AGENDA ITEM 11c.
GOVERNING BODY IN PUBLIC – PART I
ACUTE COMMISSIONING AND PERFORMANCE REPORT
Date of the meeting
Author
Sponsoring Board Member
Presented by
Purpose of Report
Recommendation
Reason for inclusion in Part II
Stakeholder Engagement
Previous GB / Committee/s,
Dates
04.08.2016
Emily Hughes, Head of Commissioning
Phil Read, Head of System Resilience
Robert Shaw, Joint Director of Acute Commissioning and
Contracting
Emily Hughes, Head of Commissioning
To provide an update regarding current performance
against key standards and QIPP progress.
The Governing Body is asked to Note the report.
N/A
Only relevant for GB Meeting reports
As outlined in the report.
Quality, Finance, Performance Committee
Monitoring and Assurance Summary
This report links to the
following Assurance Domains
•
•
•
•
•
•
•
Quality
Equality and Diversity
Engagement
Outcomes
Governance
Partnership-Working
Leadership
I confirm that I have considered the
implications of this report on each of the
matters below, as indicated:
All three Domains of Quality (Safety,
Quality, Patient Experience)
Board Assurance Framework / Risk
Register
Budgetary Impact
Legal / Regulatory
People / Staff
Financial / Value for Money / Sustainability
Information Management &Technology
Equality Impact Assessment
Freedom of Information
Any action required?
Yes
[e.g. ]
Yes
No
Detail in report
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



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Initials: EH & PR
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1.
Introduction
1.1
In its commissioning role, NHS Southend CCG continues to work with providers to
improve the delivery of services and their associated access and performance
standards.
1.2
This report updates the Governing Body on current acute NHS performance and the
actions we have taken with our partners to ensure delivery of key standards and
measures. It also highlights specific areas of concern and describes our mitigating
actions. Key areas of performance in summary;
o
o
o
o
Accident & Emergency (A&E) performance remains a significant risk with
performance below trajectory
Continued under performance on Cancer 62 Day standard, however achieved
Recovery Action Plan trajectory. NHS England & NHS Improvement have
escalated the three Mid & South Essex systems to an escalation meeting to
discuss recovery on the 27th July 2016.
Referral to Treatment performance below trajectory
Elective back log significantly below trajectory with independent sector
outsourcing slowing
2.
Report
2.1
Accident & Emergency
2.1.1
Southend University Hospitals NHS Foundation Trust (SUHFT) (A&E) performance
Year To Date (YTD) is lower than it was for the same period of 15-16. However as
we’d expect, YTD 16/17 remains consistently higher than Q3 and Q4 of 1516
(October 15 – March 16) but is not meeting the recovery trajectory. The Trust
remains full with bed occupancy constantly remaining beyond 100% during the last
month. Flow has been difficult to achieve due to;
•
Continued acuity of patients resulting in longer lengths of stay (Complex Frail
Elderly, Acute Respiratory conditions, Paediatrics has seen excessive
demand at times), continued high trauma cases (also impacting elective
activity). Length of stay currently in excess of 4 days.
•
Packages of Care both in terms of timing and availability (particularly large
double handed packages resulting in discharge delays, (note: delayed
transfers of care (DtoC) standard failed currently 2.98% (Improved position
from 4.5%) against national stretch target of 2.5%, recovery plan in
development. Significant challenges across both Essex & Southend in
delivering timely reablement. Patients are ‘exit blocked’ within both acute and
community settings awaiting reablement provision.
•
Access to Care Home / Nursing placement again resulting in delays in
discharge
2
•
2.1.2
95% std
Predicte
d
Attend
4Hr Breach
Performance
Apr-16
May-16
Jun-16
Qtr 1
∗
July-16 (@07.07.16)
8,234
8,838
8,523
25,59
1,031
1,036
1.102
3,169
87.48%
88.28%
87.07%
87.61%
2,089
280
86.60%
Year to date
27,68
3,449
87.11%
The recovery action plan for A&E continues to be delivered to achieve the September
16 agreed recovery date. *Position @ 7th July 2016
Apr
16
87.4
8
88.4
5
Actual
1617 Month
May
16
88.2
8
89.3
8
June
16
87.0
7
89.0
3
July
16
86.6
0
91.6
2
Aug
16
Sept
16
Oct
16
Nov
16
Dec
16
Jan
17
Feb
17
Mar
17
92.7
3
95.3
8
95.5
3
95.3
8
95.5
3
95.5
3
95.0
5
95.5
3
Year
to date
87.11
%
93.26
%
2.1.3
Staff vacancies remain a significant risk for the hospital to manage (RN
remains -200+ vacancies). A detailed Nursing / Medical recruitment program
is underway although the trust is currently circa 20 whole time equivalents
(wte) registered nurses behind trajectory. Current day to day pressures
requires staff to be redirected in accordance with acuity and demand tools
used by the trust to mitigate patient risks. High acuity continues to impact safe
staffing levels.
2.2
Referral to Treatment
2.2.1
SUHFT has not achieved aggregate compliance on the incomplete standard 90.81%
with 27,046 pathways of which 2,487 were over 18 weeks and 1 was over 52 weeks.
As above this position is at risk due to recent CQC inspection outcomes resulting in
significant Orthopedic elective position.
2.2.2
The backlog recovery continues to be significant challenge with the list remaining
around 1500 patients. This is despite 850+ patients (admitted and non-admitted)
being assessed and either dated within SUHFT or outsourced off the backlog.
1600
1400
1200
1000
800
600
400
200
0
Trajectory
Actuals
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2.3
Cancer
2.3.1
Challenges continue for both 31 Day Treatment / Treatment for surgery
and the operational 62 day cancer standard. (Below figures as of
06/07/2016)
Standard
93%
Ex Non
Cancer
Breast
93%
Southend
88% 
69% 
May
2016
2wk
wait
31 day
Subsequent
May
2016
Standard
Southend
96%
97% 
31 day 1st
Treatment
96%
31 day 1st
Treatment
(Drug)
96%
31 day 1st
Treatment
(Surgery)
96%
31 day 1st
Treatment
(Palliative)
96%
31 day 1st
Treatment
(Radio)
96%
31 day 1st
Treatment
(Other)
96%
98% 
100% 
97% 
100% 
100% 
100% 
31 day
Subsequent
(Drug)
98%
100% 
31 day
Subsequent
(Surgery)
94%
88% 
31 day
Subsequent
(Palliative)
96%
100% 
31 day
Subsequent
(Radio)
94%
100% 
62 Day
(standard)
62 Day
(Screening)
85%
58% 
90%
100% 
2.3.2 Delivery below the 31 day standards remain low volumes of patients with
decision to treat with Day Subsequent Treatment (Surgery): 7 out of 8 patients
were treated within 31 days.
2.3.3 62 Day Operational Standard: There are a number of on-going challenges with
delivering the 62 day standard. 18/31 patients were treated within the 62 days.
The issues remain the same as previously advised. The cancer breach numbers
remain low meaning a slight change in performance places performance at risk.
2.3.4 Cancer Performance High Level Observations:
•
As noted last month, there was high referral/treatment activity in March
and in contrast, some of the April activity levels were significantly low.
Activity spiked again in May for 2 week wait referrals which were
significantly higher than any month in 15/16 (600 referrals is approx. 37%
above the 15/16 average of 435.) It is also worth noting that February,
March, April and May have all been above the 15/16 average, which
highlights a continued increasing trend in activity.
•
Exhibited (non-cancer) breast symptoms activity is back in line with
average, however performance has dropped significantly below any month
in 15/16.
•
31 Day 1st treatment palliative activity remains low. So far in 16/17 there
has been 1 patient treated (average = 10) and 31 Day Subsequent activity
has increased since April but still remains low overall (drug, surgery &
radiotherapy in particular), performance has also increased.
•
62 day standard has not been achieved since June 2015. April had low
activity and May has increased back in line with average, however
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performance has dropped considerably to 58%.
2.4
QIPP – Joint Acute
2.4.1 Stroke – Early Supported Discharge – Remains on track for go live 1st August.
2.4.2 Integrated Diabetes Service for Adults – The new service will commence from
September 2016 with the following key elements: clinical leadership of consultant to
community teams (including presence at Multi Disciplinary Team discussions),
Educational intervention and co-location of podiatry with existing diabetes clinic
locations. The recruitment of a dietician will enable the Insulin pump service to
commence in October 2016.
2.4.3 MSK - The Physio Direct service is now in business as usual, with monthly monitoring
in place. Phase 1 of the CATS service has been formally commissioned within the
block contract. Phase 2 of the CATS service is on track to commence on 1st
September 2016. Phase 2 will see all MSK referrals directed via CATS regardless
of provider. Additional physiotherapists and administrative staff have been
recruited.
2.4.4 Ophthalmology - The re-commissioned Glaucoma Repeat Readings service is now
mandated by both commissioners and the Trust who are rejecting/redirecting referrals
to this service. The Shared Care Glaucoma service has mobilized, however the Trust
have not made many referrals. This has been escalated to the Trust Executive and a
tentative launch date of August agreed.
2.4.5 Follow Ups – Four specialties have been agreed with the Trust for a review of follow
up activity; Orthopaedics, General Surgery, Paediatric Ophthalmology and
Respiratory. The reviews are underway with clinical discussions across acute and
primary care being scheduled. Commissioners await financials from the Trust.
2.4.6 Urgent Care Pathway – Phase 1 of the new Navigation service launched on 4th July.
Phase 1 sees the redirection of non-urgent patients to alternative services such as
GP, Pharmacy, Dental or self care. Phase 2 is on track to commence in mid August.
All of the Navigator posts have been recruited to. The full service (Phase 3) is
expected to be in place in mid October 2016.
Author’s name and Title : Emily Hughes, Head of Acute Commissioning and
Contracting
Phil Read, Head of System Resilience
Date : 26.07.2016
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