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Hillingdon PCT

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									9645b4f4-12d5-4ffd-9124-20206c538a7d.doc




Integrated Performance Report (IPR)

Position as at March 2007
(Board Report)


Contents

1.    Background .................................................................................................................................... 2
2.    Summary performance ................................................................................................................ 2
3.    Red-risked performance.............................................................................................................. 3
4.    Recovery.......................................................................................................................................... 5
6.    Workforce ........................................................................................................................................ 6
7.    National priorities.......................................................................................................................... 7




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1. Background
This report provides an update to Board members on the PCTs progress and performance in an
integrated way bringing together recovery, core and national priorities.

This reports forms part of the new performance management arrangements for the PCT aiming to
strengthen accountability and ownership at all levels of resource utilisation and performance.


2. Summary performance
   Although the position is improving adverse financial variance continues at M11 largely relating to
    Acute SLA over performance valued at £5,765m. Limited detail is provided in the report and further
    information including progress on the recovery programme is provided in the M11 finance report.

   National priorities: at risk and requiring continued action are Financial Balance, 18 Weeks, Choose
    & Book, 4 Week Smoking Quitters and GUM access.




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3. Red-risked performance
 Target                                 Risk Commentary         Impact        on     Lead       Corrective actions      By When
                                                                Finance /Clinical    Director   taken/required.

                         Commissioni    Actual spend for        Over-                Kevin      Continued               Ongoing
                         ng             Acute        SLAs       performance          Mullins    programme of data
                                        £109,024m.    M11       partly as a result              validation and close
                                        plan £103,420m          of         demand               scrutiny of invoices.
                                                                management not
                                                                delivering                      Review of current
                                                                required savings.               critical agreements,
   Core




                                                                Plus volatility of              pricing and usage
                                                                critical care use.              to be incorporated
                                                                                                into        Recovery
                                                                                                Programme        for
                                                                                                2007/08           in
                                                                                                conjunction     with
                                                                                                emerging     London
                                                                                                wide action plan

                         Choose     &   Current                 The PCT did not      Kevin      Programme Board
                         Book           performance    of       achieve     the      Mullins    reconvened. Action
                                        33%. 45 practices       incentive    for                plan agreed across
                                        are live.               100k.                           economy.
                                                                                                Performance
                                                                                                monitoring systems
                                                                                                improved.
                                                                                                                        31/03/07
                                                                                                Communications
                                                                                                and Clinical
                                                                                                engagement
   National priorities




                                                                                                initiatives to be
                                                                                                launched.
                         18 Weeks       06/07           LDP     Initial estimates    Kevin      All Trusts contacted
                                        trajectories at risk    are           that   Mullins    and assurances
                                        on       all    four    increased activity              received regarding
                                        indicators for M10...   to achieve 18                   short term
                                                                weeks RTT is                    contingencies that
                                                                overall    approx               will improve            31/03/07
                                                                £3.5m This does                 performance to
                                                                not take account                achieve trajectory.
                                                                service redesign,
                                                                PBC or demand                   Risk likely to
                                                                management.                     continue with
                                                                                                regard to
                                                                                                Dexascanning and        31/03/07
                                                                                                discussions are
                                                                                                being pursued with
                                                                                                the main provider




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 Target                     Risk Commentary        Impact        on    Lead       Corrective actions        By When
                                                   Finance /Clinical   Director   taken/required.

          GUM Access        In the absence of      Associated health   Kevin      Trust and PCT have        31/03/07
                            choosing    health     risks.              Mullins    reviewed operational
                            money available.                                      processes       and
                                                                                  agreed improvements
                                                                                  in place.

                                                                                  Priority being given
                                                                                  to     recruit   into
                                                                                  vacant posts
          Smoking           Not     likely    to   Associated health   Hilary     Looking to recruit a      January
          Cessation         achieve target.        risks.              Pickles    smoking cessation         07
                                                                                  advisor.

                                                                                  Increased marketing
                                                                                  efforts    and      the   Some
                                                                                  appointment of a          impact
                                                                                  part-time midwife in      on     Q3
                                                                                  The         Hillingdon    bigger
                                                                                  Hospital Trust to lead    impact
                                                                                  smoking cessation in      on     Q4
                                                                                  maternity services.       data.


Please note: Action taken are in normal font. Actions to be pursued are in bold




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4.     Recovery
Please refer to M11 Finance report.

5.     Commissioning
Acute Over and Under Performance Report Month 11 2006/07

All figures extrapolated from M10 monitoring reports unless otherwise indicated

Trust                     Target YTD       Actual YTD        Variance   Commentary
                                                             YTD
Chelsea and Westminster   £408k            £545k             £137k      Non-elective over by £80k.
Hospital                                                                Critical Care actual £15k against plan £7k (mainly
                                                                        Special Care Baby).
GOSH                      £793k            £944k             £104k      Over performance due to 22 bed days of Non-PBR
                                                                        specialist high cost ECMO cardiac assessment at
                                                                        £114k with 0 in plan and 1 PBR Cochlear Implant
                                                                        £33k.

GST                       £289k            £539k             £250       Critical Care £130k at m10, ‘0’ in plan. Patients
                                                                        validated as Hillingdon patients.
                                                                         - The transfer of Adult ITU patients from other
                                                                        hospitals is costed via TISS points (£70 per TISS
                                                                        depending on dependency and retrieval costs)
                                                                        whereas patients directly admitted or admitted from
                                                                        another ward in the Trust are charged on discharge
                                                                        on a bed day basis.
                                                                         - The rest are critical care bed days spread across
                                                                        General Medicine ITU and HDU and one patient in
                                                                        Lane Fox High Dependency Unit in April/May for 39
                                                                        days.

                                                                        Over in elective IP by £17k, over £24k in Non-elective
                                                                        Non-PBR complex oesophageal procedures and
                                                                        General Medicine, ‘0’ plan.
                                                                        PBR exclusion Drugs & Devices £107k, cost per case.

Hammersmith               £6,473k          £6,604k           £131k      Critical care underperforming by £362k.
Hospitals
                                                                        Over mainly due to Non-elective by £76k. Elective by
                                                                        £173k mainly due to cancer, digestive system, breast,
                                                                        hepato-pancreatic system.
                                                                        Renal over by £262k mainly due to dialysis and renal
                                                                        transplant

Hillingdon Hospital       £66,531k         £73,115k          £6,584k    £2.4m over performed on Elective in-patients
                                                                        £2.0m over performed Non-elective in patient
                                                                        £914k over performance in out patients
                                                                        £1.2m over performance in Out patient            with
                                                                        procedures, A&E and Ward attenders combined

North     West London     £4,448k          £4,193            -£255k     Critical care over by £198k.
Hospitals                                                               All other aspects of plan under performing
Royal Brompton and        £5,368           £6,021            £653       Over by mainly due Coronary Catheterisation, Cardiac
Harefield                                                               Valve Procedure, Coronary Bypass, Percutaneous
                                                                        Coronary.
                                                                        Critical care under by £11k.
RNOH                      £669k            £836k             £168k      Critical Care £56k.
                                                                        Scoliosis surgery(R10) unit cost £32k (Non-PBR
                                                                        Activity). 6 patients reported as having had R10 at
                                                                        cost £190k. Other PCTs also reporting increases in
                                                                        R10, reported to Lead Commissioner, Barnet PCT to
                                                                        raise at SLA meetings. Further work by Barnet PCT
                                                                        on Scoliosis rebanding.



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Trust                                                             Target YTD           Actual YTD             Variance      Commentary
                                                                                                              YTD
Royal Free Hospital                                               £583k                £859k                  £276k         Over mainly in Plastic due to service transfer from
                                                                                                                            WHT to RFH Oct 06. Transfer value not adjusted
                                                                                                                            between the two Trusts.
                                                                                                                            Over also due to neurosurgery and ENT (including 1
                                                                                                                            Adult Cochlear Implant approved by Exception
                                                                                                                            Committee) £20k.

St Marys Hospital                                                 £1383k               £1279k                 -£104k        Underperformance across most specialties but over in
                                                                                                                            critical care due to long stay patients, validated as
                                                                                                                            Hillingdon’s.

UCLH                                                              £959k                £1,619k                £660k         Critical care over by £247k due to complex, long stay
                                                                                                                            patients, validated as Hillingdon’s.
                                                                                                                            Over in Non-PBR, mainly due to day cases with actual
                                                                                                                            of £171k and £12k in plan.

West Herts                                                        £4,949k              £4,385k                - £564k       Variance mainly due to Plastics activity moving to
                                                                                                                            Royal Free. Finance and activity plans have not been
                                                                                                                            adjusted between the two Trusts. There is an
                                                                                                                            expected fall in activity in Plastics over all resulting
                                                                                                                            from the transfer of service



6.                                       Workforce

The information provided on workforce highlights current payroll performance.
                                                                                          November        December                    HC = Headcount, WTE = Whole time
                                                                                          HC WTE          HC   WTE                    equivalent
                                                Chief Executive             Starters
                                                                            Leavers       1      1.00     1        1.00
  Starters and Leavers




                                                Commissioning &             Starters      1      1.00
                                                Performance Mgmt            Leavers
                                                HQ Support Services         Starters                                                  Now includes IT
                                                                            Leavers                       1        1.00
                                                Operational Services        Starters      42     36.97    4        3.6                Now includes Therapies
                                                                            Leavers                       4        3.01
                                                Primary Care                Starters
                                                                            Leavers
                                                Public Health               Starters
                                                                            Leavers
                                                TOTAL                       Starters      43     37.97    4        3.6
                                                                            Leavers       1      1.00     6        5.01

                                                Chief Executive                           13     12.81    12       11.81
                         (as at end of month)




                                                Comm. & Perform. Mgmt                     32     29       33       30                 Amendment +1 HC, +1 WTE
  Staff in Post




                                                HQ Support Services                       59     52.76    58       53.56              Amendment -0.2 WTE
                                                Operational Services                      566    423.70   557      419.45             Amendment -9 HC, -4.84 WTE
                                                Primary Care                              32     28.26    32       28.29              Amendment +.03 WTE
                                                Public Health                             24     23.41    24       23.41
                                                TOTAL                                     726    572.94   717      566.52             Some amendments made due to
                                                                                                                                      database cleansing, some are due to staff
                                                                                                                                      changing their hours.




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7.               National priorities

National Priorities (Selbie six)
                     Indicator            Measurement      Apr-06       May-06       Jun-06   Jul-06   Aug-06   Sep-06   Oct-06   Nov-06   Dec-06   Jan-07   Feb-07   Mar-07
                 Financial Balance        Target        Refer to Finance Report
                                          Actual
                                          Performance



                     Inpatients Waiting
                     longer than 20 weeks Target            291           262         233      204      175      146      116      87       58       29       15        0
                                          Actual            268           190         174      200      211      179      158      141      168      149
                                          Performance     GREEN         GREEN        GREEN    GREEN     RED      RED      RED      RED      RED      RED

                     Outpatients waiting
      18 Weeks




                     longer than 11 weeks Target            108           97           86      76       65       54       43       32       22       11        5        0
                                          Actual             66           100          52      53       96       100      61       38       75       44
                                          Performance     GREEN          RED         GREEN    GREEN     RED      RED      RED      RED      RED      RED
                     Diagnostic Waits
                     (MRI etc)            Target             55           50           57      50       43       36       28       21       14        7        4        0
                                          Actual             78           50           48      47       34       25       22       21       32       27
                                          Performance       RED         Amber        GREEN    GREEN    GREEN    GREEN    GREEN    Amber     RED      RED
                     Diagnostic Waits
                     (other tests)        Target            290           264         237      211      185      158      132      106      79       53       26        0
                                          Actual            360           362         354      309      194      201      200      163      110      79
                                          Performance       RED          RED          RED      RED      RED      RED      RED      RED      RED      RED



                     Cancer 31 days       Target             0             0           0        0        0        0        0        0        0        0        0        0
      Cancer




                                          Actual             0             0           0        0        0        0        0        0        0        0
                                          Performance     GREEN         GREEN        GREEN    GREEN    GREEN    GREEN    GREEN    GREEN    GREEN    GREEN
                     Cancer 62 days       Target             0             0           0        0        0        0        0        0        0        0        0        0
                                          Actual             1             0           1        0        0        0        0        0        0        0
                                          Performance       RED         GREEN         RED     GREEN    GREEN    GREEN    GREEN    GREEN    GREEN    GREEN
                 Choose and Book          Target                           6           12      20       32       44       58       73       90       90       90       90
                                          Actual                           2           2        4        4        7       10       15       11       20
                                          Performance      Amber         RED          RED      RED      RED      RED      RED      RED      RED      RED
     4 Week Smoking Quitters              Target            145           293         440      580      720      862     1001     1140     1280     1470     1660     1850
                                          Actual                                      353      470      553      650      713      839      885
                                          Performance                                 RED      RED      RED      RED      RED      RED      RED
                   GUM Access             Target                                      1380                      1500                       1620                       1741
                                          Actual                                      1333                      1111                       1232
                                          Performance                                 RED                        RED                        RED



Actions to address targets that are not on track are documented under 2. Red risked performance




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18 week waits

Progress towards key targets for 31st March is at risk. All Trusts who are behind the planned trajectory
for these targets have been contacted for assurances and where necessary copies of action plans they
have put in place to ensure targets are achieved by 31st March. Hillingdon Hospital has moved spinal
surgery, at their financial risk, to an alternative provider and vascular services to Hammersmith in order
to avoid 20 week breaches.

Dexascanning (a diagnostic test for Osteoporosis) is the one area for concern in relation to
achievement of the 13 weeks target for diagnostics. North West London Trust is the only local provider
of this test at secondary care level and there is pressure on this capacity for all North West London
PCTs. The Trust has been asked to flex capacity in the short term to ensure patients are seen within
the access target times. Funding for any additional work will be minimal at between £3,000 - £4,000 in
total.

Cancer Breaches

No cancer breaches reported for the period.

Choose and Book Bookings

Good progress was made in January, the level of choose and book usage increased to 20% of all
referrals. Momentum continued in February, however Hillingdon Hospital experienced a computer virus
which resulted in no choose and book usage for two weeks. Technical issues continue to be the
biggest reason for low usage across Hillingdon. Since the start of March the numbers of bookings are
increasing again.

The Health Economy Programme Board has been reconvened. The PCT Action Plan is being
integrated with the Hospital plan and a combined issues log produced, both these documents will be
performance managed by the programme board. Individual training material and support continues to
be offered to GP Practices. Clinical engagement is being strengthened and events are being organised
with Hillingdon Hospital to help GPs with selection of services. The PCT has extended the scope of
choose and book to include PCT Providers services (physiotherapy & podiatry) and is working on the
integration of choose and book with Practice Based Commissioning and the eighteen week pathway.

GUM

The audit by the HPA in Nov 06 reported exceptional 78% Hillingdon attendees in a one-week sample
seen within 48 hours against England average of 65% and London 78%. There was a 28%
improvement from the August 06 audit. The audit also reported 78% of Hillingdon attendees offered an
appointment within 48 hours (new LDP target for 0708), comparable against London average of 82%
and England 69%.

The PCT has been working with the Hillingdon Hospital in service redesign and this will continue in
2007/08. Future section includes a meeting in March with the Sexual Health Consultants and Service
Managers to review and redesign services in line with the DH high Impact Changes for GUM 48 Hour
Access.

Smoking Cessation

The stop smoking 4 week quitters rate is reporting latest figure of 839 (74%) compared to our current
estimate target of 1140. Compared to Q2 figure it has increased by 29% from 650 to 839. In Q1 this


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target ranked 5th out of 8 PCT in the NFL sector. At current activity levels a shortfall of 300 quitters
(16%) is predicted for the whole year.

Actions taken to date include restarting GP LES programme (Dec 06), set up clinic in a local pub in
West Drayton (Feb 07), appointment of sessional advisors and a midwife post (both currently in post)
and further drive on our Marketing efforts through GP smokers mail out (since Oct 06) and No Smoking
Day (March 07), this will have small to medium impact on Q3 and bigger impact on Q4. More people
will be expected to use the service in Q4 as the government smoke-free campaign increase its
momentum in preparation for the smoking ban legislation in July 07.

LAS

Of the three LAS targets only Cat A19 minutes is above plan. The CAT A 8 minutes is still below plan
73.6% compared to a target of 75%.The Cat B 19 minutes remains of concern and is not expected to
be delivered. The development of the action plan as highlighted in the previous months report is
ongoing.




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