Contract Headlines. OPD headlines 07Jan15

Transcription

1 Contract Headlines OPD headlines 07Jan15

2 Contract Headlines Key issues: ENHT PAH Royal Free HUC Acute In Hours Visiting Service (AIHVS)

3 Contract Headlines Updates: Format / frequency for future updates ENHT Development Session example 17Dec14

4 Key issues ENHT: Remedial Action Plan for achievement of A&E Agreed in principle but not yet signed Contract penalty can withhold 2% of monthly income if RAP not agreed Planning to achieve 95% target by 22 nd Feb

5 ENHT: Key issues RTT/A&E/Cancer updates in Performance Exceptions Daily PTL / beds management meeting attended by CCG for next fortnight (from 7Jan)

6 Key issues PAH: Electronic Patient Record system no robust monitoring data since July implementation PAH requested TDA to be removed from National Reporting until 31 st March No PTL / unable to evidence RTT achievement Block contract to be agreed for remainder 2014/15 Block contract possible for 2015/16

7 Key issues Royal Free (BCFH): Longstanding data issues with no National Reporting (UNIFY) since end of 2013 Extensive validation process by Royal Free post 1 st July 2014 takeover of BCFH RTT position by CCG due 19Jan National Reporting expected from April

8 Key issues AIHVS: Capacity to see 75 patients per weekday HUC consistently unable to fill GP rota Capacity now pro-rata d to Localities Suspended service in last 10 days (to 5Jan) Suspended 16 of 21 available weekdays in December

9 Updates Format / frequency for future updates No Commissioner & Performance Workshop Use of Development Sessions ENHT Development Session example 17Dec14

10 East and North Herts NHS Trust 17 th December 2014

11 Current Position Contract Monitoring Activity and Finance Performance Data Quality Service Development Feedback from other Directorates

12 Contract Monitoring Collaborative Commissioning Forums I. Cancer Adult and Paediatric-2 week wait pathway II. Paediatric Orthotic Service III. Autism IV. Cancer Performance Review Quality Review Meeting (QRM) Bi-Monthly Contract Review Meeting (CRM) Monthly Commissioning Information and Performance Group (CIG) Monthly Contract Management Meetings (A&E RAP) EEAST/ENHT/ENHCCG Tripartite Meetings Looked After Children Contract Monitoring Monthly Validations Quarterly (as required) Stroke Performance Review Meeting Monthly

13 Activity and Finance-Month 8 Position MONTH 8 ENHT Plan Actual Variance Trust Report 127,855, ,046,194 (809,153) Adjustments NEL Threshold (8/12 th's) 800,000 (800,000) TPP (3,457,828) 3,457,828 Delayed transfers of Care 98,390 (98,390) Cancer MDT's (32,287) 32,287 Histology/Cytology (78,357) 78,357 Lucentis Injections 0 (318,635) (318,635) 125,185, ,727,559 1,542,294 EL RTT Funding (Identified in SLAM Report) 0 (316,000) (316,000) Total Before Penalties 125,185, ,411,559 1,226,294 N.B. Total submission for EL RTT Funding was 609k -balance of 293k to be confirmed and the other related expenditure to be identified above Penalties/Other Adjustments 18 week Admitted RTT penalty (M1-M3; no penalties to be applied M4-M8) 0 23,184 23, week Non Admitted RTT penalty (M1-M3; no penalties to be applied M4-M8) 0 1,012 1, week Incomplete RTT penalty (M1-M3; no penalties to be applied M4-M8) 0 20,148 20,148 6 week diagnostic wait (penalties to be applied in M2, M3 and M4) 0 35,614 35,614 A&E four hour wait (estimate) 0 231, , week breaches (CCG to be clarified) 0 25,000 25,000 Ambulance to A&E clinical handovers >30 mins (M1-M8; estimate) 0 362, ,440 Ambulance to A&E clinical handovers >60 mins (M1-M8 estimate) 0 274, ,550 Cancer Penalty - 2ww breast symptommatic (quarter 1) 0 8,694 8,694 Cancer Penalty - 31 day subsequent treatment surgery (quarter 1) 0 9,196 9,196 Cancer Penalty- 62 days GP referral to first definitive treatment (quarter 1) 0 35,112 35,112 MRSA penalties (4 cases YTD) 40,000 40,000 Total Penalties M1-M8 0 1,066,680 1,066,680 M8 Position 125,185, ,344, ,614 Penalties FOT (based on M1-M8 position) 0 1,592,332 1,592,332 14/15 FOT (including penalties based on M1-M8 position) 186,906, ,113, ,419

14 Activity and Finance-Exception Reporting Item Issue Action Lucentis (prescription medication for eye injection) SLAMreport Validations Chargingas Day Case as opposed to an OP Procedure Plans incorrectfor Non Elective, DToCand Pathology Outstandingissues relating first and follow up attendance on same day at ENHT within same speciality Raised at CIG; Adjustmentssent to CCG circa 300k to be credited to CCG. Raisedat CIG; now being escalated to CRM Raisedat CIG and CRM; Trust to explain pathways for CCG consideration C2Creferrals Increase in C2C referrals Raisedat CIG; Trust advised not aware of any pathway changes; audit to be undertaken in gynaecology. A&EAudit Critical Care High proportionof activity coded under a resuscitation code (most expensive) in comparison to the national median. Audit undertaken on sample of activity. Audit to be repeated to look at full cohort of A&E activity Detailedinformation not received to understand the number of patients delayed in being transferring back to wards from critical care Requestedaudit to be undertaken at the Trust; Trust asked to be deferred given A&E RAP. CCG agree to defer but needs to be completed by end Jan. Requesteddata from the Trust; data not received and being escalated to CRM on 18 th December unless provided at CIG on 17 th December.

15 Performance-Exception Reporting Item Issue Action Quality of Performance Report Data incorrect or missing from the report. Information not quality checked by the Trust Escalated to CRM innovember 2014; Issues not rectified-to be discussed at CRM on 18 th December A&E 95%four target not being achieved Contract Query Issuedby ENHCCG; Excusing notice sent by ENHT-not accepted; Contract management meeting held and agreed to implement a Remedial Action Plan (RAP). RAP to be agreed. Recommended that deadline set of 18 th December to agree RAP otherwise terms and conditions of contract enforced. Clinical Handovers 15minute clinical handover from EEastto ENHT not being met Tripartite meetings between EEast, ENHT and ENHCCG implemented anda&e RAP includes milestones to reduce the number of delays over 30 minutes by 20% in quarter 4 14/15.

16 Performance-Exception Reporting (cont d) Item Issue Action Stroke Thresholdsfor the 4hour access to the stroke unit and 90% of time spent on the stroke unit not being met Separate stroke performance monitoring meetings established. Awaitingclinical nurse specialist posts to start in January 2015 as it is anticipated that performance will improve from this point. If performance does not improve, a contract query is likely to be implemented Cancelled Operations Two patientshad cancelled operations and not offered binding date within 28 days. Information had not been flagged correctly on performance report Requested information when patientshad been treated and quality of performance report escalated to CRM 18 week RTT performance RTT nationalstandard to be met from 1 st December (Trust has consistently met the Non-Admitted and Incomplete targets) Trust has assured CCG of meeting the required standards. Trust is in process of identifying patients for outsourcing to IS Provider. Cancer Failure of 62 day standard; Trust had not flagged breachesin tumour sites other than Urology. Trajectories for Cancer performance does not yet take into account change in NICE guidance/cancer campaigns RCA Analysis undertaken for all breaches in September by ENHT CancerForum being set up in January 2015

17 Data Quality Improvement Plan- Exception Reporting Item Issue Action CAD Number CAD number not recordedat ENHT Part of RAP; costedimplementation plan to be signed off by endof December A&E Diagnosis Code Code not recorded-to be implemented following roll out of EPR system Part of RAP fortimescales to be agreed for implementation of Diagnosis code

18 Service Development-Exception Reporting Item Issue Action Autism Paediatric Orthotic Service Ahigh number of children awaiting an autism diagnosis. Funding provided in 13/14 to reduce the backlog backlog has not been reduced to required level Concerns regarding service provisionand impact on children who have not received a timely appointment. DischargeSummaries Delayed discharge summaries;new reporting mechanism to raise challenges trialled at Regal Chambers Assurancerequested from the Trust that all patients have received a 6 month review that are on the waiting list. Escalated to Contract Review Meeting and flagged on CCG Risk Register Escalatedto Contract Review Meeting and flagged on CCG Risk Register. Feedback requestedfrom both Regal Chambers and ENHT regarding new challenges process.