Document

Page Number

EC01 3

EC02 4

EC03 6

EC04 7

EC05 8

EC06 9

EC07 10

EC08 11

EC09 12

EC13 13

EC14 14

NPI01 15

NPI02 17

NPI03 18

NPI05a 19

NPI05b 20

NPI06a 21

NPI06b 22

NPI06b 22

NPI06c 24

NPI07a 25

Content Page

Existing Commitments

Guaranteed access to a GUM clinic within 48 hours of contacting a service

All ambulance trusts to respond to 75 percent of Category A calls within 8 minutes

All ambulance trusts to respond to 95 percent of Category A calls within 19 minutes

All ambulance trusts to respond to 95 percent of Category B calls within 19 minutes

Access to Crisis Resolution Services

Access to Early Intervention in Psychosis Services

Data quality on ethnic group

Delayed Transfers of Care

Diabetic Retinopathy Screening

Thrombolysis 'call to needle'

A 4-hour maximum wait in A&E from arrival to admission, transfer or discharge

National Priorities

Percentage of patients seen within 18 weeks for admitted and non-admitted pathways (Monthly Validated Data)

Access to Primary Care "GP Patient Survey".

Access to NHS Dental Services

All cancers: two week wait

Proportion of patients with breast symptoms referred to a specialist who are seen within two weeks of referral

The proportion of patients receiving their first definitive treatment within one month (31 days) of a decision to treat (as a

proxy for diagnosis) for cancer

Proportion of patients waiting no more than 31 days for second or subsequent cancer treatment (surgery)

Proportion of patients waiting no more than 31 days for second or subsequent cancer treatment (drug treatments)

Proportion of patients waiting no more than 31 days for second or subsequent cancer treatment (radiotherapy

The proportion of patients receiving their first definitive treatment for cancer within two months (62 days) of GP or

dentist urgent referral for suspected cancer

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NPI07b 26

NPI07b 26

NPI09

(LAA)

28

NPI10 29

NPI11 30

NPI13

(LAA)

31

NPI14 33

NP15 35

NP17 (LAA) 36

NPI18 38

NP23 (LAA) 39

OPI01 40

OPI02 42

OP103 Convenience and Choice - GP Referrals (GP Booking) 43

OPI06

(LAA)

44

OPI07 45

46

Proportion of patients with suspected cancer detected through national screening programmes or by hospital

specialists who wait less than 62 days from referral to treatment (from an NHS Cancer Screening Service during a

given period)

Proportion of patients with suspected cancer detected through national screening programmes or by hospital

specialists who wait less than 62 days from referral to treatment (Percentage of patients receiving first definitive

treatment for cancer within 62-days of a consultant decision to upgrade their priority status )

Obesity among primary school age children (National Child Measurement Programme (NCMP))

Prevalence of Chlamydia

Effectiveness of Children and Adult Mental Health Service (CAMHS)

Smoking prevalence

Rates of Clostridium Difficile - Kirklees

NHS staff survey scores based measures of job satisfaction

Emergency Bed Days

Hospital admissions for ambulatory care sensitive conditions

End of Report

Prevalence of infants breastfed at 6-8 weeks

Proportion of children who complete immunisation by recommended ages

Percentage of women who have seen a midwife or a maternity healthcare professional, for assessment of health and

social care needs, risks and choices by 12 completed weeks of pregnancy.

MRSA number of infections

Supporting measures: Extended opening hours for GP practices, Increased capacity in primary care, Patient reported

access to out-of-hours care

Other Performance Measures

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(1) (4)

(8) Comments

Percentage: first attendances at a GUM service who were offered an appointment to be seen within 48 hours of contacting a service

Aug-10 31 Aug 2010 98% 100%

PI Due Date Planned Latest YTD Variance (9)

Sponsor Judith Hooper

Key Achievements Since Last

Report:

Both clinics continue to offer a selection of drop in and booked appointments.

Current Concerns

The PCT is meeting its trajectory for this indicator with 100% offered and 98% seen for August.

First appointments 993, offered 993 seen 976.

EC01: Guaranteed access to a GUM clinic within 48 hours of contacting a service. 31 Aug 2010 4 Oct 2010

Owner Rachel Spencer

Performance Report 2010/11

Accountability Period Submitted

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(1) (4)

Reasons for Variance and Actions

Taken The Operational Improvement Plan is currently going through the 6 month review process and an updated plan

will be circulated mid-October.

1 Patient Self Handover

This initiative, already in place in Bradford, is to be rolled out across Bradford/Calderdale/Kirklees (BCK) and

Rotherham shortly. The PPI forum had some concerns but these are being addressed prior to roll out.

2 Front Loaded Model (FLM)

Following resolution of the staff grievance in BCK, the FLM is to be implemented in BCK, York, Harrogate and

the coast w/c 4th October.

3 Conveyance Rate Reduction working group

The BCK YAS Assistant Director is leading a working group to address conveyance rate reduction regionally.

4 Training

To help ensure maximum staff availability, the YAS training requirement is being re-profiled –YAS will be

monitoring this to ensure that an unmanageable training backlog is not created.

5 System efficiencies

These are currently running somewhat under plan, particularly around abstraction and overtime (O/T)

management. Action has been taken to tighten up the management of these parameters, especially around

appropriate targeting of O/T. This is intended to redress the performance fluctuations (mainly weekends) that

YAS are currently experiencing.

6 Rota changes

The review of rotas / resource requirement has been completed. The new rotas to reflect the review results are

now being prepared and staff will be consulted about them from mid – October. The statutory 90 days notice of

change will be issued in December to facilitate operation of the new rota patterns from April 2011.

Sponsor Carol McKenna


Report:

August performance for YAS was 78.8% compared with a target of 75%. The cumulative annual performance

for YAS (CQC measure) at the end of August was 76.6% (i.e. above target). Performance for Kirklees was

76.4% in August (10th of 12 PCTs) and 73.9% year-to-date (10th of 12 PCTs).

Current Concerns

NHS Kirklees has been identified as one of 4 PCTs with underperforming YAS performance, with a target

identified of 70% by September 2010 (which was achieved). There has been significant improvement in NHS

Kirklees performance in 2010/11, but this masks significant variation across the different Kirklees localities. In

August, performance ranged from:

Cat A8: 25.0% in Denby Dale and Kirkburton, to 89.4% in Huddersfield North.

Cat A19: 95.3% in Denby Dale and Kirkburton, to 100% in Birstall, Batley and Birkenshaw, Dewsbury and

Mirfield, and Spen (NB all localities above 95% target).

Cat B19: 83.6% in Denby Dale and Kirkburton, to 99.0% in Birstall, Batley and Birkenshaw.

Overall activity for Kirklees is up 5.4% against plan for August and 3.2% for YtD. At £192.28 marginal rate, this

translate to £122k current pressure and a projected full-year overspend of £296k.

EC02 : All ambulance trusts to respond to 75 percent of Category A calls within 8

minutes

31 Aug 2010 4 Oct 2010

Owner Rachel carter


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Due Date Planned Latest YTD Variance (8) (9)

31 Aug 2010 75% 76.6%

PI Comments

Percentage of category A calls resulting in an emergency response arriving at the scene of the incident within 8 minutes

Aug-10 This is the CQC measure.

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31 Aug 2010 95% 97.8%

PI Comments

Percentage of category A calls requiring transport resulting in an emergency response arriving at the scene of the incident within 19 minutes




Report:

August performance for YAS was 98.2% compared with a target of 95%. The cumulative annual performance

for YAS (CQC measure) at the end of August was 97.8% (i.e. above target). Performance for Kirklees was

99.0% in August (7th of 12 PCTs) and 98.5% year-to-date (9th of 12 PCTs).

EC03 : All ambulance trusts to respond to 95 per cent of Category A calls within 19

minutes

31 Aug 2010 4 Oct 2010

Owner Rachel carter


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(1) (4)


31 Aug 2010 95% 94.7%

PI Comments

Percentage of category B calls resulting in an ambulance vehicle able to transport the patient arriving at the scene of the incident within 19

minutes




Report:

June performance for YAS was 93.9%. Cumulative annual performance (the CQC measure) at the end of June

was 94.0%. At 27th June, in-month performance was achieving the target at 95.09%. Performance for Kirklees

was 93.0% in June (8th of 12 PCTs) and 92.7% Year-to-date.

April performance for YAS was 94.3%, compared with a target of 95.0% (i.e. under-achieving). Performance for

Kirklees patients was the 10th poorest of the PCTs commissioning from YAS, at 92.1%.

May performance for YAS was 93.8%. Performance for Kirklees was 92.9%.

EC04 : All ambulance trusts to respond to 95 percent of Category B calls within 19

minutes

31 Aug 2010 4 Oct 2010

Owner Rachel carter


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(1) (4)


30 Jun 2010 213. 389

30 Jun 2010 100. 182.6%Quarter 1 June 10

PI Comments

Number of separate episodes of home treatment provided by crisis resolution teams

Quarter 1 June 10

Percentage of separate episodes of home treatment provided by crisis resolution teams of locally agreed share of the national target

Sponsor Carol Mckenna


Report:

Performance targets were fully achieved at the end of quarter 4 09/10.

A new mental health contract was agreed for April 2010.

Performance indicators were agreed with providers and financial penalty clauses were agreed as part of the

process.

Maintenance of the year end position is expected.

Current Concerns

Current quarter 1 data is been checked for accuracy & rigor. this should be confirmed by the 21/7 as per

contract requirements

EC05 : All patients who need them to have access to crisis services, with delivery of

100,000 new crisis resolution home treatment episodes each year

30 Jun 2010 9 Aug 2010

Owner Vicky Dutchburn


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30 Jun 2010 48. 42

PI Comments

Number of people with newly diagnosed cases of first episode psychosis receiving early intervention in psychosis services

Quarter 1 June 10



Report:

Performance targets were fully achieved at the end of quarter 4 09/10.

A new mental health contract was agreed for April 2010.

Performance indicators were agreed with providers and financial penalty clauses were agreed as part of the

process.

Maintenance of the year end position is expected.

Current Concerns

Current quarter 1 data is been checked for accuracy & rigor. this should be confirmed by the 21/7 as per

contract requirements

EC06 : Deliver 7,500 new cases of psychosis served by early intervention teams per

year

30 Jun 2010 9 Aug 2010

Owner Vicky Dutchburn


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31 Aug 2010 85. 89.38%

31 Aug 2010 85. 97.21%Aug-10

PI Comments

Percentage of care spells for inpatients (bed days greater than 0) recorded for the PCT (commissioner basis) on Mental Health Minimum Data

Set (MHMDS) with valid 2001 census coding for ethnic category (excluding 'not stated' and 'not known').

Aug-10

Percentage of Finished Consultant Episodes (FCEs) for the PCT (commissioner basis) on Hospital Episode Statistics (HES) data with valid

2001 census coding for ethnic category (excluding 'not stated' and 'not known').

Sponsor Peter Flynn


Report:

Both acute and mental health providers continue to maintain high levels of ethnicity coding completeness.

Current Concerns

No major concerns, however, Mid Yorkshire Hospitals Trust had aimed for 90% completeness by March 2010,

which has not been achieved. A detailed coding improvement plan had been developed to identify actions for

improvement - there will be ongoing discussions at the regular SLA meetings to monitor progress in this area.

EC07: Ethnic coding data quality 31 Aug 2010 4 Oct 2010

Owner Helen Bridges


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Planned Latest YTD Variance (8) (9)

0 8

The number of patients (acute and non-acute, aged 18 and over) whose transfer of care was delayed, averaged across quarter one to quarter

four. (numerator)

Quarter 1 June 10 30 Jun 2010

Sponsor Sheila Dilks


Report:

5 delayed discharges in Q1. CHFT 1 Acute delayed 75+ and MYHT 4 Acute delayed, 2 of which 75+ and 3

Non Acute delayed in Q1

PI Due Date Comments

EC08 : Delayed transfers of care to be maintained at a minimal level [NI131] 30 Jun 2010 30 Jul 2010

Owner Paul Howatson


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31/06/2010 100. 83.09%

Current Concerns

NHS Kirklees is the lead commissioner for the Calderdale and South Kirklees Diabetic Retinopathy Screening

Programme, however, the lead commissioning manager left the organisation in June 2010 and has not been

replaced. In the interim, Gaynor Scholefield, Senior Public Health Manager for NHS Calderdale, is managing

the Programme on behalf of NHS Kirklees with NHS Kirklees input from Philip Hargreaves, Public Health

Improvement Practitioner Specialist and Gillian Longbottom, Diabetes Project Co-ordinator.

At the beginning of July 2010 the service had a software upgrade to Optimize Vs2 which necessitated the

Programme having one week’s down time to facilitate the upgrade, user training etc. The reporting function of

the upgrade has not been successful and we have been unable to provide 2010/11 Q1 data for the Vital Signs

Monitoring Returns for South Kirklees area and NHS Calderdale. It has been identified that this issue is not

specific to our Programme and in this instance, this matter has been reported to the English National

Screening Programme for their attention. Digital Healthcare are addressing this as a matter or urgency.

Due to the shut down of the Programme 28th November 2009 to 15th February 2010, as a result of the

External Quality Assurance (EQA) visit, the re-call of patients for screening is running 2 months behind and a

meeting is arranged for September to look at 'catch up' options.


PI Comments

The percentage of patients with diabetes identified by practices in the PCT who were offered screening.

Qtr 1 10/11

EC09: 100 percent of people with diabetes to be offered screening for the early

detection (and treatment if needed) of diabetic retinopathy

30 Jun 2010 11 Aug 2010

Owner Gaynor Schofield


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68% 100%

Percentage of eligible patients with acute myocardial infarction who received thrombolysis treatment either by injection or by infusion

within 60 minutes of calling for professional help

Qtr 1 10/11 31/06/2010


Percentage of eligible patients with acute myocardial infarction who received primary PCI within 150 minutes of calling for professional

help.

Qtr 1 10/11 31/06/2010



Report:

This target has been achieved. However thrombolysis is not the preferred local treatment for heart attack and

the numbers receiving thrombolysis are low, NHS Kirklees and the other WY PCTs are ruled out on the low

numbers rule against this target.

Current Concerns No current concerns

EC13 : Thrombolysis call to needle of at least 68 percent within 60 minutes, where

thrombolysis is the preferred local treatment for heart attack

31 Mar 2010 7 Jul 2010

Owner Alison Bragg


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26 Sep 2010 95% 97.73%


Report:

A&E targets green for both MYHT and CHFT. Relaxation of the target has made sustained performance easier

to achieve for both trusts.

Current Concerns

Increase in overall number of attendances at A&E is concerning and is being investigated via both GPs and

commissioners. Variance across practices is being looked at, plus use of A&E by other UC services such as

OOH and WIC.


PI Comments

Percentage of patients spending four hours or less in all types of A&E department

Weekly

EC14 : A 4-hour maximum wait in A&E from arrival to admission, transfer or discharge W/E 26/09/2010 4 Oct 2010

Owner Tony Cooke


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31 Aug 2010 90% 87.9%

31 Aug 2010 95% 97.9%

31 Aug 2010 95% 100%

Aug-10

18 week RTT - Direct Access to Audiology (monthly validated data)

Aug-10

PI Comments

Percentage of eligible (*) admitted patients whose adjusted RTT clock stopped during the month who waited 18 weeks or less (<127 days)

(monthly validated data)

Aug-10

Percentage of eligible (*) non-admitted patients whose RTT clock stopped during the month who waited 18 weeks or less (<127 days)

(monthly validated data)



Report:

18 Standard has been maintained at CHFT.

Current Concerns

18 week standard not being met at MYHT. Action plan developed and agree; MYHT progressing. Specific

issues relate to:

* Size of the backlog continue to increase despite validation and activity;

* The PAS system does not accurately record the back log and diagnostics. This is being resolved;

* Not meeting 18 weeks in the sub-specialisations.


Taken

Further work with MYHT through contract mechanism to address scale of back log including identifying

additional capacity to treat patients.

NPI01: Percentage of patients seen within 18 weeks for admitted and non-admitted

pathways

31 Aug 2010 4 Oct 2010

Owner Jim Barwick


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(1) (4)

(8) Comments

Percentage of respondants who were able to get an appointment same day or in next working day.

Year End 2009/10 31 Mar 2010 89% 82.52%



Report:

England average 24/48 hr target is 80%. Kirklees 83%


NPI02: Access to Primary Care "GP Patient Survey". 31 Aug 2010 4 Aug 2010

Owner Mark Jenkins


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(1) (4)

(8)


DH is reluctant to sign off the trajectory submission for NHS Kirklees as they feel we are not investing

appropriately to increase access (for reasons stated below).

The team had significant concerns about the demand estimate of 63% made by Kirklees for the following

reasons:

• the demand estimate is 7% below the lower end of the GP survey based forecast of demand which ranged

from 70% to 76%

• the access level has not improved since March 2006 and there is no plan to improve access, yet.....

• the success rate for people getting NHS dentistry over a 6 month period measured by the GP survey was

93% - this compares with a national average of 95% and an expected success threshold for the new indicator

from April 2011 in the region of 97-98%

• the success rate for people getting NHS dentistry over a 24 month period measured by the GP survey was

89% - this compares with a national average of 92%

• the PCT is only aiming to achieve minimal productivity gains through contract management

Information taken to PCCG and agreed at Director level as correct for what NHS Kirklees has submitted to

DH.

Removal of a further number of underachieved UDAs from the dental budget to support the PCR shortfall is a

cause for concern with the LDC. Reduction in the number of practices accepting NHS patients on a monthly

basis has been noted.

NP103: Primary dental services, based on assessments of local needs and with the

objective of ensuring year-on-year improvements in the numbers of patients

accessing NHS dental services (VSB18)

31 Aug 2010 4 Oct 2010

Owner Clare Priestley

Due Date Planned Latest YTD Variance (9)



Report:

Removal of waiting list and provision of list of dentists providing NHS dentistry supplied to patients on request.

End of year contract management undertaken and carry forward of a number of UDAs from practices who

achieved within the 4% tolerance. Practices noted as outliers for clinical data have been addressed and

continue to be monitored for compliance.

Current Concerns

Comments

Number of patient receiving NHS primary dental services located within the PCT area within a 24 month period

Aug-10 30 Aug 2010 256,403272,564

PI

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30 Aug 2010 93% 96.07%


Taken:

MYHT have capacity problems in Radiology due to two radiologists leaving. The main impact of this has been

on the 2 week breast symptomatic target but it may also begin to impact on the sustainability of this target so

we will be closely monitoring over the next couple of months.

PI Comments

Percentage of patients first seen by a specialist within two weeks (14 days) when urgently referred by their GP or dentist with suspected

cancer

Aug-10



Report:

We have achieved 96.55% performance in August which gives us a year to date position of 96.07% as we

continue to sustain this target.

Current Concerns

MYHT have capacity problems in Radiology due to two radiologists leaving. The main impact of this has been

on the 2 week breast symptomatic target but it may also begin to impact on the sustainability of this target so

we will be closely monitoring over the next couple of months.

NPI05a : A two-week maximum wait from urgent GP referral to first outpatient

appointment for all urgent suspected cancer referrals

31 Aug 2010 11 Oct 2010

Owner Janet Cawtheray


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(1) (4)


30 Aug 2010 100. 90.81%


NP105b: Proportion of patients with breast symptoms referred to a specialist who are

seen within two weeks of referral (VSA08)

31 Aug 2010 11 Oct 2010




Report:

August Performance is 97.55% giving a Year to Date position of 90.81%.

The 2 week waiting time for Breast Symptomatic at Mid Yorkshire has been sustained again this month after

the dip in performance in May and June.

Current Concerns There were 4 breaches of this target in August, 3 of which were due to patient choice.

PI Comments

Percentage of Patients referred for evaluation/investigation of "breast symptoms" by a primary care professional during a period (excluding

those referred urgently for suspected breast cancer) who are FIRST SEEN within 14 calendar days

Aug-10

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30 Aug 2010 96% 98.58%


NPI06a : A maximum wait of one month from diagnosis to treatment for all cancers 31 Aug 2010 11 Oct 2010


Percentage of patients receiving their first definitive treatment within one month (31 days) of a decision to treat (as a proxy for diagnosis) for

cancer

Aug-10



Report:

National operational standard (96%) being maintained withAugust performance at 99.28% giving a year to date

position of 98.58%.

PI Comments

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30 Aug 2010 98% 100%

30 Aug 2010 94% 95.14%


NP106b: Proportion of patients waiting no more than 31 days for second or subsequent

cancer treatment (surgery and drug treatments) (VSA11)

31 Aug 2010 11 Oct 2010



Current Concerns

The 31 day subsequent surgery target has dipped in August to 90.63% against the 94% standard. There have

only been 3 patients seen over the 31 days but because the numbers are small it has a bigger impact on the

target.

PI Comments


Report:

100% achievement in drug treatment in August against an operational standard of 98%, YTD 100%

Surgery achieved 90.63% inAugust giving a year to date position of 95.14% against an operational standard of

94%


Taken:

The 3 breaches for subsequent surgery were at Leeds. The longest wait was 57 days. We do not have a

breakdown of what surgery they were waiting for but the reasons for the longer waits were due to inadequate

capacity. We will monitor this more closely over the next couple of months and if the problem continues we will

escalate our concern through contracting via the lead commissioner NHS Leeds.

Percentage of patients receiving subsequent drug treatment within one month (31 days) of a decision to treat

Aug-10

Percentage of patients receiving subsequent surgery treatment within one month (31 days) of a decision to treat

Aug-10

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1 Aug 2010 93% 96.70%


NP106c: Proportion of patients waiting no more than 31 days for second or subsequent

cancer treatment (radiotherapy treatments) (VSA12)

31 Aug 2010 11 Oct 2010


Percentage of patients receiving subsequent/adjuvant radiotherapy treatment within a maximum waiting time of 31-days during a given

period, including patients with recurrent cancer

Aug-10



Report:

100% was achieved inAugust against an operational standard of 94% giving a year to date position of 96.70%.

This is still a shadow indicator until December 2010.

PI Comments

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1 Aug 2010 85. 87.46%


NPI07a : A maximum wait of two months from urgent referral to treatment for all

cancers

31 Aug 2010 11 Oct 2010


Percentage of patients receiving their first definitive treatment for cancer within two months (62 days) of GP or dentist urgent referral for

suspected cancer Aug-10



Report:

Performance in August of 84.48% again the national operating standard of 85%, however, year to date position

is 87.46%.

PI Comments

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30 Aug 2010 88.57%

30 Aug 2010 90% 97.78%

Percentage of patients receiving first definitive treatment for cancer within 62-days of a consultant decision to upgrade their priority status

Aug-10

Percentage of patients receiving first definitive treatment within 62-days following referral from an NHS Cancer Screening Service during a

given period

Aug-10



Report:

100% achievement inAugust against an operational standard of 90% for screening giving a year to date

position of 97.78% and 66.67% achievement for upgrade giving a year to date position of 88.57% - there is no

operational standard yet for upgrade.

PI Comments

NP107b: Proportion of patients with suspected cancer detected through national

screening programmes or by hospital specialists who wait less than 62 days from

referral to treatment (VSA13)

31 Aug 2010 11 Oct 2010



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31 Mar 2010 10% 9.3%

31 Mar 2010 92% 95%

31 Mar 2010 17% 16.4%

31 Mar 2010 88% 92%


NPI09 VSB09 NI55 : NI56 Obesity among primary school age children 30 Sep 2009 5 Jul 2010

Owner Liz Messenger



Report:

Weighing and measuring of year 6 pupils commenced at the beginning of June and is now nearing completion.

The data from the 2009/10 programme will not be available until December 2010.

The routine feedback pilot project is currently being implemented in Spen and Huddersfield South. Parents will

receive a letter within six weeks of their child being weighed and measured to inform them of the result.

Supporting materials have been developed to ensure parents with overweight and obese children are sign

posted to appropriate programmes and services.

Current Concerns

Capacity within the School Nursing Team to complete the weighing and measuring has been reduced this

year. This could impact on the coverage of the programme, as potentially not all schools will be visited before

the end of the academic year; this raises concerns about meeting the participation targets. Steps have been

taken by the School Nursing Teams to free up capacity in order to meet the requirements of the programme.

PCT’s have experienced negative media interest following the implementation of routine feedback to parents.

The Obesity Programme is working closely with the Communications Team to proactively work with the local

press around the National Child Measurement Programme and provide information about local initiatives and

services for overweight and obese children, young people and their families.

PI Comments

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

School Year Sept 2009 Data from the 2009/10 NCMP will

not be available until December

2010.

Percentage of children in Reception with height and weight recorded.



2010.



2010.

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



2010.

Percentage of children in Year 6 with height and weight recorded.

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31 Jul 2010 4,675 4,538


Taken

The following actions are taking place to obtain the additional screens needed to meet the trajectory of 14024

screens by March 2011.

Sexual health youth workers will increase screening capacity in all youth clubs.

Evidence is being gathered to identify areas of high risk in order to target screening where prevalence and

positivity may be higher.

A more targeted approach to Chlamydia screening is being considered.

Number of people aged 15 - 24 screened or tested for chlamydia

Jul-10

PI Comments



Report:

Screens in North Kirklees have seen considerable improvement this month as a result of increased outreach

screening i.e. party in the park.

Sexual Health Youth workers have increased screening for a third month with over 70 screens, agreements

made at the SLA performance meeting that Sexual health Youth Workers will now focus on increasing capacity

for screening with in all youth centres.

GPs and Pharmacies: small numbers of screen still being received from pharmacies and GPs and further

training is being offered via CSOs.

F.E. SLA has been agreed to continue the Sexual health Nurse led clinic at Kirklees College.

Current Concerns

The PCT is not currently meeting the August trajectory of ????? Screens. The total number of screens

performed to date is ????? (inclusive of those screens obtained direct from the lab)

Core services continue not to meet required screening levels per month in order to meet trajectory.

Screens carried out in North Kirklees via Brunswick outreach have been decreasing.

NPI10: Prevalence of Chlamydia (VSB13) [NI113] 31 Jul 2010 4 Oct 2010



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4. 4

4. 4

4. 2

4. 2


NPI11: Effectiveness of Children and Adult Mental Health Service (CAMHS) (percentage

of PCTs and Local Authorities who are providing a comprehensive CAMHS) (VSB12) Owner Debi Hemingway



Are arrangements in place for the council area to ensure that 24 hour cover is available to meet urgent mental health needs of children and

young people and for a specialist mental health assessment to be undertaken within 24 hours or the next working day where indicated?

(rate 1-4)

Considerable progress as been made over the past 3 months towards developing a full range of early

intervention support services delivered in universal settings and through targeted services for children and

young people experiencing mental health problems. Through the Targeted Mental Health in Schools (TaMHS)

grant we have started a pilot project which aims to work closely with schools to find the best ways to support

children at risk of or experiencing mental health problems. This will promote strategic integration across

children’s services and foster stronger links between schools and CAMHS. Targeted support will be based

upon the existing evidence base relating to effective interventions to guide the support offered to children.

Fourteen schools are involved in the TaMHS project and will focus on developing an emotional wellbeing

pathway for schools to include early intervention and targeted support. Work is progressing well and the rating

for this indicator has progressed from a 2 to a 3


Report:

The lack of a CAMHS/LD service is still an ongoing concern and risk to performance

Current Concerns

Qtr 1 10/11 30 Jun 2010

Do 16 and 17 year olds from the council area who require mental health services have access to services and accommodation appropriate

to their age and level of maturity? (rate 1-4)

Qtr 1 10/11 30 Jun 2010

Has a full range of CAMH services for children and young people with learning disabilities been commissioned for the council area? (rate 1-

4)

Qtr 1 10/11 30 Jun 2010

Is a full range of early intervention support services delivered in universal settings and through targeted services for children experiencing

mental health problems commissioned by the Local Authority and PCT in partnership? (Indicator in Development (rate 1-4)

Qtr 1 10/11 30 Jun 2010

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NPI13: Smoking prevalence among people aged 16 or over and, aged 16 or over in

routine and manual groups (quit rates locally 2008) (VSB05) [NI123]

Judith Hooper



Report:

The Tobacco Programme has been presented at WHIB to help identify interdependencies and partnership

working opportunities to improve outcomes. Aspects of Tobacco Control have also been discussed at LPSB

and KPE and actions agreed.

A pilot smoke free homes project in North Kirklees ran for twelve months from June 2009, parents’ awareness

of the dangers to children of second hand smoke were raised and they were encouraged to make their home

smoke free. The project funding has come to an end and a business case is being prepared to enable further

work on this agenda.

An enhanced service specification has been agreed with the Stop Smoking Service 2010-11 building in quality

measures and development work to support the target populations, a reduced target has been set in

recognition of work with more difficult to engage clients. Specialist advisors from the Stop smoking Service

have been given a development role with an allocated target population focus. They will provide peer support

and inform the training for frontline workers (Brief interventions) and are key members of the Tobacco Control

Alliance cessation subgroups.

Smoking cessation pilot groups targeting R&M workers began in January 2010 following social marketing

insight work. Designated R&M advisors from the specialist service, outside speakers and ex-service users are

involved in programme delivery. This work is being evaluated to inform future service provision.

GPs and pharmacists provide an intermediate stop smoking service via a locally enhanced service, both

schemes are under review to increase activity in areas of highest smoking prevalence and improve access to

treatments.

Systems are being reviewed to improve quality of maternity data and monitoring forms are being amended,

alongside training on their completion, to capture occupation status more accurately.

Brief interventions training is being recommended for all front-line workers in contact with target populations,

an audit of training needs of identified staff is underway. An e-learning package is being developed with

colleagues from Calderdale and Wakefield which will support front line workers who are unable to attend face

to face training.

A project focused on raising awareness of dangers of “niche tobacco products” in BME communities has been

awarded funding and will be led by WYJS in Kirklees and Bradford.

Current Concerns

Smoking prevalence in Yorkshire and Humber region has increased from 22% in 2007 to 25% in 2008 making

it the region with the highest smoking rate in England. Reduce smoking in 'routine and manual' groups where

32% people smoke and to stop smoking during pregnancy are the biggest challenges regionally as well as in

Kirklees.

Development of the Tobacco control Alliance is crucial to a whole systems approach to tobacco control and

reduced smoking prevalence; this has been slow to progress due to capacity in the Tobacco programme.

Currently R&M make up only 26% of 4 week quits through the specialist service; development work is required

to ensure services meet the needs of this population and target group is engaged.

Momentum and stakeholder commitment around smoke-free homes may be lost whist funding is sought.

From 2011 measurement will move to prevalence rather than 4 week quits. Kirklees GP recording of smoking

status remains below the 70% required by DH to calculate smoking prevalence, risk taken to Primary Care

Quality Group for follow-up action. More work is required to establish method for calculating prevalence.

There is a lack of public concern re cheap & illicit tobacco especially among populations targeted in the

Tobacco programme plan. Withdrawal of regional funding has postponed the planned awareness raising social

marketing campaign. Kirklees Tobacco Alliance has “Tackling Cheap and Illicit Tobacco” as a work stream and

partnerships are being developed to take work forward at a local level.

Jun-10 04/10/2010


Sponsor

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573. 565


Taken

Total quit numbers are below target for June 2010 (565 against target of 573), the specialist service is on

target however reduced targets for the specialist service require good quit rates from intermediate advisors

(via LES schemes) in order to meet target. The specialist service have been asked to increased peer support

to practices, particularly in areas of high prevalence, to strengthen commitment to smoking cessation prior to

the new LES scheme being launched.

Jun-10 30 Jun 2010


Number of 4-week smoking quitters who attended NHS Stop Smoking Services

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(8)

Number of C. Difficile infections - MYHT

Aug-10 31 Aug 2010 70. 58

Number of C. Difficile infections - CHFT

Aug-10 31 Aug 2010 45. 36

Number of C. Difficile infections - Kirklees

Aug-10 31 Aug 2010 62. 52


PI Due Date Planned Latest YTD Variance (9) Comments

NPI14 : Rates of Clostridium Difficile (Commissioner) VSA03a 31 Aug 2010 4 Oct 2010

Owner Jane O'Donnell


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(1) (4)


31 Dec 2010 3.49


At this point in time the CQC has not confirmed which questions will be used for the assessment of staff

satisfaction as part of the 2009/10 Periodic Review. The latest CQC guidance states "selected questions from

the NHS Staff Survey will be used to calculate a job satisfaction key score, which will be used to score this

indicator overall". The staff survey currently consists of 40 key findings, all relating to staff satisfaction. At this

point in time, based on a best guesstimate of the specific questions under the Job Satisfaction Additional

Theme, for 2009/10 the PCT is above better than national average for the 4 questions asked. This would give

an overall weighted achievement of "green".

Also, overall staff engagement is a new focus within the staff survey for 2009/10, and it could be that the

questions asked in this area are the ones used by the CQC for the Periodic Review. If this is the case, the

overall staff engagement score for the PCT is in the best 20% nationally, which would result in a "green" rating.

However, until the CQC specify which questions they will assess for overall rating, there remains uncertainty.

Until clarity has been received, the indicator used in this instance is the staff response rate for the

questionnaire, which was the measurement in 2008/9 Annual Assessment process.

NPI15: NHS staff survey scores based measures of job satisfaction (VSB17) 31 Dec 2010 13 Jul 2010

Owner Carolyn Dixon

PI Comments

National NHS staff survey: Job Satisfaction

2010

Sponsor Sue Ellis


Report:

The 2009/10 NHS Survey ran from October-December 2009. Our response rate stands at 69%, exceeding our

2008 response of 66%. We have seen significant improvement overall. Areas identified for continued

improvement are being taken forward through individual directorate and organisational action plans for

implementation during 2010/11. It is anticipated that the 2010/11 NHS Survey will run between October-

December 2010.

Current Concerns

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(1) (4)


95. 90.83%

48.3 40%

655. 638

358. 184

1440. 1255

338. 318


Owner Keith Henshall


NPI17: Percentage of infants breastfed at 6-8 weeks (VSB11) [NI53]


Coverage: The number of children with a breastfeeding status recorded as a percentage of all infants due for a 6-8 week check.

Q1 figures show a continued steady improvement in prevalence rates across Kirklees, as coverage rates have

improved significantly over the quarter. GP practices have been continuously supported with data collection.

Work continues to increase prevalence (ie maintenance) of breastfeeding at 6-8 weeks through the

development of peer support projects and by increasing initiation on delivery suites. Kirklees Partnership

Executive are sponsoring work to develop workplace breastfeeding policies to support women returning to

work early after having their baby. This will include appropriate provision for expressing and storing breast

milk.


Report:

The difference in prevalence between north and south Kirklees continues to cause concern. Initiation and

maintenance of breastfeeding, along with many other health related outcomes, are linked to cultural and socio-

economic factors. These deprivation linked factors are intractable and difficult to address in the short term. Current Concerns


Taken

Continue to develop local community based solutions to support women to initiate and continue breastfeeding

beyond discharge from maternity services. Ensure links to wider programmes are developed to address

inherent cultural and socio-economic factors in areas with low prevalence.

Qtr 1 10/11 30 Jun 2010

Prevalence; The number of infants recorded as being totally breastfed at 6-8 weeks plus the number of children recorded as being partially

breastfed (receiving both breast milk and infant formula) at 6-8 weeks as percentage of the number of infants due for a 6-8 week check.

Qtr 1 10/11 30 Jun 2010

The number of children being recorded as not at all breastfed at 6-8 weeks during quarter 4.

Qtr 1 10/11 30 Jun 2010

The number of children recorded as being partially breastfed (receiving both breast milk and infant formula) at 6-8 weeks during quarter 4.

Qtr 1 10/11 30 Jun 2010

The number of infants due for a 6-8 week check during quarter 4.

Qtr 1 10/11 30 Jun 2010

The number of infants recorded as being totally breastfed at 6-8 weeks during quarter 4.

Qtr 1 10/11 30 Jun 2010

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(1) (4)


30 Jun 2010 95. 96.13 1.13

30 Jun 2010 95. 93.33 -1.67

30 Jun 2010 95. 91.65 -3.35

30 Jun 2010 95. 92.63 -2.37

30 Jun 2010 95. 93.93 -1.07

30 Jun 2010 95. 89.32 -5.68

Immunisation rate for children aged 5 who have completed immunisation for diphtheria, tetanus, polio, pertussis (DTaP/IPV) (i.e. all 4 doses)

Q1 2010/11

Immunisation rate for children aged 5 who have completed immunisation for measles, mumps and rubella (MMR) (i.e. 2 doses)

Q1 2010/11

Immunisation rate for children aged 2 who have completed immunisation for measles, mumps and rubella (MMR) - (i.e. 1 dose of MMR)

Q1 2010/11

Immunisation rate for children aged 2 who have completed immunisation for pneumococcal infection (i.e. received Pneumococal booster)

(PCV)

Q1 2010/11

Immunisation rate for children aged 2 who have completed immunisation for Haemophilus influenzae type b (Hib), meningitis C (MenC) - (i.e.

received Hib/MenC booster)

Q1 2010/11


PI Comments

Immunisation rate for children aged 1 who have completed immunisation for diphtheria, tetanus, polio, pertussis, Haemophilus influenzae

type b (Hib) - (i.e. all 3 doses of DTaP/IPV/Hib)

Q1 2010/11

NPI18 : Proportion of children who complete immunisation by recommended ages

(VSB10)

30 Jun 2010 23 Jul 2010



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(1) (4)


85. 89.38%


Owner Keith Henshall


NPI23: Percentage of women who have seen a midwife or a maternity healthcare

professional, for assessment of health and social care needs, risks and choices by 12


Data quality return for women who have seen a midwife or maternity healthcare professional, for assessment of health and social care need,

risks and choices, by 12 weeks and 6 days of pregnancy

Out of 1338 pregnancies in Q1 2010/11, 1196 were under 13 weeks when they had their assessment. This is a

ratio of 89.4% against a target of 90%.

In order to focus on the more vulnerable women and families, pregnancy care still needs to increase

community midwifery capacity and skill mixing with Maternity Support Workers. Investment in staffing still

seems to be an issue. This may be due to providers investing income from maternity services into other

priorities.

The shortfall in investment from tariff into maternity services and the accuracy of activity coding is being

analysed by commissioners. This will be addressed through the contracting process.

Current Concerns


Report:


Taken

Qtr 1 10/11 30 Jun 2010

The percentage of women in the relevant PCT population who have seen a midwife or a maternity healthcare professional, for health and

social care assessment of needs, risks and choices by 12 weeks and six days of pregnancy.

Qtr 1 10/11 30 Jun 2010

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(1) (4)


31 Aug 2010 5. 11

31 Aug 2010 1. 2

31 Aug 2010 4. 6


OPI01: MRSA number of infections (VSA01) 31 Aug 2010 4 Oct 2010



Current Concerns

As the health economy of Kirklees and Wakefield is over trajectory, contact has been made with the SHA and

the Department of Health HCAI improvement team to discuss the assistance and support they can offer to

ensure that the health economy team has reviewed all the necessary actions.

PI Comments

Number of MRSA bacteraemia - MYHT

Aug-10

Number of MRSA bacteraemia - Kirklees

Aug-10

Number of MRSA bacteraemia - CHFT

Aug-10

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(1) (4)

(8)


2 Aug 2010

Owner Mark Jenkins


OPI02 : Supporting measures: Extended opening hours for GP practices, Increased

capacity in primary care, Patient reported access to out-of-hours care (indicator to be

31 Jul 2010


Report:

July 10 - 64 practices out of 72 practices provide extended hrs (88.9%)

PI Due Date Planned Latest YTD Variance (9) Comments

Percentage of GP practices in the PCT offering extended opening in compliance with Department of Health guidelines

Aug 10 31 Aug 2010 85.1 88.9%

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(1) (4)

(8)


Choose and Book usage for NHS Kirklees in August was 51%, representing a sustained drop in performance

(April – 59%, May 60%, June 55%, July 52%). This reflects continued drops in both National and Regional

performance but in August the Kirklees performance was below both National (August 52%, July 55%, June

57%, May - 61%; April – 60%) and Regional (August 58%, July 60%, June 62%, May - 66%; April – 64%)

performance. Kirklees performance was 10th of 14 PCTs in Y&TH; Y&TH performance was 4th of 10 SHAs.

The Kirklees performance reflects performance for referrals to our main providers of 60% for CHFT (July 62%,

June 63%, May 66%, April 65%) and 42% for MYHT (July 45%, June 45%, May 51%, April 49%).

The proportion of C&B bookings made to Directly Bookable services was 96% for Kirklees (96% in April, May

and June, 97% in July) compared with National performance of 87% (87% April, May, June and July) and

Regional performance of 90% (91% in April, May, June and July). This reflects rates of 100% at CHFT (100%

in April, May, June and July) and 85% at MYHT (89% in July, 88 % in June, 87% in May, 88% April).

OPI03 : Convenience & Choice – GP referrals (PCT booking) 31 Aug 2010 4 Oct 2010

Owner Rachel Carter




Report:

Current Concerns:

MYHT is a national outlier in slot availability issues (i.e. no slot available for patient to book into when

accessing C&B). Progress in this area is being monitored at operational and Executive contract management

groups. We are receiving soft feedback from HP referrers that the lack of available slots is affecting their

willingness to use C&B. The PCT does not have a Local Enhanced Service for C&B in 2010/11 and this may

be affecting C&B usage.

There are recognised concerns with the accuracy of figures used nationally for C&B performance reporting

and it is anticipated that a revised system will be implemented in the next few months.

Comments

Aug 10

Convenience & Choice – GP referrals (PCT booking)

31 Aug 2010 90% 51.0%

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(1) (4)


31 Aug 2010 71,445 83,347


OP106: Number of emergency bed days per head of weighted population (VSC20)

[NI134]

31 Aug 2010 4 Oct 2010

Owner Pat Andrewartha



Report:

The predictive risk tool is being used in most practices.

Work continues which is looking at the variation in use, by practice population, in the urgent care services

(A&E, OOHs, WiC), this will enable specific, targeted work to be undertaken with particular groups and

practices. It will also support planning and developments around primary care / A&E integration.-

There is a reduction in EBD's of -837 / -24.9% on the same period last year, for trauma and orthopedics for

CHFT.

Current ConcernsWinter planning is underway; however there remain concerns that winter activity will impact further upon

emergency bed usage.


Taken:

See above; work is continuing to understand the use of urgent care services and through it to provide clarity

and understanding for patients on the best alternative for their needs.

PI Comments

Number of emergency bed days per head of weighted population

Aug-10

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(1) (4)


1 Jun 2010 1323 1575


Taken:

Early identification of those at risk of admission STILL not being identified early enough and therefore

opportunities to proactively manage to prevent admission not being realised. The predictive risk tool will enable

clinicians and the PCT to identify current and future resource/service utilization.

Need to review care pathways for those areas where there is significant or increased activity.

Areas identified as priorities for development/ redesign are COPD, heart failure and epilepsy admission

avoidance service

PI Comments

Rate of hospital admissions for ACS conditions per 100,000 population

Jun-10



Report:

People with Long term Conditions being supported by Community Matrons or Specialist Nurses are being

identified as suitable for telehealth monitoring – and significantly reducing reliance on secondary care.

The Kirklees Predictive risk model is now available to all practices who have consented to share their data - 69

practices data now available in the Kirklees Tool. All these practices are using the predictive risk tool in their

practice unit MDT meetings

Generic workers are available 24 hours per day 7 days per week via a single point of access and can support

people with health or social needs at home to prevent hospital admission or facilitate early discharge.

There is a significant reduction in activity and bed days for people who are managed by the LTC services

Current Concerns

Availability of community therapy services to respond in a timely manner to hospital discharges still requiring a

rehabilitation programme - potentially will increase Length of stay or readmission to hospital

Under utilization of generic worker service

Under utilization of Early supported discharge service

OP107: Rates of hospital admissions for ambulatory care sensitive conditions per

100,000 population (VSC21)

01 Jun 2010 4 Oct 2010

Owner Joanne Crewe


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