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					Appendix 1 - NHS North Somerset - Quarterly Performance Framework Scorecard 2009/10

  Performance Area PCT Objectives                                             Indicators                                        Traffic Light      Traffic Light      Traffic Light     Traffic Light
                                                                                                                              Qtr 1 (Apr-June)   Qtr 2 (July-Sept)   Qtr 3 (Oct-Dec)   Qtr 4 (Jan-Mar)
  Delivering National Improve quality and earn autonomy by meeting necessary targets:
  Priorities          Delivering Key Priorities                            Delivery of Key Priorities (Key Priorities
                                                                           Scorecard)
                                                                                                                                  Amber


                       Care Quality Commission assessment                     Corporate Work Plan (Vital Sign indicators as
                                                                              subset)
                                                                                                                                  Amber


                                                                              World Class Commissioning / Standards for
                                                                              Better Health
                                                                                                                                   Green


                                                                              Value for money (auditor‟s Use of Resources
                                                                              assessment)
                                                                                                                                   Green


                       Staff Satisfaction                                     To be confirmed
                                                                                                                                 N/A in Q1


  Delivering Local     Meet our challenges through innovative service redesign Principal Objectives Work Plan
  Priorities                                                                                                                       Green

                       Reduce health inequalities and promote health and      Principal Objectives Work Plan
                       wellbeing                                                                                                  Amber

                       Be a competent commissioner                            Principal Objectives Work Plan
                                                                                                                                   Green

                                                                              Supporting Function Key Performance
                                                                              Indicators (KPIs)                                    Green

                       Ensure the development of a fit for purpose provider   Principal Objectives Work Plan
                       service                                                                                                     Green

                                                                              Provider Services Key Performance Indicators
                                                                              (KPI's)                                             Amber

                       Be a good partner to work with                         Principal Objectives Work Plan
                                                                                                                                   Green

  Delivering Quality   Clinical Quality                                       Key Performance Indicators (KPIs)
                                                                                                                                  Amber

                       Patient Experience                                     Key Performance Indicators (KPIs)
                                                                                                                                  Amber


                                                                                                                                                                                                   1 of 44
Appendix 2 - Key Priorities Scorecard 2009/10



                                                                                                                                                                                          Annual Health Check
                                                                                                                                                                                                                                      Plan/                                                                                            Direction of
                                                   Area                                                                   Performance indicator                         Target            Threshold to Achieve          Trust                      FY 08/09       Apr-09       May-09        Jun-09         Jul-09         YTD
                                                                                                                                                                                                                                      Actual                                                                                              Travel
                                                                                                                                                                                               (2008/09)
                                                                                                             18 week Referral to Treatment - Admitted            90%                     TBC                        NHS NS         N/A              93.7%         93.2%         93.5%         93.6%        90.9%          90.9%              i
                                                                                                             18 week Referral to Treatment - Non Admitted        95%                     TBC                        NHS NS         N/A              98.1%         98.4%         98.3%         98.8%        98.0%          98.0%              i
                                                                                                             18 week Referral to Treatment - Direct Access to
                                                                                                             Audiology
                                                                                                                                                              95%                        N/A                        NHS NS         N/A              99.5%         100.0%       100.0%         99.5%        99.5%          99.5%              o




                                                      No Delays
                                                                                                             18 week target: 6 week Diagnostic wait              100%                    N/A                        NHS NS         N/A              98.8%         99.3%         99.4%         99.4%        99.7%          99.7%              h
                                                                                                             13 week Referral to Treatment - Admitted            90%                     N/A                        NHS NS         N/A              83.3%         84.5%         85.5%         82.7%        80.5%          80.5%              i
                                                                                                             13 week Referral to Treatment - Non Admitted        95%                     N/A                        NHS NS         N/A              95.0%         96.5%         95.6%         96.2%        95.1%          95.1%              i
                                                                                                             No. of inpatients waiting longer than 6 months
                                                                                                             (26 weeks)
                                                                                                                                                                 0                       <=0.03%                    NHS NS         N/A                 0             0             0             0            0             0                o
                                                                                                             No. of outpatients waiting longer than 13 weeks     0                       <=0.03%                    NHS NS         N/A                 3             0             0             0            6             6                i




                                                   Primary

                                                   Access
                                                    Care
                                                                                                             GP Practices offering extended hours                50%                     TBC                        NHS NS         N/A               88%           88%           88%           92%           92%           92%               o

                                                                                                                                                                                                                                          2           12             1                                                       1
                                                                                                                                                                 SHA level                                                         Plan                                            0            0             0
                                                                                                             MRSA (Total) - Weston 1                                                     N/A                        Weston
                                                                                                                                                                 (SHA ambition)
                                                                                                                                                                                                                                   Actual              6             1             0            0             0              1               o
                                                      Hospital Cleanliness Acquired Infections (HCAI)


                                                                                                                                   1                             SHA level                                                         Plan2              23             2             2            1             1              6
                                                                                                             MRSA (Total) - UHB                                                          N/A                        UH Bristol
                                                                                                                                                                 (SHA ambition)
                                                                                                                                                                                                                                   Actual             14             0             0            3             2              5               h
                                                                                                                                   1                             SHA level                                                         Plan2              29             2             2            1             2              7
                                                                                                             MRSA (Total) - NBT                                                          N/A                        NBT
                                                                                                                                                                 (SHA ambition)
                                                                                                                                                                                                                                   Actual              9             4             1            4             3             12               h
                                                                                                                                                                                                                                   Plan               290           18            18            18            17            71
                                                                                                                                                                 SHA level (Vital
                                                                                                             C Diff (Total) - NHS North Somerset                                         TBC                        NHS NS
                                                                                                                                                                 Sign)
                                                                                                                                                                                                                                   Actual             215            9             4            10            10            33               o

                                                                                                                                                                 SHA level (Vital                                                  Plan               128            7             7             7            7             28
                                                                                                             C Diff (apportioned to acute trust) - Weston                                TBC                        Weston
                                                                                                                                                                 Sign)
                                                                                                                                                                                                                                   Actual             94             2             4            4             4             14               o
                                                                                                                                                                 SHA level (Vital                                                  Plan               305           21            18            15            12            66
                                                                                                             C Diff (apportioned to acute trust) - UHB                                   TBC                        UH Bristol
                                                                                                                                                                 Sign)
                                                                                                                                                                                                                                   Actual             286           17            11            12            11            51               h
                                                                                                                                                                 SHA level (Vital                                                  Plan               557           13            13            13            13            52
                                                                                                             C Diff (apportioned to acute trust) - NBT                                   TBC                        NBT
                                                                                                                                                                 Sign)
                                                                                                                                                                                                                                   Actual             204           18            16            10            15            59               i
                                                                                                                                                                                                                                                                                                                                             i
                                                   Accident and




                                                                                                                                                                                                                    Weston         N/A              97.8%         99.1%         98.9%         98.7%         98.0%         98.7%
                                                    Emergency




                                                                                                             % of A&E attendees seen within 4 hours (inc.
                                                                                                             partner orgs)
                                                                                                                                                                 98%                     >=98%                      UH Bristol     N/A              97.6%         98.1%         97.7%         99.2%         98.1%         98.3%              i
                                                                                                                                                                                                                    NHS NS         N/A              97.9%         98.9%         98.6%         98.8%         98.0%         98.6%              i
                                                                                                                                                                                                                    Weston                          0.74%          0.2%          0.2%         0.0%          0.4%          0.2%               i
                                                                                                             % of cancelled elective operations                  0.5%                    0.8%                       UH Bristol                      1.17%          0.7%          1.0%         1.1%          0.9%          0.9%               h
                                                      Elective Care




                                                                                                                                                                                                                    NBT                             1.35%          1.9%          2.4%         1.2%          1.3%          1.7%               i
                                                                                                                                                                                                                    Weston                          100.0%         100%         100%          100%          100%          100%               o
                                                                                                                                                                 100% of patients
                                                                                                             % of 28 day readmissions                            that are eligible for   95%                        UH Bristol                      90.1%         93.5%         97.4%         87.0%        94.0%          93.0%              h
                                                                                                                                                                 readmission
                                                                                                                                                                                                                    NBT 3                           87.3%         91.6%         80.9%         82.4%        74.2%          82.3%              i
                                                Times - GWAS




                                                                                                             % of category A calls attended within 8 minutes     75%                     75%                        GWAS                            68.4%         74.6%         75.7%         74.5%        71.4%          74.0%              i
                                                  Ambulance
                                                  Response




                                                                                                             % of category A calls attended within 19 minutes 95%                        95%                        GWAS                            93.9%         96.5%         96.8%         96.1%        95.9%          96.3%              i
                                                                                                             % of category B calls attended within 19 minutes 95%                        95%                        GWAS                            87.2%         91.9%         92.7%         92.0%        90.5%          91.8%              i
                                                                                                                                                                                                                    Weston                           100%          100%         100%          100%          100%          100%               o
                                                                                                             RACP clinic 2 week wait                             100%                    TBC                        UH Bristol                       100%          100%         100%          100%          100%          100%               o
                                                                                                                                                                                                                    NBT                              100%          100%         100%          100%          100%          100%               o
                                                                                                             CABGs > 3 mth wait                                  0                       <=0.5%                     NHS NS                             0             0             0             0            0              0               o
                                                      CHD




                                                                                                             PTCAs > 3 mth wait                                  0                       <=0.5%                     NHS NS                             0             0             0             0            0              0               o
                                                                                                                                                                                         Either greater than or    Weston                            TBC        No cases      No cases      No cases     No cases       No cases             o
                                                                                                                                                                                         equal to 68% or greater                                                                                           Not yet
                                                                                                             Thrombolysis (60mins call to needle time)           >=68%                   than or equal to 38% with UH Bristol                       76.9%       No cases      No cases      No cases
                                                                                                                                                                                                                                                                                                          available
                                                                                                                                                                                                                                                                                                                        No cases             o
                                                                                                                                                                                         a 20 percentage point                                                                                           No eligible
                                                                                                                                                                                         annual increase.          NBT                               TBC           50%         100.0%         0.0%
                                                                                                                                                                                                                                                                                                            pts
                                                                                                                                                                                                                                                                                                                           60%               i
                                                                                                                                                                                                                    Weston         N/A               97%5         96.9%         94.4%         97.3%        96.3%          96.2%              i

                                                                                                                                                                                         To be published in         UH Bristol     N/A               91%5         91.8%         91.8%         94.3%        94.7%          93.2%              h
                                                                                                             Urgent GP Referrals < 2 weeks                       93%
                                                                                                                                                                                         autumn 2009 (by CQC)4
                                                                                                                                                                                                                    NBT            N/A               94%5         91.0%         91.4%         94.4%        93.5%          92.6%              i
                                                                                                                                                                                                                    NHS NS         N/A               94%5         93.6%         93.1%         93.9%        94.7%          93.8%              h
                                                                                                                                                                                                                    Weston         N/A              100%5        100.0%        No data       No data       No data       100.0%              o

                                                                                                             Urgent GP Referrals < 2 weeks (breast                                                                  UH Bristol     N/A              No data      No data       No data       No data       50.0%          50.0%              o
                                                                                                                                                                 93%                     N/A
                                                                                                             symptoms) 6
                                                                                                                                                                                                                    NBT            N/A               92%5        No data       No data       No data       No data       No data             o
                                                                                                                                                                                                                    NHS NS         N/A               92%5        100.0%        No data       No data       No data       100.0%              o
                                                                                                                                                                                                                    Weston         N/A              97.7%5       100.0%        100.0%         97.9%        98.0%          99.0%              h

                                                                                                             Cancer: Diagnosis to treatment < 31 days (1st                               To be published in         UH Bristol     N/A              98.0%5        95.8%         97.8%         94.1%        96.5%          96.1%              h
                                                                                                                                                                 96%
                                                                                                             treatment)                                                                  autumn 2009 (by CQC)1
                                                                                                                                                                                                                    NBT            N/A              99.2%5        99.4%         95.3%         97.9%        96.4%          97.3%              i
                                                                                                                                                                                                                    NHS NS         N/A              98.4%5       100.0%        100.0%         97.4%        95.3%          98.2%              i
                                                                                                                                                                                                                    Weston         N/A                                                       100.0%        100.0%        100.0%              o

                                                                                                             Cancer: Diagnosis to treatment < 31 days
                                                                                                                                                                                                                    UH Bristol     N/A                                                        90.2%        97.8%          94.0%              h
                                                                                                                                                                 94%                     N/A
                                                                                                             (subsequent - Surgery)
                                                                                                                                                                                                                    NBT            N/A                                                        98.5%        96.4%          97.5%              i
                                                                                                                                                                                                                    NHS NS         N/A              98.0%         95.2%        100.0%         95.5%        100.0%         97.7%              h
                                                      Cancer Waiting Times




                                                                                                                                                                                                                    Weston         N/A                                                       100.0%        100.0%        100.0%              o

                                                                                                             Cancer: Diagnosis to treatment < 31 days
                                                                                                                                                                                                                    UH Bristol     N/A                                                        98.3%        100.0%         99.2%              h
                                                                                                                                                                 98%                     N/A
                                                                                                             (subsequent - Drug treatment)
                                                                                                                                                                                                                    NBT            N/A                                                       100.0%        100.0%        100.0%              o
                                                                                                                                                                                                                    NHS NS         N/A              100.0%       100.0%        100.0%        100.0%        100.0%        100.0%              o
                                                                                                                                                                                                                    Weston         N/A                N/A          N/A           N/A           N/A           N/A           N/A              N/A

                                                                                                             Cancer: Diagnosis to treatment < 31 days
                                                                                                                                                                                                                    UH Bristol     N/A                                                        97.2%        98.3%          97.8%              h
                                                                                                                                                                 94%                     N/A
                                                                                                             (subsequent - Radiotherapy) 6
                                                                                                                                                                                                                    NBT8           N/A                                                       100.0%          N/A         100.0%              i
                                                                                                                                                                                                                    NHS NS         N/A              100.0%       100.0%        100.0%        100.0%        100.0%        100.0%              o
                                                                                                                                                                                                                    Weston         N/A              94.2%5        97.7%         92.3%         90.8%        88.5%          92.3%              i

                                                                                                             Cancer: Urgent Referrals to treatment < 62 day -                            To be published in         UH Bristol     N/A              83.2%5        83.0%         79.6%         69.7%        76.2%          77.1%              h
                                                                                                                                                              85%
                                                                                                             GP                                                                          autumn 2009 (by CQC)4
                                                                                                                                                                                                                    NBT            N/A              89.9%5        90.2%         90.7%         93.1%        90.1%          91.0%              i
                                                                                                                                                                                                                    NHS NS         N/A              89.6%5        93.5%         82.9%         92.9%        91.7%          90.3%              i
                                                                                                                                                                                                                    Weston         N/A             100.0%5       100.0%        100.0%        100.0%        90.0%          97.5%              i

                                                                                                             Cancer: Urgent Referrals to treatment < 62 day
                                                                                                                                                                                                                    UH Bristol     N/A              76.5%5        25.0%         85.0%         96.3%        86.7%          73.3%              i
                                                                                                                                                                 90%                     N/A
                                                                                                             screening service
                                                                                                                                                                                                                    NBT            N/A             100.0%5        96.2%         95.0%         94.1%        80.0%          91.3%              i
                                                                                                                                                                                                                    NHS NS         N/A              80.0%5       100.0%        100.0%        100.0%        92.3%          98.1%              i
                                                                                                                                                                                                                    Weston         N/A             100.0%5       100.0%        100.0%         87.5%        No data        95.8%              o
                                                                                                                                                                 90% - interim
                                                                                                             Cancer: Urgent Referrals to treatment < 62 day                                                         UH Bristol     N/A             100.0%5        87.5%        100.0%        100.0%        88.9%          94.1%              i
                                                                                                                                                                                         N/A
                                                                                                             consultant upgrade 9                                TBC (by DH) 7
                                                                                                                                                                                                                    NBT            N/A             100.0%5       100.0%        100.0%         85.7%        100.0%         96.4%              h
                                                                                                                                                                                                                    NHS NS         N/A             100.0%5       100.0%        100.0%         75.0%        100.0%         93.8%              h
                                                                                                                                                                 National level (Vital                                             Plan              1285           103           88           113            97           401
                                                      Health Inequalities




                                                                                                             Smoking cessation                                                         Perf consistent with plan    NHS NS
                                                                                                                                                                 Sign)                                                             Actual     10     1304           67           88            108           91            355               i
                                                                                                                                                                 National level (Vital                                             Plan              3396           515          451           459           445          1870
                                                                                                             Chlamydia screening (numbers screened)                                    Perf consistent with plan    NHS NS
                                                                                                                                                                 Sign)                                                             Actual            3403          343           304           347           412          1406               h
                                                                                                             Access to GUM Clinic - Appt. offered within
                                                                                                             48hrs
                                                                                                                                                                 100%                    100%                       NHS NS         N/A              100.0%        100.0%       100.0%        100.0%        100.0%        100.0%              o
                                                                                                             Access to GUM Clinic - seen within 48hrs            95%                     95%                        NHS NS         N/A              81.8%         81.7%         81.8%         86.0%        82.9%          83.1%              i
                                                         Financial
                                                         Balance




                                                                                                             Achieve set control total                           Breakeven               Breakeven                  NHS NS         N/A             Breakeven    Breakeven     Breakeven     Breakeven    Breakeven     Breakeven             o
                                                and Book
                                                 Patient
                                                 Choice




                                                                                                             Choice and Book Utilisation                         90%                     90%                        NHS NS         N/A              74.6%         97.0%         91.0%         85.0%        94.0%          91.8%              h


                                                      h                                                      Denotes an improvement in performance
                                                      i                                                      Denotes a drop in performance
                                                      o                                                      Denotes consistency in performance

                                                  Note:                                                      For some targets data can be subject to change retrospectively (e.g. 28 day readmissions) due to data validation exercises post submission.

                                                                                                         1
                                                                                                             The HPA has stopped giving a pre/post 48hr split for MRSA, hence all numbers are trust 'totals'. These are also Trust totals are not a NS PCT proportion
                                                                                                         2
                                                                                                             Note that these plan figures relate to post 48 hour infection whereas the actuals currently relate to total infections
                                                                                                             Please note that the 28 readmissions data for NBT is subject to change monthly. This is because the underlying data for readmissions is constantly being refreshed. Only patients with a confirmed new date within 28 days are
                                                                                                         3
                                                                                                             included.
                                                                                                         4
                                                                                                             Care Quality Commission
                                                                                                         5
                                                                                                             Q4 in 2008/9 only
                                                                                                         6   These indicators go 'live' in January 2009. Data is currently being collected but in some cases in not yet robust. The Provider Trusts are currently trying to work out how to collect the data for this target as efficiently as possible
                                                                                                             by January
                                                                                                         7
                                                                                                             Department of Health
                                                                                                         8
                                                                                                             NBT mistakenly entered figures for radiotherapy in June (1 pt). The Trust does not provide radiotherapy services and this error is currently being rectified.
                                                                                                             An operational standard for the commitment of a maximum wait of 62 days for first treatment for those patients who are upgraded with a suspicion of cancer by the consultant responsible for their care has not been provided
                                                                                                             by the DH. This is because not enough patients have benefited from the implementation of this service yet to provide enough data for a robust calculation of an operational standard. This work will be undertaken as soon as
                                                                                                         9
                                                                                                             this is possible. In the meantime the PCT is following the approach taken by the SHA and local cancer network and assigning an interim threshold of 90%, similar to the screening target
                                                                                                             The monthly smoking figures for Apr-June have been updated in line to reflect the Q1 position as per the Stop Smoking Services Return. This includes quitters whose forms would have not have been processed in time for
                                                                                                        10
                                                                                                             inclusion in the monthly figures.




                                                                                                                                                                                                                                                                                                                                                          2 and 44
        Appendix 3 - Periodic Review Indicators 2009/2010 - Q1 (Apr-Jun) self assessment

PCT Indicator                                                  Indicator Description                                        Lead Director      Lead Manager     2009/10 Planned   Action    Monitoring     AHC thresholds to achieve Apr-09        May-09    Jun-09     YTD        POINTS   On target to     Commentary
                                                                                                                                                                 Performance      Plan?     frequency      2008/9 (where published)                                                         deliver?
                                                                                                                                                                                  (Y/N)

EXISTING COMMITMENT INDICATORS

Access to GUM clinics                                          Percentage: first attendances at a GUM service who were      Max Kammerling     Ginette Corr          100%              N       Monthly     Not yet published              100.0%    100.0%     100.0%     100%        3        Achieved
                                                               offered an appointment to be seen within 48 hours of
                                                               contacting a service
Category A (8 and 19 minutes) and category B ambulance         % Response times Cat A8                                      Jeanette George    Caerrie Barber        75%               Y       Monthly     achieve - Greater than or      74.6%      75.7%     74.5%      74.9%       2      Underachieved   Gloucester PCT as lead PCT has set up regular meetings (Contract, commissioning and quality meetings) around the GWAS
response times                                                                                                                                                                                             equal to 75%                                                                                      contract to ensure improvement in response times. Work is being undertaken to review the current model to ensure efficient use
                                                                                                                                                                                                           underachieved - Greater than                                                                      of staffing. Commissioners are arranging Ride along with GWAS staff to review policy in the community. C Barber reviewing CAT
                                                                                                                                                                                                           or equal to 70%                                                                                   C response to increased use of appropriate alternative responses such as NHS Direct.
                                                                                                                                                                                                           failed - Less than 70%
                                                               % Response times Cat A19                                     Jeanette George    Caerrie Barber        95%          Y         Monthly        achieved - Greater than or     96.5%      96.8%     96.1%      96.5%       3        Achieved
                                                                                                                                                                                                           equal to 95%
                                                                                                                                                                                                           underachieved - Greater than
                                                                                                                                                                                                           or equal to 90%
                                                                                                                                                                                                           failed - Less than 90%


                                                               % Response times Cat B19                                     Jeanette George    Caerrie Barber        95%               Y       Monthly     achieved - Greater than or     91.9%      92.7%     92.0%      92.2%       2      Underachieved
                                                                                                                                                                                                           equal to 95%
                                                                                                                                                                                                           underachieved - Greater than
                                                                                                                                                                                                           85%
                                                                                                                                                                                                           failed - Less than 85%




Commission of crisis resolution / home treatment services      Number of separate episodes of home treatment provided Jeanette George          Julie Kell            294               N       Quarterly   Statistical banding                                   85           85      3        Achieved
                                                               by crisis resolution teams.
Early intervention in psychosis                                Number of people with newly diagnosed cases of first        Jeanette George     Julie Kell             22               N       Quarterly   Statistical banding                                   3            3       3        Achieved      This is the same Q1 figure as 2008/9. The PCT achieved by year end in 2008/9 hence a rating of achieved has been assigned.
                                                               episode psychosis receiving early intervention in psychosis
                                                               services
Data quality on ethnic group                                   Construction to be confirmed in release of 0708 ratings.     Mary Hutton        Sarah Foster                            N        Annual     achieved - Greater than or                                                 3        Achieved
                                                                                                                                                                                                           equal to 85%
                                                                                                                                                                                                           underachieve - Less than or
                                                                                                                                                                                                           equal to 60%
                                                                                                                                                                                                           fail - Less than 60%
Delayed transfers of care                                      Percentage of patients occupying an acute bed whose          Jeanette George    Clare-Louise          TBC               N       Quarterly   Not yet published                                     5            5       3        Achieved      Less than Q1 in 2008/9
                                                               transfer of care was delayed                                                    Nicholls
Diabetic retinopathy screening                                 Percentage of people with diabetes offered screening for      Jeanette George     Angela Kell        >90%               N       Quarterly   achieved - Greater than or                          115%       115%        3        Achieved      Green based on Q1 performance. Assurances received from NHS Bristol around management cover for this area. Weekly and
                                                               the early detection of diabetic retinopathy                                                                                                 equal to 95%                                                                                      monthly reports being received from the service. One point to note - PCT must not have more pts offered appointments than
                                                                                                                                                                                                           underachieved - Greater than                                                                      those with diabetes per quarter or they could fail in the Periodic Review
                                                                                                                                                                                                           or equal to 90%
                                                                                                                                                                                                           failed - Less than 90%




Inpatients waiting longer than the 26 week standard            Percentage of inpatients waiting a maximum of 26 weeks       Jeanette George    Alan Lawler          <0.03%             N       Monthly     achieve - less than or equal   0.0%       0.0%       0.0%      0.0%        3        Achieved
                                                                                                                                                                                                           0.03%
                                                                                                                                                                                                           underachieve - less than or
                                                                                                                                                                                                           equal to 0.15%
                                                                                                                                                                                                           fail - greater than 0.15%
Outpatient waiting longer than the 13 week standard            Percentage of outpatients waiting a maximum of 13 weeks Jeanette George         Alan Lawler          <0.03%             N       Monthly     achieve - less than or equal   0.0%       0.0%       0.0%      0.0%        3        Achieved
                                                                                                                                                                                                           0.03%
                                                                                                                                                                                                           underachieve - less than or
                                                                                                                                                                                                           equal to 0.15%
                                                                                                                                                                                                           fail - greater than 0.15%
Patients waiting longer than the three months (13 weeks) for   Percentage of patients waiting over 13 weeks for a CABG      Jeanette George    Alan Lawler          <0.03%             N       Monthly     achieve - less than or equal   0.0%       0.0%       0.0%      0.0%        3        Achieved
revascularisation                                              or a PTCA                                                                                                                                   0.5%
                                                                                                                                                                                                           underachieve - less than or
                                                                                                                                                                                                           equal to 1.0%
                                                                                                                                                                                                           fail - greater than 1.0%
Time to reperfusion for patients following a heart attack      New target - to be confirmed by DoH. Is this thrombolysis.   Jeanette George    Clare-Louise         >=68%             TBC                  achieve - greater than or                                                  3        Achieved      This is still based on thrombolysis - impacted by small numbers. PCT was not been assessed against this indicator in 2007/8 or
                                                                                                                                               Nicholls                                                    equal 68%                                                                                         2008/9 due to low numbers. The 2009/10 indicator is still under development by the Care Quality Commission.
                                                                                                                                                                                                           underachieve - greater than
                                                                                                                                                                                                           or equal to 48%
                                                                                                                                                                                                           fail - less than 48%




Total time in A&E                                              Percentage of patients waiting a maximum of 4 hours in       Jeanette George    Tim Wye               98%               N       Monthly     achieved - Greater than or     98.9%      98.6%     98.8%      98.8%       3        Achieved      Weekly A&E monitoring taking place - looking at all trusts performance. GP in Urgent Care and GP Led Health Centre started
                                                               A&E from arrival to admission, transfer or discharge                                                                                        equal to 98%                                                                                      April 09 - this should have an impact on reducing A&E attendances in Weston.
                                                                                                                                                                                                           underachieved - Greater than
                                                                                                                                                                                                           or equal to 97%
                                                                                                                                                                                                           failed - Less than 97%




                                                                                                                                                                                                                                                                                                                                                                                                                            3 of 44
        Appendix 3 - Periodic Review Indicators 2009/2010 - Q1 (Apr-Jun) self assessment

PCT Indicator                                                      Indicator Description                                         Lead Director     Lead Manager   2009/10 Planned     Action   Monitoring     AHC thresholds to achieve Apr-09      May-09     Jun-09       YTD          POINTS   On target to     Commentary
                                                                                                                                                                   Performance        Plan?    frequency      2008/9 (where published)                                                            deliver?
                                                                                                                                                                                      (Y/N)

EXISTING COMMITMENT INDICATORS

NATIONAL PRIORITY INDICATORS                                                                                                                                                                                                                                                                40    Fully Met

18 week referral to treatment times*                               Percentage of patients waiting 18 weeks or less for a         Jeanette George   Alan Lawler          90%                N      Monthly     Not yet published            93.2%      93.5%      93.6%        93.5%         3        Achieved      Please note, in the CQC Periodic Review PCTs will be assessed against 18 week performance against 90% (admitted pts) and
                                                                   admitted pathway                                                                                                                                                                                                                                95% (non-admitted) thresholds. They will also be assessed based on no. of treatment functions achieving these standards. Exact
                                                                   Percentage of patients waiting 18 weeks or less for a non     Jeanette George   Alan Lawler          95%                N      Monthly                                  98.4%      98.3%      98.8%        98.3%                                thresholds for this are yet to be confirmed. The CQC expects that treatment functions with low numbers will be excluded from the
                                                                   admitted pathway                                                                                                                                                                                                                                assessment. For NHS NS this includes neurosurgery where performance is below the 90% standard for admitted pts in Apr, May
                                                                   Direct access to audiology                                    Jeanette George   Alan Lawler          95%                N      Monthly                                  100.0%    100.0%      99.5%       100.0%                                and July. Trauma and Orthopaedics is the main risk area for the PCT in terms of meeting the 90% and 95% standards each
                                                                                                                                                                                                                                                                                                                   month, along with 'Other' for admitted pts. The performance team are currently investigating if 'other' will count as a treatment
                                                                                                                                                                                                                                                                                                                   function.

Access to Primary Dental Services*                                 Number of patient receiving NHS primary dental services       Jeanette George   Maxine             118,332              Y      Quarterly   Not yet published                                  114074                     2      Underachieved   Rated amber based on revised trajectory of for 2009/10 (118,332) Performance has improved since March 2009 but still remains
                                                                   locatecd within the PCT area within a 24 month period                           Quantril                                                                                                                                                        below target. The PCT resubmitted its plan figures for 2009/10 in July as part of a national exercise. Several contractors across
                                                                                                                                                                                                                                                                                                                   North Somerset have increased their contracted units of dental activity to provide approximately an additional 15,000 units of
                                                                                                                                                                                                                                                                                                                   dental activity by 31st March 2009. This additional level of activity will continue into 09/10 to maintain steady rise in patients seen.

Cancer: Urgent GP Referrals < 2 weeks                              Cancer: Urgent GP Referrals < 2 weeks                         Mary Hutton       TBC                  93%                N      Monthly                 93%               94%        93%        94%         94%           3        Achieved




Cancer: Urgent GP Referrals < 2 weeks (breast symptoms)            Cancer: Urgent GP Referrals < 2 weeks (breast symptoms) Mary Hutton             TBC                  93%                N      Monthly     N/A - no longer 2008/9 AHC   100%      No data    No data       100%
                                                                                                                                                                                                                        indicator



Cancer: Diagnosis to treatment < 31 days (1st treatment)           Cancer: Diagnosis to treatment < 31 days (1st treatment)      Mary Hutton       TBC                  96%                N      Monthly                 96%              100%       100%        97%         99%           3        Achieved

Cancer: Diagnosis to treatment < 31 days (subsequent treatment -   Cancer: Diagnosis to treatment < 31 days (subsequent          Mary Hutton       TBC                  94%                N      Monthly     N/A - no longer 2008/9 AHC    95%       100%        96%         97%
surgery)                                                           treatment - surgery)                                                                                                                                   indicator
Cancer: Diagnosis to treatment < 31 days (subsequent treatment -   Cancer: Diagnosis to treatment < 31 days (subsequent          Mary Hutton       TBC                  98%                N      Monthly     N/A - no longer 2008/9 AHC   100%       100%       100%         100%
drug treatment)                                                    treatment - drug treatment)                                                                                                                            indicator
Cancer: Urgent Referrals to treatment < 62 day - GP                Cancer: Urgent Referrals to treatment < 62 day - GP           Mary Hutton       TBC                  85%                N      Monthly                   85%            94%        83%        93%          90%           3        Achieved
Cancer: Urgent Referrals to treatment < 62 day - screening         Cancer: Urgent Referrals to treatment < 62 day - screening    Mary Hutton       TBC                  90%                N      Monthly     N/A - no longer 2008/9 AHC   100%       100%       100%         100%
service                                                            service                                                                                                                                                indicator
Cancer: Urgent Referrals to treatment < 62 day - consultant        Cancer: Urgent Referrals to treatment < 62 day - consultant   Mary Hutton       TBC                  TBC                N      Monthly     N/A - no longer 2008/9 AHC   100%       100%        75%         92%
upgrade                                                            upgrade                                                                                                                                                indicator
All age all cause mortality*                                       A wide gap in life expectancy between the least and most      Max Kammerling    Mary Hart          2009:                N      Annualy     Statistical banding                                                           3        Achieved      Annual Data
                                                                   deprived 20% of the population. The PCT intends to focus                                         Males - 585
                                                                   its efforts on reducing this variation.                                                         Females - 435
Commissioning a comprehensive child and adolescent mental          Has a full range of Child and Adolescent Mental Health        Max Kammerling    Dali                  4                 N      Quarterly   Not yet published                                 Level 3                     3        Achieved      PCT will be assessed against this indicator in Q3 (Dec). Thresholds will not be known until October (whether or not we'll be
health service (CAMHS)*                                            Services (CAMHS) for children and young people with                             Sidebottom                                                                                                                                                      measured against our VS trajectory is not clear). Rated as achieved at present until thresholds are known. Performance team
                                                                   learning disabilities been commissioned? (Scale 1-4)                                                                                                                                                                                            liasing with lead to establish if action plan is required

                                                                   Do 16 and 17 year olds who require mental health services Max Kammerling        Dali                  4                 N      Quarterly   Not yet published                                 Level 4
                                                                   have access to services and accommodation appropriate                           Sidebottom
                                                                   to their age and level of maturity? (Scale 1-4)

                                                                   Are arrangements in place to ensure that 24 hour cover is     Max Kammerling    Dali                  3                 N      Quarterly   Not yet published                                 Level 3
                                                                   available to meet urgent mental health needs of children                        Sidebottom
                                                                   and young people and for a specialist mental health
                                                                   assessment to be undertaken within 24 hours or the next
                                                                   working day where indicated? (Sc
                                                                   Is a full range of early intervention support services        Max Kammerling    Dali                  4                 N      Quarterly   Not yet published                                 Level 3                                            PCT will be assessed against this indicator in Q3 (Dec). Thresholds will not be known until October (whether or not we'll be
                                                                   delivered in universal settings and through targeted                            Sidebottom                                                                                                                                                      measured against our VS trajectory is not clear). Rated as achieved at present until thresholds are known. Performance team
                                                                   services for children experiencing mental health problems                                                                                                                                                                                       liaising with lead to establish if action plan is required
                                                                   commissioned by the Local Authority and PCT in
                                                                   partnership? (Scale 1-4)
Incidence of Clostridium difficile*                                Number of CDiFF infections in the period                  Julie Clatworthy Suzanne                   207                Y      Monthly     Statistical banding            9          4          10             23        3        Achieved
                                                                                                                                              Golding-Ellis
NHS Staff satisfaction*                                            NHS staff surbey based measures of job satisfaction       Madeline Vaughan Marcus Ede                3.49               N       Annual     Statistical banding                                                           2      Underachieved   Annual Data. Rated as amber to be prudent
                                                                   survey
Number of drug users recorded as being in effective treatment*     The percentage change in the number of drug users using Jeanette George    Julie Kell              4% (666)             N      Quarterly   Statistical banding                                Not yet                    3        Achieved      Will achieve in 2008/9 AHC.
                                                                   crack and/or opiates recorded as being in structured drug                                                                                                                                    available
                                                                   treatment in a financial year who were discharged from
                                                                   treatment after 12 weeks or more, or who were discharged
                                                                   from treatment in a care plan


Prevalence of breastfeeding at 6-8 weeks from birth: data          Percentage of infants breastfed at 6-8 weeks                  Max Kammerling    Ginette Corr   - 90.2% coverage         Y      Quarterly   Not yet published                                   40%          40%          2      Underachieved   This target is rated as underachieved based on knowledge that there are currently staffing issues with health visitors. This has
completeness                                                       Percentage coverage                                                                            - 40.7% breastfed                                                                            prevelance   prevelance                             inevitably had a knock on affect for the return of completed forms for 6-8 week breastfeeding status (they are responsible for
                                                                                                                                                                                                                                                                  79%          79%                                 completing the forms that are then sent on to the child health analyst team in Bristol). Q1 data shows the PCT as achieving on
                                                                                                                                                                                                                                                                coverage     coverage                              prevalence but not against coverage. The DH's data completeness check was failed in Q1 (whereby there must be less than 15%
                                                                                                                                                                                                                                                                                                                   of unknown status's i.e. mothers who don't attend the 6-8 wk check or where the status is not recorded on the form). The
                                                                                                                                                                                                                                                                                                                   performance team have been advised that the VSMR can be resubmitted in December, with robust rationale. Figures for breast
                                                                                                                                                                                                                                                                                                                   feeding are rerun on a weekly basis and the Q1 position has improved significantly with coverage almost on plan.

                                                                                                                                                                                                                                                                                                                   Actions to improve performance include:
                                                                                                                                                                                                                                                                                                                   SLA is being developed to create a 24 hour telephone buddy support service
                                                                                                                                                                                                                                                                                                                   New Breastfeeding Lead has commenced she is responsible for:
                                                                                                                                                                                                                                                                                                                   - updating local action plan
                                                                                                                                                                                                                                                                                                                   - developing local network
                                                                                                                                                                                                                                                                                                                   - improving data collection
                                                                                                                                                                                                                                                                                                                   - developing local action plan
                                                                                                                                                                                                                                                                                                                   - working towards BFI status




                                                                                                                                                                                                                                                                                                                                                                                                                                         4 of 44
       Appendix 3 - Periodic Review Indicators 2009/2010 - Q1 (Apr-Jun) self assessment

PCT Indicator                                               Indicator Description                                        Lead Director     Lead Manager   2009/10 Planned    Action   Monitoring     AHC thresholds to achieve Apr-09              May-09     Jun-09         YTD     POINTS   On target to     Commentary
                                                                                                                                                           Performance       Plan?    frequency      2008/9 (where published)                                                                 deliver?
                                                                                                                                                                             (Y/N)

EXISTING COMMITMENT INDICATORS

Teenage pregnancy rates per 1,000 females aged 15-17        Conception rate per 1000 females ages 15-17                  Max Kammerling    Ginette Corr        2008:              Y       Annual     achieved - Performance                                   Rate of 33.9              0          Failed      Red based on 2008/9 performance.
                                                                                                                                                            22.1% or 79                              consistent with plan                                      against FY
                                                                                                                                                                                                     underachieved -                                           2008 rate                                       Actions to achieve include:
                                                                                                                                                                                                     Performance poorer than                                  plan of 22.1                                     - Recruit additional nurse support to offer an outreach service to very vulnerable groups - Awaiting OPP process 50% of funding
                                                                                                                                                                                                     plan                                                                                                      awarded - recruitment process due to start July 09.
                                                                                                                                                                                                     failed - Performance poorer                                                                               - Recruit full time teenage parent coordinator/project worker - Developing an advert for recruitment process has started.
                                                                                                                                                                                                     than plan by a clear margin                                                                               - Offer a No Worries clinic to all secondary schools in North Somerset - included in Specialist Public Health Nursing Service Spec -
                                                                                                                                                                                                                                                                                                               recruitment process has started.
                                                                                                                                                                                                                                                                                                               - Include condom distribution in the pharmacy locally enhanced scheme - Draft LES developed, awaiting pharmacists to complete
                                                                                                                                                                                                                                                                                                               CRB process

Chlamydia screening (as a proxy for chlamydia prevalence)   Percentage of 15 - 24 year old persons screened or tested Max Kammerling       Ginette Corr         25%               Y      Monthly     Not yet published                  343        304        347              994      0          Failed      994 vs plan of 1425 to June hence currently rated as failed. In the Periodic Review (replaces annual health check) PCT's are
                                                            for Chlamydia                                                                                                                                                                                                                                      assessed against plan.

                                                                                                                                                                                                                                                                                                               Actions to improve performance July-Sept include (updated from G Corr):
                                                                                                                                                                                                                                                                                                               - Temi will write to all existing GP practices with a LES and provide them with an update on their activity and encourage them to
                                                                                                                                                                                                                                                                                                               write to their patients to actively promote the programme
                                                                                                                                                                                                                                                                                                               - Temi write to all practices that have not got a LES to offer them a lunch time promotional session including lunch (this will be
                                                                                                                                                                                                                                                                                                               delivered by Karl and Temi)
                                                                                                                                                                                                                                                                                                               - Now our funding has been agreed Temi will work with Karl to initiate the pharmacy LES which includes chlamydia screening
                                                                                                                                                                                                                                                                                                               testing and treatment (we have a number of pharmacies that have completed their training and have obtained CRB clearance)
                                                                                                                                                                                                                                                                                                               - School Nursing Team will commence Chlamydia screening alongside the HPV programme in September
                                                                                                                                                                                                                                                                                                               - We are exploring the idea of having a sexual health awareness bus campaign for work places which will include chlamydia
                                                                                                                                                                                                                                                                                                               screening – this will be delivered by our new outreach nurse, Temi and Karl
                                                                                                                                                                                                                                                                                                               - Temi will work with the No Worries service to agree stretch targets – these will be incentivized in a similar way to the GP LES
                                                                                                                                                                                                                                                                                                               - I have asked Liz Lansley (health in the workplace lead) to liase with our communication team and NSC communication team re
                                                                                                                                                                                                                                                                                                               putting an advertisement promoting the programme in staff newsletters
                                                                                                                                                                                                                                                                                                               - Temi to widely disseminate posters advertising the programme
                                                                                                                                                                                                                                                                                                               - Temi to explore local media advertising opportunities – including the possibility of a bus campaign
                                                                                                                                                                                                                                                                                                               - During September Karl and his team will be systematically visiting classrooms at the college to promote the programme



Childhood obesity rate                                      % weighed and measured in year 6                             Max Kammerling    Dali           14.9% prevalence        N       Annual     Performance against plan. 2                                                        2      Underachieved   This has been flagged up as a risk with the SHA and the PCT is investigating if it can revise it's 2008/9 plan figures: In 2009/10
                                                                                                                                           Sidebottom      86% coverage                              standards deviations                                                                                      (assuming the Care Quality Commission continues to use the same methodology as the HC) we will be assessed against 2008/9
                                                                                                                                                                                                                                                                                                               actuals vs plan for obesity. Our 2008/9 plan figures are based on baseline data from 2006/7 which was not robust due to poor
                                                                                                                                                                                                                                                                                                               coverage for Yr 6 in particular. As a result we could be at risk of not achieving the indicator as coverage, and subsequently
                                                                                                                                                                                                                                                                                                               prevalence, has increased since the plans were set. Our actual prevalence performance in 2007/8 for Yr 6 increased to 16.77%
                                                                                                                                                                                                                                                                                                               from 13.85% in 2006/7, an increase of almost 3%. Our Yr 6 plan for 2008/9 is set at 14.90% and we have not been allowed to
                                                                                                                                                                                                                                                                                                               revise it using 2007/8 actuals. Now that participation levels are higher we would reasonably expect that prevalence in 2008/9 will
                                                                                                                                                                                                                                                                                                               again to show an increase and subsequently make it virtually impossible to achieve 14.90%.

                                                            % weighed and measured in reception year                     Max Kammerling    Dali           8.80% prevalence        N       Annual                                                                                                               Actions to improve performance include:
                                                                                                                                           Sidebottom       86% coverage                                                                                                                                       - Several schools-based interventions to encourage healthy behaviours amongst upper Key Stage 2 pupils have been identified.
                                                                                                                                                                                                                                                                                                               2 of these appear suitable and plans to roll these out will be discussed by members of the Childhood Obesity Action Group in July.
                                                                                                                                                                                                                                                                                                               - We are investigating an opportunity to invest in a regional training scheme to upskill practitioners working 1:1 with parents
                                                                                                                                                                                                                                                                                                               around healthy behaviours


Proportion of individuals who complete immunisations by     Proportion of individuals who complete immunisations by      Max Kammerling    Dali               Various             Y      quarterly   Not yet published                                          Not yet                 2      Underachieved   Amber based on mixed 2008/9 performance. This will be reassessed once Q1 data is known.
recommended ages                                            recommended ages                                                               Sidebottom                                                                                                          available                                       Actions include:
                                                                                                                                                                                                                                                                                                               Improve uptake - LES agreed will be disseminated to practices later this month
                                                                                                                                                                                                                                                                                                               Improve awareness - Life channel advert developed will be played in practices in Sept
                                                                                                                                                                                                                                                                                                               Up to date information - lead is working with the contracting management team to address this issue
                                                                                                                                                                                                                                                                                                               3rd HPV dose started in April 09 - take up approx 85%.




Four week smoking quitters (proxy for smoking prevalence)   Smoking quitters per 100,000 population.                     Max Kammerling    Mary Hart           1316               Y      Monthly     achieved - Greater than or               58         79         99         236      0          Failed      Performance of 236 vs plan of 304 to June. This represents a slow start to the year. Rated as failed as currently performing
                                                                                                                                                                                                     equal to 100% of planned                                                                                  below plan.
                                                                                                                                                                                                     performance                                                                                               Actions include:
                                                                                                                                                                                                     underachieved - Greater than                                                                              - Initial contact made with Local Authority senior officer responsible for HR. Two senior managers identified. Contact made and
                                                                                                                                                                                                     or equal to 90% of planned                                                                                looking to set up a meeting to discuss how to encourage LA staff who smoke to quit.
                                                                                                                                                                                                     performance                                                                                               Brief Intervention training planned for August at the HLC & again in September/Oct.
                                                                                                                                                                                                     failed - Less than 90% of                                                                                 - Attended NHS Trust meeting for all SSS. Lead identified at Weston - Ian Bramley to take forward.
                                                                                                                                                                                                     planned performance                                                                                       - Meeting held with Iplato to explore the application of sms texting to increase referrals.
                                                                                                                                                                                                                                                                                                               - Programme for Health trainers to identify referrals as part of the Cardio Vascular Screening programme being rolled out in
                                                                                                                                                                                                                                                                                                               September
                                                                                                                                                                                                                                                                                                               - Ongoing programme train new advisors in primary care setting – planned Sept / Oct
                                                                                                                                                                                                                                                                                                               - GP led Health Centre visited and equipped to deliver service.
                                                                                                                                                                                                                                                                                                               - The Tea Cosy will be included as a venue for delivering smoking services when developed . SFSW marketing company
                                                                                                                                                                                                                                                                                                               considering pilot stop smoking shops. Expression of interest given for pilot-await outcome.
                                                                                                                                                                                                                                                                                                               - Pregnant smokers - Health visitors and midwifes have been briefed – the service is being reviewed and more capacity
                                                                                                                                                                                                                                                                                                               being considered. A family support scheme is being rolled out in September and may help generate referrals.
                                                                                                                                                                                                                                                                                                               - Calendars issued to advisors to encourage monthly returns are submitted and repeat operation Swoop in
                                                                                                                                                                                                                                                                                                               October/November.
                                                                                                                                                                                                                                                                                                               Quarterly Newsletter to reinforce


Reduction in <75 CVD Mortality Rate (40% by 2010)           Mortality rate per 100,000 (directly age standardised)       Max Kammerling    Mary Hart         2009 = 56            N       Annual     Statistical banding                                                                3        Achieved
                                                            population from heart disease and stroke and related
                                                            diseases in people aged under 75
Reduction in <75 Cancer Mortality Rate (20% by 2010)        The mortality rate per 100,000 (directly age standardised)   Max Kammerling    Mary Hart         2009 = 95            N       Annual     Statistical banding                                                                3        Achieved
                                                            population from cancer in people aged under 75

Breast cancer screening for women aged 53 to 70 years       % women 53 - 64 screened                                      Max Kammerling     Mary Hart          N/A               N       Annual     achieve - for Part 1 >=70%,                                                        3        Achieved
                                                                                                                                                                                                     for Part 2 >=65%
                                                                                                                                                                                                     underachieve - for Part 1
                                                            % women 65 - 70 screened                                                                                                                 <70%, >=60%, for Part 2
                                                                                                                                                                                                     <65%, >=50%
                                                                                                                                                                                                     fail - for Part 1 <60%, for Part
Cervical screening                                          % of women 25 - 49 screened                                   Max Kammerling     Mary Hart          N/A               N       Annual     New indicator, thresholds not                                                      2      Underachieved   This is a new indicator for 2009/10. Rated as underachieved to be prudent until performance and thresholds are known. In 2008/9
                                                                                                                                                                                                     known                                                                                                     NHS NS performance was 75.6% for 25-49 yr olds and 81.6% for 50-64 yr olds.

                                                            % of women 50 - 64 screened




                                                                                                                                                                                                                                                                                                                                                                                                                                 5 of 44
        Appendix 3 - Periodic Review Indicators 2009/2010 - Q1 (Apr-Jun) self assessment

PCT Indicator                                                         Indicator Description                                          Lead Director         Lead Manager       2009/10 Planned      Action     Monitoring     AHC thresholds to achieve Apr-09   May-09   Jun-09   YTD     POINTS   On target to     Commentary
                                                                                                                                                                               Performance         Plan?      frequency      2008/9 (where published)                                              deliver?
                                                                                                                                                                                                   (Y/N)

EXISTING COMMITMENT INDICATORS

Access to Primary Care                                                Extended Hours                                                 Jeanette George       Penny Hynds               50%                 N       Quarterly   Not yet published                                               3        Achieved
                                                                                                                                                                                                                                                          88%      88%      92%     92%

                                                                      Patient Experience                                             Jeanette George       Penny Hynds               TBC                 N        Annual     Not yet published                                                                      Based on annual survey



Women who have seen a midwife or maternity healthcare                 Percentage of women who have seen a midwife or a               Max Kammerling        Ginette Corr              89%                 Y       Quarterly   Not yet published                              98%     98%      3        Achieved      In 2008/9 performance was assessed against data quality in Q4 (line 2008 above). NHS North Somerset submitted a 1, meaning
professional by 12 completed weeks of pregnancy                       maternity healthcare professional, for health and social                                                                                                                                                                                      highest quality (from choice of 1-3). It should therefore reasonably expect to achieve the target in 2008/9 AHC. However, it is not
                                                                      care assessment of needs, risks and choices by 12                                                                                                                                                                                             clear how PCTs will be assessed in 2009/10. As the PCT did not achieve its plan in 2008/9 for numbers seeing a midwife the
                                                                      completed weeks of pregnancy                                                                                                                                                                                                                  action plan will roll on into 2009/10 as it may be that it is assessed in 2009/10 based on numbers seen.

                                                                                                                                                                                                                                                                                                                    Actions to improve performance include:
                                                                                                                                                                                                                                                                                                                    Amalgamate booking in visit with scan – bring forward to 8-10 weeks: Systems are in place to do this
                                                                                                                                                                                                                                                                                                                    Ensure robust data recording - Manual data collection has started


Experience of patients                                                To be confirmed                                                Julie Clatworthy      Lynne Liptrot                                 N        Annual     Statistical banding                                             3        Achieved
Stroke care                                                           % pts spending 90% of their time on a stroke unit              Jeanette George       Clare-Louise              TBC                 Y       Quarterly   Not yet published                              31%   31%        2      Underachieved   Measured by data quality in 2008/9. May achieve depending on thresholds but as yet unknown. Rated as underachieved to be
                                                                      % of high risk TIA patients treated within 24 hrs                                    Nicholls                                                                                                         44%   44%                               prudent. Details of 2009/10 construction not yet confirmed.

                                                                                                                                                                                                                                                                                                                    Actions to improve performance include:
                                                                                                                                                                                                                                                                                                                    - Support WAHT develop a specialist TIA clinic accessible Monday-Friday - Business case received and approved. Clinic start
                                                                                                                                                                                                                                                                                                                    date to be confirmed.
                                                                                                                                                                                                                                                                                                                    - Secure 7 day access via the BHSP Service Design work for acute Stroke/TIA care - in the interim access for Weston patients to
                                                                                                                                                                                                                                                                                                                    UHB‟s one stop TIA has been secured on behalf of Weston GPs.
                                                                                                                                                                                                                                                                                                                    - Develop service specification for TIA services - TIA clinic standards ratified by PECs and included in acute stroke service
                                                                                                                                                                                                                                                                                                                    specification. Common Network TIA referral form agreed and due to be distributed in BNSSG imminently. Network Primary care
                                                                                                                                                                                                                                                                                                                    TIA follow-up standards to be ratified by PECs and shared with GP forums.
                                                                                                                                                                                                                                                                                                                    - Via the Weston Futures Stroke Workstream Project support WAHT to secure a dedicated, specialist stroke unit for acute and
                                                                                                                                                                                                                                                                                                                    rehabilitation stroke care - WAHT Stroke team meeting regularly with Divisional Manager and Programme Manager to implement
                                                                                                                                                                                                                                                                                                                    NS Stroke Action Plan. Internal development funding secured by Divisional Manager. 8 acute
                                                                                                                                                                                                                                                                                                                    stroke beds now ringfenced on Draycott ward as a dedicated stroke unit. Acute stroke unit activity being captured from
                                                                                                                                                                                                                                                                                                                    1.7.09.
                                                                                                                                                                                                                                                                                                                    Recruitment underway to establish a dedicated specialist stroke multi-disciplinary team. Rehabilitation beds to be
                                                                                                                                                                                                                                                                                                                    dedicated for stroke on Quantock ward – timescales for project to be confirmed.



                                                                                                                                                                                                                                                                                             56          Fair
Annual Health Check scoring rules from 2008/9 (2009/10 Periodic Review rules not yet published):
1. An organisation that is 'not met' for either core standards or existing national targets will receive a score of weak overall.                                                                                                                                                           >=66       Excellent
2. For an organisation to receive an overall score of 'good' it must be at least 'almost' met' for core standards and existing national targets, as well as being at least 'good' for new national targets.                                                                                 >=59        Good
3. For an organisation to receive an overall score of 'excellent', it must be 'fully met' for core standards and existing national targets, as well as being 'excellent' for new national targets.                                                                                          >=52         Fair
4. If none of the above three rules apply to an organisation, it will receive a score of 'fair' overall.                                                                                                                                                                                    <52         Weak




                                                                                                                                                                                                                                                                                                                                                                                                                                      6 of 44
          Appendix 4 - NHS NS Corporate Work Plan 2009/10


NHS North Somerset - Corporate Work Plan 2009/10                                                                                                                                     =Tier 3 not chosen by the PCT / Deferred
                                                                                                                                                                                     = SHA ambition not being adopted by NHS NS

Ref                 Target                                                                           PCT           Programme         Target detail                                   2009/10 Target       Related SHA Ambition                                                   PCT Target         LAA        Periodic WCC health   2009/10 actions to deliver                Delivery Date   Q1 (Apr-June)   RAG status   Q1 Progress against actions to deliver                                                 Q2              Q3
                                                                                                     Executive     Lead                                                                                                                                                          Slipped?           (lead      Review outcome                                                                  Performance                                                                                                         Performance     Performance
                                                                                                     Director                                                                                                                                                                                       partner)                                                                                   (data)
Existing            Maintain a 4 hour maximum wait in A&E from arrival to admission, transfer or Mary Hutton       Caerrie Barber    Percentage of patients waiting a maximum >=98%                       95% of patients who attend emergency departments, minor                                              Periodic              To be reported by data showing progress                   98.8%           Green        On track to deliver
Commitment          discharge.                                                                                                       of 4 hours in A&E from arrival to admission,                         injury units, walk in centres and community settings for urgent                                      Review                against target
                                                                                                                                     transfer or discharge                                                care will have treatment initiated within two hours of arrival by 31
                                                                                                                                                                                                          March 2011.
Existing            100% of people with diabetes to be offered screening (and screened) for the      Jeanette      Clare-Louise      Percentage of people with diabetes offered      100%                                                                                                                      Periodic              To be reported by data showing progress                   115%            Green        On track to deliver
Commitment          early detection (and treatment if needed) of diabetic retinopathy                George        Nicholls          screening (and screened) for the early                                                                                                                                    Review                against target
                                                                                                                                     detection of diabetic retinopathy
Existing            Guaranteed access to a genito-urinary medicine clinic within 48 hours of         Max           Ginette Corr      Broader strategy to improve sexual health:      100%                 100% of service users seeking access to genito-urinary medicine                                      Periodic              To be reported by data showing progress                   100%            Green        On track to deliver
Commitment          contacting the service.                                                          Kammerling                      Access to GUM clinics                                                clinics will be offered an appointment within 48 hours, measured                                     Review                against target
                                                                                                                                                                                                          over a full calendar week, by 31 March 2010
Existing            Has a full range of Child and Adolescent Mental Health Services (CAMHS) for Max                Dali Sidebottom   Commissioning a comprehensive child and         4                    Make available the full range of specialist community-based      Yes - adopt                         Periodic              To be reported by data showing progress                   Level 3         Amber        Q1 plan was Level 4, hence rating of amber. Q3 performance will count towards
Commitment          children and young people with learning disabilities been commissioned?     Kammerling                           adolescent mental health service.                                    child and adolescent mental health services (Tiers 2 and 3) to   revised SHA                         Review                against target                                                                         Periodic Review. WAHT to risk assess the children and young people with
                    (Scale 1-4)                                                                                                                                                                           residents of every Primary Care Trust by 31 March 2011           ambition but                                                                                                                                     learning disability on the waiting list needing psychiatric assessment and
                                                                                                                                                                                                                                                                           delay                                                                                                                                            determine the best solution to manage the risk in the short term. Explore other
                                                                                                                                                                                                                                                                           implementation                                                                                                                                   options on providing the service by approaching neighbouring authorities to
                                                                                                                                                                                                                                                                           by 1 year                                                                                                                                        consider sharing a post or purchasing a service from existing staff.
Existing            Do 16 and 17 year olds who require mental health services have access to         Max           Dali Sidebottom   Commissioning a comprehensive child and         4                    As above                                                         As above                            Periodic              To be reported by data showing progress                   Level 4         Green        Shared care protocol is being implemented between CAMHS and AMHS - regular
Commitment          services and accommodation appropriate to their age and level of maturity?       Kammerling                      adolescent mental health service.                                                                                                                                         Review                against target                                                                         monitoring meetings held
                    (Scale 1-4)


Existing            Are arrangements in place to ensure that 24 hour cover is available to meet      Max           Dali Sidebottom   Commissioning a comprehensive child and         3                    As above                                                               As above                      Periodic              To be reported by data showing progress                   Level 4         Green        BNSSG rota in place with involvement from North Somerset CAMHS
Commitment          urgent mental health needs of children and young people and for a specialist     Kammerling                      adolescent mental health service.                                                                                                                                         Review                against target
                    mental health assessment to be undertaken within 24 hours or the next
                    working day where indicated? (Scale 1-4)

Existing            Is a full range of early intervention support services delivered in universal  Max             Dali Sidebottom   Commissioning a comprehensive child and         4                    As above                                                               As above                      Periodic              To be reported by data showing progress                   Level 3         Amber        Q1 plan was Level 4, hence rating of amber. Q3 performance will count towards
Commitment          settings and through targeted services for children experiencing mental health Kammerling                        adolescent mental health service.                                                                                                                                         Review                against target                                                                         Periodic Review. A draft locality specification has been produced.
                    problems commissioned by the Local Authority and PCT in partnership?
                    (Scale 1-4)




Existing            All ambulance trusts to respond to 95% of category A calls within 19 minutes. Mary Hutton      Caerrie Barber    Percentage of category A calls responded        95%                                                                                                                       Periodic              To be reported by data showing progress                                                The PCT is working with Glos PCT (as lead commissioner) to ensure
                                                                                                                                                                                                                                                                                                                                                                                               74.9%           Amber
Commitment                                                                                                                           to within 19 minutes                                                                                                                                                      Review                against target                                                                         improvements in performance. An action plan is in place.
Existing            All ambulance trusts to respond to 75% of category A calls within 8 minutes.     Mary Hutton   Caerrie Barber    Percentage of category A calls responded        75%                                                                                                                       Periodic              To be reported by data showing progress
Commitment                                                                                                                           to within 8 minutes                                                                                                                                                       Review                against target                                            96.5%           Green

Existing            All ambulance trusts to respond to 95% of category B calls within 19 minutes. Mary Hutton      Caerrie Barber    Percentage of category B calls responded        95%                                                                                                                       Periodic              To be reported by data showing progress                                                The PCT is working with Glos PCT (as lead commissioner) to ensure
Commitment                                                                                                                           to within 19 minutes                                                                                                                                                      Review                against target                                            92.2%           Amber        improvements in performance. An action plan is in place.

Existing            Deliver 7,500 new cases of psychosis served by early intervention teams per      Jeanette      Julie Kell        Commissioning early intervention in             22                                                                                                                        Periodic              To be reported by data showing progress                   3               Amber        Same number as Q1 in 2008/9. The PCT met this target in 2008/9 with 25 cases
Commitment          year nationally. The no. of cases for NHS NS is 22                               George                          psychosis services*                                                                                                                                                       Review                against target                                                                         against a target of 22. It can reasonably expect to achieve again in 2009/10.




Existing            All patients who need them to have access to crisis services, with delivery of   Jeanette      Julie Kell        Number of separate episodes of home             294                                                                                                                       Periodic              To be reported by data showing progress                   85              Green        On track to deliver
Commitment          100,000 new crisis resolution home treatment episodes each year nationally.      George                          treatment provided by crisis resolution                                                                                                                                   Review                against target
                    The no. of cases for NHS NS is 294                                                                               teams.*
Existing            Deliver thrombolysis 'call to needle' of at least 68% within 60 minutes, where   Mary Hutton   Caerrie Barber    Percentage of eligible patients with acute     >=68%                                                                                                                      Periodic              To be reported by data showing progress                                   Green        The PCT has not been assessed against this indicator in the 2007/8 and 2008/9
Commitment          thrombolysis is the preferred local treatment for heart attack                                                   myocardial infarction receiving thrombolysis                                                                                                                              Review                against target                                                                         annual health checks due to the low numbers of pts treated.
                                                                                                                                     with in 60 minutes of calling for professional
                                                                                                                                     help

Existing            Maintain a maximum wait of 26 weeks for inpatients.                              Mary Hutton   Alan Lawler       Percentage of inpatients waiting a              <0.03%                                                                                                                    Periodic              To be reported by data showing progress                   0.00%           Green        On track to deliver
Commitment                                                                                                                           maximum of 26 weeks                                                                                                                                                       Review                against target


Existing            Maintain a maximum wait of 13 weeks for an outpatient appointment.               Mary Hutton   Alan Lawler       Percentage of outpatients waiting a             <0.03%                                                                                                                    Periodic              To be reported by data showing progress                   0.047%          Amber        The PCT has had 6 breaches of this target in Q1. 5 breaches were at NBT and 1
Commitment                                                                                                                           maximum of 13 weeks                                                                                                                                                       Review                against target                                                                         at UH Bristol. Processes are in place to ensure there are no reoccurrences and it
                                                                                                                                                                                                                                                                                                                                                                                                                            is anticipated that the PCT will achieve this indicator by the year end.

Existing            Delayed transfers of care to reduce to a minimal level.                          Jeanette      Tim Wye           Percentage of patients occupying an acute       TBC                                                                                                                       Periodic              To be reported by data showing progress                   5               Green        This is less than Q1 in 2008/9 (8). The PCT is on track to deliver this target.
Commitment                                                                                           George                          bed whose transfer of care was delayed                                                                                                                                    Review                against target

Existing            Maintain a three month wait for revascularisation.                               Jeanette      Clare-Louise      Percentage of patients waiting a maximum        0%                                                                                                                        Periodic              To be reported by data showing progress                   0               Green        On track to deliver
Commitment                                                                                           George        Nicholls          of 3 months for revascularisation                                                                                                                                         Review                against target

Existing            Guaranteed access to a primary care professional within 24 hours and a           Jeanette      Penny Hynds       Percentage of patients waiting a maximum 100%                        95% of patients able to book an appointment with a general                                                                 To be reported by data showing progress                   92%             Green        This indicator is assessed against the annual pt survey - Your doctor, your
Commitment          primary care doctor within 48 hours.                                             George                          of 48 hours to access a primary care doctor                          practitioner by 31 March 2009.                                                                                             against target                                                                         experience, your say and practice extended opening hours. The PCT cannot
                                                                                                                                                                                                                                                                                                                                                                                                                            currently assess performance against the annual survey. However, it is well above
                                                                                                                                                                                                                                                                                                                                                                                                                            target against the extended opening hours standard of 50%. Currently 92%
                                                                                                                                                                                                                                                                                                                                                                                                                            (23/25) of practices are offering extended hours.
Existing            Ensure a maximum waiting time of one month from diagnosis to treatment for Mary Hutton         Ellie Devine      Percentage of patients waiting a maximum        96%                                                                                                                       Periodic              To be reported by data showing progress                   99.1%           Green        On track to deliver
Commitment          all cancers.                                                                                                     of 31 days from diagnosis to treatment for                                                                                                                                Review                against target
                                                                                                                                     all cancers
Existing            Achieve a maximum waiting time of two months from urgent referral to             Mary Hutton   Ellie Devine      Percentage of patients waiting a maximum        85%                                                                                                                       Periodic              To be reported by data showing progress                   90.6%           Green
Commitment          treatment for all cancers.                                                                                       of 62 days from referral to treatment for all                                                                                                                             Review                against target
                                                                                                                                     cancers
Existing            Maintain a two week maximum wait from urgent GP referral to first outpatient Mary Hutton       Ellie Devine      Percentage of patients waiting a maximum        93%                                                                                                                       Periodic              To be reported by data showing progress                   93.6%           Green
Commitment          appointment for all urgent suspected cancer referrals.                                                           of two weeks from urgent GP referral to first                                                                                                                             Review                against target
                                                                                                                                     outpatient appointment for suspected
                                                                                                                                     cancer
Existing            Chlamydia screening programme to be rolled out nationally.                       Max           Ginette Corr      Broader strategy to improve sexual health:      25% (5700)           Reduce the year-on-year rise in sexually transmitted infections                                      Periodic              To be reported by data showing progress                   994             Amber        Rated as amber in Corporate work plan based on action plan being in place to
Commitment                                                                                           Kammerling                      Percentage of people aged 15 to 24                                   by 2013                                                                                              Review                against target                                                                         deliver by year end. Red in Key Priorities scorecard based on actual data to date.
                                                                                                                                     accepting Chlamydia screening*                                                                                                                                                                                                                                                         Q1 994 actual against target of 1425. An action plan is in place to improve
                                                                                                                                                                                                                                                                                                                                                                                                                            performance and deliver this target. Key actions include:
                                                                                                                                                                                                                                                                                                                                                                                                                            Writing to all existing GP practices with a LES and provide them with an update on
                                                                                                                                                                                                                                                                                                                                                                                                                            their activity and encourage them to write to their patients to actively promote the
                                                                                                                                                                                                                                                                                                                                                                                                                            programme
                                                                                                                                                                                                                                                                                                                                                                                                                            Now that funding has been agreed - working to initiate the pharmacy Local
                                                                                                                                                                                                                                                                                                                                                                                                                            Enhanced Service which includes Chlamydia screening testing and treatment
                                                                                                                                                                                                                                                                                                                                                                                                                            School Nursing Team will commence Chlamydia screening alongside the HPV
                                                                                                                                                                                                                                                                                                                                                                                                                            programme in September




Existing            Data quality on ethnic group                                                     Mary Hutton   Alan Lawler                                                       >=85%                Data quality on ethnic group                                                                         Periodic              To be reported by data showing progress                   Annual target   Green        Rated as green as the PCT expects to achieve this indicator in the 2008/9 Annual
Commitment                                                                                                                                                                                                                                                                                                     Review                against target                                                                         Health Check and could reasonably expect to achieve in 2009/10 (as it also
                                                                                                                                                                                                                                                                                                                                                                                                                            achieved in 2007/8). Data is taken from Hospital Episode Statistics and Mental
                                                                                                                                                                                                                                                                                                                                                                                                                            Health Minimum Data Set.
Existing            Breast cancer screening (53-70 yrs)                                              Max           TBC                                                               >=70% (part 1)                                                                                                            Periodic              To be reported by data showing progress                   Annual target   Green        PCT expects to achieve this indicator in the 2008/9 Annual Health Check. 2009/10
Commitment                                                                                           Kammerling                                                                      >=65% (part 2)                                                                                                            Review                against target                                                                         will be available after March 2010.
Existing            Cervical cancer screening (25-64 yrs)                                                                                                                                                                                                                                                      Periodic                                                                        Annual target   Green
Commitment                                                                                                                                                                                                                                                                                                     Review
Tier 1 Vital Sign   Supporting Activity Lines                                                        Mary Hutton   Alan Lawler       Activity data*                                  Various              90% of diagnostic tests are carried out and the results available      Yes - SHA                                           To be reported by data showing progress                   N/A             Green        Not a target in itself per se. PCT has plans for expected monthly activity to
                                                                                                                                                                                                          to the referrer within two weeks by 31 March 2011.                     ambition is 2011                                    against target                                                                         support delivery of 18 weeks.
Tier 1 Vital Sign   NHS-reported waits for elective care                                             Mary Hutton   Alan Lawler       Percentage of patients seen within 18           90% Admitted         90% of diagnostic tests are carried out and the results available      Yes - commitment              Periodic              To be reported by data showing progress                   Various         Green        On track for delivery
                                                                                                                                     weeks for admitted and non-admitted             95% Non              to the referrer within two weeks by 31 March 2012.                     to deliver same               Review                against target
                                                                                                                                     pathways                                        Admitted                                                                                    timescales for
                                                                                                                                                                                                          90% of admitted patients and 95% of non-admitted patients to           therapies and
                                                                                                                                                                                                          be treated within eight weeks by 31 March 2011.                        wheelchair
                                                                                                                                                                                                                                                                                 services removed




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 7 of 44
          Appendix 4 - NHS NS Corporate Work Plan 2009/10


Ref                 Target                                                                          PCT           Programme         Target detail                                  2009/10 Target          Related SHA Ambition                                                  PCT Target   LAA        Periodic WCC health   2009/10 actions to deliver                Delivery Date   Q1 (Apr-June)   RAG status   Q1 Progress against actions to deliver                                                    Q2              Q3
                                                                                                    Executive     Lead                                                                                                                                                           Slipped?     (lead      Review outcome                                                                  Performance                                                                                                            Performance     Performance
                                                                                                    Director                                                                                                                                                                                  partner)                                                                                   (data)
Tier 1 Vital Sign   Extension of NHS Breast Screening Programme to women aged 47-49 and             Max           TBC               Proportion of women aged 47-49 and 71-73 TBC                           Achieve by 2013 uptake rates for breast and cervical screening                                                      To be reported by data showing progress                   N/A             Green        PCT's will not be assessed against this age bracket in 2009/10 Periodic Review
                    71-73 National requirement (to follow)                                          Kammerling                      offered screening for breast cancer                                    of at least 80% in all local communities                                                                            against target                                                                         assessment. Plans deferred for 09/10 refresh exercise. Plans will be required for
                                                                                                                                                                                                                                                                                                                                                                                                                      2010/11.



Tier 1 Vital Sign   Patient reported measure of GP access                                           Jeanette      Penny Hynds       Various %                                      Various                 Achieve 95% of patients able to book an appointment with a                                    Periodic              To be reported by data showing progress                   This is an      Amber        Performance is assessed based on results of pt experience survey - your doctor,
                                                                                                    George                                                                                                 named general practitioner by 31 March 2009.                                                  Review                against target                                            annual target                your experience, your say. Rated as amber to be prudent. Thresholds to achieve
                                                                                                                                                                                                                                                                                                                                                                                                                      are not yet known.



Tier 1 Vital Sign   Rates of Clostridium Difficile                                                  Julie         Suzanne Ellis-    CDiff number of infections*                    207                     50% reduction across all ages in clostridium Difficile in hospitals                           Periodic   WCC        To be reported by data showing progress                   23 against plan Green        On track to deliver
                                                                                                    Clatworthy    Golding                                                                                  from 2007/08 to 2008/09                                                                       Review                against target                                            of 54




Tier 1 Vital Sign   Incidence of MRSA                                                               Julie         Suzanne Ellis-    MRSA number of infections                      No plan                 No methicillin resistant staphylococcus aureus bacteraemia in                                                       To be reported by data showing progress                   N/A             Green        No plan for PCTs in 2009/10. Performance at Weston is within plan.
                                                                                                    Clatworthy    Golding                                                                                  hospital more than 48 hours after admission                                                                         against target




Tier 1 Vital Sign   Supporting Lines: patient reported measure of GP access (to follow)             Jeanette      Penny Hynds       The percentage of GP practices in the PCT      62.5% 2009/10 (15/24) All patients to have an option available to them of extended                                    Periodic              To be reported by data showing progress                   92%             Green        On track to deliver
                                                                                                    George                          offering extended opening in compliance                              opening hours in general practice by 31 March 2010                                              Review                against target
                                                                                                                                    with Department of Health guidelines

Tier 1 Vital Sign   Quality stroke care (outcome: Reduction in stroke related mortality and         Jeanette      Clare-Louise      Implementation of the stroke strategy - % of 25% in 09/10                                                                                                            Periodic              To be reported by data showing progress                   44%             Green        12 out of 27 patients in Q1. On track to deliver
                    disability                                                                      George        Nicholls          higher risk TIA cases who are treated within                                                                                                                         Review                against target
                                                                                                                                    24 hours



Tier 1 Vital Sign   Quality stroke care (outcome: Reduction in stroke related mortality and         Jeanette      Clare-Louise      Implementation of the stroke strategy -        64% in 09/10            90% of stroke patients will spend 90% of their time in hospital in                            Periodic              To be reported by data showing progress                   31%             Amber        22 out of 71 (31%) pts against plan of 72 out of 120 (60%). Performance is
                    disability                                                                      George        Nicholls          patients who spend at least 90% of their                               an acute specialist multi-disciplinary stroke unit by 31 March                                Review                against target                                                                         expected to improve in Q2 with Weston now having a dedicated stroke unit from 1
                                                                                                                                    time on a stroke unit                                                  2011.                                                                                                                                                                                                      July.



Tier 1 Vital Sign   Supporting measure: Proportion of admissions screened for MRSA                  Julie         Suzanne Ellis-    Proportion of admissions screened for          -                       20% reduction in methicillin resistant staphylococcus aureus                                                        To be reported by data showing progress                   100%            Green        100% at Weston for Apr and May. June to be confirmed, data not yet available. All
                                                                                                    Clatworthy    Golding           MRSA                                                                   (MRSA) bacteraemias detected less than 48 hours from                                                                against target                                                                         pts screened at Clevedon.
                                                                                                                                                                                                           admission to NHS provided care

Tier 1 Vital Sign   Extension of NHS Bowel Cancer Screening Programme to men and women              Mary Hutton   TBC               Proportion of men and women aged 70-75         TBC                                                                                                                                         To be reported by data showing progress                   N/A             N/A          Plans deferred for 09/10 refresh exercise.
                    aged up to 75 (National requirement) (to follow)                                                                taking part in bowel screening programme                                                                                                                                                   against target

Tier 1 Vital Sign   31-Day Standard for Subsequent Cancer Treatments (Radiotherapy)                 Mary Hutton   TBC               Proportion of patients waiting no more than    94%                                                                                                                   Periodic              To be reported by data showing progress                   100%            Green        On track to deliver
                                                                                                                                    31 days for second or subsequent cancer                                                                                                                              Review                against target
                                                                                                                                    treatment (radiotherapy treatments)
Tier 1 Vital Sign   31-Day Standard for Subsequent Cancer Treatments (Surgery)                      Mary Hutton   TBC               Proportion of patients waiting no more than    94%                                                                                                                   Periodic              To be reported by data showing progress                   97%             Green        On track to deliver
                                                                                                                                    31 days for second or subsequent cancer                                                                                                                              Review                against target
                                                                                                                                    treatment (surgery)
Tier 1 Vital Sign   31-Day Standard for Subsequent Cancer Treatments (Drug)                         Mary Hutton   TBC               Proportion of patients waiting no more than    98%                                                                                                                                                                                                   100%            Green        On track to deliver
                                                                                                                                    31 days for second or subsequent cancer
                                                                                                                                    treatment (drug treatments)
Tier 1 Vital Sign   Breast Symptom Two Week Wait                                                    Mary Hutton   TBC               Proportion of patients with breast symptoms    93%                                                                                                                   Periodic              To be reported by data showing progress                   No data' for Q1 N/A          This target becomes a LIVE target on 1 January 2010 but data collection and
                                                                                                                                    referred to a specialist who are seen within                                                                                                                         Review                against target                                                                         monitoring is currently being undertaken now. The Provider Trusts are currently
                                                                                                                                    two weeks of referral                                                                                                                                                                                                                                                             trying to work out how to collect the data for this target as efficiently as possible
                                                                                                                                                                                                                                                                                                                                                                                                                      i.e. how to identify these patients, how to get the patients onto the system without
                                                                                                                                                                                                                                                                                                                                                                                                                      increasing time consuming data inputting and as it is likely that a large number of
                                                                                                                                                                                                                                                                                                                                                                                                                      these patients will not have cancer how to sign these patients off the system
                                                                                                                                                                                                                                                                                                                                                                                                                      afterwards.
Tier 1 Vital Sign   Extended 62-Day Cancer Treatment Targets - screening                            Mary Hutton   TBC               Proportion of patients with suspected      90%                                                                                                                       Periodic              To be reported by data showing progress                   100%            Green        On track to deliver
                                                                                                                                    cancer detected through national screening                                                                                                                           Review                against target
                                                                                                                                    programmes

Tier 1 Vital Sign   Extended 62-Day Cancer Treatment Targets - consultant upgrade                   Mary Hutton   TBC               Proportion of patients with suspected          TBC by DH                                                                                                             Periodic              To be reported by data showing progress                   88.9%           Amber        There is no operational standard yet for this target. Rated as amber to be
                                                                                                                                    cancer detected by hospital specialists who    Using 90% (same as                                                                                                    Review                against target                                                                         prudent.
                                                                                                                                    wait less than 62 days from referral to        screening) until then
                                                                                                                                    treatment
Tier 1 Vital Sign   Proportion of women receiving cervical cancer screening test results within 2   Max           TBC               Proportion of women receiving cervical         TBC                                                                                                                                         To be reported by data showing progress                   N/A             N/A          Plans deferred for 09/10 refresh exercise. Plan expected in 2010/11. Advise was
                    weeks                                                                           Kammerling                      cancer screening test results within 2 weeks                                                                                                                                               against target                                                                         issued in The Week, issue 42 18-24 April 2008. Roll out will continue with SHA
                                                                                                                                                                                                                                                                                                                                                                                                                      bids invited for the second wave of NHS Improvement: Cancer support in March
                                                                                                                                                                                                                                                                                                                                                                                                                      2009. PCTs should continue to prepare for full roll out and engage in support as
                                                                                                                                                                                                                                                                                                                                                                                                                      invited.
Tier 2 Vital Sign   Prevalence of Breastfeeding at 6-8 weeks                                        Max           Ginette Corr      Percentage of infants breastfed at 6-8         90% coverage (41%       Increase the number of women initiating breastfeeding to 78%.                                 Periodic   WCC        To be reported by data showing progress                   40%             Amber        40% prevalence against plan of 37.4% for Q1. However coverage of recording is
                                                                                                    Kammerling                      weeks                                          breastfed)              Increase the percentage of women breastfeeding their children                                 Review                against target                                                                         below 85%, the level that the DH expects PCTs to meet each quarter. An action
                                                                                                                                                                                                           at six to eight weeks to 60% by 31 March 2011                                                                                                                                                              plan is in place to improve performance. The PCT is allowed to resubmit it's Q1
                                                                                                                                                                                                                                                                                                                                                                                                                      data, the refresh of which is now showing us as meeting our target for the quarter.

Tier 2 Vital Sign   All-age all cause mortality (AAACM) rate                                        Max           Mary Hart         All-age all cause mortality (AAACM) rate per Males - 567               Match the highest life expectancy in Europe by 2013                                LAA        Periodic              To be reported by data showing progress                   Annual target   Amber        Data for 2009 will not be available until 2010. Performance for 2008 was mixed
                                                                                                    Kammerling                      100 000 population                           Females - 426                                                                                                           Review                against target                                                                         with more males deaths and less female deaths than plan. Progress is being
                                                                                                                                                                                                                                                                                                                                                                                                                      made on the targeted cardio vascular risk project, Weight Management
                                                                                                                                                                                                                                                                                                                                                                                                                      programme is successful in reaching those in the most deprived quintile Health
                                                                                                                                                                                                                                                                                                                                                                                                                      trainer for men has been appointed. Actions to increase uptake of smoking
                                                                                                                                                                                                                                                                                                                                                                                                                      cessation services is continuing.




Tier 2 Vital Sign   Cancer Mortality Rate                                                           Max           Mary Hart         Cancer Mortality Rate                          94                      Reduce mortality rates from cancer in people aged under 75 to                                 Periodic   WCC        To be reported by data showing progress                   Annual target   Green        Data for 2009 will not be available until 2010. Green based on having lower rate
                                                                                                    Kammerling                                                                                             reach a level of 100 per 100,000 European standardised                                        Review                against target                                                                         in 2008 than plan. Skin cancer film showing at surgery waiting rooms June-sep
                                                                                                                                                                                                           population by 2013                                                                                                                                                                                         through Life Channel program.
Tier 2 Vital Sign   CVD Mortality Rate                                                              Max           Mary Hart         CVD Mortality Rate                             53                      Reduce mortality rates from heart disease and stroke and                                      Periodic   WCC        To be reported by data showing progress                   Annual target   Green        Data for 2009 will not be available until 2010. Green based on having lower rate in
                                                                                                    Kammerling                                                                                             related diseases in people aged under 75 to 65 per 100,000                                    Review                against target                                                                         2008 than plan. Local Enhanced Services have been agreed and service will
                                                                                                                                                                                                           European standardised population by 2013                                                                                                                                                                   commence in September.
Tier 2 Vital Sign   Mixed Sex Accommodation                                                         Julie         Marie Davies      Elimination of mixed sex accommodation for N/A                         Improve levels of patient satisfaction with separate male and                                                       To be reported by data showing progress                   Annual target   Green        Clevedon Hospital are now single sex. Weston have made a statement of
                                                                                                    Clatworthy                      hospital inpatients                                                    female provision year-on-year, with satisfaction in all NHS South                                                   against target                                                                         compliance towards achieving this.
                                                                                                                                                                                                           West facilities in the top 10% nationally
Tier 2 Vital Sign   Primary dental services, based on assessments of local needs and with the       Jeanette      Penny Hynds       Number of patient receiving NHS primary     118,332 (revised fig       There will a year on year improvement in the number of people                                 Periodic              To be reported by data showing progress                   TBC             Amber        Performance has improved since March 2009 but still remains below target. The
                    objective of ensuring year-on-year improvements in the numbers of patients      George                          dental services located within the PCT area July 09)                   accessing NHS dental services.                                                                Review                against target                                                                         PCT resubmitted its plan figures for 2009/10 in July as part of a national exercise.
                    accessing NHS dental services                                                                                   within a 24 month period                                                                                                                                                                                                                                                          Several contractors across North Somerset have increased their contracted units
                                                                                                                                                                                                                                                                                                                                                                                                                      of dental activity to provide approximately an additional 15,000 units of dental
                                                                                                                                                                                                                                                                                                                                                                                                                      activity by 31st March 2009. This additional level of activity will continue into 09/10
                                                                                                                                                                                                                                                                                                                                                                                                                      to maintain steady rise in patients seen.
Tier 2 Vital Sign   Childhood Obesity                                                               Max           Dali Sidebottom   Obesity among primary school age children 87% (coverage)       Reverse the trend in childhood obesity to achieve a clear                                  LAA        Periodic              To be reported by data showing progress                   Data not        Amber        Data for this indicator will be available in December 2009. Initial plans for 2
                                                                                                    Kammerling                                                                9% (Prevalence-YrR) downward trend in the level of childhood obesity by 2013                                               Review                against target                                            available                    schools based interventions to prevent childhood obesity have been agreed. Also
                                                                                                                                                                              17% (Prevalence-Yr6)                                                                                                                                                                                                                    providing support for North Somerset Council family based intervention. National
                                                                                                                                                                                                                                                                                                                                                                                                                      Child Measurement Programme and other data will inform the choice of schools in
                                                                                                                                                                                                                                                                                                                                                                                                                      which interventions take place.




Tier 2 Vital Sign   Percentage of women who have seen a midwife or a maternity healthcare           Max           Ginette Corr      Percentage of women who have seen a            89%                     Achieve United Nations Children‟s Fund Baby Friendly Initiative                               Periodic              To be reported by data showing progress                   98%             Green        On track to deliver. In Q1 568 women were seen by 12 weeks and 6 days against
                    professional, for assessment of health and social care needs, risks and         Kammerling                      midwife or a maternity healthcare                                      status or equivalent in all maternity services in the South West                              Review                against target                                                                         577 maternities. This is a good indicator as to how we can expect to perform at
                    choices by 12 completed weeks of pregnancy.                                                                     professional, for assessment of health and                             by 31 March 2010                                                                                                                                                                                           the year end. The CQC will use Q1 & Q2 vs Q3 and Q4 maternities to capture the
                                                                                                                                    social care needs, risks and choices by 12                                                                                                                                                                                                                                        same cohort of mothers.
                                                                                                                                    completed weeks of pregnancy.




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              8 of 44
          Appendix 4 - NHS NS Corporate Work Plan 2009/10


Ref                 Target                                                                              PCT           Programme        Target detail                                  2009/10 Target     Related SHA Ambition                                                PCT Target   LAA        Periodic WCC health   2009/10 actions to deliver                Delivery Date   Q1 (Apr-June)     RAG status   Q1 Progress against actions to deliver                                                 Q2              Q3
                                                                                                        Executive     Lead                                                                                                                                                   Slipped?     (lead      Review outcome                                                                  Performance                                                                                                           Performance     Performance
                                                                                                        Director                                                                                                                                                                          partner)                                                                                   (data)
Tier 2 Vital Sign   Individuals who complete immunisation                                               Max           Ginette Corr     Proportion of children who complete            Various            By 2012 achieve a minimum of 90% immunisation against                                       Periodic              To be reported by data showing progress                   Data not          Amber        The PCT expected that it would have to give children the H1N1 vaccine, which
                                                                                                        Kammerling                     immunisation by recommended ages (95%                             measles, mumps and rubella (MMR) in all Primary Care Trusts,                                Review                against target                                            available                      would therefore impact on their capacity to carry out the HPV immunisation
                                                                                                                                       by 2011 for MMR aged 2)                                           with a regional average vaccination rate of at least 95%                                                                                                                                                   programme. The PCT has since learned that the vaccine does not have to be
                                                                                                                                                                                                                                                                                                                                                                                                                    given to children as they have not been included as a priority group by the DoH.
                                                                                                                                                                                                                                                                                                                                                                                                                    Childhood immunisations paper produced for Executive Team. MMR catch up
                                                                                                                                                                                                                                                                                                                                                                                                                    Local Enhanced Service agreed and disseminated
                                                                                                                                                                                                                                                                                                                                                                                                                    HPV programme - catch up programme taking place during Aug and Sept.




Tier 2 Vital Sign   Smoking Prevalence (Smoking Quitters)                                               Max           Mary Hart        Smoking prevalence among people aged 16 1,316                     Reduce smoking levels in South West to equal the best in                                    Periodic              To be reported by data showing progress                   264 vs 304 in     Amber        Rated as amber in Corporate work plan based on action plan being in place to
                                                                                                        Kammerling                     or over (quit rates locally 2008)*                                Europe by 2013.                                                                             Review                against target                                            Q1                             deliver by year end. Red in Key Priorities scorecard based on actual data to date.
                                                                                                                                                                                                                                                                                                                                                                                                                    Key actions being undertaken include:
                                                                                                                                                                                                                                                                                                                                                                                                                    Initial contact made with Local Authority senior officer responsible for HR. Two
                                                                                                                                                                                                                                                                                                                                                                                                                    senior managers identified. Contact made and looking to set up a meeting to
                                                                                                                                                                                                                                                                                                                                                                                                                    discuss how to encourage LA staff who smoke to quit.
                                                                                                                                                                                                                                                                                                                                                                                                                    Brief Intervention training planned for August at the HLC & again in
                                                                                                                                                                                                                                                                                                                                                                                                                    September/Oct.
                                                                                                                                                                                                                                                                                                                                                                                                                    - Attended NHS Trust meeting for all SSS. Lead identified at Weston - Ian
                                                                                                                                                                                                                                                                                                                                                                                                                    Bramley to take forward.
                                                                                                                                                                                                                                                                                                                                                                                                                    - Meeting held with Iplato to explore the application of sms texting to increase
                                                                                                                                                                                                                                                                                                                                                                                                                    referrals.
                                                                                                                                                                                                                                                                                                                                                                                                                    - Programme for Health trainers to identify referrals as part of the Cardio Vascular
                                                                                                                                                                                                                                                                                                                                                                                                                    Screening programme being rolled out in September
                                                                                                                                                                                                                                                                                                                                                                                                                    - Ongoing programme train new advisors in primary care setting – planned Sept /
                                                                                                                                                                                                                                                                                                                                                                                                                    Oct
                                                                                                                                                                                                                                                                                                                                                                                                                    - GP led Health Centre visited and equipped to deliver service.
                                                                                                                                                                                                                                                                                                                                                                                                                    - The Tea Cosy will be included as a venue for delivering smoking services when
                                                                                                                                                                                                                                                                                                                                                                                                                    developed . SFSW marketing company considering pilot stop smoking shops.
                                                                                                                                                                                                                                                                                                                                                                                                                    Expression of interest given for pilot-await outcome.
                                                                                                                                                                                                                                                                                                                                                                                                                    - Pregnant smokers - Health visitors and midwifes have been
                                                                                                                                                                                                                                                                                                                                                                                                                    briefed – the service is being reviewed and more capacity
                                                                                                                                                                                                                                                                                                                                                                                                                    being considered. A family support scheme is being rolled out
                                                                                                                                                                                                                                                                                                                                                                                                                    in September and may help generate referrals.
                                                                                                                                                                                                                                                                                                                                                                                                                    - Calendars issued to advisors to encourage monthly returns
                                                                                                                                                                                                                                                                                                                                                                                                                    are submitted and repeat operation Swoop in
                                                                                                                                                                                                                                                                                                                                                                                                                    October/November.
Tier 2 Vital Sign   Suicide & Injury of Undetermined Intent                                             Max           Julie Kell       Suicide & Injury of Undetermined Intent        N/A at PCT level   Reduce mortality rates from suicide and undetermined injury to 7                                                  To be reported by data showing progress                   N/A               Amber        This is not assessed at PCT level. PCT does not have individual target due to
                                                                                                        Kammerling                     Mortality Rate                                                    per 100,000 European standardised population by 2013                                                              against target                                                                           small numbers. For 2005-2007 the rate was 9.88 males and 2.68 females. Suicide
                                                                                                                                                                                                                                                                                                                                                                                                                    audit completed for last financial year. Action plan being worked upon.


Tier 2 Vital Sign   Teenage pregnancy                                                                   Max           Ginette Corr     Under 18 conception rate per 1,000 females 17.8%                  Achieve a minimum of 50% reduction in under 18 conception                        LAA        Periodic              To be reported by data showing progress                   Rate of 33.9      Amber        Rated as amber in Corporate work plan based on action plan being in place to
                                                                                                        Kammerling                     aged 15-17 (42% reduction by 2011)                                rates by 2013 (from the 1998 baseline)                                                      Review                against target                                                                           deliver by year end. 1st quarter data down on same quarter in 2007 (43.4 which
                                                                                                                                                                                                                                                                                                                                                                                                                    equated to 39 conceptions) with a rate of 33.9 which equates to 30 conceptions.
                                                                                                                                                                                                                                                                                                                                                                                                                    An action plan is in place to improve performance. Key actions include: 'No
                                                                                                                                                                                                                                                                                                                                                                                                                    Worries' project worker for vulnerable groups is in post; Funding has been agree
                                                                                                                                                                                                                                                                                                                                                                                                                    to recruit an additional nurse support to offer an outreach service to very
                                                                                                                                                                                                                                                                                                                                                                                                                    vulnerable groups; A project has commenced to support boys and young men;
                                                                                                                                                                                                                                                                                                                                                                                                                    and 3 more 'No Worries' clinics due to commence Sept 09




Tier 2 Vital Sign   NHS staff survey based measures of job satisfaction                                 Penny Brown Marcus Ede         NHS staff survey based measures of job         3.52                                                                                                                                 To be reported by data showing progress                   Annual target     Amber        Unclear as to how score is derived. Staff satisfaction survey will be carried out
                                                                                                                                       satisfaction                                                                                                                                                                        against target                                                                           during Autumn 2009 with results due to be released in February 2010. Rated as
                                                                                                                                                                                                                                                                                                                                                                                                                    amber to be prudent until results are known. The PCT is also devising internal
                                                                                                                                                                                                                                                                                                                                                                                                                    measures to assess staff satisfaction throughout the year.
Tier 2 Vital Sign   Self reported experience of patients/users (National priority for local delivery)   Julie         Mary Adams       Patient experience score (PCT survey of        79.5                                                                                                           Periodic              To be reported by data showing progress                   Annual target     Green        The PCT engages with the local community regularly through stakeholder events
                                                                                                        Clatworthy                     primary care services)                                                                                                                                        Review                against target


Tier 2 Vital Sign   Number of drug users recorded as being in effective treatment                       Max           Julie Kell       The percentage change in the number of         666 (4%)                                                                                            LAA        Periodic              To be reported by data showing progress                   Data not          Green        Data for Q1 is not yet available. Rated green based on 2008/9 performance.
                                                                                                        Kammerling                     drug users using crack and/or opiates                                                                                                                         Review                against target                                            available
                                                                                                                                       recorded as being in structured drug
                                                                                                                                       treatment in a financial year who were
                                                                                                                                       discharged from treatment after 12 weeks
                                                                                                                                       or more, or who were discharged from
                                                                                                                                       treatment in a care planned way.
Tier 2 Vital Sign   Public Confidence in local NHS                                                      Julie         Mary Adams                                                      N/A                                                                                                                                  To be reported by data showing progress                   N/A               Green        The PCT received feedback from SHA survey which was quite positive.
                                                                                                        Clatworthy                                                                                                                                                                                                         against target
Tier 3 Vital Sign   Number of emergency bed days per head of weighted population                        Mary Hutton   Alan Lawler      Number of emergency bed days per head of 125,970                  Reduce emergency bed days for people with long-term                              LAA                              To be reported by data showing progress                   126,454           Amber        Performance is very slightly above target.
                                                                                                                                       weighted population                                               conditions by 30% from the 2006/07 baseline by 31 March 2010                                                      against target




Tier 3 Vital Sign   Patients with diabetes in whom the last HbA1c is 7.5 or less from Quality           Jeanette      Clare-Louise     Patients with diabetes in whom the last     63%                                                                                                                                     To be reported by data showing progress                   35% at June       Green        June 2009 (Q1): 10 practices not submitted in Q1 (1619/4571 = 35.42%). All
                    Outcomes Framework (QOF)                                                            George        Nicholls         HbA1c is 7.5 or less from Quality Outcomes                                                                                                                                          against target                                                                           practices will have submitted data by year end at which time the target would be
                                                                                                                                       Framework (QOF)                                                                                                                                                                                                                                                              expected to be met.
Tier 3 Vital Sign   Proportion of people with long-term conditions supported to be independent          Jeanette      Clare-Louise     Proportion of people with long-term         125,970                                                                                                                                 To be reported by data showing progress                                     Green        Measured against patient survey. PCT scored
                    and in control of their condition                                                   George        Nicholls         conditions supported to be independent and                                                                                                                                          against target
                                                                                                                                       in control of their condition (proxy -
                                                                                                                                       emergency bed days)
Tier 3 Vital Sign   Proportion of all deaths that occur at home                                         Jeanette      Clare-Louise     Proportion of all deaths that occur at home 20%                   Responding to individual preferences will lead to a 10%                          LAA                   WCC        To be reported by data showing progress                   Info team         Green        As at 18/8/2009 (data gets updated each month) performance was 20.8% in Q1
                                                                                                        George        Nicholls                                                                           reduction year-on-year in adult deaths in acute hospital for each                                                 against target                                                                           2009/10 compared to 18.8% in Q1 2008/9.
                                                                                                                                                                                                         of the next three years (this should exclude deaths in community
                                                                                                                                                                                                         hospitals and palliative care units in acute hospitals)

Tier 3 Vital Sign   Proportion of people with depression and/or anxiety disorders who are               Jeanette      Julie Kell       Proportion of people with depression and/or Various               Adults with mild to moderate depression and anxiety to have                                            WCC        To be reported by data showing progress                   Info team         Green        The PCT submitted a business plan to the SHA for implementing the IAPT
                    offered psychological therapies                                                     George                         anxiety disorders who are offered                                 access to psychological therapies by 31 March 2011, three years                                                   against target                                                                           Programme. The PCT is a wave 2 site and is meeting all its targets.
                                                                                                                                       psychological therapies                                           ahead of the national requirement                                                                                                                                                                          The PCT has a monthly performance meeting with the provider and manages
                                                                                                                                                                                                                                                                                                                                                                                                                    targets within this meeting.



Tier 3 Vital Sign   Rate of hospital admissions per 100,000 for alcohol related harm                    Max           Mary Hart        Rate of hospital admissions per 100,000 for 1,914                 Halt the rise in hospital admissions for alcohol-related harm and                LAA                              To be reported by data showing progress                   Annual target /   Amber        Data is annual. 1479 admissions in 2008 against plan of 1271. England ave was
                                                                                                        Kammerling                     alcohol related harm                                              achieve a downward trend by 2013                                                                                  against target                                            data                           1384. Support via A&E in place. Alcohol Strategy Implementation Group has been
                                                                                                                                                                                                                                                                                                                                                                                                                    convened. Commissioning of additional capacity has begun.



Tier 3 Vital Sign   Achievement of CNST risk management standards                                       Julie                          Achievement of CNST risk management
                                                                                                        Clatworthy                     standards
Tier 3 Vital Sign   Adults and older people receiving direct payments and/or individual budgets         Jeanette      Maya Bimson      Adults and older people receiving direct
                    per 100,000 population (aged 18 and over)                                           George                         payments and/or individual budgets per
                                                                                                                                       100,000 population (aged 18 and over)
Tier 3 Vital Sign   Ambulance conveyance rate to A&E (to be developed)                                  Mary Hutton   Caerrie Barber   Ambulance conveyance rate to A&E (to be
                                                                                                                                       developed)
Tier 3 Vital Sign   Healthy life expectancy at age 65                                                   Max           Mary Hart        Healthy life expectancy at age 65
                                                                                                        Kammerling
Tier 3 Vital Sign   Hospital admissions caused by unintended and deliberate injuries                    Max           Pat Richards     Hospital admissions caused by unintended       1.2% / 1.0%                                                                                                                          To be reported by data showing progress                   Annual Target     Amber        Identifying current progress towards this target. Review care pathways for injuries-
                                                                                                        Kammerling                     and deliberate injuries                                                                                                                                                             against target                                                                           both accidental and deliberate. Ensure focus by specialist public health nurses on
                                                                                                                                                                                                                                                                                                                                                                                                                    injury prevention. The PCTs rate in 2007/8 was amongst the lowest in the South
                                                                                                                                                                                                                                                                                                                                                                                                                    West.
Tier 3 Vital Sign   Learning Disabilities (Indicator to be developed)                                   Jeanette      Tim Wye          Learning Disabilities (Indicator to be
                                                                                                        George                         developed)
Tier 3 Vital Sign   Mortality rate from causes considered amenable to healthcare                                                       Mortality rate from causes considered
                                                                                                                                       amenable to healthcare
Tier 3 Vital Sign   NHS estates energy/carbon efficiency                                                                               NHS estates energy/carbon efficiency
Tier 3 Vital Sign   Number of delayed transfers of care per 100,000 population (aged 18 and             Jeanette      Tim Wye          Number of delayed transfers of care per
                    over)                                                                               George                         100,000 population (aged 18 and over)
Tier 3 Vital Sign   Number of generic prescription items as a percentage of all prescription            Jeanette      Gerry Keysell    Number of generic prescription items as a
                    items.                                                                              George                         percentage of all prescription items.
Tier 3 Vital Sign   Parents' experience of services for disabled children                               Max           Gerry Keysell    Parents' experience of services for disabled
                                                                                                        Kammerling                     children
Tier 3 Vital Sign   Patient and user reported measure of respect and dignity in their treatment         Julie         Clare-Louise     Patient and user reported measure of
                                                                                                        Clatworthy    Nicholls         respect and dignity in their treatment
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         9 of 44
          Appendix 4 - NHS NS Corporate Work Plan 2009/10


Ref                 Target                                                                              PCT           Programme        Target detail                                   2009/10 Target           Related SHA Ambition                                                   PCT Target   LAA        Periodic WCC health   2009/10 actions to deliver                       Delivery Date   Q1 (Apr-June)   RAG status   Q1 Progress against actions to deliver                                                 Q2               Q3
                                                                                                        Executive     Lead                                                                                                                                                             Slipped?     (lead      Review outcome                                                                         Performance                                                                                                         Performance      Performance
                                                                                                        Director                                                                                                                                                                                    partner)                                                                                          (data)
Tier 3 Vital Sign   Patient reported measure of choice of hospital                                      Jeanette      Penny Hynds      Patient reported measure of choice of           60% aware of choice                                                                                                                           To be reported by data showing progress                          Data not        Amber        Surveys due to be carried out locally by PCT as DH (Ipsos Mori) no longer carry
                                                                                                        George                         hospital                                        92% attended hosp of                                                                                                                          against target                                                   available                    these out. Most recent published results (June 08) for PCT show 42% awareness
                                                                                                                                                                                       choice                                                                                                                                                                                                                                      of choice and 59% were able to go to hospital they wanted.
Tier 3 Vital Sign   Patient reported unmet care needs                                                                                  Patient reported unmet care needs
Tier 3 Vital Sign   Percentage of patients admitted with a heart attack who were prescribed an          Jeanette      Gerry Keysell    Percentage of patients admitted with a
                    anti-platelet, a statin and a beta-blocker                                          George                         heart attack who were prescribed an anti-
                                                                                                                                       platelet, a statin and a beta-blocker
Tier 3 Vital Sign   Proportion of adults (18 and over) supported directly through social care to        Jeanette      Tim Wye          Proportion of adults (18 and over) supported
                    live independently at home                                                          George                         directly through social care to live
                                                                                                                                       independently at home (Emergency Bed
                                                                                                                                       Days)
Tier 3 Vital Sign   Proportion of adults in contact with secondary mental health services in            Jeanette      Julie Kell       Proportion of adults in contact with
                    employment                                                                          George                         secondary mental health services in
                                                                                                                                       employment
Tier 3 Vital Sign   Proportion of adults in contact with secondary mental health services in            Jeanette      Julie Kell       Proportion of adults in contact with
                    settled accommodation                                                               George                         secondary mental health services in settled
                                                                                                                                       accommodation
Tier 3 Vital Sign   Proportion of adults with learning disabilities in employment                       Jeanette      Tim Wye          Proportion of adults with learning disabilities
                                                                                                        George                         in employment
Tier 3 Vital Sign   Proportion of adults with learning disabilities in settled accommodation            Jeanette      Tim Wye          Proportion of adults with learning disabilities
                                                                                                        George                         in settled accommodation
Tier 3 Vital Sign   Proportion of carers receiving a 'carer's break' or a specific carers' service as   Jeanette      Maya Bimson      Proportion of carers receiving a 'carer's
                    a percentage of clients receiving community based services                          George                         break' or a specific carers' service as a
                                                                                                                                       percentage of clients receiving community
                                                                                                                                       based services
Tier 3 Vital Sign   Proportion of people achieving independence 3 months after entering care/ re- Jeanette            Maya Bimson      Proportion of people achieving
                    hab - rate per 10,000                                                         George                               independence 3 months after entering care/
                                                                                                                                       re-hab - rate per 10,000
Tier 3 Vital Sign   Proportion of people where health affects the amount/type of work they can                                         Proportion of people where health affects
                    do                                                                                                                 the amount/type of work they can do
Tier 3 Vital Sign   Rates of hospital admissions for ambulatory care sensitive conditions per           Mary Hutton   Maya Bimson      Rates of hospital admissions for ambulatory 601                                                                                                                                               To be reported by data showing progress                          Annual target   Green        608 against a plan of 646 for Q1
                    100,000                                                                                                            care sensitive conditions per 100,000                                                                                                                                                         against target

Tier 3 Vital Sign   Self-reported measure of people‟s overall health (EQ5D)                                                            Self-reported measure of people‟s overall
                                                                                                                                       health (EQ5D)
Tier 3 Vital Sign   Timeliness of social care packages                                                  Jeanette      Tim Wye          Timeliness of social care packages              89.40%                                                                                                                                        To be reported by data showing progress                          90%             Green        On track in Q1
                                                                                                        George                                                                                                                                                                                                                       against target
Tier 3 Vital Sign   Timeliness of social care assessment                                                Jeanette      Tim Wye          Timeliness of social care assessment            77.40%                                                                                                                                        To be reported by data showing progress                          67%             Amber        Below target in Q1
                                                                                                        George                                                                                                                                                                                                                       against target
Tier 3 Vital Sign   Vascular risk score                                                                                                Vascular risk score
VS supporting       Maternity plans                                                                     Max           Ginette Corr     Maternity plans, April 2009 to March 2011       Various                                                                                                                                       To be reported by data showing progress                                          Green        Service Delivery Group established. Local North Somerset meeting planned for
measure -                                                                                               Kammerling                                                                                                                                                                                                                   against target                                                                                Sept.
maternity
LAA                 Reduce the absolute gap in all age all cause mortality between the most             Max           Mary Hart        Reduce the absolute gap in all age all          209                      Reduce the current gap in life expectancy between the worst                         LAA                WCC           To be reported by data showing progress                          Annual target   Green        Progress is being made on the targeted cardio vascular risk project, Weight
                    deprived quintile and least deprived quintile in North Somerset to the 2000-        Kammerling                     cause mortality between the most deprived                                and best areas in the South West by one third by 2013                                                                against target                                                                                Management programme is successful in reaching those in the most deprived
                    2002 levels                                                                                                        quintile and least deprived quintile in North                                                                                                                                                                                                                                               quintile Health trainer for men has been appointed. Actions to increase uptake of
                                                                                                                                       Somerset to the 2000-2002 levels                                                                                                                                                                                                                                                            smoking cessation services is continuing

LAA                 Increase the number of recorded obese individuals losing weight through a           Max           Mary Hart        Increase the number of recorded obese           80 (with stretch)                                                                                            LAA                              To be reported by data showing progress          Mar-10          9               Green        Q1 Figure of 9 is for pts who started slimming 6 mths previously. Cumulatively the
                    personalised weight management programme.                                           Kammerling                     individuals losing weight through a                                                                                                                                                           against target                                                                                service has had 112 pts who have lost weight since Q4 2007/8 thereby already
                                                                                                                                       personalised weight management                                                                                                                                                                                                                                                              exceeding the target of 80 by end of 2009/10.
                                                                                                                                       programme.
LAA                 Achieving independence for older people through rehabilitation/intermediate         Jeanette      Clare-Louise     Achieving independence for older people                                                                                                                      LAA                              To be reported by data showing progress                          Data not        N/A          NS Council lead on this target. They do not yet have data available
                    care                                                                                George        Nicholls         through rehabilitation/intermediate care                                                                                                                                                      against target                                                   available
LAA                 Increase the number of four week quitters from the 20% most deprived areas Max                    Mary Hart        Increase the number of four week quitters       1092 (without stretch)                                                                                       LAA                              To be reported by data showing progress          Mar-10          Data not        Amber        Q1 figures will not be available until Sept. These are supplied 1 quarter in arrears
                    in North Somerset.                                                         Kammerling                              from the 20% most deprived areas in North       12623 (with stretch)                                                                                                                          against target                                                   available                    due to having to wait 4 weeks until the end of the month to count someone as
                                                                                                                                       Somerset.                                                                                                                                                                                                                                                                                   quite at 4 weeks. Q1 figures will be available for the Q2 return. The PCT's
                                                                                                                                                                                                                                                                                                                                                                                                                                   smoking cessation action plan to address performance is updated each month.
                                                                                                                                                                                                                                                                                                                                                                                                                                   Actions include: All contacts from Face2Face event are being followed up and
                                                                                                                                                                                                                                                                                                                                                                                                                                   encouraged to set a quit date; Development of a more robust referral scheme for
                                                                                                                                                                                                                                                                                                                                                                                                                                   pregnant smokers - Health visitors and midwifes have been briefed. The service is
                                                                                                                                                                                                                                                                                                                                                                                                                                   being reviewed and more capacity being considered. A family support scheme is
                                                                                                                                                                                                                                                                                                                                                                                                                                   being rolled out in September and may help generate referrals.




LAA                 Increase the number of four week quitters through the local NHS Support to          Max           Mary Hart                                                        0 (without stretch)                                                                                          LAA                              To be reported by data showing progress          Mar-10          Data not        Amber        As above
                    Stop Smoking Services from staff and users of mental health services                Kammerling                                                                     30 (with stretch)                                                                                                                             against target                                                   available
                    identified either by inclusion in the GP register of those suffering from severe
                    & enduring mental health problems or accessed through mental health user
                    groups.
LAA                 96% of schools to achieve healthy schools status by 2010                            Max           Shaun            96% of schools to achieve healthy schools       96%                                                                                                          LAA                              To be reported by data showing progress          Mar-10          82%             Amber        At the end of Quarter 1 2009-10, 64 schools (82%) have Healthy School Status.
                                                                                                        Kammerling    Cheesman         status by 2010                                                                                                                                                                                against target                                                                                The programme is 2 schools less than it would have liked or anticipated at this
                                                                                                                                                                                                                                                                                                                                                                                                                                   point.
                                                                                                                                                                                                                                                                                                                                                                                                                                   There are risks that may prevent the programme from meeting the LAA stretch
                                                                                                                                                                                                                                                                                                                                                                                                                                   target for April 2010:
                                                                                                                                                                                                                                                                                                                                                                                                                                   The schools we are working with now are the hardest to „crack‟, which is why they
                                                                                                                                                                                                                                                                                                                                                                                                                                   have not achieved Healthy Schools Status already. Many of them have relatively
                                                                                                                                                                                                                                                                                                                                                                                                                                   inexperienced Healthy Schools Coordinators working in isolation, with little
                                                                                                                                                                                                                                                                                                                                                                                                                                   support from senior management in the school.

                                                                                                                                                                                                                                                                                                                                                                                                                                   In response to the risks facing the programme, a plan has been written and we
                                                                                                                                                                                                                                                                                                                                                                                                                                   will be increasing capacity in September to meet with schools more regularly and
                                                                                                                                                                                                                                                                                                                                                                                                                                   monitor their progress more closely.

World Class         Life Expectancy                                                                     Max           Mary Hart        Life expectancy at time of birth, Years                                                                                                                                         WCC           To be reported by data showing progress          Mar-10                          Amber        Draft strategy is being finalised before circulation to partners for agreement. The
Commissioning                                                                                           Kammerling                                                                                                                                                                                                                   against target                                                                                most recent life expectancy figures are based on a 5 year average using 2003 to
                                                                                                                                                                                                                                                                                                                                                                                                                                   2007 figures. The deprivation quintiles are based on national quintiles so there
                                                                                                                                                                                                                                                                                                                                                                                                                                   are not equal numbers of people in each quintile. This shows a gap of 9.5 for
                                                                                                                                                                                                                                                                                                                                                                                                                                   males and 7.3 for females. We will not have any new data for this until next year.
                                                                                                                                                                                                                                                                                                                                                                                                                                   The Health and Wellbeing Strategic Partnership are leading on producing a new
                                                                                                                                                                                                                                                                                                                                                                                                                                   Health Inequalities Strategy and Action Plan with they key aim of the strategy to
                                                                                                                                                                                                                                                                                                                                                                                                                                   reduce the gap. They have a number of programmes targeted at the areas with
                                                                                                                                                                                                                                                                                                                                                                                                                                   the highest mortality rates including an enhanced home visiting service for new
                                                                                                                                                                                                                                                                                                                                                                                                                                   parents, a cardio vascular risk assessment project, a weight management project
                                                                                                                                                                                                                                                                                                                                                                                                                                   and enhanced smoking cessation services. They have increased the number of
                                                                                                                                                                                                                                                                                                                                                                                                                                   Health Trainers working in the areas with the highest mortality rates. They have
                                                                                                                                                                                                                                                                                                                                                                                                                                   plans to open a nurse led drop in service in Central Weston and are developing a
                                                                                                                                                                                                                                                                                                                                                                                                                                   service specification for the Healthy Living Centre in the South Ward. These are
                                                                                                                                                                                                                                                                                                                                                                                                                                    the two wards with the highest mortality rates.

World Class         % of stroke admissions given a brain scan within 24 hours                           Jeanette      Clare-Louise     % of stroke admissions given a brain scan                                                                                                                                       WCC           To be reported by data showing progress          Mar-10                          Green        All Trusts working to 30 minutes arrival in ED to CT. Need to work with Trusts to
Commissioning                                                                                           George        Nicholls         within 24 hours                                                                                                                                                                               against target                                                                                measure this. Anecdotally the PCT is assured that patients are being seen within
                                                                                                                                                                                                                                                                                                                                                                                                                                   30 minutes (and most definitely within 24 hours).




World Class         Drug treatment waiting times                                                        Max           Julie Kell       Drug treatment average waiting times in         % of drug users                                                                                                                 WCC           To be reported by data showing progress          Mar-10          88%             Green        The PCT is on track against this health outcome
Commissioning                                                                                           Kammerling                     weeks of all treatments e.g. Rehab, GP          waiting < 3 weeks.                                                                                                                            against target
                                                                                                                                       specialist, outpatients etc. 1st intervention   Target TBC
                                                                                                                                       treatment.
PCT Ambition        95% of patients who attend emergency departments, minor injury units, walk Mary Hutton            Caerrie Barber                                                                            95% of patients who attend emergency departments, minor                                                              Ensure a robust trajectory is designed to        Apr-09                          Amber        Trajectory to be developed. GP Led Health Centre and GP in Urgent Care fully
                    in centres and community settings for urgent care will have treatment initiated                                                                                                             injury units, walk in centres and community settings for urgent                                                      show positive movement towards the two                                                        established, performance management on going
                    within two hours of arrival by 31 March 2011.                                                                                                                                               care will have treatment initiated within two hours of arrival by 31                                                 hour target
                                                                                                                                                                                                                March 2011.
PCT Ambition        Ensure 100% of service users seeking access to genito-urinary medicine              Max           Ginette Corr                                                                              100% of service users seeking access to genito-urinary medicine                                                      Develop a LES to move 10% of the GUM             Mar-10                          Green        Service specification developed. Awaiting feedback from WAHT.
                    clinics continue to be offered an appointment within 48 hours on any day of         Kammerling                                                                                              clinics will be offered an appointment within 48 hours, measured                                                     activity from level 3 services to primary care
                    the week.                                                                                                                                                                                   over a full calendar week, by 31 March 2010                                                                          Conduct a local sexual health needs audit




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        10 of 44
        Appendix 4 - NHS NS Corporate Work Plan 2009/10


Ref            Target                                                                          PCT           Programme         Target detail   2009/10 Target   Related SHA Ambition                                                  PCT Target         LAA        Periodic WCC health   2009/10 actions to deliver                        Delivery Date   Q1 (Apr-June)   RAG status   Q1 Progress against actions to deliver                                                    Q2               Q3
                                                                                               Executive     Lead                                                                                                                     Slipped?           (lead      Review outcome                                                                          Performance                                                                                                            Performance      Performance
                                                                                               Director                                                                                                                                                  partner)                                                                                           (data)
PCT Ambition   Make available the full range of specialist community-based child and           Max           Dali Sidebottom                                    Make available the full range of specialist community-based           Yes - adopt                                         Ensure effectiveness of child and adolescent Mar-10                               Amber        WAHT to risk assess the children and young people with learning disability on the
               adolescent mental health services (Tiers 2 and 3) to residents of every         Kammerling                                                       child and adolescent mental health services (Tiers 2 and 3) to        revised SHA                                         mental health services in providing swift and                                                  waiting list needing psychiatric assessment and determine the best solution to
               Primary Care Trust by 31 March 2012                                                                                                              residents of every Primary Care Trust by 31 March 2011                ambition but                                        easy access for vulnerable children and                                                        manage the risk in the short term. Explore other options on providing the service
                                                                                                                                                                                                                                      delay                                               young people                                                                                   by approaching neighbouring authorities to consider sharing a post or purchasing
                                                                                                                                                                                                                                      implementation                                                                                                                                     a service from existing staff.
                                                                                                                                                                                                                                      by 1 year
PCT Ambition   95% of patients able to book an appointment in advance with a general           Jeanette      Penny Hynds                                        95% of patients able to book an appointment with a general                                                                Reported through patient satisfaction survey. Mar-10                              Amber        Data not available from GP Patient Survey on advanced access with named GP.
               practitioner by 31 March 2009.                                                  George                                                           practitioner by 31 March 2009.                                                                                            Work with GPs on informing patients about                                                      The GP patient survey results from 2008/9 shows that 90% of patients were able
                                                                                                                                                                                                                                                                                          advanced access such as newsletters, local                                                     to see a doctor fairly quickly (more than 2 days in advance).
                                                                                                                                                                                                                                                                                          adverts and waiting room posters.

PCT Ambition   Reduce the year-on-year rise in sexually transmitted infections by 2013         Max           Ginette Corr                                       Reduce the year-on-year rise in sexually transmitted infections                                                           Develop a LES to improve the take up of long Mar-10                               Green        Local Enhanced Service developed awaiting CRB checks to sign up pharmacies.
                                                                                               Kammerling                                                       by 2013                                                                                                                   acting reversible contraception                                                                Targets set with No Worries clinics.
                                                                                                                                                                                                                                                                                          Develop a LES to move 10% of the GUM
                                                                                                                                                                                                                                                                                          activity from level 3 services to primary care
PCT Ambition   90% of diagnostic tests are carried out and the results available to the        Mary Hutton   Alan Lawler                                        90% of diagnostic tests are carried out and the results available                                                         Work with providers and other                  Mar-10                             Green        A pathway is being developed with Weston. Approx 4 meetings have been held so
               referrer within two weeks by 31 March 2012.                                                                                                      to the referrer within two weeks by 31 March 2011.                                                                        commissioners to implement the findings of                                                     far and there is involvement from consultants and anaesthetists. This work is part
                                                                                                                                                                                                                                                                                          the NHS Southwest Radiology Review                                                             of the rapid improvement pathway being led by the SHA and Institute of
                                                                                                                                                                                                                                                                                                                                                                                         Innovation.
PCT Ambition   90% of admitted patients and 95% of non-admitted patients to be treated         Mary Hutton   Alan Lawler                                        90% of admitted patients and 95% of non-admitted patients to          Commitment to                                       Work with providers to deliver 13 weeks RTT Mar-10                                Amber        For this year the PCT is holding the position at 13 weeks with Weston delivering
               within eight weeks by 31 March 2011.                                                                                                             be treated within eight weeks by 31 March 2011.                       deliver same                                        at specialty level for 90% admitted and 95%                                                    this by specialty.
                                                                                                                                                                                                                                      timescales for                                      non admitted patients to trajectories agreed
                                                                                                                                                                                                                                      therapies and                                       with Trusts redesigning services where
                                                                                                                                                                                                                                      wheelchair                                          necessary.
                                                                                                                                                                                                                                      services removed                                    Expansion of MSK interface service through
                                                                                                                                                                                                                                                                                          recruitment of additional clinical staff and
                                                                                                                                                                                                                                                                                          redesign of pathways through service to
                                                                                                                                                                                                                                                                                          ensure delivery of 13 week RTT for all
                                                                                                                                                                                                                                                                                          patients.
PCT Ambition   Achieve by 2013 uptake rates for breast and cervical screening of at least      Max           TBC                                                Achieve by 2013 uptake rates for breast and cervical screening                                                            Continue work with Avon, Somerset and         Mar-10                              Green
               80% in all local communities                                                    Kammerling                                                       of at least 80% in all local communities                                                                                  Wiltshire Cancer Services network and
                                                                                                                                                                                                                                                                                          BNSSG Cancer Service Design Group on the
                                                                                                                                                                                                                                                                                          delivery of specific measures set out in the
                                                                                                                                                                                                                                                                                          Cancer Reform Strategy. Link with
                                                                                                                                                                                                                                                                                          Specialised Commissioning Group on the
                                                                                                                                                                                                                                                                                          services commissioned through this group
                                                                                                                                                                                                                                                                                          and on the designation process.
PCT Ambition   Achieve 95% of patients able to book an appointment in advance with a           Jeanette      Penny Hynds                                        Achieve 95% of patients able to book an appointment in                                                                    Reported through patient satisfaction survey. Mar-10                              Amber        Data not available from GP Patient Survey on advanced access with named GP.
               named general practitioner by 31 March 2009.                                    George                                                           advance with a named general practitioner by 31 March 2009.                                                               Work with GPs on informing patients about                                                      The GP patient survey results from 2008/9 shows that 90% of patients were able
                                                                                                                                                                                                                                                                                          advanced access such as newsletters, local                                                     to see a doctor fairly quickly (more than 2 days in advance) and 67% were able to
                                                                                                                                                                                                                                                                                          adverts and waiting room posters.                                                              see their preferred doctor.

PCT Ambition   Sustain the 30% reduction in clostridium Difficile in hospitals achieved        Julie         Suzanne Ellis-                                     50% reduction across all ages in clostridium Difficile in hospitals                                                       Continue to monitor performance on              Mar-10                            Green        Regular monitoring underway
               between 2007/08 and 2008/09                                                     Clatworthy    Golding                                            from 2007/08 to 2008/09                                                                                                   Clostridium Difficile rates via Partnership and
                                                                                                                                                                                                                                                                                          Quality meetings. Recruit an ICN to work in
                                                                                                                                                                                                                                                                                          Provider services who will monitor pre-48hr C
                                                                                                                                                                                                                                                                                          diff cases via ICNET (HCAI Case
                                                                                                                                                                                                                                                                                          Management and Surveillance software) and
                                                                                                                                                                                                                                                                                          conduct root cause analysis, following up
                                                                                                                                                                                                                                                                                          actions from RCAs around particular care
                                                                                                                                                                                                                                                                                          areas and prescribing activities.

PCT Ambition   90% of stroke patients will spend 90% of their time in hospital in an acute     Jeanette      Clare-Louise                                       90% of stroke patients will spend 90% of their time in hospital in                                                        Monitor the implementation of the action plan Ongoing                             Amber        22 out of 71 (31%) pts against plan of 72 out of 120 (60%). Performance is
               specialist multi-disciplinary stroke unit by 31 March 2011.                     George        Nicholls                                           an acute specialist multi-disciplinary stroke unit by 31 March                                                            via the North Somerset Stroke Strategy                                                         expected to improve in Q2 with Weston now having a dedicated stroke unit from 1
                                                                                                                                                                2011.                                                                                                                     Group.                                                                                         July.
                                                                                                                                                                                                                                                                                          Work with partners to oversee the project to
                                                                                                                                                                                                                                                                                          develop life after stroke services utilising the
                                                                                                                                                                                                                                                                                          DH grant to NSC.
PCT Ambition                                                                                   Julie         Suzanne Ellis-                                     No methicillin resistant staphylococcus aureus bacteraemia in         Remove                                                                                               Mar-10                           Amber
                                                                                               Clatworthy    Golding                                            hospital more than 48 hours after admission



PCT Ambition   All patients to have an option available to them of extended opening hours in   Jeanette      Penny Hynds                                        All patients to have an option available to them of extended                                                              Broaden extended opening hours in GP              Apr-09          92%             Green        The PCT is currently offering 92% extended hours access (23/25) practices. It has
               general practice by 31 March 2010                                               George                                                           opening hours in general practice by 31 March 2010                                                                        Practices to offer this facility in all practices                                              a trajectory for 25/26 practices offering extended hours by 2010. GP led Health
                                                                                                                                                                                                                                                                                          able to do so, and provide an alternative                                                      Centre will for offering all of NS patients extended hours.
                                                                                                                                                                                                                                                                                          option in the GPLHC.
PCT Ambition   20% reduction in methicillin resistant staphylococcus aureus (MRSA)             Julie         Suzanne Ellis-                                     20% reduction in methicillin resistant staphylococcus aureus                                                              Proposed six month project (RUM)                  Mar-10                          Amber
               bacteraemias detected less than 48 hours from admission to NHS provided         Clatworthy    Golding                                            (MRSA) bacteraemias detected less than 48 hours from                                                                      commencing in January 2009 in nursing
               care                                                                                                                                             admission to NHS provided care                                                                                            homes to concentrate on reducing MRSA
                                                                                                                                                                                                                                                                                          bacteraemia in patients who are catheterised
                                                                                                                                                                                                                                                                                          (and reduce numbers of urinary catheterised
                                                                                                                                                                                                                                                                                          patients). Two day Improvement event to
                                                                                                                                                                                                                                                                                          improve care and facilities for patients with
                                                                                                                                                                                                                                                                                          diabetic foot ulcers who have been identified
                                                                                                                                                                                                                                                                                          as being high risk for MRSA bacteraemia.
                                                                                                                                                                                                                                                                                          Meet with local Trusts and Community ICNs
                                                                                                                                                                                                                                                                                          to share learning from Root Cause analysis
                                                                                                                                                                                                                                                                                          of MRSA bacteraemia. Monitor MRSA
                                                                                                                                                                                                                                                                                          screening requirements of Trusts via
                                                                                                                                                                                                                                                                                          Partnership/Quality meetings



PCT Ambition   Increase the number of women initiating breastfeeding to 78%. Increase the      Max           Ginette Corr                                       Increase the number of women initiating breastfeeding to 78%.                                                             Increase initiation rate by using CQUINS to   Mar-10                              Amber        Midwifery manager has been on long term sick leave - meeting set up for the 13th
               percentage of women breastfeeding their children at six to eight weeks to       Kammerling                                                       Increase the percentage of women breastfeeding their children                                                             incentivise maternity services                                                                 Aug to discuss a number of issues including breastfeeding.
               60% by 31 March 2011                                                                                                                             at six to eight weeks to 60% by 31 March 2011                                                                             Explore opportunities of third sector
                                                                                                                                                                                                                                                                                          involvement to develop peer support groups
                                                                                                                                                                                                                                                                                          One day a week health visitor recruited to
                                                                                                                                                                                                                                                                                          develop a local network and action plan
                                                                                                                                                                                                                                                                                          (which will include plans to implement Unicef
                                                                                                                                                                                                                                                                                          BFI Initiative)

PCT Ambition   Increase life expectancy to match the highest life expectancy in Europe by      Max           Mary Hart                                          Increase life expectancy to match the highest life expectancy in                                                          1. Agree prioritised initiatives to improve the   Apr-09                          Amber        Draft strategy is being finalised before circulation to partners for agreement.
               2013                                                                            Kammerling                                                       Europe by 2013                                                                                                            health and well-being of those groups who
                                                                                                                                                                                                                                                                                          currently have the lowest life expectancy.

PCT Ambition   Reduce mortality rates from cancer in people aged under 75 to reach a level     Max           Mary Hart                                          Reduce mortality rates from cancer in people aged under 75 to                                                             Monitor uptake of cancer screening                                                Green        Skin cancer film showing at surgery waiting rooms June-sep through Life Channel
               of 100 per 100,000 European standardised population by 2013                     Kammerling                                                       reach a level of 100 per 100,000 European standardised                                                                    programmes and develop action plans to                                                         program.
                                                                                                                                                                population by 2013                                                                                                        increase uptake if required
PCT Ambition   Reduce mortality rates from heart disease and stroke and related diseases in Max              Mary Hart                                          Reduce mortality rates from heart disease and stroke and                                                                  Complete the implementation of targeted           Mar-10                          Amber        Local Enhanced Services have been agreed and service will commence in
               people aged under 75 to 65 per 100,000 European standardised population      Kammerling                                                          related diseases in people aged under 75 to 65 per 100,000                                                                Vascular Risk Screening and provide health                                                     September. Community exercise class record more participants recovering from
               by 2013                                                                                                                                          European standardised population by 2013                                                                                  trainer support and pharmacotherapy to                                                         stroke particularly tai chi.
                                                                                                                                                                                                                                                                                          those identified at risk.
PCT Ambition   Improve levels of patient satisfaction with separate male and female provision Julie          Marie Davies                                       Improve levels of patient satisfaction with separate male and                                                             Elimination of mixed sex accommodation will       Mar-10                          Amber        On track
               year-on-year, with satisfaction in all NHS South West facilities in the top 10% Clatworthy                                                       female provision year-on-year, with satisfaction in all NHS South                                                         be monitored through CQRG process.
               nationally                                                                                                                                       West facilities in the top 10% nationally                                                                                 Exception reporting through incident
                                                                                                                                                                                                                                                                                          reporting system and audit programme.
PCT Ambition   Achieve a year on year improvement in the number of people accessing NHS Jeanette             Penny Hynds                                        There will a year on year improvement in the number of people                                                             To deliver this additional activity the PCT       2009/10                         Amber        Performance has improved since March 2009 but still remains below target. The
               dental services.                                                         George                                                                  accessing NHS dental services.                                                                                            needs to re-commission the current UDA                                                         PCT resubmitted its plan figures for 2009/10 in July as part of a national exercise.
                                                                                                                                                                                                                                                                                          under achievement of 24,000 UDAs with                                                          Several contractors across North Somerset have increased their contracted units
                                                                                                                                                                                                                                                                                          dentists who can achieve their targets, and                                                    of dental activity to provide approximately an additional 15,000 units of dental
                                                                                                                                                                                                                                                                                          commission an additional approx 20,000                                                         activity by 31st March 2009. This additional level of activity will continue into 09/10
                                                                                                                                                                                                                                                                                          UDAs activity.                                                                                 to maintain steady rise in patients seen.
PCT Ambition   Reverse the trend in childhood obesity to achieve a clear downward trend in     Max           Dali Sidebottom                                    Reverse the trend in childhood obesity to achieve a clear                                                                 Increase capacity to deliver evidenced based      Mar-10                          Amber        Data for this indicator will be available in December 2009. Initial plans for 2
               the level of childhood obesity by 2013                                          Kammerling                                                       downward trend in the level of childhood obesity by 2013                                                                  programmes to tackle childhood obesity                                                         schools based interventions to prevent childhood obesity have been agreed. Also
                                                                                                                                                                                                                                                                                          Support children centres and schools in                                                        providing support for North Somerset Council family based intervention. National
                                                                                                                                                                                                                                                                                          areas with the highest rates of childhood                                                      Child Measurement Programme and other data will inform the choice of schools in
                                                                                                                                                                                                                                                                                          obesity to provide training advice and                                                         which interventions take place.
                                                                                                                                                                                                                                                                                          information in implementing health eating
                                                                                                                                                                                                                                                                                          and physical activity policies and action plans


PCT Ambition   Achieve United Nations Children‟s Fund Baby Friendly Initiative status or       Max           Ginette Corr                                       Achieve United Nations Children‟s Fund Baby Friendly Initiative                                                           One day a week health visitor recruited to    Mar-10                              Amber        Coverage rates high for quarter 1 but breastfeeding status a concern as many
               equivalent in all maternity services in the South West by 31 March 2010         Kammerling                                                       status or equivalent in all maternity services in the South West                                                          develop a local network and action plan                                                        have no status recorded
                                                                                                                                                                by 31 March 2010                                                                                                          (which will include plans to implement Unicef
                                                                                                                                                                                                                                                                                          BFI Initiative)
PCT Ambition   Achieve a minimum of 90% immunisation against measles, mumps and                Max           Ginette Corr                                       Achieve a minimum of 90% immunisation against measles,                                                                    Develop a plan to address the catch-up        Mar-10                              Green        Local Enhanced Service developed and sent out to GP's
               rubella (MMR) by 2012                                                           Kammerling                                                       mumps and rubella (MMR) by 2012                                                                                           campaign for MMR and Teenage boosters
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 11 of 44
        Appendix 4 - NHS NS Corporate Work Plan 2009/10


Ref            Target                                                                          PCT           Programme        Target detail   2009/10 Target   Related SHA Ambition                                                 PCT Target            LAA        Periodic WCC health   2009/10 actions to deliver                       Delivery Date   Q1 (Apr-June)   RAG status   Q1 Progress against actions to deliver                                                 Q2               Q3
                                                                                               Executive     Lead                                                                                                                   Slipped?              (lead      Review outcome                                                                         Performance                                                                                                         Performance      Performance
                                                                                               Director                                                                                                                                                   partner)                                                                                          (data)
PCT Ambition   Reduce smoking levels in North Somerset to equal the best in Europe by          Max           Mary Hart                                         Reduce smoking levels in South West to equal the best in                                                                    Continue to provide a comprehensive,             Mar-10                          Amber        Work with Weston Hospital to develop referrals to service from staff and patients.
               2013.                                                                           Kammerling                                                      Europe by 2013.                                                                                                             accessible Stop Smoking Service and                                                           Attended NHS Trust meeting for all Stop Smoking Service Leads re Health
                                                                                                                                                                                                                                                                                           increase number of community based                                                            Promoting Hospitals. Ian Bramley, Associate Director of Nursing at Weston
                                                                                                                                                                                                                                                                                           advisors                                                                                      General Hospital to take forward.
                                                                                                                                                                                                                                                                                           Implement Smoking Cessation in Practice
                                                                                                                                                                                                                                                                                           toolkit
                                                                                                                                                                                                                                                                                           Develop and implement a comprehensive
                                                                                                                                                                                                                                                                                           tobacco control strategy and action plan
                                                                                                                                                                                                                                                                                           including continuing smoke free home and
                                                                                                                                                                                                                                                                                           Life channel campaigns
                                                                                                                                                                                                                                                                                           Commission a „stop before the op‟ scheme at
                                                                                                                                                                                                                                                                                           Weston General Hospital
PCT Ambition   Reduce mortality rates from suicide and undetermined injury to 7 per 100,000 Max              Julie Kell                                        Reduce mortality rates from suicide and undetermined injury to 7                                                            Monitor mortality rates annually and             Mar-10                          Amber        Suicide audit completed for last financial year action plan being worked upon.
               European standardised population by 2013                                     Kammerling                                                         per 100,000 European standardised population by 2013                                                                        implement action plans if required
                                                                                                                                                                                                                                                                                           Agree the Suicide Strategy through the
                                                                                                                                                                                                                                                                                           Mental Health Local Implementation Team
                                                                                                                                                                                                                                                                                           and implement the action plan.
PCT Ambition   Achieve a minimum of 50% reduction in under 18 conception rates by 2013         Max           Ginette Corr                                      Achieve a minimum of 50% reduction in under 18 conception                                                                   Recruit a number of posts to address the         Dec-10                          Amber        All posts recruited to. Action plan updated. 1st quarter data down on same quarter
               (from the 1998 baseline)                                                        Kammerling                                                      rates by 2013 (from the 1998 baseline)                                                                                      gaps in service provision identified in the                                                   in 2007 (43.4 which equated to 39 conceptions) with a rate of 33.9 which equates
                                                                                                                                                                                                                                                                                           recent teenage pregnancy audit                                                                to 30 conceptions.
                                                                                                                                                                                                                                                                                           Recruit an additional outreach nurse
PCT Ambition   Reduce emergency bed days for people with long-term conditions by 30%           Jeanette      Clare-Louise                                      Reduce emergency bed days for people with long-term                                                                         Maintain strong performance management                                           N/A          Work is underway with the Community Matrons to consider additional patient
               from the 2006/07 baseline by 31 March 2010                                      George        Nicholls                                          conditions by 30% from the 2006/07 baseline by 31 March 2010                                                                and review of community matron services to                                                    groups that might be included in the caseloads to increase caseload to the
                                                                                                                                                                                                                                                                                           ensure people with complex long term                                                          recognised "typical" size. Enhanced therapy in place to support transfer of
                                                                                                                                                                                                                                                                                           conditions receive maximal management in                                                      patients undergoing rehabilitation in the BGH to Clevedon. Transfer of this
                                                                                                                                                                                                                                                                                           by the Department of Health consider how                                                      contract took place wef 1.6.09. Therapists care for patients both in CCH and at
                                                                                                                                                                                                                                                                                           the integrated Rapid Response Team might                                                      home following the patient journey. Initial analysis of LOS and bedday use to be
                                                                                                                                                                                                                                                                                           evolve to deliver rehabilitation services in the                                              undertaken. Rapid response and Intermediate care team integrated to for Rapid
                                                                                                                                                                                                                                                                                           community in conjunction with the integrated                                                  Response and Rehab Service as part of the integration of community services.
                                                                                                                                                                                                                                                                                           community teams.
                                                                                                                                                                                                                                                                                           Ongoing work to develop a rehabilitation                                                      A RAG rating will be assigned from Q2 once data has been collected.
                                                                                                                                                                                                                                                                                           pathway for North Somerset that builds on
                                                                                                                                                                                                                                                                                           the development of community rehabilitation
                                                                                                                                                                                                                                                                                           services and Clevedon Hospital to support
                                                                                                                                                                                                                                                                                           the transfer of patients previously cared for in
                                                                                                                                                                                                                                                                                           the Bristol General Hospital (BGH) to North
                                                                                                                                                                                                                                                                                           Somerset rehabilitation services and that
                                                                                                                                                                                                                                                                                           links to the work of the Rehabilitation SDG in
                                                                                                                                                                                                                                                                                           particular neuro rehabilitation.

PCT Ambition   Responding to individual preferences will lead to a 10% reduction year-on-      Jeanette      Clare-Louise                                      Responding to individual preferences will lead to a 10%                                                                     Through the Marie Curie Delivering Choices Apr-09                                Amber        Marie Curie Delivering Choice Programme phase 2 come to a conclusion. Service
               year in adult deaths in acute hospital for each of the next three years (this   George        Nicholls                                          reduction year-on-year in adult deaths in acute hospital for each                                                           Programme redesign community end of life                                                      redesign proposals being submitted to Exec Committee for approval. Will then
               should exclude deaths in community hospitals and palliative care units in                                                                       of the next three years (this should exclude deaths in community                                                            services. Implement and monitor redesigned                                                    come through PCT service design processes for ratification.
               acute hospitals)                                                                                                                                hospitals and palliative care units in acute hospitals)                                                                     services through the North Somerset End of
                                                                                                                                                                                                                                                                                           Life Strategy Group.
                                                                                                                                                                                                                                                                                           Implementation new/review existing policies
                                                                                                                                                                                                                                                                                           that support service delivery at home thereby Mar-10
                                                                                                                                                                                                                                                                                           reducing admissions to hospital e.g. Do Not
                                                                                                                                                                                                                                                                                           Attempt Resuscitation, anticipatory
                                                                                                                                                                                                                                                                                           prescribing, verifying expected death.

PCT Ambition   Adults with mild to moderate depression and anxiety to have access to           Jeanette      Julie Kell                                        Adults with mild to moderate depression and anxiety to have                                                                 Ensure that a third of the workforce of high     Mar-10                          Green        On target part of wave 2 , 2nd level of posts now advertised meeting training
               psychological therapies by 31 March 2011, three years ahead of the national     George                                                          access to psychological therapies by 31 March 2011, three years                                                             and low level intervention workers are trained                                                requirements.
               requirement                                                                                                                                     ahead of the national requirement                                                                                           and able to deliver psychological therapies by
                                                                                                                                                                                                                                                                                           March 2009
PCT Ambition   Halt the rise in hospital admissions for alcohol-related harm and achieve a     Max           Mary Hart                                         Halt the rise in hospital admissions for alcohol-related harm and                                                           Work with partners across North Somerset to Mar-10                               Amber        Support via A&E in place. Alcohol Strategy Implementation Group has been
               downward trend by 2013                                                          Kammerling                                                      achieve a downward trend by 2013                                                                                            implement the Alcohol Strategy                                                                convened. Commissioning of additional capacity has begun
                                                                                                                                                                                                                                                                                           Commission the delivery of alcohol related
                                                                                                                                                                                                                                                                                           advice and additional support for Weston A
                                                                                                                                                                                                                                                                                           & E on managing Alcohol –related
                                                                                                                                                                                                                                                                                           attendances         See Weston Psychiatric
                                                                                                                                                                                                                                                                                           Liaison Service.
PCT Ambition   Contribute to the SHA SW ambition to reduce the current gap in life             Max           Mary Hart                                         Reduce the current gap in life expectancy between the worst                                                                 Continue to develop the Health Trainer           Apr-09                          Amber        Draft strategy is being finalised before circulation to partners for agreement. This
               expectancy between the worst and best areas in North Somerset by 2013 by        Kammerling                                                      and best areas in the South West by one third by 2013                                                                       project and recruit a health trainer to focus on                                              is linked to all age all cause mortality Vital Sign.
               reducing the current gap in all age all cause mortality                                                                                                                                                                                                                     men‟s health
                                                                                                                                                                                                                                                                                           Increase health services in Central Weston
                                                                                                                                                                                                                                                                                           Super Mare through commissioning a nurse
                                                                                                                                                                                                                                                                                           led drop in service and opening a Health
                                                                                                                                                                                                                                                                                           Shop
                                                                                                                                                                                                                                                                                           Revise and implement the North Somerset
                                                                                                                                                                                                                                                                                           Health Inequalities Action Plan
PCT Ambition                                                                                   Mary Hutton   Caerrie Barber                                    Achieve the 8 minute response time standard for 75% category         PCT note:
                                                                                                                                                               A calls which should already be being achieved. Achieve the 19       Remove. GWAS
                                                                                                                                                               minute response time standard for 95% category B calls which         advise this will be
                                                                                                                                                               should already be being achieved. Achieve upper quartile             achieved.
                                                                                                                                                               emergency ambulance response times by March 2010.

PCT Ambition   No ambulance handover times at emergency departments will be greater            Mary Hutton   Caerrie Barber                                    No ambulance handover times at emergency departments will                                                                   Ensure hand over delays of above 30              Ongoing                         Red          Avon wide commissioners meeting undertaking review of processes. Monthly
               than 15 mins by March 2010.                                                                                                                     be greater than 15 mins by March 2010.                                                                                      minutes are eliminated by April 2009 by                                                       meetings with WAHT, GWAS and PCT in place to work through joint action plan.
                                                                                                                                                                                                                                                                                           developing a joint action plan in line with best                                              Ambulance handover audit planned to provide benchmarking and data for review.
                                                                                                                                                                                                                                                                                           practice provided by the Department of
                                                                                                                                                                                                                                                                                           Health. This will include a trajectory plan to
                                                                                                                                                                                                                                                                                           allow continual monitoring.
                                                                                                                                                                                                                                                                                           Ensure incentive‟s/sanctions relating to hand Apr-09
                                                                                                                                                                                                                                                                                           over performance are part of this years
                                                                                                                                                                                                                                                                                           contracts with both acute and ambulance and
                                                                                                                                                                                                                                                                                           community services are compliant with data
                                                                                                                                                                                                                                                                                           entry requirements
PCT Ambition   Have jointly agreed plans (with North Somerset Council) in place by 30 June     Max           Karin Dixon                                       Have jointly agreed plans (with North Somerset Council) in place                                                            Implement the Go4Life strategy                   Jun-09                          Green        Draft NS obesity strategy is with North Somerset Council for comment. Joint NS
               2009 in each local authority area to reduce adult obesity.                      Kammerling                                                      by 30 June 2009 in each local authority area to reduce adult                                                                                                                                                              food policy has been adopted by NSP.
                                                                                                                                                               obesity.
PCT Ambition   Contribute to the South West ambition to have the highest levels of fruit and   Max           Mary Hart                                         Have the highest levels of fruit and vegetable consumption in                                                               Promote healthy eating and reduce            Mar-10                              Amber        Bid for funding from Food Standards Agency to run healthy cooking skills training
               vegetable consumption in England by 2013.                                       Kammerling                                                      England by 2013.                                                                                                            inequalities in the uptake of healthy foods                                                   from practitioners was unsuccessful. Investigating possibility of running training
                                                                                                                                                                                                                                                                                           and develop new evidence based projects to                                                    anyway.
                                                                                                                                                                                                                                                                                           increase health eating
PCT Ambition   Increase the proportion of adults in the general population of North Somerset Max             Mary Hart                                         Raise levels of exercise in the population in the South West to                            LAA                              Implement the Go4Life Action plans including Mar-10              Amber           Green        Using active people survey we are on target to increase the proportion of adults
               achieving at least 30 minutes of moderate physical activity at least three    Kammerling                                                        50% in men and 40% in women by 2013                                                                                         using health settings to promote physical                                                     who are active 30 mins, 3 days a week by 2010 - 21.6% Oct 06, Dec 08 this had
               times a week and raise levels of exercise in the population to 50% in men                                                                                                                                                                                                   activity and distribute the Active Directory                                                  increased to 24.9% - need 0.7% more to reach stretch target of 25.6%
               and 40% in women by 2013.                                                                                                                                                                                                                                                   Support roll out of community exercise
                                                                                                                                                                                                                                                                                           classes and health walks

PCT Ambition   Target oral health promotion in those communities that have average             Max           Mary Hart                                         Target oral health promotion in those communities that have                                                                 Implement Oral Health Promotion Strategy         Mar-10                          Amber        Oral Health Promotion Strategy in place - need to review effectiveness of
               decayed, missing or filled tooth scores of 2.0 or higher at age five            Kammerling                                                      average decayed, missing or filled tooth scores of 2.0 or higher                                                                                                                                                          targeting delivery
                                                                                                                                                               at age five
PCT Ambition   By March 2010, provide access to termination of pregnancy services with         Max           Mary Hart                                         Access to termination of pregnancy services within nine weeks        Yes - Timescales                                       Commission a single point of entry service       Mar-09                          Amber        Robust plan in place for Bristol Providers.
               nine weeks of gestation for all women in North Somerset who present early       Kammerling                                                      of gestation will be 100% in the South West by 31 March 2009         moved timescales                                       from Marie Stopes                                                                             Concerns re Weston - awaiting a meeting in September
               enough.                                                                                                                                                                                                              to March 2010                                          Ensure all providers of abortion services
                                                                                                                                                                                                                                    from March 2009                                        provide contraception advice and services
                                                                                                                                                                                                                                                                                           after an abortion has taken place

PCT Ambition   Full implementation of all actions and recommendations of the national End      Jeanette      Clare-Louise                                      Full implementation of all actions and recommendations of the        PCT note - New                                         The PCT is participating in a Marie Curie        From Apr-09                     Green        PCT End of Life Strategy Group, BHSP EOL Service Design group and Marie
               of Life Care Strategy in all Primary Care Trusts                                George        Nicholls                                          national End of Life Care Strategy in all Primary Care Trusts        SHA ambition.                                          Delivering Choices Programme project as a                                                     Curie DCP all working to support delivery of the strategy.
                                                                                                                                                                                                                                    Review when                                            partner to Somerset PCT. This project will
                                                                                                                                                                                                                                    SHA proposed                                           identify current services, barriers to service
                                                                                                                                                                                                                                    timescales for                                         provision and based on this learning support
                                                                                                                                                                                                                                    delivery are                                           the redesign of services and pathways to
                                                                                                                                                                                                                                    understood.                                            meet the ambitions of the national strategy.

PCT Ambition   To be able by 31 March 2011 to identify the number of people with a plan for Jeanette         Clare-Louise                                      All health communities will be able by 31 March 2011 to identify                                                            Introduce and implement Advanced Care          From Apr-09                       Green        Advance care planning documentation agreed and distributed across all providers
               their death and to report the percentage of cases where the preference about George           Nicholls                                          the number of people with a plan for their death and to report the                                                          Planning using agreed BNSSG tools by staff                                                    in BNSSG. Training in ACP commissioned from St Peter's Hospice. End of Life
               place of death has been delivered.                                                                                                              percentage of cases where the preference about place of death                                                               who have undergone specific communication                                                     register in development that will allow the capture of this data.
                                                                                                                                                               has been delivered                                                                                                          skills training.
PCT Ambition   People can access at all times the „basic building blocks‟ for effective care   Jeanette      Clare-Louise                                      People can access at all times the „basic building blocks‟ for                                                              Scope the development of a register for        From Apr-09                       Green        On track to deliver. Part of Marie Curie Delivering Choice Programme work.
               (community nursing, equipment, palliative care drugs, specialist advice, the    George        Nicholls                                          effective care (community nursing, equipment, palliative care                                                               those at the end of their life that links with
               patient plan, and rapid discharge from hospital) by 31 March 2011.                                                                              drugs, specialist advice, the patient plan, and rapid discharge                                                             Ambulance and GP out of hours systems.
                                                                                                                                                               from hospital) by 31 March 2011.



                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              12 of 44
        Appendix 4 - NHS NS Corporate Work Plan 2009/10


Ref            Target                                                                           PCT           Programme         Target detail   2009/10 Target   Related SHA Ambition                                                 PCT Target          LAA        Periodic WCC health   2009/10 actions to deliver                        Delivery Date   Q1 (Apr-June)   RAG status   Q1 Progress against actions to deliver                                               Q2               Q3
                                                                                                Executive     Lead                                                                                                                    Slipped?            (lead      Review outcome                                                                          Performance                                                                                                       Performance      Performance
                                                                                                Director                                                                                                                                                  partner)                                                                                           (data)
PCT Ambition   Providing support at home will lead to reduced unplanned admissions to           Jeanette      Clare-Louise                                       Providing support at home will lead to reduced unplanned                                                                  Through the Marie Curie Delivering Choices        From Apr-09                     Amber        See above re Marie Curie Delivering Choice Programme
               hospital from nursing homes in the last 12 months of life by 10% per annum       George        Nicholls                                           admissions to hospital from nursing homes in the last 12 months                                                           Programme redesign community end of life
               (from the 2007/08 baseline) for each of the next three years.                                                                                     of life by 10% per annum (from the 2007/08 baseline) for each                                                             services. Implement and monitor redesigned
                                                                                                                                                                 of the next three years.                                                                                                  services through the North Somerset End of
                                                                                                                                                                                                                                                                                           Life Strategy Group.
PCT Ambition   By 31 March 2011, 75% of the 160 procedures identified by the British            Mary Hutton   Alan Lawler                                        By 31 March 2011, 75% of the 160 procedures identified by the                                                             Manage trajectory to ensure 75 % of the           Mar-10                          Green        The PCT is working towards building a baseline in this year.
               Association of Day Surgery will be carried out as a day case or in line with the                                                                  British Association of Day Surgery will be carried out as a day                                                           identified procedures are treated as day
               best practice recommendations of the Association.                                                                                                 case or in line with the best practice recommendations of the                                                             cases –via acute contracts.
                                                                                                                                                                 Association.
PCT Ambition   Reduce outpatient follow-ups to achieve best quartile performance in each        Mary Hutton   Alan Lawler                                        Outpatient follow-ups will be reduced to achieve best quartile                                                            Reducing follow-up outpatient appointments Mar-10                                 Green        This is being worked through the PRAT (Practice Referrals Action Team) initiative.
               specialty by 31 March 2011.                                                                                                                       performance by 31 March 2011                                                                                              as a ratio to first out-patient appointments,
                                                                                                                                                                                                                                                                                           highlighting follow-ups which are not clinically
                                                                                                                                                                                                                                                                                           necessary or could be delivered closer to
                                                                                                                                                                                                                                                                                           where people live and work
PCT Ambition                                                                                    Mary Hutton   Alan Lawler                                        By 31 March 2011, 90% of patients referred by a general              Yes - remove as
                                                                                                                                                                 practitioner will be able to book appointments, diagnostic tests     an ambition.
                                                                                                                                                                 and treatments at times and dates convenient to them                 Implement in line
                                                                                                                                                                                                                                      with national
                                                                                                                                                                                                                                      timescales
PCT Ambition   95% of fractures requiring surgery will be operated on within 24 hours of        Mary Hutton   Alan Lawler                                        95% of fractures requiring surgery will be operated on within 24                                                          Work with WAHT to design and implement            Ongoing                         Green        A pathway is being developed with Weston. Have had approx 4 meetings to date
               admission or fit for surgery by 31 March 2010                                                                                                     hours of admission or fit for surgery by 31 March 2010                                                                    new patient pathways for fracture patients                                                     with involvement from consultants and anaesthetists. Part of rapid improvement
                                                                                                                                                                                                                                                                                                                                                                                          pathway led by the SHA and Institute of Innovation


PCT Ambition   95% of acute medical patients will have an assessment by an acute physician Mary Hutton        Alan Lawler                                        95% of acute medical patients will have an assessment by an                                                               Work with Weston to get baseline data.            Mar-10                          Green        Working with Weston to establish a baseline.
               consultant within four hours of admission by 31 March 2011.                                                                                       acute physician consultant within four hours of admission by 31
                                                                                                                                                                 March 2011.


PCT Ambition   The length of stay for acute medical care will be in the best quartile for       Mary Hutton   Alan Lawler                                        The length of stay for acute medical care will be in the best                                                             Maintain strong performance management                                            Green        The PCT is working with the Commissioning Discharge Liaison Team focusing
               England by 31 March 2011.                                                                                                                         quartile for England by 31 March 2011.                                                                                    and review of community matron services to                                                     efforts of discharge specification at Weston. Taking forward long stay reports at
                                                                                                                                                                                                                                                                                           ensure people with complex long term                                                           UH Bristol and NBT.
                                                                                                                                                                                                                                                                                           conditions receive maximal management in
                                                                                                                                                                                                                                                                                           the community with prompt facilitated
                                                                                                                                                                                                                                                                                           discharge when they do receive acute
                                                                                                                                                                                                                                                                                           hospital care.
PCT Ambition   A&E attendances at acute hospitals will reduce by 10% over 5 years.              Mary Hutton   Caerrie Barber                                     Accident and emergency attendances at acute hospitals will                                                                Develop use of Clevedon Hospital as a        Ongoing                              Amber        Plans in place to maximise potential alternatives. GP led health centre and GP in
                                                                                                                                                                 reduce by 10% per annum over five years                                                                                   potential bedded service for managing                                                          Urgent Care fully operational. Recent rise in attendances and activity across
                                                                                                                                                                                                                                                                                           people as an alternative to hospital care                                                      BNNSG to be understood and investigated.
                                                                                                                                                                                                                                                                                           Develop further RUM schemes such as
                                                                                                                                                                                                                                                                                           “Forecasting the Nations Health”, weather
                                                                                                                                                                                                                                                                                           predictions to prevent attendances and
                                                                                                                                                                                                                                                                                           admissions
                                                                                                                                                                                                                                                                                           Monitor GP-Led Health Centre
PCT Ambition   Patients with a fractured neck of femur will have a length of stay in the best   Mary Hutton   Alan Lawler                                        Patients with a fractured neck of femur will have a length of stay                                                        Provide commissioning input to the North     Ongoing                              Amber        Commissioners taking forward falls pathways with GWAS. Rapid improvement
               quartile for England by 31 March 2010                                                                                                             in the best quartile for England by 31 March 2010                                                                         Somerset Falls Steering Group and support                                                      project with Weston on fracture neck of femur delays in primary care management
                                                                                                                                                                                                                                                                                           the development of a work programme that                                                       pathway.
                                                                                                                                                                                                                                                                                           includes:
                                                                                                                                                                                                                                                                                           Pending NICE guidance scope the
                                                                                                                                                                                                                                                                                           development of an osteoporosis pathway as
                                                                                                                                                                                                                                                                                           part of the Do Once And Share (DOAS)
                                                                                                                                                                                                                                                                                           pathway,
                                                                                                                                                                                                                                                                                           Implement primary care management of         Apr-09
                                                                                                                                                                                                                                                                                           fallers as part of DOAS pathway from April
                                                                                                                                                                                                                                                                                           2009 – with the aim to improved primary care
                                                                                                                                                                                                                                                                                           services for people who have fallen or who
                                                                                                                                                                                                                                                                                           are at risk of falling in North Somerset.
                                                                                                                                                                                                                                                                                           Implementation of full DOAS pathway i.e.
                                                                                                                                                                                                                                                                                           comprehensive falls service by March 2010


PCT Ambition   Contribute to the national target to reduce the gap in infant mortality between Max            Ginette Corr                                       Contribute to the national target to reduce the gap in infant                                                             Recruit a Specialist Midwife and Health           May-09                          Amber        Both posts recruited to - there are issues with accommodation
               the routine and manual group, and the population as a whole, by at least 10% Kammerling                                                           mortality between the routine and manual group, and the                                                                   Visitor to provide intensive support to
               by 31 March 2010.                                                                                                                                 population as a whole, by at least 10% by 31 March 2010.                                                                  vulnerable families and develop a care
                                                                                                                                                                                                                                                                                           pathway
PCT Ambition   Continue to reduce maternal deaths and stillbirths each year                     Max           Ginette Corr                                       Continue to reduce maternal deaths and stillbirths each year                                                              Develop an action plan to ensure full             Mar-10                          Amber        Midwifery manager has been on long term sick - meeting set up for the 13th Aug
                                                                                                Kammerling                                                                                                                                                                                 implementation of the recommendations from                                                     to discuss a number of issues including breastfeeding
                                                                                                                                                                                                                                                                                           the SANDS - Saving Lives Document
PCT Ambition   Full delivery in North Somerset of Maternity matters: Choice, access and         Max           Ginette Corr                                       Full delivery in each health community of Maternity matters:       Yes - PCT                                              BNSSG Implementation Action plan                  Mar-10                          Green        Service Delivery Group established. Local North Somerset meeting planned for
               continuity of care in a safe service (April 2007) by December 2011               Kammerling                                                       Choice, access and continuity of care in a safe service (April     timescale of 2011                                      developed. Service Development Group                                                           Sept.
                                                                                                                                                                 2007) ahead of the national timescale of 31 December 2009          instead of SHA                                         Established with sub groups. Implement,
                                                                                                                                                                                                                                    timescale of                                           monitor and evaluate all actions stemming
                                                                                                                                                                                                                                    March 2009                                             from these groups/action plans.
PCT Ambition   Choice of how to access maternity care, including self-referral to the local     Max           Ginette Corr                                       Choice of how to access maternity care, including self-referral to Yes - PCT                                              Bristol providers already enable self referral.   Mar-10                          Amber        Midwifery manager has been on long term sick - meeting set up for the 13th Aug
               midwifery service by December 2011                                               Kammerling                                                       the local midwifery service by March 2009                          timescale of 2011                                      Develop care pathway which enables self-                                                       to discuss a number of issues including breastfeeding
                                                                                                                                                                                                                                    instead of SHA                                         referral to Ashcombe Ward.
                                                                                                                                                                                                                                    timescale of
                                                                                                                                                                                                                                    March 2009
PCT Ambition   Choice of type of antenatal care, including midwifery care or team care by       Max           Ginette Corr                                       Choice of type of antenatal care, including midwifery care or      Yes - PCT                                              Request a workforce capacity plan. Agree a        Mar-10                          Green        Workforce capacity plan requested - awaiting a response.
               December 2011                                                                    Kammerling                                                       team care by March 2009                                            timescale of 2011                                      two year development plan
                                                                                                                                                                                                                                    instead of SHA
                                                                                                                                                                                                                                    timescale of
                                                                                                                                                                                                                                    March 2009
PCT Ambition   Choice of place of birth, including home, local midwifery unit or birthing       Max           Ginette Corr                                       Choice of place of birth, including home, local midwifery unit or Yes - PCT                                               Already achieved need to increase capacity        Mar-10                          Amber        Midwifery manager has been on long term sick - meeting set up for the 13th Aug
               centre and hospital by December 2011                                             Kammerling                                                       birthing centre and hospital by September 2009                     timescale of 2011                                      in the community improve systems for home                                                      to discuss a number of issues including breastfeeding
                                                                                                                                                                                                                                    instead of SHA                                         births
                                                                                                                                                                                                                                    timescale of
                                                                                                                                                                                                                                    March 2009
PCT Ambition   Choice of postnatal care, including how and where to access postnatal care       Max           Ginette Corr                                       Choice of postnatal care, including how and where to access        Yes - PCT                                              All Trusts to produce a plan detailing current Mar-10                             Amber        Midwifery manager has been on long term sick - meeting set up for the 13th Aug
               by 31st December 2011.                                                           Kammerling                                                       postnatal care by 31st March 2009.                                 timescale of 2011                                      postnatal provision information to be collated                                                 to discuss a number of issues including breastfeeding
                                                                                                                                                                                                                                    instead of SHA                                         by relevant SDG group
                                                                                                                                                                                                                                    timescale of                                           information will be shared with MSLC group.
                                                                                                                                                                                                                                    March 2009                                             If necessary action plan will be developed to
                                                                                                                                                                                                                                                                                           improve choice.
PCT Ambition   As a result of making available well-supported birthing options and             Max            Ginette Corr                                       As a result of making available well-supported birthing options                                                           Need to assess current workforce capacity.     Mar-10                             Amber        Midwifery manager has been on long term sick - meeting set up for the 13th Aug
               responding to individual preferred choices it is expected that there will be an Kammerling                                                        and responding to individual preferred choices it is expected that                                                        Develop a two year development plan.                                                           to discuss a number of issues including breastfeeding
               increase in the percentage of babies born at home to 10% and in midwife-led                                                                       there will be an increase in the percentage of babies born at
               units to 30% by 31 March 2011                                                                                                                     home to 10% and in midwife-led units to 30% by 31 March 2011

PCT Ambition   Increase the normal birth rate by 1% per year and as a result reduce             Max           Ginette Corr                                       Increase the normal birth rate by 1% per year and as a result                                                             Trusts to develop clinical policies with clinical Mar-10                          Amber        Midwifery manager has been on long term sick - meeting set up for the 13th Aug
               caesarean section rates until there is research evidence available about the     Kammerling                                                       reduce caesarean section rates until there is research evidence                                                           support. Training/information programme in                                                     to discuss a number of issues including breastfeeding
               optimum level and a clear improvement in maternal and perinatal morbidity                                                                         available about the optimum level and a clear improvement in                                                              place for midwives. Review financial
                                                                                                                                                                 maternal and perinatal morbidity                                                                                          incentives.
                                                                                                                                                                                                                                                                                           Trusts to undertake clinical audit. NBT to
                                                                                                                                                                                                                                                                                           share lessons learnt as an NHS Institute
                                                                                                                                                                                                                                                                                           Early Adopter Site.
PCT Ambition   Reduce admissions to inpatient (Tier 4) child and adolescent mental health       Max           Dali Sidebottom                                    Reduce admissions to inpatient (Tier 4) child and adolescent         Yes - Adopt                                          Work with WAHT on the development of              Mar-10                          Green        Service Specification in place for Tier 4 inpatient service - need to identify
               services by 20% by 31 March 2012 from the 2006/07 baseline                       Kammerling                                                       mental health services by 20% by 31 March 2011 from the              revised SHA                                          Specialist CAMHS and the interface with Tier                                                   resource in localities to reduce admissions
                                                                                                                                                                 2006/07 baseline                                                     ambition but                                         4 services
                                                                                                                                                                                                                                      delay
                                                                                                                                                                                                                                      implementation
                                                                                                                                                                                                                                      by 1 year (from
                                                                                                                                                                                                                                      2011)
PCT Ambition   Ensure that same-day urgent assessments for acute care are available to all      Max           Dali Sidebottom                                    Ensure that same-day urgent assessments for acute care are                                                                Establish baseline information form relevant Mar-10                               Green        BNSSG Children's Service Development Programme includes proposal to reduce
               children who need them, so as to halt the rise in emergency hospital             Kammerling                                                       available to all children who need them, so as to halt the rise in                                                        Trusts. Ensure specification for Extended day                                                  emergency admissions.
               admissions for children by 31 March 2010                                                                                                          emergency hospital admissions for children by 31 March 2010                                                               care unit at Weston includes this
                                                                                                                                                                                                                                                                                           performance indicator and liaise with lead
                                                                                                                                                                                                                                                                                           commissioners for other Bristol Trusts.

PCT Ambition   By 31 March 2010, ensure that every child and young person needing long-      Max              Dali Sidebottom                                    By 31 March 2010, ensure that every child and young person                                                                This is a key part of the integration of          Mar-10                          Green        Draft specification produced.
               term support will have an identified care co-ordinator who manages their care Kammerling                                                          needing long-term support will have an identified care co-                                                                services for disabled children and will been
               needs and the transition to adult services                                                                                                        ordinator who manages their care needs and the transition to                                                              included in the specification for that service.
                                                                                                                                                                 adult services




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             13 of 44
        Appendix 4 - NHS NS Corporate Work Plan 2009/10


Ref            Target                                                                            PCT           Programme         Target detail   2009/10 Target   Related SHA Ambition                                                  PCT Target           LAA        Periodic WCC health   2009/10 actions to deliver                        Delivery Date   Q1 (Apr-June)   RAG status   Q1 Progress against actions to deliver                                               Q2               Q3
                                                                                                 Executive     Lead                                                                                                                     Slipped?             (lead      Review outcome                                                                          Performance                                                                                                       Performance      Performance
                                                                                                 Director                                                                                                                                                    partner)                                                                                           (data)
PCT Ambition   Ensure that by 2013 there are no predictable child deaths in an acute hospital Max              Dali Sidebottom                                    Ensure that by 2013 there are no predictable child deaths in an                                                             Take an active part in the implementation of      Mar-10                          Amber
               setting, unless it is the stated preference by parents.                        Kammerling                                                          acute hospital setting, unless it is the stated preference by                                                               the BNSSG Palliative Care Strategy
                                                                                                                                                                  parents.                                                                                                                    Analyse existing information sources to
                                                                                                                                                                                                                                                                                              ensure that required data is available and
                                                                                                                                                                                                                                                                                              robust enough to support an action plan to
                                                                                                                                                                                                                                                                                              achieve this target

PCT Ambition   Fully implement the NSF for children and young people and maternity               Max           Dali Sidebottom                                    Fully implement the NSF for children and young people and                                                                   Work with providers, partners and           Mar-10                                Green        Progress report on NSF has been produced identifying areas which need attention
               services ahead of the national timescale of 2014.                                 Kammerling                                                       maternity services ahead of the national timescale of 2014.                                                                 stakeholders to monitor and review progress
                                                                                                                                                                                                                                                                                              in implementing NSF through existing
                                                                                                                                                                                                                                                                                              commissioning and partnership mechanisms

PCT Ambition   Full implementation of the standards set out in the National Service              Jeanette      Julie Kell                                         Full implementation of the standards set out in the National                                                                Various:                                      Mar-10                              Amber        Action plan submitted to achieve NSF requirements by Dec 2009
               Framework for mental health ahead of national timescales of 2010.                 George                                                           Service Framework for mental health by December 2009 ahead                                                                  • Agree the Suicide Strategy and implement
                                                                                                                                                                  of national timescales of March 2010.                                                                                       the action plan.
                                                                                                                                                                                                                                                                                              • Review Joint Protocols within learning
                                                                                                                                                                                                                                                                                              disability and adult mental health to reflect
                                                                                                                                                                                                                                                                                              joint working and deliver services to a
                                                                                                                                                                                                                                                                                              standard of care set out in the NSF for
                                                                                                                                                                                                                                                                                              Mental Health, Valuing People and the CPA
                                                                                                                                                                                                                                                                                              programme.
                                                                                                                                                                                                                                                                                              • Dual Diagnosis Steering Group to review
                                                                                                                                                                                                                                                                                              Strategy and action plan in accordance with
                                                                                                                                                                                                                                                                                              required standards and submit to Mental
                                                                                                                                                                                                                                                                                              Health Local Implementation Team for
                                                                                                                                                                                                                                                                                              agreement and submission to Strategic
                                                                                                                                                                                                                                                                                              Health Authority
                                                                                                                                                                                                                                                                                              • Work with providers to provide an
                                                                                                                                                                                                                                                                                              Alternative Place of Safety as set out in
                                                                                                                                                                                                                                                                                              Section 136 of the Mental Health Act as an
                                                                                                                                                                                                                                                                                              alternative to the present use of the police
                                                                                                                                                                                                                                                                                              cells in Weston-super-Mare.
                                                                                                                                                                                                                                                                                              • Develop and update the needs assessment
                                                                                                                                                                                                                                                                                              process for patients with borderline
                                                                                                                                                                                                                                                                                              personality disorder and agree a local
                                                                                                                                                                                                                                                                                              strategy for service delivery.
PCT Ambition   Improved access to specialist mental health services: routine multidisciplinary Jeanette        Julie Kell                                         Improved access to specialist mental health services: routine                                                               Monitored monthly through AWP scorecard       Mar-10                              Amber        Performance below target at 89%. Both adult and older people services are being
               assessments started within eight weeks by 31 March 2010 and within four         George                                                             multidisciplinary assessments started within eight weeks by 31                                                                                                                                                             tasked with working towards delivery of the 6 week target by the end of November
               weeks by 31 March 2011. This includes responding to the particular needs of                                                                        March 2010 and within four weeks by 31 March 2011. This                                                                                                                                                                    2009 and a trajectory has now been set.
               mothers, children, adolescents, adults of working age and older people                                                                             includes responding to the particular needs of mothers, children,
                                                                                                                                                                  adolescents, adults of working age and older people

PCT Ambition   Improved access for carers: assessments and initial care plans for the         Jeanette         Julie Kell                                         Improved access for carers: assessments and initial care plans                                                              Monitored monthly through AWP scorecard           Mar-10                          Amber        No target, performance showing 41%.
               identified main carer started within four weeks of a service user‟s assessment George                                                              for the identified main carer started within four weeks of a
               by 31 March 2010                                                                                                                                   service user‟s assessment by 31 March 2010


PCT Ambition   Specialist community-based eating disorder services, as defined in National       Jeanette      Julie Kell                                         Specialist community-based eating disorder services, as defined                                                             • Develop Training on understanding eating       Mar-10                           Amber        Patients currently being reviewed by Primary Care Mental health service
               Institute for Health and Clinical Excellence guidelines, to be available to PCT   George                                                           in National Institute for Health and Clinical Excellence                                                                    disorders, early identification and intervention
               residents by 31 March 2011                                                                                                                         guidelines, to be available to PCT residents by 31 March 2011                                                               to be made available to all GPs and other
                                                                                                                                                                                                                                                                                              relevant primary health care staff.
                                                                                                                                                                                                                                                                                              • Develop a range of educational leaflets for
                                                                                                                                                                                                                                                                                              eating disorders to be distributed for use in
                                                                                                                                                                                                                                                                                              primary health care.

PCT Ambition   Ensure all people diagnosed with dementia have an initial agreed care plan        Jeanette      Julie Kell                                         People diagnosed with dementia to have an initial agreed care                                                               Monitored monthly through AWP scorecard           Mar-10                          Amber        Indicator still under development with provider.
               within four weeks of their diagnosis by 31 March 2010.                            George                                                           plan within four weeks of their diagnosis by 31 March 2010



PCT Ambition   People receiving acute hospital care for physical conditions to have access to Jeanette         Julie Kell                                         People receiving acute hospital care for physical conditions to                                                             Monitored monthly through AWP scorecard           Mar-10                          Amber        A/E Liaison Service commenced April 2009.
               a full range of mental health liaison services by 31 March 2010                George                                                              have access to a full range of mental health liaison services by
                                                                                                                                                                  31 March 2010
PCT Ambition   People who have experience of serious mental illness, and are discharged to Jeanette            Julie Kell                                         People who have experience of serious mental illness, and are                                                               Underway. Will be delivered as part of work       Mar-10                          Amber        Pathways between Primary Care and secondary care under development
               primary care, to have a named worker in primary care to ensure rapid        George                                                                 discharged to primary care, to have a named worker in primary                                                               around IAPT.
               response and access to information and support by 31 March 2010                                                                                    care to ensure rapid response and access to information and
                                                                                                                                                                  support by 31 March 2010
PCT Ambition   Develop at least three best practice pathways, based on published guidelines Jeanette           Julie Kell                                         All Primary Care Trusts to use at least three best practice                                                                 Agree referral protocols for exchange of        Mar-10                            Amber        3 best pathways currently under development
               from the National Institute for Health and Clinical Excellence, and incorporate George                                                             pathways, based on published guidelines from the National                                                                   information
               service user-led outcomes in their commissioning requirements by 31 March                                                                          Institute for Health and Clinical Excellence, and to incorporate                                                            Develop systems for delivering specialist
               2011.                                                                                                                                              service user-led outcomes in their commissioning requirements                                                               mental health services in primary care
                                                                                                                                                                  by 31 March 2011                                                                                                            settings (out posted clinics, primary mental
                                                                                                                                                                                                                                                                                              health care liaison teams etc.)
PCT Ambition   95% of general practices will be able to identify the people with a learning      Jeanette      Penny Hynds                                        95% of general practices will be able to identify the people with                                                           Being delivered by the new DES and the          Mar-10                            Amber        16 practices (64%) have signed up to the DES. This includes those with large LD
               disability in the practice population by 31 March 2010                            George                                                           a learning disability in the practice population by 31 March 2010                                                           work of the learning disabilities team with the                                                populations. Health checks are now commencing. The PCT does not expect to
                                                                                                                                                                                                                                                                                              annual health checks for people with learning                                                  achieve 95% by March 2010. The SHA is aware of this.
                                                                                                                                                                                                                                                                                              disabilities
PCT Ambition   Each person with a learning disability will have full access to the physical and Jeanette       Tim Wye                                            Each person with a learning disability will have full access to the                                                         All people with a learning disability will be   Mar-10                            Amber        The PCT is rolling out the GP DES for learning disabilities. The Community Team
               mental health care they need. The health care is to be based on a                George                                                            physical and mental health care they need. The health care is to                                                            offered a health action plan, (and where                                                       for People with LD is currently providing training and support for individual
               comprehensive annual health check, included in a personal health plan and                                                                          be based on a comprehensive annual health check, included in                                                                appropriate linked to their Person Centred                                                     practices. 15 practices have currently signed DES. All with large LD registers. 39
               checked by a primary care professional by 31 March 2009                                                                                            a personal health plan and checked by a primary care                                                                        Plan) which has been initiated or checked by                                                   Health checks carried out to date.
                                                                                                                                                                  professional by 31 March 2009                                                                                               a primary care professional and is based on
                                                                                                                                                                                                                                                                                              a comprehensive health check.
PCT Ambition                                                                                     Jeanette      Maya Bimson                                        All people in NHS campus provision are to be housed in                PCT note - N/A -
                                                                                                 George                                                           accommodation of their choice, with the appropriate level of          No NS patients in
                                                                                                                                                                  care and support by 31 March 2010                                     campus
                                                                                                                                                                                                                                        accommodation
PCT Ambition   People with a learning disability will have the same access to screening for      Jeanette      Tim Wye                                            People with a learning disability will have the same access to                                                              Ensure that information about ALL health          Mar-10                          Amber        This target will be picked up as part of the annual health screening process (see
               breast and cervical cancer as everyone else. Screening rates will be              George                                                           screening for breast and cervical cancer as everyone else.                                                                  services is available in a variety of formats                                                  above)
               increased year-on-year, towards the same uptake rate as the general                                                                                Screening rates will be increased year-on-year, towards the                                                                 and information about how to complain is
               population of 80% by 2013                                                                                                                          same uptake rate as the general population of 80% by 2013                                                                   available in a variety of accessible formats.


PCT Ambition   Enable diagnostic services to be booked using the Choose and Book system          Mary Hutton   Andy Kinnear                                       Enable diagnostic services to be booked using the Choose and                                                                Review of options during 2009/10 and              Mar-10                          Green        On track to deliver
               by 31 March 2011.                                                                                                                                  Book system by 31 March 2011.                                                                                               inclusion of proposal in prioritisation process
                                                                                                                                                                                                                                                                                              for 2010/11 operational plan.
PCT Ambition   Enable all prescribers to send prescriptions electronically to a dispenser of     Mary Hutton   Andy Kinnear                                       Enable all prescribers to send prescriptions electronically to a                                                            TBC                                               Mar-10                          Amber        The delivery of this ambition is dependent on the companies that supply the
               patient‟s choice by 31 March 2011.                                                                                                                 dispenser of patient‟s choice by 31 March 2011.                                                                                                                                                                            software.
PCT Ambition   Implement information systems to support integrated care planning and             Mary Hutton   Andy Kinnear                                       Implement information systems to support integrated care                                                                    Implementation of RIO in 2009/10                  Mar-10                          Green        AWPT is implementing RIO
               assessment in mental health NHS Trusts by 31 March 2011.                                                                                           planning and assessment in mental health NHS Trusts by 31
                                                                                                                                                                  March 2011.

PCT Ambition   Implement hospital systems that support clinical activity (electronic clinical    Mary Hutton   Andy Kinnear                                       Implement hospital systems that support clinical activity                                                                   Implementation of Cerner at NBT                   Mar-10                          Green        Progress on track. Performance monitored through BNSSG NLOC (National Local
               orders, prescribing and care pathways) in all acute NHS Trusts by 31 March                                                                         (electronic clinical orders, prescribing and care pathways) in all                                                                                                                                                         Ownership Programme)
               2011.                                                                                                                                              acute NHS Trusts by 31 March 2011.
PCT Ambition   Achieve deployment of the Summary Care Record across NHS South West               Mary Hutton   Andy Kinnear                                       Achieve deployment of the Summary Care Record across NHS                                                                    Achieve deployment of the Summary Care            Dec-10                          Amber        Will be agreed as part of the operational plan process for 2010/11
               by 31 December 2010.                                                                                                                               South West by 31 December 2010.                                                                                             Record
PCT Ambition   Ensure access by community-based health and social care professionals to          Mary Hutton   Andy Kinnear                                       Ensure access by community-based health and social care                                                                     Ensure access by community-based health           Mar-10                          Green        Will be delivered with implementation of RIO and FACE
               all relevant service user information by 31 March 2011.                                                                                            professionals to all relevant service user information by 31                                                                and social care professionals to all relevant
                                                                                                                                                                  March 2011.                                                                                                                 service user information
PCT Ambition   Expand the use of telecare, telemedicine and assistive technology                 Mary Hutton   Andy Kinnear                                       Expand the use of telecare, telemedicine and assistive                Yes - Generalise                                      Plan will be developed during 2009/10 for         Mar-10                          Green        Will be agreed as part of the operational plan process for 2010/11
                                                                                                                                                                  technology in three or more health communities by 31 March            but no timescales.                                    inclusion in 2010/2011 operational plan.
                                                                                                                                                                  2011                                                                  Depends on
                                                                                                                                                                                                                                        making cost
                                                                                                                                                                                                                                        neutral or cost
                                                                                                                                                                                                                                        saving business
                                                                                                                                                                                                                                        case.

PCT Ambition   Enable relevant clinical outcome information to be published by all NHS           Mary Hutton   Andy Kinnear                                       Enable relevant clinical outcome information to be published by                                                             Enable relevant clinical outcome information      Mar-10                          Green        Work is on progress for this
               providers by 31 March 2010                                                                                                                         all NHS providers by 31 March 2010                                                                                          to be published by all NHS Providers.

PCT Ambition   Contribute to the SHA SW target to reduce primary energy consumption by           Mary Hutton   TBC                                                Reduce primary energy consumption by 15% or 0.15 million                                                                    Assess our contribution to this during            Mar-10                          Green
               15% or 0.15 million tonnes carbon from 31 March 2000 levels by 31 March                                                                            tonnes carbon from 31 March 2000 levels by 31 March 2010                                                                    2009/10 with plan to contribute to reduction
               2010.                                                                                                                                                                                                                                                                          being implemented in 2010/11


                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                14 of 44
        Appendix 4 - NHS NS Corporate Work Plan 2009/10


Ref            Target                                                                            PCT           Programme           Target detail   2009/10 Target   Related SHA Ambition                                                PCT Target           LAA        Periodic WCC health   2009/10 actions to deliver                         Delivery Date   Q1 (Apr-June)   RAG status   Q1 Progress against actions to deliver                                                       Q2               Q3
                                                                                                 Executive     Lead                                                                                                                     Slipped?             (lead      Review outcome                                                                           Performance                                                                                                               Performance      Performance
                                                                                                 Director                                                                                                                                                    partner)                                                                                            (data)
PCT Ambition   Contribute to the SHA SW target to achieve energy levels of 35-55 gigajoules Mary Hutton        TBC                                                  Achieve energy levels of 35-55 gigajoules per 100 cubic metres                                                            Assess our contribution to this during             Mar-10                          Green
               per 100 cubic metres for new developments and refurbishments and 55-65                                                                               for new developments and refurbishments and 55-65 gigajoules                                                              2009/10 with plan to contribute to reduction
               gigajoules per 100 cubic metres for existing facilities by 31 March 2010.                                                                            per 100 cubic metres for existing facilities by 31 March 2010.                                                            being implemented in 2010/11


PCT Ambition   All hospitals to have a hospital standardised mortality ratio among the lowest    Julie         Marie Davies /                                       All hospitals to have a hospital standardised mortality ratio                                                             Monitor incidents through CQRG process.            Mar-10                          Green        Incidents being monitored through CQRG process.
               in England by 31 March 2011                                                       Clatworthy    Lynne Liptrot                                        among the lowest in England by 31 March 2011                                                                              Work with Commissioning to support End of
                                                                                                                                                                                                                                                                                              Life strategies
PCT Ambition   A year-on-year reduction in moderate or severe harm arising from medical          Julie         Marie Davies /                                       A year-on-year reduction in moderate or severe harm arising                                                               Ensure NHS NS provider services take heed          Mar-10                          Green        Never events included in contract. SUIs reported
               and clinical error as reported through the National Reporting and Learning        Clatworthy    Lynne Liptrot                                        from medical and clinical error as reported through the National                                                          of areas for improvement as indicated by
               System statistics                                                                                                                                    Reporting and Learning System statistics                                                                                  HCC in patient surveys.
PCT Ambition   Increase reporting, where medical errors have occurred, in order to assist the    Julie         Marie Davies /                                       Increase reporting, where medical errors have occurred, in order                                                          Monitor through CQRG process. Quarterly            Mar-10                          Green        Never events included in contract. SUIs reported
               NHS South West to have the highest reporting rate in the country                  Clatworthy    Lynne Liptrot                                        to assist the NHS South West to have the highest reporting rate                                                           reports within North Somerset relating to
                                                                                                                                                                    in the country                                                                                                            commissioning incidents.
PCT Ambition   Full implementation of the National Patient Safety Agency safe practice           Julie         Marie Davies /                                       Full implementation of the National Patient Safety Agency safe                                                            Scoping of work programme undertaken and           Mar-10                          Amber        Work currently underway
               guidance.                                                                         Clatworthy    Lynne Liptrot                                        practice guidance.                                                                                                        actions to be put into place.


PCT Ambition   Full and timely implementation of Technology Appraisal guidance published         Julie         Marie Davies /                                       Full and timely implementation of Technology Appraisal                                                                    Incorporate into training programmes and           Mar-10                          Green        Being incorporated into training programmes
               by the Institute of Health and Clinical Excellence                                Clatworthy    Lynne Liptrot                                        guidance published by the Institute of Health and Clinical                                                                encourage incident reporting.
                                                                                                                                                                    Excellence                                                                                                                Datix Risk Management Software update in
                                                                                                                                                                                                                                                                                              January 2009 installation.

PCT Ambition   Achieve and maintain excellent performance for cleanliness in all hospitals       Julie         Marie Davies /                                       Achieve and maintain excellent performance for cleanliness in                                                             Ensure NS provider services, NBT, UHB and Mar-10                                   Green        Providers are reporting compliance. Reviewed through contracting monitoring
               that serve North Somerset patients                                                Clatworthy    Lynne Liptrot                                        all hospitals that serve North Somerset patients                                                                          Weston has an ongoing programme of deep
                                                                                                                                                                                                                                                                                              clean activity. Certificates to be awarded and
                                                                                                                                                                                                                                                                                              displayed with expiry dates.
                                                                                                                                                                                                                                                                                              Cleanliness audits to be completed at least
                                                                                                                                                                                                                                                                                              quarterly using National Specifications for
                                                                                                                                                                                                                                                                                              Cleanliness, reports produced and cascaded.

PCT Ambition   75% of general practices will adopt the self care policy of the locality by 31    Jeanette      Clare-Louise                                         75% of general practices will adopt the self care policy of the     Yes - SHA                                             Develop a North Somerset Self Care Policy     Apr-09                               Amber        Self Care policy ratified by PEC in July 2009. Implementation plans being set in
               March 2010.                                                                       George        Nicholls                                             locality by end July 2009.                                          ambition is by end                                    for ratification by the PEC and PBC Clusters.                                                   place in conjunction with the development of self management plans by long term
                                                                                                                                                                                                                                        July 09                                               Develop an implementation plan to secure      Mar-10                                            condition.
                                                                                                                                                                                                                                                                                              adoption of the policy by practices.

PCT Ambition   75% of general practices will be able to identify the people most at risk of an   Jeanette      Clare-Louise                                         75% of general practices will be able to identify the people most                                                         To be included in work programmes for              Mar-10                          N/A          Good use of PARR+ by Community Matrons. New tools being considered.
               emergency admission in their practice population by 31 March 2010                 George        Nicholls                                             at risk of an emergency admission in their practice population by                                                         Service Improvement Manager.
                                                                                                                                                                    31 March 2010
PCT Ambition   75% of general practices will be able to identify the health inequalities of their Jeanette     Sylvia Pilkington                                    75% of general practices will be able to identify the health                                                              Public Health seminars to be offered to PBC Oct-09                                 Amber        A risk stratification tool is available which can identify patients at risk of potentially
               registered population by 31 March 2010, in order to target people at risk of       George                                                            inequalities of their registered population by 31 March 2010, in                                                          clusters which will: a) Demonstrate how the                                                     developing these illnesses. Not all practices in the PCT area have signed up and
               developing long-term conditions such as cardiac disease and diabetes                                                                                 order to target people at risk of developing long-term conditions                                                         primary care reporting tool dashboards can                                                      there are capacity issues within the primary care team to take this work forward.
                                                                                                                                                                    such as cardiac disease and diabetes                                                                                      assist with CVD or CHD or Diabetes risk
                                                                                                                                                                                                                                                                                              assessment b) Provide information on the
                                                                                                                                                                                                                                                                                              recent application of QRISK2 in North
                                                                                                                                                                                                                                                                                              Somerset and communicating results to
                                                                                                                                                                                                                                                                                              patients c) Provide an overview and copies of
                                                                                                                                                                                                                                                                                              the relevant NICE guidelines.

PCT Ambition   Ensure that all people with a long term condition have an action plan that        Jeanette      Clare-Louise                                         Ensure that all people with a long term condition have an action    Yes - SHA                                             Work with specialist clinicians and the       Mar-10                               Amber        See above re self care
               supports their self-management by 31 March 2011.                                  George        Nicholls                                             plan that supports their self-management by 31 March 2010.          ambition by 31                                        voluntary sector to create condition specific
                                                                                                                                                                                                                                        March 10                                              self management plans that are ratified by
                                                                                                                                                                                                                                                                                              PEC and PBC Clusters in a phased way over
                                                                                                                                                                                                                                                                                              the next 18 months.
PCT Ambition   Each locality to have a co-ordinated multi-disciplinary team approach for long Jeanette         Clare-Louise                                         Each locality to have a co-ordinated multi-disciplinary team                                                              Plan for the ongoing expansion of the North Mar-10                                 Green        Single point of access developed through the POPP project has been resourced
               term conditions by 31 March 2010 with a single point of access.                George           Nicholls                                             approach for long term conditions by 31 March 2010 with a                                                                 Somerset single point of access to                                                              recurringly and is being rolled out across North Somerset.
                                                                                                                                                                    single point of access.                                                                                                   community services established in June
                                                                                                                                                                                                                                                                                              2009.
PCT Ambition   To reduce emergency admissions as a result of a fall by 30% from the              Jeanette      Clare-Louise                                         To reduce emergency admissions as a result of a fall by 30%         Yes - SHA                                             Pending NICE guidance scope the               Mar-10                               Amber        Waiting on report of SHA review of falls and bone health to inform and guide
               2006/07 baseline by 31 March 2011 through effective falls prevention and          George        Nicholls                                             from the 2006/07 baseline by 31 March 2010 through effective        ambition is 2010                                      development of an osteoporosis pathway as                                                       action plan. Commissioner capacity will need to be identified to support redesign
               bone health promotion programmes                                                                                                                     falls prevention and bone health promotion programmes                                                                     part of the Do Once And Share (DOAS)                                                            work. Falls steering group meets regularly to share good practice and will be the
                                                                                                                                                                                                                                                                                              pathway,·                                                                                       forum through which an action plan is developed and delivered. The Do Once and
                                                                                                                                                                                                                                                                                              Implement primary care management of                                                            Share Falls pathway has been adopted by the group for implementation.
                                                                                                                                                                                                                                                                                              fallers as part of DOAS pathway from April
                                                                                                                                                                                                                                                                                              2009 – with the aim to improved primary care
                                                                                                                                                                                                                                                                                              services for people who have fallen or who
                                                                                                                                                                                                                                                                                              are at risk of falling in North Somerset.
                                                                                                                                                                                                                                                                                              Implementation of full DOAS pathway i.e.
                                                                                                                                                                                                                                                                                              comprehensive falls service by March 2010


PCT Ambition   Increase year-on-year by 5% per annum the percentage of carers of people          Jeanette      Clare-Louise                                         Increase year-on-year by 5% per annum the percentage of                                                                   Working in partnership with North Somerset Ongoing                                 Amber        Partnership working with NSC is ongoing. All North Somerset practices have
               with a long-term condition who have a carer assessment and support.               George        Nicholls                                             carers of people with a long-term condition who have a carer                                                              Council (NSC) implement the refreshed North                                                     identified a Carer's Champion and agreed to Crossroads Care North Somerset
                                                                                                                                                                    assessment and support.                                                                                                   Somerset Carers Strategy focussing on key                                                       having an active presence in all practices to raise awareness and improve links for
                                                                                                                                                                                                                                                                                              task areas of carers‟ health, information,                                                      carers with Crossroads and therefore better support. Carer's assessment integral
                                                                                                                                                                                                                                                                                              education and training and young carers.                                                        part of the EOL pathway. There is now a focus on assessment numbers in NSC
                                                                                                                                                                                                                                                                                              Bid to become a Caring with Confidence      Apr-09                                              further to a CQC review.
                                                                                                                                                                                                                                                                                              provider.

PCT Ambition   To fully implement the quality requirements of the National Service               Jeanette      Clare-Louise                                         To fully implement the quality requirements of the National                                                               With partners from the statutory and               Ongoing                         Amber        Local Implementation Group pulled together and will meet for the first time in
               Framework for long-term conditions ahead of the national timescale of 2015.       George        Nicholls                                             Service Framework for long-term conditions ahead of the                                                                   voluntary sectors, establish a multi-agency                                                     October. Neurological conditions training day been organised with the support
                                                                                                                                                                    national timescale of 2015.                                                                                               Local Implementation Group and agree work                                                       from the SW Alliance of Neurological Organisations (SWANO)
                                                                                                                                                                                                                                                                                              programme.
                                                                                                                                                                                                                                                                                              To link with the Specialist Commissioning          Ongoing
                                                                                                                                                                                                                                                                                              work to develop a South West
                                                                                                                                                                                                                                                                                              Neuromuscular Services model.
                                                                                                                                                                                                                                                                                              Working with specialist clinicians and the         Mar-09
                                                                                                                                                                                                                                                                                              voluntary sector develop best practice care
                                                                                                                                                                                                                                                                                              pathways for each specific condition
                                                                                                                                                                                                                                                                                              including multiple sclerosis, Parkinson‟s
                                                                                                                                                                                                                                                                                              disease, motor neurone disease, other
                                                                                                                                                                                                                                                                                              neuromuscular conditions, and epilepsy.
PCT Ambition   Cancer patients will receive earlier diagnosis. By 31 March 2011 90% of all       Mary Hutton   TBC                                                  Cancer patients will receive earlier diagnosis. By 31 March 2010 Yes - SHA                                                Initiate and develop plans to ensure the           31-Mar-11                       Green        Part of Avon Somerset and Wiltshire Cancer Network work programme
               diagnostic tests for suspected cancer patients will be carried out and the                                                                           90% of all diagnostic tests for suspected cancer patients will be ambition is 2010                                        delivery of the improved access to
               results available to the referrer within seven days                                                                                                  carried out and the results available to the referrer within 5 days and within 5 days                                     diagnostics. Work with BNSSG PCTS,
                                                                                                                                                                                                                                                                                              primary care and Weston Area Health Trust
                                                                                                                                                                                                                                                                                              to identify implications and deliver first stage
                                                                                                                                                                                                                                                                                              of move to meet this ambition.
PCT Ambition                                                                                     Jeanette      Maya Bimson                                          The National Cancer Reform Strategy (December 2007) will be         Yes - removed as                                      Targets related to this are monitored through
                                                                                                 George                                                             implemented by 31 March 2011 in the South West, two years           an ambition.                                          Vital Signs.
                                                                                                                                                                    ahead of the national timetable.                                    Implement in line
                                                                                                                                                                                                                                        with national
                                                                                                                                                                                                                                        timescales.
PCT Ambition   To improve uptake of cardiac rehabilitation services to at least 75% for          Jeanette      Clare-Louise                                         By 31 March 2011, at least 85% of people who have a heart           Yes - SHA                                             Prepare service redesign options appraisal       Apr-09                            Amber        Capacity issues at present to take this work forward (due to maternity leave)
               people who have had a heart attack, bypass surgery or coronary angioplasty        George        Nicholls / Angela                                    attack, bypass surgery or coronary angioplasty will receive         ambition is 85%                                       for provision of cardiac rehabilitation services
               by December 2011.                                                                               Kell                                                 cardiac rehabilitation                                              and timescale is                                      within existing resources in 2009.
                                                                                                                                                                                                                                        March 2011                                            Prepare business case for funding for            Oct-09
                                                                                                                                                                                                                                                                                              expansion of cardiac rehabilitation services
                                                                                                                                                                                                                                                                                              by October 2009

PCT Ambition   For 95% of eligible patients with myocardial infarction to be treated by          Jeanette      Clare-Louise                                         For 95% of eligible patients with myocardial infarction to be                                                             Continue to work with BNSSG, PCTs and         Mar-10                               Amber        Working closely with BNSSG to implement action plan
               primary angioplasty within 3 hours of onset by 31 March 2011.                     George        Nicholls / Angela                                    treated by primary angioplasty within 3 hours of onset by 31                                                              other providers , to implement the action
                                                                                                               Kell                                                 March 2011.                                                                                                               plan to achieve angioplasty 3 hour targets by
                                                                                                                                                                                                                                                                                              March 2010

PCT Ambition   For 95% of urgent cardiac surgical procedures to be performed within 5 days Jeanette            Clare-Louise                                         For 95% of urgent cardiac surgical procedures to be performed                                                             Ensure the PCT's investment in revasc is    Mar-09                                 Green        Ratios are 4.8 for
               of diagnosis by 31 March 2009.                                              George              Nicholls / Angela                                    within 5 days of diagnosis by 31 March 2009.                                                                              delivering the expected outcomes and that
                                                                                                               Kell                                                                                                                                                                           procedures are performed within 5 days of
                                                                                                                                                                                                                                                                                              diagnosis.
                                                                                                                                                                                                                                                                                              Achieve PTCA to CABG ratio of at least 2:45
                                                                                                                                                                                                                                                                                              by end Q1




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         15 of 44
        Appendix 4 - NHS NS Corporate Work Plan 2009/10


Ref            Target                                                                            PCT           Programme         Target detail   2009/10 Target   Related SHA Ambition                                                  PCT Target   LAA        Periodic WCC health   2009/10 actions to deliver                      Delivery Date   Q1 (Apr-June)   RAG status   Q1 Progress against actions to deliver                                                 Q2               Q3
                                                                                                 Executive     Lead                                                                                                                     Slipped?     (lead      Review outcome                                                                        Performance                                                                                                         Performance      Performance
                                                                                                 Director                                                                                                                                            partner)                                                                                         (data)
PCT Ambition   Full implementation of all Quality Markers of the National Stroke Strategy by     Jeanette      Clare-Louise                                       Full implementation of all Quality Markers of the National Stroke                                                   Implementation of the North Somerset action Mar-10                              Amber        SHA reviews of stroke services held in July 2008 and will be undertaken again in
               31 March 2011.                                                                    George        Nicholls                                           Strategy by 31 March 2011.                                                                                          plan developed to meet the requirements of                                                   Weston before the end of 2009. Progress being made against the North Somerset
                                                                                                                                                                                                                                                                                      the national stroke strategy. This will include                                              action plan.
                                                                                                                                                                                                                                                                                      for example securing access to rapid
                                                                                                                                                                                                                                                                                      imaging, TIA clinics, acute stroke unit care,
                                                                                                                                                                                                                                                                                      services that support life after stroke,
                                                                                                                                                                                                                                                                                      development of specialist teams with the
                                                                                                                                                                                                                                                                                      right skill mix and competencies.
                                                                                                                                                                                                                                                                                       Work with partners to finalise the BHSP
                                                                                                                                                                                                                                                                                      models of care for acute and rehabilitation
                                                                                                                                                                                                                                                                                      stroke care.

PCT Ambition   95% of stroke patients will be assessed using standardised assessment tools Jeanette            Clare-Louise                                       All stroke patients will be assessed using standardised                                                             In 2009/10 the stroke register or equivalent    Mar-10                          Amber        All emergency departments reviewing existing assessments against the
               by 31 March 2009.                                                           George              Nicholls                                           assessment tools by 31 March 2009.                                                                                  will be rolled out. It is expected that the PCT                                              benchmark tool.
                                                                                                                                                                                                                                                                                      will be able to identify patients assessed
                                                                                                                                                                                                                                                                                      using standardised assessment tools.
PCT Ambition   95% of people who have suffered a stroke will receive brain imaging within        Jeanette      Clare-Louise                                       95% of people who have suffered a stroke will receive brain                                                         Implementation of the North Somerset action Ongoing                             Green        Although yet to be verified Weston report patients are being scanned within 30
               30 minutes of arrival at hospital, seven days a week by 31 March 2010             George        Nicholls                                           imaging within 30 minutes of arrival at hospital, seven days a                                                      plan developed to meet the requirements of                                                   minutes of arrival in ED.
                                                                                                                                                                  week by 31 March 2010                                                                                               the national stroke strategy. This will include
                                                                                                                                                                                                                                                                                      for example securing access to rapid
                                                                                                                                                                                                                                                                                      imaging, TIA clinics, acute stroke unit care,
                                                                                                                                                                                                                                                                                      services that support life after stroke,
                                                                                                                                                                                                                                                                                      development of specialist teams with the
                                                                                                                                                                                                                                                                                      right skill mix and competencies.·
                                                                                                                                                                                                                                                                                       Work with partners to finalise the BHSP
                                                                                                                                                                                                                                                                                      models of care for acute and rehabilitation
                                                                                                                                                                                                                                                                                      stroke care.

PCT Ambition   All vascular emergencies receive emergency care from a vascular surgeon by Jeanette             Alan Lawler                                        All vascular emergencies receive emergency care from a                                                              Will be built into directorate work plan for    Mar-10                          N/A          Investigating data collection for this indicator
               31 March 2009                                                              George                                                                  vascular surgeon by 31 March 2009                                                                                   2009/10. Pathway in place for patients
                                                                                                                                                                                                                                                                                      requiring specialist surgery.
PCT Ambition   95% of high risk blockages of the carotid artery will be operated on within 72    Jeanette      Clare-Louise                                       95% of high risk blockages of the carotid artery will be operated                                                                                                   Mar-10                          N/A          There is conflicting timescales cited in the strategy and NICE guidelines. The
               hours of diagnosis by 31 March 2009.                                              George        Nicholls                                           on within 72 hours of diagnosis by 31 March 2009.                                                                   Will be built into directorate work plan for                                                 AGWS Stroke Network has adopted "within 2 weeks" as its standard thereby
                                                                                                                                                                                                                                                                                      2009/10. Pathway in place for patients                                                       giving patients time to discuss and make decisions where it is clinically safe to do
                                                                                                                                                                                                                                                                                      requiring specialist surgery.                                                                so. N/A as no data at present
PCT Ambition   Fully implement the standards set out in the National Service Frameworks for Jeanette           Clare-Louise                                       Fully implement the standards set out in the National Service                                                       2009/10 detail is set out in the operational    Mar-10                          Green        Annual self assessments for the SHA demonstrate this is good work in progress.
               Older People, Coronary Heart Disease, Diabetes and Renal Services ahead George                  Nicholls                                           Frameworks for Older People, Coronary Heart Disease,                                                                plan for each of these areas. All targets
               of the national timescales for their delivery                                                                                                      Diabetes and Renal Services ahead of the national timescales                                                        relating to these areas link directly to the
                                                                                                                                                                  for their delivery                                                                                                  NSFs.
PCT Ambition   Fully implement Valuing People – a new strategy for learning disability for the Jeanette        Rose Barker/Tim                                    Fully implement Valuing People – a new strategy for learning                                                        The main „driver‟ for the LD work programme Mar-10                              Amber        As agreed with SHA the main driver for delivering this is implementing the GP
               21st Century.                                                                   George          Wye                                                disability for the 21st Century.                                                                                    is „Valuing People‟. Implementation plan to                                                  DES. This is linked to the ambition for 95% of practices being able to identify
                                                                                                                                                                                                                                                                                      deliver the recommendations of Revised                                                       people with a learning disability.
                                                                                                                                                                                                                                                                                      Valuing People document „Valuing People
                                                                                                                                                                                                                                                                                      Now‟ (due Spring 2009)

PCT Ambition   By 2013, to develop a health campus based on the community health model           Julie         TBC                                                By 2013, to develop a health campus based on the community                                                                                                          Mar-10                          Amber        Work is being done to develop this through the further development of the self
               through which lay people become the local resource for their population.          Clatworthy                                                       health model through which lay people become the local                                                                                                                                                           care policy information prescriptions and voices for health.
                                                                                                                                                                  resource for their population.
PCT Ambition   Contribute to the SHA ambition to improve the productivity of clinical activity   Mary Hutton   Mary Hutton                                        Improve the productivity of clinical activity by at least £700                                                      RUM Plans included in 2009/10 and               Mar-10                          Green        Rum performance being monitored through the Commissioning Group
               by at least £700 million per annum by 31 March 2014, with 50% of the                                                                               million per annum by 31 March 2014, with 50% of the potential                                                       monitored by the Commissioning Group.
               potential achieved by 31 March 2011                                                                                                                achieved by 31 March 2011                                                                                           Plans will be developed as part of 2010/11
                                                                                                                                                                                                                                                                                      Operational Plan.
PCT Ambition   Support delivery of the objectives in the national concordat, Putting People      Jeanette      Tim Wye                                            Support delivery of the objectives in the national concordat,                                                                                                       Mar-10                          Amber        Improved access to health care through GP DES (above) other actions include
               First: A shared vision and commitment to the transformation of Adult Social       George                                                           Putting People First: A shared vision and commitment to the                                                                                                                                                      producing health care information in accessible formats and the Community team
               Care (December 2007)                                                                                                                               transformation of Adult Social Care (December 2007)                                                                                                                                                              improving information systems to identified those with high needs. Also improving
                                                                                                                                                                                                                                                                                                                                                                                   links with Weston hospital for managing LD clients in acute settings. This is
                                                                                                                                                                                                                                                                                                                                                                                   encapsulated in the action plan following the SHA self assessment
PCT Ambition   Fully implement the Common Assessment Framework for all vulnerable                Jeanette      Clare-Louise                                       Fully implement the Common Assessment Framework for all                                                                                                             Mar-10                          Amber        Common assessment is integral to the work of integrating community teams and
               children, adults and older people by 31 March 2011                                George        Nicholls                                           vulnerable children, adults and older people by 31 March 2011                                                                                                                                                    the SPA.
PCT Ambition   Achieve excellent ratings by the Care Quality Commission for both quality of      Chris Born    Louise                                             Achieve excellent ratings by the Healthcare Commission for both                                                     Plan for 2009/10 is to achieve and sustain      Mar-10                          Green        On track to achieve Good by end of 2009/10
               services and use of resources.                                                                  Morley/Julie                                       quality of services and use of resources.                                                                           Good
                                                                                                               Clatworthy                                                                                                                                                             Ensure robust monthly performance
                                                                                                                                                                                                                                                                                      improvement framework to drive forward
                                                                                                                                                                                                                                                                                      improvements by reviewing and challenging
                                                                                                                                                                                                                                                                                      specific areas.
                                                                                                                                                                                                                                                                                      Align all reporting / communication with the
                                                                                                                                                                                                                                                                                      latest guidance as released from the Care
                                                                                                                                                                                                                                                                                      Quality Commission.
                                                                                                                                                                                                                                                                                      Produce a self assessment in line with the
                                                                                                                                                                                                                                                                                      most up to date methodology on a quarterly
                                                                                                                                                                                                                                                                                      basis and report to Board.
                                                                                                                                                                                                                                                                                      Performance team to act as point of contact
                                                                                                                                                                                                                                                                                      and expertise to all staff in relation to the
                                                                                                                                                                                                                                                                                      delivery of national indicators.

               *Scoring methodology:                                                                                                                                                                         Existing commitments       Green        91%                   Thresholds:
               Green = 3 points / Amber = 2 points / Red = 0 points                                                                                                                                                 Tier 1 Vital Sign   Green        93%                       Red: < 80%
               The total max score possible for each indicator is 3 points. Actual performance is derived by                                                                                                        Tier 2 Vital Sign   Amber        81%                    Amber: >= 80%
               assigning 3, 2, or 0 points based on the RAG rating. This total is then divided into the max                                                                                                         Tier 3 Vital Sign   Amber        85%                    Green: >= 90%
               score possible to come up with a % performance.                                                                                                                                                                   LAA    Amber        80%
                                                                                                                                                                                                                                WCC     Green        93%
                                                                                                                                                                                                                     PCT ambitions      Amber        80%




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        16 of 44
Appendix 4 - NHS NS Corporate Work Plan 2009/10




                                                  Q4            Actual   Max poss
                                                  Performance   score    score


                                                                3        3



                                                                3        3


                                                                3        3


                                                                2        3




                                                                3        3




                                                                3        3




                                                                2        3




                                                                2        3

                                                                3        3



                                                                2        3


                                                                2        3




                                                                3        3



                                                                3        3




                                                                3        3



                                                                2        3



                                                                3        3


                                                                3        3


                                                                3        3




                                                                3        3


                                                                3        3


                                                                3        3



                                                                2        3




                                                                3        3                  Actual   Max
                                                                                                     poss


                                                                3        3          Total   68       75

                                                                3        3

                                                                3        3

                                                                3        3




                                                                                                            17 of 44
Appendix 4 - NHS NS Corporate Work Plan 2009/10


                                                  Q4            Actual   Max poss
                                                  Performance   score    score


                                                                3        3




                                                                2        3




                                                                3        3




                                                                3        3




                                                                3        3



                                                                3        3




                                                                2        3




                                                                3        3




                                                                3        3


                                                                3        3


                                                                3        3




                                                                3        3



                                                                2        3



                                                                                    Total   42   45




                                                                2        3




                                                                2        3




                                                                3        3


                                                                3        3


                                                                3        3


                                                                2        3




                                                                2        3




                                                                3        3




                                                                                                      18 of 44
Appendix 4 - NHS NS Corporate Work Plan 2009/10


                                                  Q4            Actual   Max poss
                                                  Performance   score    score


                                                                2        3




                                                                2        3




                                                                2        3




                                                                2        3




                                                                2        3




                                                                3        3



                                                                3        3




                                                                3        3          Total   39   48

                                                                2        3




                                                                3        3


                                                                3        3



                                                                3        3




                                                                3        3




                                                                2        3




                                                                2        3




                                                                                                      19 of 44
Appendix 4 - NHS NS Corporate Work Plan 2009/10


                                                  Q4            Actual   Max poss
                                                  Performance   score    score


                                                                2        3




                                                                3        3




                                                                3        3

                                                                2        3

                                                                                    Total   28   33
                                                                3        3


                                                                3        3




                                                                3        3




                                                                2        3




                                                                2        3




                                                                2        3          Total   12   15




                                                                2        3




                                                                3        3




                                                                3        3




                                                                2        3



                                                                3        3




                                                                                                      20 of 44
Appendix 4 - NHS NS Corporate Work Plan 2009/10


                                                  Q4            Actual   Max poss
                                                  Performance   score    score


                                                                2        3




                                                                2        3




                                                                3        3



                                                                3        3



                                                                2        3




                                                                3        3




                                                                2        3




                                                                3        3




                                                                2        3




                                                                2        3




                                                                3        3



                                                                2        3




                                                                2        3




                                                                2        3



                                                                3        3


                                                                2        3



                                                                2        3



                                                                2        3




                                                                2        3




                                                                2        3



                                                                3        3

                                                                                    21 of 44
Appendix 4 - NHS NS Corporate Work Plan 2009/10


                                                  Q4            Actual   Max poss
                                                  Performance   score    score


                                                                2        3




                                                                2        3




                                                                2        3




                                                                2        3




                                                                3        3



                                                                2        3




                                                                2        3




                                                                0        3




                                                                3        3


                                                                2        3



                                                                3        3




                                                                2        3


                                                                2        3




                                                                3        3




                                                                3        3



                                                                3        3




                                                                                    22 of 44
Appendix 4 - NHS NS Corporate Work Plan 2009/10


                                                  Q4            Actual   Max poss
                                                  Performance   score    score


                                                                2        3




                                                                3        3



                                                                3        3




                                                                3        3




                                                                3        3




                                                                3        3




                                                                2        3




                                                                2        3




                                                                2        3



                                                                2        3


                                                                3        3




                                                                2        3




                                                                3        3




                                                                2        3




                                                                2        3




                                                                2        3




                                                                2        3




                                                                3        3




                                                                3        3




                                                                3        3




                                                                                    23 of 44
Appendix 4 - NHS NS Corporate Work Plan 2009/10


                                                  Q4            Actual   Max poss
                                                  Performance   score    score


                                                                2        3




                                                                3        3




                                                                2        3




                                                                2        3




                                                                2        3




                                                                2        3




                                                                2        3




                                                                2        3


                                                                2        3




                                                                2        3




                                                                2        3




                                                                2        3




                                                                2        3




                                                                3        3



                                                                2        3

                                                                3        3



                                                                3        3


                                                                2        3

                                                                3        3


                                                                3        3




                                                                3        3


                                                                3        3




                                                                                    24 of 44
Appendix 4 - NHS NS Corporate Work Plan 2009/10


                                                  Q4            Actual   Max poss
                                                  Performance   score    score


                                                                3        3




                                                                3        3


                                                                3        3


                                                                3        3


                                                                2        3



                                                                3        3




                                                                3        3




                                                                2        3




                                                                2        3




                                                                2        3




                                                                3        3



                                                                2        3




                                                                2        3




                                                                2        3




                                                                3        3




                                                                2        3




                                                                2        3




                                                                3        3




                                                                                    25 of 44
Appendix 4 - NHS NS Corporate Work Plan 2009/10


                                                  Q4            Actual   Max poss
                                                  Performance   score    score


                                                                2        3




                                                                2        3



                                                                3        3




                                                                3        3




                                                                2        3




                                                                2        3


                                                                3        3



                                                                2        3




                                                                2        3

                                                                3        3          Total   261   327




                                                                         555




                                                                                                        26 of 44
Appendix 5 - NHS NS 2009/10 Principal Objectives Work Plan



Work Stream                                     PCT Lead Director   Principal objectives for 2009/10                                         PCT Lead Manager   Deliverables 2009/10                             Delivery Date    Q1 RAG   Q1 Progress against deliverables
                                                                    What do we want to achieve this year?                                                       How will we know that the objective has                           status
                                                                                                                                                                been delivered?
Be an Competent Commissioner
World Class Commissioning                       Chris Born          Deliver on the 5 priorities for action identified by the World Class     Jeanette George    Robust reporting process in place to ensure                June-09 Green   Quarterly reports going to the Board
                                                                    Commissioning Panel Report.                                                                 delivery of the 5 key priorities. This will be             Sept-09
                                                                                                                                                                done through quarterly reporting to the                     Jan-10
                                                                                                                                                                Board.                                                       Mar10
World Class Commissioning                       Chris Born          Develop systems and processes that will enable us to deliver our          Jeanette George   Robust reporting process in place to ensure                June-09 Green   Quarterly reports going to the Board
                                                                    strategic ambitions within our financial constraints, through partnership                   delivery of this objective. This will be done              Sept-09
                                                                    working and targeting of resources.                                                         through quarterly reporting to the Board.                   Jan-10
                                                                                                                                                                                                                             Mar10
World Class Commissioning                       Chris Born          Ensure that all competencies or part-competencies where the Panel        Jeanette George    Internal self-assessment submitted to the                   Oct-09 Green   Work underway by the World Class Commissioning
                                                                    Report assessed the PCT as operating at Level 1 will be addressed                           SHA.                                                                       lead to meet this deadline.
                                                                    robustly over the coming year so that assessment in 2009 confirms
                                                                    PCT achievement at Level 2.
World Class Commissioning                       Chris Born          Become an employer of choice through smarter working and                 Jeanette George    Submit application to be considered for the                 Mar-10 Green   The PCT has requested details of the registration form
                                                                    organisational development.                                                                 Healthcare 100 awards.
World Class Commissioning                       Chris Born          Review and improve commissioning information, procurement and            Jeanette George    Revised commissioning strategy produced                     Oct-09 Amber   Draft revised commissioning strategy produced but
                                                                    contracting systems across the commissioning cycle.                                         and submitted to the PCT Board.                                            some delay in consulting on this due to constraints on
                                                                                                                                                                                                                                           commissioning resources; due to swine flu planning
                                                                                                                                                                                                                                           and staffing
World Class Commissioning                       Jeanette George     Manage the Action Plan within the financial constraints of the current    Mary Claridge     Delivery of all due actions within WCC action               Oct-09 Green   Q2 progress reported to Board Sept 09. All work
                                                                    financial year and deliver value for money in all improvement activities.                   plan                                                                       streams on target. Financial aspect to be reported in
                                                                                                                                                                                                                                           Q3.
Contract and Performance Management             Mary Hutton         Develop a system for monitoring and evaluating the progress of           Vicki Cruze        Proposed Contract Management Framework                      Apr-09 Green   Proposed Framework was circulated and signed off by
                                                                    contracts agreed with providers to deliver agreed redesign projects or                      to go to Commissioning Group. Highlighting                                 PEC and Commissioning Group in May 09.
                                                                    system/efficiency improvements.                                                             way forward for 2009/10

Contract and Performance Management             Mary Hutton         Develop a system for monitoring and evaluating the progress of           Vicki Cruze        Devise a suite of contract monitoring reports,             May-09 Amber    Top level summary analysis is in place. The PCT team
                                                                    contracts agreed with providers to deliver agreed redesign projects or                      ranging from top level summaries to detailed                               are continually working to highlight and move forward
                                                                    system/efficiency improvements.                                                             analysis on contract levers and significant                                lower level analysis to identify areas of variances to
                                                                                                                                                                variances.                                                                 enable contract discussions and work with PBC.

Contract and Performance Management             Mary Hutton         Develop a system for monitoring and evaluating the progress of           Vicki Cruze        Clearly link contract monitoring reports with               Jun-09 Amber   Contract team still awaiting minimum dataset from
                                                                    contracts agreed with providers to deliver agreed redesign projects or                      MSK, Community matrons , ICRT and ATC                                      specific RUM schemes.
                                                                    system/efficiency improvements.                                                             Schemes on an ongoing basis to include with                                Providers and Commissioners have now fully signed up
                                                                                                                                                                suite of reports.                                                          to data requirements on an ongoing basis - The first full
                                                                                                                                                                                                                                           report will be available to the Commissioning group at
                                                                                                                                                                                                                                           the end of Sept.
Contract and Performance Management             Mary Hutton         Ensure live information can be fed back to partners in the system who Jackie Green          Referral data to be supplied to GP practices               May-09 Green    Team of key players from the PCT visiting all GP
                                                                    can support the delivery of key targets and performance improvements                                                                                                   Practices on GP Referrals and the way forward,
                                                                    (e.g., providers, GPs etc).                                                                                                                                            sharing best practice. PCT is circulating regular GP
                                                                                                                                                                                                                                           referral data to each practice.
Contract and Performance Management             Mary Hutton         Ensure live information can be fed back to partners in the system who Jackie Green          Activity reports to be supplied to all GP                   Jul-09 Amber   PCT is working with practices to identify and move
                                                                    can support the delivery of key targets and performance improvements                        practices in line with PBC requirements                                    forward best value added reporting. Delays have been
                                                                    (e.g. providers, GPs etc).                                                                                                                                             incurred due to the shift to hag 4 - It is envisaged that
                                                                                                                                                                                                                                           this will be delivered by end of Sept 09.

Contract and Performance Management             Mary Hutton         Systematise the contract performance management process                  Alan Lawler        Merge Contract Performance Meetings with                    Apr-09 Green   Completed
                                                                                                                                                                Trusts to include quality and Performance
                                                                                                                                                                section followed by activity and finance
                                                                                                                                                                section
Contract and Performance Management             Mary Hutton         Systematise the contract performance management process                  Alan Lawler        Sign off with Providers clear lines of                     May-09 Green    Completed
                                                                                                                                                                communication (incl. escalation and ad hoc
                                                                                                                                                                processes) for 2009/10 contract
Contract and Performance Management             Mary Hutton         Build on a strong track record and maintain the focus on performance     Louise Morley      Create a robust performance management                      Apr-09 Green   Performance Management Framework signed off by
                                                                                                                                                                framework that is clearly linked to strategic                              the PCT Board in April 2009
                                                                                                                                                                objectives and the PCTs operational plan.
                                                                                                                                                                Paper for sign off by Board and PEC
Contract and Performance Management             Mary Hutton         Build on a strong track record and maintain the focus on performance     Louise Morley      Ongoing communications on latest                          Ongoing Green    Presentation given to finance team on 18 June. Article
                                                                                                                                                                performance issues within the PCT                                          will be submitted to Team Talk in Q2.
                                                                                                                                                                1) Articles to team talk every quarter
                                                                                                                                                                2) Attend directorate team meetings as and
                                                                                                                                                                when
Contract and Performance Management             Mary Hutton         Build on a strong track record and maintain the focus on performance     Louise Morley      Set up clear links with partners and providers              Jul-09 Green   Attendance at Weston and provider arm contract and
                                                                                                                                                                to build on shared learning and alignment                                  quality meetings on a monthly basis. Liase with NS
                                                                                                                                                                - Weston Provider                                                          Council regularly around Local Area Agreement and
                                                                                                                                                                - PCT Provider                                                             Comprehensive Area Assessment. Regular
                                                                                                                                                                - Primary Care                                                             discussions with commissioning lead around primary
                                                                                                                                                                - Local Authority                                                          care performance monitoring. Monthly meetings with
                                                                                                                                                                Organise regular meetings                                                  SHA and Weston performance leads.




                                                                                                                                                                                                                                                                                                 27 of 44
Appendix 5 - NHS NS 2009/10 Principal Objectives Work Plan



Work Stream                                         PCT Lead Director   Principal objectives for 2009/10                                           PCT Lead Manager       Deliverables 2009/10                               Delivery Date       Q1 RAG   Q1 Progress against deliverables
                                                                        What do we want to achieve this year?                                                             How will we know that the objective has                                status
                                                                                                                                                                          been delivered?
Financial Balance                                   Mary Hutton         Develop and improve financial planning processes and procedures to         Cathy Costello         Revised Medium Term financial plan &                         Dec-09 Green       This will be complete by end Oct 09
                                                                        produce robust financial plans to deliver the PCTs long term strategy                             strategy
                                                                        and short term priorities
Information Systems                                 Mary Hutton         Fit for Purpose IT Systems                                                 Andy Kinnear           Achieve deployment of the Summary Care                       Dec-10 Amber       Will be agreed as part of Operational plan 2010/11.
                                                                                                                                                                          Record - actions for delivery to be included in                                 Investment was not agreed for 2009/10.
                                                                                                                                                                          the IT strategy action plan
Information Systems                                 Mary Hutton         Fit for Purpose IT Systems                                                 Andy Kinnear           Enable relevant clinical outcome information                  Jun-09 Green      Work is in progress for this. This is already reported in
                                                                                                                                                                          to be published by all NHS providers. This                                      the corporate work plan as a PCT ambition and will be
                                                                                                                                                                          will be included in the IT Strategy that will go                                removed from this work plan in Q2.
                                                                                                                                                                          to the Board
Information Systems                                 Mary Hutton         Fit for Purpose IT Systems                                                 Andy Kinnear           Ensure access by community-based health                       Mar-10 Green      RIO is on target with monthly meetings in place.
                                                                                                                                                                          and social care professionals to all relevant                                   Progress is underway on FACE.
                                                                                                                                                                          service user information by implementing
                                                                                                                                                                          new systems e.g. RIO and FACE

Integration                                         Jeanette George     Joint commissioning group established for adult care                       Tim Wye                In place. Completed in 2008/9.                                Apr-09 Green      Completed
Integration                                         Jeanette George     To promote integration of both commissioning & provision of services       Andrew Hughes          Option appraisal for future models of                         Oct-09 Green      Transforming community services programme
                                                                        in partners to improve efficiencies.                                                              commissioning. Report to all relevant groups.                                   underway. Commissioning intentions on target for
                                                                                                                                                                                                                                                          completion at end of October
Market Management                                   Jeanette George     Transforming the commissioning of community services                       Maya Bimson            Draft commissioning community services                       June 09 Green      Draft commissioning strategy submitted to SHA in
                                                                                                                                                                          Strategy to SHA.                                                                June.
                                                                                                                                                                          Final Transforming Community Services Plan                   Sept 09            Final strategy will be completed by the end of Oct and
                                                                                                                                                                          and Commissioning Strategy and transition                                       will include a procurement plan
                                                                                                                                                                          plan to SHA.
                                                                                                                                                                          Procurement Plan for Community Services.                      Nov 09
                                                                                                                                                                          Strategy for future of community estates to
                                                                                                                                                                          be in place                                                   Nov 09
Market Management                                   Mary Hutton         Non-urgent patient transport                                               Alan Lawler            To work with other PCTs across BNSSG to                       Mar-10 Green      There is a working project group in Bristol for this and
                                                                                                                                                                          develop a specification that increases quality                                  the PCT links into this.
                                                                                                                                                                          & value. To be signed off by Board and
                                                                                                                                                                          PEC.
Market Management                                   Jeanette George     To market test domiciliary care for patients requiring continuing health   Maya Bimson            Specification due to be completed Apr 09.                     Apr-09 Green      Specification tendered. PQQs and short listing
                                                                        care in order to address the gap in the market                                                    Tender from May. Procurement complete                                           completed, interviews scheduled for 23rd September.
                                                                                                                                                                          Sept 09. New contract from Nov/Dec.                         Sept-09
                                                                                                                                                                                                                                      Nov/Dec
Ensure development of a Fit for Purpose Provider Service
Development of a fit for purpose Provider Service Penny Brown           Making the best use of all available resources by ensuring the delivery    Kyla Dawe              Delivery of RUM Scheme Targets                                Mar-10 Amber      Rapid Response & Rehabilitation - Green
                                                                        of the Resource Utilisation Schemes that have been commissioned.                                                                                                                  Community Matrons - Amber (expected Green by Q2)
                                                                                                                                                                                                                                                          MSK Interface - Red - Action Plan in place.
                                                                                                                                                                                                                                                          Tissue Viability - no information provided from
                                                                                                                                                                                                                                                          Commissioner.

Development of a fit for purpose Provider Service   Penny Brown         Ensuring our services enable NHS North Somerset to meet the national AD Governance and            Delivery of Performance Targets in                            Mar-10 Amber      Performance greatly improved, action plans in place for
                                                                        and local targets established as part of the NHS and South West NHS Performance                   Community Contract                                                              those services which are not currently performing on
                                                                        operating frameworks for 2009/10                                                                                                                                                  target which are monitored by Commissioners at the
                                                                                                                                                                                                                                                          Contract Review Meeting
Development of a fit for purpose Provider Service   Penny Brown         Ensuring our services enable NHS North Somerset to meet the national       AD Governance and      Delivery of Quality Targets in Community                      Mar-10 Green      On target
                                                                        and local targets established as part of the NHS and South West NHS        Performance            Contract
                                                                        operating frameworks for 2009/10
Development of a fit for purpose Provider Service   Penny Brown         Developing our partnership working to provide a seamless service           Rose Barker            Implement actions from self assessment                        Mar-10 Amber      Action Plan in place
                                                                        between health and social care and increase the focus on enabling                                 against 'Valuing People Now'
                                                                        health and wellbeing alongside treatment and rehabilitation
Development of a fit for purpose Provider Service   Penny Brown         Developing our partnership working to provide a seamless service           AD Nursing and        Implement actions from action plan for                        Aug-09 Green       On target
                                                                        between health and social care and increase the focus on enabling          Integrated Service/AD Transforming Community Services
                                                                        health and wellbeing alongside treatment and rehabilitation                AHP and Integrated
                                                                                                                                                   Services
Development of a fit for purpose Provider Service   Penny Brown         Developing our partnership working to provide a seamless service           Penny Brown           Implement a Single Point of Access                            Aug-09 Green       Completed
                                                                        between health and social care and increase the focus on enabling
                                                                        health and wellbeing alongside treatment and rehabilitation
Development of a fit for purpose Provider Service   Penny Brown         Developing our services to ensure people receive the right care at the Penny Brown                Undertake service reviews                                     Jun-09 Green      Working with Commissioners as part of Transforming
                                                                        right time and place by the right people, endeavouring to provide this at                                                                                                         Community Services. Delivery date now slipped by
                                                                        home or as near to home as possible.                                                                                                                                              Commissioners to Sept 09 and on target to complete.

Development of a fit for purpose Provider Service   Penny Brown         Ensuring our services are patient focused with high levels of patient      Ben Littlewood         Undertake one patient survey per quarter                     Aug-09 Green       District Nurses Survey complete.
                                                                        satisfaction
Development of a fit for purpose Provider Service   Penny Brown         Ensuring our services are patient focused with high levels of patient      Ben Littlewood         Implement action plans resulting from patient                 Mar-10 Green      Survey recently completed. Action plan drawn up and
                                                                        satisfaction                                                                                      survey                                                                          implementation begun.
Development of a fit for purpose Provider Service   Penny Brown         Benchmarking our services with appropriate comparable providers and        Kyla Dawe              Identify comparable providers                                 Mar-10 Green      Comparable providers being identified
                                                                        taking appropriate action to ensure value for money
Development of a fit for purpose Provider Service   Penny Brown         Benchmarking our services with appropriate comparable providers and        Kyla Dawe              Join NHS Benchmarking Group                                   Jun-09 Green      Completed
                                                                        taking appropriate action to ensure value for money




                                                                                                                                                                                                                                                                                                                 28 of 44
Appendix 5 - NHS NS 2009/10 Principal Objectives Work Plan



Work Stream                                         PCT Lead Director   Principal objectives for 2009/10                                       PCT Lead Manager        Deliverables 2009/10                             Delivery Date      Q1 RAG   Q1 Progress against deliverables
                                                                        What do we want to achieve this year?                                                          How will we know that the objective has                             status
                                                                                                                                                                       been delivered?
Development of a fit for purpose Provider Service   Penny Brown         Benchmarking our services with appropriate comparable providers and    Kyla Dawe               Benchmark services as part of review                        Apr-09 Green     Taking place as part of review
                                                                        taking appropriate action to ensure value for money
Development of a fit for purpose Provider Service   Penny Brown         Develop at least three award winning services                          Kyla Dawe               Establish calendar of awards                                Mar-10 Green     Now being undertaken by Communications Team
Development of a fit for purpose Provider Service   Penny Brown         Develop at least three award winning services                          Kyla Dawe               Nominate appropriate services                               Apr-09 Green     Award nominations made for a number of awards
Development of a fit for purpose Provider Service   Penny Brown         Install the new community information system                           Kyla Dawe               Implement Community Activity Reporting                      Mar-10 Green     Completed
                                                                                                                                                                       Tool (short term solution)
Development of a fit for purpose Provider Service   Penny Brown         Install the new community information system                           Penny Brown             Roll out of RIO                                            May-09   Green    Roll out now due in February 2010
Development of a fit for purpose Provider Service   Penny Brown         Become one of the top 100 employers                                    Penny Brown             Create action plan against criteria                        Nov-09   Green    Completed
Human Resources                                     Penny Brown         Implement all action plans agreed in response to staff surveys         Lisa Hornik             Implement Action Plans                                     Jun-09   Green    On target
Improving Working Lives                             Penny Brown         Implement the Improving Working Lives Action Plan                      Marcus Ede              Implement Action Plans                                     Mar-10   Green    On target


Improving Working Lives                             Penny Brown         Locality teams for adults achieve year 1 objectives                    AD's Integrated         Deliver work plan objectives in year 1 in line              Mar-10 Green     On target
                                                                                                                                               Services                with specified timescales
Innovative Service Redesign
Weston                                              Mary Hutton         Urgent care vision: ATC fully operational and meeting agreed target,   Caerrie Barber          SLA agreed. Monthly review meetings in                      Apr-09 Amber     SLA areas around tariffs, staffing and costs to be fully
                                                                        GP-led health centre meeting targets                                                           place. Update to the Commissioning Group                                     agreed. ATC clinical recording being agreed. Detailed
                                                                                                                                                                       monthly.                                                                     monthly data available. Audits to be arranged. Aiming
                                                                                                                                                                                                                                                    for re-launch by 3rd quarter. GPLHC not meeting 4
                                                                                                                                                                                                                                                    hour, may impact on PCT score.

Weston                                              Chris Born          Maintain a programme of care pathway improvement (at least six more Julie Clatworthy           Six pathways include cancer, diagnostics,                   Mar-10 Green     There is good progress being made against this
                                                                        pathways)                                                                                      acute MI, acute stroke, respiratory disease &                                deliverable. On track so far.
                                                                                                                                                                       urgent care. See cancer & cardiac service
                                                                                                                                                                       redesign indicators below. For urgent care -
                                                                                                                                                                       develop Outline Business Case for redesign
                                                                                                                                                                       of ED and urgent care front door at Weston.
                                                                                                                                                                       Actions for diagnostics and respiratory to be
                                                                                                                                                                       confirmed.

Weston                                              Chris Born          Encourage Weston Hospital to achieve health promoting hospital         Mary Hart               Self assessment completed; action plan                      Mar-10 Green     Ian Bramley, WAHT Associate Director of Nursing and
                                                                        status                                                                                         developed and implemented; actions                                           Practice Development, is now attending BNSSG Health
                                                                                                                                                                       reflected in CQINS for 10/11                                                 Promoting NHS Trusts Group which is compiling
                                                                                                                                                                                                                                                    Healthy NHS Trusts strategy.
Weston                                              Chris Born          Deliver Weston Futures Phase 2                                         Julie Clatworthy        Agree work plan by May 09 to go to ET.                     May-09 Green      Working on a Cinical Strategy and Commissioning
                                                                                                                                                                       Agree revised capacity plan for Weston by                  Oct-09            Plan. Expected to be ready by October 09
                                                                                                                                                                       Oct 09
Service Redesign                                    Jeanette George     Priorities in Practice Based Commissioning (PBC) plans achieved        Penny Hynds             Woodspring Referral Support Service set up                 Sep-09 Green      Plans for RSS agreed and project established to
                                                                                                                                                                       & operational                                                                implement from Sept 09
Service Redesign                                    Jeanette George     Priorities in Practice Based Commissioning (PBC) plans achieved        Penny Hynds             Effective implementation of admissions                      Jul-09 Green     GP Led Health Centre and GP A&E project
                                                                                                                                                                       avoidance service at Weston                                                  commenced on time. Performance reports being
                                                                                                                                                                                                                                                    finalised.
Service Redesign                                    Jeanette George     Shaping our Future projects developed to timetable: Marina Healthcare John Follows             Centre opening in May. Post project                        Nov-09 Green      Centre opened in May. Post project evaluation report
                                                                        Centre                                                                                         evaluation report to be produced 6 months                                    being prepared.
                                                                                                                                                                       later.
Service Redesign                                    Jeanette George     Shaping our Future projects developed to timetable: Clevedon Hospital John Follows             Outline Business Case submitted and plan in                Nov-09 Green      Outline Business Case being submitted to the SHA and
                                                                                                                                                                       place to progress Full Business Case. FBC                                    will be presented to Capital Investment Group in
                                                                                                                                                                       agreed (subject to SHA approval).                                            September
Service Redesign                                    Jeanette George     Shaping our Future projects developed to timetable: Rurals Plan        Penny Hynds             Quarterly meetings. Agreed premises plan for               Sep-09 Green      Plan for Wrington Vale in place. Consultation on
                                                                                                                                                                       rural development                                                            proposals to commence August 2009
Service Redesign                                    Jeanette George     Shaping our Future projects developed to timetable: Weston Practice    Penny Hynds             Outline Business Care to PCT Board.                        May-09 Amber      Outline Business Case agreed in principle in May 2009
                                                                        Premises                                                                                       Development commenced by Sept 09.                                            by Board. Full Business Case in development.
                                                                                                                                                                                                                                                    Consultation plan being finalised. Requirement for 3
                                                                                                                                                                                                                                                    month consultation may delay start of implementation
                                                                                                                                                                                                                                                    phase until December 2009
Service Redesign                                    Mary Hutton         Resource Utilisation Management (RUM) schemes delivered                Maya Bimson / Cathy     RUM Plan approved by commissioning group                   May-09 Green      Plans have been approved. Monitoring is now in place
                                                                                                                                               Costello                and monitored monthly through RUM Group                                      and has been moved forward with further analysis and
                                                                                                                                                                       meetings. Actions plans will be implemented                                  links to acute contract performance. Schemes have
                                                                                                                                                                       to address areas of underperformance.                                        been asked to provide pseudo randomised data in line
                                                                                                                                                                                                                                                    with national timeframes. Any schemes reporting an
                                                                                                                                                                                                                                                    underperformance are being asked to submit a clear
                                                                                                                                                                                                                                                    action plan with identified timescales and lead
                                                                                                                                                                                                                                                    responsibilities
Service Redesign                                    Jeanette George     Implementation of the rehabilitation care pathway across the whole     Maya Bimson             North part of the service to be up and running                      Green    North part of the service is up and running. Further
                                                                        PCT                                                                                            in Clevedon Hospital by May 09. Consider                                     work required re Weston PBC population
                                                                                                                                                                       implications for Weston PBC population.
                                                                                                                                                                       Report agreed with PBC cluster.

Service Redesign                                    Jeanette George     To review the pathway for cardiac services provided by acute providers Clare-Louise Nicholls   Agreed plans in place by Oct 09                             Oct-09 Amber     This relates to tariff sharing. No work from
                                                                        and ensure transfers between trusts are in line with best practice and                                                                                                      commissioning end taking place
                                                                        provide value for money for the PCT.




                                                                                                                                                                                                                                                                                                           29 of 44
Appendix 5 - NHS NS 2009/10 Principal Objectives Work Plan



Work Stream                                      PCT Lead Director   Principal objectives for 2009/10                                           PCT Lead Manager   Deliverables 2009/10                              Delivery Date    Q1 RAG   Q1 Progress against deliverables
                                                                     What do we want to achieve this year?                                                         How will we know that the objective has                            status
                                                                                                                                                                   been delivered?
Service Redesign                                 Jeanette George     To review cancer pathways particularly those elements that could be        Ellie Devine       Agreed plans in place by Oct 09                              Oct-09 Amber   BNSSG pathways are being reviewed and the cancer
                                                                     provided in the community and agree plans with current providers for                                                                                                      reform action plan updated
                                                                     the necessary service redesign.
Service Redesign                                 Chris Born          Orchard View plan implemented                                              Tim Wye            Service closed in 2009/10. Project plan on                   Mar-10 Green   Due for closure end of Sept 09, on schedule.
                                                                                                                                                                   schedule.                                                                   Relocation of placements going well but some risks
                                                                                                                                                                                                                                               that placements can not be found for some individuals.

Reduce Health Inequalities and promote health and wellbeing
Health Inequalities - PH Information and Needs  Max Kammerling       Publish revised health inequalities plan in the light of the Joint Strategic Mary Hart        Publish revised health inequalities plan in the              Mar-10 Green   Draft strategy is with partner organisations to include all
assessment                                                           Needs Assessment                                                                              light of the Joint Strategic Needs Assessment                               relevant targets

Health Inequalities - PH Information and Needs   Max Kammerling      At least three new initiatives to meet the needs of black and minority     Jay Akerlele       Identify needs and specific groups effected.                 Mar-10 Green   The PCT is leading on the September 2009 Multi-
assessment                                                           ethnic groups with mental health problems                                                     Discuss this with community and devise and                                  Agency Consultation open to all BME residents. This
                                                                                                                                                                   plan appropriate actions                                                    will focus on questions that relate to all aspects of their
                                                                                                                                                                                                                                               health. A North Somerset Polish Association has also
                                                                                                                                                                                                                                               been formed to help its members to have a stronger
                                                                                                                                                                                                                                               voice in use of all statutory services. The PCT is also
                                                                                                                                                                                                                                               working with the local Imam to train him & other
                                                                                                                                                                                                                                               BNSSG Imams to better help their congregations
                                                                                                                                                                                                                                               members, who are suffering emotional/mental/ isolation
                                                                                                                                                                                                                                               problems. The PCT has agreed to deliver Race
                                                                                                                                                                                                                                               Equality & Cultural Capability (RECC) training to the
                                                                                                                                                                                                                                               wellbeing advisors team for the North Somerset
                                                                                                                                                                                                                                               Primary Care Mental Health Service.

Health Inequalities - PH Information and Needs   Max Kammerling      Achieve health improvement ambitions for 2009-10 and progress on           Max Kammerling     Ambitions are included in the public health                  Mar-10 Green   Work programme is updated on a quarterly basis
assessment                                                           future ambitions                                                                              work programme which is reported against
                                                                                                                                                                   quarterly.
Health Inequalities - PH Information and Needs   Max Kammerling      Health equity audits in at least 3 key areas                               Helen Yeo          Appropriate areas/topics for health equity                   Mar-10 Green   Hips & knees, and cataract provision audits completed
assessment                                                                                                                                                         audit agreed with commissioners and                                         to date.
                                                                                                                                                                   neighbouring PCTs Audit scoped, data
                                                                                                                                                                   identified and analysis completed.
Children Services                                Max Kammerling      Deliver the Child Health Promotion Programme                               Dali Sidebottom    Commission Specialist Public Health Nursing                  Mar-10 Green   Specification agreed which includes Healthy Child
                                                                                                                                                                   Service to lead on this programme and                                       Programme
                                                                                                                                                                   deliver as part of integrated locality working
                                                                                                                                                                   arrangements
Children Services                                Max Kammerling      Safeguard and Promote the welfare of children and young people             Pat Richards       Implement the recommendations of our                         Mar-10 Amber   Work in the child protection arena across the PCT area
                                                                                                                                                                   arrangements to ensure that we comply with                                  is challenged by the increase in cases and the
                                                                                                                                                                   the statutory requirements of Section 11 of                                 relatively low provision of specialist public health
                                                                                                                                                                   the Children Act 2004 and Working Together                                  nurses. All staff in post who work directly with children
                                                                                                                                                                   to Safeguard Children 2006                                                  are trained and could respond appropriately if worried
                                                                                                                                                                                                                                               about a child. An audit of activity against Section 11 is
                                                                                                                                                                                                                                               planned once additional senior child protection staff are
                                                                                                                                                                                                                                               in post. Working Together to Safeguard Children is
                                                                                                                                                                                                                                               being updated and is expected to be published
                                                                                                                                                                                                                                               Autumn/Winter 2009
Children Services                                Max Kammerling      Locality teams for children and young people achieve year 1 objectives Dali Sidebottom        Commission Specialist Public Health Nursing                  Mar-10 Green   Management structures in place
                                                                                                                                                                   Service as part of integrated locality working
                                                                                                                                                                   arrangements
Emergency Planning                               Max Kammerling      Preparing to respond in a state of emergency, such as an outbreak of       Rod Dewar          Evaluate and improve Business Continuity                     Mar-10 Amber   Events [swine flu] have overtaken the improvement
                                                                     pandemic flu.                                                                                 Plans for PCT Commissioners and Providers                                   process. Directorates and Teams have all been
                                                                                                                                                                                                                                               required to review and update their Business Continuity
                                                                                                                                                                                                                                               plans. This process continues with additional work
                                                                                                                                                                                                                                               asked for by the Flu Management Group

Emergency Planning                               Max Kammerling      Preparing to respond in a state of emergency, such as an outbreak of       Rod Dewar          Provide training to staff to ensure business                 Mar-10 Green   Training undertaken with all GP practices and provider
                                                                     pandemic flu.                                                                                 continuity plans are embedded in both the                                   services.
                                                                                                                                                                   commissioning and provider parts of the
                                                                                                                                                                   organisation
Emergency Planning                               Max Kammerling      Preparing to respond in a state of emergency, such as an outbreak of       Rod Dewar          Ensure other PCT Contractors have                            Mar-10 Green   As at Q1 this was not yet underway from a
                                                                     pandemic flu.                                                                                 Business Continuity plans                                                   commissioning perspective. However, it would be
                                                                                                                                                                                                                                               expected to be completed by March 2010. The PCT's
                                                                                                                                                                                                                                               Provider arm has been working hard on it's Business
                                                                                                                                                                                                                                               Continuity plans.
Emergency Planning                               Max Kammerling      Preparing to respond in a state of emergency, such as an outbreak of       Rod Dewar           Use simulation exercises to test plans and                  Mar-10 Green   Outbreak of H1N1 offered a real life test of our plans
                                                                     pandemic flu.                                                                                 ensure wide understanding of roles and
                                                                                                                                                                   responsibilities in the event of an emergency.




                                                                                                                                                                                                                                                                                                       30 of 44
Appendix 5 - NHS NS 2009/10 Principal Objectives Work Plan



Work Stream                                     PCT Lead Director   Principal objectives for 2009/10                                       PCT Lead Manager   Deliverables 2009/10                          Delivery Date     Q1 RAG    Q1 Progress against deliverables
                                                                    What do we want to achieve this year?                                                     How will we know that the objective has                         status
                                                                                                                                                              been delivered?
Health Inequalities - Local Area Agreement      Max Kammerling      Achieve the Local Area Agreement (LAA) targets agreed with North       Mary Hart          Achieve the Local Area Agreement (LAA)                   Mar-10 Amber     The PCT does not expect to achieve the smoking
                                                                    Somerset Council                                                                          targets agreed with North Somerset Council                                target relating to areas of deprivation. It does however
                                                                                                                                                                                                                                        expect to achieve the following LAA targets: Healthy
                                                                                                                                                                                                                                        Schools, weight management programme, smoking
                                                                                                                                                                                                                                        cessation for users of mental health services & staff



Patient and Public Involvement                  Julie Clatworthy    Agree a protocol and programme for working with the LINk               Lynne Liptrot      Work with LINK to establish programme for      April to July 2009 Amber   Good progress made. Final programme being put
                                                                                                                                                              2009/10                                                                   together now that they have completed their public
                                                                                                                                                                                                                                        survey
Patient and Public Involvement                  Julie Clatworthy    Establish a new information prescription scheme                        Lynne Liptrot      Research develop and pilot information         April to July 2009 Amber   Preliminary research done. Further work now being
                                                                                                                                                              prescription scheme                                                       done following PEC approval of Self Care Policy
Patient and Public Involvement                  Julie Clatworthy    Establish a new information prescription scheme                        Lynne Liptrot      Roll out across North Somerset and collect     April to July 2009 Amber   At planning stage
                                                                                                                                                              and measure feedback
Patient and Public Involvement                  Julie Clatworthy    Implement actions to strengthen local accountability (e.g. a           Lynne Liptrot      Build up membership on Membership                 April to August Green   Voices for Health' Involvement Scheme launched in
                                                                    membership scheme)                                                                        Scheme established in 2008/09                               2009          July 2009. Currently 40 people registered
Patient and Public Involvement                  Julie Clatworthy    Implement actions to strengthen local accountability (e.g. a           Lynne Liptrot      Research , develop and pilot other                April 2009 and Amber    Research being undertaken
                                                                    membership scheme)                                                                        interventions to strengthen local                         ongoing
                                                                                                                                                              accountability
Patient and Public Involvement                  Julie Clatworthy    Implement actions to strengthen local accountability (e.g. a           Lynne Liptrot      Measure impact of interventions in terms of       April 2009 and Green    Action Plan in place. Impact measured and reported
                                                                    membership scheme)                                                                        strengthened local accountability                        ongoing          through Involvement and Engagement Group

Patient and Public Involvement                  Julie Clatworthy    Publish action taken as a result of engagement and consultation        Mary Adams         Build on data capture and dissemination                  Mar-10 Green     Being done. Feedback also posted on website
                                                                                                                                                              system established during 2008/09
Patient and Public Involvement                  Julie Clatworthy    Publish action taken as a result of engagement and consultation        Mary Adams         Ensure quarterly report presented to the                 Mar-10 Green     System in place and on schedule to deliver
                                                                                                                                                              Board and Governance and Risk Committee

Patient and Public Involvement                  Julie Clatworthy    Publish action taken as a result of engagement and consultation        Mary Adams         Ensure full compliance to 2009 legislation                Oct-09 Amber    System in place and on schedule to deliver
Patient and Public Involvement                  Julie Clatworthy    Patient Satisfaction                                                   Mary Adams         Embed procedures for capturing patient            April 2009 and Amber    Procedures developed and being rolled out
                                                                                                                                                              satisfaction data throughout PCT                         ongoing



Patient and Public Involvement                  Julie Clatworthy    Patient Satisfaction                                                   Mary Adams         Ensure rapid feedback to Commissioners for        April 2009 and Amber    Being done through existing systems
                                                                                                                                                              action                                                   ongoing
Patient and Public Involvement                  Julie Clatworthy    Patient Satisfaction                                                   Mary Adams         Check actions taken and ensure feedback to        April 2009 and Amber    Further work being done to embed
                                                                                                                                                              patients has taken place                                 ongoing
Patient and Public Involvement                  Julie Clatworthy    Establish new complaints and compliments system                        Vanessa Dando      Ensure work started in 2008 on new national               Apr-09 Green    New system in place
                                                                                                                                                              system is in place
Patient and Public Involvement                  Julie Clatworthy    Establish new complaints and compliments system                        Vanessa Dando      Ensure new policy in place                               Apr-09 Green     New policy been to Governance & Risk and now out to
                                                                                                                                                                                                                                        consultation
Patient and Public Involvement                  Julie Clatworthy    Establish new complaints and compliments system                        Vanessa Dando      Conduct training sessions across the PCT                May-09 Amber      Programme in place

Patient and Public Involvement                  Julie Clatworthy    Establish new complaints and compliments system                        Vanessa Dando      Provide quarterly reports to the Governance       April 2009 and Green    Programme in place
                                                                                                                                                              and Risk Committee and to the Audit                      ongoing
                                                                                                                                                              committee
Patient and Public Involvement                  Julie Clatworthy    Establish new complaints and compliments system                        Vanessa Dando      Build systems whereby measures and                April 2009 and Amber    Systems established and being monitored for success
                                                                                                                                                              feedback of actions taken in response to                 ongoing
                                                                                                                                                              complaints can be evidenced.
Inequalities                                    Julie Clatworthy    Act on patient satisfaction levels amongst black and minority ethnic   Mary Adams         Annual report for inclusion in Annual                    Mar-10 Amber     Work being started to ensure this
                                                                    groups                                                                                    Integrated Governance Report.
Equalities                                      Julie Clatworthy    Establish and embed new Equalities Scheme                              Andrew May         Equalities Scheme approved by Board                     May-09 Green      Approved by PCT Board subject to finalisation and
                                                                                                                                                                                                                                        submission of Action Plan to September Board
Equalities                                      Julie Clatworthy    Establish and embed new Equalities Scheme                              Andrew May         Equalities and Equalities Impact Assessment               Jul-09 Green    Schedule in place
                                                                                                                                                              Training schedules in place
Equalities                                      Julie Clatworthy    Establish and embed new Equalities Scheme                              Andrew May         Annual report for inclusion in Annual                    Mar-10 Amber     Work being started to ensure this
                                                                                                                                                              Integrated Governance Report.
Be a Good Partner to work with
Partnerships                                    Chris Born          Increase satisfaction from stakeholders in the way we work together    Lynne Liptrot      A 360 appraisal to be conducted during                  Sep-09 Green      Getting positive feedback from stakeholders
                                                                                                                                                              September 09.
Partnerships                                    Chris Born          Ensure partnership groups achieve their programmes                     Jeanette George    Set up system of annual reports by each                  Mar-10 Green     Joint transformation and commissioning group has
                                                                                                                                                              partnership - adults                                                      been established and is currently reviewing all planning
                                                                                                                                                                                                                                        groups which contribute to adult partnerships. Health &
                                                                                                                                                                                                                                        wellbeing partnership relaunched and refreshed




                                                                                                                                                                                                                                                                                              31 of 44
Appendix 5 - NHS NS 2009/10 Principal Objectives Work Plan



Work Stream                                            PCT Lead Director         Principal objectives for 2009/10                                  PCT Lead Manager   Deliverables 2009/10                       Delivery Date     Q1 RAG   Q1 Progress against deliverables
                                                                                 What do we want to achieve this year?                                                How will we know that the objective has                      status
                                                                                                                                                                      been delivered?
Partnerships                                           Chris Born                Ensure partnership groups achieve their programmes                Max Kammerling     Set up system of annual reports by each               Mar-10 Green    Annual report form Health and Wellbeing Partnership
                                                                                                                                                                      partnership - Children's Trust, North                                 produced and received by Board in May. Children Trust
                                                                                                                                                                      Somerset Partnership, Health and Wellbeing                            annual repot in development. Notes of North Soemrset
                                                                                                                                                                      Partnership, Community Safety Partnership                             Partnership, Safer and Stronger Partnership and
                                                                                                                                                                                                                                            Childrens Trust meetings now being received regularly
                                                                                                                                                                                                                                            by Board.

*Scoring methodology:                                                            1. Be a Competent Commissioner                                    Green              93%                                             Thresholds:
Green = 3 points / Amber = 2 points / Red = 0 points                             2. Ensure the Development of a Fit for Purpose Provider Service   Green              95%                                                 Red: < 80%
The total max score possible for each indicator is 3 points. Actual              3. Meet our challenges through Innovative Service Redesign        Green              91%                                              Amber: >= 80%
performance is derived by assigning 3, 2, or 0 points based on the RAG           4. Reduce Health Inequalities and promote health and wellbeing    Amber              85%                                              Green: >= 90%
rating. This total is then divided into the max score possible to come up with   5. Be a Good Partner to work with                                 Green              100%
a % performance.                                                                    Overall score                                                  Amber              91%




                                                                                                                                                                                                                                                                                              32 of 44
Appendix 6 - Provider Services KPIs



NHS North Somerset Principle          Work Stream                     PCT Lead      Provider Services Objective                                                    Provider         Deliverables 2009/10                                        Progress at Q1                  Q1 RAG
Objectives                                                            Director                                                                                     Reporting                                                                                                    status
                                                                                                                                                                   Manager
Be a Competent Commissioner           Integration                     Penny Brown Developing our partnership working to provide a seamless service between         Thelma           Locality teams for children and young people achieve year   On Target                       Green
                                                                                  health and social care and increase the focus on enabling health and             Howell           1 objectives
                                                                                  wellbeing alongside treatment and rehabilitation
Be a Competent Commissioner           Financial Balance               Penny Brown Making best use of our resources to provide affordable services of high    Cathy Costello         Forecast outturn is within budget set for 2009/10           Forecasting Break-even          Green
                                                                                  quality
Be a Competent Commissioner           Financial Balance               Penny Brown Benchmarking our services with appropriate comparable providers and taking Kyla Dawe              Join NHS Benchmarking Group by end of April 09              Completed                       Green
                                                                                  appropriate action to ensure value for money
Be a Competent Commissioner           Financial Balance               Penny Brown Benchmarking our services with appropriate comparable providers and taking Kyla Dawe              Take an active part in Commissioner reviews of each         All taking place. Date slipped by Green
                                                                                  appropriate action to ensure value for money                                                      service to include benchmarking. All to be completed by     Commissioners to end of
                                                                                                                                                                                    end of August 09                                            September 2009
Ensure Development of a Fit for       Development of a fit for        Penny Brown Ensuring our services enable NHS North Somerset to meet the national and Kyla Dawe                MSK Interface Service - all patients treated within 13 weeks Target is currently 18 weeks and Amber
Purpose Provider Service              purpose Provider Service                    local targets established as part of the NHS and South West NHS Operating                         on pathways controlled by NS PCT from April 09               5 weeks.
                                                                                  Frameworks for 2009/10                                                                                                                                         18 weeks - Green
                                                                                                                                                                                                                                                 5 weeks - Red (88% against a
                                                                                                                                                                                                                                                 target of 95%) expected on
                                                                                                                                                                                                                                                 target for Q2
Ensure Development of a Fit for       Development of a fit for        Penny Brown Ensuring our services enable NHS North Somerset to meet the national and         Kyla Dawe        Gastrointestinal Endoscopies - all patients treated within 4 National Target is 6 weeks - all Amber
Purpose Provider Service              purpose Provider Service                    local targets established as part of the NHS and South West NHS Operating                         weeks                                                        patients treated within this
                                                                                  Frameworks for 2009/10                                                                                                                                         timeframe. 87% patients treated
Ensure Development of a Fit for       Development of a fit for        Penny Brown Ensuring our services enable NHS North Somerset to meet the national and         Kyla Dawe        95% of inpatient admissions do not result in a C. difficile  within 4 weeks. All patients
                                                                                                                                                                                                                                                 On Target                        Green
Purpose Provider Service              purpose Provider Service                    local targets established as part of the NHS and South West NHS Operating                         infection (CDI) post 48 hours
                                                                                  Frameworks for 2009/10
Ensure Development of a Fit for       Development of a fit for        Penny Brown Ensuring our services enable NHS North Somerset to meet the national and         Kyla Dawe        95% of inpatient admissions do not result in a MRSA         On Target                       Green
Purpose Provider Service              purpose Provider Service                    local targets established as part of the NHS and South West NHS Operating                         bacteraemia post 48 hours
                                                                                  Frameworks for 2009/10
Ensure Development of a Fit for       Development of a fit for        Penny Brown Ensuring our services enable NHS North Somerset to meet the national and         Kyla Dawe        95% of items of equipment or minor adaptations delivered    On Target                       Green
Purpose Provider Service              purpose Provider Service                    local targets established as part of the NHS and South West NHS Operating                         within seven days
                                                                                  Frameworks for 2009/10
Ensure Development of a Fit for       Development of a fit for        Penny Brown Develop our services to ensure people receive the right care at the right time Kyla Dawe          Implement Transforming Community Services action plan       On Target                       Green
Purpose Provider Service              purpose Provider Service                    and place by the right people, endeavouring to provide this at home or as
                                                                                  near to home as possible
Ensure Development of a Fit for       Ensure the PCT's Provider       Penny Brown Develop at least three award winning services                                    Penny Brown Nomination submitted for all appropriate awards                  On Target                       Green
Purpose Provider Service              Services are leaders in their
                                      field
Ensure Development of a Fit for       Ensure the PCT's Provider       Penny Brown Install new community information system                                         Thelma           Implement RIO by December 2009                              On Target                       Green
Purpose Provider Service              Services are leaders in their                                                                                                Howell
                                      field
Ensure Development of a Fit for       Human Resources                 Penny Brown Implement all action plans agreed in response to staff surveys                   Marcus Ede       Full implementation of action plan                          On Target                       Green
Purpose Provider Service
Ensure Development of a Fit for       Human Resources                 Penny Brown Take necessary action to win a top 100 employer award                            Marcus Ede       Develop action plan using benchmarking of current position On Target                        Green
Purpose Provider Service                                                                                                                                                            against criteria
Ensure Development of a Fit for       Improving Working Lives         Penny Brown Implement the Improving Working Lives Action Plan                                Marcus Ede       Full implementation of action plan                         On Target                        Green
Purpose Provider Service
Innovative Service Redesign           Service Redesign                Penny Brown Making the best use of all available resources by ensuring the delivery of the   Angela Perrett MSK Interface Service - Delivery of 4,199 avoided first       Action plan in place to raise   Red
                                                                                  Resource Utilisation Schemes that have been commissioned                                        outpatient appointments                                       referral rates.
Innovative Service Redesign           Service Redesign                Penny Brown Making the best use of all available resources by ensuring the delivery of the   Angela Perrett Rapid Response & Rehab - Delivery of 156 (validated)          On Target                       Green
                                                                                  Resource Utilisation Schemes that have been commissioned                                        Avoided ACS Admissions
Innovative Service Redesign           Service Redesign                Penny Brown Making the best use of all available resources by ensuring the delivery of the   Angela Perrett Community Matrons - Delivery of 364 (validated) Avoided       86 against a Q1 target of 90    Amber
                                                                                  Resource Utilisation Schemes that have been commissioned                                        ACS Admissions
Innovative Service Redesign           Service Redesign                Penny Brown Making the best use of all available resources by ensuring the delivery of the   Angela Perrett Tissue Viability Specialist Nurse - Delivery of prescribing   Working with commissioners to N/A
                                                                                  Resource Utilisation Schemes that have been commissioned                                        savings of £37,760                                            ensure robust information
                                                                                                                                                                                                                                                provision on prescribing savings

Innovative Service Redesign           Service Redesign                Penny Brown To work with Commissioners to inform service redesign through innovative         Kyla Dawe        Working group to be established resulting in action plan by Requirements for Swine Flu        Amber
                                                                                  practice                                                                                          July 09                                                     have resulted in date slippage to
                                                                                                                                                                                                                                                October 09
Reduce Health Inequalities and                                                 Ensuring our services are patient focused with high levels of patient               Kyla Dawe        Undertake 4 patient satisfaction surveys on agreed services On Target                         Green
promote health and wellbeing          Patient & Public Involvement Penny Brown satisfaction                                                                                         in 2009/10

                                                                                    *Scoring methodology:                                                                                                                                                          Overall score Amber
                                                                                    Green = 3 points / Amber = 2 points / Red = 0 points                                                                                                                                         88%
                                                                                    The total max score possible for each indicator is 3 points. Actual performance is derived by
                                                                                    assigning 3, 2, or 0 points based on the RAG rating. This total is then divided into the max                                                                                          Red: < 80%
                                                                                    score possible to come up with a % performance.                                                                                                                                    Amber: >= 80%
                                                                                                                                                                                                                                                                       Green: >= 90%



                                                                                                                                                                                                                                                                                          33 of 44
Appendix 7 - NHS NS Supporting function KPIs



                                                                                             Max poss Actual
Indicator                                      Responsibility      Actual Q1     Target       score   score    Notes
Services delivered within budget               AIMTC                 100%        100%           3         3
Annual satisfaction survey to show             AIMTC               N/A this Q     90%           0              Satisfaction Survey results are yet to be
percentage of users assessing the services                                                                     collated but survey has been issued to
as 'good' or excellent                                                                                         staff to respond to.
Statutory returns completed for sign off and   AIMTC                 100%         100%          3         3
submission by agreed/statutory deadline

Ad-hoc analysis to be provided by agreed       AIMTC                  80%          95%          3         2    The new analysts appointed are
deadline between Requestor and Analyst                                                                         developing well. A new Team Leader
                                                                                                               has been appointed for the Central
                                                                                                               Team and in April interviews for the
                                                                                                               Head of information were undertaken,
                                                                                                               post to be occupied from August 3rd.
                                                                                                               However, demand for analysis
                                                                                                               continues to increase substantially.
                                                                                                               This is associated mainly with the over-
                                                                                                               performance against contract; the
                                                                                                               requirements of World Class
                                                                                                               Commissioning; and the requirement to
                                                                                                               integrate activity demand modelling
                                                                                                               associated with the Capacity Plan and
                                                                                                               Bristol Health Services Plan.
Commissioning data to be processed and         AIMTC                  65%          90%          3         0    Continuing issues with data from both
available by agreed deadline                                                                                   Weston Area Health Trust and North
                                                                                                               Bristol Trust, these were then
                                                                                                               compounded by South Plaza flooding.
                                                                                                               The amber status represents that the
                                                                                                               NBT data issues are now close to
                                                                                                               resolution and the impact from the
                                                                                                               flooding as stabilised. Avon IM& T
                                                                                                               Consortium continues to work to
                                                                                                               address issues but many key factors are
                                                                                                               outside our direct control.
Urgent application problems fixed within 24    AIMTC                 100%          90%          3         3
hours
Telephone training booking and advice          AIMTC                  95%          90%          3         3
available 9am - 5pm weekdays
Evaluation reports from training sessions      AIMTC                  95%          90%          3         3
show training 'meets or exceeds' needs of
learners
Annual programme of Information                AIMTC                 100%         100%          3         3
Governance sessions for PCT staff to be
available at multiple venues for 50% of
staff on 2 year rolling programme.
Smartcard requests responded to within 1       AIMTC               N/A this Q      95%          0         0    Monitoring has commenced in July 09
working day                                                                                                    and will be formally reported in Q2 09/10

Project reports showing progress, risks and AIMTC                    100%         100%          3         3
issues produced within 10 days of month
end
Priority 1 issues to have permanent or      AIMTC                     95%          99%          3         3    Of 21 Priority 1 calls logged, only 1 was
temporary fix within 5 working hours of                                                                        not resolved within the 5 hour target. IT
being reported                                                                                                 services had, during the quarter, to deal
                                                                                                               with both requests for Swine Flu
                                                                                                               reorganisations and several issues
                                                                                                               around the flooding.
Service desk calls answered within 30          AIMTC               N/A this Q      90%          0         0    Cannot currently be monitored.
seconds (Q2 onwards)                                                                                           However, with the planned migration to
                                                                                                               a Voice Over IP system reporting should
                                                                                                               be available from Q2 2009-10 onwards.

Network and service uptime (8.30am -           AIMTC                97.80%         95%          3         3
5.30pm)
Percentage of staff attending statutory and    HR                     84%         100%          3         3    HR lead expecting 100% compliance by
mandatory training - Clinical                                                                                  Sept 09 target
Percentage of staff attending statutory and    HR                     78%         100%          3         3    HR lead expecting 100% compliance by
mandatory training - Non Clinical                                                                              Sept 09 target
Percentage of staff that have an up-to-date    HR                     99%         100%          3         3
Personal Development Record (PDR)

Increase ratio of qualified to HCA staff       HR                    3 to 1      3.3 to 1       3         3
compared to 2007/8 ratio                                                          ratio
Reduce agency costs compared to 2008/9         HR                   £82,297     £750,000        3         3
spend - cumulative
Reduce staff turnover rate compared to         HR                    13.6%        12.0%         3         2
2008/9 rate
Reduce sickness absence rate compared          HR                    4.1%         4.5%          3         3
to 2008/9 rate
Volume of media contacts made during the       Communications         54          up from       3         2    Previous quarter was 77. This quarter
quarter (inbound and outbound)                                                  previous Q                     only inbound calls were measured.
                                                                                                               Outbound calls will also be logged from
                                                                                                               Q2 onwards
Analysis of coverage by Advertising Value Communications           £10,832.00     up from       3         3
Equivalent for the quarter                                                      previous Q
Analysis of coverage by favourability       Communications           100%         up from       3         3    Last quarter was 48%
(positive+neutral coverage) for the quarter                                     previous Q
Analysis of coverage by core message for Communications            N/A this Q     up from       0         2    Core message plan was not
the quarter                                                                     previous Q                     implemented during this quarter. It will
                                                                                                               be implemented in Q3
Total website visits for the quarter           Communications       50,366        up from       3         3    42,479 in previous quarter
                                                                                previous Q
Page visits by non-NHS staff for the           Communications        8,997        up from       3         3    3,708 in previous quarter
quarter                                                                         previous Q
Bounce rate (the % of initial visitors to a    Communications        38%        down from       3         3    42% in previous quarter
site who "bounce" away to a different site)                                     previous Q
by non-NHS staff for the quarter
Page visits by new visitors for the quarter    Communications        6,265        up from       3         2    New visits fell during this period ahead
                                                                                previous Q                     of the website relaunch. Research is
                                                                                                               underway to understand how to improve
                                                                                                               the usefulness of the site to the public

Staff survey - staff feel valued               Communications        56%          up from       3         3    Same as previous quarter
                                                                                previous Q
Staff feel supported                           Communications        49%          up from       3         3    Same as previous quarter
                                                                                previous Q
Staff feel well-informed                       Communications        46%          up from       3         3    Same as previous quarter
                                                                                previous Q
Raise awareness within the PCT of social       Communications      N/A this Q     up from       3         2    Two projects are ongoing but not
marketing                                                                       previous Q                     complete: population segmentation
                                                                                                               using MOSAIC software and an
                                                                                                               integrated campaign to promote the GP
                                                                                                               health centre in Weston to target
                                                                                                               audiences
Raise awareness within the PCT of social       Communications      N/A this Q     up from       3         2    Training programmes developed with
marketing                                                                       previous Q                     NSMC for Q3
Help raise the number of people who feel       Communications         48          up from       3         3    N/A in previous quarter
they can influence decisions in the locality                                    previous Q
(National Indicator 4)
                                                                                                93       86
                                                          Score:      92%         Green

                                                          Red: <      80%
                                                       Amber: >=      80%
                                                       Green: >=      90%




                                                                                                                                                           34 of 44
Appendix 8 - Quality Patient Experience KPIs


Clinical Quality KPIs 2009/10
                                                                                                                                                                                                                Actual
                                                                                                                                                   Section in acute Monitoring
      Area                     Sector                      Named Provider                              Quality Standard / target                                                         Apr-09        May-09        Jun-09        YTD
                                                                                                                                                      contract      frequency
                                                                                    MRSA bacteraemias - number of infections in period             N/A                                      0             0               0          0
                                                                                    MRSA screening - % of screened patients to inpatients in
                                                                                                                                                   N/A                                    100%          100%          100%         100%
                                                                                    month
                     Community                NHS NS                                Clostridium Difficile - No. of infections in period            N/A                     Monthly          0             0               0          0

                                                                                    Tissue Viability / Pressure Ulcers- No of grade 2 and above
                                                                                    hospital acquired pressure ulcers (to show reduction from      N/A                                      0             0               0          0
                                                                                    the 2008/09 baseline)

                                              Weston                                                                                               Part 4a & c                              1             0               0          1

                                              UH Bristol                            MRSA bacteraemias - number of infections in period             Part 4a & b        Monthly               0             0               3          3

                                              NBT                                                                                                  Part 4a                                  4             1               4          9
                     Acute
                                              Weston                                                                                               Part 4a                                  2             4               4         10

                                              UH Bristol                            Clostridium Difficile - No of infections in period             Part 4a            Monthly              17             11             12         40
     Safety
                                              NBT                                                                                                  Part 4a                                 18             16             10         44

                     Continuing Health Care   NHS NS                                Indicators have been set and will be routinely gathered from Q2 onwards

                                              Aspects and Milestones Trust          These KPIs cover four separate contracts which do not lend themselves easily to benchmarking.
                                                                                    AWP as a mental health trust is in the process of finalising their clinical indicators and CQUINs which NHS NS has fed into.
                                              Positive Steps                        Quality KPIs will formulated to be reported in Q3, backdated where possible to the beginning of the financial year
                     Mental Health
                                              Friend (Weston-super-Mare) Ltd

                                              AWP

                                              GP Care (Urology)                     The Primary Care Quality scorecard is currently being formulated and agreed. Based on QOF data there is a challenge to build a regular indicator of
                                                                                    current indicators.
                     Primary Care             Harmoni Urgent Care Centre            Quality Indicators will be discussed at the GP Clinical Governance Leads meeting on the 24th of September and it is envisaged this will mark the
                                                                                    beginning of a discussion with GPs in setting quality KPIs.
                                              Nursing Homes

                     Ambulance                GWAS                                  Indicators have been set and will be routinely gathered from Q2 onwards

                                                                                    % of patients with Long Term Conditions who have
                                                                                                                                                  N/A
                                                                                    personalised Care Plans in place (Target – 100%)
                     Community                NHS NS                                Increase the % of patients receiving palliative care who have
                                                                                    advanced care plans in place by 5% of benchmark by March N/A
                                                                                    2010
                                              Weston                                                                                              Part 4c                   4.08          3.83           3.8
                                              UH Bristol                            Number of falls per 10,000 bed days                            Schedule 3.6
                                              NBT                                                                                                  Schedule 3.6
                     Acute
                                              Weston                                                                                               Part 4c                 64.28%        64.44%        60.53%
                                                                                    Percentage of patients who have had a falls assessment on
                                              UH Bristol                            admission                                                      Schedule 3.6        Liasing with NHS Bristol and acute trusts
                                                                                                                                                                                to report performance
                                              NBT                                                                                                  Schedule 3.6
  Effectiveness                                                                     Indicators have been set and will be routinely gathered from Q2 onwards
                     Continuing Health Care   NHS NS
                                                                                    These KPIs cover four separate contracts which do not lend themselves easily to benchmarking.
                                              Aspects and Milestones Trust          AWP as a mental health trust is in the process of finalizing their clinical indicators and CQUINs which NHS NS has fed into.
                                                                                    Quality KPIs will formulated to be reported in Q3, backdated where possible to the beginning of the financial year
                                              Positive Steps
                     Mental Health
                                              Friend (Weston-super-Mare) Ltd

                                              AWP

                                              GP Care (Urology)                     The Primary Care Quality scorecard is currently being formulated and agreed. Based on QOF data there is a challenge to build a regular indicator of
                                                                                    current indicators.
                     Primary Care             Harmoni Urgent Care Centre            Quality Indicators will be discussed at the GP Clinical Governance Leads meeting on the 24th of September and it is envisaged this will mark the
                                                                                    beginning of a discussion with GPs in setting quality KPIs.
                                              Nursing Homes

                     Ambulance                GWAS                                  Indicators have been set and will be routinely gathered from Q2 onwards



                                                                                    Number of breaches of SHA mixed sex accommodation
                                                                                                                                                   N/A                Quarterly             0             0               0          0
                                                                                    standards


                     Community                NHS NS                                                                                                                                    N/A as no     N/A as no     N/A as no
                                                                                    Number of breaches reported to PCT by 48 hours                 N/A                Quarterly
                                                                                                                                                                                        breaches      breaches      breaches

                                                                                                                                                                                       District Nurse survey - overall 98.6% of
                                                                                    4 Patient experience surveys to be undertaken annually and
                                                                                                                                               N/A                    Quarterly        patients surveyed rated the service as
                                                                                    results reported to commissioner:
                                                                                                                                                                                             excellent, very good or good.

                                                                                                                                                                                         100%          100%          100%
                                              Weston                                                                                               Part 4b                                                                          0%
                                                                                                                                                                                       compliance    compliance    compliance
                                                                                    Number of breaches of SHA mixed sex accommodation
                                                                                                                                                                      Quarterly        Applicable    Applicable     Applicable
                                              UH Bristol                            standards per 10,000 bed days                                  Part 4b
                                                                                                                                                                                        from Oct      from Oct       from Oct
                                              NBT                                                                                                  Part 4b                                TBC           TBC              TBC
                                              Weston                                                                                               Part 4b
                                                                                                                                                                                         Liasing with NHS Bristol and acute
                                              UH Bristol                            Numbers of breaches reported to PCT by 48 hours                Part 4b            Quarterly
                                                                                                                                                                                            trusts to report performance
                                              NBT                                                                                                  Part 4b

                                                                                    Patient experience survey - increase scores (from 2008                                             Weston action plan in place - monitored
                     Acute                                                          baseline) relating to:                                                                             through Clinical Quality Review Groups
Patient Experience                            Weston                                - Noise at night                                               Part 4c            Annual
                                                                                    - Medication side effects info
                                                                                    - Overall rates of patient satisfaction
                                                                                    Using Picker 2007 Survey Qs for The Hospital and Ward,
                                              UH Bristol                                                                                           Part 4c            Q4
                                                                                    achieve no red ratings and 50% green
                                                                                    Using Picker 2007 Survey Qs for The Hospital and Ward,
                                              NBT                                                                                                  Part 4c            Q4
                                                                                    achieve no red ratings and 50% green
                                              Weston                                                                                               Part 4b                                82%            78%             68%       76%

                                              UH Bristol                            Choose & Book slot availability - 90%                          Part 4b            Monthly             85%           81%              71%       79%

                                              NBT                                                                                                  Part 4b                                66%           70%              66%       67%

                     Continuing Health Care   NHS NS                                Indicators have been set and will be routinely gathered from Q2 onwards

                                                                                    These KPIs cover four separate contracts which do not lend themselves easily to benchmarking.
                                              Aspects and Milestones Trust          AWP as a mental health trust is in the process of finalizing their clinical indicators and CQUINs which NHS NS has fed into.
                                                                                    Quality KPIs will formulated to be reported in Q3, backdated where possible to the beginning of the financial year
                                              Positive Steps
                     Mental Health
                                              Friend (Weston-super-Mare) Ltd

                                              AWP

                                              GP Care (Urology)                     The Primary Care Quality scorecard is currently being formulated and agreed. Based on QOF data there is a challenge to build a regular indicator of
                                                                                    current indicators.
                     Primary Care             Harmoni Urgent Care Centre            Quality Indicators will be discussed at the GP Clinical Governance Leads meeting on the 24th of September and it is envisaged this will mark the
                                                                                    beginning of a discussion with GPs in setting quality KPIs.
                                              Nursing Homes

                     Ambulance                GWAS                                  Indicators have been set and will be routinely gathered from Q2 onwards


                     Key:
                     Part 4a                  Clinical Quality Performance indicator
                     Part 4b                  Performance indicators
                     Part 4c                  CQUIN - Commissioning for Quality and Innovation - incentive scheme indicators

                     Note:                    Where a RAG rating has not been assigned - this is because the target has not yet been established




                                                                                                                                                                                                                                          35 of 44
                                                                                                                                               Appendix 9

                                                              North Somerset PCT
                                                                     Month 5
                                                               April - August 2009
                                                        Summary of Income and Expenditure

Expenditure & Budgets


   Initial         Total                         Forecast                                                                      Actual        Variance to
  Annual          Current       Forecast        Variance                                                      Total Budget Expenditure to       Date
  Budget          Budget        Outturn        over/(under)                                                     to Date        Date         over/(under)
  £ 000s          £ 000s         £ 000s           £ 000s                                                         £ 000s       £ 000s           £ 000s
                                                              Commissioning Budgets
    170,707        175,782        175,997              215      NHS Trusts                                         73,890          73,994            104
       (499)                -              -             -      RUM schemes                                             -               -              -
      4,736          3,456          3,455                -      Commissioning Panel / Cost per case                 1,209           1,209              -
     11,155          7,933          8,724              792      Continuing Care/Individual Packages of Care         3,305           3,740            435
     20,853         21,957         22,024               67      Other Patient Services                             15,233          15,222            (11)
     16,072         15,832         15,832                0      Provider Budget                                     6,619           6,571            (48)
    223,024        224,960        226,033            1,073      Total                                             100,256         100,737            480


                                                              Primary Care
     36,072         39,878         39,878                -      Primary Care                                       15,735          15,735              -
     31,499         31,074         31,074                -      Prescribing                                        12,904          12,904              -
     67,571         70,952         70,952                -      Total                                              28,639          28,640              -


                                                              Management & Reserves
      9,661         10,202         10,112              (90)     Management Costs                                    4,467           4,461             (6)
      1,692                 -              -             -      Inflation reserve                                       -               -              -
                     2,557          1,574             (983)     Contingency                                           475               -           (475)
                            -              -             -      Budget Reviews                                          -               -              -
     11,353         12,759         11,686           (1,073)     Total                                               4,942           4,461           (481)


    301,948        308,671        308,671                - Total Expenditure                                      133,837         133,837             (1)


Allocation


    Initial         Total                        Forecast                                                                                    Variance to
  Annual          Current       Forecast        Variance                                                      Total Budget Actual Funding       Date
 Allocation      Allocation     Outturn        over/(under)                                                     to Date       to Date       over/(under)
   £ 000s          £ 000s        £ 000s           £ 000s
    301,948        301,948        301,948                -      Initial Budget                                    125,812         125,812              -
                       630           630                 -      M1 Allocation                                         263            263               -
                       626           626                 -      M2 Allocation                                         261            261               -
                     1,139          1,139                -      M3 Allocation                                         475            475               -
                     4,328          4,328                       M4 & M5 Allocation                                  1,803           1,803              -


    301,948        308,671        308,671                - Total Allocation                                       125,812         125,812              -


             -              -              -             - Net PCT Position                                         8,026           8,025              -
                                                                                                                                                            Appendix 10



                                                                   North Somerset PCT
                                                                           Month 5
                                                                    April - August 2009
                                                                  Analysis of Expenditure




                                                 Forecast                                                                          Actual    Variance to
 Initial       Total Current   Forecast         Variance                                                           Total Budget Expenditure     Date
Budget           Budget        Outturn         over/(under)                                                          to Date      to Date   over/(under)
£ 000s            £ 000s        £ 000s            £ 000s                                                              £ 000s       £ 000s      £ 000s
                                                                  NHS Trusts
   46,115            39,952         39,952                    -   UHB                                                    16,761      16,761            -
   57,882            59,577         59,577                    -   Weston                                                 25,155      25,155            -
   39,462            30,193         30,193                    -   NBT                                                    12,783      12,783            -
   16,408            16,408         16,408                    -   AWPT                                                    6,836       6,837            -
    5,009             5,293          5,293                    -   GWAS                                                    2,205       2,204            -
    5,831            24,359         24,574              215       Specialist Commissioning Consortium                    10,149      10,255         105
 170,707           175,782        175,997               215       Total NHS Trusts                                      73,890      73,994          105


                                                                  Resource Utilisation Schemes (not in SLAs)
     (499)                -               -                   -   RUM Schemes to be identified                               -            -            -
     (499)                -               -                   -   Total Resource Utilisation Schemes                         -            -            -




                                                                  Out of area/Cost per case
      591               577           577                     -   Individual Commissioning Panel                           241          241            -
    1,025               860           860                     -   SLAs out of area                                         358          358            -
      219               223           223                     -   Health Protection Agency                                  91           91            -
    1,729             1,759          1,758                    -   Out of area - cost per case                              504          504            -
      617                37               37                  -   Mental Health SCP                                         15           15            -
      183                 0               0                   -   AWPT - Low secure                                          0            0            -
    4,363             3,456         3,455                     -   Total Out of Area /Cost per case                       1,209       1,209             -


                                                                  Continuing Care
      435               476           476                     -   Learning difficulties                                    198          198            -
           -              0               0                   -   -                                                          0            0            -
    1,209             1,279          1,279                    -   Mental Health                                            533          533            -
    2,352             2,629          2,629                    -   Physical Disabilities                                   1,095       1,095            -
      129                98               98                  -   Rehabilitation                                            41           41            -
      501               328           328                     -   Fast Track                                               137          137            -
       38                79               79                  -   CHC - Weston Hospice                                      33           33            -
       18                 -               -                   -   Provider Services                                          -            -            -
    2,354                 2           571               570       Assessment & Retrospective cases                           1          242         241
    7,038             4,891         5,461               570       Total Continuing Care                                  2,038       2,279          241


                                                                  Individual Packages of Care
      529               821           821                     -   Children                                                 342          342           (0)
    2,360               867          1,089              222       Mental Health                                            361          555         194
    1,032             1,144          1,144                    -   LD Sectn & JF                                            477          477            -
      195               210           210                     -   Joint Packages of Care                                    87           87            -
    4,117             3,042         3,264               222       Total Individual Packages of Care                      1,267       1,461          194


                                                                  Other Patient Services
    1,593             2,045          2,049                    4   Mental Health                                           1,323       1,323            -
    1,361             1,774          1,774                    -   Learning difficulties - Commissioning                    836          836            -
    5,018             5,018          5,018                    -   Learning difficulties - Commissioning S75               5,018       5,018            -
      623               711           711                     -   Children                                                 251          251            -
                        821           821                     -   ICES                                                     420          421            -
    1,969             1,969          1,969                    -   Drug Misuse                                              484          483            -
    4,915             4,484          4,484                    -   Funded Nursing Care                                     4,916       4,915            -
      259               259           249                (11) Continence Services                                          108           96          (12)
      136               204           205                     1   Sexual Health                                             56           58            2
       88               138           138                     -   Maternity services                                        40           40            -
      254               254           254                     -   Diabetes                                                   0            0            -
       48                79               79                  -   Stroke Funding                                            13           13            -
      265               325           324                 (1) Smoking Cessation                                             97           97           (1)
      622               622           622                     -   Hospice Care                                             238          238            -
      372               164           164                     -   Specialist commissioning                                 132          132            -
    3,018             2,681          2,754                73      Misc Other Patient Services                             1,144       1,144            -
      311               411           411                     -   Misc Other Patient Services - Health Promotion           158          158            1
   20,853           21,957         22,024                 66      Total Other Patient Services                          15,233      15,222           (11)


                                                                  Provider Services
   16,072            15,832         15,832                    -   Provider Services                                       6,619       6,571          (48)
   16,072           15,832         15,832                     -   Total Provider Services                                6,619       6,571           (48)


                                                                  Primary care
   18,061            19,672         19,672                    -   Primary care - contract                                 8,370       8,371            -
    2,578             2,997          2,997                    -   Enhanced services                                       1,089       1,089            -
    6,666             7,538          7,538                    -   Dental Contract                                         2,929       2,929            -
    2,359             2,960          2,960                    -   Primary care - other                                    1,187       1,187            -
    4,089             4,336          4,336                    -   QuOF                                                    1,170       1,170            -
    2,319             2,375          2,375                    -   Out of hours                                             990          990            -
   36,072           39,878         39,878                     -   Total Primary Care Budgets                            15,735      15,735             -


                                                                  Prescribing
                                                                                                                                                  Appendix 10



                                                                   North Somerset PCT
                                                                           Month 5
                                                                    April - August 2009
                                                                  Analysis of Expenditure




                                                 Forecast                                                                Actual    Variance to
 Initial       Total Current   Forecast         Variance                                                 Total Budget Expenditure     Date
Budget           Budget        Outturn         over/(under)                                                to Date      to Date   over/(under)
£ 000s            £ 000s        £ 000s            £ 000s                                                    £ 000s       £ 000s      £ 000s
   28,381            28,106         28,106                    -   GP Prescribing                               11,667      11,667            -
    1,551             1,551          1,551                    -   Pharmacy contract                              646          646            -
      697               477           477                     -   Domiciliary Oxygen                             199          199            -
      495               495           495                     -   Central Drug Costs                             206          206            -
      375               445           445                     -   Medicines Management Team                      186          186            -
   31,499           31,074         31,074                     -   Total Prescribing                           12,904      12,904             -


                                                                  Management Costs
      521               396           399                     3   Community Pay                                  165          166            1
      152                 6               2               (3) Community                                            2            0           (2)
      841               705           704                 (1) Governance and Quality Pay                         294          292           (2)
      181               189           206                 17      Governance and Quality                          79           85            6
      993             1,448          1,442                (7) Finance, Performance and Information Pay           600          599           (2)
    2,141             2,299          2,215               (84) Finance, Performance and Information              1,147       1,144           (3)
      398               720           729                     8   Corporate Services                             325          370          45
      320               320           320                     -   Human Resources Pay                            133          132           (1)
      143               143           145                     2   Human Resources                                 59           64            4
    1,296             1,108          1,108                (1) Commissioning Pay                                  465          440          (25)
      181               213           218                     5   Commissioning                                   89          127          38
      269               337           337                     -   Primary care Pay                               141          141            -
           4              4               4                   -   Primary care                                     1            1            -
      479               621           601                (20) Public Health Pay                                  259          232          (27)
      450               367           368                     1   Public Health                                  154          151           (3)
      335               337           330                 (6) Chief exec Pay                                     140          132           (8)
       52                71               60             (10) Chief exec                                          29           29           (1)
      123               123           123                     -   PEC Pay                                         51           44           (7)
       61                61               61                  -   PEC                                             25           20           (5)
      131               131           131                     -   Chair Pay                                       54           51           (3)
       21                21               21                  -   Chair                                            9           13            4
      555               555           561                     6   Funded Care Pay                                231          217          (14)
       17                27               27                  1   Funded Care                                     14           10           (3)
    9,661           10,202         10,112                (90) Total Management Budget                          4,467       4,461            (6)


                                                                  Reserves
    1,692                 0               0                   - Inflation reserve                                  0            0            -
                      2,557          1,574              (983) Contingency                                        475            0         (475)
                                                              - Budget Reviews                                                               -
    1,692             2,557         1,574               (983) Total Reserves                                     475            -         (475)

 301,575           308,671        308,671                     -                                              133,837     133,837             -
                                                                                                     Appendix 11
                                      North Somerset PCT
                                           Allocation

                                                    Rec         Non Rec    Total       Cash

Initial Budget                                        6,719         285      7,004       7,004

Month 1 Allocations
Dental                                                    630                  630            630

Month 1 Allocations                                       630         0        630            630


Month 2 Allocations
Clinical Excellence                                                  14         14             14
Personal Admin for non dispensing Doctors                            31         31             31
Recombinant clotting                                                210        210            210
Childhood vaccinations girls 12-13                                   33         33             33
End of life care                                                     14         14             14
Burns                                                                53         53             53
Mental health capacity act                                           38         38             38
Contract fees for dispensing doctors                                149        149            149
Weston Clinical excellence                                           84         84             84
                                                           0        626        626            626

Month 3 Allocations
Childhood vaccinations girls 14-16                                    61        61          61
Childhood vaccinations girls 16-18                                    67        67          67
Contraceptive funding                                                 43        43          43
Capital to Revenue transfer - fair price for care                    436       436         436
LD Cost of living rebasing                                            20        20          20
Single Sex Weston                                                    944       944         944
Single Sex Weston                                                   -460      -460        -460
Single Sex PCT                                                        28        28          28
2008/09 additonal levy not actioned in 2008/09                                   0         -42
                                                           0       1,139     1,139       1,097

Month 4 & 5 Allocations
New specialised children's top up                                    81         81          81 uhb
Healthy schools                                                      38         38          38
Darzi                                                  -580                   -580        -580
Central Budgets topslice                                             615       615         615
Adjustemnt to ICES cap to rev                                        -80       -80         -80
GP training capital to revenue                                     1,125     1,125       1,125
Aldi site - capital to revenue                                       750       750         750
Brandon - capital to revenue                                         590       590         590
GP IT kit - capital to revenue                                       200       200         200
Dental - capital to revenue                                          242       242         242
surplus from 08/09                                                    48        48          48
Single Sex Weston - reversal                                         460       460         460
Commissioning adjustment ??????                                      -69       -69         -69
acute stroke funding                                                  31        31          31
Additional funding - Weston                                          888       888         888
transforming community services                                        2         2           2
Psycological therapies                                               414       414         414
Childhood vaccinations                                                33        33          33
Single Sex Weston - reversal                                        -460      -460        -460


                                                       -580        4,908     4,328       4,328


                                                    295,005       13,666   308,671     308,629

Budgets                                             295,005       13,666   308,671

diff                                                       0          0            0



Iniital Allocation                                                         302,499     302,457


GP Practice procurement                                                        708         708
ICES capital to Revenue                                                        820         820
Transfer from Somerset PCT re Psychiatric liaison                               30          30
Dental                                                                         630         630
Single Sex Weston                                                              944         944
Single Sex PCT                                                                  28          28
Fair price for care                                                            436         436
GP training capital to revenue                                               1,125       1,125
Aldi site - capital to revenue                                                 750         750
Brandon - capital to revenue                                                   590         590
GP IT kit - capital to revenue                                                 200         200
Dental - capital to revenue                                                    242         242
surplus from 08/09                                                              48          48
New specialised children's top up                                               81          81
Single Sex Weston - reversal                                                  -460        -460

                                                                             6,172       6,172

                                                                           308,671     308,629

                                                                                   0
                                                                                 Appendix 12

                                   North Somerset PCT
                                         Month 5
                                   April - August 2009
                                     Balance Sheet



                                        2009              2009
                                       August            March      Change
                                       £ 000s            £ 000s     £ 000s
Fixed Assets
Land                                      1,692           1,692            -
Buildings (inc £170k Donated)             3,347           3,295           52
Plant & Equipment inc (£22k Donated)         93              44           49
IT                                          697             582          115
Fixtures and Fittings                       106              80           26
Software                                     15              15            -
Total Fixed Assets                        5,950           5,708          242


Current Assets
General Debtors NHS                         964             619           345
Prepayments                                   -           5,940        (5,940)
General Debtors Non NHS                   2,397             378         2,019
Cash                                          8               4             4
Total Current Assets                      3,369           6,941        (3,572)


Current Liabilities
General Creditors Prescribing             4,570           4,129          441
General Creditors NHS                     2,376           2,588         (212)
General Creditors Non NHS                12,128           8,105        4,023
Total Current Liabilities                19,074          14,822        4,252

Provisions
General Provisions                        3,772           3,817           (45)
Total Provisions                          3,772           3,817           (45)

Net Assets/(Liabilities)                (13,527)          (5,990)      (7,537)


Financed By:
General Fund                            (15,725)          (8,188)      (7,537)
Donated Asset Reserve                       169              169            -
Revaluation Reserve                       2,029            2,029            -
Total                                   (13,527)          (5,990)      (7,537)
                                                                             Appendix 13
                  North Somerset PCT
                         Month 5
                   April - August 2009
      Cash to Income and expenditure reconciliation




                                               £000's     £000's

Cash Drawn                                                110,200
Top Slice                                                  16,100

Total Income of Cash                                      126,300

Movements in Balance Sheet Items
Debtors (increase)/decrease                      3,576
Creditors increase/(decrease)                    4,252
Provisions increase/(decrease)                     (45)
Movement in Fixed Assets (inc Depreciation)       (242)
                                                            7,541

Bank Balance                                                       (4)
Cash Balance                                                        -

Net Cash Utilisation                                      133,837


Expenditure to date (including Depreciation)              133,837        0


Cash Limit notified at 31 August 2009                     308,629
                                                                                                                                                                                                                                 Appendix 14



                                                                                North Somerset Primary Care Trust
                                                                                              Month 5
                                                                                      April 2009 - March 2010
                                                                                             Cashflow


                          Actual         Actual       Actual       Actual       Actual            Planned       Planned        Planned        Planned      Planned           Planned            Planned
                           April          May          June         July        August           September      October       November       December      January           February            March             Total
Opening Balance                    860       10,708     175,842         9,357            9,230          6,274       52,608         98,942         45,276      191,610                 97,049        133,379                860
Allocation Drawdown       24,000,000     22,000,000   20,500,000   19,000,000     24,700,000       21,000,000    23,000,000     23,000,000    23,700,000    23,000,000           23,000,000       30,680,000      277,580,000
PPA and Dental Topslice    3,339,000      3,280,000    3,130,000    3,097,000      3,254,000        3,339,000     3,339,000      3,339,000     3,339,000     3,339,000            3,339,000        3,339,000       39,473,000
Other Income                 509,561        789,248       67,364      204,038       782,843          300,000       300,000        300,000        300,000      300,000                300,000        300,000          4,453,053
Total                     27,849,421     26,079,956   23,873,206   22,310,395     28,746,073       24,645,274    26,691,608     26,737,942    27,384,276    26,830,610           26,736,049       34,452,379      321,506,914


Annual Grants              4,915,200                                                                                                                                                                                 4,915,200
Blocks                    13,642,156     14,006,277   14,006,277   14,488,873     15,804,865       14,172,666    14,172,666     14,172,666    14,172,666    14,172,666           14,172,666       14,172,666      171,157,110
Creditor Payments          8,384,449     10,959,627    8,815,542    6,865,127     11,984,132        8,500,000    10,500,000     10,600,000    11,100,000    10,800,000           10,500,000       17,028,000      126,036,878
Payroll                      880,476        886,232     924,078       925,264       917,257          920,000       920,000        920,000        920,000      920,000                920,000        920,000        10,973,307
Capital                       16,432         51,977     117,952        21,901        33,543         1,000,000     1,000,000      1,000,000     1,000,000      840,895             1,010,004        2,331,296         8,424,000
Total                     27,838,713     25,904,114   23,863,849   22,301,165     28,739,799       24,592,666    26,592,666     26,692,666    27,192,666    26,733,561           26,602,670       34,451,962      321,506,496


Month End Bank Balance        10,708        175,842        9,357        9,230            6,274        52,608        98,942         45,276        191,610       97,049                133,379              417              417




                                                                                                                                                                                  Cash Allocation as at 31 August 2009
                                                                                                                                                                         Drawdown                                 277,580,000
                                                                                                                                                                         Top Slice                                 39,473,000
                                                                                                                                                                         Total                                    317,053,000
                                                                                                                        Appendix 15


                                         North Somerset PCT
                                                Month 5
                                         April - August 2009
                                                 Capital


                                                     2009/10
                                                     Budget       Spend to
                                                                                 Variance    Project Lead
                                                     £000's         date


Schemes: Capital
IT kit                                                      254          81          -173   Consortium
Patient environment                                          10                       -10   V Lovis
Clevedon Hospital Redevelopment                           3,427          54        -3,373   M Hutton
Setting up new GP led Health Centre                         170           1          -169   C Morton
Seasons                                                      50                       -50   V Lovis
Worle                                                        30          11           -19   V Lovis
Teacosy                                                      70                       -70   M Kammerling
10 Bedded detoxification unit - Broadway Lodge              250                             M Hutton
Portishead                                                               55                 V Lovis
Waverley House                                                           36                 V Lovis
East End Court                                                            1                 V Lovis

                                                          4,261         239        -3,864
Schemes: Capital Grants
ICES                                                        820                      -820   M Hutton
Fair price for Care                                         436                      -436   M Hutton
Aldi - GP Practice                                          750              3       -747   J Follows
Brandon Trust LD reporvision                                590                      -590   M Hutton
IT kit - GP                                                 200                      -200   Consortium
GP Training                                               1,125                    -1,125   L Day
Dental                                                      242                      -242   M Quantrill
                                                          4,163              3     -4,160


                                                          8,424         242        -8,024


RiO                                                      79.458
GP capital spend                                                    104.952




                                                                                                            GP survey
                                                                                             Appendix 16


                                North Somerset PCT
                                      Month 5
                                April - August 2009
                                   Savings Plan

                                                                                     RAG
                                                R             NR          Total      score
3% Trust Provider efficiency                        (4,637)                (4,637)     G
3% PCT provider Efficiency                            (418)                  (418)     G
Provider Efficiency Sub Total                       (5,055)          0     (5,055)



Productivity                                        (4,149)        486     (3,663)    A
Prescribing                                         (2,802)                (2,802)    A
Mental Health                                         (300)                  (300)    R
Other Savings Identified                              (701)    (522)       (1,223)    G
Contract Limiters / Reduction in activity           (1,095)                (1,095)    G
PCT Efficiency Sub Total                            (9,047)        (36)    (9,083)

TOTAL SAVINGS                                   (14,103)           (36)   (14,139)

				
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