NHS Nottingham North & East G Admitted...NHS Nottingham North & East G Monthly Quality & Performance...

1

The table above displays a current view of performance against a range of standards for Nottingham North & East, Nottingham West and Rushcliffe Clinical Commissioning Groups. Indicators where a national standard has not been defined are not traffic lighted. A summary of key issues and concerns can be found overleaf.

NHS Nottingham North & East CCG Monthly Quality & Performance Report

May 2017

Summary (Pages 1 to 2) Key Issues and Concerns

Improvement and Assessment

Framework (Page 3 to 7)

CCG Improvement and Assessment

Framework

Level 1 (Page 8 to 12) Summary of CCG Performance

Level 2 (3 to 43) Summary of Provider Performance

Quality Premium (Page 44) CCG Quality Premium

BCF (Page 45 to 48) Better Care Fund

The above table displays the standards contained within the CCG Improvement and Assessment Framework where either one or more of the South Nottinghamshire CCGs are currently performing within the lowest quartile. Commentary relating to these standards is contained within the IAF section of this performance report.

CCG Improvement and Assessment Framework - Lowest Quartiles

NNE NW Rush

CancerPeople with urgent GP referral having first definitive treatment for cancer

within 62 days of referralQ2 16/17 H 82.3% 73.4% 82.6% 80.2%

Reliance on specialist inpatient care for people with a learning disability

and/or autism (per 1 million pop.)Q2 16/17 L 84 84 84

Neonatal mortality and stillbirths (per 1000 births) 2014 L 7.1 3.1 9.1 2.9

Choices in maternity services 2015 H 62.8 61.6 64.8

Urgent & Emergency

Care

Achievement of milestones in the delivery of an integrated urgent care

serviceAug-16 H 1 1 1

Urgent & Emergency

Care

Percentage of patients admitted, transferred or discharged from A&E within

4 hoursNov-16 H 88.4% 81.7% 81.4% 79.8%

Primary Medical

CarePrimary care access Q3 16/17 H 0.0% 0.0% 0.0%

BE

TT

ER

CA

RE

Learning Disability

Maternity

Lowest Quartile

Theme Area Indicator Name

Latest

Data

Period

Better Is

(H/L)England

Performance

Area Indicator Standard NNE NW Rush NNE NW Rush

4 Hour Standard % Achievement - A&E and Eye Cas 95% Mar-17 83.86% 84.13% 84.40% 82.24% 81.39% 81.86%

Left without being seen 5% Mar-17 3.64% 2.82% 3.89% 3.34% 2.85% 3.19%

Unplanned Re-attendance rate 5% Mar-17 0.92% 1.08% 1.16% 0.84% 0.89% 1.02%

Time to initial assessment (95th percentile) 15 mins Mar-17 01:08 01:13 01:06 01:09 01:13 01:10

Time to treatment decision (median) 60 mins Mar-17 00:52 00:57 00:48 00:44 00:48 00:43

Time to departure (admitted) (95th percentile) 4 hours Mar-17 09:43 10:21 09:01 11:51 11:48 11:57

Time to departure (non-admitted) (95th percentile) 4 hours Mar-17 05:05 04:44 05:01 05:06 05:10 05:10

Time to departure (admitted & non-admitted) (95th percentile) 4 hours Mar-17 06:42 06:48 06:22 07:36 07:47 07:47

Cancer 2ww 93% Feb-17 93.91% 97.54% 98.36% 93.51% 95.03% 94.82%

Cancer 31d DTT 96% Feb-17 98.57% 96.67% 98.08% 95.71% 95.66% 95.41%

62d Urg RTT 85% Feb-17 80.56% 72.00% 92.59% 79.82% 80.62% 84.21%

Cancer 2ww - Breast Symptoms 93% Feb-17 100.00% 100.00% 92.31% 96.70% 95.27% 89.47%

Diagnostics % patients waiting longer than 6 weeks 1% Mar-17 0.16% 0.10% 0.07% 0.42% 0.28% 0.30%

Red 1 calls responded to within 8 minutes 75% Mar-17 75.00% 73.08% 64.29% 69.82% 64.84% 59.92%




MRSA 0 Apr-17 0 0 0 0 0 0

C-Diff - YTD standard: NNE=7 NW=3 Rush=2 <<< notes Apr-17 3 2 0 3 2 0

Admitted % 90% Mar-17 86.46% 84.91% 82.65% 86.32% 85.55% 83.90%

Non-Admitted % 95% Mar-17 96.07% 96.29% 95.74% 96.06% 95.90% 95.64%

Incomplete % 92% Mar-17 96.11% 95.42% 95.34% 95.85% 95.30% 95.25%

Incomplete number of 52 week waiters 0 Mar-17 0 0 0 7 0 1

Care Programme Approach: 7 day follow up 100% Q4 2016-17 91% 100% 100% 96% 97% 100%

Crisis Resolution Home Treatment: Gate kept by CR Teams 100% Q4 2016-17 95% 92% 89% 99% 97% 96%

IAPT IAPT - Standard: NNE = 3.76% NW = 3.76% Rush = 3.76% <<< notes Mar-17 1.32% 1.60% 1.78% 4.08% 4.19% 4.62%

Treated within two weeks % 100% Mar-17 50.00% 100.00% 55.56% 52.17% 80.00%

Incomplete waiting less than two weeks % 100% Mar-17 33.33% 100.00% 50.00% 41.18% 50.00%

Dementia Dementia Diagnosis Rate 67% Mar-17 70.43% 74.85% 79.00%

YTD

A&E

Cancer

Waiting

Times

Latest

data

period

RTT

Ambulance

HCAIs

Latest period dataCCG Performance Snapshot

EIP

Mental

Health

2

Summary – Key issues and concerns

CCG Improvement and Assessment Framework CCG performance against IAF indicators is available on pages 3-6. Individual CCG’s performance against IAF Mental Health Transformation areas is shown on page 7.

CCG Indicators out of trajectory - Cancer (page 8) – Performance for February 2017 highlights that Nottingham North & East CCG is below standard

for the following pathways - 62 Day Urg RTT (80.56% against a standard of 85%)

A&E (Page 11) – Nottingham North & East CCG failed to achieve the A&E standard for March 2017 with performance at 78.70% against a standard of 95%

NUH Indicators out of trajectory -

Cancer (Page 13-14) – The following pathways failed to meet their respective standards during February 2017 -

62 Day Urgent RTT - 75.09% (standard = 85%)

31 Day DTT - Subs: Surgery - 93.10% (standard = 94%) A&E (Page 16-17) – March 2017 A&E performance was below standard at 80.79% Cancelled Ops - 28 Day Readmission (Page 18) - There was 1 breaches of the Cancelled Ops 28 day readmission

standard in March 2017 which is a breach of the national standard set at 0 Appointment Slot Issues (Page 19) - NUH had a ratio of 0.14 slot issues per successful booking in February 2017

which is a breach of the 0.04 standard NHS E-Referrals (1) - Of patients waiting to arrange an appointment, 49% were seen within 7 working days

which is below the 95% standard, 63% were waiting less than 14 working days which is below the 100% standard Ambulance Handovers (Page 21) - Performance for March 2017 shows that 322 handovers took longer than 30

minutes and 23 exceeded 60 minutes. This is against a standard of 0 Venous Thromboembolism (Page 21) - December 2016 performance shows that 94.15% of eligible patients were

assessed for VTE within 24 hours which is below the 95% standard Pressure Ulcers (Page 23) - NUH failed to meet the standard for the reduction of grade 2 and 3 pressure ulcers in

February 2017 Falls (Page 23) - March 2017 performance for falls was above the threshold of 0.98 with 1.20 falls per 1000

occupied bed days resulting in harm at NUH Sherwood Forest (Page 25-26) - Performance for SFHFT is available on pages 25-26

Circle (Page 27-31) - Circle performance is available on pages 27-31

NHCT (Page 32-34) - Nottinghamshire Health Care Trust performance is available on pages 32-34

EMAS (Page 35-40) – Red 1 and Red 2 performance remains below standard for the 8 and 19 minute targets. Comparative

performance and outcomes across ambulance trusts is shown on pages 39 & 40

Arriva (Page 41) - Performance for Arriva patient transport services is now available

NHS 111 (Page 42-43) – Performance is available for the key NHS 111 indicators

Quality Premium (Page 44) - Performance against the quality premium is summarised for the CCG

Better Care Fund (Page 45-48) - BCF monitoring at Nottinghamshire County Local Authority Level

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CCG Improvement and Assessment Framework

The table above shows how each CCG is performing for the IAF indicators within the Better Health section. None of the three CCGs are currently within the lowest quartile nationally for any of these indicators.

The table above shows how each CCG is performing for the IAF indicators within the Sustainability section.

Lowest Quartile


The CCG Improvement and Assessment Framework (IAF) is intended to align key national objectives and priorities whilst providing a focal point for joint work, support and dialogue between NHS England and CCGs.

The IAF is a tool with which to measure CCG performance against the “triple aim” outlined by NHS England. These aims are:

1. Improving the health and wellbeing of the whole population 2. Better quality for all patients, through care redesign 3. Better value for taxpayers in a financially sustainable system Below is how the three South Nottinghamshire CCGs are presently performing against the indicators within the IAF and also how their performance compares against the average for England. There are no fixed targets to meet within the IAF, rather the focus is that CCGs meet and perform beyond the expectations that are relative to their individual positions.

NNE NW Rush

Smoking Maternal smoking at delivery Q2 16/17 L 10.4% 11.6% 9.7% 5.2%

Child Obesity Percentage of children aged 10-11 classified as overweight or obese 2014/15 L 33.2% 31.4% 31.2% 21.1%

Diabetes patients that have achieved all the NICE recommended treatment

targets: Three for adults and one for children2014/15 H 39.8% 37.8% 39.7% 40.1%

People with diabetes diagnosed less than a year who attend a structured

education course2014/15 H 5.7% 7.0% 8.3% 4.1%

Falls Injuries from falls in people aged 65 and over (per 100,000 pop.) Jun-16 L 1985 2258 2145 2044

Utilisation of the NHS e-referral service to enable choice at first routine

elective referralSep-16 H 51.1% 95.4% 88.7% 101.6%

Personal health budgets (per 100,000 pop.) Q2 16/17 H 18.7 8.6 8.4 8.0

Percentage of deaths which take place in hospital Q1 16/17 <> 47.1% 51.6% 50.9% 44.8%

People with a long-term condition feeling supported to manage their

condition(s)2016 H 64.3% 66.1% 70.1% 65.4%

Inequality in unplanned hospitalisation for chronic ambulatory care sensitive

conditionsQ4 15/16 L 929 958 759 800

Inequality in emergency admissions for urgent care sensitive conditions Q4 15/16 L 2168 1943 1798 1520

Anti-microbial resistance: appropriate prescribing of antibiotics in primary

careSep-16 <> 1.1 1 0.9 0.90

Anti-microbial resistance: Appropriate prescribing of broad spectrum

antibiotics in primary careSep-16 <> 9.1% 10.6% 9.0% 8.6%

Carers Quality of life of carers 2016 H 80.0% 82.2% 79.3% 83.7%

Anti-microbial

Resistance

Health Inequalities

BE

TT

ER

HE

ALT

H

Diabetes

Personalisation and

choice


Latest

Data

Period

EnglandPerformanceBetter Is

(H/L)

NNE NW Rush

Financial plan 2016 <> GREEN GREEN GREEN

In-year financial performance Q2 16/17 <> AMBER GREEN GREEN

Outcomes in areas with identified scope for improvement Q2 16/17 H Not Incl. Not Incl. Not Incl.

Expenditure in areas with identified scope for improvement Q2 16/17 H Not Incl. Not Incl. Not Incl.

Local digital roadmap in place Q3 16/17 <> YES YES YES

Digital interactions between primary and secondary care Q3 16/17 H 73.1% 67.8% 69.0%

Estates Strategy Local strategic estates plan (SEP) in place 2016-17 YES YES YES

Better Is

(H/L)Theme Area Indicator Name

Latest

Data

Period

England

Paper-free at the

point of care

SU

ST

AIN

AB

ILIT

Y

Financial

sustainability

Allocative efficiency

Performance

4


The table above shows how each CCG is performing for the IAF indicators within the Better Care section. Nottingham North & East CCG are in the lowest quartile nationally for five of these indicators. Further information relating to underperformance of these indicators can be found overleaf.

Lowest Quartile

The table above shows how each CCG is performing for the IAF indicators within the Well Led section.

NNE NW Rush

Probity & corporate

governanceProbity and corporate governance Q2 16/17 H

Fully

Complia

Fully

Complia

Fully

Complia

Staff engagement index (1 to 5 - 5 good) 2015 H 3.8 3.9 3.9 3.9

Progress against workforce race equality standard (0 = equality) 2015 L 0.2 0.2 0.2 0.2

CCGs’ local

relationshipsEffectiveness of working relationships in the local system 2015/16 H 71.8% 81.5% 84.1%

Quality of leadership Quality of CCG leadership Q2 16/17 <> GREEN GREEN GREEN

Better Is

(H/L)Indicator Name

Latest

Data

Period

EnglandPerformance

WE

LL L

ED Workforce

engagement

Theme Area

NNE NW Rush

Care Ratings Provision of high quality care Q3 16/17 H 62 64 63

Cancers diagnosed at early stage 2014 H 50.7% 52.1% 57.4% 51.7%

People with urgent GP referral having first definitive treatment for cancer


One-year survival from all cancers 2013 H 70.2% 69.6% 69.0% 71.0%

Cancer patient experience 2015 H 87.0% 89.0% 87.3% 86.8%

Improving Access to Psychological Therapies recovery rate Sep-16 H 48.4% 56.2% 55.4% 63.8%

People with first episode of psychosis starting treatment with a NICE-

recommended package of care treated within 2 weeks of referralNov-16 H 77.2% 78.6% 77.8% 100.0%

Children and young people’s mental health services transformation Q2 16/17 H 75.0% 75.0% 75.0%

Crisis care and liaison mental health services transformation Q2 16/17 H 52.5% 52.5% 52.5%

Out of area placements for acute mental health inpatient care -

transformationQ2 16/17 H 87.5% 87.5% 87.5%


and/or autism (per 1 million pop.)Q2 16/17 L 84 84 84

Proportion of people with a learning disability on the GP register receiving an

annual health check2015/16 H 37.1% 33.9% 41.6% 35.0%


Women’s experience of maternity services 2015 H 82.2 77.4 77.4


Estimated diagnosis rate for people with dementia Nov-16 H 68.0% 70.7% 74.0% 80.0%

Dementia care planning and post-diagnostic support 2015/16 H 81.5% 80.3% 80.8%



Emergency admissions for urgent care sensitive conditions (per 100,000

pop.)Q4 15/16 L 2359 2145 2232 1621


4 hoursNov-16 H 88.4% 81.7% 81.4% 79.8%

Delayed transfers of care per 100,000 population Nov-16 L 15.0 7.8 6.3 8.2

Population use of hospital beds following emergency admission (days per

1000 pop.)Q1 16/17 L 1.0 1.10 1.1 1.0

Management of long term conditions (emergency admissions per 100,000

pop.)Q4 15/16 L 795 773 776 563

Patient experience of GP services H1 2016 H 85.2% 84.3% 89.9% 88.2%

Primary care access Q3 16/17 H 0.0% 0.0% 0.0%

Primary care workforce (FTE per 1000 weighted patients) H1 2016 H 1 1.1 0.93 1.33

Elective Access Patients waiting 18 weeks or less from referral to hospital treatment Nov-16 H 90.6% 95.7% 95.8% 95.8%

NHS Continuing

HealthcarePeople eligible for standard NHS Continuing Healthcare (per 50,000 pop.) Q2 16/17 <> 46.2 48.4 36.2 41.1

Better Is

(H/L)

Performance

Mental Health


Latest

Data

Period

England

BE

TT

ER

CA

RE

Cancer

Primary Medical

Care

Dementia

Urgent & Emergency

Care

Learning Disability

Maternity

5


Nottingham North & East CCG was in the lowest quartile nationally in Quarter 2 of 2016-17 for Reliance on specialist inpatient care for people with a learning disability and/or autism (per 1 million pop.) Rather than individual CCGs being measured, the performance of the Nottinghamshire Transforming Care Partnership is assessed as a whole. The footprint of this organisation encompasses 7 CCGs, 2 Local Authorities, and NHS England Specialised Commissioning. Performance across the cluster has improved from the Quarter 1 of 2016-17 position of 87 people with a learning disability and/or autism (per 1 million population) relying on specialist inpatient care. Trajectories have been agreed with the area team to improve performance to 57 people by the end of 2017/18 and to 36 people come the end of 2018/19. Actions are being taken to ensure this trajectory is met. These include:

Commissioners continuing to liaise regularly with inpatient units and other members of the multi-disciplinary team to expedite discharges where this is clinically indicated.

Commissioners continuing to carry out blue light reviews as necessary with the aim of avoiding admissions where possible or expediting discharge.

A new City and County wide Care and Treatment Review service with new enhanced specification has been commissioned. This started on the 2nd of January.

Meetings are taking place to finalise the Intensive Community Assessment and Treatment Team service which will be in place by quarter 1 of 2017/18.

Nottingham North & East CCG was in the lowest quartile nationally in August 2016 for the Achievement of milestones in the delivery of an integrated urgent care service. This performance is shared across the three South Nottinghamshire CCGs. There are 8 key elements to achieving fully Integrated Urgent Care services. These are:

A single call to get an appointment Out of hours Data can be shared between providers The capacity for NHS 111 and Out of hours is jointly planned The Summary Care Record (SCR) is available in the hub and elsewhere Care plans and special patient notes are shared Appointments can be made to in-hours GPs There is joint governance across Urgent and Emergency Care Suitable calls are transferred to a Clinical Hub containing GPs and other health care professionals.

The three South Nottinghamshire CCGs have consistently been within the lowest national quartile for the percentage of patients meeting the 4 hour A&E waiting time target. This is because most people attending A&E from Nottingham North & East CCG, Nottingham West CCG, and Rushcliffe CCG present at Nottingham University Hospitals which has continually struggled to meet high overall demand and therefore performs below standard. Further information relating to issues affecting A&E at NUH can be found within Level 2 of the performance report on pages 16 and 17.

All three South Nottinghamshire CCGs scored 0% when measured on the ability of their practices to offer full provision for pre-bookable appointments on Saturdays and Sundays, plus on each weekday for at least 1.5 hours either before 8am or after 6pm. However, in Quarter 3 of 2016/17 some practices within the three CCGs were able to offer partial provision. 50% of Nottingham North & East CCG practices, and 75% of Nottingham West CCG and Rushcliffe CCG practices were able to offer partial provision of access to pre-bookable appointments either at weekends or early mornings and evenings during the week.

NNE NW Rush


and/or autism (per 1 million pop.)Q2 16/17 L 84 84 84Learning Disability

Area Indicator Name

Latest

Data

Period

Better Is

(H/L)England

Performance

NNE NW Rush

Urgent & Emergency

Care



Area Indicator Name

Latest

Data

Period

Better Is

(H/L)England

Performance

NNE NW Rush

Urgent & Emergency

Care


4 hoursNov-16 H 88.4% 81.7% 81.4% 79.8%

Area Indicator Name

Latest

Data

Period

Better Is

(H/L)England

Performance

NNE NW Rush

Primary Medical

CarePrimary care access Q3 16/17 H 0.0% 0.0% 0.0%

Area Indicator Name

Latest

Data

Period

Better Is

(H/L)England

Performance

6


Nottingham West CCG was within the bottom quartile for the Choices in maternity services indicator having scored 61.6 in 2015. The performance is calculated from a CQC survey of which answers to six questions reflecting several points across the care pathway are used. Scores are adjusted for age and for parity (the number of times a woman has given birth). The national maternity review ’Better Births’, published in February 2016, sets out a five year plan for improving maternity services. Commissioners and NUH have been working closely over the past 18 months to progress a number of pathway improvements in relation to maternity care and therefore are well placed to begin implementation of Better Births.

Nottingham West CCG was within the bottom quartile for Neonatal mortality and stillbirths (per 1000 births) in 2014. During Quarter 2 of 2016/17 (the time period in the IAF) 9.7% (23 smokers) of women were smokers at the time of delivery. Other challenges remain around information sharing across the maternity service as community midwives use SystmOne whilst the hospital maternity service at NUH uses Medway. Plans are afoot to roll Medway out into the community. The national maternity review ’Better Births’, published in February 2016, sets out a five year plan for improving maternity services. Commissioners and NUH have been working closely over the past 18 months to progress a number of pathway improvements in relation to maternity care and therefore are well placed to begin implementation of Better Births.

NNE NW Rush


Area Indicator Name

Latest

Data

Period

Better Is

(H/L)England

Performance

Maternity

NNE NW Rush


Area Indicator Name

Latest

Data

Period

Better Is

(H/L)England

Performance

Maternity

NNE NW Rush

CancerPeople with urgent GP referral having first definitive treatment for cancer


Area Indicator Name

Latest

Data

Period

Better Is

(H/L)England

Performance

Nottingham North & East CCG was within the bottom quartile for People with urgent GP referral having a first definitive treatment for cancer within 62 days of referral in Quarter 2 of 2016/17. The CCG achieved 73.4% with the national average at 82.3%. Most patients from the CCG use cancer services at NUH which have continually failed to meet the 85% target for 62 day RTT. Actions are in place to improve performance at the provider which should in turn lift NNE’s performance. These actions can be found in section 2 of this report on page 13.

7


To deliver improvements in ratings across the CCGIAF overall rating and

transformation measures CCGs should ensure that by 2020 they –

1. Commission additional psychological therapies so that at least 25% of people with

anxiety and depression access treatment each year, the majority of which is integrated

with physical healthcare.

2. Deliver better employment support for people with mental health problems; with improved

employment support in psychological therapies services and a doubling of Individual

Placement Support for people with severe mental illness in secondary care services.

3. Commission additional high-quality mental health services for children and young

people, so that at least an extra 70,000 people nationally are able to access services by

2020. This should include all areas being part of CYP IAPT by 2018.

4. Ensure all women can access evidence-based specialist perinatal mental health care

locally.

5. Implement a suicide reduction plan together with local government and other local

partners that reduces suicide rates by 10% against the 2016/17 baseline.

6. Expand capacity so that more than 60% of people experiencing a first episode of

psychosis receive treatment within two weeks of referral.

7. Commission community eating disorder teams so that children and young people to

receive treatment within four weeks of referral for routine cases, and one week for urgent

cases.

8. Commission effective 24/7 mental health crisis response services in all areas; Crisis

Response and Home Treatment Teams as an alternative to acute admissions, supporting

the elimination of out of area placements for nonspecialist acute care.

9. At least half of all acute hospitals locally should meet the ‘core 24’ standard for mental

health liaison as a minimum, with the remainder aiming for this level.

The table above shows the progress each CCG has made against the three mental health transformation areas contained within the CCG Improvement and Assessment Framework. The three areas are self-assessed and updated quarterly to reflect the ongoing transformation programme taking place within mental health services. Below is a list of expected improvements that CCGs are measured against to formulate the percentages shown above:

Transformation AreaNottingham North and

East CCG

Children and Young

People's Mental Health

Crisis Care

Out of Area PlacementsCompliance w ith a self-assessed list of minimum service expectations for Out of Area

Placements, w eighted to reflect preparedness for transformation

Rushcliffe CCG

75%

53%

88%

75% 75%

53% 53%

88% 88%

Nottingham West CCG

Compliance w ith a self-assessed list of minimum service expectations for Children and

Young People’s Mental Health, w eighted to reflect preparedness for transformation

Compliance w ith a self-assessed list of minimum service expectations for Crisis Care,

w eighted to reflect preparedness for transformation

Level 1 – Summary of CCG Performance

8

1.1 Cancer - CCG

All three South Nottinghamshire CCGs experienced breaches of standard for February 2017. Please see the table below for a breakdown of patients seen and breaches by CCG.

NHS Nottingham North & East CCG failed one standard in February 2017, details of the breaches for this pathway are below. 62 Day Urg RTT: 7 Breaches

6 x NUH - 5x Complex Case, 1x Unknown

1 x NUH (First seen at Circle) - 1x Complex Case

CCG Description of Standard Period Target CCGPeriod

Perf

Last 12

months

2016/17

YTD

NNE 80.56% 79.82%

NW 72.00% 80.62%

Rush 92.59% 84.21%

NNE 100.00% 94.29%

NW 100.00% 85.00%

Rush 100.00% 95.56%

NNE N/A N/A 85.71%

NW 100.00% N/A 90.91%

Rush 0.00% N/A 83.33%

NNE 98.57% 95.71%

NW 96.67% 95.66%

Rush 98.08% 95.41%

NNE 100.00% 93.13%

NW 100.00% 93.65%

Rush 92.86% 93.44%

NNE 100.00% 98.41%

NW 100.00% 99.37%

Rush 100.00% 99.16%

NNE 95.24% 98.72%

NW 100.00% 100.00%

Rush 95.00% 98.17%

NNE 93.91% 93.51%

NW 97.54% 95.03%

Rush 98.36% 94.82%

NNE 100.00% 96.70%

NW 100.00% 95.27%

Rush 92.31% 89.47%

62d Urg RTT Cons Upgrade Feb-17 N/A

62d Urg RTT Feb-17 85%

62d Urg RTT - Screening Service Feb-17 90%

Po

sit

ive

exp

eri

en

ce o

f

care

96%

Cancer 31d DTT - Subs: Surgery Feb-17 94%

Cancer 31d DTT - Subs: Drugs Feb-17 98%

Cancer 31d DTT Feb-17

94%

Cancer 2ww Feb-17 93%

Cancer 2ww - Breast Symptoms 93%

Cancer 31d DTT - Subs: Radiotherapy Feb-17

Feb-17

Pre

ven

tin

g p

eo

ple

fro

m d

yin

g p

rem

atu

rely

Patients

seenBreaches %

Patients

seenBreaches %

Patients

seenBreaches %

62d Urg RTT 36 7 80.56% 25 7 72.00% 27 2 92.59%

62d Urg RTT - Screening Service 7 0 100.00% 8 0 100.00% 3 0 100.00%

62d Urg RTT Cons Upgrade 2 0 100.00% 1 0 100.00% 1 1 0.00%

Cancer 31d DTT 70 1 98.57% 60 2 96.67% 52 1 98.08%

Cancer 31d DTT - Subs: Surgery 12 0 100.00% 5 0 100.00% 14 1 92.86%

Cancer 31d DTT - Subs: Drugs 18 0 100.00% 23 0 100.00% 15 0 100.00%

Cancer 31d DTT - Subs:

Radiotherapy21 1 95.24% 17 0 100.00% 20 1 95.00%

Cancer 2ww 460 28 93.91% 244 6 97.54% 365 6 98.36%

Cancer 2ww - Breast Symptoms 17 0 100.00% 13 0 100.00% 13 1 92.31%

Nottingham North & East Nottingham West Rushcliffe


9

1.1 Cancer - CCG (Cont.) Cancer 62 Day Urgent RTT - Long Waiters

The indicator above displays the number of 62 Day Urgent RTT patients who have been waiting 104 days and longer. This is measured by CCG and encompasses patients being treated by all providers. At the time of reporting in February 2017, Nottingham North & East CCG had 5 patients waiting 104 days or longer whilst on a 62 Day Urgent RTT pathway. Details are below:

Patient 1 - 115 days (NUH) - Complex case with multiple investigations

Patient 2 - 120 days (NUH) - Complex case with multiple diagnostics

Patient 3 - 127 days (NUH) - Complex diagnostic pathways

Patient 4 - 137 days (NUH) - Complex diagnostic pathway with multiple tests

Patient 5 - 142 days (NUH) - Unknown

Year-to-date Nottingham North & East CCG have had 30 patients on a Cancer 62 Day Urgent RTT pathway waiting 104 days or longer.

CCG Description of Standard Period Standard CCG PatientsLast 12

Months

2016/17

YTD

NNE 5 30

NW 3 14

Rush 0 12

Positive

Experience

of Care

Cancer 62 Day Urg RTT - Patients

Waiting 104+ DaysFeb-17 0


10

1.2 Referral To Treatment (RTT) - CCG

Referral to Treatment Standards Nottingham North & East CCG achieved the 92% Incomplete standard in March 2017 with performance at 96.11%. However, one specialty did not meet this standard, this was General Surgery (91.62%). The table below shows the performance of individual specialties for Nottingham North & East CCG in March 2017:

Referral to Treatment - Activity v Plan

The above table shows the number of completed admitted and non-admitted pathways during the month. In March 2017,

Nottingham North & East CCG was above plan by 28.91% for completed admitted pathways. Meanwhile completed pathways

for non-admitted patients was above plan by 19.49%.


Perf

Last 12

months

NNE 96.11%

NW 95.42%

Rush 95.34%

NNE 90.37%

NW 89.38%

Rush 87.99%

NNE 4335

NW 2465

Rush 3396Po

sit

ive e

xp

eri

en

ce o

f care RTT - Incomplete pathways (% within 18

weeks)Mar-17 92%

RTT - Incomplete pathways with a

Decision to Admit (% within 18 weeks)Mar-17 N/A

New RTT Periods During the Month Mar-17 N/A

New RTT

Periods

Patients 18Wks+ Perf Patients 18Wks+ Perf Patients

191 16 91.62% 79 12 84.81% 108

272 7 97.43% 55 4 92.73% 237

752 37 95.08% 339 26 92.33% 446

633 34 94.63% 120 25 79.17% 289

1003 24 97.61% 300 22 92.67% 514

1 0 100.00% 0 0 0

34 1 97.06% 7 0 100.00% 22

41 2 95.12% 18 1 94.44% 26

13 0 100.00% 10 0 100.00% 10

49 3 93.88% 5 0 100.00% 29

423 18 95.74% 57 5 91.23% 237

377 29 92.31% 89 21 76.40% 155

398 21 94.72% 246 17 93.09% 238

252 12 95.24% 8 2 75.00% 128

215 5 97.67% 2 0 100.00% 108

99 1 98.99% 2 0 100.00% 51

56 0 100.00% 1 0 100.00% 45

397 4 98.99% 60 2 96.67% 326

1882 62 96.71% 378 34 91.01% 1366

7088 276 96.11% 1776 171 90.37% 4335Total

Cardiothoracic Surgery

General Medicine

Gastroenterology

Cardiology

Dermatology

Thoracic Medicine

Neurology

Rheumatology

Geriatric Medicine

Gynaecology

Other

Plastic Surgery

Nottingham North & East

Incomplete

Standard = 92%

Incomplete

With Decision to Admit

General Surgery

Urology

Trauma & Orthopaedics

ENT

Ophthalmology

Oral Surgery

Neurosurgery

Number of patients

waiting over 18 Weeks

CCG Description of Standard Period CCG Activity Plan % DiffLast 12

months

NNE 923 716 28.91%

NW 583 590 -1.19%

Rush 755 666 13.36%

NNE 2544 2129 19.49%

NW 1427 1557 -8.35%

Rush 1855 1727 7.41%

Acti

vit

y v

Pla

n RTT - Completed Pathways for Admitted

PatientsMar-17

RTT - Completed Pathways for Non-

Admitted PatientsMar-17


11

1.3 A&E 4 hour waiting time standard - CCG

NUH performance for A&E Type 1 (consultant-led 24 hour service with full resuscitation facilities) waiting times was below standard during March 2017, which caused failure to achieve 95% for all three South Nottinghamshire CCGs. The performance above does not take into account performance in the Eye Casualty department. Please see Level 2 (page 13-14) for details of actions to improve NUH performance.

The graphs below show the level of A&E Type 1 performance at each CCG since April 2013 and the volume of attendances in the lower graph.


Perf

Last 12

months

2016/17

YTD

NNE 78.70% 74.45%

NW 76.88% 72.50%

Rush 79.46% 73.98%

Positive

experience

of care

A&E waiting time (Type 1 Only) Mar-17 95%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

No

v-1

3

Dec

-13

Jan

-14

Feb

-14

Mar

-14

Ap

r-1

4

May

-14

Jun

-14

Jul-

14

Au

g-1

4

Sep

-14

Oct

-14

No

v-1

4

Dec

-14

Jan

-15

Feb

-15

Mar

-15

Ap

r-1

5

May

-15

Jun

-15

Jul-

15

Au

g-1

5

Sep

-15

Oct

-15

No

v-1

5

Dec

-15

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

No

v-1

6

Dec

-16

Jan

-17

Feb

-17

Mar

-17

A&E Type 1 4hr Achievement by CCG

Nottingham North & EastNottingham WestRushcliffeStandard

0

500

1000

1500

2000

2500

3000

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

No

v-1

3

Dec

-13

Jan

-14

Feb

-14

Mar

-14

Ap

r-1

4

May

-14

Jun

-14

Jul-

14

Au

g-1

4

Sep

-14

Oct

-14

No

v-1

4

Dec

-14

Jan

-15

Feb

-15

Mar

-15

Ap

r-1

5

May

-15

Jun

-15

Jul-

15

Au

g-1

5

Sep

-15

Oct

-15

No

v-1

5

Dec

-15

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

No

v-1

6

Dec

-16

Jan

-17

Feb

-17

Mar

-17

A&E Type 1 Attendances by CCG

Nottingham North & East Nottingham West Rushcliffe


12

1.5 Healthcare Associated Infections (HCAIs) - CCG

Nottingham North & East CCG experienced no cases of MRSA in April 2017.

April’s standard for Clostridium Difficile infections was also within the threshold with 3 cases against a standard of 4.

1.4 Diagnostics Waiting Times - CCG

In March 2017 Nottingham North & East CCG achieved the 1% national standard with performance at 0.16%. Nottingham West CCG and Rushcliffe CCG were also within the standard at 0.10% and 0.07% respectively.

1.6 Continuing Healthcare - CCG

NHS Continuing Healthcare is the name given to a package of care that is arranged and funded solely by the NHS for individuals who are not in hospital and have been assessed as having a "primary health need".

The Continuing Healthcare indicators include activity that is both fast track and non-fast track. The eligible totals are taken from snapshot figures. Quarter 4 of 2016-17 shows that Nottingham North & East CCG had 69 CHC packages that were newly agreed as eligible in the quarter. Meanwhile, the CCG had 158 eligible CHC packages at the end of the quarter.


Perf

Last 12

months

NNE 0.16%

NW 0.10%

Rush 0.07%

1%

Positive

experience

of care

Diagnostics (% of patients waiting over

six weeks)Mar-17

Apr-17 NNE 0 0 0 0

Apr-17 NW 0 0 0 0

Apr-17 Rush 0 0 0 0

Apr-17 NNE 4 3 4 3

Apr-17 NW 2 2 2 2

Apr-17 Rush 2 0 2 0

Period

Perf

HC

AIs

MRSA

C-Diff

YTD

Standard

2017/18

YTDCCG Description of Standard Period

Period

StandardLast 12 monthsCCG

CCG Period CCG Eligible Previous Perf

NNE 69

NW 51

Rush 71

NNE 158

NW 78

Rush 124

Continuin

g

Healthcare

Description of Standard

CHC - Newly Eligible in Quarter

CHC - Number Eligible at end of

Quarter

Q4 16-17

Q4 16-17

Level 2 – NUH Performance

13

NUH 2.1 Cancer Waiting Times

In February 2017, NUH failed to achieve the Cancer 62 day standard with performance at 75.09% against the national standard of 85%, the standard has not been achieved in any of the last 12 months. The Trust were also below the 94% national standard for 31 Day Subsequent Treatment: Surgery with performance of 93.10%. NUH achieved all other standards in February 2017. Year-to-date the Trust are below the 85% standard for 62 day referral to treatment with performance of 76.16%.

Feb-17 Q3 2016-17

62d Urg RTT 85% 75.09% 77.19% 76.14%

62d Urg RTT - Screening Service 90% 94.44% 88.24% 91.32%

62d Urg RTT Cons Upgrade N/A 69.44% 77.57% 81.47%

Cancer 31d DTT 96% 96.03% 96.43% 96.36%

Cancer 31d DTT - Subs: Surgery 94% 93.10% 96.19% 94.74%

Cancer 31d DTT - Subs: Drugs 98% 100.00% 99.13% 99.11%

Cancer 31d DTT - Subs: Radiotherapy 94% 97.40% 98.41% 99.01%

Cancer 2ww 93% 95.32% 94.86% 93.61%

Cancer 2ww - Breast Symptoms 93% 93.04% 95.57% 93.63%

2016/17

YTD

PeriodP

reven

tin

g p

eo

ple

fro

m d

yin

g p

rem

atu

rely

Po

sit

ive

exp

eri

en

ce

of

care

NUH Description of Standard TargetLast 12

months

62 Day Urgent RTT - 104+ Day Waiters

NUH Description of Standard Period Standard PatientsLast 12

Months

2016/17

YTD

Positive

Experience

of Care

Cancer 62 Day Urg RTT - Patients

Waiting 104+ DaysFeb-17 0 14 154

During February 2017 NUH had 14 patients waiting over 104 days. Reasons for the long wait were as follows -

9 x Complex Pathway 2 x Medically Unfit 1 x Patient Choice 1 x Late Tertiary 1 x Unknown


14

NUH 2.1 Cancer Waiting Times (cont.) Cancer 62 day RTT Performance by Tumour Site

The above table shows the performance of 62 day cancer (excluding rare cancers) at NUH for all patients by tumour site for

February 2017. There are two tumour sites where performance has been consistently below standard over the last 12 months—

Lower Gastrointestinal and Lung.

Escalation Due to continued below standard performance a Remedial Action Plan (RAP) is in place for 62 day, actions include - Focus on Lung, Upper GI, Lower GI Lung - Increase diagnostic and outpatient capacity Lung - Improve pathway management, reporting and escalation of patient pathways and administration UGI - Reduce new appointment waiting time to maximum of 10 days - offer increased 2ww slots UGI - Escalate patients wishing to book appointments outside of 10 days UGI - Secure additional capacity UGI - Provide NUH consultant presence at Kings Mill to help navigate patients towards NUH in a more timely fashion UGI - Increase cohort of endoscopists able to perform UGI endoscopies LGI - Implementation of 7 day testing for histo for GI patients. LGI - Recruit to administrative vacancies to reduce typing turnaround for all patients on 2ww pathway LGI - Increased capacity for flexi to support faster diagnostics pathways

Patients % Chart Patients %

Brain/Central Nervous System Feb-17 85% 0 N/A 1.5 33.33%

Breast Feb-17 85% 22 97.73% 327 95.87%

Gynaecological Feb-17 85% 9 88.89% 111.5 87.44%

Haematological (Excluding Acute

Leukaemia)Feb-17 85% 16.5 87.88% 135.5 86.35%

Head & Neck Feb-17 85% 8 56.25% 117.5 71.06%

Lower Gastrointestinal Feb-17 85% 15.5 61.29% 163.5 58.10%

Lung Feb-17 85% 15 60.00% 245 55.51%

Other Feb-17 85% 3 100% 13.5 74.07%

Sarcoma Feb-17 85% 2 75.00% 25.5 70.59%

Skin Feb-17 85% 1 0.00% 28.5 59.65%

Upper Gastrointestinal Feb-17 85% 15.5 58.06% 144 65.28%

Urological (Excluding Testicular) Feb-17 85% 25 76.00% 415.5 81.23%

Total (Excluding Rare Cancers) Feb-17 85% 132.5 75.09% 1728.5 76.34%Ca

nce

r 6

2 D

ay R

TT

Pe

rfo

rma

nce

by T

um

ou

r S

ite

fo

r a

ll C

CG

pa

tie

nts

at N

UH

(A

dm

itte

d

& N

on

Ad

mitte

d)

Last 12 MonthsNUH Tumour Site Period Standard

Latest Period


15

NUH 2.2 Referral To Treatment (RTT)

During March 2017 the 92% Incomplete standard was achieved for all specialties except General Surgery (89.34%),

Cardiothoracic Surgery (89.74%), and Cardiology (90.66%). Incomplete with Decision to Admit does not currently have a

national standard, but does show that 87.35% of patients with a decision to admit are currently waiting under 18 weeks.

The table below shows the number of patients still waiting at NUH at the end of March 2017 segmented by time band and upload specialty.

There were three patients reported as having waited over 52+ weeks at the end of March. All three patients relate to spines (the patient reported as “Other” is Anaesthetics). Two of the patients have since been admitted and had their clocks stopped, the third is a Nottingham City CCG patient who has chosen to wait until June before surgery.

NUH Description of Standard Period TargetPeriod

Perf

Last 12

months

RTT - Incomplete pathways (% within 18

weeks)Mar-17 92% 96.05%

.RTT - Incomplete pathways with a

Decision to Admit (% within 18 weeks)Mar-17 N/A 87.35%

.

New RTT Periods During the Month Mar-17 N/A 19223

Po

sit

ive

exp

eri

en

ce o

f care

New RTT

Periods


272 29 89.34% 120 26 78.33% 168

910 21 97.69% 184 15 91.85% 801

3490 269 92.29% 1519 223 85.32% 2012

3290 180 94.53% 673 120 82.17% 1489

5218 198 96.21% 1621 188 88.40% 2543

1208 16 98.68% 181 11 93.92% 778

492 39 92.07% 149 23 84.56% 258

341 18 94.72% 184 16 91.30% 205

195 20 89.74% 132 16 87.88% 121

54 0 100.00% 18 0 100.00% 28

842 31 96.32% 182 10 94.51% 662

1927 180 90.66% 545 143 73.76% 759

0 0 0 0 0

800 10 98.75% 39 3 92.31% 412

1521 13 99.15% 3 0 100.00% 791

0 0 0 0 0

211 2 99.05% 6 0 100.00% 150

930 4 99.57% 136 4 97.06% 763

10037 224 97.77% 1820 152 91.65% 7283

31738 1254 96.05% 7512 950 87.35% 19223Total

Other

Gynaecology

Geriatric Medicine

Rheumatology

Neurology

Thoracic Medicine

Dermatology

Cardiology

Gastroenterology

General Medicine


Plastic Surgery

Neurosurgery

Oral Surgery

Mar-17

Incomplete

Standard = 92%

Incomplete


Ophthalmology

ENT


Urology

General Surgery

Number of patients


Mar-17 26-40 Wks 40-48 Wks 48-52 Wks 52 Wks+

General Surgery 7 0 0 0

Urology 9 1 0 0

Trauma & Orthopaedics 58 6 3 2

Ear, Nose & Throat (ENT) 53 4 1 0

Ophthalmology 41 1 0 0

Oral Surgery 3 0 0 0

Neurosurgery 9 0 0 0

Plastic Surgery 3 0 0 0

Cardiothoracic Surgery 1 0 0 0

Gastroenterology 5 2 0 0

Cardiology 40 1 0 0

Thoracic Medicine 2 0 0 0

Neurology 1 0 0 0

Other 53 4 3 1

Total 285 19 7 3


16

NUH 2.3.1 A&E 4 hour waiting time standard

In March 2017 the national 95% performance level was not met with NUH performance at 80.79%, the standard has not been met in any of the last 12 months. There is a Remedial Action Plan (RAP) in place. Actions being taken to improve performance are bulleted below -

Deliver 95% non-admitted performance - March performance = 86.9%, minors performance = 96.2%

Reduce non-admitted breaches related to medical wait to be seen to less than 20%

Revised pathways in place for ‘GP expect’ attendances to ED to reduce overcrowding within the department. Further modelling required to understand impact on performance

Implementation of Band 7 at front door to deliver ‘Luton model’ to increase % of patients seen by primary care to 20%

Review of function of ‘Green team’ following effective implementation of front door model and pathways for GP expects. Modelling will confirm breach reduction through reduction in WTBS caused by high department occupancy or cubicle space

Adoption of ‘Home First’ mantra through effective engagement between acute and community teams

Review of LJU model to ensure maximum impact on ability to reduce breaches. To be monitored by a reduction in admitted and non-admitted breaches with trajectory set once modelled

Achievement against trajectories which will reduce the wait to be seen in the department through a reduction in handover time and time for IAU cycle to be completed

Revision and implementation of ED consultant rotas to improve overnight and weekend cover

Domain Description of Standard Target Mar-17Last 12

months

2016/17

YTD

A&E waiting time - QMC + Eye Cas 95% 80.79% 76.39%

A&E waiting time - QMC only 95% 78.64% 73.74%

A&E waiting time - Eye Cas only 95% 99.33% 98.89%

Positiv

e

experience o

f

care

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

No

v-1

3

Dec

-13

Jan

-14

Feb

-14

Mar

-14

Ap

r-1

4

May

-14

Jun

-14

Jul-

14

Au

g-1

4

Sep

-14

Oct

-14

No

v-1

4

Dec

-14

Jan

-15

Feb

-15

Mar

-15

Ap

r-1

5

May

-15

Jun

-15

Jul-

15

Au

g-1

5

Sep

-15

Oct

-15

No

v-1

5

Dec

-15

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

No

v-1

6

Dec

-16

Jan

-17

Feb

-17

Mar

-17

NUH - A&ENational TrajectoryLocal TrajectoryPerformance

Contract Query Notice, which was raised on 21/06/2012, closed on 01/08/2013 as NUH made 95% standard in 3 consecutive months

Contract Query Notice raised on 05/08/2014

Contract Query Notice closed on 13/05/2015 due to improved performance in April and May

Remedial Action Plan raised on 12/01/2016


17

NUH 2.3.1 A&E 4 hour waiting time standard (cont.)

NUH 2.3.2 A&E 12 Hour Trolley Waits

The chart below shows A&E performance and attendances at NUH between 1st May 2016 and 30th April 2017.

As well as the Remedial Action Plan there continues to be bi-weekly monitoring of the updated System Resilience Plan, which is centred around the following themes - Front Door

New model of front door primary care Development of integrated urgent care

Internal Flow NUH led actions to embed Safer bundle across Trust wards Multi agency discharge events have taken in place on Trust wards, these have identified opportunities for improvement

External Flow Focus on interface with external capacity for medically fit for discharge patients System-wide capacity and flow review

Enablers Development of system wide dashboard Development of System Resilience Group process for allocation of resilience funding

During March 2017 there was one breach of the 12 hour trolley wait standard at NUH although this was a mental health patient and therefore not the responsibility of NUH. Year to date there has been two non-NUH responsible breaches, and four NUH responsible breaches.

NUH Description of Standard Period Target

NUH

Responsible

Breaches in

period

NUH Responsible

Breaches:

Last 12 months

NUH

Responsible

Breaches

YTD

Non-NUH

Responsible

Breaches

YTD

Number of 12 hour trolley waits in A&E Mar-17 0 0 4 2

0

100

200

300

400

500

600

700

800

900

1000

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17A

tte

nd

ance

s

Pe

rfo

rman

ce

NUH A&E Performance May16-Apr17Attendances BreachesPerformance Standard


18

NUH 2.4 Cancelled Operations

In total, there were 336 cancelled operations in March 2017 of which 46 were on the day of admission and 290 were cancelled

prior to the day of admission, this equates to a total of 3.46% elective admissions being cancelled either on the day or prior to

the day of admission.

The cancelled operations national standard was achieved in March 2017 in which there were 46 ‘on the day’ cancellations.

However, not all cancelled operations were rebooked within 28 days which is a breach of the national standard. Details relating

to the affected CCGs are forthcoming.

The table below shows the number of on the day cancellations at NUH broken down by reason.

The table below shows the total number of cancelled operations for NUH over the most recent 12 month period available.

Over the past 12 months, list overrun - clinical reasons and staffing are the most common reasons given for on the day

cancellations at NUH. Administrative error, other, and replaced by emergency patient are also cited by NUH as frequent reasons

for cancellation.

NUH 2.5 Diagnostics Waiting Times

NUH achieved the Diagnostics standard for the fifteenth consecutive month in March 2017 with performance at 0.20%. There

were 16 breaches in March with 9 relating to Gastroscopy, 4 to Colonoscopy, 1 to Audiology - Audiology Assessment, 1 to Flexi

Sigmoidoscopy, and 1 to Cystoscopy.

Reason for Cancellation Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17Last 12

Months

Administrative Error 8 8 8 6 12 10 7 4 3 7 4 7 84

Equipment Unavailable 6 2 5 8 3 9 2 0 1 0 4 4 44

Hospital Clinical Cancellation 0 0 0 0 0 0 0 0 0 0 0 0 0

External Issues 0 1 0 0 0 0 0 0 0 0 0 0 1

ICU/HDU Bed Unavailable 4 1 0 5 2 5 0 1 2 2 1 0 23

List overrun - clinical reasons 8 7 3 3 7 13 7 11 14 7 19 8 107

List overrun - non-clinical reasons 0 1 13 9 2 0 1 1 0 1 0 0 28

Other 0 1 1 0 26 2 2 0 12 22 2 2 70

Replaced by emergency patient 8 8 12 9 7 3 2 1 7 9 6 12 84

Replaced by other patient 1 0 0 3 1 0 0 0 1 0 0 0 6

Staffing 9 6 4 15 7 3 1 7 1 9 26 3 91

Theatre unavailable 0 0 1 0 0 0 0 0 0 0 0 0 1

Ward Bed Unavailable 9 6 10 4 0 2 4 2 4 4 9 4 58

Unknown 0 0 6 0 0 0 0 0 0 0 0 0 6

Total 53 41 63 62 67 47 26 27 45 61 71 40 603


Perf

Last 12

months


six weeks)Mar-17 1% 0.20%


Perf

Last 12

months

Cancelled Ops - % of elect act Mar-17 0.8% 0.47%

Cancelled Operations - Rebooked 28

days+Mar-17 0 1

Number of urgent operations cancelled

for a second timeMar-17 0 0

Positiv

e

experience o

f

care

Detailed information for March 2017 is not yet available

Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17Last 12

Months

On the day Cancelled Operations 41 63 62 67 47 26 27 45 61 71 40 46 596

Prior to the day Cancelled Operations 313 221 185 236 274 218 187 204 193 280 263 290 2864

Total Cancelled Operations 354 284 247 303 321 244 214 249 254 351 303 336 3460


19

NUH 2.7 NHS E-Referral Report

The NHS E-Referral report details how long it takes the Trust to contact patients who have had slot issues. During February 2017, 613 patients had slot issues with 75 patients waiting less than 7 working days. However, 311 were waiting longer than 7 working days and 227 patients were waiting beyond 14 working days. Specialties where patients had slot issues in February lasting longer than 14+ working days include ENT (211), Clinical Haematology (12), and Neurology (4).

NUH 2.6 Appointment Slot Issues

During the appointment booking process, the NHS e-Referral Service will allow the referral to enter the Appointment Slot Issues process if there are no slots available for booking at the time of the appointment search. The above indicator displays the ratio of slot issues per successful Directly Bookable Service (DBS) booking. It is not necessarily the same as the ratio of patients encountering slot issues, as some patients may encounter multiple issues. NUH failed to meet the slot unavailability standard of 0.04 issues per successful DBS booking with performance at 0.14. The trust are also below target year-to-date with performance at 0.15. The specialties with the largest number of slot issues are: Ear, Nose, and Throat - 328 slot issues Ophthalmology - 163 slot issues Child and Adolescent Services - 155 slot issues Two week wait - 88 slot issues Allergy - 74 slot issues Haematology - 54 slot issues Cardiology - 42 slot issues


Perf

Last 12

months

2016/17

YTD

Ratio of slot issues per successful DBS

bookingFeb-17 0.04 0.14 0.15


Perf

Last 12

months

Patients waiting less than 7 working

days to arrange an appointmentMar-17 95% 49%

Patients waiting less than 14 working

days to arrange an appointmentMar-17 100% 63%

NH

S E

-

Refe

rral A

SIs


20

NUH 2.8 Delayed Transfers of Care

The number of delays is measured as at midnight on the last Thursday of the reporting month. During February 2017 there were 18 delays, which is below the average of 32 per month during 2015/16.

The number of days delayed in February 2017 was below the average of 1421 per month during 2015/16 with 741 days delayed during the month. This indicator is a total of delayed days in the month as opposed to a snapshot.

The above table shows that NUH has been deemed responsible for the majority of DTOCs in February 2017. The most common reason for delays was due to a lack of capacity in further non acute NHS care. This was affecting 17 patients on the last Thursday of the month with a total of 611 days delayed during the month.

There is a threshold of 3.5% for the rate of delays affecting occupied bed days during the month. NUH experienced delayed transfers of care in 1.9% of all occupied bed days in February 2017. This is the fifth time in the last 12 months that NUH has achieved the target.

Domain Description of Standard Period TargetPeriod

Perf

Last 12

months

DToC - % Rate of Occupied Bed Days Feb-17 3.5% 1.9%


Perf

Last 12

months

DToC - Acute/Non-Acute 18+ - Delays Feb-17 Minimum 18

DToC - Acute/Non-Acute 18+ - Days

DelayedFeb-17 Minimum 741P

osit

ive

exp

eri

en

ce

of

care

Nottingham University

Hospitals

Reason For Delay

February 2017

Number of

Patients

Delayed (last

Thursday of

month

snapshot)

Number of

Days Delayed

(total during

month)

Number of

Patients

Delayed (last

Thursday of

month

snapshot)

Number of

Days Delayed

(total during

month)

Number of

Patients

Delayed (last

Thursday of

month

snapshot)

Number of

Days Delayed

(total during

month)

A) Completion of assessment 0 40 0 0 0 0

B) Public Funding 0 0 0 0 0 0

C) Further non acute NHS care

(including intermediate care, rehab, etc)17 611 0 0 0 0

Di) Aw aiting Residential Care Home

Placement0 2 0 0 0 0

Dii) Aw aiting Nursing Home Placement 0 6 0 0 0 0

E) Care package in ow n home 0 0 0 0 0 0

F) Community Equipment/adaptions 0 1 0 0 0 0

G) Patient or family choice 1 81 0 0 0 0

H) Disputes 0 0 0 0 0 0

I) Housing - patients not covered by

NHS and Community Care Act0 0 0 0 0 0

Total 18 741 0 0 0 0

NHS Responsible for DelaySocial Care Responsible for

Delay

Both NHS & Social Care

Responsible for Delay


21

NUH 2.12 Venous Thromboembolism (VTE)

NUH 2.11 Ambulance Handovers

NUH 2.10 Mixed Sex Accommodation Breaches (MSA)

Ambulance handovers to the Emergency Department (ED) remain above the national standards, the key reasons for this include: High levels of occupancy in ED cubicles Continuing increase in ambulance attendances There are a high proportion of vacancies To improve performance there is an action plan in place.

December 2016 performance is below standard for the seventeenth consecutive month with performance at 94.15% of eligible patients for VTE assessed within 24 hours. Actions to improve performance include - VTE Clinical Nurse Specialist commenced her role on the 31st October 2016. Key focus on initiatives to drive compliance

with 95% standard. Undertaking ward visits to areas with poorer compliance VTE risk assessment will move to Nervecentre from early 2017 - easier access to complete, review, and update Review of clinically low-risk exempt cohorts to identify whether further groups should be cohorted out Performance can be accessed in real-time across the Trust via Qlikview. Wards can be made aware of patients approaching

24 hours

During March 2017, there were no Mixed Sex Accommodation breaches at NUH.

NUH 2.9 Healthcare Associated Infections (HCAIs)

Please be aware that the trust will only be penalised for MRSAs that are considered avoidable and Clostridium Difficile infections that are considered to be due to lapses in care. During April 2017 NUH had 1 Clostridium Difficile infection. Information is currently forthcoming as to whether this was avoidable. Year to date there has been 1 Clostridium Difficile infection against a standard of 7. NUH had 0 cases of MRSA during April 2017. Year to date there has been 0 cases of MRSA that were deemed clinically avoidable.


Perf

Last 12

months

2016/17

YTD

Percentage of patients assessed for risk

of VTE on admissionDec-16 95% 94.15% 93.99%

AllAvoidable /

LapseAll

Avoidable /

Lapse

MRSA (Full year standard = 0) Apr-17 0 0 0 0 0

C-Diff(YTD standard = 7)

(Current month standard = 7)Apr-17 7 1 TBC 1 0

2017/18 YTDLast 12 months

Avoidable / Lapse

HC

AIs

NUH Description of Standard PeriodYTD

Standard

Period Perf


Perf

Last 12

months

Mixed Sex Accommodation Breaches Mar-17 0 0


Perf

Last 12

months

Ambulance A&E handovers over 30

minutesMar-17 0 322

Ambulance A&E handovers over 60

minutesMar-17 0 23

Am

bula

nce

Handovers


22

NUH 2.14 Publication of Formulary

NUH 2.13 Friends & Family Test The Friends and Family score is calculated using the proportion of patients who would strongly recommend minus those who

would not recommend, or who are indifferent.

NUH failed to achieve the Friends and Family Test response rate standards for Maternity Questions 1-4 during February 2017.

The Trusts’ formulary is published by the Nottinghamshire Area Prescribing Committee. The formulary aims to provide

information on medicines available to prescribers in Nottinghamshire reflecting safe, evidence-based and cost-effective choices.

NUH 2.15 Duty of Candour breaches

NUH have had no Duty of Candour breaches during 2016/17.

NUH 2.16 Never Events

There were no Never Events reported in March 2017. Year-to-date NUH has experienced 8 Never Events.

NUH TargetFeb-17

Perf

Last 12

months

2016/17

YTD

% Recommended 68% 93.08% 90.68%

Number of Responses 2053 22914

Response Rate 20% 23.89% 21.82%

% Recommended 68% 97.53% 97.45%


Response Rate 30% 40.01% 38.54%

% Recommended 97.70% 98.38%


Response Rate 25% 11.92% 19.69%



Response Rate 25% 11.64% 7.82%



Response Rate 25% 23.84% 19.38%

% Recommended 100% 98.93%


Response Rate 25% 20.96% 30.94%

Description of Standard

Friends &

Fam

ily T

est

A&E: How likely are you to recommend

our A&E department to friends and family

if they needed similar care or treatment?

Inpatient: How likely are you to

recommend our w ard to friends and

family if they needed similar care or

treatment?

Maternity Q1: How likely are you to

recommend our antenatal service to

friends and family if they needed similar

care or treatment?


recommend our labour w ard to friends

and family if they needed similar care or

treatment?


recommend our postnatal w ard to friends

and family if they needed similar care or

treatment?


recommend our postnatal community

service to friends and family if they

needed similar care or treatment?


Perf

Last 12

months

Publication of Formulary Mar-17 Yes Yes


Perf

Last 12

months

2016/17

YTD

Duty of Candour Breaches Mar-17 0 0 0


Perf

Last 12

months

2016/17

YTD

Never Events Mar-17 0 0 8


23

NUH 2.19 Falls

NUH 2.17 Summary Hospital Level Mortality Indicator (SHMI)

The Summary Hospital Level Mortality Indicator (SHMI) standard has been achieved during January 2017.

NUH 2.18 Pressure Ulcers

NUH 2.20 Mandatory Training

The Trust failed to achieve the Falls per 1000 Occupied Bed Days resulting in harm indicator for March 2017 with performance

at 1.20 against a standard of 0.98. The standard was revised from 1.70 to 0.98 in June 2016.

The Trust are achieving the rolling 12 months standard of 90% to March 2017 with performance at 90%.

To improve performance, a new approach to mandatory training went live from April 2017 which will create more choice for

individuals to complete their mandatory training. Compliance is expected to increase as a result. Individual monthly

performance for March 2017 is not currently available.

NUH 2.21 Appraisals

The Trust has a target to deliver appraisals to 90% of staff over a rolling 12 month period. The past rolling twelve months from

April 2016 — March 2017 period is not achieving the 90% standard with performance at 89%. Monthly performance for March

2017 is not currently available.

NUH failed to achieve the standards for the reduction grade 2 and 3 pressure ulcers but did meet the target for the reduction in

grade 4 pressure ulcers during February 2017.


Perf

Last 12

months

2016/17

YTD

Summary Hospital Level Mortality

Indicator (SHMI)Jan-17

Not higher

than expected1.04 1.04


Perf

Last 12

months

Reduction of grade 2 Pressure Ulcers

per 1000 Occupied Bed DaysFeb-17 0.33 0.39


per 1000 Occupied Bed DaysFeb-17 0.06 0.07


per 1000 Occupied Bed DaysFeb-17 0.00 0.00P

ressure

Ulc

ers


Perf

Last 12

months

2016/17

YTD

Falls per 1000 Occupied Bed Days

resulting in harmMar-17 0.98 1.20 1.10

Falls

NUH Description of Standard Period Target PerfRolling 12

Months

Mandatory Training12 Months

to Mar-1790% 90%

NUH Description of Standard Period Target PerfRolling 12

Months

Rolling 12

Months

Appraisals Mar-17 90% N/A 89%

24

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Leic

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r

A&

E a

chie

vem

ent

95%

Month

Feb-1

781.0

7%

89.6

4%

83.7

9%

83.9

7%

79.3

5%

82.2

5%

86.8

8%

81.3

7%

82.0

6%

93.4

1%

81.1

0%

80.7

3%

83.7

6%

Cancer

62d U

rg R

TT

85%

Month

Feb-1

778.5

3%

78.4

9%

79.5

8%

70.1

3%

75.5

6%

78.5

4%

86.4

2%

82.0

4%

75.7

0%

81.6

4%

67.0

9%

79.0

3%

76.5

0%

Cancer

62d U

rg R

TT-S

cre

enin

g S

erv

ice

90%

Month

Feb-1

794.1

2%

50.0

0%

75.0

0%

92.9

8%

94.8

3%

100.0

0%

100.0

0%

90.7

0%

97.8

3%

91.3

8%

100.0

0%

100.0

0%

78.1

3%

Cancer

62d U

rg R

TT-C

ons U

pgra

de

94%

Month

Feb-1

7100.0

0%

82.8

6%

90.9

7%

82.3

5%

69.4

4%

100.0

0%

88.8

9%

81.0

3%

95.9

2%

63.6

4%

93.9

4%

77.7

8%

100.0

0%

Cancer

31d D

TT

96%

Month

Feb-1

797.6

9%

96.1

2%

97.2

0%

94.4

7%

96.0

3%

96.5

1%

96.6

9%

97.6

5%

98.0

1%

98.6

7%

98.6

7%

96.8

2%

95.2

9%

Cancer

31d D

TT -

Subs: S

urg

ery

94%

Month

Feb-1

794.5

1%

89.4

7%

94.7

4%

91.8

2%

93.1

0%

96.2

0%

100.0

0%

98.7

2%

96.5

2%

97.6

0%

99.2

6%

92.1

6%

88.4

6%

Cancer

31d D

TT -

Subs: D

rugs

98%

Month

Feb-1

7100.0

0%

100.0

0%

100.0

0%

100.0

0%

100.0

0%

100.0

0%

100.0

0%

99.5

4%

98.2

1%

100.0

0%

97.4

1%

100.0

0%

100.0

0%

Cancer

31d D

TT -

Subs: R

adio

thera

py

94%

Month

Feb-1

798.3

3%

97.1

8%

100.0

0%

97.4

0%

99.4

9%

96.0

9%

100.0

0%

98.1

8%

99.6

3%

97.6

3%

99.1

5%

Cancer

2w

w93%

Month

Feb-1

789.8

0%

94.8

1%

97.8

6%

96.3

5%

95.3

2%

96.3

5%

96.5

5%

96.5

4%

94.0

0%

94.5

5%

95.3

2%

95.5

3%

94.3

0%

Cancer

2w

w -

Bre

ast S

ym

pto

ms

93%

Month

Feb-1

793.8

4%

95.5

4%

95.2

7%

93.0

4%

98.2

3%

95.0

5%

91.7

5%

89.5

2%

93.4

6%

100.0

0%

97.0

3%

Dia

gnostic

Test W

T1%

Month

Feb-1

70.9

0%

2.7

8%

0.3

5%

0.5

4%

0.1

3%

0.7

7%

0.9

3%

0.0

9%

0.7

7%

0.6

1%

0.4

0%

1.3

1%

0.8

6%

DToC

- A

cute

/Non-A

cute

18+

Min

imum

Month

Feb-1

753

40

76

65

18

89

15

114

85

48

77

18

37

Friends &

Fam

ily -

A&

E (

% R

ecom

mended)

Local

Month

Feb-1

793.0

0%

88.7

2%

83.1

0%

83.7

5%

93.0

8%

87.5

1%

79.9

2%

85.2

4%

94.3

8%

93.1

6%

84.0

3%

79.6

1%

94.3

1%

Friends &

Fam

ily -

A&

E (

Response R

ate

)20%

Month

Feb-1

722.8

5%

11.0

0%

13.8

6%

31.0

6%

23.8

9%

21.1

6%

19.0

9%

25.6

3%

3.8

7%

1.9

8%

16.5

2%

17.7

4%

13.7

8%

Friends &

Fam

ily -

IP (

% R

ecom

mended)

Local

Month

Feb-1

796.4

8%

96.5

0%

91.5

1%

95.4

3%

97.5

1%

96.3

5%

91.9

6%

95.2

0%

96.8

7%

98.1

3%

98.6

4%

96.8

5%

96.4

6%

Friends &

Fam

ily -

IP (

Response R

ate

)20%

Month

Feb-1

78.9

1%

29.5

3%

27.3

6%

37.4

1%

39.5

1%

16.5

2%

29.7

8%

29.8

2%

17.8

1%

15.1

7%

17.2

0%

34.7

7%

30.7

1%

MR

SA

Local

YTD

Mar-

17

38

113

66

23

17

01

3

C-D

iff

Local

YTD

Mar-

17

47

74

57

116

93

53

54

110

38

74

92

31

60

MS

A B

reaches

Min

imum

Month

Mar-

17

00

00

00

01

00

07

1

MS

A B

reach R

ate

(per

1000 f

in c

ons e

ps)

Min

imum

Month

Mar-

17

0.0

00.0

00.0

00.0

00.0

00.0

00.0

00.0

50.0

00.0

00.0

00.5

60.0

4

RTT -

Adm

itted

90%

Month

Feb-1

772.6

5%

80.3

4%

69.5

5%

74.6

0%

82.0

5%

74.0

1%

73.8

8%

85.4

1%

80.4

5%

90.4

3%

85.3

0%

74.9

1%

79.4

9%

RTT -

Non a

dm

itted

95%

Month

Feb-1

788.9

8%

91.0

7%

83.3

7%

88.3

5%

97.0

6%

84.5

9%

87.7

5%

93.4

8%

90.1

7%

95.7

2%

84.6

6%

87.0

2%

85.8

6%

RTT -

Incom

ple

te92%

Month

Feb-1

790.2

3%

92.1

5%

84.0

5%

88.1

0%

95.9

1%

89.1

9%

88.5

8%

95.0

9%

92.0

0%

93.8

3%

92.6

9%

92.0

0%

91.1

7%

Level 2 – SFHFT Performance

25

SFHFT 2.1 Cancer Waiting Times

SFHT failed to achieve the standard for Cancer 62 day RTT - Screening Service with performance at 85.71%. Aside from this,

SFHT achieved all other targets for Cancer in February 2017.

SFHFT 2.2 Referral To Treatment (RTT)

SFHT achieved the Incomplete 92% standard during February 2017 with performance at 92.97%. Incomplete pathways with a

decision to admit does not have a national standard but shows that 85.33% of incomplete patients who have a decision to

admit are waiting less than 18 weeks. In February 2017, there were 6894 new RTT pathways started at SFHT.

SFHT Description of Standard Period TargetPeriod

Perf

Last 12

months

2016/17

YTD

62d Urg RTT Feb-17 85% 87.22% 83.36%

62d Urg RTT - Screening Service Feb-17 90% 85.71% 90.00%

62d Urg RTT Cons Upgrade Feb-17 N/A 79.17% 89.43%

Cancer 31d DTT Feb-17 96% 98.21% 97.73%

Cancer 31d DTT - Subs: Surgery Feb-17 94% 100.00% 100.00%

Cancer 31d DTT - Subs: Drugs Feb-17 98% 100.00% 99.60%

Cancer 31d DTT - Subs: Radiotherapy Feb-17 94% N/A N/A

Cancer 2ww Feb-17 93% 98.40% 95.93%

Cancer 2ww - Breast Symptoms Feb-17 93% 100.00% 97.55%

Pre

ven

tin

g p

eo

ple

fro

m d

yin

g p

rem

atu

rely

Po

sit

ive

exp

eri

en

ce

of

care

Domain Description of Standard Period TargetPeriod

Perf

Last 12

months


weeks)Feb-17 92% 92.97%


Decision to Admit (% within 18 weeks)Feb-17 N/A 85.33%

.

New RTT Periods During the Month Feb-17 N/A 6894

Po

sit

ive

exp

eri

en

ce o

f care

Level 2 – SFHFT Performance

26

SFHFT 2.4 A&E 4 hour waiting time standard

SFHT achieved the 95% A&E standard during March 2017 with performance at 95.20%. Year to date performance is below the

standard at 94.51%.

SFHT 2.3 Diagnostics Waiting Times

SFHT achieved the 1% diagnostics standard for February 2017 with performance at 0.84%. There were 38 breaches in February

with 10 relating to Sleep Studies, 8 to Colonoscopy, 8 to Cystoscopy, 7 to Gastroscopy, 3 to Flexi Sigmoidoscopy, and 2 to

Echocardiography.


Perf

Last 12

months


six weeks)Feb-17 1% 0.84%


Perf

Last 12

months

2016/17

YTD

A&E waiting time - KMH (inc CNCS) +

NewarkMar-17 95% 95.20% 94.51%

A&E waiting time - KMH (inc. CNCS) Mar-17 95% 93.23% 92.58%

A&E waiting time - Newark Mar-17 95% 99.39% 99.12%

Po

sit

ive

exp

eri

en

ce o

f care

Level 2 – Circle Performance

27

Circle 2.1 Cancer

Circle failed to meet the 62 day target but did achieve the 31 day and 2 week wait standards in February 2017.

The graph above shows a breakdown of how long patients at Circle waited on the 2 week wait pathway, please note that this is the total days waited and not the number of days over 14 waited. Patients seen within 14 days are not shown. The longest wait on the pathway at the time of reporting was 29 days. This was due to patient choice.

Cancer 31 day DTT Performance by Tumour Site

The above table shows the performance of 31 day cancer at Circle for all patients by tumour site for February 2017 and for the last twelve months. It should be noted that small numbers for tumour sites besides skin have a negligible impact upon overall 31 day DTT performance for the last 12 months. Circle achieved the standard in February 2017 with performance at 96.36%. Over the previous 12 months, performance is at 92.31% which is below the target.

Domain Description of Standard Target Feb-17 Q3 2016-17Last 12

monthsYTD

62d Urg RTT 85% 79.01% 85.08% 86.02%

Cancer 31d DTT 96% 96.36% 87.18% 92.34%

Cancer 2ww 93% 97.69% 95.02% 94.59%

Pre

venting p

eople

from

dyin

g

pre

matu

rely

0

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50+

Nu

mb

er o

f R

efer

rals

Wait (Days)

Circle - Cancer 2ww - Feb 2017

718 Patients Seen Within 14 Days

Patients % Chart Patients %

GynaecologicalFeb-17 96% 2 100.00% 5 100.00%

Lower GastrointestinalFeb-17 96% 4 100.00% 15 93.33%

OtherFeb-17 96% 0 N/A 1 100.00%

SarcomaFeb-17 96% 0 N/A 4 100.00%

SkinFeb-17 96% 47 95.74% 541 91.87%

Upper GastrointestinalFeb-17 96% 1 100.00% 5 100.00%

UrologicalFeb-17 96% 1 100.00% 14 100.00%

All CancersFeb-17 96% 55 96.36% 585 92.31%

Circle Tumour Site

Ca

nce

r 3

1 D

ay D

TT

Pe

rfo

rma

nce

by T

um

ou

r S

ite

fo

r

all C

CG

Pa

tie

nts

at C

ircle

(A

dm

itte

d &

No

n-A

dm

itte

d)

Period StandardLast 12 MonthsLatest Period


28

Circle 2.1 Cancer (cont.)

Cancer 62 day RTT Performance by Tumour Site

The above table shows the performance of 62 day cancer (excluding rare cancers) at Circle for all patients by tumour site for

February 2017 and the last twelve months. There is one tumour site where performance has been consistently below standard

over the last 12 months—Lower Gastrointestinal.

During February 2017, 62 day RTT performance at Circle has fallen further below the 85% national standard with performance at

79.01%. Performance over the past twelve months is however meeting the standard at 85.59%.

Patients % Charts Patient %

BreastFeb-17 85% 0.5 0.00% 0.5 0.00%

GynaecologicalFeb-17 85% 6 83.33% 34 88.24%

HaemotologicalFeb-17 85% 0.5 100.00% 3 50.00%

Head & NeckFeb-17 85% 0 N/A 0 N/A

Lower GastrointestinalFeb-17 85% 3 66.67% 48.5 61.86%

LungFeb-17 85% 0.5 0.00% 3 50.00%

OtherFeb-17 85% 0 N/A 1.5 33.33%

SarcomaFeb-17 85% 0 N/A 1.5 66.67%

SkinFeb-17 85% 20 90.00% 295.5 93.06%

Upper GastrointestinalFeb-17 85% 5 50.00% 36.5 72.60%

UrologicalFeb-17 85% 5 80.00% 103.5 82.61%

All Cancers (Excl. Rare

Cancers)Feb-17 85% 40.5 79.01% 527.5 85.59%

Cancer

62 D

ay R

TT

Perf

orm

ance b

y T

um

our

Site f

or

all

CC

G P

atients

(Adm

itte

d &

Non-A

dm

itte

d)

Period StandardLatest Period Last 12 Months

Circle Tumour Site


29

Circle 2.2 RTT

The only national standard for 2016/17 is the Incomplete 92% of patients to be waiting less than 18 weeks at the end of the

month. Circle have achieved this for each of the last 12 months.

The table below shows Incomplete, Incomplete With Decision to Admit and New RTT Periods by specialty:

One specialty breached the 92% Incomplete standard in March 2017; this was Ophthalmology.

Please note RTT performance is reported at provider level not contract level. Therefore Ophthalmology is included for

completeness although not commissioned via this contract.

Circle Description of Standard Period TargetPeriod

Perf

Last 12

months


weeks)Mar-17 92% 94.92%


Decision to Admit (% within 18 weeks)Mar-17 N/A 91.93%

.

New RTT Periods During the Month Mar-17 N/A 6225

Po

sit

ive

exp

eri

en

ce o

f care

New RTT

Periods


212 10 95.28% 58 7 87.93% 137

438 11 97.49% 59 1 98.31% 292

1716 105 93.88% 779 67 91.40% 1018

0 0 0 0 0

5 1 80.00% 5 1 80.00% 10

0 0 0 0 0

0 0 0 0 0

0 0 0 0 0

0 0 0 0 0

291 20 93.13% 49 5 89.80% 154

1711 106 93.80% 82 10 87.80% 800

43 0 100.00% 0 0 36

2218 133 94.00% 1126 110 90.23% 1338

677 38 94.39% 5 0 100.00% 309

0 0 0 0 0

573 9 98.43% 15 0 100.00% 327

0 0 0 0 0

871 19 97.82% 323 15 95.36% 967

1435 66 95.40% 436 21 95.18% 837

10190 518 94.92% 2937 237 91.93% 6225

Plastic Surgery

Month = Mar-17

Incomplete

Standard = 92%

Incomplete


General Surgery

Urology


ENT

Ophthalmology

Oral Surgery

Neurosurgery

Number of patients


Total


General Medicine

Gastroenterology

Cardiology

Dermatology

Thoracic Medicine

Neurology

Rheumatology

Geriatric Medicine

Gynaecology

Other


30

Circle 2.4 Cancelled Operations

During March 2017, Circle achieved the 0.8% national standard with 0.30% of operations cancelled. Of the operations that were

cancelled, 20% of them were not rebooked within 28 days which is a breach of the 5% standard. This was due to patient choice.

The table below shows that the main reason for cancellation during the last 12 months is staffing followed by administrative

error.

Circle 2.3 Diagnostics Waiting Times

Circle achieved the Diagnostics standard in February 2017, during the month there were no breaches of the six week standard.

Circle 2.5 Complaints

Circle had 20 complaints during February 2017. Circle have a culture of encouraging patients to raise concerns and any

complaints made are used to increase the quality of clinical care and provide the best possible patient experience.


Perf

Last 12

months


six weeks)Feb-17 1% 0.00%

Circle Description of Standard Period StandardPeriod

Perf

Last 12

months

2016/17

YTD

Patient

ExperienceNumber of Complaints Feb-17 Minimum 20 161


Perf

Last 12

months

2016/17

YTD

Cancelled Ops - % of elect act Mar-17 0.8% 0.30% 0.32%

Cancelled Operations - Rebooked 28

days+Mar-17 5% 20.00% 5.26%

Number of urgent operations cancelled

for a second timeMar-17 0 0 0

Positiv

e

experience o

f

care

Reason for Cancellation Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17Last 12

Months

Administrative Error 2 2 1 0 0 0 0 1 2 2 0 1 12

Clinical Priority 1 0 1 0 0 0 3 1 0 0 0 0 7

Equipment 2 0 2 0 0 0 0 0 0 0 0 0 7

ICU/HDU Bed Unavailable 0 0 0 0 0 0 0 1 0 0 0 0 2

Other 0 0 3 0 0 0 2 1 2 3 0 0 11

Staffing 3 1 1 0 6 2 0 1 5 0 0 4 23

Theatre Time 0 0 0 0 0 1 0 0 0 0 0 0 1

Ward Bed Unavailable 0 0 0 0 0 0 0 0 0 0 0 0 0

Total 8 3 8 0 6 3 5 5 9 5 0 5 63


31

Circle 2.6 HCAIs

Circle have not had any cases of MRSA or C-Diff during the last 12 months.

Circle 2.7 Venous Thromboembolism (VTE) Risk Assessment

Circle achieved the VTE risk assessment standard in December 2016 with performance at 97.96%.

Circle 2.8 Never Events

There were no Never Events reported during February 2017.

Circle 2.9 Friends & Family Test (FFT)

There are currently no national standards for the FFT. However, Circle are consistently achieving high scores amongst both

inpatients and outpatients.


Perf

Last 12

months

2016/17

YTD

Percentage of patients assessed for risk

of VTE on admissionDec-16 95% 97.96% 98.13%

Circle Description of Standard Period StandardPeriod

Perf

Last 12

months

MRSA Bacteraemia Feb-17 0 0

C Difficile Feb-17 0 0

HC

AIs


Perf

Last 12

months

2016/17

YTD

Never Events Feb-17 0 0 0

Circle Description of Standard Period Basis Standard PerformanceLast 12

months

FFT - Inpatient Score Feb-17 Monthly N/A 94.2

FFT - Inpatient Response Rate Feb-17 Monthly N/A 27.11%

FFT - Outpatient Score Feb-17 Monthly N/A 82.0

FFT - Outpatient Response Rate Feb-17 Monthly N/A 17.42%Friends &

Fam

ily T

est

(FF

T)

Level 2 – NHCT Performance

32

NHCT 2.1 IAPT

IAPT - Patient Moving Towards Recovery (Recovery Rate)

The recovery rate is the number of people who are moving to recovery, divided by the number of people who have completed treatment, minus the number of people who have completed treatment who were not at “caseness” at initial assessment. An individual is said to be at caseness when their outcome score exceeds the accepted threshold for a standardised measure of symptoms. The CCG has an IAPT recovery rate standard of 50%. During March 2017, Nottingham North & East CCG achieved the 50% standard with performance at 59.28%. The CCG has achieved the standard in each of the last 12 months.

The CCGs have set a target for 3.76% of patients who have depression and/or anxiety disorders to be seen each quarter during 2016/17. This equates to 194 patients per month for Nottingham North & East, 126 for Nottingham West and 127 for Rushcliffe. Nottingham North & East CCG are achieving the required quarterly of 3.76% in Quarter 4 with performance at 4.08% (currently awaiting validation for final figures). The CCG is averaging 210 patients treated per month during the quarter.

NHCT 2.2 Early Intervention in Psychosis

There is a national target for all patients referred onto the early intervention in psychosis pathway to be treated within 2 weeks with a NICE-recommended package of care. In March 2017, 50% of Nottingham North & East CCG patients started treatment within two weeks following referral. The CCG has achieved the standard three times in the last twelve months. Meanwhile, 33.33% of patients currently awaiting treatment are waiting below 2 weeks following referral.

NHCT Description of Standard CCG Target Mar-17Last 12

months

NNE 3.76% 4.08%

NW 3.76% 4.19%

Rush 3.76% 4.62%

IAP

T The percentage of people who have

depression and/or anxiety disorders who

receive psychological therapies

NHCT Description of Standard CCG Target Mar-17Last 12

months

NNE 50% 59.28%

NW 50% 69.61%

Rush 50% 61.90%

IAP

T

IAPT Recovery Rates

CCG Description of Standard Period Target CCGNo. of

Referrals

Period

Perf

Last 12

months

NNE 2 50.00%

NW 0 N/A

Rush 6 100.00%

NNE 3 33.33%

NW 0 N/A

Rush 1 100.00%

Early Intervention in Psychosis (% of patients

starting treatment w ith a NICE-recommended

package of care w ithin 2 w eeks of referral)

Mar-17 100%

Positi

ve E

xperience

of C

are

Early Intervention in Psychosis (% of patients

aw aiting treatment w ith a NICE-recommended

package of care w ithin 2 w eeks of referral)

Mar-17 100%


33

NHCT 2.5 Dementia During the planning round completed by CCGs in April 2016, Nottingham North & East CCG set ambitions to maintain their Dementia Diagnosis Rate at a minimum of 67% throughout 2016/17.

The table below shows that as at the end of March 2017 Nottingham North & East CCG has a Dementia Diagnosis Rate of 70%, which is above the 67% plan.

NHCT 2.4 Care Programme Approach

The Trust achieved the percentage of patients receiving follow-up contact within 7 days of discharge during June 2016.

CPA is usually for patients that have severe mental health problems and is a particular way of assessing, planning and reviewing their mental health needs. There should be a formal written care plan outlining any risks and including details of what should happen in an emergency or crisis, this should be reviewed annually.

NHCT Description of Standard Period Standard Period PerfLast 12

months

% of patients having a review last 12

monthsJun-16 95.0% 96.60%

% of patients receiving follow-up contact

within 7 days of dischargeJun-16 95.0% 98.10%

CP

A

NHCT 2.3 Children and Young Person’s Mental Health - Eating Disorder

Children and Young Person’s Mental Health - Eating Disorder is a new quarterly collection. Due to the low volume of referrals for these services, CCGs performance is to be measured on a rolling 6 months basis. The expectation is that by 2020, CCGs wil l have achieved a minimum of 95% of referrals waiting less than 1 week for urgent referrals, and 4 weeks for routine cases.

In the six months to the end of Quarter 4 2016-17, 0% of completed routine cases for Nottingham North & East CCG were seen within 4 weeks. Meanwhile, 100% of incomplete routine cases are currently waiting less than 4 weeks at the time of reporting and 100% of completed urgent cases were seen within 1 week.

NHCT Description of Standard Plan Mar-17Last 12

months

Nottingham North & East 67% 70%

Nottingham West 67% 75%

Rushcliffe 67% 79%

Dementia

Diagnosis

Rate

NHCT Description of StandardRolling six

months to

Standard

(By 2020)CCG

No. of

Referrals

6 Month

Rolling PerfPrevious Perf

Q4 16-17 95% NNE 1 0.00%

Q4 16-17 95% NW 2 100.00%

Q4 16-17 95% Rush 3 66.67%

Q4 16-17 95% NNE 3 100.00%

Q4 16-17 95% NW 5 60.00%

Q4 16-17 95% Rush 6 83.33%

Q4 16-17 95% NNE 1 100.00%

Q4 16-17 95% NW 0 N/A

Q4 16-17 95% Rush 0 N/A

Q4 16-17 95% NNE 0 N/A

Q4 16-17 95% NW 0 N/A

Q4 16-17 95% Rush 0 N/A

Positiv

e E

xperience o

f C

are

CYP ED pathways (routine cases)

completed (< 4 weeks)

CYP ED pathways (routine cases)

incomplete (< 4 weeks)

CYP ED pathways (urgent cases)

completed (< 1 week)

CYP ED pathways (urgent cases)

incomplete (< 1 week)


34

NHCT 2.6 Delayed Transfers of Care

NHCT achieved the 7.5% standard for Delayed Transfers of Care during December 2016 with performance at 3.30%. Patients

have been delayed 411 days during December 2016, which is below the 2016-17 average of 746.

A reason for delay breakdown of the DTOCs for December 2016 is shown below, this also shows whether the NHS or Social Care

was responsible for the delay.

NHCT Description of Standard Period Standard Period PerfLast 12

months

DToC - % of Non-Acute Admissions Dec-16 7.5% 3.30%

DToC - Number of Days Delayed Dec-16 Minimum 411

DT

oC

Nottinghamshire Healthcare

Trust

Reason For Delay

December 2016

Number of

Patients

Delayed (last

Thursday of

month

snapshot)

Number of

Days Delayed

(total during

month)

Number of

Patients

Delayed (last

Thursday of

month

snapshot)

Number of

Days Delayed

(total during

month)

Number of

Patients

Delayed (last

Thursday of

month

snapshot)

Number of

Days Delayed

(total during

month)

A) Completion of assessment 1 9 0 0 0 0

B) Public Funding 0 0 0 0 0 0

C) Further non acute NHS care

(including intermediate care, rehab, etc)5 118 0 0 0 0

Di) Aw aiting Residential Care Home

Placement7 124 1 12 0 0

Dii) Aw aiting Nursing Home Placement 2 12 0 8 0 0

E) Care package in ow n home 1 3 0 0 0 0

F) Community Equipment/adaptions 0 0 0 0 0 0

G) Patient or family choice 3 45 0 0 0 0

H) Disputes 1 49 0 0 0 0

I) Housing - patients not covered by

NHS and Community Care Act1 31 0 0 0 0

Total 21 391 1 20 0 0

NHS Responsible for DelaySocial Care Responsible for

Delay

Both NHS & Social Care

Responsible for Delay

Level 2 – EMAS Performance

35

Monthly Performance of the Ambulance Indicators Red 8 minutes and Red 19 minutes

Performance against standard for Red 1 and Red 2 calls.

The chart above shows EMAS Red call volumes for the three South Nottinghamshire CCGs, comparing 2016-17 volumes to the

same periods of 2015-16. All three South Nottinghamshire CCGs have seen an increase in call volumes; Nottingham North & East

has increased by 17.22%, Nottingham West by 16.23% and Rushcliffe by 18.94%.

The table above shows the EMAS performance for local CCGs against the Red 1 and Red 2 standards. During March 2017 Nottingham North & East CCG achieved the Red 1 8 minute 75% standard with performance at 75.00% from 40 responses. The CCG has achieved the standard four times in the last twelve months. The CCG failed to achieve the Red 2 8 minute 75% standard. During March 2017 there were 725 responses of which 50.48% arrived within 8 minutes, 90.86% arrived within 19 minutes which is below the standard of 95%.

Responses Performance Responses Performance

M&A 57 85.96% 651 75.58%

N&S 38 55.26% 311 52.73%

City 113 88.50% 1293 82.06%

NNE 40 75.00% 391 69.82%

NW 26 73.08% 273 64.84%

Rush 14 64.29% 237 59.92%

M&A 57 100% 651 99.54%

N&S 38 94.74% 310 94.84%

City 113 100% 1292 99.61%

NNE 40 97.50% 390 98.72%

NW 26 100% 273 98.90%

Rush 14 100% 236 96.19%

M&A 1260 61.11% 14358 62.85%

N&S 638 45.14% 6915 43.01%

City 2196 66.80% 26900 66.86%

NNE 725 50.48% 8580 49.99%

NW 557 50.63% 5987 48.10%

Rush 414 45.65% 5057 44.61%

M&A 1256 92.75% 14339 93.27%

N&S 634 72.24% 6888 73.91%

City 2190 95.39% 26843 93.63%

NNE 722 90.86% 8564 90.03%

NW 557 93.18% 5984 91.98%

Rush 410 86.10% 5015 85.40%

Red 1 - Life

threatening

requiring

defibrillation

Call timer starts

w hen the 999 call is

connected to the

sw itchboard

Red 2 - Life

threatening

Call timer starts at

earliest of the

follow ing 1. The

point at w hich the

chief complaint of

the call has been

identif ied; 2. A

vehicle has been

assigned to the call;

3. A 60 second cap

from the Call

Connect time

8 Minute Response Time 75%




Year to DateCCG Level Description of Standard Target

Last 12

months

performance

CCGMarch 2017

0

200

400

600

800

1000

1200

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

EMAS Call Volumes - Red Calls only - South Nottinghamshire CCGsComparison Between Years

NNE 15-16 NW 15-16 Rush 15-16NNE 16-17 NW 16-17 Rush 16-17


36

Percentiles The chart below shows the EMAS 75th percentile response time for Red calls for each of the South Nottinghamshire CCGs by

month. The standard is 8 minutes and, as can be seen from the chart, none of the CCGs have achieved this (please note, April

2014 data is unavailable).

Time to Respond The following chart shows the year to date response times for Red 1 & Red 2 calls across Nottingham North & East CCG. The

green line shows the expected performance if the 75% 8 minute and 95% 19 minute targets were to be met, the blue line shows

the current CCG performance.

The table within the chart shows the actual number of calls. During the specified period in total there has been 8696 Red 1 and

Red 2 calls in Nottingham North & East CCG, 4961 have been responded to within 8 minutes. 566 Red 1 and Red 2 calls have

been responded to in more than 19 minutes, and 5 calls have been responded to in over 1 hour.

Some calls are responded to within a minute, this is due to a number of reasons including - A defibrillator and someone who can

use it being close to the scene (which immediately stops the clock) and first responders arriving on the scene quickly.

00:00

01:00

02:00

03:00

04:00

05:00

06:00

07:00

08:00

09:00

10:00

11:00

12:00

13:00

14:00

15:00

Ap

r-1

4

May

-14

Jun

-14

Jul-

14

Au

g-1

4

Sep

-14

Oct

-14

No

v-1

4

Dec

-14

Jan

-15

Feb

-15

Mar

-15

Ap

r-1

5

May

-15

Jun

-15

Jul-

15

Au

g-1

5

Sep

-15

Oct

-15

No

v-1

5

Dec

-15

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

No

v-1

6

Dec

-16

Jan

-17

Feb

-17

Mar

-17

Min

ute

s

Total Red - 75th Percentile

Nottingham North & East CCG

Nottingham West CCG

Rushcliffe CCG

Standard

0

200

400

600

800

1000

1200

1400

1600

0 1 2 3 4 5 6 7 8 9

10

11

12

13

14

15

16

17

18

19

Nu

mb

er o

f re

spo

nse

s

Time (in minutes) from call connect to arrival at the scene

Time to respond to calls (Red 1 & Red 2) - Nottingham North & East CCG YTD Apr16 - Mar17

Time Responses

Under 8 minutes 4961

Over 8 minutes 3735

Under 19 minutes 8130

Over 19 minutes 566

Over 1 hour 5

Total Calls 8696

Longest w ait (mins) 120


37

Remedial Action Plan

To improve EMAS performance, a Remedial Action Plan (RAP) which details issues and actions is in place. These are shown below -

Issue - Demand - Increased Red Activity Actions Level of clinical input into the Clinical Assessment Team (CAT) desk to be increased CAT desk ability to triage Red 999 calls to be protected , this will enable more calls to be downgraded to Green Collaboration with Derbyshire Health United to pilot a Ambulance Liaison Desk in NHS 111, utilising EMAS Clinical Hub staff, to

reduce number of calls transferred to EMAS Peer review of current activity/demand to identify any additional actions required Issue - Resources - Resource Availability Actions Increase utilisation of Private and Voluntary Ambulance Services, whilst ensuring patient safety - Ongoing collaboration with

Police and Fire services to provide additional Community First Responders Development of a workforce plan and trajectory to ensure 2193 WTE staff trained and operational by March 2017 - this has

been aided by an overseas recruitment campaign that took place in early October Reduction of the number of staff on alternative duties to support operational delivery Devolve resource planning function to the responsibility of the divisional management teams Dispatch to Disposition allows up to an additional 180 seconds for calls (excluding Red 1s) to be triaged allowing extra time to

determine the most clinically appropriate response required for the patient Issue - Quality & Performance - Improved Performance Actions Analysis of the impact of revised Ambulance Quality Indicators on Red performance Monitor impact of capacity management plan on performance and quality Issue - Handovers - Handover Delays Actions Work with commissioners and providers in Leicestershire to implement actions specific to that area Ensure rollout programme of 164 defibrillators matches requirements of each division, reduce vehicle downtime

Non-Conveyance Rates

The table above shows the proportion of EMAS responses resulting in non-conveyance for the three South Notts CCGs. There is a target to increase the proportion of emergency calls closed by telephone advice, and the number of incidents to be treated at the scene or conveyed to a destination that is not A&E. In March 2017, Nottingham North & East CCG saw 13.22% of calls closed by telephone advice and 27.98% of incidents managed without the need for transport to A&E. Year to date the CCG has seen a decrease of 0.33% in the proportion of calls closed by telephone advice compared to the previous year. There has also been a 5.71% decrease in the proportion of incidents not resulting in conveyance to A&E compared to the previous year.

CCG Description of Standard Period CCG TargetPeriod

Perf

Last 12

months

16/17

YTD

15/16

YTD

NNE 13.22% 14.55% 14.88%

NW 12.59% 14.43% 14.42%

Rush 11.72% 14.42% 15.94%

NNE 27.98% 29.86% 35.57%

NW 30.97% 31.29% 36.65%

Rush 35.04% 32.51% 38.25%

Increase

Proportion

Increase

Proportion

Proportion of calls closed by telephone

advice (%)

Proportion of incidents managed without

need for transport to Accident and

Emergency Departments (%)

Am

bula

nce Mar-17

Mar-17


38

The table below shows the average times of ambulance turnover for the latest month at QMC and City hospital.

The pre-handover time is the responsibility of the hospital and is the time between the ambulance arriving at the hospital and

the patient being handed over. The post-handover time is the responsibility of EMAS and is the time between the patient being

handed over and the ambulance being ready for the next call.

Turnaround times

The main issue affecting performance remains outflow from the Emergency Department (ED), patients are continuing to wait in ED for inpatient beds. This creates capacity issues within Majors and the Initial Assessment Unit (IAU), which are then unable to receive all Majors referrals, with the exception of direct to Resus and Children’s. Subsequently, staff are unable to move away from the Majors area, and the escalation process to move staff to IAU can not be enacted. Actions to improve performance include -

Actively recruiting to nursing vacancies, any current shortfall covered by agency staff Reduction in ambulance waiting space caused by building works is monitored on a daily basis to ensure safe and

effective transfers If the ambulance crew is waiting more than 10 minutes then there is an internal escalation to the ED Nurse in charge An additional 30 minute escalation to nurse in charge to reduce chances of 60 minute turnaround delays

NUH Description of Standard Period StandardPeriod

Perf

Last 12

months

Queens Medical Centre - Pre-Handover Mar-17<15mins = G

>20Mins = R18:39

Queens Medical Centre - Post-Handover Mar-17<15mins = G

>20Mins = R13:50

Queens Medical Centre - Total Mar-17<30mins = G

>40Mins = R32:29

Nottingham City Hospital - Pre-Handover Mar-17<15mins = G

>20Mins = R20:19

Nottingham City Hospital - Post-Handover Mar-17<15mins = G

>20Mins = R12:21

Nottingham City Hospital - Total Mar-17<30mins = G

>40Mins = R32:41

Am

bula

nce H

andover

Tim

es

(in m

inute

s)

39

Leve

l 2 –

EM

AS

Pe

rfo

rman

ce

Am

bu

lan

ce

Se

rvic

e P

erf

orm

an

ce

Co

mp

ari

so

n

Am

bu

lan

ce S

erv

ice

Pe

rfo

rman

ce C

om

par

iso

n:

Syst

em

Ind

icat

ors

Ou

t o

f 1

1 A

mb

ula

nce

ser

vice

’ EM

AS

are

ran

ked

9th

or

wo

rse

in 2

ou

t o

f th

e 1

1 m

on

thly

ind

icat

ors

an

d 2

ou

t o

f th

e 4

yea

r to

dat

e in

dic

ato

rs s

ho

wn

ab

ove

. EM

AS

are

faili

ng

to a

chie

ve

the

stan

dar

ds

for

Pro

po

rtio

n o

f R

ed 1

cal

ls r

esp

on

ded

to

wit

hin

8 m

inu

tes

mo

nth

ly (

71

.31

%)

& Y

TD (

68

.55

%),

Pro

po

rtio

n o

f R

ed 2

cal

ls r

esp

on

ded

to

wit

hin

8 m

inu

tes

mo

nth

ly

(58

.71

%)

& Y

TD (

56

.84

%)

and

Pro

po

rtio

n o

f C

ateg

ory

A c

alls

res

po

nd

ed t

o w

ith

in 1

9 m

inu

tes

mo

nth

ly (

84

.85

%)

& Y

TD (

84

.13

%).

Sys

tem

In

dic

ato

rs

Are

aIn

dic

ato

r

Late

st

Mo

nth

= F

eb

-17

Pe

rio

dT

arg

et

EM

AS

Ran

k

(ou

t o

f 11)

1 =

Be

st

11 =

Wo

rst

East

Mid

lands

Am

bula

nce

Serv

ice

East of

Engla

nd

Am

bula

nce

Serv

ice

Isle

of

Wig

ht

London

Am

bula

nce

Serv

ice

Nort

h E

ast

Am

bula

nce

Serv

ice

Nort

h W

est

Am

bula

nce

Serv

ice

South

Centr

al

Am

bula

nce

Serv

ice

South

East

Coast

Am

bula

nce

Serv

ice

South

Weste

rn

Am

bula

nce

Serv

ice

West

Mid

lands

Am

bula

nce

Serv

ice

York

shire

Am

bula

nce

Serv

ice

Month

75%

471.3

1%

70.0

5%

50.0

0%

71.7

1%

72.0

1%

64.7

1%

76.7

1%

65.6

7%

YTD

75%

668.5

5%

68.4

2%

62.6

3%

69.3

6%

67.0

5%

67.9

5%

73.1

6%

64.6

2%

72.7

3%

76.2

1%

69.6

9%

Month

414.7

15.4

21.7

12.4

13.5

18.1

12.9

15.8

Month

75%

658.7

1%

61.8

0%

66.8

5%

67.6

9%

55.1

2%

60.9

6%

75.4

6%

49.7

7%

YTD

75%

10

56.8

4%

60.9

8%

70.2

1%

65.0

9%

62.3

3%

62.6

0%

72.8

1%

52.7

5%

56.8

7%

73.8

8%

74.1

6%

Month

95%

884.8

5%

91.0

1%

89.4

6%

93.3

1%

85.6

3%

88.3

8%

95.6

6%

87.6

5%

YTD

95%

11

84.1

3%

90.4

1%

91.8

1%

93.2

6%

89.1

6%

88.9

4%

94.5

3%

89.1

0%

86.0

7%

97.1

3%

95.7

1%

Month

70.7

%0.6

%0.8

%0.1

%0.3

%1.0

%0.2

%1.9

%0.7

%0.6

%1.6

%

YTD

81.6

%0.8

%1.4

%0.3

%0.4

%2.5

%1.0

%2.9

%2.0

%0.9

%1.1

%

Media

nM

onth

82

11

01

13

32

11

95th

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entil

eM

onth

10

45

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entil

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103

53

638

73

113

55

101

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41

96

Media

nM

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78

86

8

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23

19

20

30

30

18

26

99th

Perc

entil

eM

onth

341

35

42

44

49

63

27

43

Cate

gory

A

Calls

Call

Abandonm

ent

Pro

port

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abandoned b

efo

re b

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nsw

ere

d

Tim

e to a

nsw

er

call

(in s

econds)

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ent fo

r C

ate

gory

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calls

(in

min

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s)

95th

centil

e o

f re

sponse tim

e f

or

Red 1

calls

(in

min

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s)

Pro

port

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f R

ed 2

calls

responded to w

ithin

8 m

inute

s

Pro

port

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ed 1

calls

responded to w

ithin

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inute

s

Pro

port

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ate

gory

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alls

responded to w

ithin

19

min

ute

s

Tim

elin

ess

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ica

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utc

om

es

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rfo

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mp

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n

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bu

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rfo

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om

par

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ical

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tco

me

s

On

ly t

he

Uts

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gro

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is s

ho

wn

in t

he

Car

dia

c A

rre

st in

dic

ato

rs. T

he

'Uts

tein

co

mp

arat

or

gro

up

' pro

vid

es a

co

mp

arab

le a

nd

sp

ecifi

c m

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re o

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e m

anag

emen

t o

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rdia

c ar

rest

s

for

the

sub

set

of

pati

ents

wh

ere

tim

ely

and

eff

ecti

ve e

mer

gen

cy c

are

can

par

ticu

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y im

pro

ve s

urv

ival

(e.

g. 9

99

cal

ls w

her

e th

e ar

rest

was

no

t w

itn

ess

ed a

nd

th

e p

atien

t m

ay h

ave

gon

e in

to a

rres

t se

vera

l ho

urs

bef

ore

th

e 9

99

cal

l are

exc

lud

ed f

rom

th

e U

tste

in c

om

par

ato

r gr

ou

p fi

gure

).

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t o

f 1

1 A

mb

ula

nce

ser

vice

’ EM

AS

are

ran

ked

9th

or

wo

rse

in 0

ou

t o

f th

e 6

mo

nth

ly in

dic

ato

rs a

nd

1 o

ut

of

the

6 y

ear

to d

ate

ind

icat

ors

sh

ow

n a

bo

ve.

Are

aIn

dic

ato

r

Late

st

Mo

nth

= N

ov-1

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eri

od

EM

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k

(ou

t o

f 11)

1 =

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st

11 =

Wo

rst

East

Mid

lands

Am

bula

nce

Serv

ice

East of

Engla

nd

Am

bula

nce

Serv

ice

Isle

of

Wig

ht

London

Am

bula

nce

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ice

Nort

h E

ast

Am

bula

nce

Serv

ice

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h W

est

Am

bula

nce

Serv

ice

South

Centr

al

Am

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South

East

Coast

Am

bula

nce

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South

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rn

Am

bula

nce

Serv

ice

West

Mid

lands

Am

bula

nce

Serv

ice

York

shire

Am

bula

nce

Serv

ice

Month

553.4

9%

70.2

7%

#########

58.3

3%

60.7

1%

47.6

2%

38.4

6%

46.8

8%

51.0

2%

40.5

4%

72.2

2%

YTD

748.8

5%

57.8

7%

23.0

8%

54.8

9%

66.9

1%

59.7

9%

42.2

1%

52.7

8%

45.8

3%

46.3

8%

54.6

5%

Month

230.0

0%

21.8

8%

#########

27.9

1%

29.6

3%

20.5

1%

27.2

7%

4.7

6%

21.2

8%

21.6

2%

53.7

0%

YTD

922.0

5%

30.3

0%

15.3

8%

26.4

0%

38.5

8%

27.0

2%

24.7

8%

24.8

8%

21.6

6%

23.1

9%

36.1

7%

Month

844.9

0%

44.5

7%

77.2

7%

61.9

0%

58.9

6%

50.5

6%

52.7

8%

59.8

4%

40.0

5%

69.1

4%

41.3

6%

YTD

653.5

4%

50.0

2%

66.6

7%

62.4

5%

59.0

1%

53.3

8%

49.6

0%

65.7

3%

35.9

3%

57.6

5%

45.4

8%

Month

698.8

1%

98.0

2%

100.0

0%

96.3

8%

98.9

9%

99.5

9%

99.6

4%

96.2

6%

94.3

5%

94.8

6%

99.0

8%

YTD

398.7

2%

99.0

4%

97.5

9%

96.7

2%

97.8

4%

99.6

4%

98.5

9%

95.9

5%

94.3

7%

97.0

8%

98.6

5%

Month

395.1

6%

93.0

4%

100.0

0%

88.1

8%

96.3

0%

68.3

5%

81.3

6%

90.8

2%

72.7

9%

91.6

0%

81.4

4%

YTD

192.6

7%

91.8

6%

40.0

0%

90.7

0%

91.3

9%

79.9

1%

86.7

4%

91.6

4%

72.4

9%

88.1

5%

84.8

4%

Month

482.6

1%

89.4

3%

40.0

0%

72.5

5%

81.4

8%

83.7

1%

65.3

8%

67.6

1%

75.0

0%

82.0

0%

87.0

7%

YTD

483.5

1%

90.6

5%

58.3

3%

70.9

5%

81.6

8%

86.7

1%

72.3

1%

68.2

2%

76.6

1%

80.3

3%

87.4

1%

Pro

port

ion o

f patie

nts

who w

ere

resuscita

ted

who h

ad r

etu

rn o

f sponta

neous c

ircula

tion

on a

rriv

al a

t hospita

l

Pro

port

ion o

f patie

nts

who w

ere

dis

charg

ed

from

hospita

l aliv

e f

ollo

win

g r

esuscita

tion b

y

am

bula

nce s

erv

ice f

ollo

win

g a

card

iac a

rrest

Retu

rn o

f

Sponta

neous

Circula

tion

Surv

ival t

o

Dis

charg

e

Card

iac

Arr

est

(Uts

tein

gro

up)

Str

oke

Pro

port

ion o

f FA

ST p

ositi

ve p

atie

nts

pote

ntia

lly e

ligib

le f

or

str

oke

thro

mboly

sis

arr

ivin

g a

t a h

ypera

cute

str

oke

unit

with

in

60 m

inute

s

Pro

port

ion o

f suspecte

d s

troke

patie

nts

assessed f

ace to

face w

ho r

eceiv

ed a

n a

ppro

priate

care

bundle

Acute

STEM

I

Pro

port

ion o

f patie

nts

with

definite

ST-e

levatio

n m

yocard

ial

infa

rctio

n w

ho r

eceiv

ed p

rim

ary

angio

pla

sty

with

in 1

50

min

ute

s o

f call

connectin

g to a

mbula

nce s

erv

ice

Pro

port

ion o

f patie

nts

with

ST-e

levatio

n m

yocard

ial i

nfa

rctio

n

who r

eceiv

ed a

n a

ppro

priate

care

bundle

Level 2 – Arriva Performance

41

Arriva Patient Transport Services

The table above shows the Arriva Patient Transport Service (PTS) performance over the past 12 months for the 5 KPIs for Nottinghamshire. The performance for KPI1, the time in which a patient spends in the vehicle split by the distance that the patient lives from the point of care, has achieved each standard for this month. This includes the standard that patients within 10 miles of the point of care spend no longer than 60 minutes on the vehicle. Prior to this, this standard had failed once in the previous twelve months. KPI2, KPI3 and KPI5 have been below their relevant standards every recorded month over the last year. To improve performance Arriva have created a Service Improvement Plan for Nottinghamshire which has identified several areas for improvement - Improve partnership working along the patient pathway

Improve partnership working with points of care

Reduce number of aborted journeys at hospital for hospital triggered reason codes

Reduction in Crew wait times for patient at pick up from Unit

On the day patient transport changes - changes to patient clinic locations and patient collection points

Support the discharge pathway to improve the co-ordination of transport & TTOs

Improve understanding of mobility types when booking journeys

Confirmation required on the Patient support provided when a clinic has closed but the patient is not yet due to be collected by transport

Renal transport

Improve Renal performance Improve call centre performance

Improve site/HPs access to Cleric to book transport and making patients ready for collection

Reduce the number of abandoned calls and call waiting times into the Call Centre Improve performance of patient inward KPIs

Patients travelling in on crews first run not always meeting KPIs Improve internal performance management processes

The resource vs. demand peaks are only escalated on the day of travel, resulting in third party resources being engaged too late to be optimised efficiently and meet demand

More focus needed on how individual roles support and impact the KPIs Internal communication

Improve the internal communication & resolution of reoccurring service delivery issues that impact the KPIs

Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17

Patients w ithin 10 miles spend no longer than 60

mins on the vehicle97.0% 96.0% 96.0% 96.0% 96.0% 95.7% 96.7% 95.8% 96.1% 96.3% 96.4% 96.7%

10-35 miles spend no longer than 90 minutes on

the vehicle96.0% 95.0% 95.0% 96.0% 95.0% 95.0% 95.2% 94.1% 94.6% 95.5% 95.9% 96.0%

35-80 miles spend no longer than 120 minutes on

the vehicle93.0% 91.0% 91.0% 96.0% 96.0% 91.8% 92.5% 90.2% 90.1% 93.6% 90.5% 91.6%

KPI 2Arrival Times at

Point of Care

Patients shall arrive w ithin 60 minutes prior to their

appointment/zone time at the point of care82.0% 80.0% 79.0% 76.0% 76.0% 74.4% 78.2% 72.0% 70.1% 69.6% 69.5% 73.4%

OP Return patients shall be collected w ithin 60

mins of request or agreed transport/or zone time80.0% 72.0% 72.0% 65.0% 68.0% 68.1% 71.0% 65.0% 64.1% 65.4% 63.9% 66.3%

Discharge patients shall be collected w ithin 120

mins of request or agreed transport/or zone time73.0% 66.0% 61.0% 56.0% 56.0% 62.0% 60.0% 53.6% 52.2% 55.2% 53.1% 52.5%

Calls requesting PTS answ ered w ithin 10 seconds

by a booking agent, not an automated message38.0% 48.0% 40.0% 41.0% 55.0% 29.3% 32.1% 46.1% 49.7% 33.6% 58.9% 50.7%

Maximum percentage of calls requesting Non-

Emergency PTS are abandoned9.0% 15.0% 22.0% 17.0% 12.0% 26.7% 28.4% 16.3% 15.1% 22.1% 9.4% 11.1%

Nottinghamshire Patient Transport Service (PTS) Summary

Departure times

from Point of

Care

Time on Vehicle

- Patients w ithin

a certain radius

of the point of

care

Customer

Service

KPI 3

KPI 1

KPI 5

42

Leve

l 2 -

NH

S 1

11

Pe

rfo

rman

ce

Acc

ess

& Q

ua

lity,

Co

sts

and

Pati

en

t Ex

pe

rie

nce

Pe

rfo

rman

ce C

om

par

iso

n

No

ttin

gham

shir

e ar

e p

erfo

rmin

g w

ith

in t

he

top

10

fo

r 2

of

the

4 P

atien

t Ex

per

ien

ce in

dic

ato

rs. 9

0%

of

pati

ents

rep

ort

ed t

o b

e v

ery

or

fair

ly s

atisfi

ed w

ith

th

e 1

11

exp

erie

nce

, th

is

com

par

es

to 8

8%

wit

h t

he

nei

ghb

ou

rin

g ar

ea o

f D

erb

ysh

ire

Co

un

ty.

Ac

ce

ss

& Q

uali

ty,

Co

sts

an

d P

ati

en

t E

xp

eri

en

ce

The

follo

win

g p

age

s d

etai

l per

form

ance

of

key

ind

icat

ors

fo

r th

e N

HS

11

1 s

ervi

ce a

cro

ss t

he

Mid

lan

ds

and

Eas

t re

gio

n.

All

dat

a is

ap

pro

xim

ate

as D

erb

ysh

ire

Hea

lth

Un

ited

(D

HU

) as

sign

cal

ls b

ased

on

th

e ST

D C

od

e/lo

cati

on

of

mo

bile

ph

on

e m

ast,

an

d t

her

efo

re t

her

e w

ill b

e cr

oss

bo

rder

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ls a

nd

resi

den

ts o

f o

ther

are

as c

allin

g fr

om

wit

hin

No

ttin

gham

shir

e in

clu

ded

in t

he

figu

res.

Ad

diti

on

ally

th

e p

ho

ne

syst

em is

un

able

to

iden

tify

th

e lo

cati

on

of

5-1

0%

of

all c

alls

nati

on

ally

, th

ese

calls

are

allo

cate

d t

o a

ny

on

e o

f th

e 1

11

cen

tres

wh

o a

nsw

er

them

un

der

th

eir

loca

l co

ntr

acts

(th

is s

ho

uld

bal

ance

ou

t as

oth

er p

rovi

der

s w

ill a

nsw

er c

alls

fro

m N

otti

ngh

amsh

ire

resi

den

ts).

DH

U a

re w

ork

ing

to p

rovi

de

CC

G le

vel r

epo

rts

bu

t th

e sa

me

cav

eats

as

abo

ve w

ill a

pp

ly.

NC

A =

No

t cu

rren

tly

avai

lab

le

Are

aIn

dic

ato

r

Late

st

Mo

nth

= F

eb

-17

No

tts

Ran

k

(ou

t o

f 17)

1 =

Be

st

17 =

Wo

rst

Lincolnshire

Luton

Nottinghamshire

Derbyshire

Great Yarmouth

Hertfordshire

Norfolk

Suffolk

South Essex

North Essex

Northamptonshire

Milton Keynes

West Midlands

Cambridgeshire &

Peterborough

Leicstershire &

Rutland

Staffordshire

Bedfordshire

-239

226

246

271

307

335

344

269

272

252

283

234

200

327

209

278

137

-239

226

224

258

296

235

299

269

266

248

283

234

198

207

209

252

137

14

1%

1%

2%

2%

1%

2%

4%

1%

1%

1%

2%

1%

1%

1%

2%

2%

2%

13

94%

92%

91%

90%

95%

95%

89%

93%

94%

92%

89%

95%

93%

96%

90%

92%

91%

782%

81%

86%

89%

82%

78%

80%

85%

86%

87%

91%

82%

87%

79%

92%

80%

72%

-22%

15%

24%

29%

24%

22%

23%

21%

23%

25%

25%

21%

25%

23%

25%

30%

14%

11

62%

32%

48%

47%

50%

75%

63%

48%

50%

44%

42%

50%

49%

72%

40%

76%

33%

900:0

1:4

300:0

1:2

400:0

0:5

200:0

0:3

700:0

3:3

600:0

0:4

700:0

1:2

300:0

0:5

000:0

2:3

700:0

4:2

500:0

0:1

900:0

0:5

500:0

0:4

100:0

0:4

500:0

0:1

900:0

0:0

100:0

1:2

3

-N

CA

NC

AN

CA

NC

AN

CA

NC

AN

CA

NC

AN

CA

NC

AN

CA

NC

AN

CA

NC

AN

CA

NC

AN

CA

13

8%

10%

13%

15%

12%

6%

8%

11%

11%

14%

15%

11%

13%

7%

15%

7%

9%

13

43%

50%

32%

36%

33%

67%

49%

50%

28%

28%

31%

45%

49%

60%

30%

40%

49%

-00:1

3:1

600:3

3:5

400:1

4:1

800:1

4:4

400:1

6:0

000:1

0:0

700:1

2:5

400:1

2:5

600:1

5:3

600:1

8:0

000:1

5:0

600:1

3:3

500:1

2:5

300:1

0:4

500:1

4:5

400:1

1:1

700:3

1:0

1

Costs

-35%

24%

27%

26%

27%

27%

26%

22%

28%

26%

27%

22%

24%

29%

30%

28%

14%

95%

8%

6%

7%

7%

4%

5%

8%

5%

5%

7%

11%

5%

6%

5%

5%

6%

11

90%

88%

90%

88%

90%

92%

91%

85%

93%

91%

88%

81%

91%

88%

90%

93%

90%

11

87%

83%

88%

91%

90%

89%

90%

87%

91%

90%

90%

84%

89%

88%

90%

90%

85%

981%

77%

81%

80%

81%

83%

83%

69%

85%

82%

80%

62%

83%

81%

79%

85%

79%

% h

andlin

g tim

e b

y c

linic

al s

taff

Patie

nt

Experience

% d

issatis

fied w

ith 1

11 e

xperience

% v

ery

or

fairly

satis

fied w

ith 1

11 e

xperience

% c

alle

rs w

ho f

ully

com

plie

d w

ith a

dvic

e

% c

alle

rs w

here

pro

ble

m r

esolv

ed o

r im

pro

ved

% c

alls

answ

ere

d in

60 s

econds

Calls

via

111 p

er

year

per

1,0

00 p

eople

Calls

per

year

per

1,0

00 p

eople

Access &

Qualit

y

Avera

ge w

arm

tra

nsfe

r tim

e (

secs)

(clin

icia

n p

icku

p)

Avera

ge N

HS

111 li

ve tra

nsfe

r tim

e (

min

s)

% tra

nsfe

rred c

alls

live tra

nsfe

rred

% a

nsw

ere

d c

alls

tra

nsfe

rred to c

linic

al a

dvis

or

% a

nsw

ere

d c

alls

triaged

% a

bandoned c

alls

(aft

er

30 s

econds w

aiti

ng tim

e)

Avera

ge e

pis

ode le

ngth

% c

all

backs

with

in 1

0 m

inute

s

% a

nsw

ere

d c

all

passed f

or

call

back

43

Leve

l 2 -

NH

S 1

11

Pe

rfo

rman

ce

Syst

em

Imp

act

Pe

rfo

rman

ce C

om

par

iso

n

The

abo

ve t

able

loo

ks a

t th

e sy

stem

imp

act

of

the

11

1 s

ervi

ce. A

s ca

n b

e se

en 1

0%

of

calls

en

ded

wit

h a

n A

mb

ula

nce

bei

ng

dis

pat

ched

. 7%

of

pati

ents

wer

e re

com

men

ded

to

att

en

d

A&

E, t

his

is a

sim

ilar

leve

l of

per

form

ance

to

th

at s

een

acr

oss

th

e M

idla

nd

s an

d E

ast.

Th

e re

com

men

dati

on

s to

att

end

as

wel

l as

no

t to

att

end

oth

er s

erv

ices

var

y b

etw

een

No

ttin

gham

shir

e an

d o

ther

Mid

lan

ds

and

Eas

t ar

eas.

On

ly 3

% o

f N

otti

ngh

amsh

ire

pati

ents

we

re r

eco

mm

end

ed t

o a

tte

nd

oth

er s

ervi

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th

is in

clu

de

s sp

eci

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racti

tio

ner

s in

clu

din

g

mid

wiv

es,

ch

ild p

rote

ctio

n, s

oci

al s

ervi

ces

and

op

tici

ans,

th

is c

om

par

es

to 7

% o

f D

erb

ysh

ire

pati

ents

.

Sys

tem

Im

pac

t

NC

A =

No

t cu

rren

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avai

lab

le

Are

a

Late

st

Mo

nth

= F

eb

-17

No

tts

Ran

k

(ou

t o

f 17)

1 =

Be

st

17 =

Wo

rst

Lincolnshire

Luton

Nottinghamshire

Derbyshire

Great Yarmouth

Hertfordshire

Norfolk

Suffolk

South Essex

North Essex

Northamptonshire

Milton Keynes

West Midlands

Cambridgeshire &

Peterborough

Leicstershire &

Rutland

Staffordshire

Bedfordshire

13

11%

9%

10%

9%

8%

7%

9%

10%

8%

7%

9%

9%

9%

9%

10%

10%

8%

-7%

6%

7%

7%

5%

6%

6%

7%

7%

6%

8%

9%

7%

7%

7%

6%

8%

-51%

48%

50%

53%

51%

52%

50%

55%

55%

54%

57%

53%

52%

55%

52%

50%

45%

-37%

34%

33%

35%

29%

36%

31%

38%

36%

34%

42%

37%

37%

33%

35%

35%

30%

-11%

9%

11%

13%

18%

12%

15%

11%

16%

17%

12%

10%

12%

17%

13%

10%

9%

-3%

4%

5%

4%

4%

4%

4%

5%

3%

3%

2%

7%

4%

5%

5%

5%

7%

-2%

3%

3%

7%

6%

4%

3%

3%

5%

5%

2%

1%

5%

1%

3%

4%

2%

-29%

34%

30%

24%

31%

31%

32%

24%

26%

29%

24%

28%

27%

28%

27%

29%

37%

-1%

1%

2%

1%

1%

2%

1%

1%

2%

1%

1%

1%

1%

1%

2%

0%

1%

-5%

4%

5%

6%

5%

5%

6%

5%

7%

6%

5%

6%

6%

5%

5%

5%

5%

-5%

2%

11%

8%

7%

2%

5%

4%

4%

9%

9%

3%

7%

2%

12%

3%

2%

-17%

26%

13%

9%

18%

22%

20%

15%

14%

13%

9%

18%

13%

21%

8%

20%

29%

-

% o

f calls

not tr

iaged

Syste

m

Impact

-

% R

ecom

mended to d

enta

l / p

harm

acy

-

% R

ecom

mended to s

peak

to p

rim

ary

and c

om

munity

care

Of

whic

h -

% R

ecom

mended to c

onta

ct prim

ary

and c

om

munity

care

-

% R

ecom

mended n

on c

linic

al

-

% R

ecom

mended h

om

e c

are

Of

whic

h -

% G

iven h

ealth

info

rmatio

n

Ind

icato

r

111 d

ispositi

ons: %

Not re

com

mended to a

ttend o

ther

serv

ice

111 d

ispositi

ons: %

Recom

mended to a

ttend o

ther

serv

ice

111 d

ispositi

ons: %

Recom

mended to a

ttend p

rim

ary

and

com

munity

care

111 d

ispositi

ons: %

Recom

mended to a

ttend A

&E

111 d

ispositi

ons: %

Am

bula

nce d

ispatc

hes

Quality Premium

44

The Quality Premium is £5 per head of running cost population and will be payable to CCGs in 2016/17 based on the quality of health services commissioned during 2015/16. This will be based on several measures that cover a combination of national and local priorities. This initial value will be reduced if providers, from which the CCG commissions services, are unable to meet the 4 key areas of the NHS Constitution and pledges for its population. As well as achieving the above there are 3 prerequisites for the Quality Premium to be payable. A CCG will not achieve a quality premium if it: a. is not considered in a manner that is consistent with Managing Public Money during 2015/16; or b. Incurs an unplanned deficit during 2015/16, or requires unplanned financial support to avoid being in this position; or c. Incurs a qualified audit in respect of 2015/16. The table below provides an overview of the Quality Premium for the CCG.

Nottingham North & East

£130,535

Percentage

of Quality

Premium

Potential

ValueAchieve by

Latest

Performance

Latest

Period

Available

Trend Award

Premature

Mortality10% £72,520

Less than

or equal to1984.6

2015 Calendar

Year2116.9 2014 £0

Unplanned hospitalisation for chronic ambulatory care

sensitive conditions

Less than

or equal to1000 2015/16 788.6 2015/16

Unplanned hospitalisation for asthma, diabetes and

epilepsy in children

Less than

or equal to1000 2015/16 164.9 2015/16

Emergency admissions for acute conditions that

should not usually require hospital admission

Less than

or equal to1000 2015/16 1137.1 2015/16

Emergency admissions for children with lower

respiratory tract infection

Less than

or equal to1000 2015/16 388.2 2015/16

Avoidable Emergency Admissions Composite 10% £72,520Less than

or equal to1000 2015/16 887.5 2015/16 £72,520

10% £72,520More than

or equal to22.52% 2015/16 23.39%

Apr-15 -

Mar-16£72,520

10% £72,520 Less than 2709 2015/16 2421 Mar-16 £72,520

Improvement in coding of patients attending A&EMore than

or equal to90% 2015/16 98.60%

Apr-15 -

Mar-16

Reduction in the number of patients with A&E 4 hour

breaches who have attended with a mental health need

More than

or equal to89.63% 2015/16 72.12%

Apr-15 -

Mar-16

10% £72,520 Less than 0.157 2015/16 0.228 2015/16 £0

10% £72,520 Less than 37.3% 31-Mar-16 37.3% 2014/15 £72,520

5% £36,260More than

or equal to6.5 Q4 2015/16 5 2015/16 £0

5% £36,260Less than

or equal to1.10 2015/16 1.11 2013/14 £0

3% £21,756 Less than 12.23% 2015/16 13.51% 2013/14 £0

2% £14,504 Validated Yes 2015/16

Local

Measure 1C3.9

Patients who have had an acute stroke who spend 90%

or more of their stay on a stroke unit10% £72,520 More than 89.2% 2015/16 90.2% 2015/16 £72,520

Local

Measure 2C5.4

Incidence of healthcare associated infection (HCAI)

Clostridium Difficile10% £72,520

Less than

(YTD)47

Less than 47

by 2015/1632

Apr-15 -

Mar-16£72,520

100% £725,195 £435,117

Percentage

of Quality

Premium

Potential

ReductionAchieve by

Latest

Performance

Latest

Period

Available

Trend Reduction

RTT -30% -£130,535More than

or equal to92% 2015/16 97.33%

Apr-15 -

Mar-16£0

A&E -30% -£130,535More than

or equal to95% 2015/16 89.55%

Apr-15 -

Mar-16-£130,535

Cancer -20% -£87,023More than

or equal to93% 2015/16 91.67%

Apr-15 -

Mar-16-£87,023

Ambulance -20% -£87,023More than

or equal to75% 2015/16 69.12%

Apr-15 -

Mar-16-£87,023

-100% -£435,117 -£304,582

CCG Name

Measure

Reducing NHS-responsible delayed transfers of care (days delayed

per 100,000 population)

Improvement in the health-related quality of life for people with a

long-term mental health condition

Reduction in the number of people with severe mental illness who

are smokers

Urgent &

Emergency

Care Menu

Mental

Health

Menu

An increase in the level of discharges at weekends and bank

holidays

Reducing Potential Years of Life Lost (PYLL) from causes

considered amenable to healthcare over time

Quality Premium

Forecast

N/A

A&E 5%

Increase the proportion of adults with secondary mental health

conditions who are in paid employment

Reduction in the number of antibiotics prescribed in primary care

Composite

Measure

Performance

Needed

N/A

£0£36,260

N/A

Performance

Needed

Improving

Antibiotic

Prescribing

Patients on incomplete pathways (yet to start treatment) should

have been waiting no more than 18 weeks from referral

Total

Reduction in the proportion of broad spectrum antibiotics prescribed

in primary care

Secondary care providers validating their total antibiotic prescription

data

Total

Patients should be admitted, transferred or discharged within four

hours of their arrival at an A&E department

Maximum two week (14-day) wait from urgent GP referral to first

outpatient appointment for suspected cancer

Red 1 ambulance calls resulting in an emergency response arriving

within 8 minutes (Total EMAS not CCG)

NHS Constitution Right and Pledges

Better Care Fund

45

The Better Care Fund creates a local single pooled budget to incentivise the NHS and local government to work more closely

together around people, placing their well-being as the focus of health and care services.

The BCF is a critical part of the NHS 2 year operational plans and the 5 year strategic plans as well as local government planning.

Within the BCF there are six indicators as shown below, which are supported by a range of schemes that contribute towards

delivery of the required standards.

Please note, the data is monitored and reported at Nottinghamshire County Local Authority level in line with the requirements

of the BCF. Therefore commentary may relate to organisations other than the CCG to which this report relates.

The latest data available is for February 2017.

REF Indicator 2016/17 Target

2016/17 (to date)

RAG rating

and trend

BCF1 (pg 5)

Total non-elective admissions in to hospital (general & acute), all-age, per 100,000 population

19,707 Q4

February 2017

6,878.76

R

BCF2 (pg 9)

Permanent admissions of older people (aged 65 and over) to residential and nursing care homes, per 100,000 population

578.9 January

2017 561

G

BCF3 (pg 12)

Proportion of older people (65 and over) who were still at home 91 days after discharge from hospital into reablement / rehabilitation services

91.2% 80.63%

YTD R

BCF4 (pg 14)

Delayed transfers of care (delayed days) from hospital per 100,000 population (average per month)

1,101.5 Q4

February 2017 243

G

BCF5 (pg 19)

Percentage of users satisfied that the adaptations met their identified needs

75% 100%

Q3 G

BCF5 (pg 19)

BCF5: Question 32 from the GP Patient Survey: In the last 6 months, have you had enough support from local services or organisations to help manage long-term health condition(s)

65.4% 64.4% (July)

R

BCF6 (pg 20)

Permanent admissions of older people (aged 65 and over) to residential and nursing care homes directly from a hospital setting per 100 admissions of older people (aged 65 and over) to residential and nursing care homes

34% 23.4% G

Better Care Fund

46

BCF 1 - Total non-elective admissions into hospitals (general and acute), all ages

Numerator All non-elective admissions into hospital (all ages)

Denominator Nottinghamshire resident population Reporting Monthly, two months in arrears (targets quarterly). Low values are good.

Source Secondary Uses Service (SUS), NHS England.

Comments

Monitored by CCG boards and System Resilience Groups

This data is provisional from SUS (national data published monthly by NHS England)

SUS data is not currently available for CCGs outside of Nottinghamshire, MAR data presented as a

proxy

Change of definition in 2016/17 - no longer expressed as a rate per 100,000 population

R

▲

February 2017

6,878.76

Current RAG

Rating and Trend

19,743

20,038

19,866

19,707

21,457 (Proxy)

21,679 (Proxy)

23,176 (Proxy)

Apr 16 - Jun 16

Jul 16 - Sep 16

Oct 16 - Dec 16

Jan 17 - Mar 17

Planned Actual

Better Care Fund

47

BCF 3 - Proportion of older people (65 and over) who were still at home 91 days after discharge from

hospital into reablement / rehabilitation services

Better Care Fund

48

BCF 5 - Question 32 from the Patient GP Survey: In the last 6 months, have you had enough support from

local services or organisations to help manage long-term health condition(s)

Question 32 from the GP Patient Survey: In the last 6 months, have you had enough support from local services or organisations to help manage long-term health condition(s)

2013/14 Baseline 65.8%

2014/15 target 67.1%

2015/16 target 68.5%

2015/16 actual 64.4%

2016/17 target 65.4%

Latest performance (July 2016 weighted) 64.4%

Reporting Data is reported six monthly, four months in arrears. High values are good

Source NHS England six monthly reporting

NHS Nottingham North & East G Admitted...NHS Nottingham North & East G Monthly Quality & Performance...

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