Council of governors general meeting 25 January 2017 Performance and - - PowerPoint PPT Presentation

Council of governors’ general meeting – 25 January 2017

Performance and financial report – Q3

David Evans, Chief Executive

Quality of care

Key targets: 2016/17, Quarter 2 Key targets: 2016/17, Quarter 3 MRSA number: 3 (cumulative) MRSA number: 3 (cumulative)

• C. difficile: 13 vs target 30 (cumulative)
• C. difficile: 18 vs target 30 (cumulative)

18 weeks RTT incomplete operating at 92% 18 weeks RTT incomplete operating at 92% A&E in 4 hours: 95.8% A&E in 4 hours: 91.5 % Elective operations not cancelled: 99.7% Elective operations not cancelled: 99.6 % Cancer: 4 out of 7 targets met Cancer: 5 out of 8 targets met PROVIS (0 out of 2 targets) Sickness: 4.08% Sickness: 4.54% % Fully Registered with the CQC for safety and quality outcomes Fully Registered with the CQC for safety and quality outcomes Fully met the learning disability standards Fully met the learning disability standards Fully met the adult social care CQC

• utcomes

Met adult social care CQC outcomes apart from one minor issue at one care home Information governance: Level 2 Information governance: Level 2 Overall: no colour (2.0) Overall: TBC

Our performance on our priorities 2016/17

Safer Care Performance  On or Better than Target,  Below Target,  As Expected Reduce hospital acquired infections (Cdiff, MRSA,SSI)  Improve management of sepsis in hospital and community settings  Falls and pressure ulcers (based on safety thermometer)  National safety standards for invasive procedures (Nat SSIPs)  Medicine optimisation  Electronic prescribing roll out  Antimicrobial stewardship 

Our performance on our priorities 2016/17

High Quality Care Performance  On or Better than Target,  Below Target,  As Expected Elderly trauma pathway  Discharge / flow



Electronic track and trigger tool (revised project plan)



Dementia care pathway  Mortality case note reviews



Learning disabilities – care bundle



COPD bundle



Maternity bundle of care



Our performance on our priorities 2016/17

Patient Experience Performance  On or Better than Target,  Below Target,  As Expected Patient experience – including kindness and compassion measure



Alcohol management



NHS staff health and well being



Regional position: A&E

November 2016 England position = 87.2% Trust Qtr 2 Oct-16 Nov-16 Northumbria Healthcare

95.8% 93.5% 93.4%

City Hospitals Sunderland

94.3% 93.5% 91.8%

Gateshead Health

97.1% 95.3% 93.1%

North Cumbria

90.1% 88.2% 85.8%

South Tyneside

92.4% 92.8% 91.1%

Newcastle upon Tyne Hospitals

96.8% 95.5% 89.2%

County Durham & Darlington

95.4% 94.3% 82.6%

North Tees

95.6% 96.4% 94.3%

South Tees

97.0% 95.1% 93.0%

National performance metrics

Accident & Emergency 18 weeks RTT Cancer 2 Week wait 31 Day 62 day

From GP referral Breast symptoms Diagnosis to 1st treatment Subsequent treatment - Drug Subsequent treatment - Radiotherapy Subsequent treatment - Surgery Referral to treatment From screening service

North Cumbria

87.1% 87.1% 74.4% 90.4% 90.9% 97.5% 91.1% 96.8% 86.8% 91.1% 91.7% 87.8% 91.7%

South Tyneside

92.5% 91.5% 85.4% 93.1% 95.6% 98.1%

• 100.0%

100.0%

• 100.0%

92.9% 0.0%

Newcastle

94.3% 91.4% 90.1% 95.1% 94.1% 94.6% 95.0% 97.5% 99.4% 98.4% 94.8% 88.9% 93.1%

Morecambe Bay

85.9% 83.1% 76.3% 91.0% 88.5% Data not available from Northern Cancer Network

Northumbria

93.7% 92.9% 83.2% 93.3% 93.5% 95.3% 95.7% 96.0% 100.0%

• 100.0%

85.8% 100.0%

Sunderland

94.1% 90.7% 82.6% 94.1% 93.4% 97.0%

• 99.4%

100.0%

• 100.0%

88.3% 100.0%

Gateshead

95.0% 93.5% 78.9% 91.0% 92.3% 97.9% 98.5% 100.0% 100.0%

• 100.0%

91.3% 91.8%

South Tees

95.2% 92.8% 80.5% 93.0% 92.5% 93.3% 100.0% 95.3% 98.9% 99.3% 97.8% 74.1% 83.3%

North Tees & Hartlepool

95.9% 94.8% 83.8% 97.1% 93.3% 95.4% 98.3% 100.0% 100.0%

• 100.0%

90.9% 97.4%

County Durham & Darlington

93.1% 85.3% 80.9% 96.7% 92.6% 95.3% 96.3% 99.4% 100.0%

• 100.0%

80.8% 80.0%

Royal Free London

85.2% 82.7% 83.2% 92.3% 92.0%

Frimley

93.1% 93.1% 75.5% 87.8% 93.4%

Salford Royal

84.0% 84.0% 69.6% 82.0% 92.6%

Wrightington, Wigan and Leigh

84.0% 84.0% 81.2% 97.4% 96.1% Accident & Emergency: quarter to date as at November 2016 (Unify 2)Please note that the RTT - admitted figures shown are unadjusted, as adjusted figures are no longer submitted 18 weeks RTT: November 2016 (NHS England) Internally reported admitted RTT figures are adjusted Cancer: November 2016 (Northern Cancer Network) Admitted and non-admitted RTT are no longer targets Data not available from Northern Cancer Network

Incomplete

TRUST

All Type 1 Admitted Non admitted

NHS providers operational performance

• ver time - A&E

• Pressure from September 2016
• Volumes, acuity
• December changes at The Northumbria
• Christmas and New Year planning - A&E Board
• Additional capacity – North Tyneside General

Hospital orthopaedics and escalation beds

• Primary care availability
• Pressure on all staff groups

Winter

2016/17 Thu 22/12/2016 Fri 23/12/2016 Sat 24/12/2016 Sun 25/12/2016 Mon 26/12/2016 Tue 27/12/2016 Wed 28/12/2016 Thu 29/12/2016 Fri 30/12/2016 Sat 31/12/2016 Sun 01/01/2017 Mon 02/01/2017 Number of A&E attendances 259 276 279 239 286 323 309 256 303 271 307 315 Number of 4 hour breaches 41 28 11 20 79 125 87 72 104 78 142 120 4 hour performance 84.2% 89.9% 96.1% 91.6% 72.4% 61.3% 71.8% 71.9% 65.7% 71.2% 53.7% 61.9% Number of emergency admissions via A&E 122 144 97 106 139 139 128 140 130 134 114 122 Number of emergency admissions via other 29 16 7 5 1 4 10 10 26 3 6 5 Emergency admissions via A&E as a percentage of A&E attendances 47.1% 52.2% 34.8% 44.4% 48.6% 43.0% 41.4% 54.7% 42.9% 49.4% 37.1% 38.7% All emergency admissions as a percentage

• f A&E attendances

58.3% 58.0% 37.3% 46.4% 49.0% 44.3% 44.7% 58.6% 51.5% 50.6% 39.1% 40.3% 2015/16 Tue 22/12/2015 Wed 23/12/2015 Thu 24/12/2015 Fri 25/12/2015 Sat 26/12/2015 Sun 27/12/2015 Mon 28/12/2015 Tue 29/12/2015 Wed 30/12/2015 Thu 31/12/2015 Fri 01/01/2016 Sat 02/01/2016 Number of A&E attendances 262 232 216 194 269 302 288 264 241 215 274 294 Number of 4 hour breaches 33 6 8 3 30 53 33 23 1 2 13 29 4 hour performance 87.4% 97.4% 96.3% 98.5% 88.8% 82.5% 88.5% 91.3% 99.6% 99.1% 95.3% 90.1% Number of emergency admissions via A&E 115 111 79 85 122 126 127 116 124 109 117 124 Number of emergency admissions via other 17 24 20 4 7 4 16 8 16 1 2 Emergency admissions via A&E as a percentage of A&E attendances 43.9% 47.8% 36.6% 43.8% 45.4% 41.7% 44.1% 43.9% 51.5% 50.7% 42.7% 42.2% All emergency admissions as a percentage

• f A&E attendances

50.4% 58.2% 45.8% 43.8% 46.8% 44.0% 45.5% 50.0% 54.8% 58.1% 43.1% 42.9%

50 100 150 200 250 300 350 22 Dec 23 Dec 24 Dec 25 Dec 26 Dec 27 Dec 28 Dec 29 Dec 30 Dec 31 Dec 01 Jan 02 Jan

Number of attendances/emergency admissions via A&E NSECH

2015/16: Number of A&E attendances 2016/17: Number of A&E attendances 2015/16: Number of emergency admissions via A&E

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0% 22 Dec 23 Dec 24 Dec 25 Dec 26 Dec 27 Dec 28 Dec 29 Dec 30 Dec 31 Dec 01 Jan 02 Jan

4 hour performance/emergency admissions via A&E as a percentage of A&E atts NSECH

2015/16: 4 hour performance 2016/17: 4 hour performance 2015/16: Emergency admissions via A&E as a percentage of A&E attendances 2016/17: Emergency admissions via A&E as a percentage of A&E attendances

Mortality

• Financial performance is ahead of plan at the end of

December but the profile of the plan means the challenge continues to be greater in the final quarter of the year

• The trust is awaiting confirmation from Northumberland CCG

regarding any contractual challenges in 2016/17. Agreement has been reached with North Tyneside CCG regarding payments in 2016/17

Finance update

• Agreement has been reached with commissioners regarding

contractual arrangements in respect of 2017/18 and 2018/19

• Discussions remain ongoing with Northumberland in light of

the development of the accountable care organisation

Finance update

Patient experience update

A very strong position in quarter 3

Patient perspective Q3 results: feedback from 2509 patients

• Good performance – 95% of inpatients, 93% of emergency care patients, 99% of
• utpatients and 98% of patients receiving day case care rating their experience as

good, very good or excellent

• The trust performs well - inpatients 86%, outpatients 90% and emergency care 82%

all sit within the top 20% threshold when comparing with national data

• There is a site variance in the emergency department experience which can be

expected due to the difference between minor injuries for example and a serious, life threatening emergency

Hexham North Tyneside Wansbeck The Northumbria NHS top 20% 85% 83% 79% 78% 78%

81.8% 79.9% 80.1% 81.1% 81.9% 82.8% 80.1% 82.1% 82.1% 82.3% 82.0% 0.0% 20.0% 40.0% 60.0% 80.0% 100.0%

ED Overall score over time

Q1 2014 Q2 2014 Q3 2014 Q4 2015 Q1 2015 Q2 2015 Q3 2015 Q4 2016 Q1 2016 Q2 2016 Q3 2016

Real time Q3 results: feedback from 1616 patients

Good consistency across sites and high quality care being maintained in winter, despite pressures within the system. This attainment is in keeping with the improvement reported by Patient Perspective

Q3 2016 No of Pts Surveyed Coord- ination Respect & Dignity Involve- ment Doctors Nurses Clean- liness Pain Control Medicines Noise at Night Kindness & Compassion Domain Average The Northumbria 577 9.72 9.94 9.71 9.90 9.96 9.84 9.87 8.12 9.55 9.94 9.65 North Tyneside 392 9.56 9.87 9.67 9.79 9.86 9.69 9.92 8.36 9.31 9.93 9.59 Wansbeck 330 9.68 9.95 9.78 9.86 9.95 9.79 9.96 8.36 9.18 9.96 9.65 Hexham 119 9.57 9.92 9.79 9.87 9.91 9.77 9.90 9.08 9.59 9.98 9.74 Community Hospitals 198 9.75 9.96 9.77 9.85 9.94 9.88 9.95 8.85 9.26 9.96 9.72 Total 1616 9.65 9.92 9.73 9.85 9.92 9.79 9.91 8.38 9.37 9.95 9.65

9.43 9.87 9.64 9.86 9.87 9.72 9.87 8.45 9.36 9.91 9.60 9.66 9.90 9.70 9.84 9.88 9.79 9.86 8.11 9.52 9.89 9.61 9.67 9.90 9.79 9.86 9.90 9.76 9.89 8.09 9.47 9.92 9.62 9.65 9.92 9.73 9.85 9.92 9.79 9.91 8.38 9.37 9.95 9.65 0.00 2.00 4.00 6.00 8.00 10.00 Coordination Respect & dignity Involvement Doctors Nurses Cleanliness Pain Control Medicines Noise at Night Kindness & Compassion Domain Average

Real Time Domains 2016 by Quarter (6848)

Jan-Mar 16 Apr-Jun 16 Q1 Jul-Sep 16 Q2 Oct-Dec 16 Q3

92.0 98.5 93.5 97.9 98.1 98.1 97.4 80.1 92.2 98.5 94.8 96.1* 99.0* 97.2* 98.5* 98.9* 97.7 98.8* 82.3* 94.4* 99.2* 96.2* 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 100.0 Coordination* Respect and dignity* Involvement* Doctors* Nurses* Cleanliness Pain Control* Medicines* Noise at Night* Kindness & Compassion* Domain Average*

Trust wide real time domains 2016 v 2015

2015 (5646) 2016 (6848)

(Significantly better score = *)

Real time 2016 v 2015 – Significant changes over time

Patient experience quarter 3 update – Friends & Family Test

In this quarter the percentage of patients who would extremely likely or likely recommend care is: inpatients and day case 98%, emergency care 90% and maternity 98%

FFT Inpatient and Day Case

IP FFT DH Extremely likely Likely Neither likely nor unlikely Unlikely Extremely unlikely Don't know Total Score Response Rate Eligible % of Extremely Likely & Likely Oct-16 856 72 3 2 3 7 943 91 10.6% 8915 98% Nov-16 1233 117 10 2 5 6 1373 89 14.7% 9320 98% Dec-16 894 86 7 5 2 8 1002 89 11.9% 8410 98% Q3 2016 2983 275 20 9 10 21 3318 89 12.5% 26645 98%

National Average score 77, National % of Extremely Likely & Likely 95%, Response rate 24.1%

FFT Emergency Care

FFT AE Extremely likely Likely Neither likely nor unlikely Unlikely Extremely unlikely Don't know Total Score Response Rate Eligible % of Extremely Likely & Likely Oct-16 392 133 27 13 17 6 588 58 4.9% 12027 89% Nov-16 399 97 23 9 7 10 545 67 5.1% 10782 91% Dec-16 321 99 22 9 8 9 468 61 4.0% 11698 90% Q3 2016 1112 329 72 31 32 25 1601 62 4.6% 34507 90%

National average score 54, National % of Extremely Likely & Likely 86%, Response rate 12.8%

FFT Maternity

FFT Maternity Extremely likely Likely Neither likely nor unlikely Unlikely Extremely unlikely Don't know Total Score Response Rate Eligible % of Extremely Likely & Likely Oct-16 278 41 6 325 84 22.8% 1426 98% Nov-16 183 23 206 89 16.5% 1249 100% Dec-16 243 17 3 2 2 267 90 20.3% 1315 97% Q3 2016 704 81 9 2 2 798 87 20.0% 3990 98%

National average Score 74, National % of Extremely Likely & Likely 95%, Response rate 21.9%

Other notable points…

• Annual planning (2 year) - submitted
• Quality improvement projects underway
• Changes to clinical commissioning groups
• Sustainability and transformation plans (STP)
• Accountable care organisation – outline business

case submitted 23 December 2016

• Developing process with national team for the final

business case

• Evolution of The Northumbria model

Summary

• Quarter 3 continues to show stress in

performance

• Worthy of note given national NHS picture
• Therefore, clear focus on performance and the

financial position

• Some key strategic decisions in quarter 4
• We have a very challenging year ahead –

performance and key projects

Any questions?

Committee update - safety and quality and assurance

John Marsden, Non-Executive Director

• What the committee does
• Membership
• Reporting to board - monthly
• Supporting sub-committees / panels
• safety panels
• quality panels
• patient feedback committee
• quality laboratory
• and more…

Safety and quality committee

• What the committee does
• Membership
• Reporting to board - quarterly
• Supporting sub-committees / panels
• assurance policy group
• health and safety committee

Assurance committee

Any questions?

Creating a ‘Primary and Acute Care System’ (PACS) in Northumberland

What are we trying to achieve?

Urgent and emergency care when you need it, in the right place Tools and information that support self management Integrated health and social care supporting complex needs Financial stability

ACCOUNTABLE CARE ORGANISATION

Highest care needs Ongoing care needs Urgent care needs Whole population Level of needs Proportion of the population

Locality based teams, working across organisational and professional boundaries

Out of hospital model

Better communication, joined- up systems and ONE shared health record Proactively looking after and planning care for complex patients as well as rapid response

Developing services into planned and rapid response

New ways of working

Using the skill mix of teams, not just individuals Developing specific roles

• Eg. clinical pharmacists

A capitated budget for the population Mutual responsibility for the system Sustainable services for the future

Underpinned by a new model of planning and delivering care

ACCOUNTABLE CARE ORGANISATION

Tools and information that support self management

Good self - care Healthy lifestyles Resilient communities Positive wellbeing Online advice Local information

Integrated health and social care supporting complex needs

Bespoke care plans including escalation decisions Physio and

• ccupational

therapy Mental health, Care

• f Elderly and

Palliative Care specialists Enhanced primary care Specialist telephone advice & single point

• f access

Community nursing Social care Clinical Pharmacist

Programmes of care High risk Frail elderly Nursing homes Mental health Palliative care Long term conditions

Nursing home programme - planned care

• All homes with an aligned matron, pharmacist and GP
• Matron: leads care with regular discussion and review

with GP. Focus on education, clinical care and anticipatory planning

• GP: weekly round and case discussion, focus on

anticipatory planning

• Pharmacist: systems and waste management,

medicines reconciliation, acute interventions

• Care of elderly consultant: quarterly visit to home for

case discussion and patient assessments

• Part of integrated clinical record: virtual assessments

URGENT CARE PLANNED CARE

Nursing home programme

Aligned GP Matron Pharmacist CoE Consultant MDT Bespoke care plans including escalation decisions Unified record Frailty Assessment Service/ inpatients Acute Visiting Service

EMERGENCY CARE

TRANSITION CARE

Hospital @ Home Hospital to Home

Urgent and emergency care when you need it, in the right place

Acute visiting service

• triage of same day

requests to GP, community nurse or pharmacist 7 day emergency care – The Northumbria

• reduced

admissions

• reduced length of

stay Local urgent care

• Capacity and

demand exercise: increased GP urgent access

• Extended GP access

Quick access

• to specialist

telephone advice/ assessment

• single point of

access

Urgent care - acute access and visiting

• All GP practices have undergone a capacity

and demand exercise

• Those with access problems have been

incentivised to change their access models (eg. Triage process, Doctor First, Blyth Acute Service)

• By the end of the programme, capacity in

primary care will match demand enabling patient behaviour to change

Urgent care - acute access and visiting

• Extended hours provided in locality hubs/

base hospitals

• Out of hours access delivered across county
• Visits:
• multi-professional acute visiting service
• triage process
• Quick access to specialist advice / assessment

Urgent care- community

• Single point of access for community and social care:
• short term support service: integrated social care

and rehabilitation

• community nursing
• Specialty advice / assessment:
• frailty assessment service
• ambulatory care
• palliative care rapid response
• mental health crisis team
• specialty consultant phone line

Emergency care - specialist emergency hospital

• Seven day specialist services
• A&E consultants 24/7
• Dedicated diagnostics
• Improved clinical outcomes
• Improved survival rates
• Reduced admission / re-admission rates and

length of stay

Transition care

• Hospital to home team:
• early identification of patients with

complex discharge needs

• co-ordinated planning and follow

through of patients to their home

• transfer of care when stable
• Hospital at home:
• virtual beds or step-down care
• respiratory, care of elderly, palliative care

Case study

Blyth pilot

Whole system approach

Blyth planned care

• High risk / frail elderly / nursing home

programmes of care

• Care led by matron, pharmacist and GP
• Involvement of community specialists as

needed: care of elderly consultant, mental health, palliative care

• Integrated clinical record
• Focus on maintaining health and anticipatory

planning

Blyth planned care - MDT meetings

• Identification - A/E attendance / high users,

recent discharges, multiple medications, clinical opinion

• Streamlining of care, action plan
• Early warning indicators and escalation/

emergency anticipatory plans

• Review at next meeting of actions and results

Patient example

• Lady with severe arthritis - pain and mobility problems
• 72 today!
• Weekly GP attendances, weekly district nurse visits,

monthly hospital clinic attendances

• MDT case review- struggling to manage care / drifting
• Plan of action- specific request to rheumatology

consultant

• Result: streamlined care, education programme,

forward plan including self management, community plan

Blyth - acute visiting

• All patients are initially triaged by telephone
• Many are assessed and managed by telephone
• All patients who need to be seen are allocated to

community matron, pharmacist, social care or GP depending on need - ~40% of visits do not need a GP ~25-30 hour per month of GP time per 8,000 patients saved

• Link to frailty assessment service

Blyth - initial results

• By changing the workforce model we can get

to the sickest patients quicker with the right professional

• Targeting high risk patients more closely is

trending to show fewer urgent contact requests (11% decrease)

• ~40% of visits are not being seen by a GP

(~25-30 hours per month of GP time saved for 8,000 patients)

Blyth - initial results

• Individual patient level: seeing a

reduction in multiple contacts (eg. 18 A/E attendances in six months to three in three months)

• Social isolation is a major issue –

referral to support planners previously not considered

• Large amount of medications

waste / polypharmacy (£15,000 savings in complex patients, £500 per month nursing homes)

How will we know if it is working?

Urgent and emergency care when you need it, in the right place Tools and information that support self management Integrated health and social care supporting complex needs Financial stability ↓ Harm ↓ Population mortality rate ↓ A/E attendances ↓ Acute bed days ↓ Re-admission rate ↑ Patient experience ↑ Workforce satisfaction

Any questions?