Oxfordshire by xumiaomaio


Performance Report: May 2009
1        Executive introduction and summary
The report covers Oxfordshire PCT performance, principally for the period to end-March and Q4, with the
year to date position for 2009/10 indicated where available. A final year-end report for 2008/09 will be
produced in June. Commentary is focused on those areas that are under-performing against target levels.
Overall performance against key national targets and local targets are as follows:

Of the 113 in-year indicators of performance assessed across the four perspectives, 78 are better than target
levels (Green), 14 are achieving close to plan (Amber) and 21 indicators are under-performing against plan
(Red). In the previous performance report, of the 113 in-year indicators assessed, 79 were better than target
levels (Green), 10 were achieving close to plan (Amber) and 24 measures were under-performing against
plan (Red). Performance on the whole has improved from last month with two indicators changing from Red
to Green and three changing from Amber to Green.

Of those targets that are under-performing (Red or Amber) the following will be included in the 2008/09
Annual Health check (Quality of Services):

 Current              Target 08/09                                                          Risk rating for
 Position 08/09                                                                             year-end position
 Red (currently            •    High quality stroke care                                       • Red
 not met)                  •    Chlamydia screening                                            • Red
                           •    Teenage pregnancy                                              • Red
                           •    Access to Primary Dental Services                              • Red
 Amber                     •    Time to reperfusion for patients following a heart attack      • Green
 (currently                •    Ambulance Response Times: Category A < 8 minutes               • Amber
 partly met)               •    Ambulance Response Times: Category A < 19 minutes              • Amber
                           •    Ambulance Response Times: Category B < 19 minutes              • Amber
                           •    Delayed Transfers of Care                                      • Amber
                           •    Proportion of individuals who complete immunisation by
                                recommended ages                                               •   Amber
                           •    18 week wait                                                   •   Amber/Red

Please note 18 week wait has been included in above as there are concerns over the potential for this target
to under achieve at the end of the year 2008/09.

Overall performance against all indicators across the four perspectives of the Balanced Scorecard is shown
in Figure 1 below.

Figure 1 - Indicators for Oxfordshire PCT

Please note that for any group / domain of target indicators, at least 80% of individual targets in that group
must be fully met to be shown as Green. Amber represents 20-50% of indicators under-performing. Red
represents over 50% of indicators under-performing.

2       Introduction to the performance management framework
The framework views organisational performance through four perspectives, reflecting a balanced approach
to how the PCT is performing against its range of responsibilities. These four perspectives are:

•   Health quality and outcomes: Including measures of health improvement, clinical quality and safety
    and patients’ access to timely care.

•   Finance: This brings together all top level corporate financial indicators, with details on finance issues
    covered in the separate report to Board.

•   Improving care and prevention: This area focuses on the systems and processes that support the
    delivery and improvement of public health and patient services.

•   Organisational capability: This includes workforce indicators and has been developed to include
    performance on staff learning and development and feedback to both annual and in-year surveys.

Each perspective contains sub-groups of measures that reflect key themes, for example ‘Health
Improvement’ as a sub-set of Health Quality and Outcomes. The framework incorporates all national targets
and their relevant indicators where appropriate, the main health-related targets of the Local Area Agreement,
statutory finance targets, and a selected range of other key targets and measures that help track and reflect
the performance of the PCT. The main categories of targets are:

•   Vital Signs A – National Requirements
•   Vital Signs B – National Priorities
•   Vital Signs C – Local Priorities
•   Existing Commitments
•   Local Delivery Targets – targets based on the 2008/09 Operational Plan.

A diagrammatic overview of the performance management framework is attached to this report (appendix B)

3       Health quality and outcomes
Of the 35 in-year indicators of performance, 25 are better than target levels (Green), 7 are achieving close to
plan (Amber) and 3 indicators are under-performing against plan (Red). This is shown in Figure 2 below:

                                                        Health Quality and Outcomes

          Health Improvement         Clinical effectiveness,              Patient and Public                                Access
                                     safety and quality                   approval

          Health outcomes /          Improving cleanliness                NHS Surveys                  Primary Care                  Secondary Care
                                     and reducing HCAIs
          VSC29 – Injuries to        VSA01 – MRSA infection               Patient Experience           EC – GP Access                EC - % IPs Waiting >
          children                                                        (Satisfaction local NHS)                                   Standard of the waiting
                                     VSA03 – Clostridium                  Patient Experience           EC – PCP Access               EC - % OPs Waiting >
          Healthy Lifestyles         difficile infections                 (Dignity and Respect)                                      Standard of the waiting
                                                                          Patient Experience           VSA07 – GP Practice           VSA04 – 18 Week wait
                                                                          (Hospital Satisfaction)      Extended Opening hours
          VSB05 – Smoking quitters
                                                                          Patient Experience (GP       VSB18 – Dental Access         EC - % Cancers 14-day
                                                                          Satisfaction)                                              Referral to OP
          VSB09 – Childhood                                                                                                          appointment
          obesity (LAA2)                                                  Patient Experience                                         EC - % Cancers 31-day
                                                                          (Participation in Decis..)   Emergency Care                Diagnosis to Treatment
          VSB11 - % Breastfeeding
          at 6 – 8 weeks                                                                                                             EC - % Cancers 62-day
                                                                                                                                     Referral to Treatment
                                                                                                       EC - % A&E < 4 hr wait
          VSB10 – Teenage                                                                                                            VSA08 - % Breast
          Conception per 100,000                                                                                                     symptoms 2 week wait
                                                                                                       EC - % Amb Cat A 8 Min
                                                                                                       target                        VSA11 - % Cancers 31-
          Social and Helthcare                                                                                                       day follow up
                                                                                                       EC - % Amb Cat A 19 Min
                                                                                                       target                        VSA12 - % Cancers 31-
          VSC10 – DTOC per                                                                                                           day follow up
                                                                                                       EC - % Amb Cat B 19 Min
          100,000 population aged                                                                                                    (radiotherapy
                                                                                                       target                        VSA13 - % Cancers 62-
          18+ (LAA..                                                                                                                 days screening to
          EC - % Delayed Transfers
          of Care                                                                                                                    treatment mo/surgery)
                                                                                                       MH and LD                     VSB06 - % Midwife appt
                                                                                                                                     within 12 weeks
                                                                                                                                     EC - #Pts > 3 Mths
                                                                                                       EC – MH Crisis                Revascularisation
                                                                                                       Resolution Service
                                                                                                       (Assessments)                 EC – PCT facilities in
                                                                                                       EC - # New Cases              place to support choice
                                                                                                       Psychosis in EI Teams
                                                                                                                                     EC – Time to Reperfusion
                                                                                                                                     following heart attack
                                                                                                       Community Health

                                                                                                       EC - % GUM Access

Figure 2 - Health quality and outcomes indicators

3.1     Health improvement
3.1.1 Health outcomes and inequalities

Injuries to Children (Red) Vital Sign C                                              Sarah Breton
Incomplete YTD Q4 data has been received for 2008/09 which shows an actual of 1,371 against a plan
figure of 1,139, which means the original trajectory target has not been met.

The SHA and GOSE have now agreed a new trajectory for 2009/10 based on accurate 2007/8 baseline data.
A three year plan to reduce admissions will be developed through the Oxfordshire Children and Young
People’s Trust, but early analysis of the data suggests that the following issues will need to be addressed:
      • Increasing numbers of admissions for self-harm in young people
      • Differential clinical practice and thresholds for admission across the JR and HGH site
      • Clinical coding

It is difficult to assess the risk around meeting the new trajectory for 2009/10 until further analysis has been
undertaken. This will be reported back at the end of Q1.

This measure has not met (Red) its year end target for 2008/09.

3.1.2 Healthy Lifestyles

Teenage Conception Rate per 100,000 (Red) Vital Sign B                               Val Messenger
The target for 2007 was a rate of 22.3 conceptions per 1,000 women aged 15-17. This equates to 255
conceptions. The actual rate was 29.6 per 1,000 or 350 conceptions. This is disappointing as it represents
an increase of 30 conceptions since 2006. Overall Oxfordshire has a target to reduce teenage conceptions
by 45% by 2010 from a baseline of 31.4 per 1,000 in 1998. Our current reduction is 5.6% against a national
reduction of 10.7% and a reduction in the South East of 13.3%. Any actions planned during 2009 will have
no effect on the 2008 performance as these conceptions have already occurred.

Actions that took place in 2008 that will affect next year’s figures:
    • Under 25 attendances at c&sh clinics increased from 2007/8
    • More Emergency Hormonal Contraceptive (EHC) was provided through pharmacists
    • Full year effect of doubling funding for free condoms
    • Full year effect of CCard scheme launched in May 2007

Actions in place for 2009:
    • Increase to activity through c&sh contract for <18
    • Outreach worker funded to support teenagers who have already had a conception, so that they are
        aware of contraception choices available to prevent second pregnancy. This post also provides
        advice to vulnerable groups e.g. looked after children
    • Increased activity funded for EHC LES
    • A programme of work to encourage Long Acting Reversible Contraception (all ages),
    • Work with colleges of FE in Oxford and Banbury to identify the most appropriate on-site services for
        the students.
    • Recommissioning of SRE support in schools to provide additional targeted support to schools with
        catchment populations in recurrent teenage pregnancy hotspots

It is always difficult to demonstrate cause and effect as teenage pregnancy is multifaceted, so it is hard to
accurately predict the effect that actions will have on future rates. Unfortunately leading indicators for Q1
2008 predict a further rise against a falling target.

This measure has not met (Red) its year end plan for 2008/09.

3.1.3 Social and health care
Delayed Transfers of Care (QoS, Amber)                                      Existing Commitment                                   Matthew Staples
There are two components to the Delayed Transfers of Care target for 2008/09:

           •              Existing Commitment measure. The definition of this has changed from 2007/08 and now assesses
                          the number of acute and non-acute delays per Oxfordshire GP practice population.

           •              Local Area Agreement 2 target (LAA2). This measures delays in all hospital beds (acute, mental
                          health, community, learning disabilities) as a rate per 100,000 population.

For the CQC assessment, Oxfordshire PCT will be assessed on the Existing Commitment measure. Looking
at performance Q2 till Q4, the rate is 0.034% delays. As no thresholds have been set for this measure,
assessment against the national position for Q2 and Q3 has been used in order to identity our performance
level. However, ratification of data for OBMH and NOC is currently in progress which could potentially
change the numbers and national position.

At the end of Q4 the LAA2 target was met, with 88.10 average delays per week across the system, below
the 102 maximum. The LAA2 target for 2009/10 is now 96 maximum delays per week and to week ending
19/04/2009 the actual number is 71.67. The following figure shows delayed transfers of care against the
LAA2 target.

Figure 3 shows data for both components of the target.

                                                   Delayed transfers of care ‐ All Oxfordshire Patients (UNIFY data only)
     Number of delays

                                                                                                                                          Delays in week
                                                                                                                                          LAA2 Target
                                                                                                                                          YTD Average
                                                                                                                                          2009/10 Internal target

                                                            2008/09                                                         2009/10

Figure 3 – Delayed Transfers of Care, LAA2 target

Robust performance management of DTOCs continues. Whilst significant progress has been made on this
target it still remains a risk of achievement for year end. An enhanced, system wide performance
management system has now been implemented with dedicated staff in each organisation responsible for
managing delays. Weekly monitoring of reasons for delays and action to unblock has been implemented.

It is anticipated that this measure will be close to meeting (Amber) its year end plan for 2008/09.

3.2                       Access

3.2.1 Primary Care

Access to Primary Dental services (QoS, Red) Vital Sign B                                                                             Nicky Wadely
This vital sign target measures the number of patients seen at least once by an NHS dentist during a rolling
24 month period. The target is 302,588 for the rolling 24 month period ending 31st March 2009. The interim
figure for the rolling 24 months to the end of Q4 2008/09 is 287,300 (95% of target), an increase of 2.9%, on
the previous quarter. A number of practices have reported that they have claims still to be submitted and the
final year end figure is likely to be higher as these treatments claims will not be processed until end of May

The PCT recently completed a tender exercise for a new dental practice at the Leys Health Centre, Dunnock
Way, Oxford and this practice will once established provide a service to approximately 7000 patients in the
area. It is anticipated that the new service will open by the end of June 2009.

The Dental commissioning team have identified further resources to commission more new dental services
during 2009/10 with the aim of increasing the percentage of the population accessing NHS dental care from
45% to over 60%.

This measure has not met (Red) its year end target

3.2.2 Emergency care

% A&E < 4 hr wait (Amber) Existing Commitment                                                Susie Dawe
There had been a rise in breaches at the John Radcliffe hospital post Easter Bank holiday but this has
improved to 95% for the week ending 30th April. It is anticipated that this target will be achieved for year end
2009/10 and the situation is being closely monitored by both commissioners and providers. There is an
internal programme of work aligned to the PCT’s Urgent Care Programme that will reduce the number of
breaches occurring in the ED and other urgent care facilities by improving patient flow and reducing
ambulance conveyance rates.

The target was achieved (Green) for 2008/09.

Ambulance Response Times: Category A within 19 minutes (QoS, Amber) Existing Commitment
Ambulance Response Times: Category B within 19 minutes (QoS, Amber) Existing Commitment
                                                                         Susie Dawe
There are three targets surrounding ambulance response times:

    •   75% of Category A calls responded within 8 minutes
    •   95% of Category A calls responded within 19 minutes
    •   95% of Category B calls responded within 19 minutes

Two of the three targets stated above are not currently being met as at YTD 19th April 2009 for South Central
Ambulance Service (SCAS), with the following percentages being achieved:

    •   94.81% of Category A calls responded within 19 minutes
    •   88.87% of Category B calls responded within 19 minutes

Performance improvement remains a priority for both the PCT and SCAS. As part of the overarching urgent
care programme of work a specific Ambulance project group has been established and tasked with the
objectives of improving the patient experience, coupled with actions to improve national target delivery.

The Urgent Care Taskforce fortnightly meetings continue and all relevant stakeholders are actively engaged
in sharing their improvement plans to improve resilience and efficiency of the urgent care system. There are
ongoing planned workshops with the express objective of performance improvement and sharing best

It has been confirmed that Oxfordshire PCT will be marked against SCAS as a whole for the QoS
assessment; therefore data has been updated to represent SCAS-wide figures. However data for
Oxfordshire is still being monitored to ensure best delivery for Oxfordshire patients.

SCAS confirmed that they expected the forecast outturn for South Central performance as a whole will be
Amber for the two measures. The final outturn for all three measures (including Category A within 8 minutes)
was Amber for 2008/09.

3.2.3 Secondary care

18 Week Wait (QoS, Amber) Vital Sign A                                                       Emma Tidy
The latest available data for this indicator is for March (February for data completeness). Previous concern
regarding predicted February/March data completeness achievement from the ORH has been given
foundation by the publication of February audiology data completeness figures which show Oxfordshire PCT
performing at 156% (ORH 179%). The expected threshold for meeting this part of the measure will be

between 90% and 110%, therefore this part of the measure is Red. A resubmission of ORH data is
estimated to bring PCT performance down to 142% for audiology data completeness.

A response from the ORH has stated that the failure of this part of the measure was due to more activity
taking place in February in order to meet the other part of the 18 week commitment, which unfortunately has
meant that we have failed on this part. This issue has been raised directly with the SHA.

There is a moderate/high risk (Amber/Red) of this measure not meeting its year end 2008/09 target.

Cancer: Breast Symptom 2 week waits Vital Sign A
Cancer: Follow Up Treatment 31 days wait (surgery/drugs) Vital Sign A
Cancer: Follow Up Treatment 31 days wait (radiotherapy) Vital Sign A
Cancer: National Screening Programme 62 day wait (Vital Signs) Vital Sign A                     Philippa Muir
Data will be available for analysis with regards to the first three Vital Sign targets in May 2009. The ORH
and NOC have been working with the PCT to establish new ways of working, both for the additional targets
and to incorporate the new 18 week counting definitions now applied to cancer waits. Issues relating to late
notification of requirements to software suppliers and increased data collection and submission requirements
are being addressed. This work is being supported by the Thames Valley Cancer Network and South Central
SHA through the Going Further On Cancer Waits (GFOCW) Forum.

For existing targets, the change to the application of the 18 week wait methodology will appear to reduce the
level of compliance as previous suspensions are now not allowed. This does not mean deterioration in the
patient experience, or longer waits for individual patients, but only reflects changes in the way waiting-times
will be reported. This is being addressed nationally and at Cancer Network level.

There is a moderate risk (Amber) of these targets not meeting their end of year plan which, will be revised
on receipt of data in May 2009.

Time to reperfusion for patients following a heart attack (QoS, Amber)               Existing Commitment

                                                                                                Helen Baker
This target measures the number of people receiving thrombolysis for myocardial infarction within 60 minutes
(measuring the ‘call to needle’ time) divided by the total number of people receiving thrombolysis for
myocardial infarction. The target is 68% and YTD Q4 performance is 67%.

With the improvements in access to Primary PCI (percutaneous cardiac intervention/primary angioplasty)
there has been a corresponding reduction in the use of thrombolysis. Therefore only 15 patients have
undergone thrombolysis in Oxfordshire year to date at Q4. It is understood that the low number rule will be
based on 20 thrombolysed patients therefore it is assumed that Oxfordshire PCT will be excluded from this
measure. Hence, here is a low risk (Green) of this target not meeting its end of year plan for 2008/09.

4        Finance
Of the 9 in-year indicators of performance, 7 are better than target levels (Green) and 2 are achieving close
to plan (Amber). This is shown in Figure 4 below:

Figure 4 - Finance indicators

4.1      Public Sector Pay Policy
Bills paid within terms (NHS) (Amber)                                                       Alan Cadman
The under performance relates to invoices raised for supply of goods and services which are outside SLA
arrangements. Processes are being improved to ensure managers are reminded regularly of invoices that
have not been approved and to inform Creditors of any disputes, these will therefore not count in the

To improve payment of invoices, installation of new systems which will enable invoices to be approved
electronically and those that are not will have regular reminders (every 3 days) automatically sent is being
implemented. This implementation of this system has slipped and is now due to come online in July and will
assist in improving the performance in the longer term.

The target was close to being met (Amber) year end 2008/09 but it is hoped that the target will be achieved
next year as the new systems become embedded.

Bills paid within terms (Non-NHS) (Amber)                                                  Alan Cadman
The under performance relates to invoices raised for the supply of goods and services which are ordered
through procurement and estate sub systems. Work is progressing through meeting with both areas to
understand the issues and develop resolutions.

As previously stated the installation of a new system to help approve and send reminders about invoices
should come on-line in July. This system will assist in improving the performance in the longer term. In
addition, the Prime Minister recently committed Government Departments to assist Private
Companies/individuals in the current economic climate by settling invoices within 10 days of receipt.
However, no formal target has been set that performance can be measure against as this is seen as an
indication. The PCT has achieved an average of 68% of invoices paid within 10 days of receipt.

The target was nearly met (Amber) for year end 2008/09..

5        Improving care and prevention
Of the 58 in-year indicators of performance, 40 are better than target levels (Green), 4 are achieving close to
plan (Amber) and 14 indicators are under-performing against plan (Red). This is shown in Figure 5 below:-

Figure 5 - Improving care and prevention indicators

5.1     Better deal for older people
High quality stroke care (QoS, Red) Vital Sign A                                     Suzanne Jones
This vital sign measure is made up of two indicators. The first indicator defines the patients who spend at
least 90% of their time on a stroke unit and the second defines high risk TIA cases who are treated within 24
hours. The data required to measure this indicator has not been easy to obtain in Oxfordshire. This
challenge is in common with other health economies and is being addressed by the Department of Health
nationally, and this reflects the decision of the Care Quality Commission (CQC) to only rate PCTs on Quarter
4 of the stroke part of the indicator.

The year end target set for stroke is 65% spending up to 90% of their time on a stroke unit. The ORH
achieved 37% YTD Q4. The data highlights the need to ensure timely discharge of patients into the
community for their rehabilitation following a stroke, allowing the flow through the pathway so that patients
admitted to acute care can be treated on the acute stroke units in the John Radcliffe and the Horton
Hospitals and this is being addressed in the integrated stroke pathway work that is currently under way.

The year–end risk rating for this is Red for 2008/09.

Intermediate Care Treatment Sessions (Amber) Local Delivery target                   Suzanne Jones
This target consists of a cumulative increase in staffing and treatment sessions in order to increase
intermediate care treatment to elderly mental ill. There were an additional 5,149 treatment sessions by the
end of Q4 against a target of 5,500 and additional staffing of 10 against a target of 15.

The target of increased patient contacts has not been met as the service has not been fully staffed during the
year. There has been and still is an active recruitment process, however turnover of staff has occurred within
this new service, and recruitment of new staff has not kept pace. There are interviews arranged in May, and
the service is actively recruiting to ensure a full staff compliment.

This target nearly met (Amber) it’s plan for 2008/09.

Better Rehabilitation for Stroke Patients (Red) Local Delivery target                Suzanne Jones
This is a local delivery measure to increase rehabilitation therapists and number of treatment sessions for
stroke patients. Recruitment of additional therapists by the contracted service provider (Community Health
Oxfordshire) has now commenced. The commissioner has been working with the provider to ensure that
patient services are delivered as soon as possible. On March 31st the only post filled is the Health Promotion
Nurse in the TIA clinics to deliver the secondary prevention.

The specialist rehabilitation unit in Witney opened on March 30th 2009 and is accepting patients from the
Oxford Radcliffe Hospital, with community therapy staff in post to commence working in the community.

This measure has not met (Red) its year end plan for 2008/09.

% hip fracture discharged to home - Registered practitioners (Amber) Local Delivery target
                                                                   Suzanne Jones
The fractured neck of femur team at Horton and John Radcliffe Hospitals have recruited 5.5 staff members
from the 6.0 funded, there has been problems recruiting a registered physiotherapist for the Horton Hospital,
though in the last two quarters of 2008/09, the team has worked with the staff and patients on both wards to
transfer patients straight home from hospital and into intermediate care facilities to the level planned. This is
now an established team and will be working across the acute / community interface to ensure individuals
can be discharged promptly to community settings to receive their rehabilitation.

This measure has nearly met (Amber) it’s year-end plan figure.

5.2     Breaking the cycle of deprivation
Young Persons Care Planning (Red) Local Delivery target                              Sarah Breton
This target is for the number of vulnerable young people who are supported by care planning. The target to
end of Q4 is for 150 young people having completed health assessment and care plans.

There have been 45 health assessment and care plans completed to the end of Q4. The target will be
achieved but there is 8 months slippage due to delay in the recruitment of 1.5 wte health workers to support
vulnerable young people in the Youth Offending Service. These are partnership posts working across
Universal Children’s Services locality teams and Area Youth Offending Teams. The first health worker
commenced in post in Oxford City at the beginning of November and two further workers were appointed to
start work in mid-January, providing a full complement of staff.

This target has not met (Red) achieved for 2008/09.

5.3     Commissioning Excellence
Structured Education courses (Red) Local Delivery target                               Ian Cave
This measure monitors the number of people starting structured education courses by the end of 2008/09.

Adequate capacity was put in place by the provider, Community Health Oxfordshire to achieve the target, but
insufficient people with diabetes presented themselves or were referred by their GP. It is estimated that there
are 2,100 people diagnosed with diabetes each year in the county and so low uptake of the structured
education is probably due to insufficient people being aware that there is now significantly increased
availability for this course. Marketing of the course will continue.

This measure has not met (Red) its year end plan for 2008/09.

BME Structured Education courses (Amber) Local Delivery target                         Ian Cave
This target monitors the number of people from Black, Minority and Ethnic communities starting structured
education courses for people with diabetes by the end of 2008/09.

Fewer people from BME communities have attended structured education courses for people with diabetes
than planned because there have been less people attending the courses overall than anticipated.
Community Health Oxfordshire provides the courses and is undertaking increased marketing to relevant
groups to achieve this target.

This measure has not met (Red) the year end plan for 2008/09.

5.4     Prevention and promotion
5.4.1 Cross Cutting Public Health

% Chlamydia Screening (QoS, Red) Vital Sign B                                          Val Messenger
This vital sign target measures the % of the population aged 15 – 24 accepting a test/screen for Chlamydia.
The target is for 17% (14,351) of the population aged 15 – 24 to have been screened by the end of 2008/09.
At the end of Q3, 5,619 screens had been performed against a target of 10,763. This equates to 6.7% of the
population. The England average at Q3 was 9.5% and SCSHA was 8.4%. Oxfordshire is currently ranked
123 out of 152 PCTs in England. Quarter 4 data should be available at the end of June.

Actions delivered in March:
    • Invite letter sent to all 18 year olds registered with Oxfordshire PCT GPs.
    • Publicity campaign completed.
    • Support programme for sites struggling to deliver screens sharing the learning from sites which are
        performing well commenced.
    • Progress of pilot postal project was monitored. The site is being used and return rate was higher
        than anticipated.
    • Chlamydia screening target delivered through c&sh contract increased.
    • Pilot project agreed revising administration processes in c&sh in order to improve screening uptake
    • A draft LES for primary care was developed.
    • Analysis of national and south central data reviewed to inform plans for 2009/10.

The effect of these actions in improving our performance will not be clear until official Q4 data is published,
but the target will not be achieved by the end of the year.

There is a high risk (Red) of this target not meeting its year end plan for 2008/09.

Proportion of individuals who complete immunisation by recommended ages
(QoS, Amber) Vital Sign                                         Shakiba Habibula
This vital sign target is made up of 6 individual indicators:-

   Target component                                                              Current Performance
                                                                                 (YTD Q3)
   96.5% immunisation rate for children aged 1 for (DTaP/IPV/Hib)                96.70% Green
   85% immunisation rate for children aged 2 for (PCV booster)                   85.10% Green
   94.9% immunisation rate for children aged 2 for (Hib/MenC booster)            90.90% Red
   86.1% immunisation rate for children aged 5 for (DtaP/IPV)                    88.40% Green
   91% immunisation rate for children aged 2 for (MMR)                           90.50% Amber
   79.3% immunisation rate for children aged 5 for (MMR (ie 2 doses))            84.20% Green

The Public Health team, Decision Support and CHO are working closely to implement a catch up programme
to immunise all children with missing immunisation. Unimmunised children in cohort one (31 children aged
6-15 months) are being closely followed up by the Health Visitors (HV) and the Public Health team. There
are approximately over 3000 unimmunised children in cohort two (16 months – 3 years 11 months) and in
cohort three (4-5 year olds). Invitation letters were sent to all parents during February and March 09 and the
lists are currently being updated and will be sent to HV for further follow up.
This is a massive piece of work and requires additional capacity within the health visiting service. CHO is
intending to set up a peripatetic immunisation team but this will not be in place until September 2009. Public
Health is seeking additional capacity to support CHO locality immunisation teams.

There is a moderate risk (Amber) of this target not being met for Oxfordshire PCT at the end of the year.

5.5      Other programmes
5.5.1 Long Term Conditions and Case Management

Telemedicine (Red) Local Delivery target                                           Ian Cave
This measure monitors the number of additional people who received care using telemedicine in 2008-09.

The target of 20 people was not achieved because a provider of health services could not be identified who
was willing to use funding from Social and Community Services to pilot telemedicine with suitable patients.
This was due to the project management time such a project would involve. In 2009-10 additional funding to
support development of telemedicine will become available from Social and Community Services as a result
of achievement of LAA targets. This will be used to support a robust project including project management to
increase local use of telemedicine. The aim of this project will be to enable local providers of health care to
learn how this new technology can enable them to effectively manage more patients with the same staff
resource, and at the same time support more people to remain independent and in their own home.

This measure has not met (Red) the year end plan for 2008/09.

Pulmonary rehab (Amber) Local Delivery target                                      Ian Cave
This target monitors the number of people commencing pulmonary rehabilitation

This target was not achieved in 2008-09. Secondary Care has continued to provide pulmonary rehabilitation
as contracted as in previous years (90 people). To supplement this, CHO agreed to provide additional
community based pulmonary rehabilitation for people with moderate COPD, and provided capacity which
would have achieved the target. But in spite of marketing the service to local GPs, insufficient people were
identified. In 2009-10 it is expected that more patients will be identified as having moderate COPD, and so
be eligible for the service, due to changes in GMS which will incentivise this. Pulmonary rehabilitation has
been proven to reduce admissions due to COPD, and so increasing provision is a key strategy for reducing
admissions in the county, as COPD is a major component of ACS admissions locally. NICE recommend
1,500 people per year should receive the service in a county the size of Oxfordshire, and so aiming to
provide approximately 270 in 2009-10 is a reasonable first step.

This measure has nearly met (Amber) the year end plan for 2008/09.

5.5.2 Cancer and palliative care

National Bowel Screening programme (Red) Local Delivery target                     Shakiba Habibula
The target is to implement the roll out of national bowel screening programme by end of 2008/09.

This programme has not started yet and has been highlighted as a red risk previously as the ORH progress
to achieve the standards required for accreditation and delivering this service are yet to be met. The
timescale is that the standards should be met before March 2009.

In order to start screening, the ORH have to meet a number of quality criteria and pass a JAG (Joint Advisory
Group) visit. The JAG visit took place on 22nd January 2009. Unfortunately the John Radcliffe Hospital did
not pass and a revisit is not due until July/August 2009. The Horton Hospital passed its visit on 10th March,
so plans can now be put in place to commence screening there. It is anticipated that implementation will
begin in summer 2009.

This measure has not met (Red) the year end plan for 2008/09.

5.5.3 Improving access and choice

% booked via Choose & Book (Red) Local Delivery target                             Rachel Martin
The target records the % of Unique Booking Reference Numbers created in Choose and Book (C&B) by
GP’s compared with the total number of GP referral requests bookable through CAB. At the end of Q3
69.8% of GP referrals were made via C&B.

Oxfordshire PCT is currently one of the top four performing PCTS in South Central for the use of Choose
and Book to making referrals to first consultant-led appointments. Our Choose and Book performance has
been steady and stable throughout 2008-09, with between 65 and 75% of all eligible first outpatient
appointments being made using Choose and Book. Whilst slightly higher than in 2007-08, the CAB
utilisation rate has slowed. We are exploring a number of options to drive up the utilisation rate in 2009-10,
including a training needs analysis of practice staff relating to the functionality of the CAB system.

There is a high risk (Red) of this target not meeting it’s year end plan of 90%. Please note that no PCT in
South Central is yet achieving this target and it remains very ambitious.

OP First Appointments (Red) Local Delivery target                                  Emma Tidy
The number of First Outpatient Appointments to the end of March 2009 was 192,713 against a target of
170,366. Activity against this March target has been influenced by a small increase in GP referrals seen
since the beginning of 2009, as well as by a continued apparent lag in the full impact of capacity reductions
being seen in activity profiles.

As reported to the last Board meeting, detailed modelling is being undertaken, in partnership with the ORHT,
to better understand the capacity, cost, and activity dynamics from referral to treatment. Sixteen specialty
level meetings have also been held with both primary and secondary care clinicians, to identify opportunities
for pathway changes that will help to manage outpatient activity levels into 2009/10. In addition, a year end
financial position has now been agreed with the ORH, which has capped the PCTs financial risk in this area
for 2008/9.

This measure has not met (Red) the year end plan for 2008/09.

OP Follow-Up Appointments (Red) Local Delivery target                              Emma Tidy
The number of Follow-up Outpatient appointments to the end of March 2009 was 282,001 against a plan of

Over-performance against this indicator directly related to the over-performance against plan for first
outpatient appointments. Although follow-up numbers are above target, we have seen an improvement in the
first to follow up ratios in the New Year at the ORH which is encouraging. Joint clinical meetings have also
identified potential actions to reduce secondary care follow-up activity in the future, which will be taken
forward as part of the 2009/10 Operating Plan.

In common with first outpatient appointments, this measure has not met (Red) the year end plan for 2008/09.

OP Referrals (Red) Local Delivery target                                           Emma Tidy
The number of Outpatient referrals (GP and Other) to the end of March 2009 was 155,678 versus the
baseline position of 124,836.

Despite the fact that year end planned activity levels were exceeded, the end of March position is a
significant improvement on that predicted during the year. This reflects the considerable work undertaken by
clinical colleagues and the PCT team in implementing and progressing the 2008/09 Demand Management
Local Incentive Scheme. The beginning of 2009 has seen a small increase in referrals, but activity still
remains below the control chart average and is 4% lower than baseline. The four week moving average is
running 14% (212 referrals / week) lower than its high point last July. Regular performance information is
being fed back to individual practices, and a further specialty/consortia level analysis is being undertaken to
ensure we understand where any increases in referrals are occurring so that targeted follow up can take
place where any unusual increases have been identified.

This measure has not met (Red) the year end plan for 2008/09.

5.5.4 Urgent care
Admissions for ACS conditions (Red) Local Delivery target                          Ian Cave
The target level set for this indicator is to remain the same as 2007/08 levels. The latest data from the NHS
Institute showed that as at Q2 of 2008/09 Oxfordshire was ranked 14th lowest (best) out of 152 PCT across
England. This indicator is red because there is a rise in emergency admissions for ACS conditions (such as
asthma, COPD) which correlates with the general upward trend in non-elective acute care. Targeted
interventions are being undertaken to address admissions for ACS conditions, with case management being
the most developed. Increased provision of community pulmonary rehabilitation is also planned for 2009/10,
which will impact positively on admissions from chronic obstructive pulmonary disease.

There is a high risk (Red) of this target not meeting its year end plan.

Unscheduled Admissions (Red) Local Delivery target                                 Susie Dawe
This target relates to the number of unscheduled admissions to acute hospital and associated costs and
payments. The Q3 position is an actual of 37,075 against a plan of 35274. There are no Q4 figures available
but it is anticipated that the number of unscheduled admissions will fall from Q3 as work progresses.
Actions to reduce unscheduled admissions include careful predictive forecasting in peaks and demands to
manage this variability. There has been, and will continue to be, active engagement of stakeholders in
proactively planning for increased demand. A series of Workshops has been planned to share best practice
and appropriate timely information.

Due to the harsh winter experienced this year, there is a High Risk (Red) of not achieving the year end

6        Organisational capability
Of the 11 in-year indicators of performance, 6 are better than target levels (Green) and 5 indicators are
under-performing against plan (Red). This is shown in Figure 6 below.

Figure 6 - Organisational capability indicators

6.1      Workforce
£ Workforce Costs (Red)
% Contracted Staff as a percentage of total staff (Red)
Agency Costs (Red)                                                                           Alison Dean
A focused campaign is taking place to recruit to established vacancies to curb the need for agency staff at
higher cost than contracted staff.

This measure has not met (Red) the year end plan for 2008/09.

Sickness Absence (Red)                                                                       Alison Dean
Winter related illness, e.g. norovirus, colds and flu led to an increase winter sickness absence and we
believe that absence levels will begin to fall again. Recording of sickness absence reasons has begun on a
small scale and will be further rolled out this year.

This measure has not met (Red) the year end plan for 2008/09.

Learning and development
Implementation of KSF (Red)                                                                  Clair Shaw
The target is for the implementation of 80% KSFs by the end of Q4, with 40% having been actually
implemented by the end of Q4.

There has been a real drive to target completion of outlines for groups of staff where one outline covers
several people. This has seen an increase of completed outlines rise from 22% to 40%. In conjunction with
the new KSF project this increase will continue in Q1 (2009/10). Actions going forward include a
methodology for collecting evidence about outlines and an additional drive in targeting groups of large staff
numbers (where one outline applies to a large staff group). Ongoing communication and overall raising
awareness of the outline matrix produced to support managers completing outlines will be continued.

This measure has not met (Red) it’s target of 80% by year end.

Report prepared by:
Adam Pill, Senior Information Analyst
Catherine Willis, Performance Analyst
Bethan Watson, Team Manager, Decision Support & Performance
Andrew Fenton, Head of Decision Support & Performance

May 2009

Note on thresholds for colour coding:

For individual indicators the Red / Amber / Green rating is based on the specific target for that indicator:

•   Green = target met or exceeded.
•   Amber = close to target (between 1% and 4% off target, variable according to Health Care Commission
•   Red = under performing.

For groups of indicators:

•   Red if over 50% of measures in the group are Red, or a combination of Red and Amber.
•   Amber if 20-50% of measures Amber, or a combination of Red and Amber.
•   Green if over 80% of measures in the group are Green.
Appendix A

Health Quality and
                Measure                    QoS     Period       Actual     Plan     Index
VSC29 - Injuries to children -
                                                   YTD Q4        1371      1139     84.20        =
emergency admissions
VSB05 - Smoking quitters per 100,000
                                           Yes     YTD Q3        2351      2220    105.90        =
VSB09 - Childhood obesity (Yr R)
                                           Yes   school year    7.15%      8%      7.15%         =
VSB09 - Childhood obesity (Yr 6)
                                           Yes   school year    15.43%    15.40%   15.43%        =
VSB11 - % breastfeeding at 6-8
                                                   YTD Q4       57.50%    49.00%   117.35        =
VSB11 - % breastfeeding at 6-8
                                           Yes     YTD Q4       91.70%    85.00%   91.70%        =
weeks - data coverage
VSC10 - DTOC per 100,000                             YTD
                                                                 14.40    20.31     14.40        =
population aged 18+ (LAA2)                         29/03/09
EC - % Delayed transfers of care                     YTD
                                           Yes                  0.034%      -      0.034%        =
(Existing Commitment)                              29/03/09
VSA01 - Infection control - MRSA                 YTD March        45        48     93.75%        =
VSA03 - Infection control - C. difficile   Yes   YTD March        306      458     66.81%        =
EC - GP Access                                       Q4          100%     100%     100.00        =
EC - PCP Access                                       Q4         100%     100%     100.00        =
EC - % AAE 4 hour wait                     Yes                  97.63%    98.00%   97.63%         v
EC - Ambulance: Cat A response < 19                  YTD
                                           Yes                  94.81%    95.00%   94.81%        =
minutes                                            19/04/09
EC - Ambulance: Cat A response < 8                   YTD
                                           Yes                  77.67%    75.00%   77.67%         ^
minutes                                            19/04/09
EC - Ambulance: Cat B response < 19                  YTD
                                           Yes                  88.87%    95.00%   88.87%        =
minutes                                            19/04/09
                                                 March (Q4 to
VSA04_A - % 18w admitted                   Yes                  95.77%     90%     106.41        =
VSA04_A - % 18w admitted - data
                                           Yes    February      93.00%     90%     93.00%        =
                                                 March (Q4 to
VSA04_B - % 18w non-admitted               Yes                  98.30%     95%     103.47        =
VSA04_A - % 18w non admitted - data
                                           Yes    February      96.00%     90%     96.00%        =
                                                 March (Q4 to
VSA04_C - % 18w audiology                  Yes                  96.90%     95%     102.00        =
VSA04_A - % 18w audiology - data
                                           Yes    February      156.00%    90%     156.00%        v
VSA04_08 - # waiting > 6 weeks for
                                                 YTD March      99.96%    100%      99.96        =
15 key diagnostic tests
EC - IP waiting > standard                 Yes   YTD March        0%       0%      0.00%         =
EC - OP waiting > standard                 Yes   YTD March        0%       0%      0.00%         =
EC - Cancer: 2 week wait from urgent                YTD
                                           Yes                  100.0%    100%     100.00%       =
GP referral to first OP appt                      December
EC - Cancer: 31 day wait from
diagnosis to treatment (April-             Yes                  99.33%     98%     99.33%        =
December 2008)
EC - Cancer: 31 day wait from
diagnosis to treatment (January-March      Yes
VSA11 - Cancer: Follow up treatment
31 days wait (surgery/drugs) (January-     Yes
March 2009)
EC - Cancer: 62 day wait from urgent
GP referral to treatment (April-           Yes                  97.98%     95%     97.98%        =
December 2008)
Health Quality and
               Measure                    QoS     Period       Actual       Plan      Index
EC - Cancer: 62 day wait from urgent
GP referral to treatment (January-        Yes
March 2009)
VSA13 - Cancer: National screening
programme 62 day RTT (January-            Yes
March 2009)
VSA13 - Cancer: Consultant upgrade
62 day RTT (January-March 2009)
VSA08 - Cancer: Breast symptom 2
week wait
VSA12 - Cancer: Follow up treatment
31 days wait (radiotherapy)
VSB06 - % Midwife appt within 12
                                          Yes    YTD Q3        77.04%       68%      77.04%           =
EC - # waiting > 3 month for
                                          Yes   YTD March        0%         0%        0.00%           =
EC - MH Crisis Resolution services
                                          Yes    YTD Q4         2542        931      273.04%          =
EC - # new cases psychosis in EI
                                          Yes    YTD Q4          168        105      160.00%          =
EC - PCT facilities in place to support         September
                                                                 52%        48%       108.33          =
choice                                          2008 survey
EC - GUM Access                           Yes   YTD March      99.93%       98%      99.93%           =
VSB15 - Patient experience                                                 3rd in
                                          Yes       Q2        1st in SHA              166.67          =
(Satisfaction with NHS locally) (tbc)                                      SHA
VSB15 Patient experience (Dignity                                          3rd in
                                          Yes       Q1        2nd in SHA              133.33          =
and respect received) (tbc)                                                SHA
VSB15 Patient experience
                                                                           3rd in
(Satisfaction amongst hospital users)     Yes       Q2        1st in SHA              133.33          =
VSB15 Patient experience                                                   3rd in
                                          Yes       Q2        1st in SHA              133.33          =
(Satisfaction amongst GP users)(tbc)                                       SHA
VSB15 Patient experience                                                   3rd in
                                          Yes       Q2        4th in SHA              66.66           =
(Participation in decision making)(tbc)                                    SHA
EC - % of patients with acute MI
received treatment within 60mins of       Yes    YTD Q4          67%        68%      67.00%           =
total acute MI
VSA06 - Patient reported measure of
GP access - telephone access
VSA06 - Patient reported measure of
                                          Yes     Annual
GP access - see GP < 48 hrs
VSA06 - Patient reported measure of
                                          Yes     Annual
GP access - book 3+ days
VSA06 - Patient reported measure of
GP access - see specific gp
VSA06 - Patient reported measure of
                                          Yes     Annual
GP access - practice opening hours
VSA07 - GP practices offering
                                          Yes    ytd march       43          38       113.16          =
extended opening
VSB18 - Access to Primary Dental                Rolling 24
                                                                                    supplied by
services to planned acces to primary      Yes   months to      287300      302588                     =
dental services                                  end Q4
VSB08 - Teenage conception rate per
                                          Yes      2007          29.6       22.3       1.33           =
1,000 females
VSB01 - All Age All Cause Mortality       Yes     Annual
VSB03 - Reduction in <75 cancer
                                          Yes     Annual
mortality rate
VSB02 - Reduction in <75 CVD
                                          Yes     Annual
mortality rate

^ - movement positive, v- movement negative, = no movement

               Measure                   QoS   Period        Actual     Plan     Index
Under / Over spend against RRL                 March         811,543   813,724   100.27       =
Cash                                           March         100.0%    100.0%    100.00       =
Capital                                        March          6,566     6,566    100.00        ^
Run Rate                                       March          1,091     250      436.40       =
FIP: Cost Reduction                            March          7,249     5,273    137.47       =
FIP: Demand Management                         March          3,207     3,207    100.00        ^
FIP: Contract Management                       March          1,500     1,500    100.00       =
Bills paid within terms (NHS #)                March         88.6%      95%      93.26         ^
Bills paid within terms (non-NHS #)            March         93.3%      95%      98.21        =
Bills paid within terms (NHS £)                March         97.2%      95%      102.32        ^
Bills paid within terms (non-NHS £)            March         96.0%      95%      101.05        ^
^ - movement positive, v- movement negative, = no movement

Improving Care and Prevention
              Measure                    QoS   Period        Actual     Plan     Index
VSA14 - High quality stroke care -
                                         Yes   YTD Q4         37%        65%                   =
VSA14 - High quality stroke care - TIA                                 no data
LD OP1 - IC treatment sessions                  Q4            5149      5500      0.94         =
LD OP1 - IC Increased Staffing                  Q4             10        10      100.00        =
LD OP2 - Monitored dosage system
                                                Q3             21        50       0.42         =
(patients reviewed)
LD OP2a - Monitored dosage system
                                                Q3             8          3       2.67         =
(care homes visited)
LD OP3 - Better rehab for stroke
                                                Q4             1          4       0.25         =
patients - Therapists
LD OP4 - % hip fracture discharged to
                                                Q4             5.5        6       91.67        v
home - Registered practitioners
LD BTCD1 - Sexual health support in
                                                Q4             4          4      100.00        =
LD BTCD2 - Young person care
                                                Q4             45        150      30.00        =
LD BTCD3 - Breast feeding
                                                Q4            475        200     237.50        =
LD BTCD4 - Smoking cessation in
                                                Q4           100%       100%     100.00        =
Children's Centres
LD BTCD5 - Specialist counselling for
                                                Q3             4          4      100.00        =
parents w/ MH problems
LD CE1 - Diabetes risk campaigns               YTD Q4          1          1      100.00        =
LD CE2 - Foot checks                           YTD Q4         5432      3000     181.07        =
LD CE3a - Structured education
                                               YTD Q4         293        350      83.71        =
LD CE3b - BME structured education
                                               YTD Q4          5          8       62.50        =
LD CCPH1a - No of people registered
                                               YTD Q4         2887      2000     144.35        =
on Weight management courses
LD CCPH1b - No of people
completing Weight management                   YTD Q4         953        750     127.07        =
LD CCPH2 - Weight management
                                               YTD Q4         457        375     121.87        =
courses: % losing weight
LD CCPH3 - % completing exercise
                                               YTD Q4         225        125     180.00        =
on referral
LD CCPH4 - Exercise availability               YTD Q4          5          5      100.00        =

Improving Care and Prevention
               Measure                   QoS     Period         Actual       Plan       Index
LD CCPH5 - LTC-specific smoking
                                                   Q4           100%         100%       1.00          ^
LD CCPH6 - Health trainers for
                                                   Q4           10.44          5       208.80        =
vulnerable people
LD CCPH7 - Appropriate prevention
LD HWB1a - Prescribing support:
                                                   Q3           75000        50000     150.00        =
LD HWB1b - Prescribing support:
                                                   Q3           77.3%        77.4%      99.87        =
LD HWB2 - Child death review panel               YTD Q4            8           8       100.00        =
NP - Breast cancer screening - 53 - 64
                                         Yes     2007/08       81.63%        70%       81.63%
NP - Breast cancer screening 65 - 70
                                         Yes     2007/08       80.06%        65%       80.06%
VSA09 - Extension to breast
screening service
VSA10 - % cancers bowel cancer
VSA15 - Cervical screening results
within 2 weeks
VSB13 - % Chlamydia screening            Yes     YTD Q3          5619        10763      52.21        =
EC - % Diabetic retinopathy screening    Yes     YTD Q4         100%         100%      100.00%       =
VSB12 - Commissioning CAMHS              Yes       Q4              4           4       100.00        =
VSB14 - Drug users sustained in
                                         Yes   YTD October       1648        1594      103.39        =
treatment (LAA2)
LD MH2 - Community development
                                                   Q4             5.5          5       110.00        =
LD LTC1 - Telemedicine                           YTD Q4            0          20        0.00          v
LD LTC2 - VHIUs under case
                                                 YTD Q4          2039        1781      114.49        =
LD LTC3 - Predictive Risk Tool                     Q4             82          41       200.00        =
LD LTC4 - Dudley Case Management
                                                   Q4             73          30       243.33        =
LD LTC5 - GP physio referral                       Q4           20953        18528     113.09        =
LD LTC6 - Podiatry                               YTD Q4          8124        3000      270.80        =
LD LTC7 - Home oxygen service                    YTD Q4          269          15       1793.33       =
LD LTC8 - Pulmonary rehab                        YTD Q4           97          150       64.67         v
LD LTC10 - Self care via supported
                                                 YTD Q4            1           1       100.00        =
VSC20 - Emergency bed days                       YTD Q4        205894       257370     120.00         ^
LD UC1 - Admissions for ACS                      YTD Q3          5082        4812       94.39        =
LD UC2 - # unscheduled admissions                YTD Q3         37075        35274      1.05         =
LD PBC1 - LIS / Demand
                                                 YTD Q4           54          21       257.14        =
LD CPC1 - National Bowel Screening
                                                   Q4              0           1        0.00         =
LD CPC2 - PET scans                            YTD March         401          352      113.92        =
OP First Appointments                          YTD March       192713       170366      86.88        =
OP FU Appointments                             YTD March       282001       262591      92.61        =
OP First : Follow Up                           YTD March         1.46        1.54      105.19        =
OP Referrals                                   YTD March       155678       124836      75.29        =
LD AAC2 - % booked via Choose and
                                                 YTD Q3        69.23%        90%        76.92        =
LD AAC3 - ISTC utilisation                       YTD Q4        91.00%        75%       121.33        =
LD SC1 – Implement SC                                        Non-
                                                   Q4                                                =
commissioning actions                                        quantitative

Improving Care and Prevention
                 Measure                QoS     Period         Actual       Plan    Index
LD SC2 – Develop measures for                               Non-
                                                 Q4                                               =
specialist services                                         quantitative
LD SC3 – Oxfordshire priorities forum            Q4                                               =
LD LD1 - People with LD in
                                               YTD Q4           1240        1220    101.64        =
LD LD2 - People with LD with health
                                                 Q4             404         350      1.15         ^
VSB10 - % immunisation rate for
                                        Yes    YTD Q4         96.70%       96.50%   96.70%
children aged 1 for (DTaP/IPV/Hib)                                                                ^
VSB10 - % immunisation rate for
                                        Yes    YTD Q4         85.10%       85.00%   85.10%
children aged 2 for (PCV booter)                                                                  ^
VSB10 - % immunisation rate for
children aged 2 for (Hib/MenC           Yes    YTD Q4         90.90%       94.90%   90.90%
booster)                                                                                          =
VSB10 - % immunisation rate for
                                        Yes    YTD Q4         88.40%       86.10%   88.40%
children aged 5 for (DtaP/IPV)                                                                    =
VSB10 - % immunisation rate for
                                        Yes    YTD Q4         90.50%       91.00%   90.50%
children aged 2 for (MMR)                                                                         =
VSB10 - % immunisation rate for
children aged 5 for (MMR (ie 2          Yes    YTD Q4         84.20%       79.30%   84.20%
doses))                                                                                           =
EC - % of FCEs on HES data per
                                        Yes    YTD Q3         91.80%        85%     91.80%
ethnic code of total FCEs                                                                         =
EC - % of FCEs on MDHMDS data
                                        Yes     Annual
per ethnic code of total FCEs
^ - movement positive, v- movement negative, = no movement

Operational Capability
                 Measure                QoS     Period         Actual      Plan     Index
Staff in Post (WTE)                             March          1921.5      1965.1   102.22       =
Workforce costs                                 March          7,339       5921     76.05         v
Contracted staff as % total staff               March          90.5%       98.0%    92.35        =
Agency costs                                    March           799         100      0.00        =
Sickness absence                               February         4.4%       4.0%     90.00        =
Staff turnover                                  March          12.2%       15.0%    118.67       =
PDPs and Objectives                               Q2            45%         40%     112.50       =
Staff appraisals                                  Q2            49%         40%     122.50       =
Implementation of KSF                             Q4            40%         80%     50.00        =
Mandatory training                                Q4            83%         80%     103.75       =
VSB17 - NHS staff satisfaction          Yes   Annual 2008       3.65        3.52     3.65        =
^ - movement positive, v- movement negative, = no movement

Appendix B

Appendix C

Abbreviation                      Definition                    Abbreviation                    Definition

A&E            Accident & Emergency                             NICE           National Institute for Health & Clinical
Amb            Ambulance                                        NOC            Nuffield Orthopaedic Centre NHS Trust
BMI            Body Mass Index                                  NPFIT          National Program for IT
BP             Blood Pressure                                   OP             Outpatient
CAMHS          Children and Adolescent Mental Health Services   ORH            Oxford Radcliffe Hospitals Trust
Cat            Category                                         OBMHT          Oxfordshire and Buckinghamshire Mental
                                                                               Health Trust
Ch & Bk        Choose and Book                                  PC             Primary Care
CHD            Chronic Heart Disease                            PCAS           Primary Care Access Survey
CHO            Community Health Oxford                          PCP            Primary Care Practitioner
Cons           Consultant                                       Pts            Patients
CPA            Care Programme Approach                          QoS            Quality of Service – component of the Annual
                                                                               Health Check.
               Care Quality Commission                          QPID           Quality, Prevalence & Indicator Database
CRL            Capital Resource Limit                           RACPC          Rapid Access Chest Pain Clinic
CT             Computerised Tomography                          RBFT           Royal Berkshire Foundation Trust
CVD            Cardio-vascular Disease                          RRL            Revenue Resource Limit
DC             Day Case                                         RTT            Referral to Treatment
DNA            Did Not Attend                                   S&M            Swindon and Marlborough NHS Trust
DTOC           Delayed Transfers of Care                        SATOD          Smoking at Time of Delivery
EI             Early Intervention                               SecCare        Secondary Care
Eqpt           Equipment                                        SCAS           South Central Ambulance Service
FFCE           First Full Consultant Episode                    SHA            Strategic Health Authority
FIP            Financial Improvement Plan                       SocCare        Social Care
FU             Follow Up                                        Spec           Specification
G&A            General & Acute                                  TBC            To be Confirmed
GI             Gastro Intestine                                 VHIU           Very High Intensity User
GP             General Practitioner                             VSA / B / C    Vital Sign A, B, or C: A=National
                                                                               Requirements, B = National Priorities, C =
                                                                               Locally selected Vital Signs.
GPSI           General Practitioner Specialist Interest         w              with
GUM            Genito-Urinary Medicine                          Wks            Weeks
Gynae          Gynaecology                                      Yr             Year
Hlth           Health                                           YTD            Year to Date
HNA            Health Needs Assessment
Hosp           Hospital
Hrs            Hours
Info           Information
IOG            Improving Outcomes Guidance
IP             Inpatient
ISTC           Independent Sector Treatment Centre
LD             Learning Disability
LHC            Local Health Communities
LOS            Length of Stay
LTC            Long Term Condition
MDT            Multi-Disciplinary Teams
MH             Mental Health
MI             Mental Illness
Mins           Minutes
MRI            Magnetic Resonance Imaging
Mths           Months


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