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					            Appendix 6 - PCT and NHS South West ambitions




Target                                                                                         Target Description                                     Target type   Target type 2   Actions to deliver (to be reported     Traffic light   Progress at Q1 against           If amber or red, what steps Notes
                                                                                                                                                                    (where          against quarterly)                     at Q1           actions to deliver               are being taken to bring
                                                                                                                                                                    applicable)                                                                                             performance back on
Bristol PCT - Strategic Ambitions 2008-2011 (delivery by March 2011 unless otherwise                                                                  Strategic     vital sign
stated)                                                                                                                                               ambition
Work with practices to ensure that the number of people with coronary heart disease that are Coronary heart disease, cardio-vascular disease and      Strategic     N/A             Develop local guidance to promote      Amber           National guidance reviewed       Amber status given as
registered on practice disease registers reflects the registered population risk factors. Overall diabetes: secondary prevention in primary care      ambition                      relevant NICE guidance and include                     and BPCT CHD Group               progress to date has not
the PCT expects to see an increase in numbers on registers by 5% per year for the next three                                                                                        recommendation on CVD Risk                             engaged. Bristol University      involved practices - expected
years.                                                                                                                                                                              Assement Tool. Develop CVD Risk                        and DH engaged in                to achieve green on
                                                                                                                                                                                    Assement and Management                                development of CV risk           circulation of local guidance
                                                                                                                                                                                    Programme for piloting in Q4 with                      assemessment and                 to NICE Guidance
                                                                                                                                                                                    associated independant contractot                      management programme
                                                                                                                                                                                    LES. Appoint Primary Care Service                      and evaluation. Directorate
                                                                                                                                                                                    Improvement Manager to support                         / managerial
                                                                                                                                                                                    practices with secondary and primary                   accountabilities clarified for
                                                                                                                                                                                    prevention of CVD/CHD.                                 SIM post and JD agreed for
                                                                                                                                                                                                                                           advert. Agreed local
                                                                                                                                                                                                                                           guidance to be issued on
                                                                                                                                                                                                                                           NICE guidance by end of
                                                                                                                                                                                                                                           Q2 for immediate
                                                                                                                                                                                                                                           implementation by
                                                                                                                                                                                                                                           practices.


Ensure that the patients on this register are treated to the uppermost thresholds of GP quality Coronary heart disease, cardio-vascular disease and   Strategic     N/A             Employment of Primary Care Service     Green           As per CVD
standards known as Quality and Outcomes Framework (QOF) targets.                                diabetes: secondary prevention in primary care        ambition                      Improvement Manager to support
                                                                                                                                                                                    practices.
                                                                                                                                                                                    Include workstream in Practice
                                                                                                                                                                                    Support Pharmacists work plans.
                                                                                                                                                                                    Review 07/08 QOF data to identify
                                                                                                                                                                                    outliers and prioritise PCT support.
Work with practices to ensure that the number of people with diabetes that are registered on   Coronary heart disease, cardio-vascular disease and    Strategic     N/A             Develop local guidance to promote      Green           As per CVD
practice disease registers reflects the registered population risk factors. Overall the PCT    diabetes: secondary prevention in primary care         ambition                      Type II Diabetes NICE guidance.
expects to see an increase in numbers on registers by 5% per year for the next three years.                                                                                         Appoint Primary Care Service
                                                                                                                                                                                    Improvement Manager to support
                                                                                                                                                                                    practices with secondary and primary
                                                                                                                                                                                    prevention of CVD/CHD which will
                                                                                                                                                                                    overlap with diabetes workstream.

Ensure that the patients on this register are treated to the uppermost thresholds of QOF       Coronary heart disease, cardio-vascular disease and    Strategic     Vital sign      Employment of Primary Care Service     Green           As per CVD
targets.                                                                                       diabetes: secondary prevention in primary care         ambition                      Improvement Manager to support
                                                                                                                                                                                    practices.
                                                                                                                                                                                    Include workstream in Practice
                                                                                                                                                                                    Support Pharmacists work plans.
                                                                                                                                                                                    Review 07/08 QOF data to identify
                                                                                                                                                                                    outliers and prioritise PCT support.
Work with practices to maximise the number of people with a risk of developing                 Coronary heart disease, cardio-vascular disease and    Strategic     Vital sign      Develop local guidance to promote      Amber           National guidance reviewed       Amber status given as
cardiovascular disease within the next ten years of 20% or more that are registered on         diabetes: secondary prevention in primary care         ambition                      relevant NICE guidance and include                     and BPCT CHD Group               progress to date has not
practice disease registers.                                                                                                                                                         recommendation on CVD Risk                             engaged. Bristol University      involved practices - expected
                                                                                                                                                                                    Assement Tool. Develop CVD Risk                        and DH engaged in                to achieve green on
                                                                                                                                                                                    Assement and Management                                development of CV risk           circulation of local guidance
                                                                                                                                                                                    Programme for piloting in Q4 with                      assemessment and                 to NICE Guidance
                                                                                                                                                                                    associated independant contractot                      management programme
                                                                                                                                                                                    LES. Appoint Primary Care Service                      and evaluation. Directorate
                                                                                                                                                                                    Improvement Manager to support                         / managerial
                                                                                                                                                                                    practices with secondary and primary                   accountabilities clarified for
                                                                                                                                                                                    prevention of CVD/CHD.                                 SIM post and JD agreed for
                                                                                                                                                                                                                                           advert. Agreed local
                                                                                                                                                                                                                                           guidance to be issued on
                                                                                                                                                                                                                                           NICE guidance by end of
                                                                                                                                                                                                                                           Q2 for immediate
                                                                                                                                                                                                                                           implementation by
                                                                                                                                                                                                                                           practices.




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             Appendix 6 - PCT and NHS South West ambitions




Target                                                                                           Target Description                                       Target type   Target type 2   Actions to deliver (to be reported      Traffic light   Progress at Q1 against         If amber or red, what steps Notes
                                                                                                                                                                        (where          against quarterly)                      at Q1           actions to deliver             are being taken to bring
                                                                                                                                                                        applicable)                                                                                            performance back on
Maximise the number managed in line with NICE guidance.                                          Coronary heart disease, cardio-vascular disease and      Strategic     N/A             Develop local guidance to promote       Amber           National guidance reviewed Amber status given as
                                                                                                 diabetes: secondary prevention in primary care           ambition                      relevant NICE guidance and include                      and BPCT CHD Group             progress to date has not
                                                                                                                                                                                        recommendation on CVD Risk                              engaged. Bristol University involved practices - expected
                                                                                                                                                                                        Assement Tool. Develop CVD Risk                         and DH engaged in              to achieve green on
                                                                                                                                                                                        Assement and Management                                 development of CV risk         circulation of local guidance
                                                                                                                                                                                        Programme for piloting in Q4 with                       assemessment and               to NICE Guidance
                                                                                                                                                                                        associated independant contractot                       management programme
                                                                                                                                                                                        LES. Appoint Primary Care Service                       and evaluation. Directorate
                                                                                                                                                                                        Improvement Manager to support                          / managerial
                                                                                                                                                                                        practices with secondary and primary                    accountabilities clarified for
                                                                                                                                                                                        prevention of CVD/CHD.                                  SIM post and JD agreed for
                                                                                                                                                                                                                                                advert. Agreed local
                                                                                                                                                                                                                                                guidance to be issued on
                                                                                                                                                                                                                                                NICE guidance by end of
                                                                                                                                                                                                                                                Q2 for immediate
                                                                                                                                                                                                                                                implementation by
                                                                                                                                                                                                                                                practices.


95% of people who have had recent onset chest pain (stable symptoms, suspected to be             Access to specialist services (for 95% of cases unless   Strategic     N/A             Quarterly report at Clinical Quality    Update not
cardiac in origin) to have been seen at the rapid access chest pain clinic within 48 hours of    otherwise stated): Cardiac                               ambition                      Review Meetings. Action plan to be      available
referral.                                                                                                                                                                               sought if performance below 95%
95% of people who have suspected coronary artery disease or other cardiac disease have a         Access to specialist services (for 95% of cases unless   Strategic     N/A             Quarterly report at Clinical Quality    Update not
diagnostic angiogram within 2 weeks of formal cardiology assessment (e.g. RACPC, ETT,            otherwise stated): Cardiac                               ambition                      Review Meetings. Action plan to be      available
outpatient clinic). (CT angiography arrangements tbc)                                                                                                                                   sought if performance below 95%
95% of people with confirmed coronary artery disease to have a coronary angioplasty if           Access to specialist services (for 95% of cases unless   Strategic     N/A             Quarterly report at Clinical Quality    Update not
deemed appropriate within 3 weeks of angiogram (to allow for wound site recovery post            otherwise stated): Cardiac                               ambition                      Review Meetings. Action plan to be      available
angiogram).                                                                                                                                                                             sought if performance below 95%
95% of post-angioplasty to have access to rehabilitation within four weeks, and 95% of post      Access to specialist services (for 95% of cases unless   Strategic     N/A             Quarterly report at Clinical Quality    Update not
cardiac surgery to have access to rehabilitation within seven weeks (patients should not have    otherwise stated): Cardiac                               ambition                      Review Meetings. Action plan to be      available
rehab until 6 weeks post cardiac surgery). Access is defined as attending a rehab session.                                                                                              sought if performance below 95%

10% of all stroke cases to be thrombolysed. (ref Mending Hearts and Brains)                      Access to specialist services (for 95% of cases unless   Strategic     N/A                                                     Green           NBT service established.
                                                                                                 otherwise stated): Stroke                                ambition                                                                              UH B service running since
                                                                                                                                                                                                                                                Dec 07.
Appropriate cases to have thrombolysis within three hours of the onset of the stroke.            Access to specialist services (for 95% of cases unless   Strategic     N/A                                                     Green           Embedding thrombolysis as
                                                                                                 otherwise stated): Stroke                                ambition                                                                              a new service across
                                                                                                                                                                                                                                                BNSSG.
People who have suffered a transient-ischaemic attack to receive an appropriate scan (CT,        Access to specialist services (for 95% of cases unless   Strategic     N/A                                                     Green           Much work is being carried
MRI or Doppler) within 24 hours as needed. Evidence suggests that this is 80% of all TIA         otherwise stated): Stroke                                ambition                                                                              out around stroke pathway.
cases, which will be the benchmark.                                                                                                                                                                                                             Acute stroke and TIA work
                                                                                                                                                                                                                                                is linked.
All people who have suffered a stroke to receive a CT scan within three hours, seven days a      Access to specialist services (for 95% of cases unless   Strategic     N/A                                                     Green           Looking at diagnostics as
week.                                                                                            otherwise stated): Stroke                                ambition                                                                              part of acute stroke work.
100% of stroke sufferers to be offered specialised community rehabilitation at discharge.        Access to specialist services (for 95% of cases unless   Strategic     N/A                                                     Green           Will fit in with rehab Service
                                                                                                 otherwise stated): Stroke                                ambition                                                                              Delivery Group work.

A six month review including psychological assessment to be offered to 80% of stroke             Access to specialist services (for 95% of cases unless   Strategic     N/A                                                     Green           Part of Rehab pathway
sufferers.                                                                                       otherwise stated): Stroke                                ambition                                                                              SDG work. Also links with
                                                                                                                                                                                                                                                stroke strategy money that
                                                                                                                                                                                                                                                sits with the local authority.

Counselling and social support for up to three years to be offered to 80% of stroke sufferers.   Access to specialist services (for 95% of cases unless   Strategic     N/A                                                     Green           Part of Rehab pathway
                                                                                                 otherwise stated): Stroke                                ambition                                                                              SDG work. Also links with
                                                                                                                                                                                                                                                stroke strategy money that
                                                                                                                                                                                                                                                sits with the local authority.

Counselling and social support for up to three years to be offered to 50% of carers.             Access to specialist services (for 95% of cases unless   Strategic     vital sign                                              Green           Part of Rehab pathway
                                                                                                 otherwise stated): Stroke                                ambition                                                                              SDG work. Also links with
                                                                                                                                                                                                                                                stroke strategy money that
                                                                                                                                                                                                                                                sits with the local authority.

Long term disability support to be made available at the request of the GP.                      Access to specialist services (for 95% of cases unless   Strategic     N/A                                                     Green           This support will be offered
                                                                                                 otherwise stated): Stroke                                ambition                                                                              via the primary care mental
                                                                                                                                                                                                                                                health services.

80% of insulin dependant diabetics to have their contact with the diabetic specialist nurse take Access to specialist services (for 95% of cases unless   Strategic     N/A             Service lead to report on progress to   Update not
place in a community setting.                                                                    otherwise stated): Diabetes                              ambition                      PCT performance team and to provide     available
                                                                                                                                                                                        action plans
50% more patients with diabetes attending structured education programmes for patients with Access to specialist services (for 95% of cases unless        Strategic     N/A             Service lead to report on progress to   Update not
diabetes than in 2006/07.                                                                   otherwise stated): Diabetes                                   ambition                      PCT performance team and to provide     available
                                                                                                                                                                                        action plans




                                                                                                                                                                                                                                                                                                                   2 of 5
             Appendix 6 - PCT and NHS South West ambitions




Target                                                                                         Target Description                                       Target type   Target type 2   Actions to deliver (to be reported              Traffic light   Progress at Q1 against    If amber or red, what steps Notes
                                                                                                                                                                      (where          against quarterly)                              at Q1           actions to deliver        are being taken to bring
                                                                                                                                                                      applicable)                                                                                               performance back on
Increase the number of overweight or obese adults participating in the weight management       Primary and secondary prevention: Weight management      Strategic     N/A             Funding has been secured through       Green                    Target has been achieved.                             As advised by PCT reporting
referral scheme by                                                                                                                                      ambition                      the LDP to increase the number of                                                                                     manager.
- 50% in 2008/9                                                                                                                                                                       patients receiving support through the
- by 100% by 2010 (based on 2006 baseline of 250 patients)                                                                                                                            scheme.
- by a further 50% (from the baseline of 750 patients) by 2012
25% of adult patients participating in the scheme to have lost 5% or more of their starting    Primary and secondary prevention: Weight management      Strategic     N/A             See below.                                      Green           Current indicators show
weight after 12 weeks.                                                                                                                                  ambition                                                                                      5.5% body weight loss
                                                                                                                                                                                                                                                      achieved by 44-55% of
                                                                                                                                                                                                                                                      referred patients.
Patients on GP disease registers with cardiovascular disease, diabetic or hypertension, and  Primary and secondary prevention: Weight management        Strategic     N/A             To produce service specification for            Green           First draft has been
with a Body Mass Index (BMI) greater than 30, who have failed to lose weight through support                                                            ambition                      dietetic service.                                               produced.
from tier 1 weight management services (weight management referral or practice nurse
advice) to receive specialist dietetic advice.
Year 1 (2007/08): Baseline data to establish numbers of patients.
Year 2 (2008/09): 10% of patients to receive specialist dietetic advice.
Year 3 (2009/10): 30% of patients to receive specialist dietetic advice.
By March 09, all 8-month checks on children carried out by health visitors are to include a  Primary and secondary prevention: Smoking                  Strategic     N/A             Monitoring of service performance has Green                     Smoke free homes
discussion of the benefits of a smoke free home. To be recorded in the relevant page of the                                                             ambition                      been requested quarterly with                                   paperwork should be in
patient held record. The same target to be at 90% by 2012. A 10% reduction in re-admission                                                                                            appropriate action being put in place                           100% of Parent Held Child
rates for alcohol (from 2005/06 baseline)                                                                                                                                             where compliance below 100%                                     Health Record books and
                                                                                                                                                                                                                                                      this data is being recorded
                                                                                                                                                                                                                                                      in the new Child Health
                                                                                                                                                                                                                                                      Records IT system

A 10% reduction in re-admission rates for alcohol (from 2005/06 baseline)                      Primary and secondary prevention: Alcohol harm           Strategic     N/A             Data recording to be agreed by June,            Amber                                          Meeting to agree data set
                                                                                               reduction                                                ambition                      first quarter data by Aug 2008.                                                                up. Alcohol Specialist Nurse
                                                                                                                                                                                      Alcohol specialist nurse working with                                                          in post
                                                                                                                                                                                      people in hospital to reduce re-
                                                                                                                                                                                      admissions
An increase in the number of patients aged 16 years and over completing an accredited 12       Primary and secondary prevention: Physical activity      Strategic     N/A                                                             Green           Target has been achieved.                                     LAA target
week physical activity referral programme having been referred by a health practitioner (from                                                           ambition
the 2006 baseline).
An increase in the number of patients aged 16 years and over who achieved 4 positive           Primary and secondary prevention: Physical activity      Strategic     N/A                                                             Green           Target has been achieved.                                     LAA target
behavioural change health outcomes after completing an accredited 12 week physical activity                                                             ambition
referral programme following referral by a health practitioner (excluding those counted under
target „a)‟ above).
By March 2010, 100% of patients for whom it is clinically appropriate will be treated within 8 Access                                                   Strategic     N/A             Plans in place to achieve milestone of Update not
weeks of the original referral to specialist services, unless they choose to wait longer.                                                               ambition                      13 weeks by December 2008.              available
                                                                                                                                                                                      Perfromacne management via 'No
                                                                                                                                                                                      delays' board
By 2010, access to primary care services will include weekends, early evenings and early       Access                                                   Strategic     N/A             Agree internal PCT reporting mechanism. Green                   LES programme agreed
mornings.                                                                                                                                               ambition                      Action plan to be agreed if performance below                   with LMC and circulated to
                                                                                                                                                                                      98%
                                                                                                                                                                                                                                                      practices.
98% of services users attending Walk-In Centres and Minor Injuries Units to be seen within 2   Access                                                   Strategic     N/A             Agree internal PCT reporting                    Update not      No update
hours.                                                                                                                                                  ambition                      mechanism. Action plan to be agreed             available
                                                                                                                                                                                      if performance below 98%
100% of service users requiring diagnostic tests to accompany a referral to specialist         Access                                                   Strategic     N/A             Plans in place to achieve milestone of          Update not
services, to be offered the tests within 48 hours, by 2010.                                                                                             ambition                      13 weeks by December 2008.                      available
                                                                                                                                                                                      Performance management via no
                                                                                                                                                                                      delays board
Mortality rates from suicide and undetermined injury to be reduced to 6.5 per 100,000          Stretch targets - Health improvements and inequalities   Strategic     Vital sign                                                      Green           There is a suicide
European standardised population[1], by 2010.                                                  reduction                                                ambition                                                                                      prevention strategy and
                                                                                                                                                                                                                                                      audit group.There is also a
                                                                                                                                                                                                                                                      funded self harm register.

The rate of rise in childhood obesity to be reduced by 50% by 2010 (based on trajectory ref:   Stretch targets - Health improvements and inequalities   Strategic     Vital sign                                                      Green           LAA action plan has been                                      There is a LAA indicator for
Health Survey for England (1995 to 2004))                                                      reduction                                                ambition                                                                                      developed.                                                    childhood obesity for reception
                                                                                                                                                                                                                                                                                                                    age children.
The proportion of Bristol residents eating 5 portions of fruit and vegetables a day to be      Stretch targets - Health improvements and inequalities   Strategic     N/A             An application for funding has been             Green           If funding is secured this
increased from 48% in 2005 to 51% in 2010 (measured by the Bristol Quality of Life Survey).    reduction                                                ambition                      made to the Healthy Communities                                 will significantly improve
                                                                                                                                                                                      fund (Healthy Towns). Implement                                 access to fruit and
                                                                                                                                                                                      Healthy Start.                                                  vegetables to the most
                                                                                                                                                                                                                                                      disadvantaged
                                                                                                                                                                                                                                                      communities in Bristol. We
                                                                                                                                                                                                                                                      are continuing to
                                                                                                                                                                                                                                                      implement Healthy Start.
The percentage of the Bristol population participating in moderate physical activity 5 days a Stretch targets - Health improvements and inequalities    Strategic     N/A                                                             Green           £2.8m per year for 3 years                                    Bristol has succeeded in
week or more to be increased from 39% in 2005 to 42% in 2010 (measured by Bristol Quality reduction                                                     ambition                                                                                      to increase cycling rates in                                  becoming Cycling City.
of Life Survey).                                                                                                                                                                                                                                      Bristol has been secured
                                                                                                                                                                                                                                                      from Cycling England. This
                                                                                                                                                                                                                                                      is to be matched by BCC &
                                                                                                                                                                                                                                                      partners




                                                                                                                                                                                                                                                                                                                                          3 of 5
             Appendix 6 - PCT and NHS South West ambitions




Target                                                                                               Target Description                                         Target type   Target type 2   Actions to deliver (to be reported          Traffic light   Progress at Q1 against          If amber or red, what steps Notes
                                                                                                                                                                              (where          against quarterly)                          at Q1           actions to deliver              are being taken to bring
                                                                                                                                                                              applicable)                                                                                                 performance back on
Contribute to a reduction in smoking levels by meeting the challenging annual targets for „four- Stretch targets - Health improvements and inequalities         Strategic     N/A             Action Plan for widening service            Red             60% below target for            Develop a surge programme
week-quitters‟ i.e. the number of people still not smoking four weeks after quitting. Achieve a reduction                                                       ambition                      availability and accessibility. Improve                     quarter. Still awaiting         to increase accessibility to
quit rate of 870 four-week quitters per 100,000 population in the neighbourhood renewal                                                                                                       monthly monitoring to ensure                                return of monitoring forms      stop smoking support and
areas.                                                                                                                                                                                        accurate/timely reporting and early                         so figure not final             increase throughput of
                                                                                                                                                                                              identification to initiate recovery plan.                                                   clients.

Achieve a reduction of 10% in the number of care home placements for people with long-               Stretch targets - Older people, long term conditions and   Strategic     Vital sign                                                  Green           This is in the Local
term conditions by 2010, by supporting people in their own homes.                                    end of life care                                           ambition                                                                                  Authority's commissioning
                                                                                                                                                                                                                                                          plans.
Implement a validated system of risk stratification for all of the adult population, by GP           Stretch targets - Older people, long term conditions and   Strategic     N/A             Dr Foster in place to identify High         Green           PCDR procurred and pilot
practice by 2010, in order to identify those most at risk of crisis, hospitalisation and therefore   end of life care                                           ambition                      Intensity User's based on secondary                         practices identiifed for use.
benefit from active community based management.                                                                                                                                               care data. Work in progress to                              Provider required to
                                                                                                                                                                                              implement a more refined risk                               escalate workstream for
                                                                                                                                                                                              stratification model utilsiing the Kings                    use of Combined Tool.
                                                                                                                                                                                              Fund Combined Tool that
                                                                                                                                                                                              incorporates primary care data
                                                                                                                                                                                              through Primary Care Data Reporting
                                                                                                                                                                                              Tool. Services commissioned from
                                                                                                                                                                                              Bristol Community Health to provide
                                                                                                                                                                                              Case Management to high risk
                                                                                                                                                                                              patients. Project in place to develop
                                                                                                                                                                                              improved support to nursing and care
                                                                                                                                                                                              homes to ensure effective use of
                                                                                                                                                                                              resoruces for people living in these
                                                                                                                                                                                              environments.

Implement combined (health and social care) caseload management for 100% of those at                 Stretch targets - Older people, long term conditions and   Strategic     N/A                                                         Amber
risk of admission in the following year by 2010.                                                     end of life care                                           ambition
Reduce emergency hospital „bed days‟ for people over 75 with long-term conditions by 17%             Stretch targets - Older people, long term conditions and   Strategic     N/A                                                         Amber
by 2008, and by 30% for people over 65 by 2010.                                                      end of life care                                           ambition
Ensure the „Gold Standard Framework‟, a recognised tool for end of life planning, and the            Stretch targets - Older people, long term conditions and   Strategic     N/A                                                         Green
„Liverpool Care Pathway for the Dying‟, the recognised methodology for achieving the Gold            end of life care                                           ambition
Standard Framework, are adopted in all practices, with validation of size of register.

20% reduction year-on-year in people who had chosen to die at home but enter hospital in             Stretch targets - Older people, long term conditions and   Strategic     N/A                                                         Amber
the last days of their lives from all settings, including care homes.                                end of life care                                           ambition
Reduce deaths in acute hospital by 10% per year (from the 2007/08 baseline) for each of the          Stretch targets - Older people, long term conditions and   Strategic     Vital sign                                                  Amber
next three years.                                                                                    end of life care                                           ambition
Reduce unplanned admission to hospital from nursing homes in the last 12 months of life by           Stretch targets - Older people, long term conditions and   Strategic     N/A                                                         Amber
10% per annum (from the 2007/08 baseline) for each of the next three years.                          end of life care                                           ambition
Ensure that patients can access the “basic building blocks of care” as described in the South        Stretch targets - Children and maternity care              Strategic     N/A                                                         Green
West End of Life Pathway group report 24 hours a day, seven days a week.                                                                                        ambition
To increase breastfeeding initiation rates across Bristol to 81% and for breast feeding              Stretch targets - Children and maternity care              Strategic     Vital sign      Implementing UNICEF Baby Friendly           Green           Stage 1 accreditation is
continuation at 6-8 weeks to increase to 54% by March 2011. Focussing particularly but not                                                                      ambition                      initiative.                                                 taking place October 2008.
exclusively on the eight wards that have consistently had the lowest initiation and continuation                                                                                                                                                          Co-ordinator for
rates over the last 3 years, namely, Avonmouth, Bishopsworth, Filwood, Hartcliffe,                                                                                                                                                                        breastfeeding peer support
Kingsweston, Southmead, Stockwood, Whitchurch Park.                                                                                                                                                                                                       has been appointed.

Women will be offered a full range of options for where they give birth, as set out in „Maternity Stretch targets - Children and maternity care                 Strategic     N/A             Implement plan to increase midwifery Amber                  Additional community            Clarification of additional
Matters‟, and where clinically appropriate their choice will be achieved in all cases.                                                                          ambition                      capacity                                                    midwifery support recruited     funding for midwifery
                                                                                                                                                                                                                                                          by UHBristol. Both Trusts       services. Work with Trusts
                                                                                                                                                                                                                                                          to produce capacity plans       to implement capacity plans.

To reverse the trend in teenage pregnancies and reduce back to lowest level in the last 10           Stretch targets - Children and maternity care              Strategic     Vital sign      Actions have been agreed by senior       Red                                            Following the National
years.                                                                                                                                                          ambition                      partners in LA and PCT: To                                                              Support Team visit and the
                                                                                                                                                                                              implement strategic leadership, to                                                      inclusion of teenage
                                                                                                                                                                                              better target young people at risk of                                                   pregnancy as an LAA target,
                                                                                                                                                                                              teenage conception and to improve                                                       it is a top priority for both the
                                                                                                                                                                                              data for performance management                                                         PCT and the Local Authority.
                                                                                                                                                                                              and targeting. Inclusion in the LAA will                                                Strategic leadership has
                                                                                                                                                                                              maintain the high profile.                                                              been agreed shared
                                                                                                                                                                                                                                                                                      between the LA and PCT. A
                                                                                                                                                                                                                                                                                      new action plan will be
                                                                                                                                                                                                                                                                                      agreed by the end of
                                                                                                                                                                                                                                                                                      September.
Establish a managed maternity network to address the emotional and psychological needs of Stretch targets - Children and maternity care                         Strategic     N/A             A perinatal mental health strategy   Green                  Draft strategy produced for Care pathways have been
the mother in the pre and post natal period by 31 December 2007.                                                                                                ambition                      group has been established. Care                            discussion by Trust and     identified but there are likely
                                                                                                                                                                                              pathways to be mapped by July 2008                          Network Boards              to be resource issues for
                                                                                                                                                                                              and any additional investment                                                           LDP
                                                                                                                                                                                              requirements identified by September
                                                                                                                                                                                              2008.




                                                                                                                                                                                                                                                                                                                              4 of 5
             Appendix 6 - PCT and NHS South West ambitions




Target                                                                                           Target Description                              Target type   Target type 2   Actions to deliver (to be reported       Traffic light   Progress at Q1 against         If amber or red, what steps Notes
                                                                                                                                                               (where          against quarterly)                       at Q1           actions to deliver             are being taken to bring
                                                                                                                                                               applicable)                                                                                             performance back on
Parenting support to be offered to 100% of identified vulnerable new parents for the first two   Stretch targets - Children and maternity care   Strategic     N/A             Ensure robust commissioning of HV        Green           Parenting support is built     Ensure monitoring in place
years.                                                                                                                                           ambition                      services through new service                             into SLA. CYPS parenting
                                                                                                                                                                               specification; deliver specific action                   strategy launched
                                                                                                                                                                               from parenting support strategy.
Reduce smoking rates during pregnancy to a level which is half those of women in that age        Stretch targets - Children and maternity care   Strategic     N/A             Service specification for community      Amber           Smoking cessation built        Focus on establishing
group in the general population of the South West.                                                                                               ambition                      midwifrey service to include                             into CHPP.                     monitoring framework
                                                                                                                                                                               requirement for smoking cessation
                                                                                                                                                                               advice and referrals.
Increasing by 5% year on year, the number of children/ young people who are assessed as          Stretch targets - Children and maternity care   Strategic     N/A             Include in workplan for substance        Update not
living with problematically using adults and are identified, screened and referred to                                                            ambition                      misuse group; increase resources for     available
appropriate services.                                                                                                                                                          Hidden Harm through Prevention &
                                                                                                                                                                               Early Intervention Strategy.

100% of older people with mental health needs should be accessing services by 2010.              Stretch targets - Mental health                 Strategic     N/A                                                      Update not
                                                                                                                                                 ambition                                                               available
The number of older people with mental health needs accessing intermediate care reviews          Stretch targets - Mental health                 Strategic     N/A                                                      Update not
should increase by 20% by 31 March 2009.                                                                                                         ambition                                                               available
95% of people with a learning difficulty will have been offered an annually reviewed health      Stretch targets - Learning difficulties         Strategic     Vital sign                                               Update not
action plan by 2010.                                                                                                                             ambition                                                               available
All patients will have access to up-to-date information on the incidence of hospital acquired    Stretch targets - Patient safety                Strategic     N/A                                                      Update not
infections in all facilities.                                                                                                                    ambition                                                               available
NHS South West ambitions                                                                                                                         NHS South     N/A
Maximum wait time in A&E of 2 hours.                                                                                                             West
                                                                                                                                                 NHS South     N/A                                                      Amber           UH Bristol performance
                                                                                                                                                 West                                                                                   was 63% in June.
Maximum wait of 8 weeks from referral to treatment time by March 2011                                                                            NHS South     N/A             Plans in place to achieve milestone of Green             73% admitted
                                                                                                                                                 West                          13 weeks by December 2008.                               92% non-admitted
                                                                                                                                                                               Performance management via 'No                           On target against trajectory
                                                                                                                                                                               delays' board
Elimination of ambulance handover delays to ensure that all patients are transferred within 15                                                   NHS South     N/A                                                    Amber             Work is ongoing in this
minutes of arrival.                                                                                                                              West                                                                                   area.
Moving towards a maximum wait of 18 weeks from RTT for hidden waits e.g. therapies.                                                              NHS South     N/A             Secondary care services are included Update not
                                                                                                                                                 West                          in the 8 week plans. Need to review  available
                                                                                                                                                                               community based services, via 'No
                                                                                                                                                                               Delays' board.




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