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					                                                                                 April 2008 - Enclosure No. 7




                                     Quality and Performance Report 2008/09
                                            Key and High Risk Targets
                                                    April 2008
Table of Contents

                                                                               PCT Mission        Page    Current
Indicator Name                                                                  Critical ID      Number   Rating
Section 1: 2007/08 Healthcare Commission Annual Health Check
Standards for Better Health: Accessible and Responsive Care
1.1 Summary of Existing National Indicators (ENT)                                                  2        N/A
1.2 Summary of New National Targets (NNT)                                                          3        N/A

Section 2: Priority Areas for 2007/08

2.1 Waiting Time Targets                                                       1.10, 1.14, 3.2
Standards for Better Health: Accessible and Responsive Care
2.1.1 Referral to Treatment Waiting Times                                                          4
2.1.2 Diagnostic Waiting Times                                                                     6

2.2 Cancer Waiting Time Targets
Standards for Better Health: Accessible and Responsive Care
2.2.1 All cancers: two week wait                                                                   7
2.2.2 All cancers: one month diagnosis (decision to treat) to treatment                            7
2.2.3 All cancers: two month GP urgent referral to treatment                                       8

2.3 MRSA and Healthcare Acquired Infections                                         1.13
Standards for Better Health: Safety
2.3.1 Cases of MRSA (UHNS and Community)                                                           10
2.3.2 Cases of Clostridium Difficile (UHNS and Community)                                          11
2.3.3 Breakdown of Cases of Healthcare Acquired Infections in the                                  12
Community: North Staffordshire PCT Specific

2.4 48 Hour Access to Genito-Urinary Medicine (Standards for Better                 1.5            13
Health: Accessible and Responsive Care)
2.5 Smoking Cessation                                                               1.6            14
2.6 Total time in A&E: four hours or less                                           7.1            16
2.7 Choose and Book                                                                 3.10           17
2.8 Delayed Transfers of Care                                                       3.12           18

Section 3: North Staffordshire Community Healthcare Activity
Standards for Better Health: Accessible and Responsive Care
3.1 Finished Consultant Episode (FCE) Activity                                                     19       N/A
3.2 Occupied Bed Day (OBD) Activity                                                                19       N/A
3.3 Total time in A&E: four hours or less (Leek Minor Injury Unit)                  7.1            20

Section 4: Primary Care Indicators
Standards for Better Health: Clinical and Cost Effectiveness – Public Health
4.1 Blood Pressure                                                                                 21
4.2 Cholesterol Levels                                                                             22
4.3 Coronary Heart Disease (CHD) Risk Registers                                                    23
4.4 Practice-based Registers – Patients Called for Review                                          24
4.5 Prescribing: Budget vs. Actual                                                  2.6            24
4.6 Prescribing: Anti-biotic Prescribing by PBC Consortia                                          25
4.7 Emergency Admissions by PBC Consortia                                                          26
4.8 GP Written Referrals by PBC Consortia                                                          27

Section 5: Proposed Performance Report Timetable 2007/08                                           28

Annex One: Outpatient and Inpatient Waiting Times                                                  29



Performance Report/Board/JCG/April 2008                       1
Section 1: Healthcare Commission Annual Health Check

1.1 Summary of Performance against Existing National Target (ENT) Indicators

Table 1: Summary of ENT indicators




                                                                               2006/07 Score




                                                                                                                                         Of Concern


                                                                                                                                                      Movement
                                                                                                                 Achieving


                                                                                                                             Achieving
                                                                                                                                                                 Frequency




                                                                                                                             Under-
                                                                                               Page   Up to                                                        of Data
Indicator Name                                                                                  No.   date                                                       Collection
Access to a GP                                                                                        Dec-07                                           =         Quarterly
Access to a primary care practitioner                                                                 Dec-07                                           =         Quarterly
All cancers: one month diagnosis (decision to treat) to treatment                                 7   Jan-08                                           =          Monthly
All cancers: two month GP urgent referral to treatment                                            7   Jan-08                                           =          Monthly
All cancers: two week wait                                                                        8   Jan-08                                           =          Monthly
Category A calls meeting 19 minute target                                                                                                              =          Annual
Category A calls meeting 8 minute target                                                              Dec-07                                           =          Weekly
Category B calls meeting 19 minute target                                                             Dec-07                                           =          Weekly
Commissioning a comprehensive child and adolescent mental health service                              Dec-07                                           =          Annual
Commissioning of crisis resolution/home treatment services                                            Dec-07                                           =         Quarterly
Convenience and choice - PCT booking                                                                  Feb-08                                           i          Monthly
Convenience and choice - PCT facilities in place to support choice                                                                                                Annual
Delayed transfers of care                                                                        20 Dec-07                                             i         Quarterly
Diabetic retinopathy screening                                                                        Dec-07                                           =         Quarterly
Number of inpatients waiting longer than standard                                                31 Feb-08                                             =          Monthly
Number of outpatients waiting longer than standard                                               31 Feb-08                                             =          Monthly
Patients waiting longer than 3 months (13 weeks) for revascularisation                                Feb-08                                           =          Monthly
Practice based registers - patients called for review                                                                                                             Annual
Thrombolysis - 60 minute call to needle time                                                                                                                      Annual
Total time in A&E: four hours or less                                                            18   31/03/08                                         h          Weekly



Table 1 is a list of 2007/08 Existing National Target indicators for the trust. The dashboard above is the PCT
judgement on performance against these indicators in 2007/08 based on current knowledge.

Currently, of those indicators that can be assessed in-year, the PCT is achieving 14 out of the 16. The two that
are causing most concern are 1) Convenience and Choice: PCT Booking and 2) Delayed Transfers of Care.

Both these indicators are covered in more detail in section 2 of the Performance Report.
Actions: None




Performance Report/Board/JCG/April 2008                                    2
1.2 Summary of Performance against New National Target (NNT) Indicators

Table 2: Summary of NNT indicators




                                                                     2006/07 Score




                                                                                                                             Of Concern


                                                                                                                                          Movement
                                                                                                     Achieving


                                                                                                                 Achieving
                                                                                                                                                     Frequency of




                                                                                                                 Under-
                                                                                     Page   Up to                                                        Data
Indicator Name                                                                        No.   date                                                      Collection
Access to GUM clinics                                                                  15 Feb-08                                           h           Monthly
Access to reproductive health services                                                                                                                  Annual
Blood pressure                                                                         23 Dec-07                                           i          Bi-Annual
Breast cancer screening for women aged 50 to 70 years                                                                                                   Annual
Cancer mortality rate                                                                                                                                   Annual
Cardiovascular disease mortality                                                                                                                        Annual
Childhood obesity: data quality                                                                                                           N/A           Annual
Cholesterol levels                                                                     24 Dec-07                                           =          Bi-Annual
Commissioning of early intervention in psychosis services                                   Dec-07                                         =           Quarterly
Community development workers                                                                                                             N/A            TBA
Community equipment                                                                         Dec-07                                         =           Quarterly
Community matrons & additional case managers                                                Dec-07                                         =           Quarterly
CPA 7-Day follow up and Suicide Audit                                                       Dec-07                                         i           Quarterly
Data quality on ethnic group                                                                                                                            Annual
Drug misusers in treatment                                                                                                                              Annual
Drug misusers sustained in treatment                                                                                                                    Annual
Emergency bed days                                                                                                                                      Annual
Experience of patients                                                                                                                                  Annual
Four week smoking quitters                                                                  Jan-08                                         h           Monthly
GP recording of body mass index (BMI) status                                                Dec-07                                         =           Quarterly
Improving cancer services                                                                                                                               Annual
Infant health & inequalities: breastfeeding initiation rates                                Dec-07                                         =           Quarterly
Infant health & inequalities: smoking during pregnancy                                      Dec-07                                         =           Quarterly
Infection control                                                                                                                                       Annual
Number of very high intensity users                                                         Dec-07                                         =           Quarterly
Obesity: Compliance with NICE Guidance 43                                                                                                 N/A           Annual
Older people's mental health: assessment of needs and services                                                                                          Annual
Practice-based registers                                                                                                                                Annual
Referral to treatment times milestones                                                  4   Jan-08                                        N/A          Monthly
Smoking status among the population aged 16 and over                                        Dec-07                                         i          Bi-Annual
Teenage conception rates                                                                                                                                Annual
Waiting times for diagnostic tests                                                      6 Feb-08                                           h           Monthly


Table 2 is a list of 2006/07 New National Target indicators for the PCT. The dashboard above is the PCT
judgement on performance against these indicators in 2007/08 based on current knowledge.

A number of the indicators are only measured annually so the PCT is unable to assess performance in-year.

Of the 15 indicators that can be assessed at the present time, there are two that are causing some concern: 1)
CPA 7 Day Follow Up and 2) 4 Week Smoking Quitters (Smoking Cessation).

4 Week Smoking Quitters (Smoking Cessation) is discussed in more detail in section 2 of the report. CPA 7
Day Follow Up is discussed in the Director of Quality & Performance report

Actions: None




Performance Report/Board/JCG/April 2008                          3
Section 2: Key Priority Areas 2007/08
2.1 Waiting Times Targets
Note: The individual milestone targets for inpatients (20 weeks) and outpatients (11 weeks) have been formally superseded by the 18 week
target and therefore the PCT will not be measured on these milestones by the Healthcare Commission.

However, the PCT is still being measured by the Healthcare Commission to ensure that there are no breaches of the following targets for
outpatients and inpatients:
a) No 13 + week waiters (Outpatients);
b) No 26 + week waiters (Inpatients).

As such, these two elements have been removed from this section of the Performance Report so as not to cause confusion with the referral
to treatment target. However, the outpatient and inpatient figures have been put into a separate annex for information (annex one).

The diagnostic milestone target remains due to the difficulties nationally in ensuring that this element of the 18 week wait is achieved and it
is expected that it is this element that will cause the most problems.

2.1.1 Referral to Treatment (RTT)
a) The total patient journey for 85% of all patients admitted for treatment shall be 18 weeks;
b) The total patient journey for 95% of all patients not admitted for treatment (i.e. do not have an inpatient procedure) shall be 18 weeks.

Fig. 1: Percentage of patients treated within 18 weeks (admitted)


                               95.00%
                               90.00%
    % Achievement (Admitted)




                               85.00%
                               80.00%
                               75.00%                                                                                              Profile
                               70.00%                                                                                              Actual
                               65.00%
                               60.00%
                               55.00%
                               50.00%
                               27 01 2008
                               03/01 2008
                               10/02 2008
                               17/02 2008
                               24/02 2008
                               02/02 2008
                               09/03 2008
                                 /0 /20 8
                               23 03 2008
                               30/03 2008
                               06/03 2008
                               13/04 2008
                               20 04 2008
                               27/04 2008
                               04/04 2008
                               11/05 2008
                               18/05 2008
                                 /0 /20 8
                               01/05 2008
                                 /0 /20 8
                               15/06 2008
                               22 06 2008
                               29/06 2008
                               06/06 2008
                               13/07 2008
                               20 07 2008
                               27/07 2008
                               03/07 2008
                               10/08 2008
                                 /0 /20 8
                               24/08 2008
                               31/08 2008
                               07/08 2008
                               14/09 2008
                               21 09 2008
                               28/09 2008
                               05/09 2008
                               12/10 2008
                               19 10 2008
                               26/10 2008
                                 /1 /20 8
                               09/11 2008
                               16 11 2008
                               23/11 2008
                               30/11 2008
                               07/11 2008
                               14 12 2008
                               21/12 2008
                               28/12 2008
                                 /1 /20 8
                                      20 8
                                        08
                               20/01 200




                               16 3 0




                               25 5 0

                               08 6 0




                               17 8 0




                               02 0 0




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                               13/01
                               06




                                                                           Week Ending



Fig. 2: Percentage of patients treated within 18 weeks (non-admitted)


                               95.00%
    % Achievement (Admitted)




                               90.00%

                               85.00%
                                                                                                                                   Profile
                                                                                                                                   Actual
                               80.00%

                               75.00%


                               70.00%
                               27 01 2008
                               03/01 2008
                               10/02 2008
                               17/02 2008
                               24/02 2008
                               02/02 2008
                               09/03 2008
                                 /0 /20 8
                               23 03 2008
                               30/03 2008
                               06/03 2008
                               13/04 2008
                               20 04 2008
                               27/04 2008
                               04/04 2008
                               11/05 2008
                               18/05 2008
                                 /0 /20 8
                               01/05 2008
                                 /0 /20 8
                               15/06 2008
                               22 06 2008
                               29/06 2008
                               06/06 2008
                               13/07 2008
                               20 07 2008
                               27/07 2008
                               03/07 2008
                               10/08 2008
                                 /0 /20 8
                               24/08 2008
                               31/08 2008
                               07/08 2008
                               14/09 2008
                               21 09 2008
                               28/09 2008
                               05/09 2008
                               12/10 2008
                               19 10 2008
                               26/10 2008
                                 /1 /20 8
                               09/11 2008
                               16 11 2008
                               23/11 2008
                               30/11 2008
                               07/11 2008
                               14 12 2008
                               21/12 2008
                               28/12 2008
                                 /1 /20 8
                                      20 8
                                        08
                               20/01 200




                               16 3 0




                               25 5 0

                               08 6 0




                               17 8 0




                               02 0 0




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                               13/01
                               06




                                                                           Week Ending



Source: 18 Week PTLs (SHA Performance Website)




Performance Report/Board/JCG/April 2008                                4
Figure 1 and figure 2 illustrates the PCT‟s progress towards a maximum wait of 18 weeks from referral to treatment (the             Current
patient journey) by December 2008.

As the milestone target date moves closer, the 18 week target is now being measured weekly. To reflect this, the charts
above have been modified to monitor progress on this basis. Performance is measured on patients seen in the previous
seven days.

As at week ending the 30th March 2008 the PCT achieved the milestones for both the admitted and non-admitted targets.
In real terms, for the week in question, 88.2% of admitted patients were seen within 18 weeks and 90.5% of non-admitted
patients were seen within the same timescale.

Although the PCT is now monitored on a weekly basis to provide reassurance on progress, final measurement of this
target will be on the whole month of March and therefore on the monthly 18 week waiting list return.

Due to the time lag between the weekly and monthly returns, while information for the whole of March by week will be
available for the May Board report, final confirmation of whether the PCT has achieved the milestone will not be officially
confirmed until the monthly return for March has been submitted.

It is likely therefore that the PCT will not be able to report on this until the June Board report. However, initial analysis of
un-validated cumulative March data suggests that the PCT has achieved the milestones

Senior Manager Lead: Marcus Warnes

Actions:                                                                                                                           Year End
                                                                                                                                   Projection
PCT commissioners will continue to work with UHNS and other providers to transfer patients from NHS waiting lists into the
independent sector. These are primarily breach patients in pressure specialties such as orthopaedics and general surgery.

To further alleviate pressures on acute providers in meeting the 18 week target the PCT has agreement with the DoH
Central Contract Management Unit (CCMU) and the Centre for Clinical Excellence (CCE)/Nations to transfer NHS waiting
list patients. This will continue until the end of May, when it will be reviewed.

The positive effect of this will be two fold: firstly it will assist the PCT and providers to reach the waiting list target and
secondly it will enable the PCT to fulfil its minimum take on the CCE contract.

The PCT has agreed an additionality waiver for UHNS consultants and anaesthetists to work at CCE/Nations and evening
and weekend sessions are being carried out. These will continue for the foreseeable future.

To assist with the process, the PCT has recently revised its case-mix with CCE to reflect the UHNS day case mix so that
the CCE will have sufficient capacity of the correct type of procedures to facilitate transfers.

The PCT receives PTLs from every contracted provider routinely and this is closely monitored by commissioning managers
within the PCT for potential breaches and managers liaise with the providers to transfer patients as necessary




Performance Report/Board/JCG/April 2008                                5
2.1.2 Diagnostic Waiting Times
No patient shall wait more than 6 weeks for a diagnostic test by 31st March 2008

Fig. 3: Diagnostic waiting list performance: profile vs. actual (key 15 diagnostic tests)



                                        3,000
    Number of 13 and 6 week + waiters




                                        2,500

                                        2,000
                                                                                                                                   6 Week Actual
                                        1,500
                                                                                                                                   6 Week LDP Profile

                                        1,000

                                         500

                                           0
                                                Apr-07 May-07 Jun-07      Jul-07 Aug-07 Sep-07 Oct-07 Nov-07 Dec-07 Jan-08 Feb-08 Mar-08
                                                                                                Month



Source: DM01

Figure 3 monitors the PCT‟s performance against the national milestone of a maximum wait of 6 weeks in 2007/08. The                                       Current
PCT was unsuccessful in achieving the 13 week milestone by 31st March 2007.

The measurement of this indicator has changed slightly for 2007/08 to take into account all diagnostic tests (in 2006/07,
only 15 diagnostic tests were measured).

In February the PCT had 228 breaches of the diagnostic 6 week target; a decrease of 698 on January figures. This
reduction is due to the effect of the Care UK diagnostic procurement of Audiology services plus the validation of waiting
lists by UHNS. For the first time in 2007/08, the PCT is ahead of its LDP profile.

The Care UK contract was terminated in December and ceased on 14 February. The PCT has commissioned a high street
audiology provider to manage the ongoing care of patients transferred to Care UK and to treat new routine hearing loss
referrals.

Initial assessment of the March position is that all Audiology patients have been seen. UHNS have reported a number of
breaches in MRI, CT and Fluroscopy. The PCT is working with UHNS and Stoke-on-Trent PCT to clear these patients by
30th April at the latest.

Although the PCT may have a small number of breaches at the end of March it is anticipated that the Healthcare
Commission may allow a small tolerance on the target based on previous year‟s thresholds.

Senior Manager Lead: Marcus Warnes
                                                                                                                                                         Year End
Actions:                                                                                                                                                 Projection
The LHE 18 week group is working towards a 4 week maximum diagnostic wait as part of the plan for overall achievement
of the 18 week referral to treatment milestone.

To enable this target to be achieved, the following actions have been put in place in pressure areas:

                                        MRI – UHNS are utilising the free additional capacity available from Alliance Medical;
                                        Neuro-physiology – UHNS have employed an additional Neuro-Physiologist. This has enabled the Trust to clear
                                         their 6 week plus waiters by the end of December 2007/early January 2008;
                                        The PCT commissioned capacity from the IS to reduce the Audiology waiting list backlog. The PCT also
                                         commissioned activity with an alternative provider. This has ensured that there were no 6 week waiters by the
                                         end of February 2008.
                                        Echo-Cardiology – The PCT has offered additional direct access capacity to GPs which takes these referrals
                                         outside the waiting time rules.
                                        Clear March MRI, CT and Fluroscopy breaches by transferring patients to alternative independent sector and
                                         NHS providers.

The PCT is therefore confident that diagnostic waiting time performance will improve in 2007/08 and the national milestone
targets will be achieved by the target date of 30th April at the latest.




Performance Report/Board/JCG/April 2008                                                          6
2.2 Cancer Waiting Times Targets

2.2.1 All cancers: two week wait
Maintain a two-week maximum wait from urgent GP referral to first outpatient appointment for all urgent suspected cancer referrals

Fig. 4: Two week waits


                          350                                                                                                     100%
                          315                                                                                                     90%
                          280                                                                                                     80%
    Number of Patients




                          245                                                                                                     70%
                          210                                                                                                     60%
                          175                                                                                                     50%
                          140                                                                                                     40%
                          105                                                           Number o f patients seen within 1 days
                                                                                                                         4        30%
                                                                                        To tal number o f patients seen
                          70                                                                                                      20%
                                                                                        % A chievement
                          35                                                                                                      10%
                           0                                                                                                      0%
                                Jul-06 Aug-06 Sep-06 Oct-06 Nov-06 Dec-06 Jan-07 Feb-07 Mar-07 Apr-07 May-07 Jun-07
                                                                      Month


Source: SHA Cancer Waiting Times Report

The PCT achieved this target in 2006/07 with all patients referred urgently by their GP being seen within 2                            Current    Year End
weeks. The PCT will strive to improve this good performance in 2007/08.                                                                           Projection

The SHA only report two week waits by exception (i.e. when a breach of the target has occurred). As such, the
fact that the PCT has had no update since June 2007 (the SHA began to provide cancer reports from July 2007)
suggest the PCT remains at 100% for this indicator. However, the PCT is still attempting to source actual figures
for this indicator.

Senior Manager Lead: Judith Bell


2.2.2 All cancers: one month diagnosis (decision to treat) to treatment
Ensure a maximum waiting time of one month from diagnosis to treatment for all cancers by December 2005

Fig. 5: One month diagnosis to treatment



                          100                                                                                                           100%
                                                                                                                                        90%
                           80                                                                                                           80%
     Number of Patients




                                                                                                                                        70%
                           60                                                                                                           60%
                                                                                                                                        50%
                           40                                                                                                           40%
                                                                                     Number o f patients treated within o ne mo nth     30%
                                                                                     To tal number o f patients treated
                           20                                                                                                           20%
                                                                                     % A chievement                                     10%
                            0                                                                                                           0%
                                Mar-07 Apr-07 May-07 Jun-07   Jul-07 Aug-07 Sep-07 Oct-07 Nov-07 Dec-07 Jan-08 Feb-08
                                                                        Month


Source: GMCN Cancer Waiting Times Report/SHA

In 2006/07, only 4 patients did not have their first treatment within a month of diagnosis, out of a total of 790                       Current   Year End
(0.5%). The target for the PCT in 2007/08 is to ensure that 98% of patients are treated within one month.                                         Projection

Year to date figures to February 2008 are encouraging with 100% performance achieved in each of the eleven
months so far this year.

Senior Manager Lead: Judith Bell



Performance Report/Board/JCG/April 2008                                         7
2.2.3a All cancers: two month GP urgent referral to treatment
Achieve a maximum waiting time of two months from urgent referral to treatment for all cancers by December 2005.

Fig. 6: Two month GP urgent referral to treatment



                         60                                                                                                      100%
                                                                                                                                 98%
                         48                                                                                                      96%
    Number of Patients




                                                                                                                                 94%
                         36                                                                                                      92%
                                                                                                                                 90%
                         24                                                                                                      88%
                                     Number o f patients treated within two mo nths
                                                                                                                                 86%
                         12          To tal number o f patients seen                                                             84%
                                     % A chievement                                                                              82%
                         0                                                                                                       80%
                              Mar-07 Apr-07 May-07 Jun-07              Jul-07 Aug-07 Sep-07 Oct-07 Nov-07 Dec-07 Jan-08 Feb-08
                                                                                      Month



Source: GMCN Cancer Waiting Times Report/SHA

In 2006/07, 94.64% of patients were treated within two months of being referred by a GP, which equates to 28 patients of the           Current
522 referred not being seen within the target period. The target for the PCT in 2007/08 is to ensure that 95% of all patients
are treated within two months.

February 2008 figures for 62 Day GP urgent referral to treatment target hit 100% for the third time in 2007/08. This means
that PCT YTD performance has now risen to 96.12%, slightly above the 2007/08 Healthcare Commission target of 95%.

Fig 7 and fig 8 below provide a breakdown by cancer type of breaches of the 62 day target by absolute numbers and as a
proportion of total referrals. These graphs show a number of areas of concern, but particularly in Lung, Haematology, Head
and Neck, Testicular and Urological Cancers.




Performance Report/Board/JCG/April 2008                                                  8
2.2.3b All cancers: two month GP urgent referral to treatment
Analysis of breaches of two month GP urgent referral to treatment target

Fig. 7: Number of breaches of 62 day target by cancer type:



                                 9
                                 8                                                                      2007/08 Breaches to Feb 08

                                 7                                                                      2006/07 Breaches
          Number of Breaches




                                 6
                                 5
                                 4
                                 3
                                 2
                                 1
                                 0




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                                                                         Cancer Type


Fig. 8: Number of breaches of 62 day target by cancer type as a % of total referrals:



                                 100.0%
  % achievement by cancer type




                                 90.0%
                                 80.0%
                                 70.0%
                                 60.0%
                                 50.0%
                                 40.0%
                                 30.0%
                                 20.0%                                                                              2007/08 YTD % A chievement
                                                                                                                    2006/07 % A chievement
                                 10.0%
                                     0.0%
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                                                       og




                                                        er




                                                                                                                    ic
                                                                                   O


                                                                                                rc
                                        Br



                                                      lo




                                                                                                                                            lo
                                                                                                                                 pp
                                                      w
                                                      &
                                                     ol




                                                                                                                  st




                                                                                                                                          ro
                                                                                              Sa
                                                   co




                                                   Lo




                                                                                                                             U
                                                   at




                                                                                                                Te
                                                   d




                                                                                                                                          U
                                                 ea
                                                ae



                                                 m
                                              ae



                                               H
                                             yn


                                            H
                                            G




                                                                             Cancer Type


Source: GMCN Cancer Waiting Times Report/SHA

Senior Manager Lead: Judith Bell
Actions:                                                                                                                                             Year End
The PCT will investigate any breaches of the 62 day target to ascertain if there are any underlying issues                                           Projection
causing these. The Lung pathway had significant redesign to improve speed through to treatment. Patient
trackers are working with the Head and Neck team to expedite appointments.

The PCT will also work closely with UHNS to put in place corrective measures to ensure further breaches do
not occur.




Performance Report/Board/JCG/April 2008                                            9
2.3 Healthcare Associated Infections
Reduce MRSA cases by 27 cases and Clostridium Difficile by 546 cases at UHNS in 2007/08
Reduce MRSA cases to 0 cases and Clostridium Difficile to 177 cases in the Community in 2007/08

2.3.1 Cases of MRSA (UHNS and Community)

Fig. 9: Cases of MRSA at UHNS and Community


                    16
                                                M RSA Cases (Acute)              M RSA Cases (Community)
                    14
                    12
  Number of Cases




                    10
                    8

                    6
                    4

                    2
                    0
         Au 6




         Au 7
         J u 06




         J u 07
          Ju 6




         Fe 0 7




          Ju 7




         Fe 0 8
         Ap 07




                 8
         O 06


         D -06
         J a 06


         M 07




         O 07


         D -07
         J a 07


         M 08
         N 06




         N 07
         Se 06




         Se 07
         M 06




         M 07
             l-0




             l-0




              -0
               0




               0
            p-




              -




            p-




              -
              -




              -
            n-




            n-




            n-




            n-
              -
            b-




            b-
            g-




            g-
             -




             -
            r-




            r-
           ov
           ec




           ov
           ec
           ay




           ay
           ar




           ar
           ct




           ct
         Ap




                                                      Month


Table 3: MRSA Performance YTD

Acute:                                                   Community:
                               Cases
2006/07 Target:                       81                 2007/08 Target:                           0
2006/07 Actual:                      100                 2007/08 Out-Turn                          0
2007/08 Target:                       54                 2007/08 Variance:                         0
2007/08 Out-Turn                      71                 2007/08 Variance (%):                     0
2007/08 Variance:                     17
2007/08 Variance (%):               31%

Fig 9 shows the number of cases of MRSA at UHNS and within the community since April 2006. Early in the year there had        Current
been no real pattern with sharp increases and decreases each month. For three months cases appeared to have levelled out
at around 3 or 4 per month, September saw a sharp increase but figures decreased again in October and November.

Un-validated March figures have seen a slight increase in the numbers with 3 cases reported in month.

Overall, while UHNS has not achieved its 2007/08 target, the number of MRSA cases has reduced by 10 from 2006/07.

Note: The Community figures do not differentiate between PCTs. Therefore numbers reported could be for either North
Staffs PCT or Stoke PCT. The North Staffs element can be found in table 5.
Senior Manager Lead: Jane Gallimore
                                                                                                                             Year End
Actions:                                                                                                                     Projection
The PCT continues to work with key local providers directly or via lead PCT commissioner partners to ensure compliance and
implementation of agreed action plans through monthly performance monitoring regimes.

UHNS have agreed action and implemented through a phased roll-out programme to screen all patients admitted through its
A&E/emergency portals and extend the screening process to all elective admissions by March 2009.




Performance Report/Board/JCG/April 2008                               10
2.3.2 Cases of Clostridium Difficile (UHNS and Community)

Fig. 10: Cases of Clostridium Difficile at UHNS


                    70
                                                                   C diff (Acute)         C Diff Cases (Community)
                    60
  Number of Cases




                    50

                    40

                    30

                    20

                    10

                    0
                         Apr-07 May-07 Jun-07 Jul-07 Aug-07 Sep-07 Oct-07 Nov-07 Dec-07 Jan-08 Feb-08 Mar-08
                                                                Month


Table 4: Clostridium Difficile Performance YTD

Acute:                                                          Community:
                                           Cases
2007/08 Target:                                    433          2007/08 Target:                          177
2007/08 Out-Turn:                                  458          2007/08 Out-Turn:                        178
2007/08 Variance:                                   25          2007/08 Variance:                          1
2007/08 Variance (%):                              6%           2007/08 Variance (%):                    1%

Fig 10 shows the number of cases of Clostridium Difficile at UHNS and within the community since April 2006.                Current

This shows that overall there was a steady decrease in the number of cases between July 2007 and November 2007 and
after a slight rise in December, the number of cases has reached a plateau of circa 19-20 cases in Q4 (March figures un-
validated).

Overall, UHNS has not achieved its 2007/08 target; the community figures are slightly above target for the year.

Note: The Community figures do not differentiate between PCTs. Therefore numbers reported could be North Staffs PCT or
Stoke PCT. The North Staffs element can be found in table 5.
Senior Manager Lead: Jane Gallimore
Actions:                                                                                                                   Year End
Please see 2.3.1 for action plan                                                                                           Projection




Performance Report/Board/JCG/April 2008                                 11
2.3.3 Breakdown of Cases of Healthcare Acquired Infections in the Community: North Staffordshire
PCT Specific

Table 5: Breakdown of Cases of MRSA and Clostridium Difficile in the community

   Month       New C.difficile Isolates Pre 48 Hour MRSA
                Community Hospitals Bacteraemias NSPCT



Apr-07                      3                        1
                                                  Hospital
May-07                      1                        0

Jun-07                      1                         0

Jul-07                      1                       1
                                                 Community
Aug-07                      2                       0

Sep-07                      0                       1
                                                 Community
Oct-07                      1                       2
                                                 Community
Nov-07                     0                        0
Dec-07                     2                        1
                      (Cheadle=2)                Community



Jan-08                     3                          0
                     Cheadle =1
              (Transferred from UHNS to
              Cheadle with symptoms =1)

               Leek = 1 picked up during
                  Norovirus outbreak

Feb-08                     1                          0
                  Cheadle (Ward 1) = 1
Mar-08                     5                          0


Totals                     20                         7
Sources: UHNS/Health Protection Agency

KEY

Column One: New case of MRSA confirmed in specimens, e.g. wound swab, sputum confirming the presence of infection
Column Two: All positive screening results showing Colonisation only (not infection) of MRSA. Requires decolonisation procedure to be
implemented e.g. nasal mupirocin and hibiscrub baths for 5 days.
Column Three: New C. diff. infections requiring treatment if symptomatic e.g. diarrhoea, unwell, temperature. Nurse in side ward and treat
with appropriate antibiotic therapy.
Column Four: New EBBL infection (E-coli usually in urine) requiring treatment if symptomatic of urine infection e.g. frequency of passing
urine, unwell, temperature. Nurse in side ward and treat with antibiotics if needed.
Column Five: All pre 48 hour MRSA Bacteraemias (blood infection) confirmed during the first 48 hours following admission to UHNS are
deemed as acquired in the community e.g. community hospitals, care homes and patients own homes.
Column Six: All in patients in community hospitals with an MRSA Bacteraemia.

Fig 12 shows the number of cases of Clostridium Difficile at UHNS and within the community since April 2006.                     Current

Note:




Senior Manager Lead: Jane Gallimore
Actions:                                                                                                                       Year End
Please see 2.3.1 for action plan                                                                                               Projection




Performance Report/Board/JCG/April 2008                            12
2.4 48 Hour Access to Genito-Urinary Medicine (GUM)
The percentage of patients attending GUM clinics who are offered an appointment within 48 hours of contacting a service should reach
100% by 31st December 2008

Fig. 11: GUM waiting list performance: profile vs. actual



                                     100.00%
                                               Actual - Offered
                                     90.00%    Actual - Seen
     % offered appointment or seen




                                               LDP Profile - Offered
                                     80.00%    LDP Profile - Seen
                                     70.00%
                                     60.00%
                                     50.00%
                                     40.00%
                                     30.00%
                                     20.00%
                                     10.00%
                                      0.00%
                                                    08
                                                      8



                                                      8




                                                      8



                                                      8



                                                      8
                                                     8
                                                     8



                                                     8




                                                     8


                                                     8
                                                    08




                                                   /0



                                                   /0
                                                   /0



                                                   /0




                                                   /0
                                                   /0
                                                  /0



                                                  /0




                                                  /0


                                                  /0
                                                 7/
                                                 7/


                                                07



                                                07




                                                07
                                               07




                                                07



                                                07
                                                07



                                                07




                                                07


                                                07
                                              00
                                              00


                                             20



                                             20




                                             20



                                             20



                                             20
                                             20



                                             20




                                             20


                                             20
                                             20
                                            l2
                                           r2




                                           n




                                           n
                                         ay




                                           b


                                         ar
                                          ct


                                         ov


                                         ec
                                        Ju



                                          g



                                          p
                                       Ju




                                       Ja
                                       Ap




                                       Fe
                                       Au



                                       Se



                                       O




                                       M
                                       M




                                       N


                                       D
                                                                            Month


Source: GUMAMM

Figure 11 shows monthly progress by the PCT towards its two GUM targets for 2007/08. These are:                                Current

a)        The number of people offered an appointment within 48 hours of contacting the GUM service;
b)        The number of people seen within 48 hours of contacting the GUM service.

The PCT achieved its LDP target of offering 100% access by 31st December 2007. All patients who used the
service in the last three months (December, January and February) were offered an appointment within 48
hours. Of those 92% were actually seen within 48 hours in February.

The PCT was one of only three PCTs within the West Midlands to achieve this target in February, and one of
only three PCTs to have achieved 100% in December, January and February; the other two PCTs being Stoke-
on-Trent PCT and Coventry PCT.

Senior Manager Lead: Judith Bell
                                                                                                                             Year End
Actions:                                                                                                                     Projection

Plan in place to maintain target over longer term




Performance Report/Board/JCG/April 2008                                13
2.5 Smoking Cessation
Achieve in-year LDP target of 1266 smoking quitters in 2007/08 and three-year (2005-08) LDP target of 3533 smoking quitters

Fig. 12: 4 week smoking quitters – performance vs. LDP target (cumulative)



                                        4,000
                                                                 Actual
            Number of 4 Week Quitters




                                        3,500
                                        3,000                    LDP Profile

                                        2,500
                                        2,000
                                        1,500
                                        1,000
                                         500
                                           0
                                                   Q1 05/06


                                                                 Q2 05/06


                                                                               Q3 05/06


                                                                                            Q4 05/06


                                                                                                         Q1 06/07


                                                                                                                      Q2 06/07


                                                                                                                                  Q3 06/07


                                                                                                                                                Q4 06/07


                                                                                                                                                            Q1 07/08


                                                                                                                                                                        Q2 07/08


                                                                                                                                                                                    Q3 07/08


                                                                                                                                                                                                Q4 07/08
                                                                                                                       Quarter



Fig. 13: 4 week smoking quitters – performance vs. Healthcare Commission target (in-year)



                                        1400
     Number of 4 Week Quitters




                                        1200
                                                              Actual
                                        1000                  Profile

                                        800

                                        600

                                        400

                                        200

                                          0
                                                                            Jun-07


                                                                                          Jul-07




                                                                                                                                 Oct-07




                                                                                                                                                                       Jan-08


                                                                                                                                                                                   Feb-08


                                                                                                                                                                                               Mar-08
                                                                                                                                               Nov-07


                                                                                                                                                           Dec-07
                                                              May-07




                                                                                                                    Sep-07
                                                Apr-07




                                                                                                       Aug-07




                                                                                                                       Month



Source: Smoking Cessation Monitoring Returns




Performance Report/Board/JCG/April 2008                                                                                                   14
The PCT has two targets for smoking cessation based on the number of people continuing to quit smoking at             Current
their four week follow up meeting.

The first target (Fig. 12) relates to the PCT‟s LDP profile and is a cumulative target based on the PCT‟s
progress since April 2003 in persuading people to quit smoking. Progress against this target is measured
quarterly.
        st
As at 31 December 2007 the PCT was 3.1% ahead of its quarterly milestones.

The second target (Fig. 13) is set by the Healthcare Commission and relates to the number of people within
2007/08 who have quit against the number planned by the PCT. In 2006/07 the PCT under-achieved on this
target.

The PCT now receives monthly figures for Smoking Cessation. As at January, the PCT is 9.3% below its
trajectory.

This is a slippage from the position at the end of December, when the PCT was 8.5% behind trajectory. This
slippage is partly due to the fact that the monthly returns are submitted before full validation of the figures by
the service can be undertaken. Therefore the figures provided for January are likely to be understated.

The PCT requires a further 309 people to quit smoking in the remaining two months of the year to achieve the
target of 1266 smoking quitters in 2007/08.

The PCT is currently seeking assurances from the Smoking Cessation service regarding out-turn performance
and a further update will be provide in the May report.

Senior Manager Lead: Jacqueline Small
                                                                                                                     Year End
Actions:                                                                                                             Projection

Short Term:
To finalise and implement an agreed action plan which:
         Undertakes proactive press promotion and advertising promoting benefits of smoking cessation,
          including “good news stories”
         Contact GP practices and ensure proactive targeting for GPs to offer 4 week programme to all
          attending smoker patients
         Contact all pharmacies to reinvigorate programme and ensure all reporting updated
         Ensure all 4 week quitters data is rigorously trawled and submitted

Medium Term:
The Health Improvement Team is leading new plans for a social marketing approach to smoking cessation.




Performance Report/Board/JCG/April 2008                      15
2.6 Total Time in A&E: Four Hours or Less
98% of patients should be seen within the four hour maximum wait in A&E from arrival to admission, transfer or discharge

Fig 14: A&E performance at UHNS


                                     100%
                                                                  %Seen Within 4 Hours (Compliant) Type
                                                                  National Target
                                              99%                 Healthcare Commission Threshold
                                                                  YTD Average
  % Achievement




                                              98%


                                              97%


                                              96%


                                              95%
          /0 07

          /0 07
          /0 07

          /0 07

          /0 07

          /0 07

          /0 07

          /0 07

          /0 07

          /0 07

          /0 07

          /0 07

          /1 07

          /1 07

          /1 07

          /1 07

          /1 07

          /1 07
          /1 07

          /0 07

          /0 08

          /0 08

          /0 08

          /0 08

          /0 08
                08
        22 /20

        06 /20
        20 /20

        03 /20

        17 /20

        01 /20

        15 /20

        29 /20

        12 /20

        26 /20

        09 /20

        23 /20

        07 /20

        21 /20

        04 /20

        18 /20

        02 /20

        16 /20
        30 /20

        13 /20

        27 /20

        10 /20

        24 /20

        09 /20

        23 /20
              20
            3/
            4

            4

            5
            5

            6

            6

            7

            7

            7

            8

            8

            9

            9

            0

            0

            1

            1

            2

            2
            2

            1

            1

            2

            2

            3
          /0
        08




                                                                                                                                                          Week Ending

Source: SITREPS

Fig 15: A&E attendances by North Staffs PCT responsible patients at UHNS (Rolling 12 Month Totals)


                                              35,000
                                                                                                                                                                                                                           Change since M arch 2006:
                                              34,000                                                                                                                                                                       A ttendances: - 812
                                                                                                                                                                                                                           % change: - 2.52%
                                              33,000                                                                                                                                                                       Change since Octo ber 2006:
                  Number of A&E Attendances




                                                                                                                                                                                                                           A ttendances: -278
                                              32,000                                                                                                                                                                       % Change: - 0.88%

                                              31,000

                                              30,000
                                                       32,180
                                                                31,997




                                              29,000
                                                                         31,839
                                                                                  31,867


                                                                                                    31,735
                                                                                                             31,729
                                                                                           31,622




                                                                                                                      31,646
                                                                                                                               31,597




                                                                                                                                                                              31,517
                                                                                                                                        31,473
                                                                                                                                                 31,421


                                                                                                                                                                     31,411




                                                                                                                                                                                                                                                       31,424
                                                                                                                                                           31,325




                                                                                                                                                                                       31,375




                                                                                                                                                                                                                                                                31,368
                                                                                                                                                                                                         31,288
                                                                                                                                                                                                                  31,277




                                                                                                                                                                                                                                              31,314
                                                                                                                                                                                                                                     31,239
                                                                                                                                                                                                31,142




                                                                                                                                                                                                                            31,131




                                              28,000

                                              27,000

                                              26,000

                                              25,000
                                                       Mar-06


                                                                         May-06
                                                                                  Jun-06
                                                                                           Jul-06




                                                                                                                      Oct-06
                                                                                                                               Nov-06
                                                                                                                                        Dec-06
                                                                                                                                                 Jan-07
                                                                                                                                                           Feb-07
                                                                                                                                                                     Mar-07


                                                                                                                                                                                       May-07
                                                                                                                                                                                                Jun-07
                                                                                                                                                                                                         Jul-07




                                                                                                                                                                                                                                     Oct-07
                                                                                                                                                                                                                                              Nov-07
                                                                                                                                                                                                                                                       Dec-07
                                                                                                                                                                                                                                                                Jan-08
                                                                                                                                                                                                                                                                         Feb-08
                                                                                                                                                                                                                                                                                  Mar-08
                                                                                                             Sep-06




                                                                                                                                                                                                                            Sep-07
                                                                Apr-06




                                                                                                    Aug-06




                                                                                                                                                                              Apr-07




                                                                                                                                                                                                                  Aug-07




                                                                                                                                                                    Month


Source: April 05 – March 06 (Health Informatics Service); Apr 06 onwards (UHNS SLAM Reports)

Fig. 14 above shows the % of patients having to wait four hours or less to be seen in the A&E department at UHNS against                                                                                                                                                                    Current
the national target of 98% and the Healthcare Commission threshold of 97.5%.

In 2006/07, performance at UHNS (to which North Staffordshire PCT‟s performance is derived) was at 97.01%. The PCT is
now in receipt of full year figures for 2007/08 and can confirm that the final achievement figure is 97.65%. The Healthcare
Commission have now confirmed the threshold for achievement for 2007/08 remains 97.5%. Therefore the PCT will achieve
the A&E target in 2007/08.

Senior Manager Lead: Sandra Cooper
Actions:                                                                                                                                                                                                                                                                                   Year End
The redesign of A&E is now being implemented as the respective CEOs have signed-off the A&E redesign projects. The new                                                                                                                                                                     Projection
weekend service commenced on 5th January 2008. By April 2008 it is expected that this service will be extended to every
weekday evening 5pm-10pm.

As UHNS experience most difficulties around the weekend with a subsequent effect on Monday and Tuesday, the PCT‟s
assumption is that this will help to reduce the four hour wait.

Continued parallel work is increasing community based urgent health and social services for local access plus community
based pro-active case management to decrease exacerbations of long term conditions requiring acute care.

Performance Report/Board/JCG/April 2008                                                                                                                              16
2.7 Choose and Book
90% of all patient referrals should be completed via the choose and book system

Fig 16: Choose and Book performance



                                100%
                                90%
  PCT Performance vs Plan (%)




                                80%
                                70%
                                60%
                                50%                                                                 Actual
                                40%                                                                 Target
                                30%
                                20%
                                10%
                                 0%
                                       Q1           Q2                     Q3                      Q4

                                                             Month


Source: MF01

Fig. 16 above shows the % of patients referred by GPs who were booked using the Choose and Book system by quarter. The            Current
presentation of this indicator has been amended to reflect a change in method of measurement by the Healthcare
Commission in 2007/08.

YTD performance is at 55.06%. Performance has dropped over the last couple of quarters; mainly due to an apparent
increase in additions to the outpatient waiting list via GP referrals. The PCT has investigated this with UHNS and since the
transfer to the iSoft/Lorenzo system in July 2006 the Trust has been unable to fully capture the number of referrals received.
A fix was made to the software system in October, hence the apparent „increase‟ in referrals.

Based on 2006/07 Healthcare Commission thresholds, the PCT is under-achieving against this target, although if current
trends continue the PCT may be in danger of failing the target. Set against this is that the 90% target is proving problematic
nationally and also North Staffs PCT is one of the higher-performing Trusts within the West Midlands.

At present it is difficult for the PCT to achieve higher percentage as UHNS do not have a directly bookable system (DBS)
which means that the PCT cannot easily use the Choose and Book system to book into UHNS

Senior Manager Lead: Marcus Warnes
                                                                                                                                 Year End
Actions:                                                                                                                         Projection
The PCT expects that once the DES monitoring period starts again (Sept – Feb) performance will increase again as practices
will have more of an incentive to use C&B. It is thought performance may have fallen over the summer as there was no DES
in place.

The 90% target is not achievable until UHNS move to a Directly Bookable System (DBS), migration to which commenced on
31st March 2008. Once this occurs the PCT should see performance improve to 90%. However, the PCT is dependent on
UHNS moving to a DBS system to enable it to achieve its target.




Performance Report/Board/JCG/April 2008                             17
2.8 Delayed Transfers of Care
Delayed transfers of care should reduce to a minimal level by 2006

Fig 17: Level of delayed transfers vs. 2006/07 Healthcare Commission Threshold
    % of patients treated within one




                                       9.00%
                                       8.00%
                                       7.00%                                                           2007/08 Performance
                                       6.00%                                                           2006/07 Threshold
                 month




                                       5.00%
                                       4.00%
                                       3.00%
                                       2.00%
                                       1.00%
                                       0.00%
                                                      Q1                  Q2                    Q3               Q4
                                                                                 Quarter

Source: LDPR

Fig. 17 above shows the % of patients who experienced a delayed transfer of care between Q1 and Q3                                                Current
2007/08. Performance has improved slightly in Q3 with a figure of 5.79% experiencing a delayed discharge,
although this is still some way above the Healthcare Commission threshold of 3.5% for 2006/07.

Q4 figures will not be available until the end of April; an update will be provided in the May report. Performance
data received up to the end of Q3 showed current PCT performance at 6.53% for the year to date.

Senior Manager Lead: David Bassett
Actions:                                                                                                                                         Year End
A Health Economy review of Delayed Discharges through the Emergency Care Operational Group (ECOG) has                                            Projection
been undertaken with the following recommendations:

•                                      Additional capacity is required in primary care of 50 beds across the economy with the proposal that
                                       this be funded from excess bed day allocation (18 In N Staffs PCT in the Newcastle area).
•                                      That UHNS needs to improve its discharge processes and ensure simple and timely discharges from
                                       medical beds every day of at least 30.
•                                      Clarity of purpose and enhancement of the responsibilities of the discharge team will map bed
                                       availability and ensure safe discharge for the most complex and vulnerable.
•                                      The current provision of continuing care in community hospitals for older people should be reviewed
                                       and possibly moved into nursing home to give more capacity for assessment and rehabilitation in
                                       community hospitals.
•                                      Joint health and social care resolutions need to be sought to ensure patients get the right care in the
                                       right place at the right time.




Performance Report/Board/JCG/April 2008                                                    18
Section 3: North Staffordshire Community Healthcare Activity

3.1 Finished Consultant Episodes (FCEs) carried out at North Staffordshire PCT Hospitals

Fig. 18: FCEs at North Staffordshire PCT hospitals



                     500
                     450                   North Staffs PCT
                     400                   Stoke-on-Trent PCT
                     350                   Other PCTs
    Number of FCEs




                     300
                     250
                     200
                     150
                     100
                      50
                       0
                               Bradw ell Hospital                Cheadle Hospital               Leek Moorlands Hospital
                                                        North Staffordshire PCT Hospital

Source: CHIPS

Figure 18 illustrates the activity carried out at each PCT Community Hospital up to the end of February. As would be expected, the vast
majority of patients treated within the three hospitals are patients of North Staffordshire PCT.

In 2008/09 the provider arm element of this report will be developed further, once the performance management framework for the North
Staffordshire Community Healthcare has been agreed.
Actions: None

3.2 Occupied Bed Days (OBDs) at North Staffordshire PCT Hospitals

Fig. 19: OBDs at North Staffordshire PCT hospitals



                     14,000

                     12,000
                                                                           North Staffs PCT
                     10,000                                                Stoke-on-Trent PCT
    Number of OBDs




                                                                           Other PCTs
                      8,000

                      6,000

                      4,000

                      2,000

                           0
                                 Bradw ell Hospital               Cheadle Hospital              Leek Moorlands Hospital
                                                        North Staffordshire PCT Hospitals

Source: CHIPS

Figure 19 illustrates the number of occupied bed days at each hospital as a result of the activity carried out in fig.22. As would be expected,
the vast majority of patients treated within the three hospitals are patients of North Staffordshire PCT

In 2008/09 The North Staffordshire Community Healthcare element of this report will be developed further, once the performance
management framework for the North Staffordshire Community Healthcare has been agreed.
Actions: None




Performance Report/Board/JCG/April 2008                                  19
3.3 Total Time in A&E: Four Hours or Less (Leek Minor Injury Unit)
98% of patients should be seen within the four hour maximum wait in A&E from arrival to admission, transfer or discharge

Fig 20: A&E performance at Leek Minor Injury Unit



                  100%


                  99%
  % Achievement




                  98%


                  97%                                                                                    %Seen Within 4 Hours (Compliant)
                                                                                                         Type
                                                                                                         National Target
                  96%
                                                                                                         Healthcare Commission Threshold


                  95%
          /0 07

          /0 07
          /0 07

          /0 07

          /0 07

          /0 07

          /0 07

          /0 07

          /0 07

          /0 07
          /0 07

          /0 07

          /1 07

          /1 07

          /1 07

          /1 07

          /1 07

          /1 07
          /1 07

          /0 07

          /0 08

          /0 08

          /0 08

          /0 08

          /0 08
                08
        22 /20

        06 /20
        20 /20

        03 /20

        17 /20

        01 /20

        15 /20

        29 /20

        12 /20

        26 /20
        09 /20

        23 /20

        07 /20

        21 /20

        04 /20

        18 /20

        02 /20

        16 /20
        30 /20

        13 /20

        27 /20

        10 /20

        24 /20

        09 /20

        23 /20
              20
            3/
            4

            4

            5
            5

            6

            6

            7

            7

            7

            8

            8
            9

            9

            0

            0

            1

            1

            2

            2
            2

            1

            1

            2

            2

            3
          /0
        08




                                                                  Week Ending


Source: SITREPS

Fig. 20 above shows the % of patients having to wait four hours or less to be seen at Leek Minor                   Current         Year End
Injury Unit at Leek Moorlands Hospital against the national target of 98% and the Healthcare                                       Projection
Commission threshold of 97.5%.

Attendances at the unit are counted as part of the overall A&E target in indicator 2.6.

In 2006/07, performance at Leek was at 100%. The PCT is now in receipt of full year figures for
2007/08 and can confirm that the final achievement figure is 100%.

Senior Manager Lead: Sandra Cooper




Performance Report/Board/JCG/April 2008                            20
Section 4: Primary Care Indicators

4.1 Blood Pressure
Increase the percentage of patients with CHD whose last blood pressure reading (measured within the last 9 months) is 150/90 or less to
73.7% by 31st March 2008

Fig. 21: Blood pressure measurement – plan vs. actual




Fig. 22: Patients on Hypertension Register – plan vs. actual




Source: LDPR

The 2007/08 data collection for the Blood Pressure indicator has changed in three ways. Firstly, the risk                    Current
register used has now changed to the hypertension register from the CHD register, secondly the indicator
now looks for the percentage of patients measured in the last nine months, rather than the last fifteen months
and finally there are now two elements to the indicator: firstly performance versus plan (as above) and
secondly, number of patients on the hypertension register compared to predicted numbers.

GP practices have completed updating QMAS for a final 2007/08 position and it is expected that this exercise
will improve performance from the Q2 position for the following indicators:

•         Blood Pressure
•         Cholesterol Levels

It is anticipated that a final 2007/08 position will be presented to the Board in the May performance report.

Senior Manager Lead: Jan Butterworth
                                                                                                                            Year End
Actions                                                                                                                     Projection
The PCT will further investigate the reason for the drop in performance.




Performance Report/Board/JCG/April 2008                            21
4.2 Cholesterol Levels
Increase the percentage of patients with CHD whose last measured cholesterol (measured within the last 15 months) is 5mmol/l or less to
65% by 31st March 2008

Fig. 23: Cholesterol measurement – plan vs. actual




Fig. 24: Patients on CHD Register – plan vs. actual




Source: LDPR

As with the Blood Pressure indicator, the Cholesterol Level indicator has changed for 2007/08. There are                     Current
now two parts to the indicator; one assesses the number of patients called for measurement as before, but
there is now a second part which looks at the number of patients on the CHD register against those planned

For the first part, the PCT has more patients whose last measured cholesterol (measured within the last 15
months) is 5mmol/l or less than in the LDP at Q2. However, performance will need to improve by another
couple of percentage points to achieve the LDP target of 51.54% by 31st March 2008.

For the second part, the PCT has more patients on the CHD register than planned in the LDP and indeed
simple maintenance of the current position will lead the PCT to achieve its LDP target of 88%.

GP practices have completed updating QMAS for a final 2007/08 position and it is expected that this exercise
will improve performance from the Q2 position for the following indicators:

•         Blood Pressure
•         Cholesterol Levels

It is anticipated that a final 2007/08 position will be presented to the Board in the May performance report.

Senior Manager Lead: Jan Butterworth
                                                                                                                           Year End
Actions                                                                                                                    Projection




Performance Report/Board/JCG/April 2008                           22
4.3 Coronary Heart Disease (CHD) Risk Register
The numbers of GP practices with PCT-validated registers of patients without symptoms of cardiovascular disease but who have an
absolute risk of CHD events greater than 30% over the next 10 years should increase with time to all 35 practices by 31st March 2008.

Fig. 25: Practice-based registers – number of practices with PCT validated-registers




Source: LDPR

There are two targets relating to practice-based registers that the PCT is measured against:                                   Current

     a)   the number of practices that have PCT validated-registers
     b)   the percentage of patients on the registers called for review

On the first target (Fig.25), the PCT has failed to reach its target of 30 practices having PCT validated registers.

The PCT has now validated GP practice systems to establish whether these hold appropriate registers for the Coronary
Heart Disease (CHD) Risk Register indicator.

As a result of this exercise the PCT is reassured that all practices have appropriate systems in place.

Senior Manager Lead: Debi Dean/Jane Matthews
                                                                                                                              Year End
                                                                                                                              Projection




Performance Report/Board/JCG/April 2008                                23
4.4 Practice-based Registers – Patients Called for Review
80% of patients on registers of people with diabetes in practices in the PCT to have been called for review in the last 12 months

Fig. 26: Practice-based registers – percentage of patients called for review




Source: LDPR

This is the second practice-based register target, and is measured on an annual basis.                                   Current    Year End
                                                                                                                                    Projection
The PCT has performed well on this target in 2006/07 with 97.79% of patients on the register being called for
review in 2006/07 against a PCT target of 80% (carried over from 2005/06). The challenge is to continue this
good performance into 2007/08.

Senior Manager Lead: Katrina Woolley/Dorothy Clohesy



4.5 Prescribing: Budget vs. Actual
All PCT prescribing expenditure to achieve plan

Fig. 27: GP Prescribing: Budget vs. Actual



    £30,000,000

                               07/08 - P rescribing Expenditure
    £25,000,000
                               07/08 - P rescribing B udget


    £20,000,000


    £15,000,000


    £10,000,000


     £5,000,000


            £-
                                                     7
                             07


                                        07




                                                                                                          08
                                                                      07




                                                                                         7


                                                                                                  7




                                                                                                                    08


                                                                                                                            08
                                                                                7
                                                             07
                   07




                                                  l-0




                                                                                       -0


                                                                                                -0
                                                                              -0
                                                                    p-
                             -


                                      n-




                                                                                                        n-


                                                                                                                 b-



                                                                                                                             -
                                                           g-
                   r-




                                                                                    ov


                                                                                             ec
                          ay




                                                                                                                          ar
                                                                            ct
                                                Ju
                                    Ju




                                                                                                      Ja
                 Ap




                                                                  Se




                                                                                                               Fe
                                                         Au




                                                                            O




                                                                                                                         M
                                                                                    N


                                                                                             D
                         M




                                                                           Month


Source: Finance




Performance Report/Board/JCG/April 2008                                24
The chart shows actual prescribing spends against budget. The position shown is a cumulative one up to January 2008.            Current
This equates to an under-spend of £671,986 or 2.4% below plan.

There is a forecast under spend of £885,000 equating to 2.81% net ingredient cost is the same as the SHA average due to
continued cost efficiencies. The PCT prescribes more items than the SHA average due to a higher proportion of patients
with long term conditions than average.

Senior Manager Lead: Jan Butterworth
                                                                                                                               Year End
Actions:                                                                                                                       Projection
Planning for 2008/09 is in place. SHA plans for prescribing are moving the focus to clinical excellence in prescribing for
long term conditions in 2008/09.




4.6 Prescribing: Anti-biotic Prescribing by PBC Consortia
All PCT prescribing expenditure to achieve plan

Fig. 28: GP Anti-biotic Prescribing


                       £250
                                                                                            Co st/1,000 STA R P U Q107/08
                                                                                            Co st/1,000 STA R P U Q2 07/08
                                                                                            Co st/1,000 STA R P U Q3 07/08
                       £200
  Cost/1,000 STAR PU




                       £150


                       £100


                       £50



                         £-
                                                                                                                   PCT TOTAL
                              Biddulph &




                                                           Werrington
                                           Waterhouses
                              Kidsgrove




                                                                              Newcastle




                                                                                             Newcastle
                                                            Leek &
                                            Cheadle,




                                                                                               South
                                                                                North
                                             & Tean




Source: PPA

The chart above shows actual prescribing spends against budget. The position shown is a comparison between the first            Current
three quarters of 2007/08.

This shows that spend reduced across all 5 PBC consortia in Q2. Spend has since risen in Q3 as this is the winter period.
However this rise remains below the levels of Q1.


Senior Manager Lead: Jan Butterworth
Actions:                                                                                                                       Year End
New antibiotic prescribing policy in place. For 2008/09 each PBC cluster will be measured on volume of prescribing and         Projection
reduction in prescribing of quinolones and cephalosporins to link with Health Associated Infection strategy.

Some antibiotic costs will increase if the antibiotic strategy is followed.




Performance Report/Board/JCG/April 2008                                  25
4.7 Emergency Admissions by GP Practice

Fig. 29: Emergency Admissions per 1000 by GP Practice




                              9
                                    Q1 07-08
                              8
                                    Q2 07/08
                              7
   FCEs per 1000 Population




                              6

                              5

                              4

                              3

                              2

                              1

                              0




                                                                                                            PCT TOTAL
                                  Biddulph &




                                                             Werrington
                                               Waterhouses
                                  Kidsgrove




                                                                               Newcastle




                                                                                           Newcastle
                                                              Leek &
                                                Cheadle,




                                                                                             South
                                                                                 North
                                                 & Tean




Source: CBSA (based on SUS data)

The chart above shows Emergency Admissions (Finished Consultant Episodes (FCEs)) per                   Current          Year End
1000 at all providers by GP Practice up to the end of Q2.                                                               Projection

This shows that the two Newcastle PBC consortia are the heaviest users of emergency
services, which due to their relative geographical proximity to UHNS is understandable.

It is interesting to note also that with the exception of the Leek & Werrington consortia, all
consortia saw a decrease in admissions in Q2.

The Q3 position cannot currently be presented as the PCT is awaiting month 9 data from the
CBSA

Senior Manager Lead: Sandra Cooper
Actions:




Performance Report/Board/JCG/April 2008                                   26
4.8 GP Written Referrals by PBC Consortia
Fig. 30: GP First Outpatient Attendances per 1000



                                             45
  GP Written Referrals per 1000 Population




                                                                                                                   Q1 07/08
                                             40                                                                    Q2 07/08
                                             35                                                                    Q3 07/08

                                             30

                                             25

                                             20

                                             15
                                             10
                                             5
                                             0




                                                                                                                    PCT TOTAL
                                                  Biddulph &




                                                                             Werrington
                                                               Waterhouses
                                                  Kidsgrove




                                                                                           Newcastle




                                                                                                       Newcastle
                                                                              Leek &
                                                                Cheadle,




                                                                                                         South
                                                                                             North
                                                                 & Tean




Source: Monthly Practice submissions to Commissioning Team

The chart above shows GP written referrals per 1000 population by PBC consortia.                                                Current   Year End
                                                                                                                                          Projection
This shows that the Newcastle South consortia make the most referrals of all the consortia
within the PCT.

There has been a slight increase in the number of referrals made in Q3, compared to Q2

Senior Manager Lead: Jan Butterworth
Actions:




Performance Report/Board/JCG/April 2008                                                   27
Section 5: Proposed Performance Report Timetable 2007/08

Existing National Targets



                                                                           Frequency
                                                                             of Data
Indicator Nam e                                                            Collection                          Available for Report
Access to a GP                                                                  Monthly   Monthly data available, tw o months after month end from July 07
Access to a primary care practitioner                                           Monthly   Monthly data available, tw o months after month end from July 07
All cancers: one month diagnosis (decision to treat) to treatment               Monthly   Monthly data available, tw o months after month end from July 07
All cancers: tw o month GP urgent referral to treatment                         Monthly   Monthly data available, tw o months after month end from July 07
All cancers: tw o w eek w ait                                                   Monthly   Monthly data available, tw o months after month end from July 07
Category A calls meeting 19 minute target                                       Monthly   Monthly data available, tw o months after month end from July 07
Category A calls meeting 8 minute target                                        Monthly   Monthly data available, tw o months after month end from July 07
Category B calls meeting 19 minute target                                       Monthly   Monthly data available, tw o months after month end from July 07
Commissioning a comprehensive child and adolescent mental health service        Annual                                  Jun-08
Commissioning of crisis resolution/home treatment services                  Quarterly            Sep-07            Nov-07             Feb-08       May-08
Convenience and choice - PCT booking                                            Monthly   Monthly data available, tw o months after month end from July 07
Convenience and choice - PCT facilities in place to support choice              Annual                                  Jun-08
Delayed transfers of care                                                   Quarterly            Sep-07            Nov-07             Feb-08       May-08
Diabetic retinopathy screening                                              Quarterly            Sep-07            Nov-07             Feb-08       May-08
Number of inpatients w aiting longer than standard                              Monthly   Monthly data available, tw o months after month end from July 07
Number of outpatients w aiting longer than standard                             Monthly   Monthly data available, tw o months after month end from July 07
Patients w aiting longer than 3 months (13 w eeks) for revascularisation        Monthly   Monthly data available, tw o months after month end from July 07
Practice based registers - patients called for review                       Quarterly            Sep-07            Nov-07             Feb-08       May-08
Thrombolysis - 60 minute call to needle time                                    Annual                                  Jun-08
Total time in A&E: four hours or less                                           Weekly                    Latest full w eek in last full month


New National Targets



                                                                           Frequency
                                                                             of Data
Indicator Nam e                                                            Collection                          Available for Report
Access to GUM clinics                                                           Monthly   Monthly data available, tw o months after month end from July 07
Access to reproductive health services                                          Annual                                  Jun-08
Blood pressure                                                              Quarterly            Sep-07            Nov-07             Feb-08       May-08
Breast cancer screening for w omen aged 50 to 70 years                          Annual                                  Jun-08
Cancer mortality rate                                                           Annual                                  Jun-08
Cardiovascular disease mortality                                                Annual                                  Jun-08
Childhood obesity: data quality                                                 Annual                                  Jun-08
Cholesterol levels                                                          Quarterly            Sep-07            Nov-07             Feb-08       May-08
Commissioning of early intervention in psychosis services                   Quarterly            Sep-07            Nov-07             Feb-08       May-08
Community development w orkers                                                   TBA
Community equipment                                                         Quarterly            Sep-07            Nov-07             Feb-08       May-08
Community matrons & additional case managers                                Quarterly            Sep-07            Nov-07             Feb-08       May-08
CPA 7-Day follow up and Suicide Audit                                       Quarterly            Sep-07            Nov-07             Feb-08       May-08
Data quality on ethnic group                                                    Annual                                  Jun-08
Drug misusers in treatment                                                      Annual                                  Jun-08
Drug misusers sustained in treatment                                            Annual                                  Jun-08
Emergency bed days                                                              Annual                                  Jun-08
Experience of patients                                                          Annual                                  Jun-08
Four w eek smoking quitters                                                 Quarterly            Sep-07            Nov-07             Feb-08       May-08
GP recording of body mass index (BMI) status                                Quarterly            Sep-07            Nov-07             Feb-08       May-08
Improving cancer services                                                       Annual                                  Jun-08
Infant health & inequalities: breastfeeding initiation rates                Quarterly            Sep-07            Nov-07             Feb-08       May-08
Infant health & inequalities: smoking during pregnancy                      Quarterly            Sep-07            Nov-07             Feb-08       May-08
Infection control                                                               Annual                                  Jun-08
Number of very high intensity users                                         Quarterly            Sep-07            Nov-07             Feb-08       May-08
Older people's mental health: assessment of needs and services                  Annual                                  Jun-08
Practice-based registers                                                        Annual                                  Jun-08
Referral to treatment times milestones                                          Monthly
Smoking status among the population aged 16 and over                        Quarterly            Sep-07            Nov-07             Feb-08       May-08
Teenage conception rates                                                        Annual                                  Jun-08
Waiting times for diagnostic tests                                              Monthly   Monthly data available, tw o months after month end from July 07




Performance Report/Board/JCG/April 2008                                    28
Annex One: Outpatient and Inpatient Waiting Times

The charts below show progress towards the original 18 week referral to treatment milestone targets
for 2007/08. These milestones have now been superseded by the 18 week target in section 2.1, but
are included as an annex for information.

The PCT is still monitored by the Healthcare Commission on the following targets for these areas:

a)                                  No 13 + week waiters (Outpatients);
b)                                  No 26 + week waiters (Inpatients).

These will be reported on an exception basis (i.e. should the PCT have a breach of either target).
There have been no breaches of these targets so far in 2007/08 up to the end of February.

Outpatients – Number of 5 week waiters


                                   1,500
                                   1,400
                                   1,300                                                                   Actual
     Number of 5 week + waiters




                                   1,200
                                   1,100                                                                   LDP Profile
                                   1,000                                                                   2006-07 Actual (11 w eeks)
                                     900
                                     800
                                     700
                                     600
                                     500
                                     400
                                     300
                                     200
                                     100
                                       0
                                            Apr-07 May-07 Jun-07   Jul-07 Aug-07 Sep-07 Oct-07 Nov-07 Dec-07 Jan-08 Feb-08 Mar-08
                                                                                    Month



Inpatients – Number of 11 week waiters


                                   700
                                                                                                            Actual
     Number of 11 week + waiters




                                   600
                                                                                                            LDP Profile
                                   500                                                                      2006-07 Actual (20 w eeks)
                                   400

                                   300

                                   200

                                   100

                                     0
                                           Apr-07 May-07 Jun-07    Jul-07 Aug-07 Sep-07 Oct-07 Nov-07 Dec-07 Jan-08 Feb-08 Mar-08
                                                                                    Month



Summary of Current Position:

Target                                                                                              Plan                   Actual
Number of 5+ week outpatient waiters:                                                               93                     213
Number of 11+ week inpatient waiters:                                                               25                     314

Performance Report/Board/JCG/April 2008                                              29

				
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