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									BOARD MEETING 18TH MARCH 2003 PCT PERFORMANCE REPORT The Action for the Board is:- To Note for information the PCT Performance Report IMPACT ON STRATEGIC DIRECTION: The aim of the performance report is to inform the Board of how the PCT is performing against agreed national and local targets and how individual services are performing against the targets.

FINANCIAL IMPACT: The performance report will inform the Board when there is an exceptional financial risk attached to meeting a target, or where over performance in an area will have a financial impact. One of the national targets is financial balance, which will be reported on regularly.

IMPACT UPON SERVICE USERS: The performance report will indicate where services that are not meeting agreed waiting list or quality targets. In this report, particular areas of concern that impact on service users are rising waiting times in physiotherapy and paediatric occupational therapy, a high level of delayed discharges in the hospital and the community, underperformance against the target of 90% waiting no more than 4 hours in A&E and underperformance against the target of seeing a healthcare professional within 24 hours in primary care (although the criteria for this are under review currently)

IMPACT UPON STAFF: The report will enable staff to be informed of how all commissioned and provided services are performing across the PCT.

IMPACT UPON PARTNERS - INTERNAL or EXTERNAL: The performance report will demonstrate where there are areas of underperformance (or over performance) across the whole health economy, including areas of joint working.

IMPACT UPON EQUITY: This report enables the PCT to effectively performance manage its commissioned and provider services on an equitable basis.

ANY OTHER CRITICAL INFORMATION: This regular report will be received to the Board on a bi-monthly basis. Every six months, a full report will be prepared for the Board, detailing the PCT’s progress against the Local Health Delivery Plan (LHDP) and other major projects. Should detailed performance information be required on any target in the interim, it can be provided on request.

PERFORMANCE REPORT Exception Report – 18th March 2003 The performance report details the performance of our commissioned and (where available) our provider services against national targets and local targets. This information can be seen in the attached graphs. This exception report is an important part of the performance report as brings to the Board’s attention issues arising from exceptional performance, i.e. significant under or over performance, and is detailed below: Financial position Duty/Target Live within Resource Limits Live within the Cash Limit Achieve operational financial balance Demonstrate full-cost recovery on provider functions Live within management cost target Keep bank balance within DoH limits Meet PSPP targets Forecast Out-turn Recovery plan to break even currently being implemented Cash Drawings will match cash limit Recovery plan to break even currently being implemented Will achieve (annual accounts)

Break-even Year end bank balance will be within DOH limits Will achieve target set at 90%.

Delayed Discharges are currently at 55 (50 Hillingdon and 5 out of borough). Hillingdon still has the highest number of delayed discharges in the North West London Strategic Health Authority area. The PCT, Hillingdon Hospital and Hillingdon Social Services submitted an updated action plan to the StHA on 25th February. A Project Board (with all Chief Officers as members) and Operational Group have been set up to update the plan and ensure that the identified priorities are implemented in order to meet the March 31st deadline of 31. The Board and Operational Group will continue to meet and plan for the next year in order to bring delayed discharges down to an acceptable level in the health economy. In the meantime, 6 beds (2 in February and 4 in March) at Northwood & Pinner Community Hospital will be funded by Social Services for patients awaiting placement. A&E Targets: waiting times for four hours and below have improved over the last few weeks, with the position at 24th February at 72% (target is for 90% by the end of March). It is unlikely that Hillingdon Hospital will meet the 90% target, but 85% should be achievable and a transit time action plan has been put into place in order to make the necessary changes to meet this target. This is being monitored by a project board who meet fortnightly and the PCT are represented at this.

Therapy Waiting Times: Physiotherapy: Average waiting times for Physiotherapy are rising as a result of staff vacancies and increase in service demand. Paediatric Occupational Therapy: The long waiting time for OT children’s services relates to insufficient service capacity (the service is fully staffed) and rising demand. There is an action plan in place which includes additional capacity to reduce backlog assessments, implementing more effective discharge criteria, improving access for self help and advice to prevent patients and reviewing service criteria. Primary Care Access Survey: The PCT have been making steady progress towards delivery of the targets. During the last audit, when reasons for not achieving the target were checked, at least 2 practices had not recorded the information properly but it was too late to correct the information. The PCT will ensure that the information is recorded correctly in future. There is the continuing problem in Hayes of nurse recruitment that prevents practices without a nurse from achieving the target of seeing a health care professional within one working day. The PCT are actively working to address this issue with practices and plans for a practice nurse bank are being worked up. The Locality Development Managers are working with each practice to develop an access plan to achieve the targets.

Delivery of March 2003 Targets Description of Target
90% of patients to spend no more than 4 hours in A&E from arrival to admission, transfer or discharge. (Includes 100% of patients to wait no more than 4 hours on a trolley Respond to 75% of Category A calls within 8 minutes.

Target at March 2003
90% to spend no more than 4 hours in A&E. No patient to spend more than 4 hours on a trolley. 75%

January 2003 Position
72% spent no more than 4 hours in A&E. 43 was the weekly ave. over 4 hours on a trolley 62.3%

Projected Position March 2003
We do not expect to meet the targets: Although we do expect a significant improvement on January’s position

Ensure 90% of patients who wish to do so can see a primary health care professional within 1 working day, and a GP within 2 working days by March 2003. Achieve a maximum wait of 5 months (21 weeks) for an outpatient appointment and reduce the number of over 13 week outpatient waiters by March 2003. Achieve a maximum wait of 12 months for all inpatient waiters. Reduce the number of 9 month inpatient waiters by March 2003 and ensure that overall list size reduces during the year. Trusts that are already achieving the 2002/03 targets must make further progress towards achievement of the 2005 targets. Reduce the number of acute beds blocked by delayed discharge by 20% by March 2003.

90% of patients to see : GP within 2 working days, health care professional within 1 day Outpatients Over 21 weeks =0 Outpatients over 13 week target = 920 Over 12 month Target = 0 Over 9 month target =140 Overall waiting list =4059

Dec Qtr position for : Primary Care Professionals = 59% GP = 87%

The LAS is expected to achieve 75% by Feb and sustain that level thereafter as a London average. It is not envisaged that the response time in Hillingdon will deliver to that level. However the LAS is judged on its pan London figure. We will not achieve the Primary Care Professional target. However, it is anticipated that we will meet the GP target.

85 patients waited over 21 weeks. Over 13 weeks = 1388

Over 12 month waiters =21 Over 9 month waiters = 151 Overall Waiting List = 4051

Over 21 weeks waiters - It is anticipated that we meet this target. The reduction of outpatients over 13 weeks will not be achieved. The position at March 2002 was 998. It is expected that the over 12 month waiters will be met. Although the number of 9 month waiters has reduced, it is not expected that we will meet this target. The overall waiting list size is expected to be met. Every effort is being made to meet this target.


Ave weekly number =55

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