Haringey CCG Performance and Quality Dash Board January 2015

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1 Haringey CCG Performance and Quality Dash Board January 2015 Contents No. Page No. 1 Quality Premium 1 2 CCG wide Acute Dashboard Acute Trust main Providers Emergency Standards Cancer Standards Quality Dashboard Mental Health Services Community Health Services NHS 111, Barndoc and LAS Analytics 17 Measure QUALITY PREMIUM - (NHS Constitution rights and pledges) Measure achieved Referral to treatment times (18 weeks Incomplete) (April 2014 to November 2014)* 90.3% N 92% A&E waits - All types (April 2014 to Dcemberr 2014) 94.8% N 95% Cancer waits - 14 days (April 2014 to October 2014) 92.0% N 93% Category A Red 1 ambulance calls (April 2014 to October 2014) 69.3% N 75% The Quality Premium is intended to reward clinical commissioning groups (CCGs) for improvements in the quality of the services that they commission and for associated improvements in health outcomes as well as reducing inequalities. The total potential incentive equates to 5 per GP registered patient. The premium is paid in arears and in 2014/15 Haringey CCG received additional funding for this premium relating to performance in the previous year. The total performance on the local measures is reduced by 25% for each of the above National Standards which are not met. HCCG wide is currently failing on all these standards. The RTT incompletes measure achievement looks challenging as three of the four main providers continue to fail to the end of October although improvement is being demonstrated. The two week cancer wait may be achieved as the Whittington is now compliant but only sustained over performance would be required across all providers. The recovery of the A&E position will be a challenge and the Category A Red 1 Ambulance Calls cannot be recovered. 1

2 Cancer Waits 18 Weeks Referral to treatment and Diagnostics A&E Quality Premium Haringey CCG wide Dashboard - Acute Trust Performance (all providers) Theme KPI / Measure Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 YTD A&E All Types 95.5% 96.0% 95.5% 95.2% 95.5% 97.1% 96.4% 95.3% 94.9% 93.1% 97.2% 97.0% 93.9% 94.1% 95.2% 95% 18 Weeks RTT Adjusted Admitted 91.5% 91.2% 91.6% 89.9% 89.7% 87.7% 89.3% 92.7% 90.0% 89.6% 85.7% 85.3% 89.0% 89.2% 88.8% 90% 18 Weeks RTT Non-Admitted 94.6% 94.7% 96.7% 95.5% 95.1% 94.6% 95.8% 95.3% 94.9% 95.2% 94.4% 92.6% 91.9% 94.6% 94.3% 95% 18 Weeks RTT Incomplete Pathways 93.0% 93.4% 92.5% 91.0% 90.7% 90.9% 91.7% 91.9% 91.3% 88.1% 87.8% 89.8% 90.17% 93.1% 90.3% 92% >52 week waits Admitted >52 week waits Non Admitted >52 week waits Incomplete Weeks Diagnostic Waits 99.8% 99.8% 99.7% 99.5% 99.7% 99.3% 98.6% 97.9% 97.5% 98.4% 99.2% 99.1% 99.3% 98.4% 98.6% 99% Theme KPI / Measure Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 YTD 2 Week Cancer Wait 93.4% 93.2% 94.6% 90.1% 92.8% 94.9% 91.7% 92.7% 93.5% 90.9% 90.2% 92.1% 92.9% 92.0% 93% 2 Week Cancer Wait: Breast Symptoms 31 day Cancer Wait: 1st definitive treatment 31 Day Cancer Wait: Subsequent treatment (Surgery) 31 Day Cancer Wait: Subsequent treatment (Chemotherapy) 31 Day Cancer Wait: Subsequent treatment (Radiotherapy) 62 Day Cancer Wait: GP Referral 62 Day Cancer Wait: Screening service 97.7% 93.3% 94.6% 88.7% 92.4% 93.1% 87.1% 90.6% 88.6% 95.5% 90.4% 93.7% 96.9% 91.8% 93% 96.4% 100.0% 100.0% 96.9% 100.0% 100.0% 98.5% 97.3% 98.5% 100.0% 100.0% 98.7% 96.8% 98.5% 96% 93.3% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 92.9% 100.0% 100.0% 100.0% 88.9% 97.2% 94% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 97.4% 99.5% 98% 100.0% 100.0% 95.8% 96.9% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 94% 92.3% 84.2% 96.0% 80.6% 85.7% 89.5% 95.5% 84.0% 100.0% 90.9% 91.7% 90.6% 96.2% 92.4% 85% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 80.0% 96.3% 90% 62 Day Cancer Wait: Consultant Upgrade 100.0% 80.0% 87.5% 85.7% 100.0% 100.0% 87.5% 93.3% 100.0% 100.0% 100.0% 85.7% 100.0% 95.5% No Threshold Locally Agreed 2

3 A&E 4 Hour - 95% threshold As at the end of November 2014, the CCG reported position year to date showed that the 95% target had just been achieved, but the December 2014 validated performance shows that Haringey CCG (HCCG) wide, this target is now failing year to date. Performance during December 2014 showed that this target has not been achieved at the North Middlesex University Hospital (NMUH) which has failed the 4-hour standard for 4 consecutive months with performance falling below the 95% standard for both quarter 3 and year to date. There is an agreed recovery plan in place, with the focus on interventions to improve hospital flow at NMUH, improve discharge and access to community stepdown capacity. To support winter capacity planning, the System Resilience Group has invested in plans across all Haringey CCG health and social care providers. Much of the NMUH plans rely on recruitment to medical and nursing posts where the Trust historically struggles to recruit and retain staff. The Winter Hub was opened a week early but used for the first few weeks for escalation beds, it now functioning as originally planned as a 28 bedded unit with multi-agency input. Referral to Treatment s Provisional data for November shows that the CCG only met the incomplete pathways standard, failing the admitted and non-admitted standards. However, this picture is indicative of progress with the backlog clearance programme and is the first time that the incomplete pathways standard has been met in a year. Two of the CCG s patients were waiting over 52 weeks at month-end; one each at Royal Free and Aspen Highgate. Diagnostics The diagnostic standard was not met for the CCG s patients in November with 98.4%. of 86 patients, for whom the standard was not met, 54 were waiting for ultrasound at NMUH. The remainder were small numbers across different Trusts and modalities. This data is provisional and may change. The Trust has advised that the breaches were due to a mix of staffing shortages and admin processes. Extra clinics and actions have now been put in place to prevent further occurrences. Failure to deliver diagnostics in a timely way for patients could impact on the achievements of the 18 week treatment targets. Haringey CCG wide - Acute Trust Performance for main and all providers Admitted % Within 18 weeks - Non Admitted % Within Inomplete Pathways % Within Provider Name 90% 18 weeks - 95% 18 weeks - 92% NORTH MIDDLESEX UNIVERSITY HOSPITAL NHS TRUST 90.24% 96.94% 94.14% THE WHITTINGTON HOSPITAL NHS TRUST 88.76% 94.42% 92.70% UNIVERSITY COLLEGE LONDON HOSPITALS NHS FOUNDATION TRUST 82.48% 88.52% 92.64% ROYAL FREE LONDON NHS FOUNDATION TRUST 89.63% 96.99% 92.65% OTHER 91.70% 95.29% 92.51% Grand Total 89.18% 94.64% 93.14% 3

4 18 Weeks Referral to treatment, Diagnostics 18 Weeks Referral to treatment Diagnostics 6 week wait performance Referral to Treatment National Standards Elective and Diagnostic Waits at Trust Level, by month for Haringey CCG s Main Providers. This shows the monthly and year to date performance against the national referral to treatment and associated standards for HCCGs main providers. Theme KPI / Measure Provider Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 YTD RTT Barnet & Chase Farm North Middlesex 90.5% 91.7% 92.9% 90.6% 90.3% 90.0% 91.1% 92.4% 94.0% 91.6% 91.5% 93.5% 90.0% 91.9% 18 Weeks RTT Adjusted Royal Free Hospital 91.7% 92.7% 92.8% 90.5% 90.5% 91.1% 91.3% 92.1% 92.2% 91.3% 90.9% 90.3% 90.1% 91.1% Admitted UCLH 90.2% 90.2% 88.9% 87.9% 87.2% 86.4% 84.7% 84.1% 82.3% 82.4% 86.3% 79.9% 82.2% 83.1% 90% Whittington 90.1% 90.1% 90.5% 90.3% 87.4% 87.9% 78.2% 75.6% 83.3% 85.1% Barnet & Chase Farm North Middlesex 95.8% 95.7% 96.4% 96.5% 96.0% 95.0% 97.4% 97.0% 97.0% 95.2% 95.4% 95.3% 95.1% 96.1% 18 Weeks RTT Non-Admitted Royal Free Hospital 96.7% 97.5% 96.5% 96.9% 96.7% 97.3% 97.6% 97.6% 97.1% 97.4% 97.0% 97.4% 97.2% 97.3% 95% UCLH 95.6% 95.6% 95.7% 95.0% 93.9% 93.5% 94.1% 92.8% 92.6% 93.4% 93.2% 91.8% 88.3% 92.3% Whittington 95.2% 95.0% 95.1% 95.0% 95.1% 94.9% 93.9% 91.5% 90.0% 93.5% Barnet & Chase Farm North Middlesex 95.9% 96.5% 94.9% 93.2% 92.5% 92.5% 94.0% 93.7% 92.8% 86.8% 86.6% 93.7% 94.5% 91.7% 18 Weeks RTT Incomplete Royal Free Hospital 92.0% 92.0% 92.0% 92.1% 92.1% 92.1% 92.1% 92.3% 92.0% 92.1% 92.1% 92.5% 92.4% 92.2% Pathways UCLH 92.1% 91.3% 89.9% 89.0% 87.7% 87.3% 88.2% 87.3% 86.1% 87.3% 87.9% 88.6% 88.6% 87.7% 92% Whittington 90.2% 87.2% 86.9% 85.7% 85.0% 87.0% Barnet & Chase Farm 0 North Middlesex Admitted over 52 week waits Royal Free Hospital Non Admitted over 52 week waits Incomplete over 52 week waits 6 Weeks Diagnostic Waits UCLH Whittington Barnet & Chase Farm 0 North Middlesex Royal Free Hospital UCLH Whittington Barnet & Chase Farm 0 North Middlesex Royal Free Hospital UCLH Whittington Barnet & Chase Farm 99.1% 99.4% 98.9% 99.0% 99.3% 98.6% 98.6% 99.2% 99.1% 98.9% North Middlesex 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 99.2% 99.4% 99.3% 99.6% 99.6% Royal Free Hospital 99.6% 99.5% 98.8% 98.7% 98.1% 97.4% 96.0% 96.1% 96.4% 98.3% 97.7% 98.1% 98.4% 97.8% UCLH 98.4% 98.5% 97.1% 97.0% 98.2% 97.4% 97.7% 96.7% 97.4% 97.0% 96.9% 95.4% 97.8% 97.0% Whittington 99.8% 99.9% 100.0% 100.0% 100.0% 100.0% 98.9% 97.8% 97.4% 98.5% 100.0% 100.0% 99.6% 98.8% InHealth Group 99.7% 99.8% 99.7% 99.0% 99.3% 98.2% 97.5% 97.7% 98.3% 97.9% 96.2% 98.9% 97.7% 97.8% % 4

5 NMUH met all standards at aggregate level in October and November. Backlog numbers reduced in October but remained the same in November. If back log numbers do not continue to reduce this could threaten the achievement of the 18 week standards. Whittington HealthTrust reported that they achieved compliance with all RTT standards by w/e 14/12/2014, although this position is yet to be validated University College London Hospitals (UCLH) performance remains non-compliant with all 3 standards. The main specialties that are affected are: Neurosciences, ENT, Urology, Cardiac Services, Gastrointestinal services and Gynaecology. From the 1/12/15 UCLH has no over 52 weeks waiting patients as all patients have been treated. The Trust is now dating all over 40 week waiting patients. Diagnostics NMUH failed the standard as 54 patients were waiting for ultrasound. The Trust has advised that the breaches were due to a mix of staffing shortages and admin processes. Extra clinics and actions have now been put in place to prevent further occurrences. At UCLH the diagnostic performance has improved in October. Trust has now provided recovery action plans and compliance dates, for all failing modalities the main ones endoscopies and sleep studies. At the Royal Free London the challenges are in endoscopic modalities and cystoscopy. 5

6 Accident & Emergency and Ambulance Calls and Handover Emergency National Standards A&E and Ambulance Handovers at Trust Level, by month for Haringey CCG s Main Providers Theme KPI / Measure Provider Barnet & Chase Farm 87.1% 93.6% 94.9% 92.2% 88.5% 93.2% 97.3% 94.7% 96.1% 95.9% Moorfields Eye Hospital 99.8% 99.8% 100.0% 100.0% 99.8% 99.9% 99.5% 99.5% 99.2% 98.7% 99.9% 99.6% 99.3% 99.3% North Middlesex 95.8% 95.8% 95.0% 94.8% 95.3% 96.9% 96.1% 94.8% 94.7% 92.4% 97.5% 97.6% 93.4% 94.9% A&E All Types Performance Royal Free Hospital 96.6% 97.3% 95.2% 96.6% 95.1% 96.5% 95.1% 95.5% 96.6% 95.9% 95.6% 95.4% 95.4% 95.6% 95% No of waits from decision to admit to admission (Trolley waits - over 12 hours) % Ambulance Handovers within 15 mins: KPI 1 % Ambulance Handovers within 30 mins: KPI 2 Number of Ambulance Handover-30 minute breaches Number of Ambulance Handover-60 minute breaches Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 RNOH UCLH 92.4% 92.9% 92.3% 96.6% 95.2% 97.0% 96.1% 94.5% 95.2% 94.0% 94.3% 94.4% 92.8% 94.4% Whittington 95.3% 96.3% 96.5% 95.2% 96.1% 97.8% 96.9% 95.7% 93.9% 96.3% 96.3% 95.5% 93.4% 95.0% Barnet & Chase Farm Moorfields Eye Hospital North Middlesex Royal Free Hospital RNOH UCLH Whittington Barnet Hospital 77.9% 83.0% 74.1% 67.0% 59.6% 63.3% 76.6% 79.7% 81.7% 78.4% 82.1% 71.1% 82.5% 79.1% Chase Farm Hospital 64.2% 58.6% 66.7% North Middlesex 38.4% 34.5% 29.4% 28.2% 27.9% 28.0% 27.9% 41.2% 37.3% 30.6% 32.4% 30.2% 32.7% 34.5% Royal Free Hospital 47.0% 61.0% 53.0% 49.9% 42.6% 35.6% 35.8% 40.1% 40.1% 37.6% 35.2% 36.1% 31.5% 36.2% UCLH 35.0% 31.7% 39.9% 40.0% 43.3% 47.0% 49.7% 45.8% 50.6% 52.8% 56.6% 55.9% 50.4% 51.8% Whittington 32.5% 33.9% 33.2% 39.1% 40.7% 39.7% 37.9% 40.2% 33.5% 37.2% 40.3% 38.1% 38.8% 39.8% Barnet Hospital 98.7% 98.9% 97.4% 93.1% 85.6% 91.0% 96.6% 98.1% 97.9% 96.4% 97.1% 93.2% 98.3% 97.3% Chase Farm Hospital 96.1% 95.0% 96.1% North Middlesex 91.9% 90.0% 83.1% 80.5% 80.5% 82.1% 82.4% 94.1% 92.8% 90.8% 92.3% 91.4% 97.0% 96.1% Royal Free Hospital 94.9% 97.4% 84.9% 96.3% 94.4% 92.4% 91.9% 94.3% 93.5% 92.8% 92.9% 87.4% 88.5% 91.5% UCLH 89.6% 89.4% 91.7% 94.0% 93.3% 92.9% 94.8% 94.3% 95.2% 95.5% 96.7% 96.4% 93.7% 95.6% Whittington 92.1% 93.1% 92.0% 93.3% 93.7% 92.8% 94.3% 94.7% 93.0% 95.2% 94.9% 93.8% 99.4% 99.6% Barnet Hospital Chase Farm Hospital North Middlesex Royal Free Hospital UCLH Whittington Barnet Hospital Chase Farm Hospital North Middlesex Royal Free Hospital UCLH Whittington NMUH has not met the A&E standard since October and failed Quarter 3. Attendances average over 500 per day and over 50% of breaches are attributed to bed capacity. The Trust also cites high staffing vacancies and sickness absence. NMUH Ambulance handovers remain below the 15 and 30 minute thresholds and there was one 60 minute breach in November. YTD 0 100% 100% 0 0 Whittington Health has failed the standard for October. Bed capacity issues, particularly Paediatric bed availability in the early part of the month presented challenges, alongside peaks in attendance of Paediatric patients. 6

7 Cancer Waits Delayed Transfers of Care (DTOC) became a particular pressure from mid-december. There has been particular pressure in respect of access to Neuro-Rehab beds. Regarding Ambulance Handovers the LAS representative at the CCG System Resilience Group (SRG) indicated that The Whittington were not cause for any significant concerns for them at present. Cancer National Standards Referral and Treatment at Trust Level, by month for Haringey CCG s Main Providers Theme KPI / Measure Provider Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 YTD Barnet & Chase Farm 94.7% 95.2% 94.6% 93.2% 95.4% 94.4% 93.9% 94.6% 93.7% 94.0% North Middlesex 94.2% 92.2% 95.7% 93.4% 95.1% 97.0% 93.3% 93.3% 95.7% 93.7% 91.9% 93.6% 92.5% 93.4% 2 Week Cancer Wait Royal Free Hospital 96.4% 97.1% 96.8% 97.4% 98.7% 98.0% 97.2% 97.1% 97.2% 95.5% 94.0% 95.4% 96.3% 95.7% 93% 2 Week Cancer Wait: Breast Symptoms 31 day Cancer Wait: 1st definitive treatment 31 Day Cancer Wait: Subsequent treatment (Surgery) 31 Day Cancer Wait: Subsequent treatment (Chemotherapy) 31 Day Cancer Wait: Subsequent treatment (Radiotherapy) 62 Day Cancer Wait: GP Referral 62 Day Cancer Wait: Screening service 62 Day Cancer Wait: Consultant Upgrade UCLH 92.2% 94.2% 96.3% 91.7% 93.8% 94.4% 94.7% 94.8% 93.3% 94.4% 92.5% 92.4% 93.2% 93.6% Whittington 93.2% 92.9% 94.1% 87.9% 94.5% 93.6% 90.6% 91.6% 86.4% 88.2% 88.2% 91.6% 94.9% 90.2% Barnet & Chase Farm 94.4% 93.4% 94.2% 92.1% 94.2% 94.1% 93.2% 91.7% 92.5% 92.6% North Middlesex 99.5% 94.4% 97.8% 90.5% 93.1% 85.7% 93.3% 95.0% 94.6% 93.6% 81.8% 93.1% 95.5% 93.0% Royal Free Hospital 95.2% 95.4% 97.1% 96.9% 99.1% 95.4% 98.9% 97.7% 97.6% 93.9% 94.5% 94.6% 98.0% 95.9% UCLH 95.7% 98.0% 95.4% 95.5% 97.5% 95.8% 98.7% 96.7% 96.1% 96.9% 94.1% 87.4% 90.0% 94.7% Whittington 92.4% 95.2% 87.0% 89.3% 92.5% 92.0% 80.5% 87.7% 83.3% 94.0% 94.0% 90.8% 97.1% 89.2% Barnet & Chase Farm 98.4% 99.1% 99.1% 98.3% 100.0% 100.0% 98.6% 100.0% 99.0% 100.0% 99.4% North Middlesex 98.8% 100.0% 98.4% 100.0% 100.0% 100.0% 100.0% 98.4% 100.0% 100.0% 100.0% 98.6% 97.5% 99.2% Royal Free Hospital 99.0% 98.0% 100.0% 96.9% 100.0% 99.0% 96.4% 98.0% 97.0% 97.8% 98.1% 98.6% 99.5% 98.2% UCLH 96.8% 98.5% 97.8% 96.8% 99.2% 98.2% 99.4% 95.9% 96.2% 96.9% 98.1% 91.0% 96.0% 96.2% Whittington 96.3% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 97.9% 99.6% Barnet & Chase Farm 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 95.8% 98.4% North Middlesex 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% Royal Free Hospital 100.0% 97.8% 100.0% 100.0% 100.0% 96.9% 100.0% 96.0% 97.1% 98.1% 98.0% 98.1% 100.0% 98.2% UCLH 95.7% 89.4% 98.2% 98.7% 98.3% 100.0% 100.0% 100.0% 90.5% 100.0% 100.0% 91.9% 97.8% 97.1% Whittington 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% Barnet & Chase Farm 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% North Middlesex 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% Royal Free Hospital 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% UCLH 99.4% 100.0% 100.0% 100.0% 100.0% 100.0% 99.5% 100.0% 99.5% 100.0% 100.0% 100.0% 98.8% 99.7% Whittington 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% Barnet & Chase Farm 100.0% North Middlesex 96.7% 100.0% 94.4% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% Royal Free Hospital 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% UCLH 100.0% 100.0% 100.0% 97.8% 100.0% 99.0% 99.1% 100.0% 98.1% 100.0% 100.0% 100.0% 100.0% 99.5% Whittington 100.0% 100.0% 100.0% 100.0% 100.0% Barnet & Chase Farm 86.4% 86.8% 85.3% 84.8% 85.7% 83.8% 83.1% 89.7% 75.0% 74.4% 42.9% 78.5% North Middlesex 83.0% 96.6% 98.0% 92.5% 86.8% 87.0% 85.0% 91.8% 89.6% 93.1% 87.2% 88.9% 91.3% 89.5% Royal Free Hospital 85.9% 85.5% 95.6% 85.7% 88.1% 86.1% 85.2% 90.9% 86.5% 90.3% 85.4% 79.7% 77.8% 83.3% UCLH 72.5% 85.5% 80.0% 75.0% 80.6% 74.4% 73.3% 69.2% 77.4% 71.3% 65.4% 65.0% 70.2% 70.1% Whittington 97.1% 73.2% 86.5% 79.1% 94.3% 91.1% 97.4% 88.4% 87.5% 77.4% 92.6% 91.1% 98.1% 91.2% Barnet & Chase Farm 86.5% 92.7% 95.0% 97.1% 96.8% 100.0% 89.7% 97.6% 100.0% 100.0% 80.0% 96.5% North Middlesex 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% Royal Free Hospital 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 75.0% 100.0% 100.0% 100.0% 95.0% 91.4% 84.6% 90.3% UCLH 100.0% 100.0% 50.0% 83.3% 83.3% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% Whittington 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% Barnet & Chase Farm 97.1% 100.0% 100.0% 93.9% 95.8% 88.4% 96.7% 95.0% 93.5% 97.6% 71.4% 94.5% North Middlesex 100.0% 95.2% 96.7% 92.9% 97.6% 97.8% 97.7% 97.7% 98.0% 100.0% 100.0% 90.0% 100.0% 98.1% Royal Free Hospital 100.0% 85.7% 57.1% 85.7% 81.8% 71.4% 50.0% 60.0% 66.7% 95.8% 91.3% 72.7% 97.9% 86.5% UCLH 100.0% 77.8% 85.7% 76.5% 50.0% 85.7% 62.5% 53.8% 75.0% 90.0% 100.0% 63.2% 96.7% 79.8% Whittington 100.0% 50.0% 100.0% 62.5% 81.8% 100.0% 0.0% 100.0% 100.0% 100.0% 100.0% 57.1% 73.3% 93% 96% 94% 98% 94% 85% 90% No Locally Agreed Threshold 7

8 NMUH is compliant for all cancer standards. Whittington Health met all cancer standards for the first time since 2013 in October. Royal Free London failed the 62 day standard for the first time due to the Barnet site performance. There were a large number of breaches in the urology tumour site (more than 50% of all urology patients breached). A large number of patients are recorded as having exceptionally complex diagnostic pathways, such that the standard could not be met even if admin/capacity breaches were to be avoided. The CSU analysis of breach reasons and 100+ day waits is in process. The Trust is attending regional Cancer Wait forums on best practice for patient tracking lists and inter provider transfers. At UCLH a reduction in clinic availability due to reduced breast CNS capacity will have caused sub-standard performance in the breast symptomatic standard. The 62 day urgent GP referral performance for October is the 11th consecutive month of performance below standard. As with previous months, this is caused by persistent issues with capacity, administrative issues and inter- trust transfer delays across a number of complex treatment pathways and tumour sites. The trust has provided Root Cause Analyses (RCA) of 62+ day waits to the Clinical Quality Review Group (CQRG) and is working with the CSU and NHSE specialised commissioning on the process. 8

9 Quality Haringey CCG wide - Acute Trust National Standard Quality Requirements Performance all providers (Where requirements are reportable CCG wide) KPI / Measure Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 YTD MRSA reported infections Zero tolerance C. Difficile reported infections Mixed Sex Accommodation (MSA) (Number of breaches) (VTE and Cancelled Operation reporting is only available at Trust level) Zero tolerance National Standards Quality Requirements at Trust Level, by month for Haringey CCG s Main Providers Theme KPI / Measure Provider Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 YTD Cancelled operations (Breaches of 28 day standard over number of cancelled operations) MRSA reported infections C. Difficile reported infections Mixed Sex Accommodation (MSA) (Number of breaches) VTE (% admitted patients assessed for VTE risk) Barnet & Chase Farm 81.3% 92.5% 88.2% 88.2% North Middlesex 100.0% 100.0% 100.0% 100.0% 100.0% Royal Free Hospital 100.0% 100.0% 98.4% 96.3% 97.2% 100% UCLH 92.7% 95.6% 93.3% 93.3% Whittington 100.0% 100.0% 100.0% 100.0% Barnet & Chase Farm North Middlesex Royal Free Hospital Zero RNOH tolerance UCLH Whittington Barnet & Chase Farm North Middlesex Royal Free Hospital UCLH Whittington Barnet & Chase Farm Royal Free Hospital North Middlesex UCLH Whittington Barnet & Chase Farm 95.6% 95.2% 95.1% 97.0% 97.3% 97.5% 92.4% 94.1% 96.0% 94.2% Royal Free Hospital 97.6% 97.4% 98.1% 98.5% 99.2% 95.7% 98.2% 98.7% 98.4% 97.6% 96.6% 96.9% 97.6% UCLH 95.4% 95.3% 96.6% 96.1% 95.2% 95.2% 96.3% 96.0% 96.0% 95.4% 94.4% 93.3% 95.2% Whittington 95.2% 95.5% 95.5% 96.5% 96.4% 95.5% 95.5% 95.4% 96.1% 95.9% 96.1% 96.6% 95.9% Zero tolerance 95% 9

10 NMUH initially reported 12 C. Diff cases that were deemed as lapses in care (source: NMUH Infection Prevention Control committee). Following additional support from HCCG on the documentation of 3 Root Cause Analyses, and review of these, the lapses in care cases were de-escalated. Therefore 9 lapses of care have been attributed to the Trust to date to mid-december with an annual target of 21. At Whittington Health increased episodes of hospital acquired Clostridium Difficile against the hospital s trajectory. At the December CQRG the hospital reported 13 cases. A further incident was reported late in December, the initial 72 hour report suggests there have been no lapses in care associated with this case. At UCLH Trust s validated position is reporting 4 C. Diff cases in October. The year-to-date from April 14 October 14 is 61 cases. The Trust s validated position is of reporting 4 C. Diff cases in October. The year-to-date from April 14 October 14 is 61 cases. Friends & Family Test Key Trustwide for the month of October NMUH Whittington UCLH Royal Free* A&E response rate 9.1% 17.5% 19.5% 40.20% A&E Score 89.59% 88.86% 91.4% 85.98% I/P response rate 34.4% 44.8% 23.6% 39.37% I/P score 95.81% 88.49% 97.52% 88.3% Lower than previous month Higher than previous month Less than 0.5% variation from last month * Royal Free London includes Barnet & Chase Farm for FFT At NMUH following poor performance of the FFT response rate in A&E from June 2014 October 2014, the Trust have informed the CQRG (15/12/2014) that the response rate for November 2014 has substantially improved to 28%. For November 2014 the Trust will meet the obligatory 15% CQUIN target. Safer Staffing at NMUH - there has been a decrease in the fill rate for Registered Staff both for day and night shifts and for night shifts for Care Staff was noted. This is the first month of deterioration and will be monitored. 10

11 Serious Incident Reports - North Middlesex University Hospital Key points to note The Trust reported 6 SIs in November, all of which were Grade 1 SIs The Trust has two open Grade 2 SIs that occurred prior to 2014/15. CCG Head of Quality and Performance has followed this up with the Trust s Associate Director of Governance and submission of evidence for completion of action plans for both SIs is awaited from the Trust 11

12 Mental Health Barnet Enfield and Haringey Mental Health Trust The waiting times standards described in phase two of 'Achieving Better Access to Mental Health Services' state that in 2015/16: 75% of people referred to the Improved Access to Psychological Therapies programme will be treated within 6 weeks of referral, and 95% will be treated within 18 weeks of referral. The IAPT service is on track to meet these targets. October shows an improvement with recovery at 42% against the end of year 50% target 12

13 Numbers of referrals waiting more than 28 days for a first appointment decreased between the quarters and continues to reduce.q2 reported an increase in overall waiting times; but (positively) a decrease in the number of patients who waited 28 days or more, for their first treatment, compared with Q1. There was an upward trend in the number of people moving off sick-pay from Q1 to Q2. 13

14 Community Health Services *The CCG is currently querying the reported level of District Nurse Face to Face contact recorded as visit achieved 14

15 Community Health Whittington Health Community Health Services wide Performance and Quality Metrics Theme KPI / Measure Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Adult Community Nursing : % of referrals responded to within 48 hours 100% 100% 100% 100% 100% 100% 90% Adult Community Matrons: % of patients on a Community Matron caseload who has received input within the past 12 weeks and has not attended A&E Adult Community Matrons: % of patients on a Community Matron caseload who has received input within the past 12 weeks and has not had an emergency hospital admission Adult Community Nursing: % of patients with venous leg ulcer able to be healed at 12 weeks with full compression therapy Adult Community Nursing: No. & % of patients with venous leg ulcerable to be healed at 24 weeks with full compression therapy Adult Community Nursing: 60% reduction of grade 3 and grade 4 pressure ulcers acquired whilst on the DN Caseload Access - Physiotherapy: % of urgent referrals seen within 5 working days 99% 99% 90% 92% 97% 90% 50% 57% 70% 50% 71% 90% 7% 22% 60% 100% 100% 100% 100% 100% 75% 90% Access - Physiotherapy: % of routine referrals seen within 8 weeks 96% 98% 87% 81% 87% 81% 90% Physiotherapy Outcomes: % patients whose ability to resume normal activities has increased Physiotherapy Outcomes: % patients whose confidence in their ability to manage/cope with your condition has increased Community Podiatry Outcomes: % of clients discharged have improved function and/or have been given skills to self-manage Community Podiatry Outcomes: % of long term clients who report symptom relief during treatment Child protection: % up to date with required Level 1 & 2 safeguarding Training Child protection: % up to date with required Level 3 safeguarding Training 89% 93% 80% 97% 97% 80% 90% 95% 80% 100% 100% 80% 98% 95% 96% 94% 94% 89% 80% 94% 94% 95% 97% 96% 96% 80% 15

16 NHS 111, Out of Hours and the London Ambulance Service The NHS 111 and BarnDoc out of ours service met all their targets in November and for year to date. LAS summary LAS Performance Dashboard Monthly Trajectory Nov 2014 Performance Year to Date Trajectory Year to Date Performance Red 1 Performance (8 minutes) 75% 75% 64.3% 73% 68.8% Red Red 2 Performance (8 minutes) 75% 75% 54.9% 49% 61.6% Red Cat A Performance (19 minutes) 95% 95% 89.2% 89% 93.2% Amber The LAS response times for Rd 1 and 2 improved in November compared to October but the targets are still being failed year to date. LAS performance improvement plans focus on staff recruitment. LAS have targeted for an additional 204 staff to join service in Q4. The expected international recruits for Q4 have increased and will they become operational within 3 weeks of arrival. 16

17 Analytics 13,000 12,000 A&E Attenders - All Providers A&E activity rose overall, as expected in November, although attendances are slightly below the long term monthly average of 11, ,000 TOTAL AE 10,000 Linear (TOTAL AE) All Emergency Admissions 2,100 1,900 1,700 1,500 1,300 NEL Admissions - All Providers TOTAL NEL Linear (TOTAL NEL) The graph to the left shows that the long term trend in Non Elective Admissions (NEL) is increasing over time. Terms of Reference for audits into both Paediatric and adult non elective admissions have been approved by Haringey and Enfield CCGs and have been submitted to the Trust. The audits are scheduled to commence at the end of January