497 7,680 9,368 10,062

South Eastern 8,735 10,459 12,617 14,115

Southern 6,389 7,440 8,731 9,527

Western 4,318 5,076 5,544 6,069

Region 54,049 61,322 69,428 75,158

Trust Outpatients - No. waiting >15 weeks

Elective care 2 (Diagnostics) (Standard) – from April 2014, no patient waits longer than nine weeks for a diagnostic test.

30.11.14 31.12.14 31.1.15 28.2.15

Belfast 5,903 7,370 8,911 7,628

Northern 6,182 7,395 7,858 7,283

South Eastern 986 1,010 1,134 1,271

Southern 2,151 3,697 3,661 3,214

Western 665 812 735 736

Region 15,887 20,284 22,299 20,132

Trust Diagnostics - No. waiting >9 weeks

At the end of February 2015, 20,132 patients were waiting longer than nine weeks for a diagnostic test.

As previously reported, following the outcome of the October monitoring round, the Board confirmed non-recurrent funding to Trusts (at end of November 2014) to undertake additional radiology activity to deliver improved waiting times by March 2015. Funding was provided to deliver an additional 60,000 diagnostic tests however, given the timing of the confirmation of the funding and the time required to put arrangements in place for the additionality, a proportion of this additional activity has not yet been reflected in the numbers waiting longer than nine weeks, and the position is expected to improve by the end of March 2015.

The Board will monitor Trusts’ progress at the regular elective performance meetings to ensure the agreed outcomes are delivered, both in terms of activity and waiting times.

14



Elective care 3 (Diagnostic Reporting) (Standard) – from April 2014, all urgent diagnostic tests are reported on within two days of the test being undertaken.


Belfast 90% 91% 87% 89%

Northern 97% 97% 97% 98%


Southern 83% 87% 79% 85%

Western 92% 92% 92% 92%

Region 91% 92% 88% 91%

TrustDRTT (urgent) - % within 2 days (inc plain film)

Regionally during February 2015, 88% of urgent diagnostic tests were reported on within two days of the test being undertaken.

Elective care 4 (Inpatient/Daycase) (Standard) – from April 2014, at least 80% of patients and daycases are treated within 13 weeks and no patient waits longer than 26 weeks.

30.11.14 31.12.14 31.1.15 28.2.15

Belfast 48% 45% 42% 40%

Northern 84% 80% 77% 76%


Southern 71% 65% 63% 65%

Western 69% 63% 58% 55%

Region 61% 57% 54% 52%

Trust Inpatient & Daycases - % waiting

15



30.11.14 31.12.14 31.1.15 28.2.15

Belfast 13,154 14,099 15,323 16,165

Northern 854 1,088 1,325 1,374

South Eastern 1,703 2,004 2,282 2,648

Southern 2,410 2,969 3,220 3,017

Western 2,665 3,233 3,899 4,271

Region 20,786 23,393 26,049 27,475

Trust Inpatient & Daycases - No. waiting >13 weeks

30.11.14 31.12.14 31.1.15 28.2.15

Belfast 5,715 6,609 7,413 7,869

Northern 150 202 267 293

South Eastern 504 665 830 1,009

Southern 864 1,131 1,173 1,158

Western 898 1,159 1,407 1,677

Region 8,131 9,766 11,090 12,006

Trust Inpatient & Daycases - No. waiting >26 weeks

16



Healthcare acquired infections (Target) – by March 2015, secure a further reduction of 9% in MRSA and Clostridium difficile infections compared to 2013/14.

2014/15

Maximum

2014/15

Profile

(Apr 14-

Feb 15)

2014/15

Actual

(Apr 14-

Feb 15)

Variance

(actual vs

14/15 target

profile)

Belfast 105 96 129 33

Northern 56 51 58 7


Southern 32 29 38 9

Western 45 41 68 27

Region 288 264 358 94

Trust

C.Diff - No more than 288 during 2014/15

Regionally during the period April 2014 to February 2015, there have been 358 cases of C. Difficile against a target profile to have had no more than 264 cases. At the end of February 2015, all Trusts have exceeded their target maximum for the full year. The Public Health Agency (PHA) circulated an alert/learning note on the C. difficile position to Trusts in September 2014 (signalling that regional CDI position has moved above trajectory). This alert included a recommendation for the Lead HCAI Director, Lead Infection Prevention and Control doctor and nurse in each Trust to review their current CDI position to reinforce key improvement messages and actions. Regionally in the year to end of February 2015, there have been 59 episodes of MRSA against a target profile to have had no more than 46 cases. All Trusts other than South Eastern have exceeded their respective eleven month MRSA target profile – Belfast, Southern and Western Trusts have exceeded their annual target. PHA has co-ordinated a recent study of MRSA across all Trusts. Areas for improvement identified through this work include implementation and assurance of MRSA screening policy and practices, decolonisation processes and assurance, implementing learning arising from root cause analyses.

The PHA HCAI Team will shortly commence work on the annual peer group analyses of 2014 CDI and MRSA improvement/position across all Trusts. These analyses will be shared with senior leaders in each Trust, PHA, HSCB and DHSSPS. It is anticipated that the draft analyses will be available by mid-March. PHA HCAI Team is currently considering hosting a series of HSC-wide meetings to share learning and inform key improvement actions required in 2015-16. Building operational links between quality improvement expertise and infection prevention/control expertise is likely to be an area of concerted focus going forward.

17



2014/15

Maximum

2014/15

Profile

(Apr 14-

Feb 15)

2014/15

Actual

(Apr 14-

Feb 15)

Variance

(actual vs

14/15 target

profile)

Belfast 16 15 21 6

Northern 11 10 11 1

South Eastern 11 10 7 -3

Southern 3 3 9 6

Western 9 8 15 7

Region 50 46 59 13

Trust

MRSA - No more than 50 during 2014/15

Organ Transplants (Target) – by March 2015, ensure delivery of a minimum of 80 kidney transplants in total, to include live, DCD and DBD donors.

At the end of February 2015, Belfast Trust has delivered a total of 92 kidney transplants (including live, DCD (donation after cardiac death) and DBD (donation after brain death) donors) against a Ministerial target to deliver 80 by March 2015. The position reported to the Board in previous months incorrectly excluded DCD and DBD transplants.

Specialist drugs (Standard) – from April 2014, no patient should wait longer than three months to commence NICE approved specialist therapies for rheumatoid arthritis, psoriatric arthritis, ankylosing sponylitis or psoriasis.

At the end of February 2015, six patients were waiting longer than three months to commence NICE approved specialist therapies for rheumatoid arthritis, psoriatric arthritis, ankylosing sponylitis or psoriasis.

18



Stroke patients (Standard) – from April 2014, ensure that at least 12% of patients with confirmed ischaemic stroke receive thrombolysis.

Sep-14 Oct-14 Nov-14 14/15 Cum

Belfast 17% 21% 30% 23%

Northern 15% 13% 13% 14%


Southern 23% 17% 17% 16%

Western 40% 22% 27% 24%

Region 17% 18% 20% 18%

Trust

Western Coding is not up to date therefore figures above may change

retrospectively

Stroke patients - % received thrombolysis

Trusts are permitted three months to complete clinical coding. Regionally in year to end of November 2014, the standard to ensure that at least 12% of patients with confirmed ischaemic stroke receive thrombolysis has been maintained.

Pressure ulcers (Target) – by March 2015, secure a 10% reduction in pressure ulcers in all adult inpatient wards.

Profile

Reduction

(Q1-Q3)

Actual

(Q1-Q3)

Variance

(Actual vs

profile)

% Variance

(Actual vs

profile)

Belfast 182 238 57 31%

Northern 77 124 47 61%

South Eastern 80 91 12 14%

Southern 43 78 35 82%

Western 123 112 -11 -9%

Region 504 643 139 28%

Trust

Pressure Ulcers - 10% reduction by March 2015

In the year to end of December (quarter 3), there have been 643 incidences of pressure ulcers in adult inpatient wards against a target reduction profile to have had no more than 504 cases during quarters one to three. The Trusts have reached 100% compliance in rolling out the implementation of the Skin Bundle across all hospital inpatient wards (at the end of March 2014) which is aimed at reducing pressure ulcers and increasing staff awareness of the factors that lead to pressure ulcers. Trusts are committed to keep pressure ulcer prevention as a priority in their Quality Improvement Plans. The initial increase in the incidence of pressure ulcers is an expected outcome of the spread and increase in awareness.

A small pilot study in the RVH has shown that whilst there has been an increase in reporting of pressure ulcers there has been an actual decrease in the occurrence of the most severe grades (grades 3 & 4). This work is continuing to the end of March 2015 and will be reported into the PHA when complete (May 2015).

19



To improve the management of long-term conditions in the community, with a view to improving the quality of care provided and reducing the incidence of acute hospital admissions for patients with one or more long term conditions. Allied Health Professionals (AHP) (Standard) – from April 2014, no patient waits longer than nine weeks from referral to commencement of AHP treatment.

*June to September includes OT, physiotherapy and dietetics professions only.

30.11.14 31.12.14 31.1.15 28.2.15

Belfast 5521 5654 5625 5389

Northern 4501 5071 5612 5350


Southern 1773 2437 2879 2527

Western 2800 3192 3226 2853

Region 14967 16921 18006 16558

Trust>9wks all AHP services

*Due to late submission AHP figures for Belfast Trust for Physio have been rolled

over since Oct 14 . OT & SLT have been rolled over from Dec 14 to Feb 15.

As previously reported, formal reporting of AHP performance was suspended during quarter one of 2014/15 to allow Trusts to apply the revised AHP waiting time definitions and to put in place arrangements to consistently report performance in line with these definitions. This exercise has now been completed across all AHP services and returns submitted by Trusts show that at the end of February 2015, 16,558 patients were waiting longer than nine weeks from referral to commencement of treatment. The majority (77%) of the breaches at the end of February are in physiotherapy (8,662) and occupational therapy (4,161). Information up to the end of September relates only to physiotherapy, occupational therapy and dietetics.

Unplanned admissions (Target) – by March 2015, reduce the number of unplanned admissions to hospital by 5% for adults with specified long term conditions (using 2012/13 data as the baseline).

Trusts are permitted three months to complete clinical coding. Cumulatively in the year to end of November 2014, there were 7,407 unplanned admissions to hospital by adults with specified long term conditions against a maximum reduction profile of 7,900.

20



Profile

Reduction

(April - Nov

2014)

Actual (April -

Nov 2014)

Variance

(Actual vs

profile)

% Variance

(Actual vs

profile)

Belfast 1,929 2,230 302 16%

Northern 1,790 1,519 -271 -15%

South Eastern 1,537 1,635 98 6%

Southern 1,276 1,334 58 5%

Western 1,369 689 -680 -50%

Region 7,900 7,407 -493 -6%

Trust

Unplanned Hospital Admissions for specificed longterm

conditions - 5% reduction

To promote social inclusion, choice, control, support and independence for people living in the community especially older people and those individuals and their families living with disabilities. Carers’ assessments (Target) – by March 2015, secure a 10% increase in the number of carers’ assessments offered.

QE Mar 14 QTR 1 14-15 QTR 2 14-15 QTR 3 14-15

Belfast 496 556 594 645

Northern 764 686 719 640


Southern 704 697 537 560

Western 380 276 306 323

Region 2,933 2,715 2,645 2513

Carers' assessments - 10% increase by March 2015Trust

Regionally at the end of December 2014, 2,513 carers’ assessments have been offered against a profile target of 3,153.

21



Direct payments (Target) – by March 2015, secure a 5% increase in the number of direct payments across all programmes of care.

Profile

Target (Q3)Actual (Q3)

Variance

(Actual vs

profile)

% Variance

(Actual vs

profile)

Belfast 520 518 -2 0%

Northern 632 602 -30 -5%

South Eastern 609 609 0 0%

Southern 723 705 -18 -2%

Western 390 458 68 17%

Region 2,874 2,892 18 1%

Trust

Direct Payments - 5% increase by March 2015

At the end of December 2014, 2,892 direct payments were in place against a target profile of 2,874.

To improve productivity by ensuring effective and efficient allocation and utilisation of all available resources, in line with priorities.

Unnecessary hospital stays (Target) – by March 2015, reduce the number of excess bed days for the acute programme of care by 10% (using 2012/13 data as the baseline).

Trusts are permitted three months to complete clinical coding. Cumulatively in the year to end of November 2014, there were 95,597 excess bed days for the acute programme of care.

22



Profile

Reduction

(April-Nov

2014)

Actual (April-

Nov 2014)

Variance

(Actual vs

profile)

% Variance

(Actual vs

profile)

Belfast 44,963 42462 -2,501 -6%

Northern 18,144 19601 1,457 8%

South Eastern 15,380 11693 -3,687 -24%

Southern 8,277 11959 3,682 44%

Western 12,009 10882 -1,127 -9%

Region 98,773 96,597 -2,176 -2%

Trust

Unnecessary Hospital Stay - 10% reduction by March 2015

Cancelled Clinics (Target) – by March 2015, reduce the number of hospital cancelled consultant-led outpatient appointments by 17%.

0

3000

6000

9000

12000

15000

18000

Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15

No of Hospital Cancelled OP appointments (new and review)

in line with DHSSPS guidance no. that impacted on patients 14/15 target profile

2014/15

Target

Maximum

2014/15

Profile

(Apr 14 -

Feb 15)

2014/15

Actual

(Apr 14 -

Feb 15)

Variance

(actual vs

14/15 target

profile)

Number that

had an

impact on

patients

(Apr 14 -

Feb 15)

Belfast 63,436 58,150 72,717 14,567 37,191

Northern 19,580 17,948 23,660 5,712 11,673

South Eastern 19,167 17,570 22,705 5,135 10,429

Southern 12,645 11,591 15,793 4,202 8,314

Western 23,925 21,931 23,013 1,082 11,882

Region 138,753 127,190 157,888 30,698 79,489

Trust

Cancelled Consultant led OP Clinics (new and review) (-17%)

The Board is continuing to monitor and report the number of hospital cancelled consultant-led outpatient appointments in line with the latest definitions and guidance outlined by the Department of Health Statistics Branch in their Quarterly Outpatient Activity Statistical Return (Version 3 August 2011 refers) however, it should be noted that the way in which cancelled clinics are recorded means that the cancellation rates reported are overstated as a number of the reasons recorded on PAS for cancellation will not result in lost capacity.

At the request of the Health Committee (in February 2013), a Short Life Working Group was set up to establish how information on cancelled appointments could be recorded in order to be able to identify where there has been a direct impact on patients and to quantify actual lost capacity. As a result of this work, information on the number of hospital cancelled consultant-led outpatient appointments that had an impact on patients is now available. Cumulatively in the year to end of February 2015, 157,888 consultant-led outpatient appointments (new and review) have been cancelled by hospitals and, of these, 79,489 are considered to have had a direct impact on patients.

23



Patient discharge 1 (Standard) – from April 2014, ensure that 99% of all learning disability discharges take place within seven days of the patient being assessed as medically fit for discharge, with no discharge taking more than 28 days.


Belfast 50% 100% 80% 81%

Northern 75% 100% 100% 88%

South Eastern 50% 100% 100% 79%

Southern 0% 100% 100% 69%

Western 67% 100% 100% 86%

Region 56% 100% 92% 82%

Learning Disability - % discharge within 7 daysTrust


Belfast 3 0 1 9

Northern 0 0 0 3


Southern 1 0 0 3

Western 1 0 0 1

Region 7 0 1 22

Learning Disability - No. discharged >28 daysTrust

Regionally during February 2015, 92% of learning disability discharges took place within seven days and one discharge took longer than 28 days.

24



Patient discharge 2 (Standard) – from April 2014, ensure that 99% of all mental health discharges take place within seven days of the patient being assessed as medically fit for discharge, with no discharge taking more than 28 days.


Belfast 95% 100% 95% 98%

Northern 100% 100% 100% 100%


Southern 94% 97% 91% 95%

Western 96% 97% 95% 97%

Region 97% 97% 94% 96%

Mental Health - % discharge within 7 daysTrust


Belfast 1 0 2 7

Northern 0 0 0 0


Southern 3 2 3 22

Western 2 2 4 29

Region 6 6 12 89

Trust Mental Health - No. discharged >28 days

Regionally during February 2015, 94% of mental health discharges took place within seven days and 12 took longer than 28 days.

25



Patient discharge 3 (Standard) – from April 2014, ensure that 90% of complex discharges from an acute hospital take place within 48 hours, with no complex discharge taking more than seven days.


Belfast 49% 57% 55% 56%

Northern 85% 86% 87% 85%


Southern 93% 95% 92% 94%

Western 85% 90% 84% 87%

Region 78% 77% 79% 79%

Trust Patient Discharges - % < 48 hours


Belfast 51 59 44 430

Northern 24 28 18 238


Southern 2 4 4 21

Western 28 27 33 249

Region 164 163 144 1,315

Trust Patient Discharge - No >7 days

Regionally during February 2015, 79% of complex discharges from an acute hospital took place within 48 hours, 144 took more than seven days.

26



Patient discharge 4 (Standard) – from April 2014, ensure that all non-complex discharges from an acute hospital take place within six hours.


Belfast 97% 97% 97% 98%

Northern 95% 95% 95% 95%


Southern 94% 93% 92% 93%

Western 96% 96% 96% 96%

Region 96% 95% 95% 95%

Patient Discharge - % within 6 hoursTrust

Regionally during February 2015, 95% of non-complex discharges from an acute hospital took place within six hours.

To ensure the most vulnerable in our society, including children and adults at risk of harm are looked after effectively across all our services. Resettlement 1 (Target) – by March 2015, resettle the remaining long-stay patients in learning disability hospitals to appropriate places in the community.

In order to ensure achievement of the Ministerial target that all long stay patients in learning disability and psychiatric hospitals are resettled to appropriate places in the community by 31 March 2015, Trusts are required to resettle 49 learning disability patients and 42 mental health patients in 2014/15. Regionally, at the end of February 2015, eleven learning disability and 20 mental health patients have been resettled. As previously reported, Trusts have identified a number of patients who currently will require to remain in hospital after 31 March 2015, some of whom are detained under the Mental

27




Belfast 0 0 3 6

Northern 0 0 0 1


Southern 0 0 0 0

Western 0 0 0 1

Region 1 0 3 11

TrustLearning Disability 2014/15 - Number Resettled

Health Order. They have also advised the Board that a number of patients will not be resettled in 2014/15 as planned resettlement accommodations will not be ready for occupation until after 31 March 2015.

Resettlement 2 (Target) – by March 2015, resettle the remaining long-stay patients in psychiatric hospitals to appropriate places in the community.


Belfast 0 0 0 3

Northern 1 0 0 1


Southern 0 0 0 8

Western 0 0 0 1

Region 1 0 0 20

Mental Health 2014/15 - Number ResettledTrust

28



Mental health services 1 (Standard) – from April 2014, no patient waits longer than nine weeks to access child and adolescent mental health services.

31.12.14 31.1.15 28.2.15

Belfast 2 2 0

Northern 134 139 111

South Eastern 0 0 0

Southern 0 0 0

Western 0 1 0

Region 136 133 111

TrustCAMHS - No > 9 weeks

Regionally at the end of February 2015, 111 patients were waiting longer than nine weeks to access child and adolescent mental health services (CAMHS). All of the patients waiting longer than nine weeks are in the Northern Trust. The Northern Trust has reported that this position is as a result of a shortfall in capacity due to staffing issues (vacancies and sickness absence). The Trust has a recovery plan in place however, it has advised that the nine-week maximum waiting time standard will not be achieved until June 2015.

Mental health services 2 (Standard) – from April 2014, no patient waits longer than nine weeks to access adult mental health services.

There has been an increase in the number of patients waiting longer than nine weeks to access adult mental health services – 109 at end of February 2015. Belfast Trust has reported that it expects to have no patients waiting longer than nine weeks by end of March 2015.

29



31.12.14 31.1.15 28.2.15

Belfast 36 41 37

Northern 2 1 0

South Eastern 15 0 0

Southern 9 23 54

Western 27 26 18

Region 89 91 109

TrustAdult MH - No > 9 weeks

Mental health services 3 (Standard) – from April 2014, no patient waits longer than nine weeks to access dementia services.

31.12.14 31.1.15 28.2.15

Belfast 0 0 0

Northern 5 0 0

South Eastern 0 0 0

Southern 79 36 37

Western 1 5 14

Region 85 41 51

TrustDementia - No > 9 weeks

Regionally at the end of February 2015, 51 patients were waiting longer than nine weeks to access dementia services.

30



Mental health services 4 (Standard) – from April 2014, no patient waits longer than 13 weeks to access psychological therapies (any age).

31.12.14 31.1.15 28.2.15

Belfast 168 140 183

Northern 64 72 89

South Eastern 481 477 460

Southern 32 40 42

Western 85 102 80

Region 830 831 854

Psychological Therapies -

No >13 weeksTrust

The number of patients waiting longer than 13 weeks to access psychological therapies has continued to increase – 854 patients were waiting longer than 13 weeks at the end of February 2015. A detailed report is attached at Annex B.

Children in care 1 (Standard) – from April 2014, increase the number of children in care for 12 months or longer with no placement change to 85%.

77% 79% 79% 78% 77%

0%

20%

40%

60%

80%

100%

2008/09 2009/10 2010/11 2011/12 2012/13 2013/14

Care Leavers - % of Children in care for 12 months or longer with no placement change

Trust 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13

Belfast 81% 79% 83% 84% 84% 78%

Northern 81% 78% 78% 78% 74% 76%

South Eastern 80% 82% 78% 81% 79% 78%

Southern 71% 59% 73% 66% 70% 75%

Western 85% 83% 83% 82% 85% 79%

Region 80% 77% 79% 79% 78% 77%

Performance against this target is reported annually. Monitoring information for 2013/14 and 2014/15 will not be available until end 2014/15 and 2015/16 respectively.

31



Children in care 2 (Target) – by March 2015, ensure a three year time frame for 90% of children who are to be adopted from care.

2009/10 2011/12 2012/13 2013/14

Belfast 31% 59% 41% 78%

Northern 38% 29% 44% 61%


Southern 42% 50% 50% 56%

Western 100% 60% 19% 57%

Region 40% 47% 42% 58%

3-year timeframe for all children to be adopted from care Trust

Performance against this target is reported annually. For the year 2013/14, 58% of children were adopted from care. 2014/15 performance information will not be available until end of 2015.

Children in care 3 (Standard) – from April 2014, ensure that all school-age children who have been in care for 12 months or longer have a Personal Educational Plan (PEP).

Performance against this target is reported annually. Monitoring information for 2014/15 will not be available until September 2015.

32

Annex B

Review of Psychological Therapy Services Pressures in Northern Ireland

March 2015

33

1.0. Purpose of Paper – this paper aims to provide an overview of the current

Provision of Psychological Services In Northern Ireland,

Demand and capacity pressures,

Service improvement action taken to respond to these pressures, and

Highlight the service reform actions to improve access to Psychological Therapy

Services in Northern Ireland.

2.0. Strategic Context – the case for improving access to psychological therapies is well

evidenced and researched. The DHSSPS Psychological Therapies Strategy, the New HSC

Mental Health Core Pathway and the current 26 mental health NICE guidelines set out the

strategic and recovery imperatives for increasing the range and scope of evidence based

therapies. At the heart of this objective is the recognition that psychological therapies

improve outcomes, enable earlier recovery and reduce cost per capita.

3.0. What are Psychological Therapy Services – psychological therapies refer to all those

services which require the input of a Psychologist, Psychotherapist, Family Therapist,

Cognitive Behavioural Therapist and Behavioural and Trauma Therapists.

4.0. Service areas covered by Psychological Therapies 13 week maximum waiting time

standard – psychological therapy services are sub-divided into five key service delivery

categories:

Health Psychology Care Services - HIV, Pain, Neurological, Diabetes, Cancer etc.

Mental Health Services - Specialist Psychological Therapy Teams including Trauma

Care.

Learning Disability Services, including behavioural support services.

Paediatric Psychology Services for child health and child development services not

covered by CAMHS or ASD services.

Psychosexual Services – gender identity and dysfunction services.

5.0. Summary of Critical Issues

5.1. Northern Ireland has higher rates of mental ill health – one in four adults in

Northern Ireland (about 25% of the population) will experience a diagnosable mental

health problem at any given time. This makes mental ill health the largest cause of

disability in Northern Ireland. Over 45% of the working age population claiming

34

illness-related out-of-work benefits (Employment Support Allowance, Incapacity and

Severe Incapacity Benefit) do so because of mental ill health. This is the single

biggest group of all claimants. The Centre for Mental Health has estimated mental

health ill health as 25% higher than that of Great Britain. In Great Britain about 11%

of the NHS budget is spent on treating mental illness, whilst in Northern Ireland only

9% is spent on mental health care.

5.2. Rising Demand for Psychological Therapy Services – greater awareness of the

efficacy of Psychological Therapies across Health and Social Care reinforced by

recent NICE Guidance have combined to increase the demand for these services

within Northern Ireland.

5.3. Current Funding – in respect of psychological therapies, we currently invest

approximately £9.8m across Primary Care (£3m, which includes £1.4m GP

Depression DES and £1.4m Primary Care Hubs) and Secondary Mental Health Care

(£6.5m). This equates to approximately 2.6% of Mental Health expenditure. On a

comparative population basis with Great Britain we should be spending

approximately £14m. Considering Northern Ireland has a 25% higher need, this

means investment should be in the region of £17m. This represents a gap of £7.2m.

This funding gap is set to increase with the recent commitment by the UK

Government to invest a further £120m aimed at improving access to mental health

care in Great Britain. This means a further £5m gap on a comparative population

basis. Cumulatively, this means the gap between need and provision in evidence

based psychological therapies in Northern Ireland will grow to £12m.

It is well documented that Northern Ireland has the highest prescribing rates of anti-

depressants in the UK. This is in part due to the significant deficit in psychological

therapies. Currently we spend £16m on drug therapy in primary care and yet

conversely as outlined above we only spend £3m on talking therapies in primary

care. We know that if we provide low intensity psychological therapies in primary

care services this will in time reduce demand for high intensity specialist

psychological therapy services and reduce the number of patients who wait longer

than the Ministerial maximum waiting time (13 weeks).

35

In support of this research, in 2012 SMT approved a Regional Demand proposal

aimed at developing Primary Care Talking Therapy and Wellbeing Hubs. An initial

£700,000 was allocated to fund seed these Hubs, with a commitment to augment

this investment through the re-profiling of existing resources to enable the allocation

of £1m per LCG area. It was anticipated that, when fully developed, these Hubs

would support the management of 20,000 people with common mental health

problems (this includes 5,000 people who receive support through Depression DES).

Table 1 outlines progress toward this objective.

Table 1. Funding

LCG/ Trust Area

Regional Demand 2012/13

Demography

2014/15/16 Prescribing 2014/15/16

PHA Trust

Re-direct 2015/16

Total

BHSCT £151,089 £0 *£710,000 £0 *£300,000 £1,161,089

NHSCT £173,834 £0 £0 £0 £0 £173,834

SEHSCT £128,058 *£87,000 £0 £0 £0 £215,058

WHSCT £120,215 £0 £0 £0 £0 £120,215

SHSCT £139,823 *£70,000 £0 £0 £0 £209,823

Totals £713,019 *£157,000 *£710,000 £0 *£300,000 £1,880,019

Additional investment in these hubs is required to make sustained substantive

improvement in access times.

5.4. Table 2. Demand Overview 2014 -*2015 (*last quarter projected)

Trust Learning Disability

Health Psychology

Mental Health

Children's Psychology

Neuro-disability Services

Older People's Services

Psychosexual

Services All Services

Belfast 17% 38% 17% 45% 56% 10% 22% 28%

Northern 29% 22% 28% 21% 7% 7% 0% 23%

South Eastern 26% 12% 19% 20% 11% 24% 0% 18%

Southern 20% 9% 17% 8% 6% 0% 0% 13%

Western 8% 19% 18% 7% 19% 59% 78% 19%

Region 1724 2857 6128 2268 1191 579 471 15217

% 11% 19% 40% 15% 8% 4% 3% 100%

36

In April 2014, the HSC Board started collecting demand and capacity information in

order to better understand and monitor flows. As expected Mental Health and Adult

Health Psychology represents the largest demand. Currently NHSCT receives the

largest number of referrals of all five Trusts for Mental Health and Belfast the largest

for Health Psychology.

5.5. Table 3. Capacity Shortfalls

New and Review Capacity

Learning Disability

Adult Health Psychology

Adult Mental Health

Children's Psychology

Neuro-disability Services

Older People's Services

Psycho-sexual

Services

Annual 26,223 18,513 70,597 34,133 8,103 3,733 6,587

Weekly 624 441 1681 813 193 89 157

Staffing Funded

58 38 122 45 Data not currently

Available

10

Contacts Per WTE

11 12 14 18 16

Minimum Normative Activity Level Per WTE

10 10-14 14 14 10 14 10

In overall terms it would appear that psychology therapist services are delivering

activity within the agreed activity framework. Therefore, in order to address capacity

gaps in mental health, it is estimated that the service as it currently stands needs to

see about 7,290 persons (new demand + waiting list) which, with an average

treatment tail of about 11-15 sessions, would require capacity of about 95,000

sessions of care.

This equates to a shortfall in the region of 25,000 sessions which, at Band 7 level,

equates to about 42 wte with an associated cost of £2.5m, which has been logged as

a cost pressure.

37

5.6. Table 4. Rising Demand - Total Waiting all Categories, 2011 to February 2015

WL Quarter End Adult Mental

Health Service

Adult Health

Psychology

Services

Children's

Psychology

Services

Adult and

Children's

Learning Disability

Services

Psychology Led

Psychosexual

Services

Other All Services

Jun-11 1111 200 195 199 111 59 1875

Sep-11 1230 221 213 252 163 74 2153

Dec-11 1194 282 217 261 183 77 2214

Mar-12 1161 381 191 292 215 99 2339

Jun-12 1170 468 224 216 230 88 2396

Sep-12 1181 482 153 253 243 76 2388

Dec-12 1129 374 105 218 197 105 2128

Mar-13 1152 428 190 273 153 105 2301

Jun-13 1213 492 171 288 107 94 2365

Sep-13 1348 621 189 343 102 2603

Dec-13 1559 541 176 317 115 2708

Mar-14 1521 522 186 332 52 2613

Jun-14 1558 478 202 327 71 2636

Sep-14 1647 523 219 301 81 2771

Dec-14 1792 639 224 368 93 3116

Jan-15 1742 623 213 372 67 3017

Feb-15 1809 607 230 395 88 3129

%Regional 58% 19% 7% 13% 3% 100%

% BHSCT 8% 38% 60% 17% 37% 100%

% NHSCT 25% 12% 5% 27% 0% 100%

% SETHSCT 33% 27% 17% 19% 0% 100%

% SHSCT 15% 9% 1% 20% 0% 100%

% WHSCT 19% 14% 17% 17% 63% 100%

As indicated in Table 4, the total numbers waiting for a psychological therapy has

grown by 67% over the last 3 years from 1,875 in June 2011 to 3,129 in February

2015. Mental health and adult health care services represent the largest group of

waits at 77%. It is anticipated that if primary care hubs were fully developed this

would result in a 20% improvement in service capacity.

38

5.7. Table 5. Total Profile of Patients Waiting Longer than 13 weeks , 2011 to

February 2015

MONTH END

Breaches

Adult Mental

Health Service

Adult Health

Psychology

Services

Children's

Psychology

Services

Adult and

Children's

Learning

Disability

Services

Psychology Led

Psychosexual

Services

Other All Services

Jun-11 80 36 62 6 18 0 202

Sep-11 145 78 81 26 40 0 370

Dec-11 142 118 42 48 90 0 440

Mar-12 50 137 36 26 104 0 353

Jun-12 87 232 34 29 132 0 514

Sep-12 91 305 29 24 154 3 606

Dec-12 58 311 23 17 102 21 532

Mar-13 50 180 1 29 50 10 320

Jun-13 39 196 18 43 36 20 352

Sep-13 156 281 7 52 29 525

Dec-13 253 225 2 21 34 535

Mar-14 224 197 4 0 1 426

Jun-14 370 143 3 33 2 551

Sep-14 469 153 2 49 5 678

Dec-14 530 214 14 69 3 830

Jan-15 555 191 15 69 1 831

Feb-15 587 189 16 60 2 854

%Regional 69% 22% 2% 7% 0.2% 100%

% BHSCT 10% 43% 87% 53% 0% 100%

% NHSCT 14% 1% 0% 5% 0% 100%

% SETHSCT 59% 55% 0% 15% 0% 100%

% SHSCT 7% 0% 0% 2% 0% 100%

% WHSCT 10% 1% 13% 25% 100% 100%

As indicated in Table 5, the total number of patients waiting longer than 13 weeks for

a psychological therapy has increased from 202 in June 2011 to 854 in February

2015. The majority of breaches of the 13-week maximum waiting time standard are

in Mental Health and Adult Health Psychology Services. To put this in context, in

2012/13 the vast majority of breaches were in the Western Trust Mental Health and

Psychosexual Services, the Southern Trust Mental Health and Adult Psychology and

in Belfast Trust Adult Health and Psychosexual services. As a result of demand and

capacity work, additional investment resulted in substantial increase in the capacity

of these services. Currently the vast majority of 13-week breaches are in Adult

39

Mental Health and Adult Psychology Services in the Belfast, Northern and South

Eastern Trusts. The HSC Board service improvement efforts are currently focusing

on these areas.

5.8 Summary of Improvement Actions.

SEHSCT – the primary pressure is currently within South Eastern Trust’s Mental

Health Psychological Therapy services. As indicated previously, this is as a result of

a combination of increased demand/case complexity and a capacity loss of 3 wte

posts in the Trust’s Mental Health Team due to an over-commitment in psychology

posts in Children’s services.

Based on current trends, it is estimated that the Trust would need in the region of 9 -

15 wte. In costs terms this equates to approximately £800,000. In the current

financial climate this is not realisable. Consequently, a new whole system approach

will be required. In support of this objective the HSC Board proposes to combine a

range of investments to assist the Trust to remodel their primary care, secondary

mental health and specialist psychological services. The Trust will be required to

utilise the £287,000 to meet the objectives below. The Trust is now in the process of

responding to the recently revised IPT.

SEHSCT Waiting List Recovery Objectives.

1. Incrementally reduce waiting time over next 12 months (Trust will be required to agree a backstop position no greater than 26 weeks from the outset and thereafter show a month on month reduction)

To ensure that the South Eastern Trust meets the Ministerial performance target that no client waits longer than 13 weeks to access psychological services by March 2016

2. Develop the capacity of Community Mental Health Teams to be able to manage a higher level of Psychological Need

Reduce internal demand for Specialist PTS by initial 10 %.

Train 3 additional people in each Community Mental Health Team trained in line with NICE approved Therapies (please note this will include access to regionally trained commissioned places.)

3. Shift the management of common mental health problems into primary care through the progressive development of Primary Care Talking Therapy Hubs

Trust to develop plan with a view to incrementally reducing by 5% each year the numbers of people referred to secondary care with common mental health problems

40

4. Introduce New Ways of Working which increases service capacity and improves flow

Suggested 10 % increase in Group Therapies Activity. 5 Group Sessions Per Week = 10 Participant X 42 Weeks = 2,100 New Contacts

5. Reconfigure existing services including the alignment/integration of community Psychological Therapies with Community Mental Health Teams

Through skill mix replace 3 wte PT Posts previously lost to metal health or the associated activity at 1,700 contacts this equates to 115 people treated

In relation to the Trust’s pain management services, demand continues to outstrip

supply and therefore it is unlikely that these breaches will be resolved without

additional investment.

NHSCT – the position continues to improve in the Northern Trust, from 147 patients

waiting in excess of 13 weeks in July 2014 to 64 at end of December 2014. This

position is expected to improve as the Trust has received funding for an additional 3

wte. In addition, demand has reduced by 20% as a result of a number of demand

management initiatives and capacity has been freed up as result of increased group

work, the up-skilling of Community Mental Health Teams to help frontline

practitioners manage a higher threshold of need and supported by the development

of consultative/co-working practices with staff.

WHSCT – Adult Mental Health Services breaches have increased due to a

temporary capacity loss of 2 wte staff who are on maternity leave. The Trust has

appointed an additional member of staff who took up post in January 2015 and is

working on a recovery plan to reduce numbers breaching by April 2015. The Trust

has identified a capacity shortfall of 1 wte which the Board has previously

acknowledged, although no source of funding is available. Due to the small

psychology team there remains a risk of future breaching. Learning Disability Service

breaches have increased due to family intervention referrals which were previously

done in the private sector now being done in house. The return of a member of staff

who is on maternity leave will improve this situation by year end. Psychosexual

Services breaches have increased due to a temporary capacity loss of 2 wte staff

due to “internal matters”. The Trust expects this situation to be resolved in the near

future.

41

BHSCT – previously there had been a high number 13-week breaches in cancer and

HIV services, however following investment this has been resolved. Breaches

remain a problem in the Trust’s Pain and Neuropsychology services;

1. Pain Services - there is a vacant post which is currently in recruitment. The post

has proved difficult to recruit, as it is seen as a high pressure service with

difficulties in meeting demand. The work of the post involves high intensity

work. As this service is limited to 1.0wte post, breaches of the 13-week

maximum waiting time standard will continue. In reality, there is insufficient

capacity to meet the current level of demand

2. Neuropsychology - this is a regional service, staffed by 1.0 wte, which offers

both inpatient and outpatient input across regional neurology and neurosurgery.

There has been no investment in this service for over 20 years.

The growth in provision at a medical level continues with increasing demand for

Neuropsychological testing – this would include baseline

1. Measures pre/post-surgery in relation to areas of deficit or difficulty,

providing profiles to aid in decision making regarding treatment, capacity

and consent issues (this will be huge area of growth when new capacity

legislation comes online).

2. Adjustment/psychological distress following diagnosis/treatment.

3. Medically unexplained presentations (a growing area of need), complex

presentations – these are costly to services due to high attendances at ED

and clinics and multiple investigations.

4. Breaches in the Trust’s Mental Health Learning Disability services are due

to a temporary loss in capacity and it is expected significant improvement

will be made by April 2015.

6.0 Conclusion – while it is anticipated that the actions outlined in this paper will reduce the

number of breaches of the 13-week maximum waiting time standard for psychological

therapies, given the gap in funding and increasing demand it is unlikely that a zero breach

position will be achieved in 2015/16. It should also be noted that Psychological Therapy

services are often staffed with 1wte to 3wte; therefore these services will remain vulnerable

to breaches, when staff are absent or leave their posts. Moving forward, in addition to

continuing targeted service improvement, there is a need to further fund the development of

42

Primary Care Talking Therapy Hubs. In the longer term there is a need to address the

legacy of underfunding in Psychological Therapies which is exacerbated by the legacy of

the conflict and the socio-economic factors in Northern Ireland.

HSC BOARD PERFORMANCE REPORT 2014/15 (Month 11 ... BOARD...1 HSC BOARD PERFORMANCE REPORT –...

Documents

Transcript of HSC BOARD PERFORMANCE REPORT 2014/15 (Month 11 ... BOARD...1 HSC BOARD PERFORMANCE REPORT –...