Get documents about "Agenda Item No
Shared by: M95x2W
-
Stats
- views:
- 0
- posted:
- 2/7/2013
- language:
- English
- pages:
- 22
Document Sample
Trafford Primary Care Trust Agenda Item No.8.1
Agenda Item No. 8.1
Reference No. TPCTBD/241109/8.1
Part 1 X Part 2
PCT BOARD MEETING
24th November 2009
Title of Report Performance Report
Purpose of the Report To update the Board on progress toward achievement of
national and local target. Specifically, to inform the Board of
the Periodic Review targets and position to date.
Actions Requested Decision Discussion x Information x
Strategic Aims 1. Protect and improve the health of Trafford citizens x
Supported by the Report and reduce health inequalities
2. Ensure that quality is enshrined in all our activities x
3. Ensure that our services are value for money x
4. Ensure that we systematically involve staff, patients
and the public in decisions about their health and
healthcare
5. Commission services that meet the needs of local
citizens
6. Ensure the organisation is well run and fully fit for x
purpose
Discussion history prior This paper has been discussed with the Director of Finance
to PCT Board and will be presented at the Performance, Finance and
Information Technology Committee in future.
Financial Implications None.
Risk Implications Underperforming against targets will affect the outcome of the
Care Quality Commission’s performance rating.
Impact Assessment Underperforming against targets will affect the outcome of the
Care Quality Commission’s performance rating.
Communications Issues This paper should be communicated throughout the
organisation. This will be done through Team Brief
arrangements.
Public Engagement This paper has not been subject to public engagement.
Summary
th
F\Corporate Affairs\Board\2009 Meetings\24 Nov Page 1
Trafford Primary Care Trust Agenda Item No.8.1
Prepared by Michelle Irvine
Associate Director of Performance & Systems Management
Zoe Mellon
Head of Performance
Mark Embling
Head of Information
Responsible Director Tim Barlow, Director of Finance, Contracting & Performance
th
F\Corporate Affairs\Board\2009 Meetings\24 Nov Page 2
Trafford Primary Care Trust Agenda Item No.8.1
PERFORMANCE REPORT
1.0 PURPOSE OF THE PAPER
1. INTRODUCTION
The report provides the Trust Board with an overview of corporate performance.
Corporate performance includes performance against the following targets.
National Priorities (contributes to Annual Health Check/Periodic Review result)
Existing commitments (contributes to Annual Health Check/Periodic Review
results)
Vital signs
Commissioning Strategic Plan outcomes
Local Area Agreements
2. BACKGROUND
This month, the report is intended as a mid year review of the Trust’s position
against those indicators that will form part of the Periodic Review (previously
referred to as the Annual Health Check) undertaken by the Care Quality
Commission (CQC).
This mid year review is a reasonably lengthy document that contains an
explanation of the indicator, the position to date and describes any remedial
action plans in place.
The second part of this document pulls out a specific performance area from
our other vital signs and Local Area Agreement (LAA) targets. This month there
is a focus on performance against the falls target.
Finally, this document provides an overview of the work to introduce a
Commissioning Strategic Plan (CSP) key performance indicators (KPI)
scorecard.
3.0 RECOMMENDATIONS
3.1 The PCT Board is asked to note the progress against target to date and support
the work of the Performance, Finance and Information Technology Committee
and Performance Framework groups.
th
F\Corporate Affairs\Board\2009 Meetings\24 Nov Page 3
Trafford Primary Care Trust Agenda Item No.8.1
Performance Report Contents
1. Introduction
2. Background
3. Summary of Areas of Concern
4. Periodic Review Indicators and Performance
Summary of areas of concern
Areas of concern graph card
Detailed analysis
o Tackling Health Acquired infections
o Better Access to Care
o Keeping Adults and Children Well
o Data Quality
5. Themed Area
Falls – reduction in the number of people over 75 years old admitted to
hospital because of falls resulting in a fracture of neck of femur
6. Commissioning Strategic Plan Key Performance Indicators
7. Conclusions and Next Steps
8. Appendices
A. Existing commitments scorecard
B. National priorities scorecard
C. LAA scorecard
D. Vital Signs scorecard
E. Commissioning Strategic Plan – scorecard and indicators/gap analysis
th
F\Corporate Affairs\Board\2009 Meetings\24 Nov Page 4
Trafford Primary Care Trust Agenda Item No.8.1
Summary Performance Board Report
1. INTRODUCTION
The report provides the Trust Board with an overview of corporate performance.
Corporate performance includes performance against the following targets.
National Priorities (contributes to Annual health check/Periodic Review
result)
Existing commitments (contributes to Annual health check/Periodic review
results)
Vital signs
Commissioning Strategic Plan outcomes
Local Area Agreements
2. BACKGROUND
This month, the report is intended as a mid year review of the Trust’s position
against those indicators that will form part of the Periodic Review (previously
referred to as the Annual Health Check) undertaken by the Care Quality
Commission (CQC).
This mid year review is a reasonably lengthy document that contains an
explanation of the indicator, the position to date and describes any remedial
action plans in place.
The second part of this document pulls out a specific performance area from
our other vital signs and Local Area Agreement (LAA) targets. This month there
is a focus on performance against the falls target.
Finally, this document provides an overview of the work to introduce a
Commissioning Strategic Plan (CSP) key performance indicators (KPI)
scorecard.
th
F\Corporate Affairs\Board\2009 Meetings\24 Nov Page 5
Trafford Primary Care Trust Agenda Item No.8.1
3.0 SUMMARY AREAS OF CONCERN
Half way through 2009/10 there are a number of areas of concern.
Ambulance response times – Category A 8 minutes
Ambulance response times – Category B 19 minutes
Data quality on ethnic group – Admitted episodes
Delayed transfers of care
18 week referral to treatment times for admitted patients
Total Units of Dental Activity (UDA)
14 day wait for patients with breast symptoms
Number of drug users in effective treatment
Appointment with a midwife at 12 weeks of pregnancy
Prevalence of breastfeeding at 6 - 8 weeks
Stroke patients who spend 90% of their time in a stroke unit
Teenage conception rate
Where it is possible to see a trend, these areas of concern are graphed
overleaf.
The report categorises performance targets as either Red, Amber or Green.
Red indicates that performance to date is not in line with trajectories and the
year end position is poor. Amber indicates that the current position is slightly
under target with work to be done to ensure year end achievements. Green
indicates that current performance is in line with trajectories and on target to
achieve the year end performance.
Full details of performance are contained in the usual scorecard on Appendix A
and B.
th
F\Corporate Affairs\Board\2009 Meetings\24 Nov Page 6
Trafford Primary Care Trust Agenda Item No.8.1
Graph Card - Areas of Concern
1 2
. .
Delayed Transfer of Care 3 Data Quality Ethnic Group 4 18 week 5
50.0 .110% 98% . .
100% 96%
40.0
90% 94%
30.0 80%
92%
20.0 70%
90%
10.0 60%
88%
0.0 50%
86%
Q1 Q2 40%
Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09 YTD
Apr May Jun Jul Aug
Delayed Transfers Target Admitted MH data Admitted. Target Non admitted Target
Teenage pregnancy rates benchmark 6 UDA activity commissioned 7
50.0 . 500000 .
45.0 400000
40.0
300000
35.0
30.0 200000
2005
2005
2005
2005
2007
2007
2007
2007
2008
2008
2006p
2006p
2006p
2006p
100000
0
MarchJune Sept Dec MarchJune Sept Dec MarchJune Sept Dec MarchJune Apr May Jun Jul Aug Sep
Trafford North West England commisisoned UDA activity
th
F\Corporate Affairs\Board\2009 Meetings\24 Nov Page 7
Trafford Primary Care Trust Agenda Item No.8.1
TACKLING HEALTHCARE ASSOCIATED INFECTIONS
4. Periodic Review Indicators and Performance
Clostridium C Diff
Difficile: year on This year, no more than 250 cases of C Diff can be identified across
the Trafford health economy.
year reduction
In line with the national trend, the number of C Diff infections is
08/09 09/10 reducing and locally we remain on track to attain the target by the
end of the year.
Indicatively, this target is split between those infections identified in
Trafford Healthcare Trust (THT) and those in the community.
Although we are predicting that as a health economy we will be
within the 250 target. Trafford Healthcare Trust has notified us that
they expect to record more than their annual target of 84.
Quality – Effectiveness and safety
BETTER ACCESS TO CARE
Maximum waiting
26 weeks for an inpatient admission
Times Access to treatment is monitored in line with the 18 week referral to
treatment target, detailed later in this report. However, we still make
26 weeks for an a commitment to patients that less than 0.03% will wait longer than
13 weeks for first outpatient appointment and will be seen within the
impatient admission
subsequent 26 weeks if admission to hospital is required.
08/09 09/10
It is felt that this target will be removed in next years operating plan
and subsequently from the Periodic Review but for the time being, it
is still monitored and the PCT must stay within the agreed tolerance
13 weeks for an of 0.03%
outpatient
Birmingham Children’s Hospital has identified some failures in their
appointment administrative admissions systems. As a result, they have
08/09 09/10 inadvertently misreported some of their elective waiting times.
Following validation of the waiting list it would appear that a handful
of our residents have been affected and their waiting times have
already exceeded the 26 week standard. One of these patients has
been identified in the September 2009 MMR return.
Quality – Effectiveness
th
F\Corporate Affairs\Board\2009 Meetings\24 Nov Page 8
Trafford Primary Care Trust Agenda Item No.8.1
BETTER ACCESS TO CARE
Elective Care and 18 week Referral to Treatment Times
Diagnostics The Operating Framework requires action to ensure as many patients as
possible are treated within 18 weeks. In the predicted end of year
performance we have assumed the worst case scenario. Our
18 week Referral to assumption is that in the Periodic Review performance will be measured
Treatment Times on an aggregate basis across each quarter, aiming for 95% of non
(RTT) admitted patients and 90% of admitted patients in each quarter are
required to comply with the standard. We have underachieved in quarter
2 for admitted patients and therefore assumed we have underachieved
non-admitted: against this indicator.
08/09 09/10
Performance issues at South Manchester University Hospital Trust have
been well documented and this remains the key risk to delivering the 18
week target. A robust action plan is in place and regular monitoring
admitted : against this plan takes place with senior members of the organisation.
08/09 09/10 Key features of this action plan include
Clinical validation all backlog patients to assess 18 week RTT and
waiting list status
Additional clinical capacity to treat the Trust backlog within
Quarter 2
Co-ordination of the 18 week patient backlog within the
improvement trajectory plan
Pro-active review of the RTT status of all patients added to the
waiting list and tracking patients through the 18 week pathway
Review RTT data set and ‘Ready Reckoned’ calculations in order
to reflect the Trust performance status
Improve the quality of RTT data on the Trust’s Patient
Administration System (PAS)
Develop the Trust’s Primary Target List (PTL) which will include a
diagnostic PTL to facilitate the patient tracking process
Facilitate pathway redesign programme in order to support
improvements in specialty level performance in the following
areas:
o Trauma and Orthopaedics
o Vascular
o ENT
o General Surgery
o Dental
Develop a Centralised Booking and Scheduling Team
Facilitate a capacity and demand exercise by specialty groupings
and at an HRG level in order to gain an understanding of the
changes in demand and capacity requirements.
Revascularisation at Revascularisation
The 2009/10 operating framework reinforced the commitment to a three
13 weeks 08/09
08/09 09/10 month standard to ensure that no patients waits more than three months
for revascularisation. No PCT resident waits longer than the standard.
Quality – Effectiveness
th
F\Corporate Affairs\Board\2009 Meetings\24 Nov Page 9
Trafford Primary Care Trust Agenda Item No.8.1
BETTER ACCESS TO CARE Ambulance Response Times
Over the course of the whole year, 75% of category A (life threatening)
calls should be responded to within 8 minutes and 95% within 19
minutes.
Ambulance Response
Times 95% of category B (serious but not life threatening) calls should be
responded to within 19 minutes.
Cat A maximum 19 The performance of North West Ambulance service across the whole
minutes response of the North West is the performance assigned to each Greater
time Manchester PCT. It is not specific to our PCT border or our residents.
08/09 09/10
In 2008/09 the AHC assessed the service as “underachieving” against
the category A response within 8 minutes and Category B response
within 9minutes. Performance against those indicators continues to be
Cat A maximum 8 below expected levels in the first half of 2009/10.
minutes response
time This service is commissioned by Bury PCT on behalf of all the Greater
Manchester PCTs. The PCT wrote to seek assurance that action plans
08/09 09/10 were in replace to address this underperformance and is satisfied that
a raft of actions are underway, and a performance improvement plan is
in place. Key features of this plan include:
Cat B maximum 19 Dedicated CEO to lead the recovery plan
minutes response Revised trajectory for achievement of targets
Implementation of capacity management system and handover
time technology, Health Control - daily system reporting
08/09 09/10 Review of national best practice for turnaround and handover
times to produce whole system action plan
Expansion of capacity by the development of new roles to
supplement existing workforce
Utilisation analysis and profiling of resources to match capacity
to demand in high pressure areas
Improved front line clinical triage – diversion of
patients/choosing well
Development of alternatives to admission – see and treat, hear
and treat
Review hospital transfer strategy with commissioners and acute
hospitals
Review fleet and behind the scenes to maximise operational
capacity
Weekly monitoring meetings between the SHA, Bury PCT and NWAS
are taking place and regular performance reports including turnaround
times, activity hotspots, transfers and discharges are reviewed.
The PCT now has representation at the commissioning meeting which
is due to take place in early December.
Quality – Effectiveness
th
F\Corporate Affairs\Board\2009 Meetings\24 Nov Page 10
Trafford Primary Care Trust Agenda Item No.8.1
BETTER ACCESS TO CARE
Access to a GP
Primary Care Access Commissioning a GP service that is flexible to the needs of patients
08/09 09/10 is a key aspect of the NHS operating framework. Compliance with
this is measured through an annual survey of our patients.
PCTs to achieve 50% of We need to ensure that 88% of patients have access to services
GP Practices providing within 48 hours, 87% of patients can book appointments beyond 2
extended opening hours days, there is 92% satisfaction rate with telephone access to a GP,
an 87% patient satisfaction rate of opening times, 93% have the
ability to see a specific GP should they wish and 63.8% of services
Patients can access a GP are offering extended opening hours.
with 48 hours
Performance does appear to be very close to target and it is
recommended a mid year survey takes place before the official
Patients can book an annual survey to identify areas for improvement.
appointment more than 2
days in advance This year’s scoring methodology is still to be published. In the
2008/09 Annual Health Check, 4 of these standards were
measured to determine PCT performance.
Patients are satisfied with
the opening hours
Quality – Effectiveness and patient experience
Sexual Health
Quick access to Sexual Health Services
All patients requesting GUM services should have access within 2
Access to GUM working days.
services
The providers within the PCT Boundary all offer access within the
48 hour standard, therefore, performance against this target is only
at risk when Trafford residents access sexual health services at
08/09 09/10
providers outside the boundary. This happens in very small
numbers and is therefore represents a very small risk to achieving
98%
Chlamydia Screening
This measures the number of Chlamydia tests taken outside of
Chlamydia GUM services on young people ages 15 to 24. The aim is to test
screening of young 25% of the 15 to 24 population throughout the course of the year.
people aged 15 to 24
Currently over 10% of young people have been tested and we
08/09 09/10 remain on track to hit the target by the end of the year.
Quality – Effectiveness
th
F\Corporate Affairs\Board\2009 Meetings\24 Nov Page 11
Trafford Primary Care Trust Agenda Item No.8.1
BETTER ACCESS TO CARE
Time for Treatment following Heart Attack
Heart Attack The performance will be measured across the whole of the year and
Time to reperfusion data is currently being sourced.
for patients who have
had a heart attack In the 2008/09 Annual Health Check, Trafford PCT’s activity levels
were low and we were not measured on this indicator.
08/09 09/10
Access to Dentistry
Quality – Effectiveness
This indictor measures the number of patients (not activity) seeing an
NHS dentist over a 24 month period. This target has been recently
Dentistry revised following much debate with the SHA and the PCT feel this
target is now achievable.
Number of people The general trend in people accessing a dental service is upwards and
accessing an NHS should this continue it is possible to achieve this target for the first time.
dentist over a 24 However, it will require much effort and rely on the success of the
planned marketing campaigns and the ability of the newly
month period commissioned practices to see the numbers of patients they have
08/09 09/10 planned. The dentistry management team are working hard on this and
providing robust performance management framework in place with the
practices.
Total number of UDA The number of UDAs performed to date are well short of the target but
activity we hope to recover in some way as numbers accessing the service
08/09 09/10
increase. It is not yet clear whether this target will form part of the
Periodic Review.
The annual target is 459,955. The current projected outturn falls short
at 227,242.
Quality – Effectiveness
Accident and Emergency
There is a commitment that all patients attending A&E are seen within
Accident and 4 hours of arriving in A&E. The target will allow for monthly variation as
Emergency long as over the course of the year 98% of patients are seen within the
standard.
98% of people are The performance on the scorecard will improve as the walk in centre
seen and treated with figures are added in line with department of Health Guidelines. The
4 hours team is working to secure this data and provide an up date as soon as
08/09 09/10
possible.
Daily monitoring continues and clear escalation routes and exception
reporting are in place.
Quality – Effectiveness
th
F\Corporate Affairs\Board\2009 Meetings\24 Nov Page 12
Trafford Primary Care Trust Agenda Item No.8.1
KEEPING ADULTS AND CHILDREN WELL
Cancer Waiting Times
Cancer
The Cancer Reform The cancer targets focus on improving access for patients who
Strategy calls for present with symptoms that could result in a cancer diagnosis.
access to timely and The performance is measured across the whole of the year,
high quality cancer therefore it is possible to have a dip in month and still achieve the
services target.
08/09 09/10
Performance against the cancer targets is very good, this is with
96% of patients wait less
than 31 days or less from the exception of the new cancer waiting time standard, 93% of all
diagnosis to first treatment breast symptoms should be seen within 2 weeks. This was
for all cancers introduced in April 2009 to be achieved by the end of December
2009 for measurement in quarter 4, January to March 2010.
94% of patients waiting 31
days or less for subsequent Almost all of Trafford’s breast referrals are sent to UHSM with
treatment NHS Manchester being the host commissioner. UHSM did not
commence the data upload in April as required and had
85 % of patients wait less agreement with the SHA to retrospectively enter the data, and in
than 62 days from recent months the backlog has been reduced from 3000 to 380
suspected cancer to first
cases.
treatment for all cancers
90% of patients wait less In addition to data collection issues University Hospital South
than 62 days for urgent Manchester (UHSM) is establishing additional capacity to achieve
referral from a screening the target by the end of 2009. An action plan has been submitted
service to the SHA to assure the standard will be achieved.
85% of patients wait less The action plan from UHSM includes:
than 62 days for urgent Additional clinics to increase capacity within breast
referral from Consultant services
85% of patients referred Recruitment of a new consultant to commence in January
with suspected cancer will 2010
be seen within 14 days Data validation to ensure data completeness
The cancer lead maintains regular contact with the NHS
93% of patients are seen by Manchester cancer lead to review performance. Formal contact
a specialist within 2 weeks with NHS Manchester has now been established with a request for
from referral for breast a regular update of progress against the action plan to provide
symptoms additional assurance that the target will be achieved.
Quality – Effectiveness
% of patients waiting 1 days
or less for subsequent
treatment where the Quality – Effectiveness
treatment was surgery
Number of patients waiting
62 days of less from a
consultants decision to
upgrade the priority
th
F\Corporate Affairs\Board\2009 Meetings\24 Nov Page 13
Trafford Primary Care Trust Agenda Item No.8.1
KEEPING ADULTS AND CHILDREN WELL
Cancer Screening Cancer Screening
Breast Screening: Over The screening targets are aimed at improving rates of screening for
70% of 53 to 70 year olds specific groups and are measured across the 12 months. However,
are screened breast screening data is not yet available although March 09
08/09 09/10
indicates achievement of target.
Cervical Screening: Currently we do not anticipate any issues with cervical screening
80% of 25-49 year olds target.
screened within the last
3.5 years 08/09 09/10
Cervical Screening:
80% of 50-64 year olds
screened within the last 5
years 08/09 09/10 Quality – Effectiveness
Hospital Discharges Delayed Transfers of Care
This indicator measures the impact of community based care in
Delayed transfers of facilitating timely discharge from hospital. The discharge processes
are jointly facilitated by social services and therefore the
care:
performance against this target is not solely in our gift to deliver.
7.29 per 100,000 Performance is measured across the whole of the year.
population 18+
Analysis shows that the rate of delayed discharge has been
increasing over recent months. This rate is unlikely to fall within
08/09 09/10
range of the 7.2 target. The reason for delays is reported to the PCT
and they include 20% waiting completion of assessment, 30%
awaiting residential and nursing home placement 12% due to
patient choice and 8% awaiting community equipment/adaptations.
This needs to be addressed as a matter of urgency.
Quality – Effectiveness
th
F\Corporate Affairs\Board\2009 Meetings\24 Nov Page 14
Trafford Primary Care Trust Agenda Item No.8.1
KEEPING ADULTS AND CHILDREN WELL
Smoking Cessation
Smoking Cessation This target measures the number of people still smoke free after
4 weeks of setting a quit date. The target of 1307 quits has to be
Number of quitters hit by the end of the year. Historical data shows (with the
recorded after 4 weeks exception of the July smoking ban influence) that a large
of intervention proportion of activity takes place in the final quarter as people
commit to quitting in the New Year period.
08/09 09/10
Quarter 2 data is not yet available, an accurate picture of
performance is not usually known until at least 6 weeks after the
end of a quarter.
The Director of Public Health is currently reviewing the cost of
Local Enhanced Services with lead GPs.
Continued input of the pharmacy and GP liaison worker (whose
post has been extended a further 6 months until summer 2010)
will support sharing good practice and encouraging collection
and swift submission of performance forms
The Smoking Cessation service has secured a member of add-
hoc support (bank staff) to respond in January, traditionally a
busy time for the service and has a hospital specialist in post,
taking referrals from the Acute Trusts.
The service is looking at ways to increase the efficiency of the
service by improving the attendance to quit ratios. Benchmarking
between pharmacies to establish good practice is underway.
Quality – Effectiveness
th
F\Corporate Affairs\Board\2009 Meetings\24 Nov Page 15
Trafford Primary Care Trust Agenda Item No.8.1
KEEPING ADULTS AND CHILDREN WELL
Maternity
Maternity
The PCT has to ensure that 90 percent of pregnant women have
Twelve week access to a midwife at 12 weeks and 6 days of pregnancy by the end
of 2010/11. This year we must ensure 85% of women by the end of
maternity the year with a quarter 2 target of 82%.
appointment
08/09 09/10 Performance currently stands below target. The under performance
can be attributed to Central Manchester University Hospital (CMUH)
who are only achieving 52%. University Hospital South Manchester
and Trafford Healthcare Trust respectively have, at the end of quarter
2, seen 85% and 82% respectively.
An action plan in relation to this target was submitted to the SHA in
June 09 – this included actions from THT, CMMC and UHSM.
Actions include
Letters to GPs about the importance of including LMP on
referrals to ensure appropriate timing of assessment
Improved data collection
Strengthening community midwifery management and promote
initial assessments outside the hospital setting
Booking pathway reinforced to Midwives and local GPs
Promotion of midwives as the first point of contact and direct
referrals to midwives
Data quality Streamlining appointment systems
08/09 09/10
The quality of our data is measured through self assessment. The
Service is confident in the data currently received.
Breastfeeding Breastfeeding
Prevalence of The PCT is active in promoting breastfeeding in an effort to meet the
58% target. The measurement includes babies that are being
Breastfeeding 6 breastfed or partially breastfed at 6 to 8 weeks.
– 8 weeks from
The PCT performance is currently short of the target and a number of
Birth 08/09 09/10
initiatives are in place. These include, securing funding for a part time
co-ordinator training both health visitor and midwifes in helping
women to breastfeed. Longer term strategies include education of
future mothers in our schools.
Quality – Effectiveness
th
F\Corporate Affairs\Board\2009 Meetings\24 Nov Page 16
Trafford Primary Care Trust Agenda Item No.8.1
KEEPING ADULTS AND CHILDREN WELL
MENTAL MENTAL HEALTH:
CAMHS
HEALTH The NHS has made a commitment to ensuring that there are
Child and appropriate Child and mental health services for children and young
people. Access to these services is reported on a scale of 1 to 4, 1
Adolescent being the lowest and 4 being the highest.
Mental Health
The Trust has recorded access in line or in excess of the target and
Services 08/09 09/10
there are no risks to the continued delivery of this.
(CAMHS)
Children & young people with Adult Mental Health
learning disabilities The PCT must also ensure that there is appropriate commissioning of
16-17 year olds who require Crisis services offering 24-hour access to all eligible patients deliver
MH services its allocated share of the national targets, this is 424 for Trafford and
24 hour cover to meet urgent
MH needs of children & young must be achieved across the financial year.
people
EI support services for The PCT must also ensure access is available to community
children experiencing MH psychosis services. The PCT is required to continue to deliver the 32
problems new cases of early intervention services by the end of the financial
year.
Adult Mental
08/09 09/10 There is no risk to the achievement of this target.
Health Quality – Effectiveness
Commissioning of Crisis
Residential/home treatment
and community psychosis Childhood Obesity
services will
The official performance figures for the 2009/10 Periodic Review 09/10
be published in December 2009. The target is 93% of reception
Childhood Obesity: children and 90% of year 6 children must be weighed and measured,
Reception and year fewer than 10% of reception children and 15.94% of year 6 children
should be recorded as obese. Early indication suggests the number of
6 children children weighed will exceed the target, however, obesity recorded for
year 6 children will be in excess of target and therefore we will
underachieve against this indicator.
08/09 09/10 It is thought that as coverage of weighing and measuring increases so
does the proportion identified as obese.
The main areas of obesity are Old Trafford, Partington and Stretford.
The healthy schools team based at the Children and Young peoples
Partnership are running a number of initiatives including the ‘fit for life’
programme.
Diabetes Quality – Effectiveness
Diabetic
retinopathy Diabetic retinopathy
screening 95% of people with diabetes should be offered screening for early
detection of diabetic retinopathy. The PCT is currently overachieving
against this target and has a history of doing so.
08/09 09/10
Quality – Effectiveness
th
F\Corporate Affairs\Board\2009 Meetings\24 Nov Page 17
Trafford Primary Care Trust Agenda Item No.8.1
KEEPING ADULTS AND CHILDREN WELL
Drug Users
Drug Users This indicator measures the number of drug users using crack and/or
Drug users in opiates recorded as being in structured drug treatment in the financial
effective treatment year who were discharged from treatment after 12 weeks or more or
who were discharged from treatment in a planned way. The service
must successfully rehabilitate 551 by the end of the fiscal year.
08/09 09/10 The service maintains that it is unlikely we will hit this target with a
significant reduction of referrals into treatment, especially via the
criminal justice system. The annual target is 551. The first six
months of the year showed only 23 new patients accessing this
service. If this trend continues, the year end position will be 46
patients.
Quality – Effectiveness
Immunisation
Immunisation Children being vaccinated for specified infections are calculated
annually. The Trust continues to perform well against these
indicators.
08/09 09/10
There is no information available for Age 12-13 HPV target and 13-
18 Booster for Diptheria and Polio. The Trust is working with The
Children and Young Peoples Service (CYPS) information team to
secure this data.
Quality – Effectiveness
Stroke Care: Stroke
rapid treatment of The PCT must ensure that 100% of high risk TIA (Transient
high risk TIA patients Ischaemic Attack) patients are treated within 24 hours. This has
been achieved for all months in the first half of the year.
The PCT must also plan that stroke patients spend at least 90% of
08/09 09/10 their hospital stay in a specialist stroke unit. There is slight
underperformance against this target but we anticipate some
recovery in the next half of the year. UHSM is in the process of
recruiting 3 permanent band 6 specialist nurses, to enable extended
cover in A&E and admit patients directly to the stroke unit and in
turn, improving performance against this target.
Quality – Effectiveness
th
F\Corporate Affairs\Board\2009 Meetings\24 Nov Page 18
Trafford Primary Care Trust Agenda Item No.8.1
KEEPING ADULTS AND CHILDREN WELL
Teenage Teenage Conceptions
Conceptions This target measures under 18 conceptions and seeks to half the rate
Reduce rates of by 2010 from the 1998 baseline.
conceptions
The final target for this indicator is unlikely to be met, and that, in part,
amongst 15 to 17 is due to the well documented fact that the baseline year was a
year old girls “trough” in the number of conceptions identified.
08/09 09/10 However, the PCT continues to invest in new and existing strategies
that have the potential to make a significant impact on the numbers of
conceptions, and will improve the sexual health of our young people.
These include targeted work with at risk groups of young people.
Quality – Effectiveness
Mortality Rates Life expectancy
Improve life The PCT is working to improve overall life expectancy and reduce
expectancy mortality from cancer and CVD.
Quality – Effectiveness
Overall
08/09 09/10 The aim is to increase the England average life expectancy at birth to
78.6 years for males and 82.5 for females.
CVD 08/09 09/10
Locally we are currently underachieving on the all age, all cause and
CVD mortality rate and achieving the required reduction on the cancer
mortality rate.
Cancer
08/09 09/10 Quality – Effectiveness
Quality – Effectiveness
th
F\Corporate Affairs\Board\2009 Meetings\24 Nov Page 19
Trafford Primary Care Trust Agenda Item No.8.1
DATA QUALITY
Data Quality on Data quality on Ethnic Group
Performance against this indictor will be measured from
Ethnic Group April to December 2009 taken from hospital Patient
Administration Systems where any of Trafford patients are
08/09 09/10
treated as inpatients.
There is no issue with our mental health providers
85% of patients however performance at Trafford General Hospital is
admitted to hospital having an adverse impact on achievement of the 85%
have their ethnicity target. THT Trust is aware of the issue and is working to
recorded address it. Achievement of this target remains a risk due
to the December 2009 deadline.
65% of patients on the
mental health dataset
have their ethnic group
indicated Quality – Effectiveness
th
F\Corporate Affairs\Board\2009 Meetings\24 Nov Page 20
Trafford Primary Care Trust Agenda Item No.8.1
5. Themed Area
Appendix C and D show the PCT’s performance against the LAA indicators and vital
signs indicators (where they are not identified already in the Periodic review
analysis).
It was agreed that we will use the Board Report to focus on areas of significant
underperformance. This month we have decided to provide the Board with a short
brief on performance against the Falls target.
Background
Achieving the 2009/10 falls target will secure £500,000 to be split between the
Primary Care Trust (PCT) and the Local Authority.
Current performance is above trajectory and action plans and remedial actions are in
development in order to address this.
The Target
2009/2010 target is121
Definition: Number of admissions for Fractured neck of femur aged 75+.
The baseline used to set this target was incorrect. Abdul Razzaq, Director of Public
Health, has been in discussions at a senior level in an attempt to re-negotiate the
target but has had no success.
Current Performance
Month/Year 2007/08 Month/Year 2008/09 Month/Year 2009/10
Apr-07 11 Apr-08 8 Apr-09 18
May-07 10 May-08 11 May-09 14
Jun-07 15 Jun-08 7 Jun-09 18
Jul-07 11 Jul-08 8 Jul-09 12
Aug-07 10 Aug-08 12 Aug-09 2
Sep-07 5 Sep-08 9 Sep-09
Oct-07 7 Oct-08 15 Oct-09
Nov-07 5 Nov-08 8 Nov-09
Dec-07 14 Dec-08 15 Dec-09
Jan-08 18 Jan-09 14 Jan-10
Feb-08 16 Feb-09 17 Feb-10
Mar-08 17 Mar-09 16 Mar-10
Total 139 Total 140 Total 64
NB – August will be refreshed when data is received and is likely to increase.
The annual number of recorded admissions for fracture of neck of femur in 2007/08
and 2008/09 remained stable. However, early indications for 2009/10 suggest the
number of falls will exceed previous years and this years target of 121. The table
below shows comparative activity April to July for the last 3 years.
2007/08 2008/09 2009/10
47 34 62
th
F\Corporate Affairs\Board\2009 Meetings\24 Nov Page 21
Trafford Primary Care Trust Agenda Item No.8.1
Current Initiatives
Lead Nurse - The PCT’s Provider Service has a lead nurse for this area of work.
She works closely with colleagues from social services, the Acute Trust and nursing
and residential homes. There has been an increased focus on this area since June
2009, initiatives are detailed on a Provider Services action plan.
Workshop – The workshop was jointly facilitated by the lead commissioner and the
Trust’s Chief Nurse and feature presentations from the Acute Trust’s Lead
Consultant and the Provider Service’s lead nurse. The stakeholder workshop agreed
short and longer term strategies to reduce the number of falls resulting in fracture of
neck of femur in the over 75s. These strategies will be in line with the recently
published Department of Health Guidance around this area of work. The workshop
was represented by primary and secondary care, pharmacists, community services,
nursing home workers, voluntary sector, and commissioners.
Falls Strategy Group – The Terms and References for the falls strategy group are
to be reviewed.
Action Plan - A full action plan is in place, however achieving this target looks
unlikely.
6. Commissioning Strategic Plan (CSP) Key Performance
Indicators
For the first time the PCT is pulling together all indicators identified in the CSP. We
are taking a centralised approach within the Information and Performance teams
ensuring data collection processes are in place to monitor targets and regular score
card views of progress are presented to lead managers and Directors.
Appendix E comprises two things. Firstly, work to date to identify data flows and data
gaps. Secondly, update progress against the agreed CSP trajectory.
The progress of this work and an analysis of under and over performance will be
reported to the newly established Performance and Information Technology
Committee.
7. Conclusions/Next Steps
Over the next few months there will be increased focus on areas of poor
performance. A Standard Operating Procedure for exception reporting is now in
place for escalation performance issues outside the framework meetings and more
regular contact with service leads and performance teams is taking place. All
performance leads have been allocated a lead analyst to ensure performance
information is readily available to them.
th
F\Corporate Affairs\Board\2009 Meetings\24 Nov Page 22
