Appendix 1 Notes on High Level Performance Indicators Access Plans have been introduced to improve the data collection exercise and to improve access to services within the PCT. In September, with new systems in place both of these indicators are green. Emergency Care Waiting Time Sandwell and West Birmingham Trust (SWBT) have submitted a plan to the SHA detailing actions being taken to achieve the target of 90% of patients waiting less than 4 hours in A&E by the end of September. Improvement has been slow and it will be a challenge to achieve 90% within this timescale. This is therefore considered a high risk area with regard to hitting the required standard. 12 Hour Trolley Waits There has been one breach this year, due to a failure in the administrative procedures at SWBT. John Adler, Chief Executive of SWBT, has reported on this to the SHA detailing actions taken to avoid further breaches. Low risk of further breaches. Demand Components Outpatients The current national target is that no-one should wait longer than 21 weeks for first OP appointment. The target for March 2004 is 17 weeks. Although current targets are being achieved, potential pressure specialties are Orthopaedics, ENT, Ophthalmology, Plastic Surgery and Neurology. These specialties will be closely monitored throughout the year. Inpatients There have been no breaches of the national target of 12 month maximum this year. The target at 31 March 2004 is 9 months maximum. There are very specific sub-specialties where there is difficulty in achieving maximum waiting times due to shortage of specialists to deal with the demand. These are complex plastic surgery, vitreo-retinal surgery and neurosurgery. The PCTs across the BBC HA area are working together to assess the feasibility and cost of reducing the maximum waiting time for IP treatment to 6 months by the end of March 2004. If funding which has been allocated for future years can be brought forward we will aim to achieve this target. The rationale for this is that next year, if a patient has been waiting more than 6 months for treatment, they will have to be offered the option of being treated at an alternative provider. The potential costs of administering “Patient Choice at 6 months” are large. Reducing the maximum waiting time to 6 months would obviate the need to implement complex and costly administrative arrangements. Appendix 1 Total Inpatient Waiting List All PCTs and Trusts have recently been required to submit revised trajectories for total waiting list numbers to the SHA. The end of year target for the PCT is now 2751 instead of 2815 as submitted in the LDP. We are aiming to achieve this in February. The target is in itself challenging, but has been made more so by previously unreported waiters in Dermatology at SWBT (51 at the end of July). SWBT is responsible for dealing with this issue within the resources agreed in the LDP. GP Referrals Although these are below target overall, they have increased in certain specialties, most notably Orthopaedics and Plastic Surgery. These are two specialties which are both under pressure from demand and where there is most likely to be an addition to the IP waiting list resulting from an OP appointment, so this could have an adverse effect later in the year. Emergency First Finished Consultant Episodes (FFCEs) Emergency admissions are reported to be over target for all PCTs and across all providers in Birmingham. If this trend continues it could have greater implications during the winter when emergency admission rates tend to increase and there is a greater risk of elective work being cancelled as a consequence. Capacity Childhood Immunisations Targets for immunisation and pre school boosters are 90 %. These indicators already attract a reward element in both PMS and GMS contracts. CHD There is good evidence that states the quicker you get the clot busting treatment after you have a heart attack the better will be your changes of a positive outcome. This indicator measures the time from the call to the ambulance to the time drugs are received. It involves performance of ambulance trust A&E systems and commissioning decisions around appropriate drugs. We as a PCT in primary care also need to ensure our practice CHD audit data is current as per the national service framework. This is an annual record so not included. Current status amber. Prescribing Heart of Birmingham practices prescribe significantly too many antibiotics, benzodiazepines and too few generic drugs. Plans have been put in place to ensure we move from the bottom 10% nationally. Progress with selected or all practices can be monitored on a monthly basis.