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

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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 Irelan d) 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.

Transcript of 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.

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    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

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

    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

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

    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.

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    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

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

    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%

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

    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

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    (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.

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    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%

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

    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.

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    274312

    352406

    481525

    460414

    535 511 526

    426438495

    551 575610

    678 688 700

    830 831 854

    0

    200

    400

    600

    800

    1000

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

    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

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    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.

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

    otherwise) Trend Analysis Comments

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

    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

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

    Belfast 91% 89% 91% 93%

    Northern 99% 100% 100% 99%

    South Eastern 95% 94% 98% 97%

    Southern 100% 99% 100% 99%

    Western 100% 100% 100% 100%

    Region 95% 94% 96% 96%

    Cancer Services - %

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

    otherwise) Trend Analysis Comments

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

    Belfast 74% 62% 64% 67%

    Northern 68% 68% 62% 68%

    South Eastern 56% 54% 55% 64%

    Southern 91% 91% 89% 84%

    Western 94% 94% 91% 92%

    Region 75% 72% 69% 73%

    TrustCancer Services - %

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

    otherwise) Trend Analysis Comments

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

    Belfast 45 85 323 1,449

    Northern 1 42 80 469

    South Eastern 45 237 229 613

    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%

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

    NIAS - % Cat A calls

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

    otherwise) Trend Analysis Comments

    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%

    South Eastern 50% 45% 40% 41%

    Southern 53% 48% 46% 47%

    Western 60% 55% 53% 53%

    Region 49% 44% 41% 42%

    Trust Outpatients - % waiting

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

    otherwise) Trend Analysis Comments

    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

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

    otherwise) Trend Analysis Comments

    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.

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

    otherwise) Trend Analysis Comments

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

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

    Belfast 90% 91% 87% 89%

    Northern 97% 97% 97% 98%

    South Eastern 97% 97% 94% 96%

    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%

    South Eastern 72% 68% 67% 63%

    Southern 71% 65% 63% 65%

    Western 69% 63% 58% 55%

    Region 61% 57% 54% 52%

    Trust Inpatient & Daycases - % waiting

  • 15

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

    otherwise) Trend Analysis Comments

    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

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

    otherwise) Trend Analysis Comments

    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

    South Eastern 50 46 65 19

    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

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

    otherwise) Trend Analysis Comments

    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

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

    otherwise) Trend Analysis Comments

    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%

    South Eastern 12% 25% 7% 13%

    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

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

    otherwise) Trend Analysis Comments

    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

    South Eastern 372 567 664 439

    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

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

    otherwise) Trend Analysis Comments

    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

    South Eastern 589 500 489 345

    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

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

    otherwise) Trend Analysis Comments

    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

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

    otherwise) Trend Analysis Comments

    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

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

    otherwise) Trend Analysis Comments

    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.

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

    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

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

    Belfast 3 0 1 9

    Northern 0 0 0 3

    South Eastern 2 0 0 6

    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

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

    otherwise) Trend Analysis Comments

    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.

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

    Belfast 95% 100% 95% 98%

    Northern 100% 100% 100% 100%

    South Eastern 100% 95% 93% 94%

    Southern 94% 97% 91% 95%

    Western 96% 97% 95% 97%

    Region 97% 97% 94% 96%

    Mental Health - % discharge within 7 daysTrust

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

    Belfast 1 0 2 7

    Northern 0 0 0 0

    South Eastern 0 2 3 31

    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

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

    otherwise) Trend Analysis Comments

    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.

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

    Belfast 49% 57% 55% 56%

    Northern 85% 86% 87% 85%

    South Eastern 69% 76% 75% 75%

    Southern 93% 95% 92% 94%

    Western 85% 90% 84% 87%

    Region 78% 77% 79% 79%

    Trust Patient Discharges - % < 48 hours

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

    Belfast 51 59 44 430

    Northern 24 28 18 238

    South Eastern 59 45 45 377

    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

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

    otherwise) Trend Analysis Comments

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

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

    Belfast 97% 97% 97% 98%

    Northern 95% 95% 95% 95%

    South Eastern 93% 93% 92% 92%

    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

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

    otherwise) Trend Analysis Comments

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

    Belfast 0 0 3 6

    Northern 0 0 0 1

    South Eastern 1 0 0 3

    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.

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

    Belfast 0 0 0 3

    Northern 1 0 0 1

    South Eastern 0 0 0 7

    Southern 0 0 0 8

    Western 0 0 0 1

    Region 1 0 0 20

    Mental Health 2014/15 - Number ResettledTrust

  • 28

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

    otherwise) Trend Analysis Comments

    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

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

    otherwise) Trend Analysis Comments

    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

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

    otherwise) Trend Analysis Comments

    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

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

    otherwise) Trend Analysis Comments

    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%

    South Eastern 33% 57% 64% 52%

    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

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    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.

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    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

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    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.