As at 31st January 2010

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					Quality and Performance Report 2009/10
       Key and High Risk Targets
         As at 31st January 2010




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CONTENTS PAGE


1.            Overall Performance and Key Issues                3
2.            Patient Safety and Quality                        6
3.            World Class Commissioning/Strategic Plan          10
4.            Mission Critical Objectives                       12
5.            Care Quality Commission                           13
6.            Use of Resources                                  20
7.            Vital Signs                                       21
8.            Health Improvement Report                         22
9.            Provider Performance                              23
10.           Local Area Agreement                              30
11.           Fit For The Future                                31
12.           Benchmarking                                      33

Appendix 1    Performance Matrix                                35
Appendix 2    Delayed Discharges and A&E Waiting                36
Appendix 3    SUI‟s                                             37
Appendix 4    MRSA & C.difficile                                39
Appendix 5    Quality Indicators                                40
Appendix 6    WCC Performance Summary 2009/10                   46
Appendix 7    Mission Critical objective Progress 2009/10       47
Appendix 8    Care Quality Commission: Performance Indicators   48
Appendix 9    Standards for Better Health                       49
Appendix 10   Use of Resources                                  51
Appendix 11   Vital Signs Performance Summary                   53
Appendix 12   Provider Performance Reports 2009/10              54
Appendix 13   Combined Healthcare Performance Reports           63
Appendix 14   NSCH Performance Report                           64
Appendix 15   QOF outcomes – Clinical Achievements              65
Appendix 16   Prescribing Budgets                               66
Appendix 17   Units of Dental Activity                          68
Appendix 18   Local Area Agreements                             69
Appendix 19   Fit For the Future                                70
Appendix 20   Bench Marking Trend Analysis                      71




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1.    Overall Performance and Key Issues

1.1   The report covers the period April 2009 to January 2010.

1.2   Appendix 1 contains an overall summary of PCT performance. This
      benchmarks the PCT with all England PCTs, our ONS cluster of PCTs
      and West Midlands PCTs against a representative cross section of key
      performance indicators.

1.3   The Board of Directors approved 12 Mission Critical (MC) objectives for
      2009/10 in May 2009. These MC objectives represent the highest
      priority for the Board, Executive Management Team and staff during
      the year and all collective and individual work undertaken should be
      very easily associated with one or more MC objective.

1.4   Section 4 of this report provides the detailed commentary on
      performance within the MC objectives with key messages included in
      this section. In addition key performance issues raised in this section
      will be associated with the relevant mission critical. Furthermore, some
      of the MC objectives are included in separate dedicated sections of this
      report.

1.5   Of the 12 MC objectives none are currently RAG rated as RED. Of the
      12 MC objectives, 6 are RAG rated GREEN with 6 being RAG rated
      AMBER.

1.6   The main change from the last report is that Financial Duties is now
      rated as AMBER, having been previously rated as RED. This change in
      assessment is because the SHA has now adjudicated on the dispute
      between the PCT and UHNS. However, whilst the outcome of the
      adjudication with the UHNS contract is known, there are some aspects
      that require further clarification and also there are allocations that have
      not been confirmed by the SHA/DoH. If these items are resolved and
      funded at the level within the Finance Report then this should lead to
      the PCT achieving its revenue control total.

1.7   In terms of the other AMBER rated MC objectives all but one is on the
      basis of confidence that the MC objective will be achieved but evidence
      is not yet in place to RAG rate as green.

1.8   The PCT continues to monitor the A&E four hour wait target which links
      directly to MC10 – Quality and Safety.

1.9   For the period to 31st January 2010, current LHE cumulative
      performance stands at 97.92%. Out of the total of 44 weeks in 2009/10
      so far, the 98% target had been met in 15 weeks within the Emergency
      Care Centre (ECC) (i.e. excluding Leek MIU and the Walk In Centre).
      The last week the 98% standard was achieved was in the week
      commencing 9th November 2009.



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1.10   The overall Accident and Emergency service (i.e. including the WIC
       and the Leek MIU) has achieved 98% in 27 out of 44 weeks.

1.11   It is unlikely now that UHNS will achieve the 98% standard in 2009/10;
       indeed performance has slipped to the extent that the 98% standard
       will probably be missed even taking into account the Haywood WIC
       and Leek MIU.

1.12   To improve performance for the remainder of the year and into
       2010/11, a LHE wide action plan has been put in place to support
       delivery of sustained improvement, focusing on the A&E process and
       staffing, and improved assessment and discharge processes.

1.13   A meeting structure has been put in place to manage performance with
       a bi-weekly Commissioner led meeting with senior provider
       management, social care representatives, SHA representation and
       senior Quality & Performance representatives.

1.14   A further key issue is the level of delayed discharges at UHNS (which
       links to MC 4 – Fit for the Future).

1.15   UHNS has reported a surge in the number of delayed discharges in
       recent weeks and a Delayed Discharged LHE Task Group has been
       set up to review the number of delayed discharges and will meet
       weekly.

1.16   It has been agreed at the meeting that over the next 3 weeks the
       number of delayed discharges needs to be reduced to 60 from 130. To
       action this, two sub-groups will be convened and tasked with reducing
       the number of delays on specific wards and ensuring that the
       paperwork is completed for each patients needs.

1.17   A weekly task force has been set up, focusing on daily discharge
       performance with operational teams. Targets have also been applied
       to community hospitals to ensure flow of patients through the system
       and additional capacity is being commissioned to come on line with
       immediate effect i.e. 7 day social worker service, assessment and
       discharge beds in the community.

1.18   Following a period of difficulty in obtaining daily information, the
       process has been reviewed and a mechanism to report, review and
       action the delay list has been put in place.

1.19   To ensure regular monitoring of the delayed discharges a mechanism
       to report, review and action the delay list has been put in to place.

1.20   A daily and weekly NHS North Staffordshire report outlining the number
       of delays is completed on a daily basis and the PCT will liaise and work
       with all relevant agencies to ensure all the NHS North Staffordshire
       delays are being progressed.


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1.21   Therefore an update will be provided in the next Trust Board report on
       the delayed discharge position.

1.22   The updated A & E performance at UHNS is detailed in appendix 2 of
       this report.

1.23   Other areas of risk remaining or emerging since the last report to the
       Board of Directors are:

            18 Weeks: there is a potential risk around not achieving the 18
             week standard. Please see 5.7 for more details;
            West Midlands Ambulance Service: performance remains
             stable across the region, but below target in two of the three
             standards. Please see 5.21 for more details;
            NHS reported waits for diagnostic 6 week waiters: the
             number of breaches has fallen in recent months, but breaches
             remain in the system. Please see 5.26 for more details;
            GUM Waiting Times: performance has improved with regard to
             numbers seen. Please see 5.30 for more details;
            Cancer Waits: the extension of the existing cancer targets have
             been confirmed. Please see 5.33 for more details;
            Chlamydia Screening: numbers screened are higher than
             equivalent quarter in 2008/09, but remain below target required
             for achievement. Please see 5.40 for more details;
            Breast feeding at 6-8 weeks: there are performance and data
             quality issues which have been raised with the service. Please
             see 5.45 for more details;
            Childhood Obesity: 2008/09 data has been published which
             provides the PCT with information to be able to assess its likely
             rating in 2009/10. Please see 5.53 for more details.




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2.    Patient Safety and Quality

2.1   This section will provide Trust Board with more statistical data that will
      develop over the next few months which will in turn provide Trust Board
      with more quality information in order to scrutinise for weakness or
      assurance.

Patient Safety

Serious Untoward Incidents (SUIs)

2.2   The management of incident reporting continues to develop with
      enhanced communication on SUIs with our main service providers. DA
      breakdown of SUI information is presented in Appendix 3.

2.3   The Head of Quality and Patient Safety has enhanced partnership
      working between Stoke PCT, South Staffs PCT and our main providers
      regarding developing SUI sub groups.

2.4   UHNS has an established SUI Sub Group which is a sub group of the
      CQRM and has the aim of refining and agreeing SUI reporting
      requirements with providers. It is anticipated that NHS Stoke-on-Trent
      as lead commissioner will manage this from October 2010.

2.5   Similar work has commenced with other providers; North Staffordshire
      Community Healthcare, North Staffordshire Combined Healthcare and
      Mid-Staffordshire FT.

2.6   From 1st April 2010 responsibility for managing and reporting SUIs in
      respect of Combined Healthcare, North Staffordshire Community
      Healthcare and the PCT will transfer from the SHA to the PCT. The
      recent appointment of a Deputy Head of Quality will ensure this transfer
      is a success.

MRSA, Clostridium Difficile and Healthcare Acquired Infections

2.7   There is a planned programme of strengthening reporting systems and
      this is continuing by requesting that all main providers notify the Quality
      and Performance Department daily if there are positive MRSA or
      C.Difficile cases. This is being monitored through the Strategic
      Infection Control Committee and relevant Clinical Quality Review
      Meetings (CQRMs). A breakdown of incident numbers can be found at
      Appendix 4.




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Patient Experience

Developments within the Quality Department

2.8        Progress continues to be made with regard to cross directorate working
           within the quality department; the use of a dedicated database system
           across directorates (DATIX) plays a major role in facilitating this.

Quality Assurance (QA)

NHS North Staffordshire QA Visits

2.9        In order to gain assurance with regard to the quality of commissioned
           services, NHS North Staffordshire will be undertaking QA visits in
           collaboration with partners and stakeholders. The schedule below
           shows the visits to be undertaken in March and the next quarter
           (please note: dates beyond April for UHNS visits are yet to be
           released).

Fig. 1: Schedule of QA Visits

 Date 2010      Provider               Directorate/Service

 3 March        Community HC           Prison Healthcare Service - Werrington HMYOI

 9 March        UHNS                   Critical Care

 1 April        Community HC           Physiotherapy

 7 April        Combined               Crisis Team

 19 April       UHNS                   Pathology

 6 May          Community HC           Tissue Viability Service

 12 May         Combined HC            Acute Adult Mental Health Wards

 3 June         Community HC           Inpatient wards at Leek Moorlands

 30 June        Combined HC            Children‟s Inpatient Wards


2.10       Developmental feedback workshops are also planned in partnership
           with Combined HC.

2.11       The reports/findings from each visit will be presented at the CQRM.

2.12       The Head of Quality and Patient Safety is developing a QA visit
           schedule for the remainder of 2010/11 which will include at least one
           appreciative enquiry.


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2.13   All visits will include other commissioners, clinicians from either CEC,
       or the Quality department. It is anticipated that these visits will include
       NEDs and patient safety champions.

Mid Staffs Foundation Trust

2.14   The Head of Quality and Patient Safety has developed partnership
       working with South Staffs PCT and attends their CQRM when able.

2.15   In view of the risks identified at the November 2009 meeting and recent
       external inquiries, the Head of Quality and Patient Safety instigated an
       unannounced visit in conjunction with SSPCT. This will be reported
       back at the next CQRM led by SSPCT.

2.16   The recent Francis Enquiry report will be presented in a separate paper
       to the next Trust Board.

Unannounced Visits

2.17   On 8 December 2009 a Gold Fax was received at North Staffordshire
       PCT regarding A&E capacity issues.          It was agreed that an
       unannounced visit would be undertaken immediately by the Director of
       Nursing to assess the situation, to see first-hand the challenges
       clinicians were experiencing and to gain assurance that patient safety
       was not being compromised.

2.18   The findings were presented at the CQRM and the key points identified
       are now the subject of action plans that will be monitored by the
       CQRM.

Innovation and Improvement

CQUINS 2010/11

2.19   “High Quality Care for All” included a commitment to make a proportion
       of providers‟ income conditional on quality and innovation, through the
       Commissioning for Quality and Innovation (CQUIN) payment
       framework.

2.20   The key aim of the CQUIN framework is to support a shift towards the
       vision set out in “High Quality Care for All” of an NHS where quality is
       the organising principle.      The framework helps make quality a
       fundamental part of the commissioner-provider discussion.          The
       framework has been designed based on feedback from partners in the
       NHS.




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2.21   The proposed final lists have been developed for North Staffordshire
       Community Healthcare Trust, North Staffordshire Combined Healthcare
       and University Hospital of North Staffordshire and sent to the SHA for
       review. The lists will also undergo further scrutiny from the
       Commissioning and Business Support Agency (CBSA).

2.22   The PCT is still awaiting detail from the SHA regarding Patient
       Experience and Think Glucose CQUIN. The final lists have been
       agreed with providers and will be formalised through the contracting
       process.

Patient Safety First Campaign

2.23   The Patient Safety First Campaign aims to make patient safety
       everyone‟s highest priority and is part of an international move to make
       care safer.

2.24   The NHS is an enormous organisation which treats more than a million
       people successfully every day. But in complex healthcare systems
       things can, and do, go wrong no matter how dedicated and
       professional staff are.

2.25   The unique feature of this campaign is the focus on leadership by
       Boards, clinicians and managers across England to develop the project
       by sharing experiences of improvements in patient safety within their
       own organisations.

2.26   The campaign is seen as being “by the service, for the service” and
       presents a unique opportunity to demonstrate the Board‟s commitment
       to patient safety and to energise and involve frontline staff, in the
       quality and safety agenda.

2.27   The Head of Quality and Patient Safety has achieved provider sign-up
       to the campaign from North Staffordshire Combined and North
       Staffordshire Community. UHNS is already signed up and developing
       reports to the CQRMs.

2.28   Furthermore this has been discussed with the CEO who has signed up
       to the campaign and will provide the commitment in terms of board
       leadership. A presentation is to be made at the next CEC to engage
       clinicians and primary care.

2.29   Following this, the Head of Quality and Patient Safety will formulate a
       campaign project plan which will provide more detail. Part of this
       project plan will include a high profile launch involving key
       stakeholders, such as SHA, Media, public, etc.




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3.    World Class Commissioning/Strategic Plan

WCC Outcomes

3.1   Our ten WCC outcomes are:

            Reducing health inequalities (measured by the Slope Index of
             Inequality);
            Increasing life expectancy (measured by life expectancy at
             birth);
            Reducing childhood obesity (VSB09);
            Smoking: increasing the numbers of people who
             successfully quit (VSB05);
            Reducing hospital admissions for alcohol-related harm
             (VSC26);
            Reducing emergency hospital admissions for ambulatory care
             sensitive conditions (VSC21);
            Reducing premature cancer mortality (VSB03);
            Reducing premature cardiovascular disease mortality
             (VSB02);
            Palliative care: increasing the number of people dying at home
             (VSC15);
            Patient experience: improving the self-reported experience of
             patients and users (VSB15).

      All but the first two outcomes are vital signs; four of the outcomes are
      also LAA outcomes (these are highlighted in bold).

3.2   A summary update of the performance data is provided in appendix 6.

3.3   A number of RAG ratings were updated in the last Board report. This
      was because a significant number of updated indicators were published
      in December. This allowed us to update our performance RAG ratings
      against the 2009/10 stretch targets, and also allowed us to revisit the
      feasibility of our aspirational trajectories.

3.4   As a result, we have updated our aspirational trajectories for four
      outcomes

            the Slope Index of Inequality (females)
            the percentage of children in year 6 recorded as obese
            the rate of smoking quitters
            the rate of hospital admissions for alcohol related harm

3.5   The reason for the changing the Slope Index of Inequality (females)
      was to ensure that this is realistic, given the limited historical data that
      was available when this trajectory was initially proposed.




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3.6    The changes to the remaining three trajectories all take into account
       newly published data, and are based on sustainable incremental
       improvements with the aim of being within the top 20% best performing
       PCTs by 2013/14.

3.7    We are in the process of reviewing our patient experience metric, as
       the underlying data to support this will not be available until 2011 at the
       earliest. We have been liaising closely with the SHA, and will provide
       an update in the next Quality & Performance Report.

3.8    It should be noted that WCC „stretch targets‟ are aspirational targets
       and are set higher than the vital signs or LAA targets. Therefore
       instances can occur where an indicator (e.g. premature CVD mortality)
       can be rated as „amber‟ for the WCC target, but be rated as „green‟
       against the Vital Signs and LAA targets.

Strategic Plan

3.9    The PCT‟s Strategic Plan „A Healthy Future for all in North
       Staffordshire‟ was submitted on 9th February 2010 and approved by the
       SHA. The document has now been published on the PCT‟s website.

3.10   The PCT has received positive feedback from the SHA in the
       development of the plan, with the SHA remarking that the plan
       represents an “excellent piece of work” and “provides great clarity
       about the PCT strategy.

3.11   The PCT is now beginning to organise itself to be able to put into action
       the six Strategic Initiative Programmes (SIPs) that support the
       achievement of our five corporate goals. These six SIPs are:

             SIP 1. Preventing ill health
             SIP 2. Detecting illness earlier
             SIP 3. Improving primary care
             SIP 4. Improving value for money from acute care
             SIP 5. Improving community based care
             SIP 6. Improving value for money from mental health care

3.12   All of the SIPs will be delivered by multi-disciplinary project teams,
       overseen by a SIP Portfolio Board, chaired by the Deputy Chief
       Executive.




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4.    Mission Critical Objectives

4.1   The organisation has 12 Mission Critical objectives. Each has a specific
      set of initiatives that will be undertaken to ensure their delivery. A
      summary of the 12, identifying the detailed report and therefore source
      for the RAG ratings of these objectives is set out in appendix 7.

4.2   The RAG ratings are summarised in the following table:

        Green            6
        Amber            6
        Red              0
        Total           12

4.3   The 6 objectives rated as amber are as follows:

4.4   Fit for the Future: this is discussed in more detail in section 11 of this
      report.

4.5   Financial Duties: please refer to paragraph 1.6 of this report.

4.6   Local area agreement: Good progress is being made in relation to 4
      week smoking quitters, teenage pregnancy, reducing alcohol related
      admissions and AAACM. Further actions are planned in relation to our
      SIP1 & SIP2 programmes to improve performance in these areas, and
      in particular childhood obesity. Section 10 contains more detail on this
      mission critical objective.

4.7   NHS leadership role: There is a wider organisational development
      agenda in place with progress being made against agreed plans (with
      some revisions ongoing). The plans were detailed in the September
      Board report.

4.8   Emergency preparedness: The business continuity work is currently
      on track to deliver a completed business impact assessment despite
      delays resulting from the Swine Flu pandemic.

4.9   PCT Delivery Systems: Project and programme management
      expertise has been secured but this needs a wider roll out and
      cascading. The implementation of 1-2-1 meetings to undertake
      objective setting, PDPs and appraisal processes across the PCT has
      commenced as also has the development of a training and
      development programme, which will be based upon input and feedback
      from PDP (which will identify training and development needs).




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5.     Care Quality Commission

5.1    The Care Quality Commission (CQC) has stated that 2009/10 will be a
       transitional year between the old „Annual Health Check‟ and the new
       „Periodic Review‟.

5.2    This has meant changes have been made to the structure of the
       2009/10 assessment for all Trusts. The extent of these changes varies
       for PCTs and Acute and Mental Health Trusts, but in all instances the
       main change for 2009/10 concerns the assessment of core standards.
       These changes are still out to consultation at the present time.

5.3    The current position from the CQC is that no organisation will be
       formally assessed against Core Standards (Standards for Better
       Health) in 2009/10.

5.4    For the PCT, it is anticipated that the organisation will be assessed
       against selected of its World Class Commissioning (WCC) scores
       instead of core standards. Although not formally detailed, it is thought
       this will be a rating based on the levels the PCT attains against WCC
       competencies 1-10.

5.5    In addition to this change, the link between Vital Signs and the „Existing
       Commitments‟ and „National Priorities‟ has also been made more
       explicit. This has resulted in the following changes to some indicators,
       summarised in the table below:

Fig. 2: Changes to CQC Existing Commitments and National Priorities:

Area                  Indicator                              Detail of Change
National Priorities   Breast screening                       Indicator introduced for
                                                             2009/10. 2008/09 data will
                                                             be used to assess current
                                                             performance
                      Cancer diagnosis to treatment          Indicator name(s) changed
                      waiting times (previous Cancer 31      to reflect expansion of
                      day targets)                           cancer wait time targets.
                      Cancer urgent referral to first        Please see 2.6 for more
                      outpatient appointment waiting         details
                      times (previous Cancer 14 day
                      targets)
                      Cancer      urgent    referral to
                      treatment waiting times (previous
                      Cancer 62 day targets)
                      Cervical Screening                Indicator introduced for
                                                        2009/10. 2008/09 data will
                                                        be used to assess current
                                                        performance
                      Quality of Stroke Care            Sub indicator „Stroke care
                                                        – TIA seen within 24
                                                        hours‟ Indicator removed
                                                        from assessment


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5.6    With regard to current performance issues, areas of remaining or
       emerging risk are detailed below:

18 Weeks

Synopsis of Issues

5.7    At the weekly LHE 18 week meeting, UHNS gave an update on
       January performance against 18 week targets. The PCT was informed
       that at UHNS it had failed to achieve the 90% admitted standard, being
       at 88.7%. The PCT did achieve the non admitted standard of 95%.

5.8    This was an unexpected development as at a previous meeting UHNS
       had stated the PCT were on course to achieve 90% in January based
       on un-validated figures.

5.9    It should also be noted that both UHNS and NHS Stoke-on-Trent did
       achieve their 90% admitted standard in January.

5.10   The main cause of under-performance is due to difficulties in treating
       patients in T&O. Indeed with regard to achieving 18 week standards
       across all specialties, all three partners failed to achieve the 90%
       standard in January 2010.

Implications

5.11   According to CQC guidance on the 18 week standard, to achieve the
       18 week targets, the PCT must achieve:

       a)      18 week admitted and non admitted performance standards as a
               whole (Apr 09 – Mar 10);
       b)      18 week admitted and non admitted performance standards in
               each specialty (Jan-Mar 2010);
       c)      Data completeness checks (Apr 09 – Mar 10).

5.12   The LHE has been aware for some time it was unlikely to meet (b) due
       to the aforementioned issues in T&O.

5.13   There has also been a further complication with the SHA mandate that
       all 18 week backlog breach patients need to be treated before 31st
       March 2010, which would also have an impact on achievement of the
       targets.




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5.14   The PCT had been in discussions with the SHA around these issues
       and informally indications have been that a „failure‟ to achieve in one
       month would not be terminal to our overall CQC rating, with the PCT
       probably being rated as under-achieved. However, this was predicated
       on maybe only failing in March while the backlog patients were treated.
       If we should fail in January as well, we could well be in danger of failing
       the 18 week target overall

5.15   The situation in January may yet be salvaged. We only know the
       standard has failed at UHNS. Our patients at other providers (e.g. East
       Cheshire) are also included to give an overall PCT performance
       position.

5.16   Therefore the PCT is now reliant on performance being excellent at
       these other providers to raise our 18 week admitted performance
       above 90%. However, as UHNS is responsible for the vast majority of
       our 18 week patients, performance at other providers cannot be relied
       upon to save the situation.

5.17   Given the issues at UHNS, both local PCTs and UHNS met on 3 rd
       March to develop an action plan to deal with the current situation and
       work to improve performance in the future.

5.18   This meeting has identified a number of possible plans to improve the
       situation and these are currently being modelled by the three
       organisations to assess their feasibility.

Performance Assessment

5.19   Given the current situation, it is increasingly likely that we will not
       achieve 18 weeks altogether, based on the likelihood of not attaining
       the level required for (a) and (b) in two of the next three months.

5.20   From an overall CQC Period Review perspective, this does not
       necessarily affect our overall rating. The PCT failed 18 weeks last year
       due to a data issue, as detailed in January‟s Trust Board report, yet
       were still rated as „Fair‟ on our Quality of Services. However, this may
       impact on the organisation‟s ambition to achieve a „Good‟ in 2009/10.

West Midlands Ambulance Service Response Times

5.21   West Midlands Ambulance Service (WMAS) overall performance
       remains a concern across two of the three CQC indicators (Category A
       calls within 8 minutes and Category B calls within 19 minutes).

5.22   Performance within the old Staffordshire Ambulance Service area
       remains strong and shows achievement of all three indicators.
       However, the organisation will be mapped to WMAS performance as a
       whole.



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5.23   Commissioners have issued a performance notice to WMAS through
       the contract mechanisms and action plans have been formulated and
       continually reviewed to improve performance.

5.24   Routine monitoring continues on a regular basis through the contract
       review meetings.

5.25   Although performance is stable across both these areas, levels remain
       below the national response time standards measured by the CQC,
       with the organisation expected to under-achieve against both these
       indicators

NHS reported waits for diagnostic 6 week waiters

5.26   There has been one breach of the 6 week standard in December,
       giving a cumulative year to date position of 29 breaches.

5.27   The breaches have mainly been at East and Mid Cheshire. The PCT
       has raised the issue of performance through the contract via the co-
       ordinating commissioner for both Trusts: Central and Eastern Cheshire
       PCT.

5.28   The PCT is now developing the „Early Warning Process‟ discussed
       briefly in previous performance reports, which will enable the PCT to be
       aware of potential breaches as soon as possible, and therefore be able
       to proactively support Trusts so that these do not become actual
       breaches.

5.29   For 2009/10, the CQC has confirmed in its list of indicators for
       assessment that there is no separate indicator for diagnostic six week
       waiters. Therefore, although the PCT needs to continue to address
       performance issues in this area, diagnostic waits have now been
       subsumed into the overall 18 week target.

GUM Waiting Times

5.30   In the last Performance Report, it was highlighted that performance
       with regard to the number of patients seen by the service within 48
       hours had fell below 80%, which had resulted in a request for an
       exception report from the SHA.

5.31   November figures showed that the number of patients seen by the
       service within 48 hours improved to 86.4%, giving a YTD performance
       of 83.7%.

5.32   Performance by the service will continue to be closely monitored as
       levels have fluctuated throughout the year and from discussions with
       UHNS, the staffing issues which have caused this dip in performance
       remain a concern in the short to mid-term.



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Cancer Waits

5.33   The CQC has now formally confirmed the extension of the 14 day, 31
       day and 62 day cancer standards (see fig. 2).

5.34   As reported in the January performance report, the PCT has concerns
       over the 62 day and 2 week breast symptom indicators.

5.35   The PCT has worked closely with UHNS principally to formulate action
       plans to improve these areas, and cancer waits are now a regular item
       on the 18 week LHE meeting agenda.

5.36   Performance in 2 week wait breast symptoms has been poor, with
       UHNS falling well short of the target. However, much work has been
       carried out to address issues in this area and early indications are that
       the target was achieved in December and the Trust continued to
       perform well in January.

5.37   UHNS have provided unofficial figures for the Cancer 62 day target to
       the end of December, which give a YTD performance of 83% against a
       target of 85%.

5.38   UHNS are not confident that they will be able to continue their recent
       improvement in performance by enough to be able to achieve this
       target. Performance has fluctuated throughout 2009/10 and although
       UHNS has hit the 85% standard in November and December, the Trust
       has only just achieved these standards.

5.39   In addition, there appears to be no correlation between numbers on the
       62 day pathway and achievement of the target at present. For example,
       in May 09, UHNS achieved the 85% standard with c.120 patients on
       the pathway. However, in September 2009, the Trust only attained a
       standard of 81% despite only c. 105 patients being on the pathway in
       the month.

Chlamydia Screening

5.40   All three quarters have seen an increase in the number of 15-24 year
       olds screened, compared to the equivalent quarters in 2008/09.
       However the numbers need to increase still further to meet the PCT
       target.

5.41   As detailed in previous reports, the action plan for 2009/10 has been
       reviewed and refreshed to ensure that the organisation meets the
       performance target for Chlamydia screening.

5.42   New initiatives are currently in progress to increase uptake, including
       training to build capacity for a diverse range of providers to carry out
       Chlamydia screening.



                                      17
5.43   In addition supporting improvements in the number of the target group
       screened will ensure that we train and support providers within our
       priority areas to carry out screening.

5.44   Screening activity is known to be higher during Q4 of the financial year
       and promotional campaigns and community engagement opportunities
       have been launched to take advantage of this.

Breast Feeding at 6-8 Weeks

5.45   Current performance figures at Q3 show that the levels of
       breastfeeding initiation in the PCT remain low (c. 30% of women either
       fully or partially breastfeeding at 6-8 weeks).

5.46   In addition, the figures also show that the PCT is performing poorly
       against the CQC data completeness target, which measures the
       number of women accessing midwife services where the breast feeding
       status of these women is known.

5.47   As part of the WCC work stream – Preventing Ill-Health, the PCT has a
       planned intervention to address increasing breast feeding uptake
       through development and implementation of a peer support
       programme. This would involve responding to local data relating to
       local women who access maternity services, and ensuring that those
       who initiate breast feeding are supported within community settings to
       continue to breast feed for at least 6 months or more.

5.48   This planned programme of work is a follow on from recent investment
       to support UNICEF Baby Friendly Training of staff within our Health
       Visiting Teams, and resources in place to support women who breast
       feed to continue to do so.

5.49   Another issue is the recording of data. The PCT has been in
       discussions with the service and it is apparent from manual reports
       provided that it is likely the service is attaining the breastfeeding
       prevalence levels, but due to delays in recording figures onto data
       systems, these figures are not being reported formally.

5.50   It is also likely that if data were recorded and therefore reported, the
       PCT would also have higher breastfeeding initiation figures.

5.51   The PCT has highlighted these issues to service managers and
       formally at contract negotiation meetings and actions are being put in
       place by the service to ensure that data is recorded promptly and
       accurately.




                                      18
5.52   As such, at Q4 there will be a re-extraction of data for all of 2009/10,
       from which it is anticipated that the data will show the PCT did achieve
       the breastfeeding prevalence standards in each of the four quarters of
       the year. It is also expected that breastfeeding initiation figures will also
       improve.

Childhood Obesity

5.53   2008/09 data has been now been published for this indicator (due to
       the nature of the indicator, the PCT is measured against data from the
       previous year).

5.54   The percentage of children with height and weight recorded in
       reception year and year 6 is 85.3% and 93.8% respectively. This is an
       improved coverage rate on 2007/08 (83% and 86% respectively).

5.55   The percentage of reception aged children defined as obese is 9.6 %
       and Year 6 children identified as obese 19.2%. This is against a plan of
       10.67% and 16.46% respectively. In the CQC assessment, the PCT will
       be assessed on actual performance against plan.

5.56   As the PCT has a lower rate of reception year children recorded as
       obese, but a higher rate of year 6 children than planned, it is likely the
       PCT will under-achieve on this target, as in 2008/09.




                                        19
6.    Use of Resources

2009/10 Update

6.1   The Use of Resources submission (KLoE narratives and case studies)
      was signed off on the 18th February 2010 and submitted to the external
      auditors, PricewaterhouseCoopers (PwC), on the 22nd February 2010.
      The PCT has also submitted the Audit Commission “SNAP” Survey to
      PwC which is used by both PwC and WCC analysts to triangulate
      evidence and data sources across both UoR and WCC.

6.2   As previously reported it has been agreed to set a target score of level
      2 for all KLoEs, apart from two KLoEs included within the Managing
      Finances theme, KLoEs 1.1 and 1.3, where a level 3 target has been
      set.

6.3   For PwC to test the evidence included within the KLoE narratives and,
      to garner a greater understanding of the PCT, three days of interviews
      have been scheduled between PCT colleagues and PwC.

6.4   Two days of interviews have already been held with PwC and the
      feedback from PwC in relation to the UoR process for 2009/2010 and
      the evidence/outcome focused examples from the interviews have
      been positive. The PCT is currently predicting it will on target to
      achieve the aforementioned scores.




                                     20
7.     Vital Signs

7.1    As detailed in section 5, the organisation has now had details of the
       proposed changes to the annual assessment by the CQC for 2009/10.

7.2    Although still in consultation, it is clear that the link between Vital Signs
       and the Existing Commitment and National Priorities elements of the
       assessment will be made explicit.

7.3    As such, and to make this link clear, it is anticipated that future Board
       reports will not feature a separate „Vital Signs‟ section, and instead it
       will feature as a sub-section of the CQC section.

7.4    With regard to current Vital Signs performance, most areas of
       remaining or emerging risk have been discussed in section 5:

7.5    The one remaining area or risk not covered in this section is VSA05:
       Supporting Activity, where the organisation remains RAG rated as red.

7.6    UHNS is over-performing against plan for electives, non-electives and
       outpatients, which is the main cause for the PCT being at variance with
       the vital signs trajectories.

7.7    The organisation continues to work together with NHS Stoke-on-Trent
       and UHNS to understand the drivers for this over-performance, which
       began in month 12 (March 2009). These issues are covered in more
       detail in section 9 of this report.

7.8    Lines relating to VSA05 are amongst those the organisation has been
       asked by the DoH to review and resubmit for 2010/11.

7.9    The organisation is currently in the process of reviewing and re-
       submitting some trajectories for a number of vital sign indicators, of
       which VSA05 forms part of this review.

7.10   This is a national exercise and occurs annually. It is an opportunity for
       organisations to review previously submitted plans and re-submit
       based on changes in guidance or trends.

7.11   First draft trajectories were submitted at the end of January. The SHA
       has provided feedback on these initial submissions and the
       organisation will submit final trajectories at the end of March 2010.
       These revised trajectories will also align with the organisation‟s
       operational plan.




                                        21
8.    Health Improvement Report

8.1   NHS West Midlands produces quarterly health improvement reports on
      all 17 PCTs within the West Midlands.

8.2   Publication of the final Q2 2009/10 report was delayed; it has now been
      published on the NHS West Midlands website, and can be found at:

      http://www.westmidlands.nhs.uk/Default.aspx?grm2catid=106&tabid=56

8.3   The PCT provided information on actions to improve performance in
      four specific areas:

           MMR vaccination: We are one of the best performing PCTs in
            the West Midlands. Our uptake for April to June was 93.4%
            against a target of 95.5%. All 17 PCTs in the West Midlands had
            uptake rates below target during April to June.

           GUM waiting times: Performance during September 2009 shows
            that we are achieving the 100% target for patients being offered
            an appointment to be seen within 48 hours.

           Health Trainers: During July to September, our rate was 53.8
            per 10,000 adults with multiple lifestyle risk factors, and we were
            one of the 15 PCTs in the West Midlands who were considered
            unlikely to achieve this target. 8.4 It is expected that the Health
            Trainer indicator will remain at red in the short to medium term
            as the PCT has removed the funding of the Health Trainers
            service. The PCT is developing alternative methods to achieve
            this target.

           Expert Patient Programme: This indicator looks at the number of
            people completing the programme during July to September.
            Our programme only started in July.

8.4   The PCT received the draft Q3 2009/10 report for comment in early
      February. Comments have been sent back accordingly to the SHA and
      the final Q3 report is expected in March.




                                     22
9.     Provider Performance

Secondary Care (Acute Services)

9.1    Appendix 12a provides a summary which compares planned and actual
       activity across the different points of delivery (POD) for the acute
       providers from whom information was available at month 9
       (December).

9.2    These show a number of variances – some of which will change as
       data is validated in the „flex and freeze‟ process.

9.3    The Commissioning and Redesign directorate, in partnership with the
       Quality and Performance directorate, pursue issues with providers and
       any outcomes will be reported and monitored within this report.

9.4    Appendices 12b to 12i provide the summary pages of the individual
       provider performance reports. A brief summary of each follows:

UHNS

9.5    The UHNS contract continues to over-perform at month 9. This over-
       performance is across most areas of the contract, but is particularly of
       concern in Non Electives, Electives and Outpatients.

9.6    The SHA has now made its adjudication on the dispute the Local
       Health Economy has had on activity and finance patterns in 2009/10,
       which is discussed in section 4.

9.7    As highlighted in section 3, the PCT, as part of the strategic plan,
       designed a SIP – improving value for money from acute care. It is
       anticipated that this programme will support work to resolve the issues
       there has been with this contract in 2009/10.

9.8    The January Trust Board report provided details of the key areas of
       focus for this SIP. There are also a number of other performance
       issues at UHNS currently, which have been discussed in this report.
       These are:

            A&E (section 1)
            Delayed Discharges (section 1)
            18 Weeks (section 5)
            Cancer waits (section 5)




                                      23
East Cheshire

9.9     East Cheshire is the second largest provider of acute services for the
        PCT.

9.10    There are four areas RAG rated as red, where there are significant
        performance issues:

             Elective activity and finance
             First outpatient activity and finance
             Follow up outpatient activity and finance
             Cost and volume finance

9.11    Of these, elective and outpatient are of the most concern. Elective
        activity has seen an increase in over-performance since month 8
        (November). Over-performance in outpatients has also risen further
        since month 8.

9.12    The SLA has over-performed as a whole since April. Particular areas of
        pressure have been T&O (which is a consistent problem specialty
        across a number of Trusts and indeed nationally) and General Surgery.

9.13    The PCT continues to closely monitor levels of activity and work with
        the Trust to understand what is driving the over-performance.

Mid Cheshire

9.14    The Mid Cheshire SLA continues to under-perform at month 9.

9.15    There are a couple of areas of concern within the contract:

             Cost and volume activity and finance
             High cost drugs activity

9.16    Both these areas can be volatile as both contain elements that are
        difficult to plan. For example, much of the over-performance in cost and
        volume is due to critical care patients.

9.17    The PCT will continue to monitor these areas closely.

Derby

9.18    There are four areas RAG rated as red, where there are performance
        issues:

             Planned Same Day activity and finance
             Non elective activity and finance
             Non elective excess bed days activity and finance
             A&E attendance activity and finance



                                       24
9.19   Planned same day activity is currently 16.5% above plan. On a
       medium-sized contract such as this, this equates to 23 extra spells of
       treatment above the plan.

9.20   There are three areas which are causing most of the over-performance
       in non-electives: respiratory, musculo-skeletal (T&O) and obstetrics.

9.21   In activity terms, this contract is slightly under-performing overall,
       although this activity equates to an over-performance financially,
       suggesting a more complex case-mix is being treated at the Trust in
       2009/10.

UHB

9.22   There are eight areas RAG rated as red, where there are performance
       issues:

            Elective activity
            Elective excess bed day activity and finance
            Non elective non emergency finance
            Planned same day activity and finance
            First outpatient activity and finance
            Follow up outpatient activity and finance
            Unbundled inpatient
            Non tariff items

9.23   This is a relatively small contract for the PCT and a small number of
       cases can cause the SLA to over-perform, hence the relatively long list
       of areas of over-performance.

9.24   The main driver for over-performance has been in elective excess bed
       days, unbundled inpatient and non tariff items.

9.25   The issues surrounding the areas of over-performance are in the
       process of being investigated with the provider.

Mid Staffordshire

9.26   The Mid Staffordshire SLA is under-performing overall at month 9.

9.27   There are no significant 2009/10 contract performance issues at this
       Trust presently.

9.28   Issues with regard to the recent Francis enquiry will be reported at the
       next Trust Board.




                                      25
Burton

9.29   The summary page for Burton is from the April 2009 report. No data
       was available for December 2009. The organisation is addressing this
       issue and hopes to be able to report an up-to-date position for this
       Trust at the next Board meeting.

9.30   There are four areas RAG rated as red, where there are performance
       issues:

             Elective finance
             Non elective emergency finance
             First outpatient activity and finance
             Follow up outpatient activity and finance

9.31   As this is a small contract, a single patient can cause the RAG rating to
       move from „red‟ to „green‟. For example, the non elective emergency
       finance over-performance is due to a single patient in trauma &
       orthopaedic.

9.32   Therefore, although the organisation will investigate any performance
       issues with the Trust, those issues highlighted above are not thought to
       pose a significant risk.

Robert Jones & Agnes Hunt

9.33   There are four areas RAG rated as red, where there are significant
       performance issues at month 9:

             Elective activity and finance
             Planned Same Day activity and finance
             First outpatient activity
             Follow up outpatient activity

9.34   As this is both a small contract, and the activity carried out by the Trust
       is of a specialist nature, a small number of patients can cause a „red‟
       RAG rating. However, the organisation continues to investigate any
       performance issues with the Trust.

Secondary Care (Mental Health)

9.35   The PCT is currently working with the Joint Commissioning Unit (JCU),
       Combined Healthcare (CHCT) and the Health Informatics Service (HIS)
       to develop information flows to draft a performance report that will
       provide detail on progress against the SLA and performance targets.
       Appendix 13 provides detail of current CHCT performance in those
       areas which impact on PCT performance.




                                       26
Secondary Care (Community Services)

9.36   Appendix 14 provides details of performance data relating to January
       2010. This has highlighted the following issue:

9.37   Healthcare Acquired Infections: as reported previously an action
       plan was put in place in December to improve performance in this area.

9.38   This plan has helped improve performance, with no C-Diff cases for 3
       months and no ESBL for 2 months.

Primary Care (Quality Outcomes Framework)

9.39   As part of the initiative for improving primary care, work continues in
       putting together an additional framework to QOF. This framework –
       entitled QOFXL - has been designed with support and clinical help from
       the PCT‟s QOF assessors, PBC leads, Health Improvement Teams,
       and the PCT Medical Director.

9.40   As highlighted in previous Board reports, the primary care team is
       developing a balanced scorecard to compare quality and productivity.
       This will result in the sharing of best practice across the PCT, and will
       be a means by which improvement in services can be demonstrated.

9.41   It is hoped that these developments will provide an enhanced set of
       quality and performance indicators to complement the QOF process,
       and provide a more comprehensive overview of practice performance.

9.42   The 2009/10 QOF information up to the end of December can be found
       in appendix 15.

9.43   Current practice performance on QMAS varies between 692.19 and
       484.71 points. However this reflects how different practices organise
       their submission rather than a variance at year end at this stage.

Primary Care (Practice Based Commissioning (PBC))

9.44   Work continues to further refine, enhance and automate the production
       process of the PBC data packs.

9.45   It is hoped that this work - alongside ongoing discussions with
       stakeholders - will lead to an improved timeliness for Data Pack
       dissemination, a greater understanding and improved confidence in
       what it demonstrates.

9.46   Month 8 packs have not been produced due to significant CBSA data
       structure changes. These changes were unscheduled and have had
       significant implications on the production process of the packs.




                                      27
9.47     The timetable for future PbC Data pack releases are as follows:

              Month 9 - Thursday 11th March 2010;
              Month 10 - Thursday 15th April 2010;
              Month 11 - Thursday 13th May 2010;
              Month 12 - Thursday 10th June 2010.

9.48     The CBSA have developed a new web based data system called IRIS,
         which will replace the IAN system. The Regional PbC Analyst Working
         Group has met three times and is working with the CBSA to ensure that
         relevant PbC reporting and functionality is available from the IRIS tool.
         The next Working Group meeting is on 18th March. Enhanced PbC
         reports will be demonstrated and discussed at this meeting.

9.49     Strengthening the contractual / budget setting process will enable
         greater transparency and accuracy for future Data Packs.

Primary Care (Medicines Management)

9.50     Appendix 16 shows prescribing performance for each GP practice,
         measured by actual spend versus budgeted spend cumulatively up to
         31st October 2009.

9.51     The following tables show progress against the PCT‟s aspirational
         prescribing targets in December. Fig. 3 shows those targets which
         have improved from the last month (November). For two of these
         targets - Target 2 and target 7 – the actual target for the year has been
         achieved. However, 4 of these targets have not reached the target.

Fig. 3: Aspirational Prescribing Targets: Areas of Performance Improvement in December

Target       Target Description                         Target             Performance
Number
Target 2     Increase the proportion of                 70% or above       77.67%
             simvastatin prescribed at 40mg                                Achieved
             dose
Target 5     Reduce the Annual Antibacterial            1.2 or below       1.230
             Drug Prescribing Rate                                         items/starpu
Target       Reduce the Annual NSAID                    4.6 or below       4.658
6a           Prescribing Rate                                              ADQ/starpu
Target       Increase the Percentage of                 60% or above       48.74%
6b           NSAIDs Prescribed as Naproxen
             or Ibuprofen
Target 7     Reduce the Percentage of Opioid            30% or below       29.9%
             Analgesics Prescribed as Patches                              Achieved
Target 4     Increase the proportion of                 87.5% or           83.19%
             Antiplatelet agents prescribed as          above
             aspirin




                                            28
9.52   The table below (fig. 4) detail the 4 indicators that have shown a slight
       deterioration in performance since November. Despite this, two of the
       targets have been achieved.

Fig. 4: Aspirational Prescribing Targets: Areas of Performance Slippage in December

Target       Target Description                         Target              Performance
Number
Target 1 Increase the proportion of statins             75% or above        72.83%
         prescribed as simvastatin/
         pravastatin
Target 3 Increase the proportion of ACE                 75% or above        69.98%
         Inhibitors relative to Angiotensin 2
         receptor antagonists
Target 8 Increase the proportion of PPIs                90% or above        90.26%
LOCAL    prescribed as low cost PPIs                                        Achieved

Target 9 Increase the proportion of SSRIs               75% or above        77.93%
LOCAL    prescribed as low cost, safe SSRIs                                 Achieved


Primary Care (Dental)

9.53   Dentists within NHS North Staffordshire have completed 223,187
       UDA‟s to December 2009. In total 70.52% of contracted UDA‟s have
       been completed in this period. Full details are contained in appendix
       17.

9.54   At the end of each financial year, dental practices have eight weeks to
       submit claims for treatment started before the end of March but
       completed in the new financial year. Due to this time-lag, accurate year
       end figures will not be available to the PCT until mid-June 2010. These
       will therefore be reported in the July Trust Board report.

9.55   The figures do not yet include additional capacity at the Milehouse
       Dental Practice (Rodericks Ltd), which opened on 9th November 2009.

9.56   The PCT will continue to monitor recalled attendance on a monthly
       basis. It is hoped to share comparative information with dental
       practices so they can compare themselves with peers.




                                            29
10.    Local Area Agreement

10.1   The Local Area Agreement (LAA) is a three-year agreement comprising
       priorities agreed by local partners across Staffordshire and by the
       Government Office for the West Midlands on behalf of central
       Government. The priorities within the LAA are reviewed on an annual
       basis. This is to ensure that the priorities contained in the agreement
       are still the priorities for the area.

10.2   The LAA contains 35 improvement targets, 4 of which are directly
       related to health:

      NI 39: Rate of hospital admissions per 100,000 for alcohol related
       harm;
      NI 56: Obesity among primary school children in Year 6;
      NI 121: Mortality rate from all circulatory diseases at ages under 75;
      NI 123: Stopping smoking

10.3   More detail on the Staffordshire LAA can be found at:

       http://www.staffordshirepartnership.org.uk/

10.4   The Staffordshire-wide targets are split between ourselves and South
       Staffordshire PCT. Our share of each target matches our
       corresponding vital sign target.

10.5   Current performance against our share of the agreed LAA targets is
       summarised in appendix 18.

10.6   The organisation submitted Q3 data in mid-January. However, there
       are time lags involved in the monitoring of all of these outcomes. The
       time period that the most recent data relates to is stated in the
       appendix.




                                         30
11.    Fit For The Future

11.1   The objective of the programme can be summarised as:

            Move 118,000 outpatient attendances into community facilities;
            Reduce unnecessary admissions to hospital;
            Provide more community intermediate care and rehabilitation
             beds/services;
            Perform more day case surgery;
            Reduce the length of time patients spend in hospital;
            Provide state of the art new hospitals.

11.2   The latest position regarding the Fit for the Future programme is:

            Diabetes, COPD and Heart failure services are being set up in
             Stoke for delivery in July 2010 through contract variation
             negotiations with Stoke-on –Trent Community Health. NHS
             North Staffordshire recommenced the commissioning of these
             services in January 2010 and hope to have specifications for
             services out to contract by 1st March 2010. Partners are agreed
             on the extent of the bed reduction and the size of the task
             required. More detailed plans are required, plus agreement on
             metrics for delivery.
            Phase 3 – The Stroke Project is being delayed by investment
             decisions. The North Staffs maternity project is awaiting
             decisions on diagnostics in the community.
            Cancer Follow up projects and Oncology SAMs have been
             passed through the Programme Board to commissioners,
             proposing blood transfusion, supportive therapies and stoma
             care in the community.
            The Colposcopy SAM is to be amended to identify that nothing
             is required from commissioners at this time as this is not part of
             the FFtF plan.
            Phase 4 projects - The Trauma and Orthopaedic SAM is
             currently delayed and the reasons for this along with plans for
             resolution is anticipated shortly. Paediatric pathways are being
             delayed by clinicians feeling „rushed‟ through the process, hence
             CEC approvals have been stalled. A successful workshop was
             held at the end of January to re-engage.
            The Programme office is proposing a shortened approach to
             SAM development with preparation time ahead of the first
             workshop to include: data analysis, Map of Medicine, PPI,
             clinical engagement etc in order to make the SAM meetings
             more productive and reduce delivery time.
            Ophthalmology – The activity transfer will not deliver the SAM
             target as the SAM was based on incidence and not actual
             activity. The Programme Board is to advise if shortfall should be
             pursued through ophthalmology or another programme.



                                      31
            The bed reconfiguration plan is now agreed. A Project Group is
             in place, with the first meeting held on 2nd February 2010. 292
             beds are to close. Support to deliver the bed numbers and
             monitoring will be available from the Programme Office
            Map of Medicine (MoM) – GPs are increasing their use of the
             map. The MoM pathways are being used to deliver the
             Programme office workshops to reduce the development time of
             the SAMS. The MoM manager is working with the OD team to
             develop joint sessions on FFtF.

11.3   Further information on the programme can be found in the Fit for the
       Future Programme Director‟s report.

11.4   A summary of current progress is contained within appendix 19.




                                     32
12.    Benchmarking

12.1   This section includes benchmarking information provided by the
       Commissioning & Business Support Agency (CBSA). This can be
       found in appendix 20.

12.2   This information is presented to inform the Board of areas of possible
       interest, with reference to performance amongst West Midlands Acute
       Trusts in a number of areas.

12.3   Planned Same Day/Day Case Rates: This shows UHNS to have one
       of the highest rates of planned same day/day case in the West
       Midlands. This is a good indicator as it is better for patients to be in
       hospital for as little time as possible. As would be expected, analysing
       this by PCT shows that NHS North Staffordshire has the highest day
       case rate amongst West Midlands PCTs.

12.4   Average Length of Stay (Elective): This shows that UHNS has one of
       the highest average length of stay rates in the West Midlands, second
       only to Robert Jones & Agnes Hunt (RJAH). This is slightly misleading
       as RJAH tend to treat a more complex case-mix of patients as a
       specialist orthopaedic Trust, so it is more likely that patients at RJAH
       would stay longer in the hospital. Again, this position at UHNS
       correlates with the PCT view which shows both local PCTs to have the
       highest average length of stay rates.

12.5   Average Length of Stay (Non Elective): This conversely shows
       UHNS to have one of the lower average length of stay rates in the
       West Midlands. This is not a surprise as UHNS has had a relatively
       high rate of Non Elective admissions with a short (i.e. 0-1 day) length of
       stay. Both NHS North Staffordshire and NHS Stoke-on-Trent also have
       low average length of stay rates.

12.6   Elective Excess Bed Days: This analyses the number of excess bed
       days per spell and shows UHNS to have one of the higher rates in the
       West Midlands. This fits logically with the average length of stay
       analyses. A low average length of stay would suggest a lower number
       of bed days. Discounting RJAH again, UHNS is second only to
       University Hospital of Coventry and Warwickshire. From a PCT
       viewpoint, NHS North Staffordshire has the highest rate in the West
       Midlands.

12.7   Non Elective Excess Bed Days: This analysis shows UHNS to have
       one of the lowest rates of non elective excess bed days per spell. As
       with electives, this correlates with the average length of stay position
       discussed earlier in this section. Again, turning this analysis to a PCT
       position, both local PCTs have among the lowest number of excess
       bed days per spell in the region.




                                       33
12.8   Future reports will continue to feature benchmarking information that is
       thought of interest to the Board.




                                      34
Appendix 1: Performance Matrix

                                                                                                                                   BENCHMARKS                                       PERFORMANCE

                                                                                                                                                                                                             WCC
                                                                                                                                    Compared to                        Vital Sign          LAA
                                                                                                                     Compared to                     Compared to                                         aspirational
Area                   Metric                                                           Time period      Value                       our ONS                          performance      performance
                                                                                                                       England                      the WM region                                        performance
                                                                                                                                      cluster                            (YTD)            (YTD)
                                                                                                                                                                                                           2009/10
                       Slope index of inequality: males                                   2004-08          7.4              53            3                5               NA               NA              TBC
                       Slope index of inequality: females                                 2004-08          7.1             111            9                15              NA               NA              TBC
Health Inequalities    Life expectancy: males                                             2006-08         77.6              75           12                11              NA               NA              RED
                       Life expectancy: females                                           2006-08         81.9              74           13                12              NA               NA              RED
                       Infant Mortality (<1 year)                                         2006-08          6.1             132           11                10              NA               NA               NA
                       Smoking in pregnancy                                               2008/09        18.6%              99            4                11              NA               NA               NA
Birth
                       Breastfeeding initiation                                           2008/09        64.4%             102            4                8               NA               NA               NA
                       Completion of MMR immunisation (1st and 2nd dose) by their
                                                                                          2008/09        91.4%              2             2                1               NA               NA               NA
Children               5th birthday
                       Prevalence of obesity in Year Six children                         2008/09        19.2%              90           10                8            AMBER*            AMBER             RED
                       Smoking quitters (4-week) (rate)                                   2008/09        654.2             124           13                15            GREEN            GREEN             RED
                       Hypertension prevalence (GP practice registers)                    2008/09        15.9%             142           13                15              NA               NA               NA
Staying Healthy        Chlamydia screening                                              Q2 2009/10        8.4%              87           11                10              RED              NA               NA
                       Breast Screening (53 to 70)                                        2008/09        78.2%              65            9                7               NA               NA               NA
                       Cervical Screening (25 to 49)                                      2008/09        77.5%              13            4                3               NA               NA               NA
                       18 Week RTT (admitted)                                              2008         83.94%             121           12                13            GREEN              NA               NA
                       18 Week RTT (non -admitted)                                         2008         92.37%              96           11                9             GREEN              NA               NA
                       Cancer waits: 14 day target                                        2008/09        99.9%              38            6                4               NA               NA               NA
Planned Care
                       Cancer waits: 31 day target                                        2008/09        99.4%             122           13                15              NA               NA               NA
                       Cancer waits: 62 day target                                        2008/09         93%              149           13                17              NA               NA               NA
                       Premature cancer mortality (rate per 100,000 population)           2006-08        113.43             63            2                7             GREEN              NA              RED
                       Access to primary care: appointment within 48 hours                2008/09         91%               16            1                1               NA               NA               NA
Primary Care
                       Access to primary care: appointment 2 days ahead                   2008/09        72.9%             134           13                15              NA               NA               NA
                       Delayed transfer of care (rate per 100,000 population)           Q2 2009/10         7.9              76           10                4             AMBER              NA               NA
Acute Care
                       C Diff infection (rate per 10,000 population)                      2008/09         6.74              71            8                7             GREEN              NA               NA
                       Hospital admissions for alcohol-related harm (rate per 100,000
                                                                                        Q1 2009/10       404.3              66            4                8             GREEN            GREEN            GREEN
Mental Health          population)
                       Effectiveness of CAMHS services                                  Q2 2009/10         12              =135          =12              =10            GREEN              NA               NA
                       Emergency admissions for ACS conditions (rate per 1,000
                                                                                          2008/09        14.07              70            1                6             AMBER              NA              RED
Long Term Conditions   population)
                       Premature CVD mortality (rate per 100,000 population)              2006-08        71.87              59            3                6             GREEN            GREEN            AMBER
End of Life            Percentage of people dying at home                                  2008          16.5%                                                             NA               NA              RED
                       Self-reported experience of patients and users                     2007/08          79               47            4                6               NA               NA             AMBER
Other: Experience
                       NHS Staff Satisfaction                                              2008           3.44             144           14                17           AMBER*              NA               NA


                                                                                                                                   * data not monitored in year, rating based on latest data available


                                                                                        Benchmarking rank key                      Performance key
                       Total PCTs in England = 152                                      Green = in best (top) 20%                  Green = target achieved or exceeded within most recent time period available
                       Total PCTs in ONS Cluster = 14                                   Amber = in the middle 21% to 79%           Amber = target within 95% CI during the most recent time period available
                       Total PCTs in West Midlands = 17                                 Red = in the worst (bottom) 20%            Red = target outside of 95% CI during the most recent time period available
                                                                                                                                   TBC = To be confirmed (new indicator)




                                                                                                         35
Appendix 2: A&E




                  36
Appendix 3: Serious Untoward Incidents (SUIs)

              SUIs breakdown for each provider November 2009 – January 2010 and comparison with same period for 2009/08


                                                                                NORTH STAFFS                INDEPENDENT           NORTH STAFFS COMBINED
                                                       UHNS                COMMUNITY HEALTHCARE            CONTRACTORS                   HEALTHCARE
                                              Jan       Dec       Nov       Jan      Dec     Nov       Jan       Dec     Nov       Jan       Dec      Nov
                                            10   09   09   08   09   08   10   09  09   08 09   08   10   09   09   08 09   08   10   09   09   08  09   08
TYPE OF INCIDENT
MRSA Bacteraemia                            6    6    1    3    1
C.Diff and HCAI                                                                     2       1                                                  2
Confidential Information Leak                    1         1
Maternity Service
Other                                                 1
Other (missing patient)
Other (clinical)
Other (over-exposure of radiation)
Accident whilst in hospital                      1    1         1
Serious incident by patient                                     1
Surgical error
Unexpected death (community)                                                                                                                   1         1
                                                                                                                                 1
Unexpected death (in patient)                                   1    1                                                           1                  2    1
Unexpected death (community in                                                                                                   5    1
receipt)
Unexpected death (general)                                      1
Ward\Unit closures                          14   8    24   11   7    2        4         2                                                      1
Prisoner in receipt of care                                                                     1
Suicide by Outpatient (in receipt)                                                                                                    1
Allegation against healthcare                         1
professional
Child death                                           1                                 1
Drug Incident (general)                          1                            1
Communicable disease and Infection               1
issue
Communication Issue                               1
Delayed Discharges                           2    2
                                   Totals   22   21   29   15   12   3    0   5     2   3   1   1    0    0   0    0   0    0    7    2    0   4    2    2


                                                                               37
                  0
                          1
                                        2
                                                3
                                                        4
                                                                  5
                                                                      6
                                                                              7
                                                                                  8
                                                                                          9
                                                                                                                                                                       0
                                                                                                                                                                                     10
                                                                                                                                                                                                     20
                                                                                                                                                                                                          30
                                                                                                                                                                                                               40
                                                                                                                                                                                                                    50
                                                                                                                                                                                                                         60
                                                                                                                                                                                                                                   70




                                            2
     2009/11697                                                                                                                                              2010/62




                              1
                                                                                                                                                                           1 1




                      0
                                                                                                                                                                                   6
     2009/11754                                                                                                                                             2010/117




                                                                                                                                                                           0




                              1
                                            2
     2009/11986                                                                                                                                             2010/138                                                          62


     2009/11981                                                                                                                                             2010/113




                                                                                                                                                                                          13 13 13




                              1 1 1
                                                                                                                                                            2010/199




                                                            4
     2009/12011
                                                                                                                                                                                                                                                                                                    Time Taken to Report SUIs




                                                                                                                                                                           0 1
                                                                                                                                                                                                                                                                                                                                Appendix 3: SUIs continued




                                                    3
                                                                                                                                                            2010/287




                      0
     2009/12145




                                                            4
                                                                                                                                                                                 4 5 5
                                                                                                                                                            2010/590



                                                                                                                                                                           0
     2009/12313
                                                                                                                                                            2010/593
                                                                                                                                                                            3 2




38
     2009/12317
                                                                                                                                                                                  5

                                                                                                                                                            2010/623




                              1 1 1 1
                                                                                                                                                                           0




                                            2
     2009/12324
                                                                                                                                                                                   6




                                                                                                                                                            2010/792




                                                            4
                                                                                                                                                                           0




                      0
     2009/12342
                                                                                                                                                                                   6




                                                                                                                                                            2010/902




                              1
                                                                                                                                                                                 4




                                                    3
     2009/12349                                                                                                                                             2010/952
                                                                                                                                                                           0 0




                                                            4 4
     2009/12665                                                                                                                                            2010/1076
                                                                                                                                                                                                                                        Number of days between incident and report - Janaury 2010




                                                                          6
                                                                                                                                                                           3 2 2




                                                                                                                                                           2010/1106




                                                    3
     2009/12642
                                                                                              Number of days between incident and report - December 2009
                                                                                                                                                                                 1




                                                                                      8
                                                                                                                                                                                  5




                                                                                                                                                           2010/1206




                      0
     2009/12910
                                                                                                                                                                            2




                                                    3
                                                            4
     2009/13007




                              1
                                                    3
     2009/13009
Appendix 4: MRSA and Clostridium Difficile

MRSA (UHNS)
2009/10

Provider - UHNS          Apr       May          June            July       Aug       Sep       Oct      Nov      Dec          Jan          Feb           Mar          YTD       FOT
UHNS                       7          1             0              1          2         2         2        2        1                                                   18        27
Plan                       3          3             3              3          4         4         4        4        4           4            4              4           24        44
Variance                   4         -2            -3             -2         -2        -2        -2       -2       -3          -4           -4             -4           -6       -17
%                     233.3%     33.3%          0.0%          33.3%      50.0%     50.0%     50.0%    50.0%    25.0%                                                75.0%     61.4%

2008/09

Provider - UHNS          Apr       May          June         July           Aug      Sep       Oct      Nov       Dec      Jan           Feb             Mar          YTD       FOT
UHNS                       5         7              0           5             6         0         0        2        4        5              3               2           39        39
Plan                       4         5              4           5             4         5         4        5        4        5              4               5           54        54
Variance                   1         2             -4           0             2        -5        -4       -3        0        0             -1              -3          -15       -15
%                     125.0%    140.0%          0.0%      100.0%         150.0%     0.0%      0.0%    40.0%    100.0%   100.0%         75.0%           40.0%        72.2%     72.2%

Source: WMSHA Intranet ( Health Care Acquired Infections )



Clostridium Difficile (Total PCT)
2009/10

Commissioner                              Apr       May          June       July     Aug      Sep     Oct      Nov      Dec         Jan      Feb           Mar         YTD      FOT
Plan                                       14        14            14        14       14       14      14       14       14          14       14            14           98      168
Actual            Acute                     8         2             7          7        4       0       4        2        6                                              40       60
                  Community Hospital        3        12             7          4        3      13       4        6        2                                              54       81
                  Other Non Acute           0         0             0          0        0       0       0        0        0                                               0        0
                  Total                    11        14            14        11         7      13       8        8        8           0           0             0        78      141
Variance                                   -3         0             0         -3       -7       0      -6       -6       -6           0           0             0       -20      -27

2008/09

Commissioner                              Apr       May          June       July     Aug      Sep     Oct      Nov      Dec         Jan      Feb           Mar         YTD      FOT
Plan                                       12        12            12        12       12       12      12       12       12          12       12            13         145       145
Actual            Acute                     8        12             4          6        7      10      13        8       11            4        7           10         100       100
                  Community Hospital        3         2             0          0        0       0       0        1        0            1        1            2          10        10
                  Other Non Acute           3         1             2          3        2       6       2        2        3            2        3            1          30        30
                  Total                    14        15             6          9        9      16      15       11       14            7      11            13         140       140
Variance                                    2         3            -6         -3       -3       4       3       -1        2           -5       -1            0           -5       -5

2009/10

Provider ( UHNS)                          Apr       May          June       July     Aug      Sep     Oct      Nov      Dec         Jan      Feb           Mar         YTD      FOT
Plan                                       28        30            29        29       29       29      29       29       29          29       29            29         203       348
Actual           Acute                     20        16            12        24        8        9      15        7       11                                            122       183
                 Non Acute                                                                                                                                                0        0
                 Total                     20            16         12        24        8        9      15        7      11           0           0             0      122       183
Variance                                   -8           -14        -17        -5      -21      -20     -14      -22     -18           0           0             0       -81     -165

2008/09

Provider ( UHNS)                          Apr       May          June       July     Aug      Sep     Oct      Nov      Dec         Jan      Feb           Mar         YTD     FOT
Plan                                       33        33            33        33       33       33      33       33       35          35       35            35          404     404
Actual           Acute                     32        27            14        12       14       11      11       10       13          17       14            16          191     191
                 Non Acute                                                                                                                                                0 #DIV/0!
                 Total                     32           27          14        12       14       11      11       10      13          17           14         16         191     191
Variance                                   -1           -6         -19       -21      -19      -22     -22      -23     -22         -18          -21        -19        -213    -213




                                                                                        39
Appendix 5: Quality Indicators

Safety
                                                                                                                    NORTH STAFFS
                                                                              NORTH STAFFS                           COMMUNITY                 UNIVERSITY HOSPITAL
                                                                           COMBINED HEALTHCARE                       HEALTHCARE                 OF NORTH STAFFS
                                                                                                                                                Dec 2009 Information
                                                                                                                                                 taken from Month 9
Indicator Description                             Threshold                   Dec-09            Jan-10           Oct-09         Dec-09           Performance Report
PLEASE STATE N/A IF INDICATOR NOT
APPLICABLE

QUALITY DOMAIN - SAFETY
GUIDING PRINCIPLE - Patients should not be harmed by the care that they receive or exposed to unnecessary risk
                                                                                             13 = 12 adult
                                                                                             and urgent
Medication Errors: All medication errors.                                                    casre
An overall rating should be provided and                                                     division. 1
then the information should be broken down                                                   children and
by service/directorate/speciality          100% compliance                                   families                                     0

Medicines Management: The provider will
ensure that all clinicians are aware of
medicines management commissioning
intentions below along with any detailed
prescribing guidance that is to be in place       100% compliance

Formularies/Prescribing Guidelines:

1.   Compliance with agreed formulary             90% compliance                                              Compliant       Compliant


2. Clinicians should not ask GPs to routinely
prescribe unlicensed drugs or drugs for use
outside their licensed indications, unless
there is established practice or a substantial
body of evidence to support it                    100% compliance                                             Compliant       Compliant

3. The provider will ensure that generic drug
names are used except where this is
inappropriate                                                                                                 Compliant       Compliant
4. The provider clinicians should prescribe
proprietary generic products whenever
possible - the prescribing of "special"
formulations should only be considered
when suitable alternative proprietary options
have been exhausted                                                                                           Compliant       Compliant

5. Provider clinicians should prescribe
proprietary generic products whenever
possible - the prescribing of "special"
formulations should only be considered
when suitable alternative proprietary options
have been exhausted                                                                                           Compliant       Compliant
Medicines Supply by Hospitals
1. W here commissioned providers should
ensure that medication is reviewed before
discharge and any necessary changes
made. W hen a patient is discharged and
ongoing care is required, medicines,
appliances and dressings will be supplied to
last for either the complete course of
treatment or 14 days, whichever is the
shorter                                                                                                       Complaint       Complaint

2. Providers should dispense in original
manufacturers packs whenever possible             100% compliance                                             Complaint       Complaint


3. Patients attending outpatient clinics who
do not require medicines immediately will be
advised to obtain a prescription from their
GP (unless provision is included within
contract). The clinic must inform the patient
that they will be contacting the GP and that
the medicines supply need is not urgent and
advise of a suitable time after which the
prescription will be available. The clinic must
then provide timely, legible information to the
GP practice.                                                                                                  Complaint       Complaint

4. If a consultant considers that the
medication need cannot wait to obtain the
prescription from the GP, the Trust should
supply a minimum, of 14 days' supply
(original pack applies). The provider must
ensure that adequate information reaches
the GP before the patient attends for further
medication                                        To ask Dr P?


5. In cases where the patient's prescription
needs are designated as "specialist" only,
the prescribing responsibility will remain with
that specialist - the GP should not be asked
to continue prescribing                           To ask Dr P?



6. The Pharmacy Department at the Trust,
should ensure that patients being discharged
from their care have sufficient information to
use their medicines safely and effectively                                                                    Complaint       Compliant


Accident and Emergency Waiting Times              98% compliance           N\A               N\A

Any Accident and Emergency 4-hour                                                                                                           2009 target - 98%.
breaches to be broken down by hourly                                                                                                        Cumulative 98.1%.
intervals.                                        100% compliance          N\A               N\A                          1               0 Monthly 96.5%


Hourly analysis of 4-hour waits                   100% compliance          N\A               N\A              Compliant       Compliant



                                                                                                                                            MRSA - 60% reduction on
Incidents of MRSA. An overall rating should                                                                                                 2003/04 baseline. Overall
be provided and then the information should                                                                                                 target for 2009/10, 44
be broken down by                                 100% compliance within                                                                    Bacteraemia: Cumulative
service/directorate/speciality                    trajectory of 46                       0                0               0               0 = 17, Monthly = 1.

                                                                                                                                            To achieve a reduction of
                                                                                                                                            25% in level of C.Diff
                                                                                                                                            positive toxin results in >2
                                                                                                                                            years, which equates to a
Incidents of Clostridium Difficile. An overall                                                                                              maximum of 348 infections
rating should be provided and then the                                                                                                      for UHNS by March 2010:
information should be broken down by              100% compliance within                                                                    Cumulative = 198; Monthly
service/directorate/speciality                    trajectory of 423                      0                0               0               3 = 16.

Healthcare associated infections. An overall
rating should be provided and then the
information should be broken down by
service/directorate/speciality                    100% compliance                        0                0 1 ESBL            1 ESBL


                                                                                                                                              Hand hygiene target 95%.
                                                                                                                                              Cumulative 91.8%.
Implementation of the Hygiene Code                100% compliance          Compliant         Compliant        Compliant       Compliant       Monthly 93.9%.


Improvement in the detection, diagnosis and,
where possible, treatment and/or vaccination                               This needs to be part of the
for blood borne viruses amongst current or                                 Health Check process which
former substance misusing clients                                          is being implemented               N/A             N/A


Hepatitis B vaccination - all current or                                   This needs to be part of the
previous injectors to be offered Hepatitis C                               Health Check process which
testing and subsequent treatment                                           is being implemented               N/A             N/A

Compliance with NHSLA Risk Management                                      Assessed by NHSLA in
Standards at current level. Evidence of                                    February 2009 confirmed as
working towards higher level (level 3 within                               compliant at Level 1 working
Standard 5)                                       100% compliance          to achieve Level 2 2010            N/A             N/A



1. SUI/significant event report with action
plans. An overall rating should be provided
and then the information should be broken
down by service/directorate/speciality            100% compliance                        3                5               0               1
                                                                           Need to review
2. The Provider to notify the Commissioner                                 processes/evidence for this
of all SUIs within 24 hours                       100% compliance          area                               N/A             Complaint


3. The Provider will notify the Co-ordinating                              Need to review
Commissioner On-call Director as a matter                                  processes/evidence for this
of routine of any major incident                  100% compliance          area
                                                                                                                                              Achievement against plan
                                                                                                                                              for number of SUIs
Providers shall provide commissioners with                                                                                                    reported as a % of total
national service user safety incident reports                                                                                                 number of incidents: Target
with action plans                                 100% compliance                                                                             = 10%; Cumulative = 3.7%.



Incident Reporting to include data on number
of incidents, type of incident trends and
action plans. An overall rating should be
provided and then the information should be
broken down by service/directorate/speciality 100% compliance                          374               43 Compliant         Compliant


                                                                           National and local service
Learning from experience with action plans.                                user survey results are
An overall rating should be provided and                                   available. The level of detail
then the information should be broken down                                 and regularity of reporting
by service/directorate/speciality                 100% compliance          requires further review            Compliant       Compliant


Safeguarding - Organisational requirements:
Named doctor; access to and adherence to
SCB agreed child protection policies:
mandatory training for staff; incident
reporting; knowledge of children on a child
protection plan within organisation's care;
regular clinical audits; Climbie compliant;                                Policies available and
Section 11 compliance audit; Involvement in                                monitoring undertaken via
the local Safeguarding Children Board             100% compliance          incident reporting                 Compliant       Compliant

Safeguarding Vulnerable Adults: adherence                                  Policies available and
to local policies; involvement in local                                    monitoring undertaken via
Safeguarding Board                                100% compliance          incident reporting                 Compliant       Compliant




                                                                                 40
Effectiveness

                                                                                                                  NORTH STAFFS
                                                                         NORTH STAFFS COMBINED                     COMMUNITY                 UNIVERSITY HOSPITAL
                                                                              HEALTHCARE                           HEALTHCARE                  OF NORTH STAFFS
                                                                                                                                                 December 2009.
                                                                                                                                             Information taken from
                                                                                                                                              Month 9 Performance
Indicator Description                         Threshold                    Dec-09            Jan-10             Dec-09         Jan-10                Report
PLEASE STATE N/A IF INDICATOR NOT
APPLICABLE

QUALITY DOMAIN - EFFECTIVENESS

GUIDING PRINCIPLE - Healthcare services should be based, as far as possible, on relevant rigorous science and research evidence


                                                                       Information can be provided
                                                                       through SUI reporting, although
                                                                       the point of decision that the
                                                                       issue relates to a suicide needs to
                                                                       be considered and agreed, ie
                                                                       confirmation of suicide confirmed
Mortality rates of suicide and injury of      Results to be in top     by Coroner and this does result in
undetermined intent                           20% nationally           delay.                                            0               0
Mortality rates from causes considered
amenable to healthcare. An overall rating
should be provided and then the information
should be broken down by                      Results to be in top     Not in the Trust's Performance &
service/directorate/speciality                20% nationally           Quality Management Framework N/A                      N/A
Implementation of appropriate evidence-
based guidelines which includes NICE
guidance technology appraisals and NICE
Public Health Guidelines                      100% compliance                          9                0
                                                                                                                                      Number resolved within
                                                                                                                                      agreed timescales: Target
                                                                                                                                      85%; cumulative 87.4%;
                                                                                                          3= 2 Adult &                monthly 83.8%.
                                                                                                          Urgent Care                 Improvement in number
Complaints reporting: an overall rating should                                                            Division; 1                 that proceed to
be provided and then the information should                                                               Children and 2 Adult &      Ombudsman: target 5%'
be broken down by                                                                                         Families       Urgent Care cumulative 4.06%; monthly
service/directorate/speciality.                                                      11                 5 Fivision       Division     3.20%.
All claims reported to the NHSLA               100% compliance                        6                 2              0            1
                                                                       Trust 2009/10 Audit Plan
                                                                       approved by Quality &
                                                                       Governance Committee May
Clinical audit programme and plan             100% compliance          2009                                  On Target       On Target
                                              A reduction in age
                                              inappropriate
                                              admissions to adult
                                              facilities and improve
By 2010, no 16/17 year olds should be         provision of age
admitted to an adult psychiatric ward (unless appropriate
such an admission is in accordance with their accommodation for
needs)                                        16/17 year olds                          0                0 N/A                N/A




                                                                               41
Access and Timeliness

                                                                                                             NORTH STAFFS
                                                                         NORTH STAFFS COMBINED                COMMUNITY              UNIVERSITY HOSPITAL
                                                                              HEALTHCARE                      HEALTHCARE              OF NORTH STAFFS
                                                                                                                                      Dec 2009 Information
                                                                                                                                       taken from Month 9
Indicator Description                          Threshold                    Sep-09         Oct-09        Nov-09         Dec-09         Performance Report

PLEASE STATE N/A IF INDICATOR NOT
APPLICABLE

QUALITY DOMAIN - ACCESS AND TIMELINESS
GUIDING PRINCIPLE -Healthcare services should be timely and provided within the appropriate setting with access to necessary skills, expertise

                                               90% inpatients; 95%
Deliver 18 weeks target for Consultant-led     outpatients (aiming for Monitoring undertaken and
pathways                                       100%)                   reported                        N/A           N/A            95% of non-admitted
                                                                                                                                    pathways completed within
                                                                                                                                    18 weeks by December
Access Policy reviewed in line with 18 weeks                             Monitoring undertaken and                                  2008: Currently achieving
guidance                                     None required               reported                      N/A           N/A            the 18 week target for the
                                                                                                       In            In             Trust but are not achiving 18
Trust to provide monthly 18 weeks reported                                                             preparation   preparation.   weeks across all specialties.
waits for all specialities/teams to support                                                            . 100% for    100% for
discussions over the long-term delivery of 18 90-95% (aiming for         Monitoring undertaken and     initial       initial
weeks                                         100%)                      reported                      observation   observations
                                                                                                       s

Delivery of Integrated Packages Approach to Initial benchmark/data
Care (InPAC)                                collection



                                                                         The Trust is assessed against
                                                                         12 questions taken from the
                                                                         Green Light Toolkit. These
                                                                         have been assessed and
                                                                         scored as follows: 4 are
                                                                         assessed as Green; 8 are
Improved access and provision of mental                                  assessed as Amber with
health care for people with learning                                     action plans in place, 0 are
disabilities                                   100% compliance           assessed as Red               N/A           N/A




                                               Service specification
                                               to be agreed, if not
                                               already in place. Once
                                               service established,
                                               local targets to be       Performance based on
                                               agreed for: numbers of    2008/09 and Q4 is 54.5%
                                               treatment episodes        which is lower than the
                                               and improvement in        England avergae of 94.068%.
                                               proportion of inpatient   Note : perofrmnace has
Comprehensive coverage of the population       admissions that are       improved at M10 98 (YTD
by crisis resolution/home treatment services   gateway kept.             94%%).



                                               Baseline and annual
Improvement in access and outcomes for         improvement targets to
psychological therapies                        be set locally                                          N/A           N/A


All patients, both mental health and learning
disability (on caseload) to have received a
physical health check, at least annually, to
include health promotion relating to smoking
cessation and tackling obesity                100% compliance            Process being implemented     N/A           N/A


The proportion of people admitted to mental
health wards from the community who have
had an MDT community assessment                100% compliance                                         N/A           N/A




Primary Care Access Level of 24 hour access
to specialist mental health services        100% compliance                                            N/A           N/A




                                                                               42
Capacity
                                                                                                             NORTH STAFFS
                                                                           NORTH STAFFS                       COMMUNITY               UNIVERSITY HOSPITAL
                                                                        COMBINED HEALTHCARE                   HEALTHCARE               OF NORTH STAFFS

                                                                                                                                       Dec 2009 Information
                                                                                                                                        taken from Month 9
Indicator Description                            Threshold                 Dec-09          Jan-10          Nov-09         Dec-09        Performance Report

PLEASE STATE N/A IF INDICATOR NOT
APPLICABLE

QUALITY DOMAIN - CAPACITY
GUIDING PRINCIPLE -Healthcare systems should be sufficiently well resourced and with adequate distribution to enable delivery of

                                                                                                         Incident      Incident
                                                                                                         Reporting;    Reporting;
                                                 Evidence of risk                                        Team &        Team &
                                                 assessment and                                          Divisional    Divisional
                                                 risk action plans      Further review and               Monitoring;   Monitoring;
Monitoring of effective staffing levels by       from local risk        agreement regarding              Budget        Budget
speciality                                       register               content and detail required      Monitoring    Monitoring


CRB checks/work permits                          100% compliance        Information available            Complaint     Complaint


                                                                                                                                      Staff turnover has
                                                                                                                                      increased in Oct as a
                                                 Evidence of risk                                                                     result of 18 staff being
Vacancy factors: An overall rating should be     assessment and                                                                       transferred from UHNS
provided and then the information should be      risk action plans                                                                    Patient Transport to
broken down by service/directorate/speciality    from local risk                                                                      West Midlands
and staff group                                  register               Vacancy controls in place                                     Ambulance Service.




                                                                                                                                      Sickness Absence Rates
                                                                                                                                      (days lost): Target =
                                                                                                                                      4.5%; Cumulative =
                                                                                                                                      4.59%; Monthly = 3.55%.
                                                                                                                                      Long-term Sickness
                                                                                                                                      Rates (30+ days lost):
                                                                                                                                      Target = 2.65%;
                                                                                                                                      Cumulative = 3.19%;
                                                                                                                                      Monthly = 2.69%).
                                                                                                                                      Frequent Sickness Rates
Sickness/absence rate: An overall rating                                                                                              (4 or more episodes of
should be provided and then the information                                                                                           absence): Target = 4%;
should be broken down by                         Results to be in top                                                                 Cumulative/Monthly =
service/directorate/speciality                   20% nationally                                                                       5.64%.




                                                                        Processes in place although                                   Appraisal Rates: Target
                                                 80% of all clinical    regular reporting (ie monthly)                                = 80.0%;
Monitoring of supervision/appraisal              staff have received    will be problematic at the                                    Cumulative/Monthly =
agreements by speciality                         an annual review       present time                                                  75.75%.




                                                                      The survey results and
                                                                      indicator construction have
                                                                      been released. The Trust's
                                                                      aggregate position is 3.504
                                                                      compared to an England
                                                                      average of 3.549. The Trust
Staff survey scores in relation to measures of   Results to be in top is therefore in line with
job satisfaction                                 30% nationally       national norms
                                                                                                                       Evidence
                                                                                                                       provided to
                                                                        The Trust has achieved the
                                                                                                                       PCT
                                                 Current scores         targeted level 3 (ie good) in
Use of Resources scores                          maintained             each of the 5 themes.

                                                                                                         On Traget     On Traget to
The Provider will be expected to be fully                                                                to ensure     ensure
compliant with Standards for Better Health.                             The Trust has declared           compliance    compliance
The PCT reserves the right to request timely                            compliance with all of the       by 31         by 31 March
information that demonstrates compliance         100% compliance        core standards                   March 2010    2010




                                                                              43
CQUIN

                                                                                                                                              NORTH STAFFS      NORTH STAFFS              UNIVERSITY
                                                                                                                                                COMBINED         COMMUNITY             HOSPITAL OF NORTH
                                                                                                                                               HEALTHCARE        HEALTHCARE                 STAFFS
Indicator Description

PLEASE STATE N/A IF INDICATOR NOT APPLICABLE

CQUINS
Category                  Indicator                           Source                              Freq        Target          Baseline                          Nov-09       Dec-09

Timely and effective      The proportion of patients for      Sample audit of records- sample
discharge processes       whom discharge planning             size be sufficient to allow for a
                          commenced on admission (within      95% confidence rate in results                                                                            First audit
                          24 hours) and process was           against standards                                                                                         completed -
                          completed in line with plan                                                         Twice -                                        On Target report
                                                                                                              yearly audit               The Care            to Achieve awaited
Productivity              Full involvement in the SHA         PIP programme reports                                                      Pathway
improvement               Productivity Improvement                                                                                       Assessment
programme                 Programme in accordance with                                                                                   Electronic
                          agreed project plan timescales
                                                                                                                                         Tool element
                                                                                                                                         of the PIPP
                                                                                                                                         programme
                                                                                                                                         will
                                                                                                                                         commence
                                                                                                                                         in September
                                                                                                                                         2009 using
                                                                                                                                         21 Care
                                                                                                                                         Pathways for
                                                                                                                                         Adult MH
                                                                                                                                         services.
                                                                                                                                         Clinicians will
                                                                                                                                         test the Tool
                                                                                                                                         and
                                                                                                                                         determine its
                                                                                                                                         effectiveness
                                                                                                                                         to allocate
                                                                                                                                         service users
                                                                                                                                         to one of the
                                                                                                                                         pathways.
                                                                                                                                         Clinical
                                                                                                                                         outcome
                                                                                                                                         measuremen                      Time to
                                                                                                                                                                         care and
                                                                                                                                         ts will form
                                                                                                                                                                         patient
                                                                                                                                         part of the                     experience
                                                                                                              Implement                  overall                         survery not
                                                                                                              PIP                        objective                       being
                                                                                                              Workstream                 within the                      undertaken
                                                                                                              s                          PIP                 Achieved    .
Supportive Care           Proportion of all deceased          Patient records
Pathway - End of Life     patients (on caseload) who had
Care (including           an end of life care plan or
Liverpool Care Pathway    documentation that a care plan                                                                                                                Audit
Plans)                    had been offered and declined                                                       Annual Audit                                   On Target commence
                                                                                                              (November)                                     to Achieve d
Patients reporting that   Internal survey score for the       Patient Experience Survey
they were treated with    following question "Did you feel
dignity and respect       that you were treated with
                          respect and dignity while you                                                                                  63% -
                          were in hospital"
                                                                                                                                         Intermediate.
                                                                                                                                         The result of
                                                                                                                                         63% is very
                                                                                                                                         close to the
                                                                                                                                         top 20% of
                                                                                                                                         Trusts for
                                                                                                                                         which the
                                                                                                                                         thereshold is
                                                                                                                                         in excess of
                                                                                                                                         63%. 2009
                                                                                                                                         results: of
                                                                                                                                         the 28
                                                                                                                                         questions 14 -
                                                                                                                                         top 20%; 22 -
                                                                                                                                         intermediate;
                                                                                                              Inpatient                  2 - lowest          100%        100%
                                                                                                              Survey                     20%                 agreed      agreed
Serious Untoward          Reporting of all SUIs in a timely STEIS Incident reporting
Incident reporting and    fashion to the PCT in accordance system
management                with the PCT SUI policy 2009/10
                          All action plans shared and
                          performance managed jointly with
                          PCT via the Clinical Quality
                          Monitoring Meeting (CQRM) PCT
                          involvement in SUI meetings (sub
                          group of CQRM) PCT sign off of
                          Investigation and action plan via
                          CQRM No Never events (as per
                          NPSA proposal October 2008)
                                                                                                              Report within                                              No SUIs
                                                                                                              24 hours                                       Achieved    reported
Reduction in MRSA         Provider shall ensure that number   tba
Bacteraemia               of MRSAs is no more than the                                                   M
                          Target
Reduction in C. Difficile Provider shall ensure that number   tba
infections                of C.diffs is no more than the                                                 M
                          Target
Mortality Rates           Provider to perform at national     Dr Foster
                                                                                                         M
                          average or better
Length of Stay - None- Provider shall ensure that             Dr Foster
Elective                  average LOS is no more than the                                                M
                          Target
Provider to issue a copy Provider shall ensure that all       tba
of the Clinical Letter,   letters and correspondence are
Discharge Letter,         treated in this manner. Provider
Discharge Summary or to report the % of compliance
such other
correspondence that                                                                                      M
has been issued as may
concern a particular
patient to the patient
and the patients' GP


Mixed sex                 Provider to provide the % of        tba
accommodation             compliance
                                                                                                         M
(implementation of
National Guidance)                                                                                                                                           Compliant Compliant




                                                                                                             44
Equity
                                                                                                           NORTH STAFFS
                                                                       NORTH STAFFS                         COMMUNITY            UNIVERSITY HOSPITAL
                                                                    COMBINED HEALTHCARE                     HEALTHCARE            OF NORTH STAFFS
                                                                                                                                  Dec 2009 Information
                                                                                                                                   taken from Month 9
Indicator Description                             Threshold               Jul-09        Aug-09         Nov-09         Dec-09       Performance Report

PLEASE STATE N/A IF INDICATOR NOT
APPLICABLE

QUALITY DOMAIN - EQUITY
GUIDING PRINCIPLE -Healthcare should be provided: 1. On the basis of clinical need, regardless of personal characteristics such as age,


Agreed health economy care pathway
compliance                                        100% compliance   PIP/Project/CPA


Bed occupancy levels. An overall rating
should be provided and then the information
should be broken down by                          85-90% monthly
service/directorate/speciality                    and cumulative            84.89%          85.01%           90%          89%

                                                                    Information is available,
                                                                    need to confirm that it can
Average length of stay. An overall rating                           be broken down as
should be provided and then the information       To be agreed by   requested by
should be broken down by speciality               Commissioners     Commissioners.



                                                                                                                                 Emergency re-admission
                                                                                                                                 within 14 day, Target
Re-admission rates. An overall rating should                                                                                     3.9%, Cummaltive 3.74,
be provided and then the information should                         There were 18 re-                                            Monthly 3.48%. Re-
be broken down by                                                   admissions from 399 eligible                                 admission with 28 days,
service/directorate/speciality who exceed the                       discharges, giving a quarter                                 Target 4.9%, Cummaltive
thresholds                                        Below 4.5%        1 re-admission rate of 4.5%.                                 4.84, Monthly 4.64%

Excess bed days. An overall rating should be
provided and then the information should be  To be agreed by
broken down by speciality                    Commissioners          N\A               N\A



Comprehensive coverage of the population by
early intervention services for psychosis   100% compliance

Comprehensive coverage of the population by
assertive outreach                          100% compliance                                          N/A            N/A


Improved early intervention in dementia           100% compliance   Further review required          N/A            N/A


Comprehensive coverage of inreach services
from community mental health teams for older                        Information should be
people into all care homes                   Set baseline           available                        N/A            N/A


Improved coverage of the population by
comprehensive CAMHS services for children                           Information as per self
and young people, including children with                           assessment using the self
learning disabilities. All areas to have access                     assessment tool provided by
to 24-hour cover for urgent needs                 Set baseline      the CQC                     N/A                 N/A


Improved management of dual diagnosis for
individuals in touch with substance misuse
services and individuals in touch with
specialist mental health services                                   Further review required          N/A            N/A


Improving access to assessment for people         Baseline data
experiencing acute mental health problems         collection        Further review required          N/A            N/A
Improving access to assessment for people
experiencing non-acute mental health              Baseline data
problems                                          collection        Further review required          N/A            N/A


All service users to have a care plan in line
with their needs that is reviewed and updated
as appropriate                                    100% compliance               70%           72%

All service users assessed and needs
identified using CPA criteria                     100% compliance               70%           72% N/A               N/A

All service users discharged on CPA to be
followed up within 7 days                         100% compliance            100%            100% N/A               N/A

Number of patients detained under Mental
Health Act                                        100% compliance   Available                        N/A            N/A

Number of patients detained under Section
5(2) of Mental Health Act                                           Available                        N/A            N/A


                                                                    During quarter 1, 186 people
Number of people receiving assertive                                were receiving Assertive
outreach services (caseload)                                        Outreach Services            N/A                N/A

                                                                    During quarter 1, 321 home
                                                                    treatment episodes were
Number of home treatment episodes                                   completed by Crisis
completed by Crisis                                                 Resolution Teams                 N/A            N/A

                                                                    During quarter 1, 284 people
                                                                    were receiving home
Number of people receiving home treatment                           treatment from the Crisis
(Crisis)                                                            Resolution Teams             N/A                N/A


Access to Crisis Resolution (face to face)        100% compliance   Information available            N/A            N/A

                                                                    During quarter 1, 18 new
Number of new cases of psychosis served by                          cases were served by Early
EI Teams                                                            Intervention Teams               N/A            N/A
                                                                    During quarter 1, 153 people
Number of people receiving early intervention                       were receiving Early
services (caseload)                                                 Intervention Services        N/A                N/A


All admissions must be made via Crisis            100% compliance               89%           90% N/A               N/A

Minimising delayed transfers of care              7.5% maximum              12.30%          11.41%            5.5          3.8




                                                                            45
Appendix 6: World Class Commissioning Performance Summary

WCC outcomes and aspirational targets
                                                             Current
                                                          performance
                                                         against 2009/10              Aspirational targets             Resulting changes to
 Outcome                    Metric                        stretch target             11/12                 13/14       the population by 2013/14

                                                                                                                       The gap in male life
                                                                                                                       expectancy between the
                             Slope Index of Inequality      7 yrs 5 mths           7 yrs 5 mths         7 yrs 4 mths   most and least deprived
                             (males)                         (2004-08)              (2009-13)            (2011-15)     is reduced by 1 month
                                                                                                                       (compared to a predicted increase
 Reducing                                                                                                              of 1 year)
 health                                                                                                                The gap in female life
 inequalities                                                                                                          expectancy between the
                             Slope Index of Inequality       7 yrs 1 mth          6 yrs 11 mths        6 yrs 10 mths   most and least deprived
                             (females)                        (2004-08)             (2009-13)            (2011-15)     is reduced by more than
                                                                                                                       3 months (compared to a
                                                                                                                       predicted increase of 2 years and
                                                                                                                       4 months)
                            Life expectancy at birth        77 yrs 7 mths         82 yrs 6 mths        83 yrs 5 mths   Males will live for an extra
 Increasing                 (males)                           (2006-08)             (2010-12)            (2012-14)     6 years and 4 months*
 life
 expectancy                 Life expectancy at birth       81 yrs 11 mths         86 yrs 2 mths        87 ys 8 mths    Females will live for an
                            (females)                        (2006-08)              (2010-12)           (2012-14)      extra 5 years 6 months*
                            The percentage of
 Reducing                   children in Year 6                  19.2%                                                  Over 300 more children
 childhood                  recorded as obese for                                   18.5%                 18.1%        will be supported in not
                                                              (2008/09)
 obesity                    their age in the past                                                                      becoming obese
                            school year
                            The number of 4-week                                                                       More than 5,500
 Increasing
                            smoking quitters                    654.2                                                  people will have given up
 smoking                                                                           1,310.87              1,774.76
                            attending NHS Stop                (2008/09)                                                smoking
 quitters
                            Smoking services#
                                                                                                                       At least 1,800 fewer
 Reducing                   Rate of hospital
                                                               1,578.1                                                 hospital admissions for
 alcohol-related            admissions for alcohol-                                1,709.83              1,567.66
                                                              (2008/09)                                                alcohol-related
 admissions                 related harm#
                                                                                                                       conditions##

                            Crude rate of
 Reducing                                                                                                              At least 5,500 fewer
                            emergency admissions                15.59^
 ACS                                                                                 9.88                  9.88        emergency admissions
                            for ACS conditions                (2009/10)
 admissions                                                                                                            for ACS conditions
                            per 1,000 population

 Reducing                   Mortality rate from                                                                        More than 250
                                                                113.43              86.44                 80.77
 premature cancer           cancer in people                                                                           premature cancer
                                                              (2006-08)           (2010-12)             (2012-14)
 mortality                  aged < 75#                                                                                 deaths avoided*

 Reducing                   Mortality rate from                                                                        More than 100
                                                                71.87               33.34                 23.39
 premature CVD              CVD in people                                                                              premature CVD deaths
                                                              (2006-08)           (2010-12)             (2012-14)
 mortality                  aged < 75#                                                                                 avoided*

                            Percentage of                                                                              Over 550 more people
 Increasing the %                                                 16.5%             23.7%                 24.5%
                            all deaths that                                                                            die at home rather than
 of deaths at home                                                (2008)            (2011)                (2013)
                            occur at home                                                                              elsewhere^^

                                                                                                                       A 5.0% improvement in
 Improving                  Average self-reported
                                                                78.97                                                  the average self-
 patient                    patient and user                                         81.78                 83.05
                                                              (2007/08)                                                reported patient and
 experience                 experience score
                                                                                                                       user experience score

 * Compared to 2005-07 baseline
 ** Compared to 2007/08 baseline
  #
    Per 100,000 population                        New indicator                 Aspiration likely to be achieved
 ##
    Compared to 2008/09 baseline
  ^ Current best guess                            Aspiration achieved           Aspiration unlikely to be achieved
 ^^ Compared to 2008 baseline




                                                                           46
Appendix 7: Mission Critical Outcomes

                                       Section of Performance
Mission Critical                                                     Executive lead               RAG Rating
                                       Report

1   World Class Commissioning Outcomes World Class Commissioning     WCC Project Director


2 World Class Commissioning            World Class Commissioning     WCC Project Director
Governance

3 World Class Commissioning            World Class Commissioning     WCC Project Director
Competencies

4   Fit for the Future                 Programme and Issues in FfTF Director of Commissioning
                                                                    & Redesign

5   Financial Duties                   Separate Corporate Resources Director of Corporate
                                       report                       Resources

6 Care Quality Commission Ratings &    CQC AND UOR                   Director of Quality &
Use of Resources Rating                                              Performance

7   Local Area Agreements              Local Area Agreements         Director of Public Health



8   NHS Leadership Role                World Class Commissioning     CEO


9   Emergency Preparedness             To be developed               Director of Public Health


10 Quality and Safety                  Quality and Safety            Director of Quality &
                                                                     Performance

11 Safeguarding                        Quality and Safety            Director of Public Health/
                                                                     Director of Quality &
                                                                     Performance
12 PCT Delivery systems                To be developed               CEO




                                                            47
Appendix 8: CQC Performance Summary

Care Quality Commission Annual Health Check Summary
                                                                                                               2009/10

                                                                                                                                       Change
                                                                                                                                       on last




                                                                                                                   YTD
Existing Commitments                                                                2008/09    Current                       FOT       month
Access to GUM clinics                                                                             M9       *                 ##          –
Category A calls meeting 8 minute standard                                                       M10                         ##          –
Category A calls meeting 19 minute standard                                                      M10                         ##          –
Category B calls meeting 19 minute standard                                                      M10                         ##          –
Commissioning of crisis resolution/home treatment services                                        Q3                                     –
Commissioning of early intervention in psychosis services                                         Q3                         ##          –
Data quality on ethnic group                                                                             Metric to be developed
Delayed transfers of care                                                                         Q3                         ##          –
Diabetic retinopathy screening                                                                    Q3                         ##          –
Inpatients waiting longer than the 26 week standard                                               M9       *                  0          –
Outpatients waiting longer than the 13 week standard                                              M9       *                  6          –
Patients waiting longer than three months (13 weeks) for revascularisation                        M8                          0          –
Time to reperfusion for patients who have had a heart attack                                  09/10 data not available             *    Key 1
Total time in A&E                                                                                W44                                     –

                                                                                                               2009/10

                                                                                                                                       Change
                                                                                                                                       on last
National Priorities                                                                 2008/09    Current                       FOT       month
18 week referral to treatment times: admitted                                                     M9                         ##          –
18 week referral to treatment times: non admitted                                                 M9                         ##          –
18 week referral to treatment times: data completeness                                            M9                                     –
18 week referral to treatment times: audiology direct access                                      M9                         ##          –
NHS-reported waits for elective care (Diagnostic 6 Week Waiters)                                  M9                         29          –
Access to primary care: Primary Care Access Survey                                                       09/10 data not available
Access to primary care: GP patient survey                                             n/a     Annual data collection               *    Key 1
Access to primary dental services                                                     n/a     Annual data collection               *    Key 2
All age all cause mortality                                                           n/a     Annual data collection               *    Key 3
All cancers: one month diagnosis to treatment                                                     M9                                     –
All cancers: two month GP urgent referral to treatment                                            M9                                     –
All cancers: two week wait                                                                        M9                                     –
Breast cancer screening for women aged 53 to 70 years                                 n/a     Not available - annual data collection
Childhood obesity rate                                                                n/a     Annual data collection               *    Key 3
Chlamydia screening (as a proxy for chlamydia prevalence)                                         Q3                                      ↓
Commissioning a comprehensive CAMHS                                                               Q3                         12          –
Experience of patients                                                                n/a     NA - HCC fieldwork 2009              *    Key 3
Four week smoking quitters (proxy for smoking prevalence)                                         Q2                                     –
Incidence of Clostridium difficile                                                               M10                         -46         –
NHS Staff Satisfaction                                                                        Annual data collection               *    Key 4
Number of drug users recorded as being in effective treatment                                 09/10 Data not available             *    Key 1
Prevalence of breastfeeding at 6-8 weeks from birth: data completeness                            Q3                         ##          –
Proportion of individuals who complete immunisation by recommended ages               n/a     Annual data collection               *    Key 5
Reduction in cancer mortality rate in people age under 75 (20% by 2010)               n/a     Annual data collection               *    Key 3
Reduction in CVD mortality rate in people age under 75 (40% by 2010)                  n/a     Annual data collection               *    Key 3
Stroke care - 90% of time on a stroke unit                                                        Q3                         ##          –
Stroke care - TIA seen within 24 hours                                                n/a         Withdrawn by the HCC
Suicide and injury of undetermined intent mortality rate                              n/a         Withdrawn by the HCC
Teenage conception rates per 1,000 females aged 15-17                                 n/a     Annual data collection               *    Key 1
Women who have seen a midwife or maternity HCP by 12 completed weeks of pregnancy                 Q3                                     –
31-Day Standard for Subsequent Cancer Treatments (Chemotherapy and Surgery)                       M9              ##          1         Key 2
31-Day Standard for Subsequent Cancer Treatments (Radiotherapy)                       N/A         M9              ##          1         Key 2
Extended 62-Day Cancer Treatment Targets-NHS Cancer Screening                         N/A         M9                1         1         Key 2
Extended 62-Day Cancer Treatment Targets- Decision to Upgrade                         N/A         M9                1         1
Cervical Cancer Screening                                                             N/A           Annual data collection




*Key for those indicators where FOT RAG ratings have been made by Proxy


1.     Last Year outturn with high degree of confidence performance has not changed in 2009/2010
2.     Based on FOT for 14,31 and 62 day cancer waits
3.     The World Class Commissioning Outcome – Life Expectancy FOT RAG
4.     Resulting from the organisational development work being undertaken
5.     By virtue of information contained in appendix 16b to this report
6.     The Strategic Plan – Improve outcomes for people with Long Term Conditions FOT RAG
7.     Based upon UHNS contract performance 2009/2010 to date.




                                                                             48
Appendix 9 – Standards for Better Health

Healthcare Commission (CQC) 2008/09 Annual Healthcheck – Insufficient Assurance


Domain                  Core Standard                                                  Lead      2008/09   2009/10   FOT
                                                                                       Manager             Current   RAG
Governance       C11b   Healthcare organisations ensure that staff concerned
                        with all aspects of the provision of healthcare participate    PW         Amber     Amber    Green
                        in mandatory training programmes.



Developmental Standards



Domain                  Developmental Standard                                         Lead      2008/09   2009/10   FOT
                                                                                       Manager             Current   RAG
Safety           D1     Healthcare organisations continuously and systematically
                        review and improve all aspects of their activities that
                        directly affect patient safety and apply best practice in
                                                                                       AH          N/A      Amber    Green
                        assessing and managing risks to patients, staff and
                        others, particularly when patients move from the care of
                        one organisation to another.
Clinical   and   D2     Patients receive effective treatment and care that :
Cost               a)              conform to nationally agreed best practice,
Effectiveness           particularly as defined in National Service Frameworks,
                        NICE guidance, national plans and agreed national
                        guidance on service delivery.
                   b)              take into account their individual requirements
                        and meet their physical , cultural, spiritual and
                                                                                       AH          N/A      Green    Green
                        psychological needs and preferences.
                   c)              are well co-ordinated to provide a seamless
                        service across all organisations that need to be involved ,
                        especially social care organisations.
                   d)              is delivered by health care professionals who
                        make clinical decisions based on evidence based
                        practice.
Governance       D3     Integrated governance arrangements representing best
                        practice are in place in all health care organisations and     PW          N/A
                        across all health communities and clinical networks.
                 D4     Health care organisations work together to
                   a)              ensure that the principles of clinical governance
                        are underpinning the work of every clinical team and
                        every clinical service
                                                                                       AH          N/A      Amber    Amber
                   b)              implement a cycle of continuous quality
                        improvement
                   c)              ensure effective clinical and managerial
                        leadership and accountability
                 D5     Healthcare organisations work together and with social
                        care organisations to meet the changing health needs of
                        their population by
                   a)              having an appropriately constituted workforce       SS          N/A      Green    Green
                        with appropriate skill mix across the community
                   b)              ensuring the continuous improvement of
                        services through better ways of working
                 D6     Healthcare organisations use effective and integrated
                        information technology and information systems which
                                                                                       PW          N/A
                        support and enhance the quality and safety of patient
                        care, choice and service planning.
                 D7     Healthcare organisations work to enhance patient care to
                        enhance care by adopting best practice in human
                                                                                       SS          N/A      Green    Green
                        resources management and continuously improving staff
                        satisfaction.
Patient Focus    D8     Healthcare organisations continuously improve the
                        patient experience, based on the feedback of patients,         LR          N/A      Green    Green
                        carers and relatives
                 D9     Patients, service users and, where appropriate , carers
                        receive timely and suitable information, when they need
                        and want it, on treatment, care, services, prevention and      LR          N/A      Amber    Green
                        health promotion and are
                   a)              encouraged to express their preferences



                                                         49
                  b)              supported to make choices and shared
                       decisions about their own health care
                D10    Patients and service users, particularly those with long
                       term conditions, are helped to contribute to planning of
                                                                                       LR        N/A   Green   Green
                       their care and are provided with opportunities and
                       resources to develop competence in self care
Accessible      D11    Healthcare organisations plan and deliver healthcare
and                    which
Responsive        a)              reflects the views and health needs of the
Care                   population served and which is based on nationally
                       agreed evidence or best practice
                  b)              maximise patient choice
                  c)              ensure access(including equality of access) to       MW        N/A   Green   Green
                       services through a range of providers and routes of
                       access
                  d)              uses locally agreed guidance, guidelines or
                       protocols for admission, referral and discharge that
                       accord with the latest national expectations on access to
                       services
Care            D12    Healthcare is provided in well designed environments that
Environment       a)              promote patient and staff well being, and meet
and Amenities          patients‟ needs and preferences, and staff concerns
                                                                                       AH        N/A   Amber   Green
                  b)              are appropriate for the effective and safe
                       delivery of treatment, care or a specific function, including
                       the effective control of healthcare associated infections
Public Health   D13    Healthcare organisations:
                  a)              identify and act upon significant public health
                       problems and health inequality issues, with primary care
                       trusts taking the leading role
                  b)              implement effective programmes to improve
                       health and reduce health inequalities, conforming to
                       nationally agreed best practice, particularly as defined in     AP/JSm/
                                                                                                 N/A   Green   Green
                       NICE guidance and agreed national guidance on public            BF
                       health
                  c)              protect their populations form identified current
                       and new hazards to health
                  d)              take fully into account current and emerging
                       policies and knowledge on public health issues in the
                       development of their public health programmes




                                                         50
Appendix 10: Use of Resources

2008/09 Indicative Scores

  Description                                                                          Indicative
                                                                                         score
  1.1 Planning for financial health.                                                        2
  1.2 Understanding costs and achieving efficiency.                                         2
  1.3 Financial reporting.                                                                  2
  2.1 Commissioning and procurement.                                                   Not scored
  2.2. Use of information.                                                                  2
  2.3 Good governance.                                                                      2
  2.4 Risk management and internal control.                                                 2
  3.1 Natural resources (no assessment required for PCTs).                                Not
                                                                                       applicable
  3.2 Strategic asset management (where significant).                                       2
  3.3 Workforce                                                                             2

Underlying Principles of Performance
Level 2         Meets only minimum requirements – performs adequately
Level 3         Exceeds minimum requirements – performs well
Level 4         Significantly exceeds minimum requirements – performs excellently

Use of Resources Framework

Theme       Description                         Key Line of Enquiry                      Lead      2009/10   Current   FOT
                                                                                        Director    Target    RAG      RAG
Managing    How effectively does the      1.1   Does the organisation plan its
Finances    organisation manage its             finances effectively to deliver its
                                                                                         MD          3       Green     Green
            finances to deliver value           strategic priorities and secure
            for money?                          sound financial health?
                                          1.2   Does the organisation have a
                                                sound understanding of its costs
                                                                                         MD          2       Green     Green
                                                and performance and achieve
                                                efficiencies in its activities?
                                          1.3   Is the organisation‟s financial
                                                reporting timely, reliable and
                                                does it meet the needs of                MD          2       Amber     Green
                                                internal users, stakeholders and
                                                local people?
Governing   How     well   does     the   2.1   Does        the        organisation
the         organisation govern itself          commission and procure quality
business    and commission services             services and supplies, tailored
                                                                                         CF          3       Green     Green
            that provide value for              to local needs, to deliver
            money and deliver better            sustainable outcomes and value
            outcomes for local people?          for money?
                                          2.2   Does the organisation produce
                                                relevant and reliable data and
                                                information to support decision          AL          2       Amber     Green
                                                making          and          manage
                                                performance?
                                          2.3   Does the organisation promote
                                                and demonstrate the principles
                                                                                         MD          2       Green     Green
                                                and       values        of      good
                                                governance?
                                          2.4   Does the organisation manage
                                                its risks and maintain a sound           MD          2       Green     Green
                                                system of internal control?
Managing    How      well  does    the    3.1   Is the organisation making
Resources   organisation manage its             effective use of natural
            natural resources, physical         resources?
            assets, and people to meet                                                   MD          2       Green     Green
            current and future needs            New for 2009/2010
            and deliver value for
            money?



                                                     51
3.2   Does the organisation manage             Does
      its assets effectively to help            not
      deliver its strategic priorities and   apply in   N/A   N/A     N/A
      service needs                          2009/201
                                                 0
3.3   Does the organisation plan,
      organise and develop its
      workforce effectively to support         CF        2    Green   Green
      the achievement of its strategic
      priorities?




           52
Appendix 11: Vital Signs
Vital Signs Performance Summary


                                                                                                                                                                    Change
                                                                                                                                                                    on last
National Requirements                                                                           2008/09 Current                                       FOT           month
VSA01 Incidence of MRSA                                                                                   M10                                0            -18         –
VSA02 Proportion of admissions screened for MRSA                                                          Provider plan only monitoring to be developed               –
VSA03 Incidence of C. Difficile (Community)                                                               M10                              -6             -46         –
VSA04 NHS-reported waits for elective care (18 Weeks)                                                     M9                                                          –
VSA05_01 No. of written referrals from GPs for OPFA in G&A specialties                                    M9                              ##              ##          –
VSA05_02 No. of other referrals from GPs for OPFA in G&A specialties                                      M9                              ##              ##          –
VSA05_03 Number of OPFA (consultant led) following GP referral in G&A specialties                         M9                              ##              ##          –
VSA05_04 Number of all OPFA (consultant led) in G&A specialties                                           M9                              ##              ##          –
VSA05_05 Total elective G&A day case FFCEs                                                                M9                              ##              ##          –
VSA05_06 Planned elective G&A day case FFCEs                                                              M9                              ##              ##          –
VSA05_07 Total elective G&A ordinary admission FFCEs                                                      M9                              ##              ##          –
VSA05_08 Planned elective G&A ordinary admission FFCEs                                                    M9                              ##              ##          –
VSA05_09 Non-elective G&A FFCEs, excluding well babies                                                    M9                              ##              ##          –
VSA05_10 Activity for 15 key diagnostics tests                                                            M9                              ##              ##          –
VSA06 Patient reported measure of GP access                                                               NA - annual data collection                           *    Key 1
VSA07 Practices offering extended opening                                                                 Q1                              ##              ##          –
VSA08 Breast symptom 2 week wait                                                                 N/A       M9                               1              0
VSA09 Extension of NHS Breast Screening Programme to women aged 47-49 and 71-73                  N/A                Plans deferred by the DH

VSA10 Extension of NHS Bowel Cancer Screening Programme to men and women aged up to 75           N/A                Plans deferred by the DH

VSA11 31-Day Standard for Subsequent Cancer Treatments (Chemotherapy and Surgery)                          M9                               1              1         Key 2
VSA12 31-Day Standard for Subsequent Cancer Treatments (Radiotherapy)                            N/A       M9                               0              1         Key 2
VSA13 Extended 62-Day Cancer Treatment Targets-NHS Cancer Screening                              N/A       M9                               1              1         Key 2
VSA13 Extended 62-Day Cancer Treatment Targets- Decision to Upgrade                              N/A       M9                               1              1
VSA14 Quality stroke care - 90% of time on a stroke unit                                                  Q3                              ##                          –
VSA14 Quality stroke care - TIA seen within 24 hours                                                               Withdrawn by the HCC                               –
VSA15 All women to receive results of cervical screening tests within two weeks                                     Plans deferred by the DH




                                                                                                                                                                    Change
                                                                                                                                                                    on last
National Priorities                                                                             2008/09                 Current                       FOT           month
VSB01 All-age all cause mortality (AAACM) rate                                                            Annual data collection                                *    Key 3
VSB02 CVD Mortality Rate (also LAA target)                                                                Annual data collection                                *    Key 3
VSB03 Cancer Mortality Rate                                                                               Annual data collection                                *    Key 3
VSB04 Suicide & Injury of Undetermined Intent                                                                        Withdrawn by the CQC

VSB05 Smoking Prevalence (Smoking Quitters) (also LAA target)                                             Q2                                                          –
VSB06 Early Access for Women to Maternity Services                                                        Q3                                                          –
VSB07 Number of Midwives                                                                                            Plans deferred by the DH

VSB08 Teenage pregnancy                                                                                   Annual data collection                                *    Key 1
VSB09 Childhood Obesity (also LAA target)                                                                 Annual data collection                                *    Key 3
VSB10 Individuals who complete immunisation                                                               Annual data collection                                *    Key 1
VSB11 Prevalence of Breastfeeding at 6-8 weeks                                                            Q3                              ##              ##          –
VSB12 Evaluating the impact of CAMHS                                                                      Q3                              12              12          –
VSB13 Chlamydia Prevalence (Screening)                                                                    Q3                              ##              ##          –
VSB14 Number of Drug Users recorded as being in effective treatment                                       0910 Data not available                               *    Key 1
VSB15 Self reported experience of patients/users                                                          Not available - CQC fieldwork 2009                    *    Key 3
VSB16 Measure of public confidence in local NHS                                                           Plans deferred by the DH
VSB17 NHS staff survey based measures of job satisfaction                                                 Annual data collection                                *    Key 4
VSB18 Dental Services                                                                                     Annual data collection                                *   Key 5



                                                                                                                                                                    Change
                                                                                                                                                                    on last
2.3 Local Priorities                                                                            2008/09                 Current                       FOT           month
VSC03 Supporting adults to live independently at home                                                     Work in progress
VSC10 Delayed transfers of care                                                                           Q3                                              ##          –
VSC11 People with a long-term condition feeling independent and in control of their condition             Monitoring under development                          *    Key 6
VSC20 Emergency bed days                                                                                  Monitoring under development                          *    Key 7
VSC21 Hospital admissions for ambulatory care sensitive conditions                                        09/10 data not available                                    –
VSC26 Hospital admissions for alcohol-related harm (also LAA target)                                      Quarterly data collection                             *    Key 3




*Key for those indicators where FOT RAG ratings have been made by Proxy


1.     Last Year outturn with high degree of confidence performance has not changed in 2009/2010
2.     Based on FOT for 14,31 and 62 day cancer waits
3.     The World Class Commissioning Outcome – Life Expectancy FOT RAG
4.     Resulting from the organisational development work being undertaken
5.     By virtue of information contained in appendix 16b to this report
6.     The Strategic Plan – Improve outcomes for people with Long Term Conditions FOT RAG
7.     Based upon UHNS contract performance 2009/2010 to date.




                                                                                  53
Appendix 12a: Provider Performance Report Summaries

                                                                                                                   Acute Provider Activity Summary December 2009
                                                       UHNS                                               UHB                                               Mid Cheshire                                       East Cheshire                                          Derby
POD                                Plan         Actual    Variance     % Activity   Plan         Actual         Variance       % Activity   Plan         Actual     Variance       % Activity   Plan         Actual    Variance    % Activity   Plan         Actual       Variance    % Activity
Elective                             2,377         2,455         78         3.28%          27             40           13         46.63%           90          82          -8          -8.89%          305       334          29      10.41%           66             42        -24      -36.68%
Elective Short Stay                       202       252          50       24.75%
Elective XBD                         1,475         1,434        -41        -2.78%           7             63           56        815.66%            3           1          -2         -66.67%          43         20         -23      -54.24%          58              1        -57      -98.28%
Non Elective                         8,724         9,282        558         6.40%          11             13               2      13.37%           178        162         -16          -8.99%          615       634          19        3.46%          62             86         24      38.71%
Non Elective Short Stay              2,546         5,467      2,921      114.73%
Non Elective XBD                     7,427         5,974      -1,453      -19.56%                                                                  32          41              9      26.19%           160       138         -22      28.97%           21             48         28     134.15%
Non Elective Non Emergency           2,223         1,966       -257       -11.56%           2             2                0      -12.79%          28          21          -7         -25.00%          414       381         -33       -1.70%
Non Elective Non Emergency XBD       1,032         1,254        222       21.51%            8             0            -8        -100.00%                                                              56        113          58      43.66%
Planned Same Day                    13,545        14,731      1,186         8.76%          18             34           16         94.00%           353        346          -7          -1.98%          979      1,056         77        8.14%          179        200            21      11.78%
Outpatient First Attendances        33,644        38,009      4,365       12.97%           51             73           22         43.84%      1,111           929        -182         -16.38%     4,269         4,884        615      11.13%           302        285           -17       -5.63%
Outpatient Follow Up Attendances    66,895        77,520     10,625       15.88%           292        367              75         25.52%      1,674         1,808         134           8.00%     5,194         6,106        912      16.34%           889        862           -27       -3.04%
A&E Attendances                     23,943        25,084      1,141         4.77%          15             17               2      13.33%           488        469         -19          -3.89%     1,896         1,923         27       -0.46%          57             95         38      66.67%
Cost and Volume                     28,783        31,527      2,744         9.53%          38             46               8      20.26%     30,004        32,174        2170           7.23%     3,165         2,901       -264      -16.18%
Op Procedures                                                                              26             18           -8         -31.43%          288        243         -45         -15.63%                                                          22             12        -10      -45.45%
Unbundled Inpatient                                                                         2             67           65       2877.78%
Unbundled Outpatient
Unbundled Tariff Based Activity                                                                                                                                                                                                                   155           142             -13       -8.39%
Non Tariff Items                                                                           74         139              65         89.04%                                                                                                        19510         19485             -25       -0.13%
High Cost Drugs                                                                                                                                    49         262         213        434.69%
Patient Transport                                                                                                                                   1           9              8
ECG                                                                                                                                                 0          91          91
Overall                            192,816       214,955     22,139       11.48%           572        879             307          53.60%    34,299        36,638       2,339           6.82%    17,096        18,490      1,394        8.15%    21,321        21,258           -63       -0.29%




                                                                                                                                             54
Appendix 12b: UHNS

                                        Provider Performance Report 2009-10 (UHNS)
                                                December-2009
                                                                                                   Current    Last
Section 1: SLA and Trend Performance Summary                                                       Rating    Updated
    1.1     SLA Performance Variance Summary                                                        Red       Dec-09

Section 2: SLA Performance and Trend Analysis
   2.1.1    Elective Activity                                                                       Red       Dec-09
   2.1.2    Elective Finance                                                                        Red       Dec-09
   2.1.1    Elective Short Stay Activity                                                            Red       Dec-09
   2.1.2    Elective Short Stay Finance                                                             Red       Dec-09
   2.1.3    Elective Excess Bed Days Actvity                                                       Green      Dec-09
   2.1.4    Elective Excess Bed Days Finance                                                       Green      Dec-09
   2.2.1    Non Elective Emergency Activity                                                         Red       Dec-09
   2.2.2    Non Elective Emergency Finance                                                          Red       Dec-09
   2.2.1    Non Elective Short Stay Activity                                                        Red       Dec-09
   2.2.2    Non Elective Short Stay Finance                                                         Red       Dec-09
   2.2.3    Non Elective Excess Bed Days Activity                                                  Green      Dec-09
   2.2.4    Non Elective Excess Bed Days Finance                                                   Green      Dec-09
   2.2.5    Non Elective Non Emergency Activity                                                    Green      Dec-09
   2.2.6    Non Elective Non Emergency Finance                                                     Green      Dec-09
   2.2.7    Non Elective Non Emergency Excess Bed Day Activity                                     Amber      Dec-09
   2.2.8    Non Elective Non Emergency Excess Bed Day Finance                                      Amber      Dec-09
   2.3.1    Planned Same Day Activity                                                               Red       Dec-09
   2.3.2    Planned Same Day Finance                                                                Red       Dec-09
   2.4.1    First Outpatient Activity                                                               Red       Dec-09
   2.4.2    First Outpatient Finance                                                                Red       Dec-09
   2.5.1    Follow Up Outpatient Activity                                                           Red       Dec-09
   2.5.2    Follow Up Outpatient Finance                                                            Red       Dec-09
   2.6.1    A&E Attendance Activity                                                                 Red       Dec-09
   2.6.2    A&E Attendance Finance                                                                  Red       Dec-09
   2.7.1    Cost and Volume Activity                                                                Red       Dec-09
   2.7.2    Cost and Volume Finance                                                                 Red       Dec-09

Section 3: Key SLA Performance Indicators
    3.1     Waiting Time Targets:
   3.1.1    Referral to Treatment Waiting Times - Weekly Trajectories (Admitted)                   Green      Dec-09
   3.1.2    Referral to Treatment Waiting Times - Weekly Trajectories (Non Admitted)               Green      Dec-09
   3.1.3a   Number of patients waiting over 6 weeks for 14 Key Diagnostic Tests (Exc. Audiology)   Green      Dec-09
   3.1.3b   Number of patients waiting over 6 weeks for Audiology                                  Green      Dec-09
    3.2     Healthcare Associated Infections:
   3.2.1    Incidence of MRSA                                                                      Green      Dec-09
   3.2.2    Incidence of Clostridium Difficile                                                     Green      Dec-09
    3.3     Cancer Waiting Time Targets:
   3.3a     Number of patients seen within 2 weeks of urgent referral for suspected cancer
                                                                                                               To be
   3.3b     Number of patients treated for cancer within 31 days of urgent referral
                                                                                                             completed
    3.3c    Number of patients treated within 62 days of urgent referral for suspected cancer
    3.4     Total time in A&E: four hours or less                                                   Red       Dec-09

Section 4: Other Performance Indicators
    4.1     Outpatient First to Follow Up Ratios                                                              Dec-09
    4.2     Cancelled Operations                                                                              Dec-09




                                                                  55
Appendix 12c: East Cheshire

                        Provider Performance Report 2009-10 (East Cheshire)

                                               December-2009
                                                                              Current    Last
Section 1: SLA and Trend Performance Summary                                  Rating    Updated

    1.1    SLA Performance Variance Summary                                    Red      Dec-09


Section 2: SLA Performance and Trend Analysis

   2.1.1   Elective Activity                                                   Red      Dec-09
   2.1.2   Elective Finance                                                    Red      Dec-09
   2.2.1   Non Elective Emergency Activity                                    Amber     Dec-09
   2.2.2   Non Elective Emergency Finance                                     Amber     Dec-09
   2.2.3   Non Elective Non Emergency Activity                                Green     Dec-09
   2.2.4   Non Elective Non Emergency Finance                                 Green     Dec-09
   2.3.1   Planned Same Day Activity                                          Amber     Dec-09
   2.3.2   Planned Same Day Finance                                           Amber     Dec-09
   2.4.1   Elective Excess Bed Days Activity                                  Green     Dec-09
   2.4.2   Elective Excess Bed Days Finance                                   Green     Dec-09
   2.5.1   Non Elective Excess Bed Days Activity                              Green     Dec-09
   2.5.2   Non Elective Excess Bed Days Finance                               Green     Dec-09
   2.5.3   Non Elective Non Emergency Excess Bed Days Activity                Amber     Dec-09
   2.5.4   Non Elective Non Emergency Excess Bed Days Finance                 Green     Dec-09
   2.6.1   First Outpatient Activity                                           Red      Dec-09
   2.6.2   First Outpatient Finance                                            Red      Dec-09
   2.7.1   Follow Up Outpatient Activity                                       Red      Dec-09
   2.7.2   Follow Up Outpatient Finance                                        Red      Dec-09
   2.8.1   A&E Attendance Activity                                            Amber     Dec-09
   2.8.2   A&E Attendance Finance                                             Green     Dec-09
   2.9.1   Cost and Volume Activity                                           Green     Dec-09
   2.9.2   Cost and Volume Finance                                             Red      Dec-09




                                                           56
Appendix 12d: Mid Cheshire

                          Provider Performance Report 2009-10 (Mid Cheshire)

                                               December-2009
                                                                               Current    Last
Section 1: SLA and Trend Performance Summary                                   Rating    Updated

    1.1    SLA Performance Variance Summary                                    Green     Dec-09


Section 2: SLA Performance and Trend Analysis

   2.1.1   Elective Activity                                                   Green     Dec-09
   2.1.2   Elective Finance                                                    Amber     Dec-09
   2.1.3   Elective Excess Bed Days Activity                                   Green     Dec-09
   2.1.4   Elective Excess Bed Days Finance                                    Green     Dec-09
   2.2.1   Non Elective Emergency Activity                                     Green     Dec-09
   2.2.2   Non Elective Emergency Finance                                      Green     Dec-09
   2.2.3   Non Elective Excess Bed Days Activity                               Amber     Dec-09
   2.2.4   Non Elective Excess Bed Days Finance                                Amber     Dec-09
   2.2.5   Non Elective Non Emergency Activity                                 Green     Dec-09
   2.2.6   Non Elective Non Emergency Finance                                  Green     Dec-09
   2.3.1   Planned Same Day Activity                                           Green     Dec-09
   2.3.2   Planned Same Day Finance                                            Amber     Dec-09
   2.4.1   First Outpatient Activity                                           Green     Dec-09
   2.4.2   First Outpatient Finance                                            Green     Dec-09
   2.5.1   Follow Up Outpatient Activity                                       Amber     Dec-09
   2.5.2   Follow Up Outpatient Finance                                        Amber     Dec-09
   2.6.1   A&E Attendance Activity                                             Green     Dec-09
   2.6.2   A&E Attendance Finance                                              Green     Dec-09
   2.7.1   OP Procedures Activity                                              Green     Dec-09
   2.7.2   OP Procedures Finance                                               Green     Dec-09
   2.8.1   Cost and Volume Activity                                             Red      Dec-09
   2.8.2   Cost and Volume Finance                                              Red      Dec-09
   2.8.1   High Cost Drugs Activity                                             Red      Dec-09
   2.8.2   High Cost Drugs Finance                                             Green     Dec-09
   2.8.1   Patient Transport Activity                                          Amber     Dec-09
   2.8.2   Patient Transport Finance                                           Amber     Dec-09
   2.8.1   ECG Activity                                                        Amber     Dec-09
   2.8.2   ECG Finance                                                         Amber     Dec-09
   2.8.1   CQUIN                                                               Green     Dec-09




                                                         57
Appendix 12e: Derby

                               Provider Performance Report 2009-10 (Derby)

                                                December-2009
                                                                             Current    Last
Section 1: SLA and Trend Performance Summary                                 Rating    Updated

    1.1    SLA Performance Variance Summary                                  Green     Dec-09


Section 2: SLA Performance and Trend Analysis

   2.1.1   Elective Activity                                                 Green     Dec-09
   2.1.2   Elective Finance                                                  Green     Dec-09
   2.1.3   Elective Excess Bed Days Activity                                 Green     Dec-09
   2.1.4   Elective Excess Bed Days Finance                                  Green     Dec-09
   2.2.1   Non Elective Emergency Activity                                    Red      Dec-09
   2.2.2   Non Elective Emergency Finance                                     Red      Dec-09
   2.2.3   Non Elective Excess Bed Days Activity                              Red      Dec-09
   2.2.4   Non Elective Excess Bed Days Finance                               Red      Dec-09
   2.3.1   Planned Same Day Activity                                          Red      Dec-09
   2.3.2   Planned Same Day Finance                                           Red      Dec-09
   2.4.1   First Outpatient Activity                                         Green     Dec-09
   2.4.2   First Outpatient Finance                                          Green     Dec-09
   2.5.1   Follow Up Outpatient Activity                                     Green     Dec-09
   2.5.2   Follow Up Outpatient Finance                                      Green     Dec-09
   2.6.1   OP Procedures Activity                                            Green     Dec-09
   2.6.2   OP Procedures Finance                                             Green     Dec-09
   2.7.1   Unbundled Tariff Finance                                          Green     Dec-09
   2.8.1   Non Tariff Based Services Activity                                Green     Dec-09
   2.8.2   Non Tariff Based Services Finance                                 Green     Dec-09
   2.9.1   A & E Attendances Activity                                         Red      Dec-09
   2.9.2   A & E Attendances Finance                                          Red      Dec-09




                                                          58
Appendix 12f: UHB

                   Provider Performance Report 2009-10 (University Hospital Birmingham)
                                       December-2009
                                                                                     Current    Last
Section 1: SLA and Trend Performance Summary                                         Rating    Updated
    1.1    SLA Performance Variance Summary                                          Amber     Dec-09

Section 2: SLA Performance and Trend Analysis
   2.1.1   Elective Activity                                                          Red      Dec-09
   2.1.2   Elective Finance                                                          Amber     Dec-09
   2.1.3   Elective Excess Bed Days Actvity                                           Red      Dec-09
   2.1.4   Elective Excess Bed Days Finance                                           Red      Dec-09
   2.2.1   Non Elective Emergency Activity                                           Amber     Dec-09
   2.2.2   Non Elective Emergency Finance                                             Red      Dec-09
   2.2.5   Non Elective Non Emergency Activity                                       Green     Dec-09
   2.2.6   Non Elective Non Emergency Finance                                        Amber     Dec-09
   2.2.7   Non Elective Non Emergency Excess Bed Day Activity                        Green     Dec-09
   2.2.8   Non Elective Non Emergency Excess Bed Day Finance                         Green     Dec-09
   2.3.1   Planned Same Day Activity                                                  Red      Dec-09
   2.3.2   Planned Same Day Finance                                                   Red      Dec-09
   2.4.1   First Outpatient Activity                                                  Red      Dec-09
   2.4.2   First Outpatient Finance                                                   Red      Dec-09
   2.5.1   Follow Up Outpatient Activity                                              Red      Dec-09
   2.5.2   Follow Up Outpatient Finance                                               Red      Dec-09
   2.6.1   A&E Attendance Activity                                                   Green     Dec-09
   2.6.2   A&E Attendance Finance                                                    Green     Dec-09
   2.7.1   Cost and Volume Activity                                                  Amber     Dec-09
   2.7.2   Cost and Volume Finance                                                   Amber     Dec-09
   2.8.1   OP Procedures Activity                                                    Green     Dec-09
   2.8.2   OP Procedures Finance                                                     Green     Dec-09
   2.9.1   Unbundled Inpatient                                                        Red      Dec-09
   2.10a   Non Tariff Items                                                           Red      Dec-09




                                                            59
Appendix 12g: Mid Staffs

                     Provider Performance Report 2009-10 (Mid Staffordshire)
                                               November-2009
                                                                           Current      Last
Section 1: SLA and Trend Performance Summary                               Rating      Updated

    1.1    SLA Performance Variance Summary                                    Green   Nov-09


Section 2: SLA Performance and Trend Analysis

   2.1.1   Elective Activity                                                   Amber   Nov-09
   2.1.2   Elective Finance                                                    Amber   Nov-09
   2.2.1   Non Elective Emergency Activity                                     Green   Nov-09
   2.2.2   Non Elective Emergency Finance                                      Green   Nov-09
   2.3.1   Planned Same Day Activity                                           Green   Nov-09
   2.3.2   Planned Same Day Finance                                            Green   Nov-09
   2.3.3   Elective Excess Bed Days Activity                                   Green   Nov-09
   2.3.4   Elective Excess Bed Days Finance                                    Green   Nov-09
   2.3.5   Non Elective Emergency Excess Bed Days Activity                     Green   Nov-09
   2.3.6   Non Elective Emergency Excess Bed Days Finance                      Green   Nov-09
   2.4.1   First Outpatient Activity                                           Green   Nov-09
   2.4.2   First Outpatient Finance                                            Green   Nov-09
   2.5.1   Follow Up Outpatient Activity                                       Green   Nov-09
   2.5.2   Follow Up Outpatient Finance                                        Green   Nov-09
   2.6.1   A&E Attendance Activity                                             Green   Nov-09
   2.6.2   A&E Attendance Finance                                              Green   Nov-09
   2.7.1   Cost and Volume Activity                                            Green   Nov-09
   2.7.1   Cost and Volume Finance                                             Green   Nov-09
   2.8.1   OP Procedures                                                       Green   Nov-09




                                                             60
Appendix 12h: Burton

                               Provider Performance Report 2009-10 (Burton)

                                              April-2009
                                                                              Current    Last
Section 1: SLA and Trend Performance Summary                                  Rating    Updated

    1.1    SLA Performance Variance Summary                                   Green     Apr-09


Section 2: SLA Performance and Trend Analysis

   2.1.1   Elective Activity                                                  Green     Apr-09
   2.1.2   Elective Finance                                                    Red      Apr-09
   2.2.1   Non Elective Emergency Activity                                    Green     Apr-09
   2.2.2   Non Elective Emergency Finance                                      Red      Apr-09
   2.3.1   Planned Same Day Activity                                          Green     Apr-09
   2.3.2   Planned Same Day Finance                                           Green     Apr-09
   2.4.1   First Outpatient Activity                                           Red      Apr-09
   2.4.2   First Outpatient Finance                                            Red      Apr-09
   2.5.1   Follow Up Outpatient Activity                                       Red      Apr-09
   2.5.2   Follow Up Outpatient Finance                                        Red      Apr-09
   2.6.1   A&E Attendance Activity                                            Green     Apr-09
   2.6.2   A&E Attendance Finance                                             Green     Apr-09
   2.7.1   Cost and Volume Activity                                           Green     Apr-09
   2.7.2   Cost and Volume Finance                                            Green     Apr-09




                                                       61
Appendix 12i: RJAH

                        Provider Performance Report 2009-10 (Robert Jones)

                                             December-2009
                                                                             Current    Last
Section 1: SLA and Trend Performance Summary                                 Rating    Updated

    1.1    SLA Performance Variance Summary                                  Amber     Dec-09


Section 2: SLA Performance and Trend Analysis

   2.1.1   Elective Activity                                                  Red      Dec-09
   2.1.2   Elective Finance                                                   Red      Dec-09
   2.2.1   Non Elective Emergency Activity                                   Green     Dec-09
   2.2.2   Non Elective Emergency Finance                                    Green     Dec-09
   2.3.1   Planned Same Day Activity                                          Red      Dec-09
   2.3.2   Planned Same Day Finance                                           Red      Dec-09
   2.6.1   First Outpatient Activity                                          Red      Dec-09
   2.6.2   First Outpatient Finance                                           Red      Dec-09
   2.7.1   Follow Up Outpatient Activity                                      Red      Dec-09
   2.7.2   Follow Up Outpatient Finance                                       Red      Dec-09
   2.9.1   Block Activity                                                    Green     Dec-09
   2.9.2   Block Finance                                                     Green     Dec-09
   2.9.1   OP Procedures Activity                                            Green     Dec-09
   2.9.2   OP Procedures Finance                                             Green     Dec-09




                                                       62
Appendix 13: North Staffordshire Combined Healthcare

                            Provider Performance Report 2009-10 (Combined Healthcare)

                                                  December-2009
                                                                                                              Current     Last
Section 1: SLA and Trend Performance Summary                                                                  Rating     Updated
    1.1      SLA Performance Variance Summary
    1.2      Trends Summary

Section 2: SLA Performance
   Please refer to the SLA Monitoring Report produced by the North Staffordshire Health Informatics Service for details on SLA
                                                         Performance

Section 3: Key SLA Performance Indicators
    3.1      Healthcare Associated Infections:
   3.1.1     Incidence of MRSA                                                                                Green      Q3 09/10
   3.1.2     Incidence of Clostridium Difficile                                                               Green      Q3 09/10
    3.2      Commissioning of crisis resolution/home treatment services
   3.2.1     Number of home treatment episodes completed by Crisis Resolution                                 Green      Q3 09/10
   3.2.2     Number of people receiving home treatment (Crisis)
   3.2.3     % of people requiring care receiving access to CRT
    3.3      Comprehensive coverage of the population by early intervention for psychosis                     Amber      Q3 09/10
   3.3.1     Number of new cases of psychosis served by EI Teams
   3.3.2     Number of suspected cases of psychosis being monitored by EI teams
   3.3.3     Number of people receiving early intervention services (caseload)
             Comprehensive coverage of the population by comprehensive CAMHS services for children
    3.4      and young people including children with learning disabilities. All areas to have access to 24   Amber      Q3 09/10
             hour cover for urgent needs
    3.5      CPA 7 Day Follow Up                                                                              Green      Q3 09/10
             Comprehensive coverage of the population by assertive outreach. Service provided meets
    3.6
             National standards
   3.6.1     Number of people receiving assertive outreach services (caseload)                                Green      Q3 09/10
   3.6.2     % achieved of target patients on Assertive Outreach
    3.7      Delayed Transfers of Care




                                                                   63
Appendix 14: North Staffordshire Community Healthcare



As at 31 January 2010
            Indicator                                   Target                      Actual              Achieved

                Finished Consultant              Increase on last year       08/09 YTD – 1,445
                Episodes                                                     09/10 YTD – 1,576



                Occupied Bed Days                Increase on last year       08/09 YTD – 44,833
Inpatients




                                                                             09/10 YTD – 48,225

                Average Length of Stay for        Less than 6 weeks                4 weeks
                Finished Consultant
                Episodes
                Delayed Discharges                  Maximum of 10               Average of 6



                Continence                             5 weeks                  No breaches

                Physiotherapy                          2 weeks                  No breaches
Waiting Lists




                Speech and Language                    2 weeks                  No breaches
                Therapy

                Ultrasound                             5 weeks                   No breaches

                Leek Minor Injuries Unit        98% within 4 hrs, 80%       78.8% within 1 hour,
                                                within 2 hrs, 70% within    97.6% within 2 hours
                                                          1 hr               and 99.8% within 4
                                                                                    hours
                Healthcare Acquired              Reduction on 2008/9         Clostridium Difficile
Patient
Safety




                Infections                                                     08/09 YTD – 7
                                                                              09/10 YTD – 12

                Timely & Effective Discharge      Twice yearly annual      UHNS Clinical Audit
                                                         audit             Dept undertaking audit
                                                                           - Audit completed for
                                                                           June discharges and
                                                                           commenced for
                                                                           December discharges
                Productivity Improvement             Deliver PIP           Achieved. Q3
                Programme                            Workstreams           requirements of patient
                                                                           experience survey and
                                                                           Time to Care audits
CQUINS




                                                                           completed.


                Supportive Care Pathway              Annual Audit          UHNS Clinical Audit
                                                                           Dept undertaking audit
                                                                           - audit has
                                                                           commenced
                Patients Treated with Dignity    Inpatient Survey of a      Patient Experience
                and Respect                       minimum of 60% of        Survey commenced.
                                                       inpatients          100% satisfaction.
                                                                           Clarification of indicator
                                                                           received - 60% of




                                                           64
                                                                            Number of Points




                                                            0
                                                                100
                                                                      200
                                                                             300
                                                                                   400
                                                                                         500
                                                                                               600
                                                                                                     700
                                                                                                                            800
                               Heathcote Street Surgery

                                    The Village Surgery

                             Werrington Village Surgery

                                     Leek Health Centre

                                     Moss Lane Surgery

                                         Ashley Surgery

                                      Stockwell Surgery

                        Dr Rabie & Partners – Kidsgrove

                                   Miller Street Surgery

                                Silverdale Health Centre

                   Well Street Medical Centre – Biddulph

                                   Audley Health Centre
                                                                                                                                                                                 Appendix 15: Quality Outcomes Framework




                             Wolstanton Medical Centre

                             Lyme Valley Medical Centre

                                    John Kelso Practice

                               Moorland Medical Centre

                      Dr Holland & Partners – Kidsgrove

                                      Biddulph Doctors

                                     The Tardis Surgery

                                      Allen Street Clinic
                                                                                                                                         Clinical Achievements of GP Practices




     GP Practice
                   Well Street Medical Centre – Cheadle

                                          Tean Surgery




65
                          Waterhouses Medical Practice

                                     Higherland Surgery

                            Kingsbridge Medical Centre

                              Alton Primary Care Centre

                                   Cross Heath Surgery

                                  Rupert Street Surgery

                             RJ Mitchell Medical Centre

                              University Medical Centre

                                         Betley Surgery

                                    Castletown Surgery

                                       Talke Pitts Clinic
                                                                                                     Forecast




                                  Loomer Road Surgery
                                                                                                     Maximum
                                                                                                     Achievement




                            High Street Medical Practice

                       Midway Medical & Walk-in Centre
                                                                                                                   Current Achievement
                                                       Cumulative Allocation/Expenditure £




                                         -
                                             200,000
                                                        400,000
                                                                  600,000
                                                                            800,000
                                                                                      1,000,000
                                                                                                  1,200,000
                                                                                                              1,400,000
                              Brown
                          Hindmarsh
                            Page RJ
                              Patel N
                         Hussain LM
                            Rees AF
                         Bennett A G
                           Cooper V
                       Carpenter GR
                               Yates
                           Holland J
                                                                                                                                                                                                                                 Appendix 16a: Prescribing Budgets – Actual vs. Budget




                             Butcher
                             King JM
                              Craven

                         Scriven B E




66
                     Porcheret M E P
                            Craven P

                          Franklin PJ
                        McVerry D N
     GP Practice



                          Walsh S R
                         High Street
                         Thorley K J

                         Griffiths M L
                         Acquah N E
                        Lyme Valley
     Midway Medical Centre
                         Gardner G I
                            Oleshko
                        Rupert Street

                           Malgwa A
                          Morgans G
                         Unyolo P M
                         Shevlin B A
                     Manudhane V V

                   Mairs T D/O'Byrne
                            Shapley
                                                                                                                                                                                Allocated budget up to this Month (Cumulative)
                                                                                                                          Expenditure up to this Month (October) (Cumulative)
Appendix 16b: Prescribing Budgets – Variances by Practice


  120,000                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            80.00%
                                                                                                                                                                                                                                                                                                                                                                                                           108,910



                                                                                                                                                                                                                                                                                                                                                                                                                                                     Variance                                                           69.56%       70.00%
  100,000
                                                                                                                                                                                                                                                                                                                                                                                                                                                     %Variance

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     60.00%

   80,000

                                                                                                                            68,122
                                                                                                                                                                                                                                                                                                           66,687
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   68,933                            50.00%
                                                                                                                                                                       65,050                                                                                  65,603
                                                                                                                                                                                                                                                                                                                                                                                                                            46.15%
                                                                                                                                                                                                                                                                                                                                                                                                                                 59,519
   60,000
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     40.00%

                                                                                                                                                                                                                                                                                                                                          43,013
                                                                                                                                                                                                                                                                                                                                                                                                                                                    38,319
   40,000                                                                                                                                                   34,863
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     30.00%
                                                                                31,378
                                                                                                            28,269

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        21,958
                                                                                                                                                                                                                                                21,230                                                                                                                                                                                                                                                                               20.00%
   20,000
                      12,892                                                                                                                                                                    13,338
                                                                                                                                                                                                                                                                                                                            10,993

                                   6,004
                                                                                                                                                  4,363
                                                                                                                                                                                                                                                                                                                                                                                                 2,706                                                            8.83%
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     10.00%
                                                                                                                                     8.18%                                       7.76%                                                                                                                                      8.40%                        8.14%
                                                                                                                                                                                                                                                                            7.65% 670

       -                                              3.81%                                                                                      3.54%                                                                                                                                                                                    3.88%
                                                                                                                                                                                                                                                                                                                                                                                                                                                    4.92%
                                                                                                                            3.17%
                       Hindmarsh

                                   Page RJ




                                                                                                                                                  Butcher




                                                                                                                                                                        Craven




                                                                                                                                                                                                                                  Franklin PJ
                                                                      Rees AF




                                                                                                                                      Holland J




                                                                                                                                                                                                                                                                                                                                                                                   Gardner G I
                                                       Hussain LM




                                                                                                                                                             King JM




                                                                                                                                                                                                                     Craven P




                                                                                                                                                                                                                                                                                                            Griffiths M L
                                                                                                 Cooper V




                                                                                                                                                                                  Scriven B E




                                                                                                                                                                                                                                                                                                                             Acquah N E
                                                                                                                                                                                                 Porcheret M E P




                                                                                                                                                                                                                                                                                                                                                          Midway Medical Centre




                                                                                                                                                                                                                                                                                                                                                                                                            Rupert Street
                                                                                                                                                                                                                                                                Walsh S R




                                                                                                                                                                                                                                                                                                                                                                                                                             Malgwa A
                                             Patel N




                                                                                 Bennett A G




                                                                                                             Carpenter GR

                                                                                                                             Yates




                                                                                                                                                                                                                                                                                                                                                                                                                                        Morgans G




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   Manudhane V V
                           2.64%
              Brown




                                                                                                                                                                                                                                                                              High Street

                                                                                                                                                                                                                                                                                             Thorley K J




                                                                                                                                                                                                                                                                                                                                                                                                 Oleshko




                                                                                                                                                                                                                                                                                                                                                                                                                                                     Unyolo P M

                                                                                                                                                                                                                                                                                                                                                                                                                                                                   Shevlin B A




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Mairs T D/O'Byrne

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         Shapley
                                                                                                                                                                                                                                                 McVerry D N




                                                                                                                                                                                                                                                                                                                                           Lyme Valley
                                      -1,401                                                                                                                     1.71%                                                                                         1.95%                                                                                                           -2,528                                                                                                                                              2.12%
                                                                                                                                 -2,844                                                                                                                                                                                                                  -3,791-2,629
             -4,214             0.60%                                                                                                       0.41%
                                            -0.73%                                                                                     -0.40%
                                                                                                                                                      -7,368-0.82%
                                                                                                                                                                                                                                                                                                           0.16%                                                          0.36%
                                                                                                                                                                                                                                                                                                                                                                     -0.32%          -0.77%                                                                             -1.20%
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     0.00%
                      -1.78%    -8,395                                                                                                                                                                                                                                                                                                                                                                                                                            -8,113
                                                                                                                                                                                                                                                                                            -3.32%                                                                                                                                                                           -3.07%
                                      -4.36%     -4.00%
                                                                                                                                                                                                                                -6.28%
   -20,000                                                          -18,857
                                                                                                                                                                                                                                     -7.21%
                                                                                                                                                                                                                                                                            -18,707                                                                                               -7.92%
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 -20,170
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     -10.00%
                                                                                                            -12.74%
                                                                                                                                                                                                                                -27,182
                                                                                                                                                                                                                   -31,141
                                                                                               -34,843
   -40,000                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           -20.00%




                                                                                                                                                                                                             67
Appendix 17: Units of Dental Activity

5PH North Staffordshire PCT Contract Summary Report for the period April 2009 to December 2009


GDS & PDS Contracts

                              Contract information                                                                            General Activity (UDA)


                                                                                                                                                                        Percentage of
                                                                                         Contracted UDA                   Total Contracted and
Contract                                                              Type of                           Carry forward UDA                       Year to date UDA for contracted UDA and
                  Name or Company Name               Contract purpose                     April 2009 to                   carry forward UDA for
number                                                                contract                           from 2008/2009                              2009/2010        carry forward UDA
                                                                                           March 2010                           2009/2010
                                                                                                                                                                           achieved

103713/0001       Rodericks Ltd                      General          GDS Contract              9,545.00             0.00               9,545.00               0.00                0.0 %
119091/0001       TLC 4 Smiles Ltd.                  General          PDS Contract             28,100.00           -371.00             27,729.00          20,319.00               73.6 %
184411/0001       Mroke Limited                      General          GDS Contract             21,756.00            84.00              21,840.00          16,049.95               73.4 %
184411/0002       Mroke Limited                      General          PDS Contract              6,956.00             -9.00              6,947.00           5,442.60               78.4 %
210013/0001       MR TC DICKERSON                    General          GDS Contract             18,842.00           662.00              19,504.00          14,062.80               71.1 %
237183/0001       MR JF SCANNELL                     General          GDS Contract              9,504.00           327.00               9,831.00           6,785.10               68.0 %
243906/0001       MRS A BEDWELL                      General          PDS Contract             16,106.00           219.00              16,325.00          10,609.35               64.5 %
322628/0001       MR W URWIN                         General          GDS Contract              3,160.00            35.00               3,195.00           1,986.30               61.8 %
332984/0004       MR AP DE JAGER                     General          PDS Contract              4,230.00             0.00               4,230.00           2,209.60               52.2 %
338524/0001       MR M SEGAL                         General          PDS Contract             16,938.00           567.00              17,505.00          10,387.35               58.0 %
572187/0001       MR PJ PHILLIPS                     General          GDS Contract             27,026.00           -649.00             26,377.00          19,716.30               75.4 %
620491/0001       MR S RIPLEY                        General          GDS Contract              2,326.00             0.00               2,326.00           1,228.95               52.8 %
679933/0001       MR CE BROOME                       General          GDS Contract               315.00             -12.00                303.00             217.00               72.7 %
680311/0001       MR D SINGH                         General          GDS Contract             25,500.00          1,558.00             27,058.00          20,637.85               74.8 %
684562/0001       MISS FH CUTHILL                    General          GDS Contract             22,216.00           -988.00             21,228.00          17,013.15               81.0 %
690872/0001       MR NS RAI                          General          PDS Contract              7,500.00           300.00               7,800.00           4,876.30               61.0 %
691011/0001       MR P NAJRAN                        General          GDS Contract             16,157.00            -53.00             16,104.00          14,508.10               90.1 %
732370/0001       MR AE WOODCOCK                     General          PDS Contract              4,044.00             0.00               4,044.00           2,210.55               54.7 %
745251/0001       MR ME NEELD                        General          GDS Contract              3,200.00             0.00               3,200.00           2,156.30               67.4 %
755362/0001       MR KS HUGHES                       General          PDS Contract              9,315.00            48.00               9,363.00           7,396.50               78.9 %
762776/0001       MR A SHAMSI                        General          GDS Contract              4,678.00            -53.00              4,625.00           4,830.00              104.4 %
809977/0001       MR JM ATKINSON                     General          GDS Contract              1,523.00             0.00               1,523.00             860.40               56.5 %
812242/0001       MR JA BLAYNEY                      General          GDS Contract             12,840.00           -245.00             12,595.00           9,752.15               77.9 %
857548/0001       MR W JOVANOVIC                     General          PDS Contract              3,000.00          5,084.00              8,084.00           4,652.25               57.5 %
906611/0002       MR RJ COOPER                       General          GDS Contract             18,833.00             0.00              18,833.00          12,558.65               66.7 %
925829/0004       MR KS AULAK                        General          PDS Contract             19,000.00             0.00              19,000.00          10,741.20               56.5 %
986801/0004       MR MN DEVLIN                       General          GDS Contract              3,848.00            -81.00              3,767.00           1,979.70               53.6 %
                                                                                 Total        316,458.00          6,423.00            322,881.00         223,187.40                70.52




                                                                                             68
Appendix 18: Local Area Agreements

                                                                Current   Projected
                       Current
 Metric                                     Time period           RAG     year end
                       performance
                                                                 rating    out-turn
 Rate of hospital
 admissions per        PCT: 404.3           Q1 2009/10
 100,000 for                                (NWPHO data)        GREEN     GREEN
 alcohol related
 harm
 Obesity among
 primary school        PCT: 19.2%           2008/09
                                                                AMBER     AMBER
 children in Year 6                         Academic Year

 Mortality rate from   Directly            3 year pooled (Oct
 all circulatory       standardised rate = 06 to Sept 09) –
 diseases at ages      69.5                used as a proxy      GREEN     GREEN
 under 75                                  for Q2 2009/10

                       4-week quitters =    Q2 2009/10
 Stopping smoking                                               GREEN     GREEN
                       349




                                           69
Appendix 19: Fit for the Future

                 RAG      Comments
                 Rating
Budget             G      There is more flexibility and contingency in the allocated budget at
                          present due to changes in staffing; however, it is noted by NHS
                          North Staffordshire finance that any further significant requirements
                          will need to be bid for and approved by the Programme Steering
                          Group for funding through the 3 partner organisations. The
                          partners have agreed to fund MoM project beyond March 2010.
External           G      An external Health Gateway Review was conducted by the
Review                    Department of Health during week commencing 20th April 2009. A
                          report was issued to the Programme Senior Reporting Officer by
                          the review team and this was issued to the 3 CEOs with a covering
                          letter. An Action Plan was developed by the Programme Director
                          to address the recommendations made by the Review Team.
                          Stock take review Feb 2010
Programme          G               Interviews were held for a Programme Accountant - Jan
Office                    2010, negotiations are on-going.
                                   One full-time analyst is in post a review is underway to
                          ascertain the need for further analyst support.
                                   There are now 2.5 wte, Workforce Transformation
                          Managers in place.
Risks & Issues     A      FBC now to be delivered at a time of reduced growth; financial
                          environment limiting to commissioning plans, and a tight delivery
                          schedule for the Fit for the Future Programme. The SAM
                          scheduling timetable is being reviewed, with a view to
                          commissioners reviewing their timetables in response.

                          Project management and Commissioning delivery must be
                          prioritised to „must do‟ parts of the pathway in order to rationalise
                          programme.
                          FBC targets relating to activity shifts based on the original PFI
                          predictions may be below what is required when compared to
                          actual activity levels today. This issue was also identified as part
                          of the UHNS Foundation Trust planning process and highlighted to
                          the Programme Team. Programme Board agreed to the specified
                          increase as a planning tool at the 25th January 2010 meeting with
                          both PCTs in agreement.

                          Bed numbers have been clarified by all three partners across the
                          health economy. A bed reduction plan is in place and providers
                          have contributed to an overall position statement / bed reduction
                          commitment plan for their organisation. There is a specific group
                          working on this issue and the bed reductions will be monitored
                          against these plans.

                          The matching workforce plan will be developed once the activity
                          shifts are modelled.




                                              70
       No




                                                                                                                                                                                                                                                                                                                                                            a)
         rth                                              Planned Same Day activity as a percentage of
                      St                                                                                                                                                                                                         Planned Same Day activity as a percentage of total
                         af                                          total Elective activity
                           fo                                                                                                                                                                                                                   Elective activity
                             rd
                                sh




                                                        68%
                                                              70%
                                                                    72%
                                                                          74%
                                                                                76%
                                                                                      78%
                                                                                            80%
                                                                                                  82%
                                                                                                               84%
                                                                                                                                                                                                       W




                                                                                                                                                                                                                            0%
                                                                                                                                                                                                                                    10%
                                                                                                                                                                                                                                           20%
                                                                                                                                                                                                                                                 30%
                                                                                                                                                                                                                                                       40%
                                                                                                                                                                                                                                                              50%
                                                                                                                                                                                                                                                                    60%
                                                                                                                                                                                                                                                                          70%
                                                                                                                                                                                                                                                                                 80%
                                                                                                                                                                                                                                                                                                              90%
                                   ir e




                                                                                                                                                                 By PCT
                                               PC                                                                                                                                                          als
                                                 T                                                                                                                                                             a   ll
                                  W
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                                                                                                                                                                                                                                                                                                                                              By Provider
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                           Appendix 20: Benchmarking




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                                                                                                                                                                                                                                                                                                                                                            Planned Same Day Rates




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                      W                  lP                                                                                                                                                         El




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                                                                                                                                                                                                   th
                                                                                                                                                                                                                                                                                                                                                                                     the organisation is currently undertaking in conjunction with the CBSA.




                                    PC                                                                                                                                                               op
                                       T
                                                                                                                                                                                                                                                                                       Inpatient Planned Same Day Rates 2009/10 by Provider




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                            re
                               fo
                                                                                                         Inpatient Planned Same Day Rates 2009/10 by Purchaser                          gh
                                                                                                                                                                                          am                     ic
              W                   rd                                                                                                                                                                W
                 or                  PC                                                                                                                                                                 om
                    ce
                       st               T                                                                                                                                                                    en
                          er                                                                                                                                                                                   s
                            sh
                                ire
                                    PC                                                                                                                                                                  RJ
                                       T                                                                                                                                                                     &
                                                                                                                                                                                                                 AH
                                                                                                                                                                                                                                                                                                                                                                                     The following charts are provided to give an indication of the type of benchmarking
          No
            rth
                      St                                             Average Length of Stay (days)
                                                                                                                                                                                                                                                                                                                                                                                           b)
                        af
                          fo                                                                                                                                                                                                                                     Average Length of Stay (days)
                            rd
                               sh




                                                                                                                                                                                                                                               0.0
                                                                                                                                                                                                                                                     0.5
                                                                                                                                                                                                                                                           1.0
                                                                                                                                                                                                                                                                   1.5
                                                                                                                                                                                                                                                                         2.0
                                                                                                                                                                                                                                                                               2.5
                                                                                                                                                                                                                                                                                     3.0
                                                                                                                                                                                                                                                                                           3.5
                                                                                                                                                                                                                                                                                                 4.0
                                                                                                                                                                                                                                                                                                       4.5
                                                                                                                                                                                                                                                                                                                                             5.0




                                                        0.0
                                                              0.5
                                                                    1.0
                                                                          1.5
                                                                                2.0
                                                                                      2.5
                                                                                            3.0
                                                                                                  3.5
                                                                                                        4.0
                                                                                                                                             4.5
                                  ir e                                                                                                                                                                                        RJ
                                               PC                                                                                                                                                                                  &
                                                 T                                                                                                                                                                                      AH




                                                                                                                                                                               By PCT
                                      St                                                                                                                                                                   Ro                UH
                 Te                       ok                                                                                                                                                                 ya
                   lfo                      e                                                                                                                                                                   l
                                                                                                                                                                                                                                 NS
                                                                                                                                                                                                                                    T
                         rd                      PC                                                                                                                                                                 Or
                                                                                                                                                                                                                                                                                                                                                                             By Provider


                              &                     T                                                                                                                                                                    th
                        W                                                                                                                                                                                                  op
                         re                                                                                                                                                                                                   ae
                                                                                                                                                                                                                                di
             Sh
               ro
                            kin                                                                                                                                                                                                   c
                 ps             PC
                   hi             T
                     re
                        Co                                                                                                                                                                                                       UH
                          un                                                                                                                                                                                                       CW
                             ty
                                PC
                                  T
                                   Du                                                                                                                                                                                               UH
                                      dl                                                                                                                                                                        Du                    B
                                         e                                                                                                                                                                         dl
                                               yP                                                                                                                                                                     e   yG
                                                 CT
                                                                                                                                                                                                                             ro
                                  W                                                                                                                                                                                              up
                                      als
                                          a   ll P                                                                                                                                                                       M
                                                  CT                                                                                                                                                                      id
                                                                                                                                                                                                                             St
                                                                                                                                                                                                                                af
                                  Co                                                                                                                                                                                               fs
                                     ve
                                        nt
                                           r   yP
                                                 CT                                                                                                                                                                                He
                                                                                                                                                                                                                                     FT
                                  So
                                    lih
                                          ul                                                                                                                                                                                  W
                                             lP                                                                                                                                                                                   als
                                               CT                                                                                                                                                                                     a   ll
                              He
                                    re
                                       fo
                                          rd                                                                                                                                                                                       SA
                                                PC                                                                                                                                                                                   TH




72
                                                  T                                                                                                                                                                 Ro
                                                                                                                                                                                                                                                                                                                                                                                           Average Length of Stay (Electives)




                                                                                                                                                                                                                      ya




     Purchaser
                                                                                                                                                                                                                         l   W
                                                                                                                                                                                        Provider                                 ol
                                         BE
                                           N                                                                                                                                                                                        v   es
                      W                          PC
                           ar                      T
                              wi                                                                                                                                                                                      He
                                 ck                                                                                                                                                                                      re
                                   sh                                                                                                                                                                                       fo
                                     ire                                                                                                                                                                                       rd
                  W                             PC
                      or                           T
                        ce                                                                                                                                                                                           W
                          st                                                                                                                                                                                           or
                                  er                                                                                                                                                                                     ce
          So                        sh                                                                                                                                                                                      st
            ut                        ire                                                                                                                                                                      So              er
               h                         PC                                                                                                                                                        Sa            ut
                                                                                                                                                                                                                    h
                      St
                         af                 T                                                                                                                                                        nd               W
                            fo                                                                                                                                                                         we               ar
                              rd                                                                                                                                                                          ll
                                 sh                                                                                                                                                                          &             wi
                                                                                                                                                                                                                              ck
                                    ir e                                                                                                                                                                       W
                                         PC                                                                                                                                                                       es
                                                                                                                                                                                                                     tB
                                            T                                                                                                                                                                          'gh
                                                                                                                                                                                                                           am
                                   W
                                       ol                                                                                                                                                                         Ge
                                          ve
                                               sP                                                                                                                                                                    or
                                                 CT                                                                                                                                                                    ge
                                                                                                                                                                                                                          El
                              Sa                                                                                                                                                                                             io
                                                                                                                                                                                                                                t
                                                                                                                                                                                                                                                                                                             Average Length of Stay, Elective Activity 2009/10 by Provider




                                nd
                                                                                                              Average Length of Stay, Elective Activity 2009/10 by Purchaser




            So                    we
              ut          lP         l
                h           CT                                                                                                                                                                                                  Bu
             Bi                                                                                                                                                                                             B'
               rm                                                                                                                                                                                             gh                  rto
                  in                                                                                                                                                                                            am                   n
     He              gh
        ar             am                                                                                                                                                                                                 W
          to              PC                                                                                                                                                                                                  om
            fB                                                                                                                                                                                             B'
              irm            T                                                                                                                                                                               gh                    en
                                                                                                                                                                                                                                     s
                                                                                                                                                                                                               am
                  in                                                                                                                                                                                                   Ch
                    gh
                       am                                                                                                                                                                                                 i   ld
                          PC                                                                                                                                                                                                     re
                                                                                                                                                                                                                                    n'
                             T                                                                                                                                                                                                         s
                 No
                   rth
                          St
                                                                                                                                                                                                                                                                                                                                                                         c)
                            af
                              fo
                                                                 Average number of Excess Bed Days per Spell                                                                                                                                    Average number of Excess Bed Days per Spell
                                rd
                                   sh




                                                           0.0
                                                                 0.1
                                                                         0.2
                                                                                 0.3
                                                                                        0.4
                                                                                                0.5
                                                                                                        0.6
                                                                                                                                                        0.7
                                                                                                                                                                                                                                         0.0
                                                                                                                                                                                                                                               0.1
                                                                                                                                                                                                                                                         0.2
                                                                                                                                                                                                                                                                   0.3
                                                                                                                                                                                                                                                                              0.4
                                                                                                                                                                                                                                                                                        0.5
                                                                                                                                                                                                                                                                                                                                    0.6
                                      ir e                                                                                                                                                                             UH
                                                  PC
                                                    T                                                                                                                                                                    CW




                                                                                                                                                                             By PCT
                                     So
                                       lih                                                                                                                                                                          RJ
                                             ul
                                                lP                                                                                                                                                                       &
                                                  CT                                                                                                                                                                          AH
                                                                                                                                                                                                                                                                                                                                                           By Provider


                                     Co
                                        ve                                                                                                                                                                            UH
                                           nt                                                                                                                                                                           NS
                                              r   yP                                                                                                                                                                      T
                                                    CT

                                                                                                                                                                                                                          UH
                                            BE
                                              N                                                                                                                                                                             B
                                                    PC
                                                      T
                                                                                                                                                                                                                         He
                                         St                                                                                                                                                                                     FT
                                             ok                                                                                                                                        Sa
                                               e                                                                                                                                         nd                    M
                          W                         PC                                                                                                                                                          id
                               ar                      T                                                                                                                                   we
                                                                                                                                                                                              l                        St
                                  wi                                                                                                                                                              l&                      af
                                     ck                                                                                                                                                                W                     fs
                                       sh                                                                                                                                                               es
                                         ire                                                                                                                                                                   tB
                                                   PC                                                                                                                                                            'gh
                                                      T                                                                                                                                                                  am
                                  Sa
           He                       nd                                                                                                                                                                  Du
                  ar                  we                                                                                                                                                                   dl
                    to                   l       lP                                                                                                                                                           e    yG
                      fB                           CT                                                                                                                                                                ro
                        irm                                                                                                                                                                                            up
                                                                                                                                                                                                                                                                                                                                                                         Elective Excess Bed Days




                                   in                                                                                                                                                                     Ro
                                     gh                                                                                                                                                                     ya
                                       am                                                                                                                                                                      l   W
                                                  PC                                                                                                                                                                   ol
                                                    T                                                                                                                                                                     v   es
                                     W
                                         als
                                             a                                                                                                                                                                      W
                                                 ll P                                                                                                                                            B'                     als
                                                     CT                                                                                                                                            gh                       a   ll




73
                                                                                                                                                                                                     am




     Purchaser
                                                                                                                                                                                                             Ch
                                      Du                                                                                                                                                                        i   ld
                  Sh                     dl                                                                                                                                                                            re
                                            e


                                                                                                                                                                                      Provider
                    ro                                                                                                                                                                                                    n'
                      ps
                                                  yP                                                                                                                                                   So                    s
                        hi                          CT                                                                                                                                                   ut
                          re                                                                                                                                                                                h
                                     Co                                                                                                                                                                         W
                                       un                                                                                                                                                                            ar
                                                                                                                                                                                                                       wi
                                          t      yP                                                                                                                                                                       ck
                                                   CT                                                                                                                                                      Ge
                                                                                                                                                                                                                or
                                                                                                                                                                                                                  ge
                                      W                                                                                                                                                                                  El
                 So                       ol                                                                                                                                                                                  io
                   ut                        ve                                                                                                                                                                                 t
                      h                           sP
                          St                        CT
                               af
                                  fo
                                    rd                                                                                                                                                                                   SA
                                       sh                                                                                                                                                                                  TH
                                          ir e
                     W                            PC                                                                                                                                                           W
                          or
                            ce                       T                                                                                                                                                              or
                               s   te
                                                                                                                                                                                                 Ro                   ce
                                                                                                                                                                                                                         s
                                       rs                                                                                                                                                          ya                         te
                 So                       hi                                                                                                                                                          l   Or                         r
                   ut                        re                                                                                                                                                                th
                      h                           PC                                                                                                                                                             op
                          Bi
                            rm                      T                                                                                                                                                               ae
                              in                                                                                                                                                                                       d      ic
                                                                                                                                                                                                                                                                                              Elective Excess Bed Days Per PbR Spell 2009/10 by Provider




                                                                                                               Elective Excess Bed Days Per PbR Spell 2009/10 by Purchaser


                                gh
                                  am
                   Te                                                                                                                                                                                            He
                      lfo                         PC
                            rd                       T                                                                                                                                                                 re
                                                                                                                                                                                                                          fo
                                 &                                                                                                                                                                                           rd
                                     W
                                      re
                                           kin
                                                   PC                                                                                                                                                                 Bu
                                                     T                                                                                                                                            B'
                                                                                                                                                                                                    gh                  rto
                                   He                                                                                                                                                                 am                   n
                                        re                                                                                                                                                                      W
                                           fo                                                                                                                                                                       om
                                              rd                                                                                                                                                                         en
                                                   PC                                                                                                                                                                      s
                                                     T
                      W                                         Average Length of Stay (days)
                                                                                                                                                                                                                                                                                                                    d)
                           ar
                              wi                                                                                                                                                                                    Average Length of Stay (days)
                                 ck
                                   sh




                                                        0
                                                            1
                                                                 2
                                                                         3
                                                                                4
                                                                                        5
                                                                                                6
                                                                                                                            7
                                                                                                                                                                                                                                        10
                                                                                                                                                                                                                                                12
                                                                                                                                                                                                                                                         14
                                                                                                                                                                                                                                                                                            16




                                                                                                                                                                                                            0
                                                                                                                                                                                                                2
                                                                                                                                                                                                                    4
                                                                                                                                                                                                                         6
                                                                                                                                                                                                                                 8
                                     ire                                                                                                                              Ro                   RJ
                                                PC                                                                                                                      ya                      &
                                                   T                                                                                                                       l     Or
                                                                                                                                                                                                     AH




                                                                                                                                                 By PCT
                                  W                                                                                                                                                   th
                                      als                                                                                                                                               op
                                          a                                                                                                                                                ae
                                              ll P                                                                                                                                            d      ic
                                                  CT
                                                                                                                                                                                                                                                                                                      By Provider


                                                                                                                                                                                  Ge
                                  Co                                                                                                                                                   or
                                                                                                                                                                                         ge
             Sh                      ve                                                                                                                                                         El
               ro                       nt
                                           r                                                                                                                                                         io
                 ps                            yP                                                                                                                                                      t
                   hi                            CT
                     re
                                  Co                                                                                                                                                       W
                                    un                                                                                                                                                         als
                                       t                                                                                                                                                           a   ll
                                              yP
                                                CT
                                  So                                                                                                                                                          UH
                                    lih                                                                                                                                         So              CW
                 Te                       ul                                                                                                                                      ut
                   lfo                       lP                                                                                                                                      h
                         rd                    CT                                                                                                                                        W
                              &                                                                                                                                                              ar
                                  W                                                                                                                                                            wi
                                                                                                                                                                                                  ck
                                   re
                                        kin
                                                PC
                                                  T
                                                                                                                                                                                             UH
                                   Du                                                                                                                                            Du             B
                                      dl                                                                                                                                            dl
                                         e     yP                                                                                                                                      ey
                                                 CT                                                                                                                                       Gr
                                                                                                                                                                                             ou
                                                                                                                                                                                               p
          So
            ut                 BE
               h                   N
                      St             PC                                                                                                                                                         SA
                  af                    T                                                                                                                                                         TH
                     fo
                        rd
                           sh                                                                                                                                                         M
                              ir e                                                                                                                                                     id
                                   PC                                                                                                                                                         St
                                      T                                                                                                                                                            af




74
                                                                                                                                                                                                      fs
                      Sa
                         nd
       So




     Purchaser
                             we
           ut

                                                                                                                                                          Provider
              h                  ll                                                                                                                                                             He
                                    PC                                                                                                                                                                 FT
                Bi
                   rm                  T
                       in
                                                                                                                                                                                                                                                                                                                    Average Length of Stay (Non Electives)




                          gh                                                                                                                                                                 Bu
                             am
            W                                                                                                                                                                                  rto
               or                  PC
                                      T                                                                                                                                                           n
                  ce                                                                                                                                                                  W
                      st                                                                                                                                                                   or
                         er                                                                                                                                                                  ce
                           sh
                                                                                                                                                                                                                                                              Activity 2009/10 by Provider




                               ire                                                                                                                                                              s    te




                                                                                                        Activity 2009/10 by Purchaser
                                    PC                                                                                                                          Sa                                     r
                                      T                                                                                                                           nd
                                                                                                                                                                    we                   He
                       He                                                                                                                                              l   l&                 re
                           re                                                                                                                                                                    fo
                              fo
                                 rd                                                                                                                                             W                   rd
                                                                                                                                                                                 es
                                     PC                                                                                                                                               tB
                                        T                                                                                                                                               'gh
                         W                                                                                                                                                                      am
                                                                                                                                                                                                                                                     Average Length of Stay, Non Elective Emergency




                                                                                                Average Length of Stay, Non Elective Emergency
      No                    ol                                                                                                                                                   Ro
          rth                   ve                                                                                                                                                 ya
               St                  sP
                                      CT                                                                                                                                              l   W
                  af                                                                                                                                                                          ol
                     fo                                                                                                                                                                          v
     He                 rd                                                                                                                                                                           es
        ar                 sh
          to                  ir e
              fB                   PC
                 irm                  T                                                                                                                                    B'
                                                                                                                                                                                             UH
                       in                                                                                                                                                    gh                NS
                          gh                                                                                                                                                   am                T
                             am                                                                                                                                                        W
                                   PC                                                                                                                                                      om
                                      T                                                                                                                                B'
                                                                                                                                                                         gh                     en
                                                                                                                                                                           am                     s
                                      St                                                                                                                                            Ch
                                           ok                                                                                                                                          i   ld
                                             e                                                                                                                                                re
                                                                                                                                                                                                 n'
                                                 PC                                                                                                                                                 s
                                                    T
                                                                                                                                                                                                                                                                                                                                                                  e)
                                                     Average number of Excess Bed Days per Spell                                                                                                                                       Average number of Excess Bed Days per Spell




                                               0.0
                                                     0.1
                                                           0.2
                                                                 0.3
                                                                       0.4
                                                                             0.5
                                                                                   0.6
                                                                                         0.7
                                                                                               0.8
                                                                                                     0.9
                                                                                                                                 1.0
                                                                                                                                                                                                                                 0.0
                                                                                                                                                                                                                                        0.5
                                                                                                                                                                                                                                                     1.0
                                                                                                                                                                                                                                                                 1.5
                                                                                                                                                                                                                                                                             2.0
                                                                                                                                                                                                                                                                                                                                              2.5
                                BE                                                                                                                                                           Ro                 RJ
                                  N                                                                                                                                                            ya                    &
                                        PC
                                          T                                                                                                                                                       l   Or
                                                                                                                                                                                                                          AH
                                                                                                                                                                                                           th




                                                                                                                                                                         By PCT
                          So                                                                                                                                                                                 op
                            lih                                                                                                                                                                                 ae
                                 ul                                                                                                                                                                                d
                  W                 lP                                                                                                                                                                                    ic
                      ar              CT                                                                                                                                                               Ge
                                                                                                                                                                                                                                                                                                                                                    By Provider


                         wi                                                                                                                                                                                 or
                            ck                                                                                                                                                                                ge
                              sh                                                                                                                                                                                     El
                                ire                                                                                                                                                                                       io
                                     PC                                                                                                                                                                                     t
                                        T
                          Co
         So                  ve                                                                                                                                                                                      He
           ut                   nt                                                                                                                                                                                         FT
              h                    r
                                   yP
               Bi
                  rm                   CT                                                                                                                                                                  M
                                                                                                                                                                                                            id
                      in                                                                                                                                                                                           St
                         gh                                                                                                                                                                                          af
                            am                                                                                                                                                                     So                   fs
           W                       PC                                                                                                                                                                ut
                                                                                                                                                                                                        h
              or
                  ce                  T                                                                                                                                                                     W
                     st                                                                                                                                                                                         ar
                        er                                                                                                                                                                                        wi
                          sh                                                                                                                                                                                         ck
                              ire
                                   PC
                                      T                                                                                                                                                                            UH
                       W                                                                                                                                                                                             CW
      So                  als                                                                                                                                                     Sa
         ut                    all                                                                                                                                                  nd
            h                      PC                                                                                                                                                 we
              St
                 af                   T                                                                                                                                                  l    l&
                    fo                                                                                                                                                                             W
                                                                                                                                                                                                                      UH
                       rd                                                                                                                                                                           es                  B
                          sh                                                                                                                                                                               tB
                             ir e                                                                                                                                                                            'gh
                                   PC
                                      T                                                                                                                                                                              am
                     Sa
                                                                                                                                                                                                                                                                                                                                                                  Non Elective Excess Bed Days




     He                 nd
        ar                 we                                                                                                                                                                              W
          to                                                                                                                                                                                                   or
                                ll                                                                                                                                                                               ce
             fB                     PC                                                                                                                                                                              s
                 irm                   T                                                                                                                                                                                  te
                                                                                                                                                                                                                             r




75
                      in
                         gh
                            am                                                                                                                                                                                 W
          Te                                                                                                                                                                                                       als


                                                                                                                                                                                  Provider
                                                                                                                                                                                                                       a




      Purchaser
            lfo                    PC
                rd                   T                                                                                                                                                                Ro                   ll
                    &                                                                                                                                                                                   ya
                       W                                                                                                                                                                                   l   W
                          re                                                                                                                                                                                       ol
                             kin                                                                                                                                                                                      v   es
                                    PC                                                                                                                                                              Du
                                      T                                                                                                                                                                dl
                                                                                                                                                                                                       yG e
                      Du                                                                                                                                                                     B'             ro
                         dl                                                                                                                                                                    gh              up
                             ey                                                                                                                                                                  am
                                PC                                                                                                                                                                  Ch
                                   T                                                                                                                                                                   ild
                     W                                                                                                                                                                                     re
                                                                                                                                                                                                              n'
        Sh              ol
                           ve                                                                                                                                                                                    s
          ro                   sP
             ps
               hi                CT
                  re
                     Co                                                                                                                                                                                              SA
       No               un                                                                                                                                                                                             TH
         rth                ty
             St                PC
                af                T                                                                                                                                                                             UH
                  fo
                    rd                                                                                                                                                                                            NS
                       sh                                                                                                                                                                                           T
                                                                                                                                                                                                                                                                                     Non Elective Excess Bed Days Per Spell 2009/10 by Provider




                          ir e
                                                                                                           Non Elective Excess Bed Days Per Spell 2009/10 by Purchaser


                               PC                                                                                                                                                                            He
                                 T                                                                                                                                                                               re
                                                                                                                                                                                                                    fo
                                                                                                                                                                                                                       rd
                              St
                                ok
                                  e                                                                                                                                                                             Bu
                                        PC                                                                                                                                                    B'
                                           T                                                                                                                                                    gh                rto
                         He                                                                                                                                                                       am                 n
                             re                                                                                                                                                                             W
                                fo                                                                                                                                                                              om
                                   rd
                                        PC                                                                                                                                                                           en
                                          T                                                                                                                                                                            s

				
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posted:7/24/2011
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