Nottinghamshire Better Care Fund Finance and Performance Report · 2015-07-14 · GB 15/112b Page 5...

GB 15/112b

Date of report: June 2015

Nottinghamshire Better Care Fund Finance and Performance Report

Reporting period: Month 1 (April) 2015/16

Contents

Performance Summary ......................................................................................................... 2

Finance Summary ................................................................................................................. 3

Key Messages ...................................................................................................................... 4

BCF1 - Total non-elective admissions in to hospital (general & acute), all-age, per 100,000 population ............................................................................................................................. 5

BCF2 - Permanent admissions of older people (aged 65 and over) to residential and nursing care homes, per 100,000 population ..................................................................................... 9

BCF3 - Proportion of older people (65 and over) who were still at home 91 days after discharge from hospital into reablement / rehabilitation services ......................................... 12

BCF4 - Delayed transfers of care (delayed days) from hospital per 100,000 population ...... 14

BCF5 - Patient / service user experience ............................................................................ 18

Disabled Facilities Grants ................................................................................................ 18

Health .............................................................................................................................. 19

BCF6 - 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 ........................................................................ 20

Finance ............................................................................................................................... 23

Disabled Facilities Grants – reports quarterly ...................................................................... 25

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Performance Summary

REF Indicator 2015/16 Target

2015/16 (to date)

RAG rating

and trend

BCF1 (pg 5)

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

2,371 (Q4

14/15)

2,562 (Q4

14/15)

R

BCF2 (pg 8)

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

657.35 549

(15/16 YTD)

G

BCF3 (pg 10)

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

90.7% 92.0% (15/16 YTD)

G

BCF4 (pg 12)

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

1,151.4 (Q1

15/16)

531 (15/16 YTD)

G

BCF5 (pg 14)

Disabled Facilities Grant: % users satisfied adaptation meet needs

75%

98.8% (Q4

14/15)

G

BCF6 (pg 15)

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

33.96% 32.4% (15/16 YTD)

G

Key: Rating Thresholds Trend Meaning

G Improvement on baseline and target met

Performance from the last two data points indicates a positive direction of travel

A Improvement on baseline yet below target

Performance from the last two data points indicates no change

R Deterioration on baseline

Performance from the last two data points indicates a negative direction of travel

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Finance Summary

Month 1 2015/16 plan to

date

Variance to date

2015/16 full year

plan

Forecast variance

RAG rating and

trend

Nottinghamshire

Expenditure v budget 7,459 -1 58,922 0

G

Savings v forecast 153 -5 7,588 0

G

Units of Planning

North Nottinghamshire

Expenditure v budget 370 -10 5,078 0

G

Savings v forecast 16 -4 245 245

G

Mid-Nottinghamshire

Expenditure v budget 1,245 0 16,997 1

G

Savings v forecast 56 0 6,379 0

G

South Nottinghamshire


G

Savings v forecast 80 0 965 -1

G

Pan Nottinghamshire


G

Savings v forecast 0 0 0 0

Key:

Rating Thresholds Trend Meaning

G In line with plan. Costs are at or below budget or savings are at or above forecast.

Performance from the last two months indicates a positive direction of travel

R Below plan. Costs are above budget or savings are below forecast.

Performance from the last two months indicates no change

Performance from the last two months indicates a negative direction of travel

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Key Messages

REF Key issues for consideration Risk Mitigating actions

Performance

BCF1 (pg 5)

Overall performance above planned baseline. Data relates to 2015 calendar year and commencement of the pay for performance period.

R

Development on new pathways and professional roles including models of transfer to assess for targeted groups, Emergency Care Assistants in EMAS, Urgent Advice Lines/Clinic.

BCF2 (pg 8)

New target set as 12 week disregard now included in monitoring.

G N/A

BCF3 (pg 10)

Overall performance on target. However, denominator is reducing. G

Reviewing health commissioned reablement services with joint health and social care input.

BCF4 (pg 12)

Overall performance on target. G

N/A

BCF5 (pg 14)

Proxy indicators on target, with exception of latest GP survey result.

G N/A

BCF6 (pg 15)

CCG data now available.

G

Three Care & Support Centres will remain open for a longer period than planned to ultimately lead to an integrated Transfer-to-Assess model of provision.

Expenditure

Notts

Expenditure and savings are on plan. G

North

Expenditure broadly in line with plan. G

Telehealth pilot not rolled out as quickly as anticipated.

Mid

Expenditure and savings in line with plan. The Better Together programme has undertaken a full review of the programme during April and May. This work is being finalised and requires the sign off of both Governing Bodies.

G

The programme review changed the timeframe of schemes, bringing some schemes forward, e.g. implementation of IT systems, and delaying others, e.g. full mobilisation of the specialist intermediate care teams. Once this has concluded the CCGs will rephase BCF budgets. It is anticipated that this will be concluded in July and a paper setting out these changes will be brought to the Programme Board.

South

Expenditure and savings below plan. G

DFGs

Reported quarterly.

Pan Notts

Expenditure on plan. G

Key: Rating Thresholds

G No or Low Risk

A Medium Risk

R High Risk

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BCF1 - Total non-elective admissions in to hospital (general & acute), all-age, per 100,000 population

Planned Actual

Current RAG rating and trend

Baseline rate (Jan-14 to Dec-14)

Jan 14 - Mar 14 2,444

R

2,562 Q4 14/15

Apr 14 - Jun 14 2,546 2,577

Jul 14 - Sep 14 2,538 2,586

Oct 14 - Dec 14 2,547 2,643

Pay for Performance (Jan-15 to Dec-15)

Jan 15 - Mar 15 2,371 2,562

Apr 15 - Jun 15 2,425

Jul 15 - Sep 15 2,416

Oct 15 - Dec 15 2,432

Comments Monitored by CCG boards and System Resilience Groups

This data is provisional (national data published annually)

Please note the January to April 15 planned data for out of area CCGs is based on original submission data and may be subject to amendment.

The original BCF plans are being used pending NHSE clarification on whether to use revised 2015/16 operational plans.

Key issues Overall performance above planned baseline.

This target is reported on a calendar year basis. The planned reduction was not achieved for 2014.

Q4 2014/15 is the first quarter of the pay for performance period. The target was not delivered by any CCGs therefore no pay for performance is due.

Mitigating actions North Current performance

Plan figure is understated due to exclusion of readmissions within 28 days, whereas actual activity includes readmissions.

Increase in activity in A&E and external pressures with YAS being on reap 5 and Sheffield putting a divert in place to DBH.

There has been an increase in activity from Ollerton and Creswell. N&S CCG and North Derbyshire CCG are following this up.

ICB and SRG, and their related subgroups, are monitoring performance regularly.

Actions

CCG will continue to monitor contracts, and Systems Resilience Group will discuss the position and continue with the agreed unplanned care actions.

Short-term System Resilience funding utilised across the health and social care community to support non-elective activity. Winter learning event held in April to inform planning for winter 2015/16 and the systems resilience plan for NHSE.

Paramedic pathfinder implemented.

EMAS 3 month pilot for non-urgent care (green calls) and FRV protected resource in the Northern Corridor of Bassetlaw (Harworth area) completed February to April. Early indications of positive outcomes however no longer term funding identified.

Development of intermediate care and transfer to assess for

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Continuing Health Care patients pathways is ongoing. Transfer to assess for CHC patients initial trial and implementation of the interim intermediate care reablement model at James Hince Court planned for summer 2015.

Implementation of Emergency Care Assistants from EMAS.

Model of primary care urgent care in A&E being discussed with CCG and partners.

Clinical scenarios being identified to enable EMAS to admit directly to ATC.

Work commenced to develop falls pathway for implementation in April 2016.

Financial position Expenditure and savings broadly in line with plan. Mid Notts Current Performance A community-wide Operational Resilience Plan is in place. This is being overseen by the Health Community’s Urgent Care Working Group (UCWG) and the System Resilience Group (SRG). Actions Actions within the A&E Recovery Plan that relate to a reduction in non-elective admissions and length of stay include:

2 additional Acute Medical Consultants in place at SFHFT.

CHP presence in A&E to “turnaround” patients who can be dealt with by PRISM and in the community.

GP Referral Telephone Line whereby GPs telephone the SFHFT ED Consultant before sending any emergency admissions to the Trust. This is being discussed at the UCWG on 24th June to agree when this can be introduced for all practices.

GP 10-Minute Protocol between EMAS and GPs. EMAS ring a patient’s GP for advice when at the patient’s home, which could avoid an unnecessary admission. This is on-going, however, as yet we have no supporting information to evaluate the scheme. This is being taken forward with EMAS.

Expansion of 7-Day working within PRISM Teams to increase support within the community.

Review of PC24 streaming criteria carried out and live. The CCG has commissioned GP daytime presence in PC24 for another year following the successful pilot.

Continued use of technology to support patients to manage their health in the community (and not worsen and require admission) e.g. Use of FLO technology continues in the community (5 Nursing Homes in now successfully using FLO), Skype is being used in Stone Cross by Macmillan Nurses.

Joint working and communications across all organisations continues to work well. Joint learning events are being held.

SRG continues to meet fortnightly, supported by a fortnightly UCWG. Weekly teleconferences continue across health community. SFHFT GOLD command continue to attend internal bed meetings.

The 95% 4-Hour standard has been achieved at SFHFT for March, April & May months. However, SFHFT has been under

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pressure in June and the Health Community is working to alleviate the position.

South Current performance A system resilience tactical implementation plan is in place and is overseen by the System Resilience Implementation Group. CCG non-elective plans are also in place. Action

Practices engaged in a clinical audit process around admissions to identify a cohort that may be preventable.

Practice visits organised to discuss benchmarked activity rates of emergency admissions.

Re-promotion of Risk Stratification as a method to identify patients at risk of admission.

Development and Implementation of map of medicine in NNE CCG.

Weekend opening at Rushcliffe CCG continues to evaluate well and access to the clinic by care homes and community staff has been introduced.

Continual promotion of best use of the Urgent Care System to patients.

Continued implementation of the Nottingham Care Navigator and Urgent Advice Lines/Clinic at NUH.

The GP model in ED was trialled again during the May bank holiday. A report is awaited

NEMS have implemented a Community Pathfinder and Home Intervention Team (CPHIT) to support nursing homes on urgent care.

Performance against the ED standard remains above 95%.

A second Breaking the Cycle week is taking place at City Hospital campus from 17th June.

The Navigation work at NUH has been recognised as an area of good practice as part of the High Impact Interventions associated with improvements in emergency and urgent care. Work is being presented at regional SRG chairs event on 24th June.

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 Monthly activity return (MAR), NHS England.

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7,2866,357

7,282 7,035

-

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

Ad

mis

sio

ns

Total non-elective admissions in to hospital (general & acute), all ages for HWB population

Actual Planned baseline

908792

907 876

-

200

400

600

800

1,000

Un

sta

nd

ard

ise

d R

ate

pe

r 1

00

,00

0

Po

pu

lati

on

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

population

Rate Planned baseline rate

Unit of planning CCG Planned

baseline

YTD

Actual

YTD

Notts HWB

actual

YTD

Notts HWB

rate

YTD

RAG and

trend

North Bassetlaw 3,433 4,112 4,013 3,620

Mansfield and

Ashfield 7,635 7,991 7,841 4,251

Newark and

Sherwood 4,076 4,439 4,332 3,407

Nottingham North

and East 4,097 4,633 4,414 3,109

Nottingham West 2,580 2,857 2,550 3,026

Rushcliffe 2,910 3,092 2,805 2,506

Total out of area 80,538 81,819 2,003 3,506

Total 105,269 108,943 27,959 3,419

Mid

South

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BCF2 - Permanent admissions of older people (aged 65 and over) to residential and nursing care homes, per 100,000 population

Planned Actual Current RAG rating and trend

Baseline rate 651.2 April - March 2013/14

G

549 15/16 YTD

2014/15 Target

601.5 12 week disregard

583.1

N/A 705.9 Without 12 week disregard

2015/16 Target

599.8 12 week disregard

No longer monitored

657.35 Without 12 week disregard

Comments Monitored by Nottinghamshire County Council ASCH&PP and the Older Adults Delivery Group

Admissions’ reporting suffers from an input lag (where records of admissions are not updated in a timely manner). This means that admissions figures reported for a month may be updated in later months. This issue is being monitored.

This data is provisional (national data published annually).

Note: the provisional target for 2015/16 has increased due to a definition change which removes the 12 week disregard i.e. people admitted for a short stay. The target needs to be approved by the Programme Board.

Key issues RAG rating for CCGs will be provided when forecasting commences at end of Quarter 1.

Mitigating actions

Current performance Overall performance on track. Action The admissions targets that Group Managers work to have been reduced for the rest of the financial year and are being reviewed for 2015/16. This will ensure that we remain on target overall. Group Managers are reviewing admissions panel processes, which can differ between localities, in an effort to even out the number of admissions across localities and bring those localities that are not currently on target back in line. Work continues on the development and implementation of five new and one refurbished Extra Care schemes across the County, along with four proposed schemes. Extra Care housing is a real alternative to traditional long-term residential care and will help to deliver the NCC ambition that more older adults stay living in their own home environment safely for longer. The new schemes are scheduled to open throughout the next two years. Three Care & Support Centres have been identified to remain open for a longer period than was originally proposed to enable joint development

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of an intermediate care/ assessment / reablement type service that will ultimately lead to the implementation of an integrated Transfer-to-Assess model of provision. This will ensure timely discharges from hospital across the county and provide service users with the best support to enable them to return to their home, rather than entering residential care. This work is all being undertaken as part of the Better Care Fund within the three units of planning.

Numerator Permanent admissions of older people to residential and nursing care. An admission is a new admission, so does not include people transferring from one home to another or from residential to nursing. It does include people moving from temporary to permanent care.

Denominator Nottinghamshire resident population

Reporting Data is reported monthly, one month in arrears. Cumulative measure. Low values are good.

Source Nottinghamshire County Council, Frameworki internal report.

706549

0 0 0 0 0 0 0 0 0 0 0

549

0

100

200

300

400

500

600

700

800

Baselineyear end

14/15

Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 YTD

Permanent admissions of older people to residential and nursing care homes, per 100,000 population

Actual Target

Unit of

planningCCG

YTD

admissions

(Apr 15)

YTD rate

(Apr 15)

Target

rate

North Bassetlaw 12 52 583

Newark and Sherwood 6 22 529

Mansfield and Ashfield 14 41 703

Nottingham North and East17 58 563

Nottingham West 11 57 568

Rushcliffe 12 48 472

Mid

South

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52

22

4158 57

48

0

10

20

30

40

50

60

70

80

90

100

Bassetlaw Newark andSherwood

Mansfield andAshfield

NottinghamNorth and East

Nottingham West Rushcliffe

North Mid South

Permanent admissions of older to residential and nursing care homes per CCG, per 100,000

population April 2015

Actual

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BCF3 - Proportion of older people (65 and over) who were still at home 91 days after discharge from hospital into reablement / rehabilitation services


Baseline rate 88.8 April – March 2013/14

G

92.0% 15/16 YTD

2014/15 Target

89.8 91.0

2015/16 Target

90.7

Comments Data reported three months in arrears due to indicator definition

Monitored by Nottinghamshire County Council ASCH&PP

This data is provisional (national data published annually).

Key issues Overall performance is above target. Small numbers and data validation (particularly in Bassetlaw) means that variation against target on a monthly basis can impact significantly on RAG rating. The target requires the denominator i.e. people receiving reablement/rehabilitation services to be maintained. The denominator has reduced significantly in Nottinghamshire as NCC has effectively monitored access to the services to ensure only eligible people are receiving them. For Nottingham West, NCC are in the process of broadening out the service which has been impacting on performance.

Mitigating actions Current performance Overall performance is on target, though the denominator is reducing. Action Ongoing monitoring of performance, particularly Nottingham West for service change. It is proposed that internally the data reporting is split to show the outcomes achieved for this indicator by Start Reablement and Intermediate Care schemes, since the data is currently merged. This may give us more useful intelligence about how these different services are being used and the outcomes they achieve. For example, the services may be taking on a high level of people with complex needs, to facilitate speedy hospital discharge, even though these people are not likely to achieve full rehabilitation 91 days after discharge. Work is ongoing to identify services commissioned by health with joint health and social care delivery that would be eligible to be included in the monitoring.

Numerator Number of people at home or in extra care housing or an adult placement scheme setting 91 days after the date of their discharge from hospital. People who are in hospital or in a registered care home at the three month date and those who have died within the three months are not included in the numerator.

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Denominator Older people aged 65 and over discharged from hospital to their own home or to a residential or nursing care home or extra care housing for rehabilitation, with a clear intention that they will move on/back to their own home. Rehabilitation includes START reablement and intermediate care in both community and residential settings.

Reporting Reported monthly, three months in arrears.


89% 90% 92%

0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0%

92%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

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

Actual Target

95% 95%

88% 88%92%

83%

76%78%80%82%84%86%88%90%92%94%96%98%

Bassetlaw Mansfield &Ashfield

Newark &Sherwood

NottinghamNorth and East

Nottingham West Rushcliffe

North Mid South

Proportion of older people who were still at home 91 days after discharge from hospital into reablement / rehabilitation services - CCG and Unit of

Planning split April 2015

Actual Target

Unit of Planning CCG Numerator Denominator Apr-15 RAG

North Bassetlaw 23 24 95.00%

Mansfield & Ashfield 95 100 95.12%

Newark & Sherwood 39 41 88.33%

Total Mid Notts 134 141 95.04%

Nottingham North and East 53 60 88.33%

Nottingham West 24 26 92.31%

Rushcliffe 30 36 83.33%

Total South Notts 107 122 87.70%

Mid

South

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BCF4 - Delayed transfers of care (delayed days) from hospital per 100,000 population

Planned Actual Current RAG rating

and trend

Baseline rate 2013/14

Apr 13 - Jun 13 1,250.8

G

531 15/16 YTD

Jul 13 - Sep 13 1,151.9

Oct 13 – Dec13 1,185.5

Jan 14 - Mar 14 1,203.1

2014/15 target

Apr 14 - Jun 14 1,218.1 1,209.9

Jul 14 - Sep 14 1,121.7 1,147.6

Oct 14 - Dec 14 1,185.0 982.6

Jan 15 - Mar 15 1,161.1 982.8

2015/16 target Apr 15 – Jun15 1,151.4

Jul 15 - Sep 15 1,121.4

Oct 15 – Dec15 1,173.3

Jan 16 - Mar 16 1,136.9

Comments Monitored by CCG boards and System Resilience Groups DBH data includes both the Bassetlaw and Doncaster hospital sites, which includes residents from both areas. Bassetlaw residents largely attend the Bassetlaw Hospital site (approx. two-thirds). Work is underway to separate out the DBH DTOCs for Notts residents only.

Key issues A difference around reporting between hospitals has been an issue during 2014/15. There was a change in SFHFT reporting in March 2015, but further work is required to ensure there is accurate reporting.

Mitigating actions

North Current performance Delayed discharges have decreased in April. On the whole, performance has been on track. ICB and SRG, and their related subgroups, are monitoring performance regularly. Actions

Hospital developments: o Redesigned Integrated Discharge Team has been

operationalised (Jan 2015) along with the implementation of the Trusted Assessor role to support discharge planning. Early indications are that this is working well.

o Weekly review of patients in hospital over 7 days is ongoing.

Community developments: o Homecare capacity is being addressed with NCC and

alternative options are being explored. o Development of intermediate care and transfer to assess for

Continuing Health Care patients pathways is ongoing. Work is underway to move the provision of residential intermediate care into James Hince Court for summer 2015.

Out of Area activity: o Meetings with out of area local authorities to develop pathways

to facilitate out of area complex discharges requiring social care input have taken place. Actions agreed and development of processes underway.

Financial position Expenditure and savings broadly in line with plan.

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Mid Notts Current performance The National DTOC Team met with key members of the Health Community on 13th March to review the level of DTOCs at SFHFT. One of the recommendations from the National Team was that SFHFT should review how they were counting and reporting DTOCs to the DoH and ensure that the Trust was consistent with the guidance. The Health Community is liaising with the NHSE to ask that SFHFT be a pilot site for the new definitional guidance that is due for release later this year. The Health Community continues to review processes to reduce all delays whether they are internal or reportable. The UCWG is taking this forward and reviewing schemes that could be implemented to reduce delays. Actions

The Health Community worked extremely well over the May Bank Holidays, putting in extra staff and processes across all organisations to ensure delays were kept to a minimum.

Transfer to Assess (T2A) continues. The scheme has been very successful and the CCG continues to commission this in 2015/16.

At SFHFT, daily Board Rounds by Senior Clinical Decision Makers continue.

The Multi-disciplinary Discharge Hub is working very well and continues to focus on patients who have been in hospital 14+ days.

Full utilisation of the Discharge Lounge.

The new discharge leaflet for patients has been finalised and agreed by the SRG. This will now be implemented. The leaflet will be given to patients on admission to clarify arrangements and avoid unnecessary delays.

Expansion of 7-Day working within PRISM Teams.

Joint working and communications across all organisations continues to work well. Joint learning events are being held.

The SRG continues to meet fortnightly, supported by a fortnightly UCWG. Weekly teleconferences continue across the health community. SFHFT GOLD command continue to attend internal bed meetings.

South Notts Current performance

The System Resilience Implementation Group continues to meet bi-weekly to review ED/System performance. A weekly dashboard position of indicators is produced which includes DTOC.

A Tactical Implementation Plan is in place to improve system resilience and is monitored by the System Resilience Group.

Actions

Steamlined discharge process at NUH for patients requiring support i.e. require health or social care services following admission.

A linked Social Worker for high referring wards is in place to ensure patients are identified for on-going needs assessments early in their admission and assessments can be completed in advance of the predicted medically safe date.

Transfer Action Group (TAG) is owned by individual directorates

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across NUH and meets weekly with community, CCG, acute and social care colleagues to discuss a prioritised list of long stay patients.

Leaving Hospital Policy: Social Care is escalating medically safe to transfer patients who have refused the offer of Interim care with health colleagues on a daily midday conference call.

Information Sharing Workstream: The clinical notes roll out is due to go live at the end of July 2015, with new style reporting to SRIG by Oct 2015. This will bring together DTOC information within the STOC

team and TAG meetings to provide real time visibility and consistency of information about a patient.

Daily discharge information is collected by both Health and Social Care colleagues within the acute and community settings and shared at conference calls throughout the day to aid visibility of capacity across the system. A discharge dashboard is being developed to enable SRIG and providers to compare data across the system to identify blockages.

A further “Breaking the Cycle” week for City Campus to take place 17th to 24th June. NCC offer includes: expediating care home discharges by working with home managers and extending direct referrals to START from all wards.

Early indications from Leivers Court assessment beds show promising results: 22 admissions over 6 weeks, average length of stay 13 days and 50% returned home who otherwise would have been placed in permanent care straight from hospital.

Co-location for SToC and social care teams at QMC is imminent to enable joint work and visibility/ accessibility of resource and capacity.

Length of stay variance between City and County social care to be analysed further to identify variances in practise, capacity and demand, recent issues with allocations given demand increasing but short-term funding for winter coming to an end.

7-day social care working for NUH in situ – arrangements being pursued to formalise and compliment this further to enable MDT coverage and access to resources over 7 days as well as admission avoidance.

Numerator Average delayed transfers of care (delayed days) (attributable to either NHS, social care or both) per month. A delayed transfer of care occurs when a patient is ready for transfer from a hospital bed, but is still occupying such a bed. A patient is ready for transfer when: (a) a clinical decision has been made that the patient is ready for transfer AND (b) a multi-disciplinary team decision has been made that the patient is ready for transfer AND (c) the patient is safe to discharge/transfer.

Denominator CCG registered population, per 100,000 population

Reporting Data is reported monthly, one month in arrears. Cumulative measure. Low values are good.

Source NHS England monthly reporting. Local data for narrative.

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1,210 1,148983 983

531

-

200

400

600

800

1,000

1,200

1,400

Q114/15

Q214/15

Q314/15

Q414/15

Q115/16

Q215/16

Q315/16

Q415/16

Un

stan

dar

dis

ed

Rat

e p

er

10

0,0

00

P

op

ula

tio

n

Quarterly Delayed transfers of care (delayed days) from hospital per 100,000 population: 2015/16

Actual Target

176

-

100

200

300

400

500

Un

stan

dar

dis

ed

Rat

e p

er

10

0,0

00

P

op

ula

tio

n

Monthly Delayed transfers of care (delayed days) from hospital per 100,000 population: 2015/16

Actual Target

290

3

316

1

51

101

151

201

251

301

Un

stan

dar

dis

ed

Rat

e p

er

10

0,0

00

P

op

ula

tio

n

Rate of Delayed Transfers of Care per 100,000 Population by provider 2015/16

NUH SFH DBH

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BCF5 - Patient / service user experience Only metrics where there is an update have been reported in this section.

Disabled Facilities Grants Percentage of users satisfied that the adaptations met their identified needs

Baseline rate None

2014/ 15 target N/A

2015/16 target 75%

Latest performance 98.8%

Q4 14/15

Key issues: Satisfaction levels with adaptations continue to be high.

Reporting Data is reported quarterly, one month in arrears. High values are good

Source Information provided by District and Borough Councils within Nottinghamshire

DFGs

completed

No of

customers

satisfied

% satisfiedDFGs

completed

No of

customers

satisfied

% satisfied

Bassetlaw 21 21 100% 68 68 100%

Total North Notts 21 21 100% 68 68 100%

Ashfield 31 31 100% 68 58 85%

Mansfield 21 19 90% 68 66 97%

Newark & Sherwood 21 21 100% 59 59 100%

Total Mid Notts 73 71 97% 195 183 94%

Broxtowe 18 18 100% 47 47 100%

Gedling 36 36 100% 101 101 100%

Rushcliffe 14 14 100% 53 53 100%

Total South Notts 68 68 100% 201 201 100%

Overall customer

satisfaction

2014/15 year end

97.4%98.8%

Qtr 4 14/15

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Health

Friends and Family Test (% recommended): April 2015 Data relates to inpatient Trust activity

Nottingham University Hospitals

Sherwood Forest Hospitals

Doncaster and Bassetlaw Hospitals

Latest performance

96%

97%

94%

Reporting Data is reported monthly, one month in arrears. High values are good

Source NHS England monthly reporting

GB 15/112b


BCF6 - 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


Baseline rate 65.0 April – March 2012/13

R 32.4% 15/16 YTD

2014/15 target 38.2 April – March 2013/14

35.1


37.3


Comments 2013/14 denominator is provisional (national data published annually and subject to timelag).

This data is provisional.

CCG data now available as using actuals rather than sampling.

Key issues Overall performance off target. The 2016/17 provisional target relates to delivery in 2015/16 due to the time delay in reporting verified data. The target needs to be approved by the Programme Board.

Mitigating actions Action Work is under way looking at various models, e.g. transfer to assess which should reduce the number of admissions direct from hospital next year. Social Care across the county are due to introduce a new panel process to scrutinise applications into long term care from hospital settings. Work continues on the development and implementation of five new and one refurbished Extra Care schemes across the County, along with four proposed schemes. Extra Care housing is a real alternative to traditional long-term residential care and will help to deliver the NCC ambition that more older adults stay living in their own home environment safely for longer. The new schemes are scheduled to open throughout the next two years. Three of our Care & Support Centres have been identified to remain open for a longer period than was originally proposed to enable joint development of an intermediate care/ assessment / reablement type service that will ultimately lead to the implementation of an integrated Transfer-to-Assess model of provision. This will ensure timely discharges from hospital across the county and provide service users with the best support to enable them to return to their home, rather than entering residential care.

Numerator Admissions to long-term residential and nursing care from an acute setting

Denominator Admissions to residential and nursing care as in BCF2

Reporting Quarterly, one month in arrears. Low values are good.

GB 15/112b



65.0%

35.1% 37.3%32.4%

0.0% 0.0% 0.0%

32.4%

0%

10%

20%

30%

40%

50%

60%

70%

Baseline(year end

12/13)

Year end13/14

Year end14/15

Apr - Jun 15 Jul - Sep 15 Oct - Dec 15 Jan - Mar 16 Year to Date

Permanent admissions of older people to residential and nursing care homes directly from a hospital (April 15)

Actual Target

32%

0%

5%

10%

15%

20%

25%

30%

35%

40%

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

Percentage of admissions into care homes directly from hospital by month (April 15)

Target

17%33% 29% 24%

36%

58%

0%

10%

20%

30%

40%

50%

60%

70%

Bassetlaw Newark andSherwood

Mansfield andAshfield

NottinghamNorth East

NottinghamWest

Rushcliffe

North Mid South

Permanent admissions of older people to residential and nursing care homes directly from hospital by CCG (April 15)

Year to date Target

GB 15/112b


79.1%

43.6% 52.4%42.3%

55.5%

30.5% 39.7%27.1%

0%

20%

40%

60%

80%

100%

2012/13 2013/14 2014/15 2015/16 YTD

Permanent admissions of older people to residential and nursing care homes directly from a hospital (April 15)

Nursing Residential Average Target

GB 15/112b


Finance The table below shows planned expenditure to date against actual expenditure and the forecast full year effect for the current year, 2015/16.

Plan £,000 Actual

£,000

Variance

£,000 Plan £,000

Forecast

£,000

Variance

£,000

A - Seven Day Working CCG £ 125 £ 125 £ - £ 1,500 £ 1,500 £ -

B - GP Access CCG £ 145 £ 145 -£ 0 £ 1,743 £ 1,743 £ -

C - Proactive and Personal ised

Care CCG £ 206 £ 206 £ 0 £ 2,471 £ 2,471 £ -

C - Proactive and Personal ised

Care NCC £ 11 £ 11 -£ 0 £ 135 £ 135 £ -

D - Community Care Co-

ordination CCG £ 189 £ 189 £ 0 £ 2,265 £ 2,265 £ -

D - Community Care Co-

ordination NCC £ 10 £ 10 -£ 0 £ 124 £ 124 £ -

E - Support for Carers NCC £ 43 £ 43 £ 0 £ 511 £ 511 £ -

E - Support for Carers CCG £ 21 £ 21 -£ 0 £ 256 £ 256 £ -

G - Rehabi l i tation/

Reablement Services - at

home and Community Bed

based

CCG £ 233 £ 233 -£ 0 £ 2,797 £ 2,797 £ -

G - Rehabi l i tation/

Reablement Services - at

home and Community Bed

based

NCC £ 18 £ 18 £ 0 £ 215 £ 215 £ -

H - Additional Support to

Socia l CareNCC £ 33 £ 33 -£ 0 £ 400 £ 400 £ -

I - Transformation CCG £ 96 £ 96 £ 0 £ 1,150 £ 1,150 £ -

K Loca l i ty Integrated Care

Teams CCG £ 594 £ 594 £ 0 £ 11,000 £ 8,405 -£ 2,595

L - Sel f Care Service CCG £ 7 £ 7 £ 0 £ 160 £ 580 £ 420

M - Specia l i sed Integrated

Care Teams CCG £ 345 £ 345 £ 0 £ 3,066 £ 4,143 £ 1,077

N - Improved Primary Care

Access and Support Closer to

Home

CCG £ 113 £ 113 -£ 0 £ 1,734 £ 1,501 -£ 233

O - Better Together

Implementation Support CCG £ 186 £ 186 -£ 0 £ 937 £ 2,237 £ 1,300

P - Communications £ - £ - £ - £ 100 £ 132 £ 32

Q - Neighbourhood Teams and

7 Day Access To Services £ 40 £ 40 £ - £ 825 £ 825 £ -

R - Mental Health Lia ison £ 35 £ 35 £ - £ 415 £ 415 £ -

U - Discharge/Assessment

incl . Intermediate Care £ 227 £ 227 £ - £ 2,918 £ 2,918 £ -

V - Respite Services £ 27 £ 27 £ - £ 325 £ 325 £ -

W - Improving Care Home

Qual i ty £ - £ - £ 100 £ 100 £ -

X - Telehealth £ 41 £ 31 -£ 10 £ 495 £ 495 £ -

F - Protecting Socia l Care

Services £ 1,347 £ 1,347 -£ 0 £ 16,167 £ 16,167 £ -

J - Disabled Faci l i ties Grant £ 3,204 £ 3,204 £ - £ 3,204 £ 3,204 £ -

Y - Socia l Care Capita l £ - £ - £ - £ 1,964 £ 1,964 £ -

Z - Care Act Implementation £ 162 £ 162 -£ 0 £ 1,945 £ 1,945 £ -

Total 7,459£ 7,448£ 11-£ 58,922£ 58,923£ 1£



Pan-Nottinghamshire

Mid-Nottinghamshire

To date (M1) Full year effect

GB 15/112b


The table below shows forecast benefits to date against actual savings and the forecast full year effect for the current year, 2015/16.

Plan

£,000

Actual

£,000

Variance

£,000

Plan

£,000

Forecast

£,000

Variance

£,000

A - Seven Day Working £ 9 £ 9 -£ 0 £ 109 £ 109 -£ 0

B - GP Access £ 11 £ 11 £ 0 £ 130 £ 130 -£ 0

C - Proactive and Personal ised Care £ 11 £ 11 £ 0 £ 131 £ 131 £ -

D - Community Care Co-ordination £ 16 £ 16 £ 0 £ 190 £ 190 -£ 0

E - Support for Carers £ 4 £ 4 -£ 0 £ 49 £ 49 -£ 0

G - Rehabi l i tation/Reablement

Services - at home and Community £ 22 £ 22 -£ 0 £ 270 £ 270 £ 0

H - Additional Support to Socia l Care £ 0 £ - -£ 0 £ 1 £ 1 -£ 0

I - Transformation £ 7 £ 7 £ 0 £ 84 £ 84 £ 0

K Local i ty Integrated Care Teams £ 56 £ 56 £ 0 £ 2,797 £ 2,797 £ -

M - Specia l i sed Integrated Care

Teams £ - £ - £ 2,493 £ 2,493 £ -

N - Improved Primary Care Access and

Support Closer to Home £ - £ - £ 1,002 £ 1,002 £ 0

P - Communications £ - £ - £ 87 £ 87 £ -

W - Improving Care Home Qual i ty £ - £ - £ - £ 49 £ 49 £ 0

X - Telehealth £ 16 £ 12 -£ 4 £ 196 £ 196 £ 0

Total 153£ 148£ 5-£ 7,588£ 7,588£ 0£


Mid-Nottinghamshire

To date (M1) Full year effect


GB 15/112b


Disabled Facilities Grants – reports quarterly

Comments Most local authorities have spent, or spent and approved, their BCF allocation for Disabled Facilities Grants at the end of the financial year. However, the overall spend on DFGs is less than predicted due to the fact that some authorities have made smaller contributions from their own capital than was originally budgeted.

Month 12 Actual

£,000

BCF allocation

2014/15

£,000

Year To

Date

Variance

£,000

Broxtowe £ 287 £ 303 £ 17

Gedl ing £ 371 £ 371 £ -

Rushcl i ffe £ 233 £ 233 £ -

Total South Notts £ 891 £ 907 £ 17

Ashfield £ 296 £ 374 £ 78

Mansfield £ 424 £ 483 £ 59

Newark and Sherwood £ 369 £ 369 £ -

Total Mid Notts £ 1,089 £ 1,227 £ 138

Bassetlaw £ 430 £ 430 £ -

Total North Notts £ 430 £ 430 £ -



Mid-Nottinghamshire

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