HSC BOARD PERFORMANCE REPORT September 2018) Purpose
Transcript of HSC BOARD PERFORMANCE REPORT September 2018) Purpose
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HSC BOARD PERFORMANCE REPORT – 2018/19 (Month 6 – September 2018)
Purpose
This paper provides Board members with an assessment of performance against the
standards and targets set out in the draft Commissioning Plan Direction (CPD) (Northern
Ireland) 2018/19. The position regionally and by Trust at the end of September 2018 for
the targets and standards that the HSCB is responsible for monitoring and where
monitoring information is currently available is set out in Annex A.
Performance
The key performance challenges, including the reasons for the current performance and
the actions being taken to address these, largely remain as reported at previous Board
meetings. An update on performance in a number of these areas is provided below – full
details are provided in Annex A. Further to discussion at the October board meeting, a
detailed update on mental health services will be provided in December.
1. Elective Care (including Diagnostics)
At the end of September 2018, 25% of patients waiting for a first outpatient appointment
were waiting less than nine weeks.
29% 28% 28% 27% 25% 25% 26% 26% 24% 23% 25% 27%
27% 26% 27% 26% 24% 25%
0%
20%
40%
60%
80%
100%
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Outpatients - % waiting <9 weeks
2017/18 2018/19
Trust Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18
Belfast 27% 27% 28% 27% 26% 27%
Northern 29% 28% 28% 28% 26% 27%
South Eastern 21% 21% 22% 21% 20% 19%
Southern 28% 28% 29% 27% 25% 26%
Western 30% 29% 30% 29% 26% 27%
Regional 27% 26% 27% 26% 24% 25%
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There has been a slight reduction in the number of patients waiting longer than nine
weeks for a first outpatient appointment – at the end of September 2018, 212,990
patients were waiting longer than nine weeks compared to 214,300 at the end of August
(-1,310). However, the number waiting longer than 52 weeks has increased from
92,070 at the end of August to 94,222 at the end of September (+2,152). The increase
in the longest waiting patients (normally routine) is not unexpected as Trusts prioritise
referrals to ensure that the clinically urgent patients (red flag/urgent) are seen first.
184,305 189,158 189,289196,348
202,697 203,478 200,213 200,494206,983 206,248 200,189 198,296
199,881 202,054 202,081 206,963214,300 212,990
0
30,000
60,000
90,000
120,000
150,000
180,000
210,000
240,000
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Outpatients - Numbers waiting >9 weeks
2017/18 2018/19
Trust Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18
Belfast 68,204 68,882 67,945 69,067 70,693 69,950
Northern 26,527 27,121 27,520 28,189 29,179 28,723
South Eastern 49,501 49,804 49,951 51,472 53,851 53,711
Southern 31,374 31,995 32,437 33,468 34,749 34,837
Western 24,275 24,252 24,228 24,767 25,828 25,769
Regional 199,881 202,054 202,081 206,963 214,300 212,990
57,57160,427
64,074 66,67769,935
73,380 75,311 77,68380,651 80,767 80,675 83,392
83,739 85,957 88,598 90,082 92,070 94,222
0
20,000
40,000
60,000
80,000
100,000
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Outpatients - Numbers waiting >52 weeks
2017/18 2018/19
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Trust Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18
Belfast 31,415 31,769 32,189 32,063 32,113 32,928
Northern 10,308 10,597 10,952 11,151 11,340 11,291
South Eastern 21,730 22,616 23,566 24,496 25,754 26,355
Southern 9,077 9,403 9,983 10,204 10,439 11,022
Western 11,209 11,572 11,908 12,168 12,424 12,626
Regional 83,739 85,957 88,598 90,082 92,070 94,222
At the end of September 2018, 33% of patients were waiting less than 13 weeks for
inpatient or daycase treatment.
42% 42% 41% 41% 39% 38% 37%41% 39% 37% 37% 38%
38% 37% 37% 36% 34% 33%
0%
20%
40%
60%
80%
100%
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Inpatient/Daycase - % waiting <13 weeks
2017/18 2018/19
Trust Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18
Belfast 31% 29% 29% 28% 26% 25%
Northern 64% 63% 63% 63% 61% 59%
South Eastern 44% 44% 46% 46% 45% 43%
Southern 40% 41% 41% 39% 37% 37%
Western 35% 35% 36% 35% 33% 33%
Region 38% 37% 37% 36% 34% 33%
The number of patients waiting longer than 13 and 52 weeks for inpatient or daycase
treatment has increased – at the end of September 2018, 57,665 patients were waiting
longer than 13 weeks compared to 56,100 at the end of August (+1,565) and, 19,727
patients were waiting longer than a year for surgery compared to 18,991 at the end of
August (+736).
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41,163 42,064 42,732 43,58545,624 47,009 46,111 45,383
48,00350,317 51,046 50,228
51,235 52,429 52,872 54,183 56,10057,665
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Inpatient/Daycase - Numbers waiting >13 weeks
2017/18 2018/19
Trust Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18
Belfast 24,825 25,925 26,592 27,299 28,388 29,202
Northern 2,547 2,606 2,660 2,720 2,828 3,045
South Eastern 5,794 5,668 5,605 5,617 5,618 5,829
Southern 7,133 7,224 7,150 7,432 7,766 7,784
Western 10,936 11,006 10,865 11,115 11,500 11,805
Region 51,235 52,429 52,872 54,183 56,100 57,665
10,134 10,670 11,261 11,62112,371
13,17613,935 14,391 14,979
15,955 16,389 16,454
16,814 17,43618,080 18,466 18,991
19,727
0
5,000
10,000
15,000
20,000
25,000
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Inpatient/Daycase - Numbers waiting >52 weeks
2017/18 2018/19
Trust Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18
Belfast 7,674 8,158 8,669 8,907 9,337 9,934
Northern 337 323 311 335 340 353
South Eastern 1,803 1,872 1,935 1,950 1,933 1,982
Southern 2,393 2,422 2,390 2,426 2,504 2,510
Western 4,607 4,661 4,775 4,848 4,877 4,948
Region 16,814 17,436 18,080 18,466 18,991 19,727
As previously advised, it is unacceptable that any patient has to wait longer than they
should for assessment or treatment and ensuring that patients have access to safe,
quality and timely care remains a key priority for the HSC. However, as demand for
elective care services continues to exceed health service capacity for both new
outpatients and inpatient/daycase treatments, regrettably it is inevitable that waiting
times will increase. While waiting times for elective care have increased it should be
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noted that there was an increase in activity during Q1 of this year compared to the same
period in 2017/18 – outpatient attendances increased by 5.5% and inpatient/daycase
treatments increased by 1.1%.
Trusts are continuing to undertake the additional activity associated with the allocation
of £30m non-recurrent funding from the Confidence and Supply (C&S) Transformation
Fund for additional elective care activity in 2018/19 to reduce hospital waiting times.
As previously reported, this funding is being utilised in the first instance to see and treat
patients with the highest clinical priority (red flag and urgent) and thereafter to target
those patients who have been waiting the longest (normally routine patients). In
addition, funding is being targeted to reduce the number of patients waiting longer than
26 weeks for a diagnostic test and 13 weeks for AHP treatment.
Robust monitoring arrangements are in place to enable the HSCB to monitor Trusts’
progress to ensure that the approved volumes of additional activity associated with the
C&S funding are delivered and the agreed outcomes achieved. Monthly updates on
progress are provided to the Department’s Top Management Group.
To date, good progress has been made in relation to reducing the backlog of patients
waiting longer than 13 weeks at the end of March 2018 for AHP treatment and 26
weeks for a diagnostic test. At the end of August 2018, the number of patients who had
been waiting longer than 13 weeks for AHP treatment at 31 March 2018 (23,375) had
reduced by more than 17,500. While this represents a significant reduction in this target
cohort of patients and has enabled the waiting list growth to be stabilised, the total
number of waiters has not materially reduced. In relation to diagnostics, regionally at
the end of August 2018, the number of patients waiting longer than 26 weeks at the end
of March 2018 had reduced by 6,700.
With regard to assessment and treatment, regionally in the five months to the end of
August 2018, approximately 20,850 patients who would otherwise still have been
waiting to be seen or treated had benefited as a result of the additional investment.
While non-recurrent funding to enable Trusts to undertake additional activity benefits
large numbers of patients and reduces waiting lists in the short term, the long-term
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solution is to reform elective care services to meet current and future demand through
the transformation of secondary, primary and community care services as set out in the
Department of Health’s Elective Care Plan. Since its publication, despite the challenging
financial environment, a number of initiatives have been taken forward consistent with the
direction of travel set out in the Plan and non-recurrent funding has been made available
to continue to take forward a range of these transformation initiatives in 2018/19 –
examples of these were provided at the board meeting in September.
In addition, the Department has recently announced new regional centres for day
surgery. From December 2018, the new prototype elective care centres will undertake
routine day surgery for cataracts and treatment of varicose veins.
This initiative represents a significant step forward in the transformation of health care,
and clearly demonstrates the benefits to patients of that process.
It is expected that the development of prototype elective care centres will have a
significant impact on the number of patients treated. For cataracts, this could mean up
to 2,000 additional treatments annually and for varicose veins, this could mean up to
500 more treatments – an increase in productivity of up to 30% in both cases.
With this improvement in productivity, combined with additional waiting list activity
currently ongoing to stabilise waiting times, it is the Department’s expectation that, for
patients who have been assessed as requiring treatment for cataracts and varicose
veins:
By December 2019, no patient will wait longer than 1 year;
By December 2020, no patient will wait longer than 26 weeks;
By December 2021, all patients will be treated within the ministerial target of 13
weeks.
The prototypes for varicose veins will be based at Lagan Valley Hospital and Omagh
Hospital and Primary Care Complex; and those for cataracts will operate from three
locations - Mid-Ulster Hospital, Downe Hospital, and South Tyrone Hospital. In all
cases, the prototypes will serve patients from across Northern Ireland.
The prototypes, will help inform the development of regional daycase elective care
centres for all appropriate specialties. Regional centres for routine day case surgery will
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secure important progress in the efficiency and effectiveness of care. Crucially, they will
operate on separate sites from urgent and emergency hospital care meaning they will
not be competing for operating rooms and other resources, leading to fewer
cancellations of operations. While some patients may be asked to travel further for their
treatment, they will be seen faster and have a better experience.
There has been a continued improved in relation to the delivery of commissioned
volumes of core activity compared to last year. For new outpatient assessments,
regionally during the first six months of 2018/19, there has been a 10.7% (21,914)
underdelivery of core activity compared to -12.2% during the same period last year. In
relation to delivery of commissioned volumes of inpatient/daycase volumes, there has
been an 8.6% (6,773) underdelivery of core activity during the first half of this year (April
to September 2018) compared to 11.0% during the same period last year.
Trusts have submitted Performance Improvement Trajectories (PITs) for a range of
elective specialties detailing the expected delivery of core position for 2018/19. In the
majority of cases, Trusts’ plans forecast an improvement on last year’s position. With
the exception of the Northern Trust, progress against the PITs at the end of September
2018 is broadly in line with or ahead of the Trusts’ planned position. The HSCB is
continuing to work with all Trusts to ensure that the delivery of funded core elective
capacity is maximised particularly in the context of the financial position and workforce
challenges.
Trust CPD Target Area
Delivery of
Core 2017/18
(full year)
Planned
Delivery of
Core
2018/19
(full year)
PITs - Planned
Delivery of
Core Position
2018/19
(Apr-Sep)
Actual Delivery
of Core Position
2018/19
(Apr-Sep)
New OP -12.6% -13.8% -14.6% -14.6%
IPDC -13.8% -11.4% -11.6% -11.0%
New OP -5.9% -4.9% -6.9% -10.1%
IPDC -11.3% -12.2% -11.0% -18.4%
New OP -4.2% -3.6% -5.4% -4.4%
IPDC -6.7% -3.9% -1.6% 1.7%
New OP -6.2% -4.5% -7.1% -5.5%
IPDC -10.0% -6.2% -7.4% -7.0%
New OP -16.8% -11.1% -13.0% -13.1%
IPDC -11.5% -7.6% -8.9% -10.0%Western
Belfast
Northern
South Eastern
Southern
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The proportion of patients waiting less than nine weeks for a diagnostic test has
increased slightly – at the end of September 2018, 50% of patients were waiting less
than nine weeks compared to 49% at the end of August.
60%57% 57% 54%
50% 52% 53% 55% 53% 53%58% 60%
57% 56% 55% 53%49% 50%
0%
20%
40%
60%
80%
100%
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Diagnostics - % waiting <9 weeks(Imaging and Physiological Measurement)
2017/18 2018/19
Trust Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18
Belfast 42% 43% 44% 45% 42% 42%
Northern 72% 66% 63% 57% 52% 51%
South Eastern 64% 61% 63% 58% 53% 56%
Southern 53% 50% 49% 47% 43% 46%
Western 84% 83% 83% 80% 76% 78%
Region 57% 56% 55% 53% 49% 50%
Regionally the number of patients waiting longer than nine weeks for a diagnostic test
has reduced – at the end of September 2018, 50,948 patients were waiting longer than
nine weeks compared to 52,997 at the end of August (-2,049). However, the number
waiting longer than 26 weeks has increased from 19,178 at the end of August to 19,772
at the end of September (+594).
35,953
40,473 41,486
46,23249,138
45,77847,962
43,70447,786
45,014
38,077 36,423
40,78843,924
46,198 46,313
52,99750,948
0
10,000
20,000
30,000
40,000
50,000
60,000
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Diagnostics - number waiting >9 weeks(Imaging and Physiological Measurement)
2017/18 2018/19
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Trust Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18
Belfast 18433 17963 18,863 15,787 18,592 16,707
Northern 5229 6955 7,890 9,570 11,425 12,197
South Eastern 5121 5973 5,980 6,888 7,713 7,471
Southern 10646 11481 11,929 12,368 13,294 12,701
Western 1359 1552 1,536 1,700 1,973 1,872
Region 40,788 43,924 46,198 46,313 52,997 50,948
8,4549,535
10,569
12,377
14,386 14,817
16,994
15,110
18,83517,572 17,615
14,867
16,377 16,96817,845
16,305
19,178 19,772
0
5,000
10,000
15,000
20,000
25,000
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Diagnostics Numbers waiting >26 weeks(Imaging and Physiological Measurement)
2017/18 2018/19
Trust Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18
Belfast 11028 10732 11482 9,039 10,615 9,968
Northern 931 1148 1358 1,651 2,153 3,330
South Eastern 1004 1142 933 1,065 1,035 995
Southern 3264 3768 3847 4,194 4,867 5,008
Western 150 178 225 356 508 471
Region 16,377 16,968 17,845 16,305 19,178 19,772
Given that diagnostics are essential in diagnosing patient conditions and enabling a
treatment plan to be put in place for patients, and recognising the increased demand
(both scheduled and unscheduled), recurrent funding has been allocated to Trusts in
2018/19 to expand health service capacity for MRI, CT and non-obstetric ultrasound.
This funding will provide an additional 44,000 examinations and close the capacity gap
to the end of March 2019. In addition, recurrent funding has been allocated to the
Southern Trust for a second CT scanner in Craigavon Area Hospital.
Trusts have also been allocated additional non-recurrent funding from the C&S Fund to
clear the backlog of patients waiting longer than 26 weeks for a diagnostic test at the
end of March 2018 and an update on progress in this regard is provided above (page
5).
The HSCB/PHA will continue to work with Trusts during 2018/19 to take forward a range
of measures to ensure that the expertise of consultant radiologists can be directed to
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those tasks which only they can do and examples of developments in imaging have
been provided in previous reports.
2. Emergency Department (ED) (4-hour and 12-hour standards)
Regionally during the month of September 2018, 1,716 patients waited longer than 12
hours in ED – this is an increase on the previous month (1,499) and also on the same
month last year (919).
702555
296 293448
919 1,0101,190
2,369
3,932
2,467
3,161
1,4141,157
1,366
1,872
1,4991,716
0 0 0 0 0 00
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
4,500
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
ED - Number Waiting >12 hours
2017/18 2018/19
Trust Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 2017/18
Belfast 62 152 31 14 22 104 385
Northern 186 38 28 89 158 355 854
South Eastern 204 182 120 110 186 250 1,052
Southern 222 157 104 39 56 115 693
Western 28 26 13 41 26 95 229
Region 702 555 296 293 448 919 3,213
Trust Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 2018/19
Belfast 299 250 172 263 243 261 1,488
Northern 332 174 294 436 559 563 2,358
South Eastern 462 464 551 545 345 397 2,764
Southern 237 240 285 500 282 310 1,854
Western 84 29 64 128 70 185 560
Region 1,414 1,157 1,366 1,872 1,499 1,716 9,024
In particular, 12-hour performance this year shows a system under considerable
pressure ahead of the winter period. This position is largely related to emerging issues
in the nursing/residential/domiciliary care systems which have been experiencing staff
shortages with a significant number of homes having to close or re-register from nursing
to residential homes because of their inability to recruit the necessary nursing staff.
In relation to the 4-hour standard, regionally during September 2018, 71% of patients
were treated and discharged, or admitted within four hours – this is a slight increase on
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the previous month (70%) however, it is a notable reduction compared to the same
month last year (74%).
75% 77%81% 81% 78%
74% 74% 74%68% 66% 67% 65%
72% 73% 73% 72% 70% 71%
0%
20%
40%
60%
80%
100%
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
ED - % seen within 4 hours
2017/18 2018/19
Trust Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 2017/18
Belfast 72% 73% 83% 83% 80% 74% 77%
Northern 71% 77% 75% 72% 70% 64% 71%
South Eastern 78% 79% 81% 83% 80% 79% 80%
Southern 73% 74% 83% 86% 84% 78% 80%
Western 80% 85% 84% 76% 76% 76% 79%
Region 75% 77% 81% 81% 78% 74% 78%
Trust Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 2018/19
Belfast 67% 67% 69% 68% 66% 69% 68%
Northern 71% 72% 71% 69% 66% 68% 69%
South Eastern 75% 76% 76% 76% 76% 76% 76%
Southern 73% 73% 73% 72% 70% 70% 72%
Western 74% 80% 78% 78% 76% 74% 77%
Region 72% 73% 73% 72% 70% 71% 72%
The delivery of safe and effective unscheduled care remains a challenge for
commissioners and providers and making improvements to the current service provision
and unscheduled care performance remains a key focus for the HSC system. A
detailed update on the issues impacting on unscheduled care services and the
measures being put in place to address these, including for this winter period, was
provided at the October board meeting.
At the start of the year, Trusts submitted PITs for 4-hour ED performance which forecast
the expected performance for 2018/19. Overall, Trusts forecast an improvement in 4-
hour performance for 2018/19 compared to 2017/18 or, in the case of South Eastern
Trust, to maintain last year’s performance (77%). However, in the year to date (April to
September 2018), Trusts’ performance is not in line with the forecast position set out in
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their trajectories for this period – see table below. This was raised by the HSCB at the
recent round of performance meetings with Trusts and they have reported that the
deviation from the planned position is largely as a result of increased demand, longer
length of stay and delays in discharging patients.
Trust/site
% <4 hours
2017/18
(full year)
Planned % <4
hours 2018/19
(full year)
Planned
% <4 hours
2018/19
(Apr-Sep)
Actual
% <4 hours
2018/19
(Apr-Sep)
Belfast (RVH) 67% 70% 70% 59%
Belfast (Mater) 72% 75% 75% 71%
Northern 68% 69% 71% 69%
South Eastern 77% 77% 80% 76%
Southern 75% 78% 81% 72%
Western 76% 78% 80% 77%
3. Cancer Services
Breast Cancer (14 days)
Regionally during September 2018, 74.5% of urgent breast cancer referrals were seen
within 14 days compared to 79.5% in August.
82%88% 85%
89%
88%
76%
81% 81% 81%
98% 100% 100%
100% 96%94% 92%
80%74%
0%
20%
40%
60%
80%
100%
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
By March 2019, all urgent breast cancer referrals should be seen within 14 days
2017/18 2018/19
Trust Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 2018/19
Belfast 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%
Northern 100.0% 84.3% 80.6% 59.2% 19.2% 11.9% 58.3%
South Eastern 100.0% 100.0% 99.5% 100.0% 100.0% 100.0% 99.9%
Southern 99.6% 98.8% 97.6% 97.9% 100.0% 100.0% 99.0%
Western 100.0% 100.0% 99.3% 100.0% 100.0% 100.0% 99.9%
Region 99.9% 96.3% 94.2% 92.1% 79.5% 74.5% 89.8%
In relation to individual Trusts, it should be noted that 100% of urgent referrals were
seen within 14 days during September in Belfast, South Eastern, Southern and Western
Trusts.
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The regional position in September (74.5%) is as a result of a further deterioration in
performance in the Northern Trust – during September 2018, only 11.9% of urgent
referrals were seen within 14 days. Where patients were not seen within 14 days
during September, the longest wait was 44 days.
68%
95% 94%100% 97% 99% 99%
71%
48%
93%100% 100%100%
84% 81%
59%
19%12%0%
20%
40%
60%
80%
100%
120%
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Northern Trust Breast Cancer - % of urgent referrals seen <14 days
2017/18 2018/19
Given the seriousness of this position and the need to improve access to the breast
service for women with suspect cancer as a matter of urgency, the HSCB has met with
the Trust to understand the reasons for the deterioration in performance and to agree
actions to improve waiting times in both the short and long term.
As previously reported, the decline in the Trust’s performance in recent months is due to
a shortfall in capacity to meet patient demand. For some time, the Trust has been
undertaking additional activity to meet patient demand however, due to bank holidays
and staff annual leave over the summer period, capacity was insufficient to meet
demand and a backlog of patients has accumulated as a result. There was also a
material impact on the availability of general surgeons (as breast surgeons are part of
general surgery rota) which has contributed to the backlog of patients. The Trust has a
recovery plan in place to address this position and has secured additional in-house
capacity and also capacity from other Trusts to clear the backlog of patients waiting. As
a result of these measures, the Trust expects a significant improvement in 14-day
performance from October.
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In relation to Trusts’ performance improvement trajectories for the 14-day breast cancer
access standard, all Trusts have forecast an improvement in performance in 2018/19
compared to last year. At the end of September, performance in four Trusts is in line
with or ahead of the planned position for this period. However, performance in the
Northern Trust (58%) is well below the planned position (92%) for the reasons set out
above.
Trust
Actual
% <14 days
2017/18
(full year)
Planned
% <14 days
2018/19
(full year)
Planned
% <14 days
2018/19
(Apr-Sep)
Actual
% <14 days
2018/19
(Apr-Sep)
Belfast 96% 98% 97% 100%
Northern 89% 91% 92% 58%
South Eastern 99% 99% 99% 100%
Southern 47% 99% 99% 99%
Western 99% 100% 100% 100%
In relation to the future configuration of breast assessment services regionally, the
Breast Assessment Project Board held a final meeting in September to agree revisions
to the consultation document in light of the outcome of the Project Assessment Review
(PAR) commissioned by DoH. The consultation document is in the process of being
revised with the intention being to present it to the HSCB Board before the end of the
year with submission to DoH early in the New Year. Public consultation on the
consolidation of assessment services will commence thereafter, subject to
Departmental approval.
Cancer (31 days)
Regionally during September 2018, 92% of cancer patients commenced treatment
within 31 days of the decision to treat (standard: 98%).
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95%
93%
95%
95% 94% 92%95% 93% 92% 92% 93%
97%95%
93%
95%
94% 93% 92%
0%
20%
40%
60%
80%
100%
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
By March 2019, at least 98% of patients diagnosed with cancer should receive their first definitive treatment within 31 days of a decision to treat
2017/18 2018/19
The continued strong performance in the Southern and Western Trusts should be
acknowledged – in the year to date (April to September 2018), 99.5% of patients in both
Trusts have commenced treatment within 31 days.
Trust Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 2018/19
Belfast 91.6% 87.5% 92.5% 90.3% 90.7% 87.5% 90.1%
Northern 95.2% 91.7% 94.8% 90.2% 81.3% 82.6% 88.9%
South Eastern 96.1% 94.2% 94.2% 95.2% 94.5% 96.0% 95.0%
Southern 96.6% 100.0% 100.0% 100.0% 100.0% 100.0% 99.5%
Western 100.0% 100.0% 100.0% 99.3% 99.2% 98.5% 99.5%
Region 94.9% 93.3% 95.4% 93.9% 93.0% 91.9% 93.7%
While regionally performance continues to be below the required level (98%), there has
been an increase in the number of patients who commenced their first treatment for
cancer following a decision to treat – 5,091 patients during the first six months of
2018/19 (April to September) compared to 4,897 during the same period in 2017/18.
In relation to Trusts’ performance improvement trajectories, three of the five Trusts plan
to maintain 2017/18 levels of performance in 2018/19 however, two Trusts (Northern
and South Eastern) have forecast a deterioration in 31-day performance compared to
last year. In the year to date (April to September 2018), performance in four Trusts is
broadly in line with, or ahead of, the planned position. The HSCB will continue to work
with the Trusts to ensure that funded capacity is fully maximised.
16
Trust
Actual
% <31 days
2017/18
(full year)
Planned
% <31 days
2018/19
(full year)
Planned
% <31 days
2018/19
(Apr-Sep)
Actual
% <31 days
2018/19
(Apr-Sep)
Belfast 90% 90% 91% 90%
Northern 93% 91% 92% 89%
South Eastern 95% 93% 93% 95%
Southern 97% 97% 98% 100%
Western 100% 100% 100% 100%
Cancer (62 days)
Regionally during September 2018, 61% of patients urgently referred with a suspected
cancer began their first definitive treatment within 62 days (standard: 95%).
68% 68%
69%
64%
64%
62%68% 66% 67% 67% 67%
74%
68% 67%
71%
62%
66%
61%
0%
20%
40%
60%
80%
100%
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
By March 2019, at least 95% of patients urgently referred with a suspected cancer should begin their first definitive treatment within 62 days
2017/18 2018/19
Trust Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 2018/19
Belfast 59.9% 55.0% 65.3% 48.7% 60.0% 47.8% 56.4%
Northern 72.4% 76.0% 70.0% 60.6% 66.9% 55.5% 67.0%
South Eastern 58.3% 60.4% 60.1% 52.9% 48.2% 48.4% 55.0%
Southern 69.4% 74.2% 79.0% 78.9% 74.2% 81.2% 76.1%
Western 90.8% 81.8% 84.7% 83.7% 84.1% 84.4% 84.8%
Region 68.2% 67.5% 70.8% 62.3% 65.8% 61.3% 66.0%
Similar to the position for 31-day cancer, there has been an increase in activity
compared to last year – during the first six months of 2018/19 (April to September),
2,240 patients commenced their first treatment for cancer following an urgent GP
referral for suspect cancer, compared with 2,143 in 2017/18.
In relation to the performance improvement trajectories for 2018/19, two Trusts
(Southern and Western) plan to deliver an improvement on, or maintain, last year’s 62-
17
day performance and this is welcomed. The remaining three Trusts expect
performance to deteriorate compared to last year. In the year to date (April to
September), performance in four Trusts is behind the planned position.
Trust
Actual
% <62 days
2017/18
(full year)
Planned
% <62 days
2018/19
(full year)
Planned
% <62 days
2018/19
(Apr-Sep)
Actual
% <62 days
2018/19
(Apr-Sep)
Belfast 58% 57% 57% 56%
Northern 73% 71% 70% 67%
South Eastern 53% 45% 48% 55%
Southern 74% 80% 78% 76%
Western 88% 88% 87% 85%
Given the lack of progress towards achievement of the 62-day cancer access standard
regionally, the HSCB is continuing to hold Director-level cancer performance meetings
with each Trust with a focus on the longest waits and to seek assurances from Trusts
that the longest waiting patients are treated as efforts continue to improve performance
to the required standard. There is also a continued focus on ensuring that where
treatment does not commence within 62 days no patient waits longer than 85 days.
4. Child and Adolescent Mental Health Services (CAMHS)
Regionally, the number of patients waiting longer than nine weeks to access CAMHS
has increased from 190 at the end of August 2018 to 201 at the end of September.
106 107
138
196 195
115 12072
116
160
132
66
69
10290
155
190201
0
50
100
150
200
250
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
CAMHS - By March 2019, no patient waits longer than 9 weeks to access child and adolescent mental health services
2017/18 2018/19
The continued strong performance in the South Eastern and Southern Trusts should be
noted.
18
Trust Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18
Belfast 56 33 28 29 57 26 20
Northern 0 0 0 0 0 70 119
South Eastern 0 0 0 0 0 0 0
Southern 0 0 0 0 0 0 0
Western 10 36 74 61 98 94 62
Region 66 69 102 90 155 190 201
More than half (59%) of the patients waiting longer than nine weeks at the end of
September 2018, were waiting to access the CAMHS Step 2 service in the Northern
Trust which manages routine referrals for children and young people who are
experiencing mild/moderate mental health difficulties. The Trust has advised that the
service experienced an unusually high number of referrals in June and July which,
combined with summer leave, has resulted in an increase in waiting times. The position
has been further compounded by a loss of community/voluntary service capacity. The
Trust is undertaking a review of the service to identify opportunities to improve the
waiting time position.
The Western Trust had advised that it expected the CAMHS waiting time positon to
deteriorate during the first half of 2018/19 due to a shortfall in capacity as a result of
vacant posts however, it expects the position to improve in the second half of the year
and it remains confident that it will have no patients waiting longer than nine weeks by
March 2019.
Trusts’ performance improvement trajectories for 2018/19 indicated that all Trusts
planned to achieve the target to have no patients waiting longer than nine weeks by
March 2019. Four of the five Trusts remain confident that they will achieve the target
outcome however, the Northern Trust has been asked to review its planned position
given the recent deterioration in performance.
Trust
No waiting >9
weeks for
CAMHS at
31.3.18
Planned
No waiting >9
weeks for
CAMHS at
31.3.19
Planned
No waiting >9
weeks for
CAMHS at
30.9.18
Actual
No waiting >9
weeks for
CAMHS at
30.9.18
Belfast 56 0 29 20
Northern 0 0 0 119
South Eastern 0 0 0 0
Southern 0 0 0 0
Western 10 0 0 62
19
5. Adult Mental Health Services (9 weeks)
Regionally the number of people waiting longer than nine weeks to access adult mental
health services has increased slightly – at the end of September 2018, 1,305 patients
were waiting longer than nine weeks compared to 1,232 at the end of August 2018
(+73).
1,0181,067
1,027
1,237
1,224
1,017849
696
837
710642 648
744 772 800892
1,2321,305
0
200
400
600
800
1,000
1,200
1,400
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Mental Health - By March 2019, no patients wait > 9 weeks to access adult mental health services
2017/18 2018/19
Trust Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18
Belfast 179 222 138 118 80 121 49
Northern 0 0 0 0 0 0 4
South Eastern 43 38 20 18 4 16 20
Southern 108 117 159 211 368 547 659
Western 318 367 455 453 440 548 573
Region 648 744 772 800 892 1,232 1,305
The number of patients waiting longer than nine weeks in the Southern Trust has
increased from 108 at the end of March to 659 at the end of September (+551). The
Trust has advised that performance has been impacted by unexpected and continuing
staff absences and, vacancies and peaks in demand.
Regionally, the majority of patients waiting longer than nine weeks at the end of
September, 1,230 (94%), are waiting to access primary care mental health services
(1,077) and addiction services (153).
20
Service Belfast NorthernSouth
EasternSouthern Western
Region
Total
Addiction Services 3 0 0 126 24 153
Community Mental Health Teams 1 0 20 9 0 30
Community Mental Health Teams for Older People 0 0 0 0 1 1
Eating Disorder Services 4 4 0 36 0 44
Forensic Services 0 0 0 0 0 0
Personality Disorder Services 0 0 0 0 0 0
Primary Care Mental Health Team 41 0 0 488 548 1,077
Trust Total 49 4 20 659 573 1,305
Mental Health Services - Breach Analysis September 2018
All Trusts have submitted PITs setting out the forecast waiting time position for 2018/19.
Trust
No. waiting >9
weeks for adult
mental health
services at
31.3.18
Planned
no. waiting >9
weeks for adult
mental health
services at
31.3.19
Planned
no. waiting >9
weeks for adult
mental health
services at
30.9.18
Actual
no. waiting >9
weeks for adult
mental health
services at
30.9.18
Belfast 179 0 122 49
Northern 0 0 0 4
South Eastern 43 43 60 20
Southern 108 533 395 659
Western 318 484 542 573
The Southern and Western Trusts have forecast a deterioration in the waiting time
position during 2018/19, in particular in primary care mental health and addiction
services – Southern (+425) and Western (+166). Both Trusts have advised that the
increased waiting times for these services are due to a combination of factors including
increased demand and workforce issues (sickness absence, maternity leave,
retirements and recruitment difficulties).
In relation to addiction services, the Southern Trust has indicated that the number of
patients waiting longer than nine weeks will increase from four at the end of March 2018
to 273 by 31 March 2019 (+269). The Trust has advised that in order to address the
growth in demand and increasing capacity gap for treatment/intervention (secondary
waits) it has transferred existing resources from new assessments to treatment/
intervention activities. The Trust is initiating a review/service improvement process to
streamline the existing pathway including a review of strategies to reduce DNA/CNA
rates and remodelling assessment processes to allow for additional clinics.
21
The Western Trust has advised that it will be undertaking a review of its mental health
service pathways to identify any issues and to redesign and streamline pathways to
improve patient experience and reduce waiting times.
6. Dementia Services (9 weeks)
Regionally there has been a continued reduction in the number of patients waiting
longer than nine weeks for dementia services – at the end of September 2018, 293
patients were waiting longer than nine weeks, a reduction of 25 from the previous
month.
68
109131 141 147 154 143 144
190
145
195183
399378
337 334318
293
0
50
100
150
200
250
300
350
400
450
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Dementia - By March 2019, no patients wait >9 weeks to access dementia services
2017/18 2018/19
The continued strong performance in Northern Trust should be acknowledged – only
one patient waiting longer than nine weeks at 30 September 2018.
Trust Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18
Belfast 77 66 49 40 33 40 34
Northern 0 0 0 0 0 0 1
South Eastern 9 203 211 185 206 213 207
Southern 15 31 30 16 12 12 10
Western 82 99 88 96 83 53 41
Region 183 399 378 337 334 318 293
Four of the five Trusts have forecast an improvement in waiting times for dementia
services by March 2019 and are on track to deliver this outcome. The South Eastern
Trust, which accounts for the majority of the patients waiting longer than nine weeks
regionally (71% at end of September), expects the waiting time position to deteriorate
during 2018/19 due to patient demand exceeding funded capacity and vacant posts.
The HSCB raised this performance issue with the Trust at the recent HSCB/Trust
22
service issues and performance meeting and the Trust has agreed to consider a
number of options to reduce waiting times for this service including enhancing its
psychiatric liaison service.
Trust
No. waiting >9
weeks for
Dementia
services at
31.3.18
Planned
no. waiting >9
weeks for
Dementia
services at
31.3.19
Planned
no. waiting >9
weeks for
Dementia
services at
30.9.18
Actual
no. waiting >9
weeks for
Dementia
services at
30.9.18
Belfast 77 40 40 34
Northern 0 0 0 1
South Eastern 9 174 165 207
Southern 15 59 42 10
Western 82 195 183 41
7. Psychological Therapies (13 weeks)
Regionally, the number of patients waiting longer than 13 weeks for psychological
therapy services has increased – at the end of September 2018, 2,027 patients were
waiting longer than 13 weeks compared to 1,829 at the end of August 2018 (+198).
1,242 1,262 1,319 1,3071,398 1,418 1,388 1,415
1,572 1,578 1,5681,474
1,5161,591 1,626
1,7611,829
2,027
0
300
600
900
1,200
1,500
1,800
2,100
2,400
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Psychological Therapies - By March 2019, no patients wait >13 weeks to access Psycholgical therapies services
2017/18 2018/19
Trust Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18
Belfast 577 586 592 604 691 682 731
Northern 31 62 123 147 128 123 102
South Eastern 228 245 252 224 252 286 383
Southern 84 96 105 118 142 161 171
Western 554 527 519 533 548 577 640
Region 1,474 1,516 1,591 1,626 1,761 1,829 2,027
23
More than two thirds (68%) of the patients waiting longer than 13 weeks regionally at
the end of September 2018 for psychological therapy services were in the Belfast (731)
and Western (640) Trusts.
Service Belfast NorthernSouth
EasternSouthern Western
Region
Total
Adult Mental Health 107 0 251 122 385 865
Primary Care Hub 0 0 0 0 0 0
Older People-Functional Services 0 0 28 0 1 29
Adult Learning Disability 14 35 26 1 118 194
Children's Learning Disability 26 16 11 1 36 90
Adult Health Psychology 314 50 67 47 10 488
Children's Psychology 71 1 0 0 90 162
Psychosexual Services 199 0 0 0 0 199
Neurodisability Services 0 0 0 0 0 0
Specialist Trauma Care 0 0 0 0 0 0
Trust Total 731 102 383 171 640 2,027
Psychological Therapies Services - Breach Analysis September 2018
The majority of patients waiting longer than 13 weeks in Belfast Trust were waiting to
access adult health psychology (314), adult mental health (107) and psychosexual
services (199). In the Western Trust, the majority of patients were waiting longer than
13 weeks in adult mental health (385) and adult learning disability (118) services.
All Trusts have submitted PITs setting out the expected performance against the target
to have no patients waiting longer than 13 weeks for psychological therapies (any age)
by 31 March 2019.
Trust
No. waiting
>13 weeks for
Psychological
Therapies at
31.3.18
Planned
no. waiting
>13 weeks for
Psychological
Therapies at
31.3.19
Planned
no. waiting
>13 weeks for
Psychological
Therapies at
30.9.18
Actual
no. waiting
>13 weeks for
Psychological
Therapies at
30.9.18
Belfast 577 801 686 731
Northern 31 102 129 102
South Eastern 228 650 373 383
Southern 84 80 63 171
Western 554 617 618 640
With the exception of the Southern Trust, Trusts have forecast a significant deterioration
in waiting times over the course of the year, in particular for adult mental health and
adult health psychology services. Trusts have identified the need for additional
24
investment, an increase in demand and complexity for psychological therapy services
and recruitment difficulties as the reasons for the forecast increase in waiting times.
At the end of September 2018, performance in four of the five Trusts is broadly in line
with their respective PITs however, this should be viewed in the context of a forecast
increase in the number of patients waiting longer than 13 weeks over the course of the
year – regionally, 2,250 waiting longer than 13 weeks at 31 March 2019 compared to
1,474 at the end of March 2018 (+776). Performance in the Southern Trust is currently
not on track to deliver the forecast outcome – 171 patients waiting longer than 13 weeks
at the end of September against a target profile of 63. The Trust has advised that
performance continues to be impacted by ongoing workforce challenges and it is
continuing to work to address these.
The Department has recently confirmed that non-recurrent funding from the C&S
Funding for mental health services should be targeted at psychological therapies. The
HSCB is working with Trusts to agree how this funding can best be utilised to reduce
waiting times.
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.
Lisa McWilliams Interim Director of Performance Management and Service Improvement November 2018
25
Annex A SUMMARY OF PERFORMANCE AGAINST 2018/19 DRAFT COMMISSIONING PLAN DIRECTION STANDARDS AND TARGETS
STANDARD / TARGET Trend Analysis Comments
Outcome 1: Reduction of health inequalities
Supporting Children and Young People
Children in care 1 (target) – by March 2019, the proportion of children in care for 12 months or longer with no placement change is at least 85%.
Trust 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Belfast 81% 79% 83% 84% 84% 79% 84% 84% 83% 85%
Northern 81% 78% 78% 78% 75% 77% 78% 82% 83% 82%
South Eastern 80% 82% 78% 81% 81% 82% 79% 82% 83% 82%
Southern 71% 59% 73% 66% 72% 78% 81% 81% 78% 80%
Western 85% 83% 83% 82% 86% 80% 81% 79% 83% 84%
Region 80% 77% 79% 79% 79% 79% 81% 82% 82% 83% Source: CIB (OC2 Community Information Return) 'Year' is school year not financial year)
Performance against this target is reported annually in arrears. Regionally during 2017 (school year), the proportion of children in care for 12 months or longer with no placement change was 83%.
Children in care 2 (target) – by March 2019, 90% of children who are adopted from care, are adopted within a three year time frame (from date of last admission).
Trust 2007/08 2009/10 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18
Belfast 75% 31% 59% 41% 78% 63% 92% 43% 42%
Northern 33% 38% 29% 44% 61% 50% 52% 60% 40%
South Eastern 20% 33% 57% 64% 52% 69% 80% 94% 32%
Southern 63% 42% 50% 50% 56% 25% 32% 53% 69%
Western 20% 100% 60% 19% 57% 25% 38% 36% 68%
Region 47% 40% 47% 42% 61% 47% 54% 56% 50% Source: CIB (these figures are based on Dept’l returns). “Year” is school year not financial year
Performance against this target is reported annually in arrears. During 2017/18 (school year), there was a 3-year timeframe for 50% of children adopted from care.
26
STANDARD / TARGET Trend Analysis Comments
Outcome 2: People using health and social care services are safe from avoidable harm
Safe in Hospital Settings
Healthcare acquired infections 1 (target) – by 31 March 2019 secure an aggregate reduction of 11% of Escherichia coli, Klebsiella spp. and Pseudomonas aeruginosa bloodstream infections acquired after two days of hospital admission, compared to 2017/18.
211 216
0
50
100
150
200
250
Jan-00
Number of episodes of HCAGNBSI (Regional)(Target: no more than 422 during 2018/19)
Target Profile (Apr-Sep 18) Actual no of episodes (Apr-Sep 18)
HAGNBSI2017/18
Actual
2018/19
Target
Maximum
2018/19
Target
Profile
(Apr-Sep)
2018/19
Actual
(Apr-Sep)
Variance
(actual vs
target
profile)
(Apr-Sep)
Belfast 208 201 101 119 19
Northern 80 75 38 15 -23
South Eastern 64 39 20 27 8
Southern 71 58 29 29 0
Western 50 49 25 26 2
Region 473 422 211 216 5
39
27
3835
32
45
0
5
10
15
20
25
30
35
40
45
50
Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19
Monthly No of cases of HAGNBSI against run-rate (regional)
No of cases of HAGNBSI Monthly run-rate
This is a new target for 2018/19. Trusts are required to have no more than 422 episodes of Escherichia coli (E-coli), Klebsiella spp. and Pseudomonas aeruginosa bloodstream infections acquired after two days of hospital admission during 2018/19. Regionally during the first six months of 2018/19 (April to September), there have been 216 Healthcare Associated Gram-negative Bloodstream Infections (HAGNBSI) against a 6-month target profile to have had no more than 211. With regard to performance in individual Trusts, at the end of September 2018 performance in the Northern and Southern Trusts is in line with, or ahead of, their 6-month target profiles however, the remaining three Trusts (Belfast, South Eastern and Western) have exceeded their target profiles for this period.
27
STANDARD / TARGET Trend Analysis Comments
Healthcare acquired infections 2 (target) – by 31 March 2019, to secure a reduction of 7.5% in the total number of in-patient episodes of Clostridium difficile infection in patients aged 2 years and over.
160
179
0
20
40
60
80
100
120
140
160
180
200
Number of episodes of C. Difficile (Regional)(Target: no more than 320 during 2018/19)
Target Profile (Apr-Sep 18) Actual no of episodes (Apr-Sep 18)
C. Difficile2017/18
Actual
2018/19
Target
Maximum
2018/19
Target
Profile
(Apr-Sep)
2018/19
Actual
(Apr-Sep)
Variance
(actual vs
target
profile)
(Apr-Sep)
Belfast 113 110 55 60 5
Northern 49 49 25 29 5
South Eastern 61 55 28 42 15
Southern 50 50 25 20 -5
Western 64 56 28 28 0
Region 337 320 160 179 19
21
27
39
27 28
37
0
5
10
15
20
25
30
35
40
45
Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19
Monthly No of cases of C. difficile against run-rate (regional)
No of cases of C. difficile Monthly run-rate
Trusts are required to have no more than 320 inpatient episodes of Clostridium difficile infection in patients aged 2 years and over during 2018/19. Regionally during the first six months of 2018/19 (April to September), there have been 179 episodes of C. difficile against a 6-month target profile to have had no more than 160. This position is largely as a result of the high number of episodes in June (40) and September (37). With regard to performance in individual Trusts, at the end of September 2018 performance in Southern and Western Trusts is in line with, or ahead of, their 6-month target profiles however, the remaining three Trusts (Belfast, Northern and South Eastern) have exceeded their target profiles for this period.
28
STANDARD / TARGET Trend Analysis Comments
Healthcare acquired infections 3 (target) – by 31 March 2019, to secure a reduction of 7.5% in the total number of in-patient episodes of Methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection compared to 2017/18.
17
31
0
5
10
15
20
25
30
35
Number of episodes of MRSA (Regional)(Target: no more than 34 during 2018/19)
Target Profile (Apr-Sep 18) Actual no of episodes (Apr-Sep 18)
MRSA2017/18
Actual
2018/19
Target
Maximum
2018/19
Target
Profile
(Apr-Sep)
2018/19
Actual
(Apr-Sep)
Variance
(actual vs
target
profile)
(Apr-Sep)
Belfast 19 12 6 11 5
Northern 14 7 4 7 4
South Eastern 5 5 3 7 5
Southern 4 5 3 0 -3
Western 4 5 3 6 4
Region 46 34 17 31 14
5
4
3
10
2
7
0
1
2
3
4
5
6
7
8
9
10
11
Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19
Monthly No of cases of MRSA against run-rate (regional)
No of cases of MRSA Monthly run-rate
Trusts are required to have no more than 34 inpatient episodes of MRSA bloodstream infection during 2018/19. Regionally during the first six months of 2018/19 (April to September), there have been 31 episodes of MRSA against a 6-month target profile to have had no more than 17. This position is largely as a result of the high number of episodes in July (10) and September (7). With regard to performance in individual Trusts, at the end of September 2018 performance in the Southern Trust is ahead of their 6-month target profile however, the remaining four Trusts have exceeded their target profiles for this period and South Eastern Trust has exceeded its annual target maximum of five.
29
STANDARD / TARGET Trend Analysis Comments
Outcome 4: Health and social care services are centred on helping to maintain or improve the quality of life of people who use them
Primary Care Setting
GP out-of-hours (target) – by March 2019, to have 95% of acute/urgent calls to GP OOH triaged within 20 minutes.
89% 90% 91% 91% 92% 92% 93% 91%
84%87% 89% 88%
86% 86% 87% 84%87% 87%
0%
20%
40%
60%
80%
100%
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
By March 2019, 95% of acute / urgent calls to GP OOH should be triaged within 20 minutes.
2017/18 2018/19
Trust Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 2018/19
Belfast 87% 87% 88% 88% 89% 91% 88%
Northern 92% 94% 94% 93% 96% 93% 94%
South Eastern 84% 87% 86% 87% 84% 80% 85%
Southern 80% 80% 80% 73% 78% 82% 79%
Western 88% 86% 89% 87% 91% 89% 88%
Region 86% 86% 87% 84% 87% 87% 86%
During September 2018, 87% of acute/urgent calls to GP OOH were triaged within 20 minutes.
Ambulance Response Time (standard) – from April 2018, 72.5% of Category A (life threatening) calls responded to within eight minutes, 67.5% in each LCG area.
Trust Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 2018/19
Belfast 51% 50% 47% 44% 47% 52% 48%
Northern 35% 33% 36% 33% 30% 27% 32%
South Eastern 36% 35% 34% 27% 29% 34% 33%
Southern 37% 36% 33% 33% 32% 36% 35%
Western 56% 47% 47% 44% 42% 48% 47%
Region 43% 41% 39% 37% 37% 40% 39%
Regionally during September 2018, 40% of Category A calls were responded to within eight minutes. Increasing demand for emergency ambulance services has placed considerable pressure on NIAS to deliver against the 8-minute Category A response standard. The Trust’s proposal on the introduction of a new Clinical Response Model (CRM) has been issued for public consultation – closing date of 20 December 2018. As reported previously, through the new model, which has been successfully introduced in the rest of the UK without any adverse impact, NIAS would seek to identify the patients with potentially life-threatening conditions and aim to ensure that, on average, these calls are reached within eight minutes and that 90% are reached within 15 minutes.
In addition to the above, as part of the Trust’s programme of reform and modernisation, NIAS is continuing to take forward the implementation of Appropriate Care Pathways which provide
30
STANDARD / TARGET Trend Analysis Comments
access to a range of new services to offer alternatives to bringing patients to an Emergency Department through treatment in the community or offering an alternative destination.
Hospital Care Setting – Acute Care
Unscheduled care 1 (target) – by March 2019, 95% of patients attending any Type1, 2 or 3 Emergency Department are either treated and discharged home, or admitted, within four hours of their arrival in the Department; and no patient attending any emergency department should wait longer than 12 hours.
Trust Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 2018/19
Belfast 67% 67% 69% 68% 66% 69% 68%
Northern 71% 72% 71% 69% 66% 68% 69%
South Eastern 75% 76% 76% 76% 76% 76% 76%
Southern 73% 73% 73% 72% 70% 70% 72%
Western 74% 80% 78% 78% 76% 74% 77%
Region 72% 73% 73% 72% 70% 71% 72%
702555
296 293448
919 1,0101,190
2,369
3,932
2,467
3,161
1,4141,157
1,366
1,872
1,4991,716
0
1,000
2,000
3,000
4,000
5,000
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
ED - Number Waiting >12 hours
2017/18 2018/19
Trust Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 2018/19
Belfast 299 250 172 263 243 261 1,488
Northern 332 174 294 436 559 563 2,358
South Eastern 462 464 551 545 345 397 2,764
Southern 237 240 285 500 282 310 1,854
Western 84 29 64 128 70 185 560
Region 1,414 1,157 1,366 1,872 1,499 1,716 9,024
Regionally during September 2018, 71% of patients were treated and discharged, or admitted within four hours – this is a slight improvement on the previous month (70%) and is a deterioration compared to the same month last year (74%). Regionally during the month of September 2018, 1,716 patients waited longer than 12 hours in ED – this is an increase on the previous month (1,499) and a material increase on the same month last year (919). Further details are provided at pages 10-12 above.
31
STANDARD / TARGET Trend Analysis Comments
Unscheduled care 2 (target) – by March 2019, at least 80% of patients to have commenced treatment, following triage, within 2 hours.
82%82%
85% 86% 85%82% 82% 82% 79% 80% 78% 76%
81% 80% 80% 80% 80% 81%
0%
20%
40%
60%
80%
100%
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
By March 2019, at least 80% of patients to have commenced treatment, following triage, within 2 hours
2017/18 2018/19
Trust Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 2018/19
Belfast 72% 72% 75% 74% 74% 75% 74%
Northern 81% 79% 76% 76% 74% 79% 77%
South Eastern 87% 87% 86% 87% 89% 90% 88%
Southern 80% 77% 77% 77% 75% 76% 77%
Western 85% 90% 87% 89% 89% 90% 88%
Region 81% 80% 80% 80% 80% 81% 80%
Regionally during September 2018, 81% of patients commenced treatment, following triage, within 2 hours.
Hip fractures (target) – by March 2019, 95% of patients, where clinically appropriate, wait no longer than 48 hours for inpatient treatment for hip fractures.
Trust Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 2018/19
Belfast 86% 77% 71% 74% 81% 82% 78%
Northern
South Eastern 56% 68% 67% 64% 70% 79% 67%
Southern 87% 91% 94% 95% 86% 96% 92%
Western 75% 91% 90% 86% 97% 82% 87%
Region 79% 80% 77% 79% 84% 83% 80%
Regionally during September 2018, 83% of patients, where clinically appropriate, received inpatient treatment for hip fractures within 48 hours.
Thrombolysis (target) – by March 2019, ensure that at least 15% of patients with confirmed ischaemic stroke receive thrombolysis treatment, where clinically appropriate.
Trusts are permitted three months to complete clinical coding – regionally at the end of June 2018, 83% of episodes had been coded. On the basis of this level of coding, during Q1 of this year (Apr-Jun), 17% of patients with confirmed ischaemic stroke received thrombolysis treatment, where clinically appropriate.
32
STANDARD / TARGET Trend Analysis Comments
Diagnostic Reporting (target) – by March 2019, all urgent diagnostic tests should be reported on within two days.
85% 88% 90%85% 87% 87% 86% 88% 86% 86% 86% 84%
83%87%
84% 83%87%
84%
0%
20%
40%
60%
80%
100%
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
DRTT - Urgent within 2 days (inc Plain Film)
2017/18 2018/19
Trust Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-1818/19
Cum
Belfast 77% 84% 79% 80% 85% 80% 81%
Northern 84% 92% 82% 81% 87% 81% 84%
South Eastern 91% 93% 92% 91% 90% 88% 91%
Southern 82% 81% 84% 82% 83% 84% 83%
Western 87% 90% 92% 89% 91% 91% 90%
Region 83% 87% 84% 83% 87% 84% 85%
Regionally during September 2018, 84% of urgent diagnostic tests were reported on within two days.
Cancer care services 1 (standard) – during 2018/19, all urgent suspected breast cancer referrals should be seen within 14 days.
Trust Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 2018/19
Belfast 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%
Northern 100.0% 84.3% 80.6% 59.2% 19.2% 11.9% 58.3%
South Eastern 100.0% 100.0% 99.5% 100.0% 100.0% 100.0% 99.9%
Southern 99.6% 98.8% 97.6% 97.9% 100.0% 100.0% 99.0%
Western 100.0% 100.0% 99.3% 100.0% 100.0% 100.0% 99.9%
Region 99.9% 96.3% 94.2% 92.1% 79.5% 74.5% 89.8%
Regionally during September 2018, 74.5% of urgent breast cancer referrals were seen within 14 days compared to 79.5% in August. Further details are provided at pages 12-14 above.
33
STANDARD / TARGET Trend Analysis Comments
Cancer care services 2 (standard) – during 2018/19, at least 98% of patients diagnosed with cancer should receive their first definitive treatment within 31 days of a decision to treat.
95%
93%
95%
95% 94% 92%95% 93% 92% 92% 93%
97%95%
93%
95%
94% 93% 92%
0%
20%
40%
60%
80%
100%
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
By March 2019, at least 98% of patients diagnosed with cancer should receive their first definitive treatment within 31 days of a decision to treat
2017/18 2018/19
Trust Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 2018/19
Belfast 91.6% 87.5% 92.5% 90.3% 90.7% 87.5% 90.1%
Northern 95.2% 91.7% 94.8% 90.2% 81.3% 82.6% 88.9%
South Eastern 96.1% 94.2% 94.2% 95.2% 94.5% 96.0% 95.0%
Southern 96.6% 100.0% 100.0% 100.0% 100.0% 100.0% 99.5%
Western 100.0% 100.0% 100.0% 99.3% 99.2% 98.5% 99.5%
Region 94.9% 93.3% 95.4% 93.9% 93.0% 91.9% 93.7%
Regionally during September 2018, 92% of cancer patients commenced treatment within 31 days of the decision to treat. Further details are provided at pages 14-16 above.
Cancer care services 3 (standard) – during 2018/19, at least 95% of patients urgently referred with a suspected cancer should begin their first definitive treatment within 62 days.
68% 68%
69%
64%
64%
62%68% 66% 67% 67% 67%
74%
68% 67%
71%
62%
66%
61%
0%
20%
40%
60%
80%
100%
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
By March 2019, at least 95% of patients urgently referred with a suspected cancer should begin their first definitive treatment within 62 days
2017/18 2018/19
Trust Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 2018/19
Belfast 59.9% 55.0% 65.3% 48.7% 60.0% 47.8% 56.4%
Northern 72.4% 76.0% 70.0% 60.6% 66.9% 55.5% 67.0%
South Eastern 58.3% 60.4% 60.1% 52.9% 48.2% 48.4% 55.0%
Southern 69.4% 74.2% 79.0% 78.9% 74.2% 81.2% 76.1%
Western 90.8% 81.8% 84.7% 83.7% 84.1% 84.4% 84.8%
Region 68.2% 67.5% 70.8% 62.3% 65.8% 61.3% 66.0%
Regionally during September 2018, 61% of patients urgently referred with a suspected cancer began their first definitive treatment within 62 days. Further details are provided at pages 16-17 above.
34
STANDARD / TARGET Trend Analysis Comments
Hospital Care Setting – Elective Care
Outpatient assessment (target) – by March 2019, 50% of patients should be waiting no longer than 9 weeks for an outpatient appointment and no patient waits longer than 52 weeks.
29% 28% 28% 27% 25% 25% 26% 26% 24% 23% 25% 27%
27% 26% 27% 26% 24% 25%
0%
20%
40%
60%
80%
100%
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Outpatients - % waiting <9 weeks
2017/18 2018/19
Trust Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18
Belfast 27% 27% 28% 27% 26% 27%
Northern 29% 28% 28% 28% 26% 27%
South Eastern 21% 21% 22% 21% 20% 19%
Southern 28% 28% 29% 27% 25% 26%
Western 30% 29% 30% 29% 26% 27%
Region 27% 26% 27% 26% 24% 25%
184,305 189,158 189,289196,348
202,697 203,478 200,213 200,494206,983 206,248 200,189 198,296
199,881 202,054 202,081 206,963214,300 212,990
0
30,000
60,000
90,000
120,000
150,000
180,000
210,000
240,000
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Outpatients - Numbers waiting >9 weeks
2017/18 2018/19
Trust Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18
Belfast 68,204 68,882 67,945 69,067 70,693 69,950
Northern 26,527 27,121 27,520 28,189 29,179 28,723
South Eastern 49,501 49,804 49,951 51,472 53,851 53,711
Southern 31,374 31,995 32,437 33,468 34,749 34,837
Western 24,275 24,252 24,228 24,767 25,828 25,769
Region 199,881 202,054 202,081 206,963 214,300 212,990
At the end of September 2018:
25% of patients were waiting less than nine weeks for a first outpatient appointment;
212,990 people were waiting longer than nine weeks; and
94,222 were waiting longer than a year. Further details are provided at pages 1-7 above.
35
STANDARD / TARGET Trend Analysis Comments
57,57160,427
64,07466,677
69,93573,380 75,311 77,683
80,651 80,767 80,67583,392
83,739 85,95788,598 90,082 92,070 94,222
0
20,000
40,000
60,000
80,000
100,000
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Outpatients - Numbers waiting >52 weeks
2017/18 2018/19
Trust Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18
Belfast 31,415 31,769 32,189 32,063 32,113 32,928
Northern 10,308 10,597 10,952 11,151 11,340 11,291
South Eastern 21,730 22,616 23,566 24,496 25,754 26,355
Southern 9,077 9,403 9,983 10,204 10,439 11,022
Western 11,209 11,572 11,908 12,168 12,424 12,626
Region 83,739 85,957 88,598 90,082 92,070 94,222 Diagnostic tests (target) – by March 2019, 75% of patients should wait no longer than 9 weeks for a diagnostic test and no patient waits longer than 26 weeks.
Trust Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18
Belfast 42% 43% 44% 45% 42% 42%
Northern 72% 66% 63% 57% 52% 51%
South Eastern 64% 61% 63% 58% 53% 56%
Southern 53% 50% 49% 47% 43% 46%
Western 84% 83% 83% 80% 76% 78%
Region 57% 56% 55% 53% 49% 50%
At the end of September 2018:
50% of patients were waiting less than nine weeks for a diagnostic test;
50,948 patients were waiting longer than nine weeks; and
19,772 were waiting longer than 26 weeks. Further details are provided at pages 8-10 above.
36
STANDARD / TARGET Trend Analysis Comments
Trust Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18
Belfast 18,433 17,963 18,863 15,787 18,592 16,707
Northern 5,229 6,955 7,890 9,570 11,425 12,197
South Eastern 5,121 5,973 5,980 6,888 7,713 7,471
Southern 10,646 11,481 11,929 12,368 13,294 12,701
Western 1,359 1,552 1,536 1,700 1,973 1,872
Region 40,788 43,924 46,198 46,313 52,997 50,948
Trust Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18
Belfast 11,028 10,732 11,482 9,039 10,615 9,968
Northern 931 1,148 1,358 1,651 2,153 3,330
South Eastern 1,004 1,142 933 1,065 1,035 995
Southern 3,264 3,768 3,847 4,194 4,867 5,008
Western 150 178 225 356 508 471
Region 16,377 16,968 17,845 16,305 19,178 19,772
37
STANDARD / TARGET Trend Analysis Comments
Inpatient/daycase treatment (target) – by March 2019, 55% of patients should wait no longer than 13 weeks for inpatient/daycase treatment and no patient waits longer than 52 weeks.
Trust Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18
Belfast 31% 29% 29% 28% 26% 25%
Northern 64% 63% 63% 63% 61% 59%
South Eastern 44% 44% 46% 46% 45% 43%
Southern 40% 41% 41% 39% 37% 37%
Western 35% 35% 36% 35% 33% 33%
Region 38% 37% 37% 36% 34% 33%
41,163 42,064 42,732 43,58545,624 47,009 46,111 45,383
48,00350,317 51,046 50,228
51,235 52,429 52,872 54,183 56,10057,617
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Inpatient/Daycase - Numbers waiting >13 weeks
2017/18 2018/19
Trust Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18
Belfast 24,825 25,925 26,592 27,299 28,388 29,193
Northern 2,547 2,606 2,660 2,720 2,828 3,044
South Eastern 5,794 5,668 5,605 5,617 5,618 5,812
Southern 7,133 7,224 7,150 7,432 7,766 7,784
Western 10,936 11,006 10,865 11,115 11,500 11,784
Region 51,235 52,429 52,872 54,183 56,100 57,617
At the end of September 2018:
33% of patients were waiting less than 13 weeks for inpatient or daycase treatment;
57,617 patients were waiting longer than 13 weeks; and
19,715 were waiting longer than a year. Further details are provided at pages 1-7 above.
38
STANDARD / TARGET Trend Analysis Comments
10,134 10,670 11,261 11,62112,371
13,17613,935 14,391 14,979
15,955 16,389 16,454
16,814 17,43618,080 18,466 18,991
19,715
0
5,000
10,000
15,000
20,000
25,000
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Inpatient/Daycase - Numbers waiting >52 weeks
2017/18 2018/19
Trust Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18
Belfast 7,674 8,158 8,669 8,907 9,337 9,933
Northern 337 323 311 335 340 352
South Eastern 1,803 1,872 1,935 1,950 1,933 1,979
Southern 2,393 2,422 2,390 2,426 2,504 2,510
Western 4,607 4,661 4,775 4,848 4,877 4,941
Region 16,814 17,436 18,080 18,466 18,991 19,715 CAMHS (target) – by March 2019, no patient waits longer than nine weeks to access child and adolescent mental health services (CAMHS).
Trust Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18
Belfast 56 33 28 29 57 26 20
Northern 0 0 0 0 0 70 119
South Eastern 0 0 0 0 0 0 0
Southern 0 0 0 0 0 0 0
Western 10 36 74 61 98 94 62
Region 66 69 102 90 155 190 201
At the end of September 2018, 201 patients were waiting longer than nine weeks to access CAMHS. It should be noted that no patients were waiting longer than nine weeks in the South Eastern and Southern Trusts at the end of September. Further details are provided at pages 17-18 above.
39
STANDARD / TARGET Trend Analysis Comments
Adult Mental Health (target) – by March 2019, no patient waits longer than nine weeks to access adult mental health services.
Trust Mar-17 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18
Belfast 179 222 138 118 80 121 49
Northern 0 0 0 0 0 0 4
South Eastern 43 38 20 18 4 16 20
Southern 108 117 159 211 368 547 659
Western 318 367 455 453 440 548 573
Region 648 744 772 800 892 1,232 1,305
Regionally at the end of September 2018, 1,305 patients were waiting longer than nine weeks compared to 648 at the end of March (+657). Further details are provided at pages 19-21 above.
Dementia services (target) – by March 2019, no patient waits longer than nine weeks to access dementia services.
68
109131 141 147 154 143 144
190
145
195183
399378
337 334318
293
0
50
100
150
200
250
300
350
400
450
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Dementia - By March 2019, no patients wait >9 weeks to access dementia services
2017/18 2018/19
Trust Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18
Belfast 77 66 49 40 33 40 34
Northern 0 0 0 0 0 0 1
South Eastern 9 203 211 185 206 213 207
Southern 15 31 30 16 12 12 10
Western 82 99 88 96 83 53 41
Region 183 399 378 337 334 318 293
At the end of September 2018, 293 patients were waiting longer than nine weeks for dementia services. The continued strong performance in Northern Trust should be acknowledged. Further details are provided at pages 21-22 above.
40
STANDARD / TARGET Trend Analysis Comments
Psychological Therapies (target) – by March 2019, no patient waits longer than 13 weeks to access psychological therapies (any age).
1,242 1,262 1,319 1,3071,398 1,418 1,388 1,415
1,572 1,578 1,5681,474
1,5161,591 1,626
1,7611,829
2,027
0
300
600
900
1,200
1,500
1,800
2,100
2,400
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Psychological Therapies - By March 2019, no patients wait >13 weeks to access Psycholgical therapies services
2017/18 2018/19
Trust Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18
Belfast 577 586 592 604 691 682 731
Northern 31 62 123 147 128 123 102
South Eastern 228 245 252 224 252 286 383
Southern 84 96 105 118 142 161 171
Western 554 527 519 533 548 577 640
Region 1,474 1,516 1,591 1,626 1,761 1,829 2,027
Regionally at the end of September 2018, 2,027 patients were waiting longer than 13 weeks compared to 1,829 at the end of August (+198). Further details are provided at pages 22-24 above.
Outcome 5: People, including those with disabilities, long term conditions, or who are frail, receive the care that matters to them
Increased Choice
Direct payments (target) – by March 2019, secure a 10% increase in the number of direct payments to all service users. 4,514
4,796
0
1,000
2,000
3,000
4,000
5,000
6,000
Apr-Sep 18
Number of Direct Payments in place for all Service Users (Regional)(Target: 4,729 by March 2019)
Target Profile Actual no of direct payments in place
In order to secure the 10% target increase, Trusts are required to have 4,729 direct payments in place for all service users by March 2019. Performance against this target area will be reported quarterly during 2018/19. Regionally at the end of Q2, 4,796 direct payments were in place against a straight line target profile to have 4,514 at the end of September 2018 (+282).
41
STANDARD / TARGET Trend Analysis Comments
Trust
No. of DPs
in place at
QE Mar 18
Target
number by
31.3.19
(+10%)
Target
profile
(Apr-Sep)
Actual DPs
in place at
end of Q2
Variance
(target
profile vs
actual)
Belfast 763 839 801 802 1
Northern 790 869 830 857 28
South Eastern 990 1,089 1,040 1,056 17
Southern 777 855 816 805 -11
Western 979 1,077 1,028 1,276 248
Region 4,299 4,729 4,514 4,796 282
Note: end of Q1 position as Q2 monitoring return o/s
Access to Services
Allied Health Professionals (AHP) (target) – by March 2019, no patient should wait longer than 13 weeks from referral to commencement of treatment by an allied health professional. 21,408
22,875 23,503
24,14525,545
27,40325,543
23,92924,978 24,607 24,159 23,37523,541 23,920 23,837
23,006 23,583 23,456
0
4,000
8,000
12,000
16,000
20,000
24,000
28,000
32,000
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
AHP (>13 weeks) - By March 2019, no patient waits longer than 13 weeks from referral to commencement of AHP treatment.
2017/18 2018/19
Trust Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18
Belfast 4,169 4,370 4,367 4,549 4,633 5,038 5,208
Northern 10,256 10,107 10,371 10,278 9,836 9,963 9,461
South Eastern 240 435 574 677 575 661 785
Southern 3,952 3,862 3,918 3,945 3,588 3,878 4,266
Western 4,758 4,767 4,690 4,388 4,374 4,043 3,736
Region 23,375 23,541 23,920 23,837 23,006 23,583 23,456
At the end of September 2018, 23,456 patients were waiting longer than 13 weeks from referral to commencement of AHP treatment. Regionally, more than half (12,823) of the patients waiting longer than 13 weeks at the end of September were waiting for physiotherapy. Trusts have been allocated non-recurrent funding in 2018/19 from the Confidence and Supply Transformation Fund to reduce the backlog of patients waiting longer than 13 weeks for AHP treatment at the end of March 2018.
42
STANDARD / TARGET Trend Analysis Comments
Profession Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18
Physio 15,078 15,147 15,182 14,868 13,542 13,412 12,823
OT 3,454 3,480 3,682 3,891 4,150 4,673 4,881
Dietetics 1,081 1,127 1,188 1,074 1,101 1,198 1,298
SLT 2,534 2,543 2,552 2,552 2,560 2,458 2,457
Podiatry 1,040 1,074 983 916 1,094 1,180 1,113
Orthoptics 188 170 333 526 559 662 884
2017/18 23,375 23,541 23,920 23,827 23,006 23,583 23,456
Care in Acute Setting
Patient discharge 1 (standard) – during 2018/19, 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.
5
0
3
2
5
1
4 4
5
3
1
3
1 1
3 3
0
1
0
2
4
6
8
10
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Delayed Discharges (Learning Disability) During 2018/19, ensure no discharge takes more than 28 days (Numbers > 28 days)
2017/18 2018/19
Regionally during September 2018, 92% (11 out of 12) of learning disability discharges took place within seven days of the patient being assessed as medically fit for discharge, and only one took more than 28 days.
43
STANDARD / TARGET Trend Analysis Comments
Patient discharge 2 (standard) – during 2018/19, 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.
97%98%
96%98%
95% 96%
97% 96% 96%
98%
95%
99%95% 97% 95%
98%
97% 97%
0%
20%
40%
60%
80%
100%
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Delayed Discharges (Mental Health) - During 2018/19, ensure 99% of discharges take place within 7 days
2017/18 2018/19
Regionally during September 2018, 97% (392 out of 406) of mental health discharges took place within seven days of the patient being assessed as medically fit for discharge, and eight took more than 28 days.
44
STANDARD / TARGET Trend Analysis Comments
Outcome 6: Supporting those who care for others
Carers’ assessments (target) – by March 2019, secure a 10% increase (based on 2017/18 figures) in the number of carers’ assessments offered to carers for all service users.
4,081 4,079
0
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
4,500
Apr-Jun 18
Number of Carers' Assessments offered to carers for all service users(Regional)
(Target: 16,324 by March 2019)
Target Profile Actual no of CAs offered
Trust
Total no. of
CAs offered
during 17/18
Target
number by
31.3.19
(+10%)
Target
profile
(Apr-Jun 18)
Total CAs
offered
(Apr-Jun 18)
Variance
(target
profile vs
actual)
Belfast 3,407 3,748 937 855 -82
Northern 5,015 5,517 1,379 1,286 -93
South Eastern 1,697 1,867 467 491 24
Southern 3,145 3,460 865 976 111
Western 1,576 1,734 433 471 38
Region 14,840 16,324 4,081 4,079 -2
In order to secure the 10% target increase by March 2019, Trusts are required to offer a total of 16,324 carers’ assessments to carers for all service users during 2018/19. Regionally at the end of Q1, 4,079 carers’ assessments were in place against a straight line target profile to have 4,081 at the end of June 2018 (+2). It is not possible to provide an update at this time on the Q2 position as a number of Trusts have not yet submitted monitoring returns for this period. An update on performance at end of September 2018 will be provided in a future report.
45
STANDARD / TARGET Trend Analysis Comments
Short Breaks (target) – by March 2019, secure a 5% increase (based on 2017/18 figures) in the number of community based short break hours (i.e. non-residential respite) received by adults across all programmes of care.
465,697 455,043
0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
450,000
500,000
Apr-Jun 18
Number of Community based short break hours received by adults across all PoCs (Regional)
(Target: 1,862,789 by March 2019)
Target Profile Actual no of short break hours received
Trust
Total no. of
short break
hours
received
during 17/18
Target
number by
31.3.19
(+5%)
Target
profile
(Apr-Jun 18)
Total short
breaks
received
(Apr-Jun 18)
Variance
(target
profile vs
actual)
Belfast 240,495 252,520 63,130 62,725 -405
Northern 788,677 828,111 207,028 197,858 -9,170
South Eastern 166,452 174,775 43,694 45,595 1,901
Southern 500,658 525,691 131,423 125,283 -6,140
Western 77,802 81,692 20,423 23,581 3,158
Region 1,774,084 1,862,788 465,697 455,042 -10,655
In order achieve the target to secure a 5% increase in the number of community based short break hours (i.e. non-residential respite) received by adults across all programmes of care, Trusts are required to provide 1,862,789 short break hours during 2018/19. Regionally at the end of Q1, 455,043 community based short break hours had been received by adults across all programmes of care against a straight line target profile to have 465,697 at the end of June 2018 (-10,654). It is not possible to provide an update at this time on the Q2 position as a number of Trusts have not yet submitted monitoring returns for this period. An update on performance at end of September 2018 will be provided in a future report.
Outcome 7: Ensure the sustainability of health and social care services provided.
Hospital Setting
Cancellations (target) – by March 2019, to establish a baseline of the number of hospital cancelled, consultant led, outpatient appointments in the acute programme of care which resulted in the patient waiting longer for their appointment and by March 2020 seek a reduction of 5%.
This is a new target for 2018/19. The HSCB will work with Trusts and the Department of Health to establish (by March 2019) a baseline of the number of hospital cancelled, consultant led, outpatient appointments in the acute programme of care which resulted in the patient waiting longer for their appointment.
Delivery of funded capacity (target) - by March 2019, to reduce the percentage of funded activity associated with elective care service that remains undelivered.
There has been a continued improved in relation to the delivery of commissioned volumes of core activity compared to last year. For new outpatient assessments, regionally during the first six months of 2018/19, there has been a 10.7% (21,914) underdelivery of core activity compared to -12.2% during the
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STANDARD / TARGET Trend Analysis Comments
same period last year. In relation to delivery of commissioned volumes of inpatient/daycase volumes, there has been an 8.6% (6,773) underdelivery of core activity during the first half of this year (April to September 2018) compared to 11.0% during the same period last year. Further details are provided at page 7 above.
Complex discharges (target) – by March 2019, ensure that 90% of complex discharges from an acute hospital take place within 48 hours, with no complex discharge taking more than seven days.
77%
78%
76% 77% 78%72% 73%
77%80%
74% 75% 76%
77%
76%
81%78%
81%78%
0%
20%
40%
60%
80%
100%
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Delayed Discharges (Complex Discharges) - from April 2018 ensure that 90% of complex discharges <48 hours
2017/18 Region
Trust of
Residence
(ToR)
2017/18
CumApr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18
2018/19
Cum
Belfast 52% 66% 63% 74% 72% 72% 69% 70%
Northern 81% 79% 72% 77% 77% 84% 77% 78%
South Eastern 75% 76% 84% 80% 84% 85% 84% 82%
Southern 92% 92% 90% 95% 91% 92% 92% 92%
Western 81% 79% 77% 86% 75% 77% 74% 79%
No ToR 80% 75% 94% 100% 80% 62% 77% 82%
Region 76% 77% 76% 81% 78% 81% 78% 79%
Regionally during September 2018, 78% of complex discharges from an acute hospital took place within 48 hours and 150 took more than seven days.
47
STANDARD / TARGET Trend Analysis Comments
Trust of
Residence
(ToR)
2017/18
CumApr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18
2018/19
Cum
Belfast 874 62 76 56 61 49 63 367
Northern 250 20 33 26 30 20 35 164
South Eastern 336 37 18 42 21 26 19 163
Southern 36 7 6 5 2 4 4 28
Western 406 40 24 28 38 45 28 203
No Trust of Residence 8 2 0 0 1 1 1 5
Region 1,910 168 157 157 153 145 150 930 Non-complex discharges (target) – by March 2019, ensure that all non-complex discharges from an acute hospital take place within six hours.
94%93%
94% 95% 94% 94% 94% 94% 93% 94% 94% 94%
94% 94% 94% 94% 93% 94%
0%
20%
40%
60%
80%
100%
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Delayed Discharges (NON Complex Discharges) - from April 2018 ensure that all non-complex discharges <6 hours
2017/18 Region
Trust
2017/18
CumApr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18
2018/19
Cum
Belfast 96% 97% 97% 97% 97% 97% 96% 97%
Northern 93% 92% 92% 92% 92% 90% 91% 92%
South Eastern 87% 88% 87% 87% 87% 88% 89% 88%
Southern 94% 95% 95% 94% 94% 93% 93% 94%
Western 97% 98% 97% 97% 97% 97% 96% 97%
Region 94% 94% 94% 94% 94% 93% 94% 94%
Regionally during September 2018, 94% of non-complex discharges from an acute hospital took place within six hours.
48