Report. Page 113 of 220. NHS South Cheshire CCG and NHS Vale Royal CCG Joint Governing Body. Report To (committee):

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1 Report Report To (committee): Report Title: Agenda No.: South Cheshire CCG and Vale Royal CCG Joint Governing Body Performance Report Meeting Date: Thursday 5 th April 2018 Report Author(s) Name/s Andy Chandler Title/s Associate Director of Provider Performance Date 26 th March 2018 CCG Strategic Priorities (5+1) supported by this paper Transforming Primary Care Transforming Mental Health Transforming Urgent Care Integration Person Centred Care Constitution Targets Outcome Required Approval Assurance Discussion Information Recommendations: South Cheshire CCG Governing Body are asked to: Note the contents of the report and scorecards outlining provider performance against national targets for the month of January 2017 Note the exceptions highlighted and take assurance on the actions being taken to resolve any performance issues Vale Royal CCG Governing Body are asked to: Note the contents of the report and scorecards outlining provider performance against national targets for the month of January 2017 Note the exceptions highlighted and take assurance on the actions being taken to resolve any performance issues Vale Royal Clinical Commissioning Group Page 113 of 220 South Cheshire Clinical Commissioning Group

2 Executive Summary (key points, purpose, outcomes) This paper provides a summary of the key performance activity against the national headline target measures for the Clinical Commissioning Groups and the performance activity of our main acute providers, predominantly Mid Cheshire Hospitals Foundation Trust (MCHfT) for January Summaries are provided on the adverse issues and the agreed action s jointly in development between commissioner and provider which will be monitored at contract meetings. Reviewed by (e.g. committee/team/director) Name (Individual or Group) Date Tracey Shewan 26 th March 2018 Finance implications Funding required? (Please tick. If yes, please complete section A) Yes No Section A Service Title Recurrent ( 000s) Non-Recurrent ( 000s) Included in 17/18 budget? (Please tick. If no, please complete section B) Yes No Section B Proposed source of funding Have the following areas been considered whilst producing this report? Yes N/A Other resource implications (apart from finances covered above) Equality Impact Assessment (EIA) Health Inequalities (JSNA, ISNA) Risks relating to the paper Quality & Safeguarding (6 C s +1, CASE) Stakeholder engagement/involvement (member practices/gp Federations, patients & public, providers etc.) Regulatory, legal, governance & assurance implications Procurement processes Vale Royal Clinical Commissioning Group Page 114 of 220 South Cheshire Clinical Commissioning Group

3 1. A&E There were no patients of either CCG who waited over 12 hours in A&E for admission. The 95% target was not achieved in January with 1,547 out of 7,138 patients waiting longer than 4 hours in A&E. A&E attendances in January saw a rise of 2.5% on the same period last year. This rise was driven by a rise in ambulance arrivals in A&E and a higher acuity of patient. January 2018 saw 25% more majors than the previous year. The STF trajectory of 90.52% was not achieved for the month and performance has been below the national benchmark for the last four months. The A&E delivery remains a key focus of the contract meetings between SCCCG and MCHFT and at the A&E Delivery Board. Additional clinical input is in place which should support in meeting the standard. Primary care streaming is now in place and working well - There is a band 7 at the front door to help stream patients as well as shared staffing to support demand. This is an 8-11 service and ongoing work is underway with Out of Hours to develop further. 2. Ambulance Response Programme (ARP) The CCGs are still awaiting the revised ARP response standards. 3. Referral to Treatment Times (RTT) South Cheshire CCG did not meet the 92% incomplete target for the month with performance at 89.4%. This was mainly due to UHNM where 522 patients did not meet the target and where the performance was only 69%. The CCG is, however, still meeting the target year to date (92.1%). Vale Royal CCG is meeting the target for the month and year to date. There were 3 South Cheshire patients who waited more than 52 weeks in December. 3 x University Hospital of North Midlands for Trauma & Orthopaedic (2) & Neurosurgery (1). There were no Vale Royal patients who waited more than 52 weeks in January. The BI team provides regular reporting and monitoring on RTT waits and the Associate Director for Provider Performance has written to the respective Trusts seeking assurance that patients have now or are being treated and that no adverse harm has been seen due to the delays. 4. Cancer All cancer targets were met for South Cheshire year to date with the exception of patients seen within two weeks for an urgent referral for breast symptoms, where the performance is 56.6% ytd against the 93% target. In total there were 36 breaches out of 47, all of which were at Mid Cheshire Hospital Foundation Trust. This was due to capacity issue as MCHFT had 2 breast radiologists retire just before Christmas. Vale Royal Clinical Commissioning Group Page 115 of 220 South Cheshire Clinical Commissioning Group

4 All cancer targets were met for Vale Royal year to date with the exception of patients seen within two weeks for an urgent referral for breast symptoms, where the performance is 85.1% ytd against the 93% target. In total there were 7 breaches, 6 of which were at Mid Cheshire Hospital Foundation Trust. 5. Diagnostics South Cheshire did not hit the target in January with performance at 1.33% (although they are hitting the target year to date at 0.73%), the first time this financial year where the target has not been attained. 37 out of 2,790 patients breached the target in January, which was 9 over the target. Mid Cheshire x 12 (Endoscopy x 2 / Imaging x 10), Aintree x1 (Endoscopy x 1), Salford x 2 (Imaging x 2), Countess x 1 (Endoscopy x 1), East Cheshire x 2 (Endoscopy x 1 / Audiology x 1), Manchester University Hospital x 5 (Endoscopy x 4 / Imaging x1), Manchester Surgical Services x 6 (Endoscopy x 6) and Industrial Diagnostics Company x 8 (Audiology x 8). Vale Royal did not hit the target in January with performance at 1.10% (although they are hitting the target year to date at 0.84%). 17 out of 1,547 patients breached the target in January, which was 2 over the target. Mid Cheshire x 4 (Endoscopy x 1 / Imaging x 3), Aintree x1 (Imaging x 1), Salford x 1 (Imaging x 1), Countess x 3 (Endoscopy x 1 / Imaging x 2), East Cheshire x 1 (Endoscopy x 1), Manchester University Hospital x 1 (Imaging x1), Royal Liverpool x 2 (Endoscopy x 2) and Industrial Diagnostics Company x 4 (Audiology 4). Both CCGs are hitting the target year to date. 6. IAPT The 1.42% target was not achieved in South Cheshire in January with 222 out of the estimated 17,760 population with depression / anxiety receiving psychological therapies. The year to date performance is also off trajectory with delivery at 10.6% against the target of 14.2%. The 1.42% target was not achieved in Vale Royal in January with 185 out of the estimated 10,345 population with depression / anxiety receiving psychological therapies. The year to date performance is slightly off trajectory with delivery at 13.0% against the target of 14.2%. The Action Plan is updated monthly and monitored by the CCGs. Regular meetings take place between the CCGs and the service managers. Monthly returns to England to monitor IAPT performance and regular meetings with CWP IAPT team continue. Proposed investment for has been agreed, with a focus on CYP and Adult Mental Health. The investment is intended to increase activity and capacity within the team to meet targets consistently from April 2018 once recruitment has been achieved. 7. Dementia Action to recover position: With respect to dementia diagnosis rates, work is continuing in regards to coding issues within primary care. Diagnosis rates are now just falling short of the national average. There is a focused piece of work being undertaken in Vale Royal which will be replicated in South Cheshire and there is also some work in respect of coding within nursing homes underway within Vale Royal which we will Vale Royal Clinical Commissioning Group Page 116 of 220 South Cheshire Clinical Commissioning Group

5 seek to replicate if the impact on the dementia diagnosis rates is a positive one. The CCGs are also currently working with Vale Royal practice managers in respect of QOF coding, as there is potential for a cohort of patients from this review to be added to the dementia register. Overall, the CCGs continue to work with the GP practices in exploring other areas in terms of potential coding issues in order to ensure that we are working towards an upward trajectory for dementia diagnosis; with the overall aim to maintain and exceed the national ambition of 66.7% In January 2017 the diagnosis rates for South Cheshire and Vale Royal were 66.6% and 65.0% respectively, this equates to approximately 3 people to reach the target in South and 21 people to reach the target in Vale. Next steps: Continue to offer intensive support to those practices who fall beneath the 66.7% diagnosis threshold Explore common themes identified as a result of the coding exercise, for example support in following procedures for patients who have been referred for investigation. Exploring potential for pathway redesign to support a shift in emphasis to greater primary and acute care support CCGs to operationalise previous findings of QOF coding exercises. 8. Referrals Total referrals for South Cheshire are 2% year to date under 2016/17 figures, although October, November & January were over by 6%, 4% & 10% respectively. GP referrals are 6% under the previous year but there was a 9% increase in January which is reversing the trend in the first half of the year. Vale Royal have seen similar performance with total referrals being 3% under 2016/17 but with October, November & January being over by 7%, 2% & 11% respectively. The CCG has also seen increases in GP referrals, October (8%), November (3%) & January (8%), although its 5% below year to date. Actions are being taken to ensure all referrals are appropriate including advice & guidance and peer review. Vale Royal Clinical Commissioning Group Page 117 of 220 South Cheshire Clinical Commissioning Group

6 Appendix 1 CCG performance scorecard - South Cheshire CCG Reporting period: January Planned care Incomplete pathways patients still waiting to start treatment at the end of the month No. of incomplete RTT pathways where patients have waited > 52 weeks Level Freq. const Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Q1 Q2 Q3 Q4 1.1 CCG Mthly E.B.3 92% 93.4% 93.6% 93.3% 93.0% 92.4% 92.1% 92.8% 92.2% 92.2% 90.0% 89.4% 92.1% 1.2 CCG Mthly E.B.S Comments Source No. of completed admitted RTT pathways 1.3 CCG Mthly E.M.18 TBC 13, ,137 1,073 1,058 1,095 1,045 1,124 1, ,063 10,444 No. of completed non-admitted RTT pathways 1.4 CCG Mthly E.M.19 TBC 40,469 2,922 3,582 3,413 3,147 3,132 3,451 3,685 3,455 2,805 3,462 33,054 % of patients waiting > 6 weeks for a diagnostic test Emergency care A&E performance % of patients who spend < 4 hours in A&E No. of patients who have waited > 12 hours in A&E from decision to admit to admission Ambulance response times % of Category A (Red 1) incidents which resulted in an emergency response within 8 minutes % of Category A (Red 2) incidents which resulted in an emergency response within 8 minutes % of Category A incidents which resulted in an emergency response within 19 minutes Ambulance delays % of ambulance handover delays > 30 minutes % of ambulance handover delays > 60 minutes % of ambulance crew clear delays > 30 minutes % of ambulance crew clear delays > 60 minutes Activity A&E attendances No. of A&E attendances No. of A&E attendances (excluding ned follow-up attendances) Referrals Total referrals for a 1st OP appointment (all specialties) GP written referrals for a 1st OP appointment (G&A) Other referrals for a 1st OP appointment (G&A) Total referrals for a 1st OP appointment (G&A) Outpatient Consultant-led first OP attendances (total activity) 1.5 CCG Mthly E.B.4 <1% 0.6% 0.3% 0.5% 0.9% 0.8% 0.7% 0.4% 0.7% 0.9% 0.9% 1.3% 0.7% 2.1 MCHFT Mthly E.B % 93.4% 90.7% 94.2% 92.6% 95.3% 94.0% 88.3% 88.0% 74.2% 78.3% 88.9% 2.2 MCHFT Mthly E.B.S CCG Mthly E.B.15.i 75% 70.6% 64.4% 57.7% 73.8% 67.6% 2.4 CCG Mthly E.B.15.ii 75% 69.8% 70.8% 71.9% 69.3% 69.3% 2.5 CCG Mthly E.B.16 95% 95.0% 95.7% 94.7% 95.1% 96.4% 2.6 MCHFT Mthly E.B.S.7a 95% 99.0% 99.2% 98.6% 98.9% 99.1% 98.6% 98.7% 98.7% 97.7% 97.7% 94.9% 98.1% 2.7 MCHFT Mthly E.B.S.7b 100% 100.0% 99.9% 100.0% 100.0% 100.0% 99.9% 100.0% 100.0% 99.9% 99.9% 99.3% 99.9% 2.8 MCHFT Mthly E.B.S.8a TBC 98.6% 99.1% 99.1% 98.5% 98.7% 98.2% 99.1% 99.0% 98.8% 99.4% 99.2% 98.9% 2.9 MCHFT Mthly E.B.S.8b TBC 99.9% 99.9% 99.9% 99.9% 99.9% 99.9% 100.0% 100.0% 100.0% 99.9% 100.0% 99.9% 3.1 CCG Mthly E.M.6 46,565 4,044 4,579 4,253 4,303 4,020 4,017 4,348 4,222 4,485 4,214 42, CCG Mthly E.M.12 46,388 4,032 4,563 4,233 4,292 3,999 3,998 4,336 4,209 4,474 4,205 42, CCG Qtrly E.M.1 66,181 14,707 15,339 14,954 45,000 QAR 3.4a CCG Mthly E.M.7a 3.4b CCG Mthly E.M.7b 3.4c CCG Mthly E.M.7 44,298 3,083 3,308 3,715 3,571 3,671 3,510 3,790 3,720 2,814 3,805 34,987 MAR 16,803 1,351 1,547 1,532 1,386 1,531 1,414 1,640 1,611 1,229 1,611 14,852 MAR 61,101 4,434 4,855 5,247 4,957 5,202 4,924 5,430 5,331 4,043 5,416 49,839 MAR 3.5 CCG Mthly E.M.2 62,896 4,338 5,088 5,065 4,869 5,003 5,206 5,320 5,416 4,361 5,055 49, % 70.4% 95.4% NWAS reports NWAS reports Page 118 of 220

7 CCG performance scorecard - South Cheshire CCG Reporting period: January Level Freq. const Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Comments Source Q1 Q2 Q3 Q4 Consultant-led first OP attendances (specific acute) Consultant Led Follow-Up Outpatient Attendances (total activity) Consultant Led Follow-Up Outpatient Attendances (specific acute) Inpatient Elective Spells (total activity) 3.6 CCG Mthly E.M.8 61,086 4,191 4,947 4,925 4,735 4,828 5,048 5,144 5,239 4,269 4,950 48, CCG Mthly E.M.3 133,208 9,761 11,547 11,142 10,665 10,531 10,833 11,678 11,638 8,992 11, , CCG Mthly E.M.9 121,106 8,941 10,511 10,077 9,705 9,463 9,860 10,471 10,454 8,179 10,532 98, CCG Mthly E.M.4 26,153 1,895 2,332 2,312 2,258 2,275 2,205 2,277 2,226 1,803 2,214 21,797 Elective Spells (specific acute) 3.10 CCG Mthly E.M.10 26,150 1,895 2,332 2,312 2,258 2,275 2,205 2,277 2,225 1,802 2,214 21,795 Non-Elective Spells (total activity) 3.11 CCG Mthly E.M.5 27,436 2,323 2,636 2,362 2,472 2,261 2,362 2,498 2,438 2,409 2,667 24,428 Non-Elective Spells (specific acute) 3.12 CCG Mthly E.M.11 22,886 1,903 2,195 1,937 2,032 1,860 1,895 2,075 2,055 1,987 2,275 20,214 Elective Beddays (total activity) 3.16 CCG Mthly 35,965 3,061 3,113 3,190 3,201 2,945 2,966 3,124 3,094 2,416 2,712 29,822 Elective Beddays (specific acute) 3.17 CCG Mthly 35,931 3,061 3,113 3,190 3,201 2,945 2,966 3,124 3,087 2,414 2,712 29,813 Non-Elective Beddays (total activity) 3.18 CCG Mthly 128,992 11,065 12,200 10,795 11,450 9,728 10,327 10,462 10,361 11,092 13, ,779 Non-Elective Beddays (specific acute) 3.19 CCG Mthly 120,145 10,271 11,387 9,989 10,576 8,939 9,344 9,585 9,593 10,241 12, ,434 Total Beddays (total activity) Total Beddays (specific acute) Diagnostic tests No. of Endoscopy diagnostic tests No. of diagnostic tests (excluding Endoscopy) No. of diagnostic tests Cancer waiting times Cancer two week waits % of patients seen within 2 weeks of urgent GP referral for suspected cancer No. of patients seen following an urgent GP referral for suspected cancer % of patients seen within 2 weeks of urgent referral for breast symptoms Cancer 31 day waits % of patients receiving 1st definitive treatment within one month (31 days) of a cancer diagnosis % of patients receiving subsequent treatment for cancer within 31 days (Surgery) % of patients receiving subsequent treatment for cancer within 31 days (Drug therapy) % of patients receiving subsequent treatment for cancer within 31 days (Radiotherapy) Cancer 62 day waits 3.20 CCG Mthly 164,957 14,126 15,313 13,985 14,651 12,673 13,293 13,586 13,455 13,508 16, , CCG Mthly E.J.3 156,076 13,332 14,500 13,179 13,777 11,884 12,310 12,709 12,680 12,655 15, , CCG Mthly E.M.13 7, , CCG Mthly E.M.14 84,645 6,433 7,078 6,552 6,456 5,964 5,574 6,067 6,120 5,293 5,996 61, CCG Mthly E.M.15 92,281 7,058 7,805 7,248 7,145 6,595 6,227 6,765 6,795 5,764 6,640 68, CCG Mthly E.B.6 93% 97.9% 97.1% 97.7% 97.1% 97.1% 96.9% 96.7% 97.8% 98.3% 96.8% 95.4% 97.1% 5.2 CCG Mthly E.M.16 5, , CCG Mthly E.B.7 93% 97.1% 98.1% 100.0% 93.2% 96.8% 96.6% 100.0% 95.9% 94.1% 91.8% 56.6% 90.3% 5.4 CCG Mthly E.B.8 96% 99.0% 100.0% 98.9% 100.0% 100.0% 97.0% 98.3% 100.0% 98.9% 100.0% 97.4% 99.1% 5.5 CCG Mthly E.B.9 94% 98.6% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 5.6 CCG Mthly E.B.10 98% 100.0% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 5.7 CCG Mthly E.B.11 94% 98.5% 100% 100% 100% 100% 100% 100% 100% 96% 94% 97% 99% Open Exeter Open Exeter Page 119 of 220

8 CCG performance scorecard - South Cheshire CCG Reporting period: January Level Freq. const Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Q1 Q2 Q3 Q4 Comments Source % of patients receiving 1st definitive treatment within two months (62 days) of an urgent GP referral 5.8 CCG Mthly E.B.12 85% 88.7% 95.6% 90.9% 95.1% 90.5% 95.4% 91.4% 93.0% 90.9% 97.7% 90.0% 93.1% No. of patients receiving 1st definitive treatment following an urgent GP referral 5.9 CCG Mthly E.M % of patients receiving 1st definitive treatment within 62 days of a Screening Service referral 5.10 CCG Mthly E.B.13 90% 100% 100% 100% 100% 100% 100% 50% 100% 91% 100% 100% 95% % of patients receiving 1st definitive treatment within 62 days of a Consultant upgrade 5.11 CCG Mthly E.B.14 n/a 90.7% 100.0% 88.9% 100.0% 83.3% 83.3% 90.0% 87.5% 82.4% 87.5% 88.2% 88.8% Other Constitution measures Mixed Sex Accomodation No. of MSA breaches 6.1 CCG Mthly E.B.S HCAI No. of MRSA cases No. of C Difficile cases Cancelled operations % of operations cancelled for non-clinical reasons, with a new date offered within 28 days No. of urgent operations cancelled for non-clinical reasons or the 2nd time Mental health IAPT % of people who have depression/anxiety who receive psychological therapies % of people who complete treatment who are moving to recovery % of people that wait 6 weeks or less from referral to entering a course of treatment (finished course) % of people that wait 18 weeks or less from referral to entering a course of treatment (finished course) Psychosis % of people experiencing a first episode of psychosis treated within two weeks of referral CPA % of patients on CPA discharged from inpatient care who are followed up within 7 days Dementia Estimated diagnosis rate for people with dementia Better Care Fund Delayed transfers of care per 100,000 population Transforming care No. of patients with a learning disability and/or autistic spectrum disorder in IP care for mental health needs No. of inpatients with a learning disability and/or autistic spectrum disorder reviewed in last 26 wks % of people with a learning disability on the GP register receiving an annual health check Readmissions Emergency Re-admissions - % within 30 days of discharge from hospital 6.2 CCG Mthly E.A.S CCG Mthly E.A.S MCHFT Qtrly E.B.S.2 0% 9.1% 6.9% 7.8% 4.1% 18.8% 6.5 MCHFT Mthly E.B.S CWP Mthly E.A.3 17% 13.0% 1.0% 1.1% 1.0% 1.2% 1.4% 0.7% 1.0% 1.1% 0.9% 1.3% 1.1% 7.2 CWP Mthly E.A.S.2 50% 58.1% 63.3% 63.9% 52.2% 59.7% 61.4% 49.2% 56.8% 48.1% 66.7% 40.2% 56.1% 7.3 CWP Mthly E.H.1_A1 75% 90.5% 85.0% 85.1% 81.1% 87.0% 96.0% 94.9% 95.6% 87.4% 97.4% 90.3% 90.6% 7.4 CWP Mthly E.H.1_A2 95% 99.2% 100.0% 100.0% 95.9% 100.0% 100.0% 98.3% 98.9% 100.0% 100.0% 100.0% 99.4% 1.42% per month; 4.2% per quarter 7.9 CCG Mthly E.H.4 50% 78% 100% 100% 100% 0% 100% 100% 67% 75% 100% 100% 82% 7.10 CCG Qtrly E.B.S.3 95% 99.4% 100.0% 100.0% 92.3% 97.4% 7.11 CCG Mthly E.A.S.1 67% 62.4% 66.3% 65.7% 66.2% 66.4% 66.3% 65.9% 66.6% 67.2% 66.3% 66.6% 66.3% Published data HSCIC 4.1 MCHFT Mthly E.J.1 TBC 5, , CCG Qtrly E.K.1 To reduce CCG Qtrly E.K.6 100% 100% 100% 100% 100% 8.3 CCG Annual E.K.7 Helping people recover following episodes of ill health or injury To improve 9.1a CCG Mthly TBC 17.1% 16.8% 16.9% 16.4% 18.4% 16.5% 17.9% 16.9% 16.0% 17.3% 19.3% 17.2% 57% 1617 data Open Exeter HCAI website CWP reports CCG US Page 120 of 220

9 CCG performance scorecard - South Cheshire CCG Reporting period: January Level Freq. const Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Q1 Q2 Q3 Q4 Comments Source Emergency Re-admissions - % within 30 days of discharge CCG - 9.1b from hospital (MCHFT) MCHFT Mthly TBC 17.3% 17.6% 17.3% 16.5% 18.8% 16.8% 18.3% 17.2% 16.3% 17.6% 19.6% 17.6% Emergency admissions Chronic Ambulatory Care Sensitive Conditions (rate of emergency admissions per 100,000) 9.2i CCG Mthly TBC 2, ,522 Asthma, Diabetes & Epilepsy in under 19s (rate of emergency admissions per 100,000) 9.3i CCG Mthly TBC 1, Acute Conditions that should not usually require hospital admission (rate of emergency adms per 100,000) 9.4i CCG Mthly TBC 4, ,668 Children with Lower Respiratory Tract Infections (LRTI) (rate of emergency admissions per 100,000) 9.5i CCG Mthly TBC 1, ,391 Emergency Admissions - Composite measure (rate of emergency admissions per 100,000) 9.6i CCG Mthly TBC 7, ,464 Preventing people from dying prematurely Other measures Maternal smoking at time of delivery Patient experience Friends and Family Test Friends and Family Test - A&E Friends and Family Test - IP Friends and Family Test - OP Friends and Family Test - Maternity combined Friends and Family Test - Community combined Friends and Family Test - Mental Health combined Friends and Family Test - Ambulance PTS Friends and Family Test - Ambulance SAT Friends and Family Test - Staff (care) Friends and Family Test - Staff (work) Better health Other measures Use of e-referral service to enable choice at 1st routine elective referral CCG Qtrly 15% 14.5% 16.9% 16.8% 14.6% 16.8% 11.1 MCHFT Mthly 94.5% 94.1% 92.5% 94.0% 90.8% 89.5% 89.4% 93.1% 91.0% 90.8% 83.8% 93.6% Published data 11.2 MCHFT Mthly 98.1% 95.6% 98.2% 98.3% 97.7% 98.8% 98.0% 97.9% 0.0% 98.6% 97.0% 97.2% Published data 11.3 MCHFT Mthly 95.1% 95.1% 95.4% 94.3% 94.9% 95.7% 96.1% 96.2% 95.7% 94.6% 96.6% 95.5% Published data 11.4 MCHFT Mthly 95.6% 98.6% 97.9% 99.1% 97.6% 96.8% 93.0% 97.0% No data 81.8% 97.7% 98.5% Published data 11.5 ECT Mthly 90.4% 91.8% 92.4% 94.1% 91.9% 92.6% 91.4% 92.1% 95.1% 92.9% 95.1% 93.2% Published data 11.6 CWP Mthly 61.8% 86.0% 89.3% 88.7% 87.7% 88.6% 84.8% 87.9% 91.1% 93.8% 94.3% 89.3% Published data 11.7a NWAS Mthly 94.8% 95.1% 94.0% 96.2% 94.9% 94.9% 93.8% 93.0% 93.6% 93.6% 95.0% 94.4% Published data 11.7b NWAS Mthly 86.1% 87.5% 75.0% 100.0% 90.0% 100.0% 79.2% 89.3% 80.6% 62.8% 60.7% 79.5% Published data 11.8a MCHFT Qtrly 85.7% 93.7% 88.1% FFT Survey for Staff is not carried out 90.7% Published data 11.8b MCHFT Qtrly 73.2% 79.4% 69.2% for Quarter % Published data 13.5 CCG Mthly 80% 39% 65% 62% 69% 71% 68% 70% 72% 68% 68% 68% Published data HSCIC SU Provider reports Eng Page 121 of 220

10 Appendix 2 CCG performance scorecard - Vale Royal CCG Reporting period: January Planned care Incomplete pathways patients still waiting to start treatment at the end of the month No. of incomplete RTT pathways where patients have waited > 52 weeks Level Freq. const Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Q1 Q2 Q3 Q4 1.1 CCG Mthly E.B.3 92% 93.8% 94.8% 95.0% 95.0% 94.4% 94.1% 94.7% 93.8% 94.2% 93.1% 92.6% 94.1% 1.2 CCG Mthly E.B.S Comments Source No. of completed admitted RTT pathways 1.3 CCG Mthly E.M.18 TBC 7, ,832 No. of completed non-admitted RTT pathways 1.4 CCG Mthly E.M.19 TBC 23,512 1,607 1,968 1,870 1,661 1,802 1,917 2,053 1,978 1,661 1,998 18,515 % of patients waiting > 6 weeks for a diagnostic test Emergency care A&E performance % of patients who spend < 4 hours in A&E No. of patients who have waited > 12 hours in A&E from decision to admit to admission Ambulance response times % of Category A (Red 1) incidents which resulted in an emergency response within 8 minutes % of Category A (Red 2) incidents which resulted in an emergency response within 8 minutes % of Category A incidents which resulted in an emergency response within 19 minutes Ambulance delays % of ambulance handover delays > 30 minutes % of ambulance handover delays > 60 minutes % of ambulance crew clear delays > 30 minutes % of ambulance crew clear delays > 60 minutes Activity A&E attendances No. of A&E attendances No. of A&E attendances (excluding ned follow-up attendances) Referrals Total referrals for a 1st OP appointment (all specialties) GP written referrals for a 1st OP appointment (G&A) Other referrals for a 1st OP appointment (G&A) Total referrals for a 1st OP appointment (G&A) Outpatient Consultant-led first OP attendances (total activity) 1.5 CCG Mthly E.B.4 <1% 0.7% 0.2% 0.4% 0.6% 1.4% 1.1% 1.1% 0.6% 0.8% 1.1% 1.1% 0.8% 2.1 MCHFT Mthly E.B % 93.4% 90.7% 94.2% 92.6% 95.3% 94.0% 88.3% 88.0% 74.2% 78.3% 88.9% 2.2 MCHFT Mthly E.B.S CCG Mthly E.B.15.i 75% 61.5% 58.6% 66.7% 56.8% 64.3% 2.4 CCG Mthly E.B.15.ii 75% 63.9% 68.0% 65.0% 62.3% 66.5% 2.5 CCG Mthly E.B.16 95% 94.4% 94.8% 93.2% 95.3% 95.2% 2.6 MCHFT Mthly E.B.S.7a 95% 99.0% 99.2% 98.6% 98.9% 99.1% 98.6% 98.7% 98.7% 97.7% 97.7% 94.9% 98.1% 2.7 MCHFT Mthly E.B.S.7b 100% 100.0% 99.9% 100.0% 100.0% 100.0% 99.9% 100.0% 100.0% 99.9% 99.9% 99.3% 99.9% 2.8 MCHFT Mthly E.B.S.8a TBC 98.6% 99.1% 99.1% 98.5% 98.7% 98.2% 99.1% 99.0% 98.8% 99.4% 99.2% 98.9% 2.9 MCHFT Mthly E.B.S.8b TBC 99.9% 99.9% 99.9% 99.9% 99.9% 99.9% 100.0% 100.0% 100.0% 99.9% 100.0% 99.9% 3.1 CCG Mthly E.M.6 35,128 3,005 3,269 3,289 3,295 2,930 2,929 3,087 2,901 2,919 2,975 30, CCG Mthly E.M.12 34,451 2,927 3,193 3,230 3,223 2,877 2,874 3,012 2,826 2,862 2,888 29, CCG Qtrly E.M.1 TBC 36,796 7,705 8,310 8,187 24,202 QAR 3.4a CCG Mthly E.M.7a 3.4b CCG Mthly E.M.7b 3.4c CCG Mthly E.M.7 24,522 1,637 1,832 1,947 1,942 2,024 2,052 2,141 2,117 1,655 2,194 19,541 MAR 9, ,538 MAR 33,593 2,308 2,607 2,760 2,675 2,792 2,756 2,928 2,911 2,329 3,013 27,079 MAR 3.5 CCG Mthly E.M.2 36,347 2,531 2,855 2,891 2,678 2,849 2,896 3,160 3,044 2,559 2,998 28, % 65.4% 94.7% NWAS reports NWAS reports Page 122 of 220

11 CCG performance scorecard - Vale Royal CCG Reporting period: January Consultant-led first OP attendances (specific acute) Consultant Led Follow-Up Outpatient Attendances (total activity) Consultant Led Follow-Up Outpatient Attendances (specific acute) Level Freq. const. 3.6 CCG Mthly E.M Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Q1 Q2 Q3 Q4 34,859 2,437 2,765 2,806 2,602 2,727 2,782 3,020 2,913 2,483 2,908 27, CCG Mthly E.M.3 79,292 5,964 6,644 6,415 6,140 6,270 6,282 6,776 7,060 5,182 6,557 63, CCG Mthly E.M.9 71,116 5,374 6,012 5,797 5,526 5,666 5,728 6,127 6,328 4,621 5,997 57,176 Comments Source Inpatient Elective Spells (total activity) 3.9 CCG Mthly E.M.4 14,890 1,029 1,190 1,232 1,155 1,160 1,199 1,228 1, ,146 11,530 Elective Spells (specific acute) Non-Elective Spells (total activity) 3.10 CCG Mthly E.M.10 14,887 1,029 1,190 1,232 1,155 1,160 1,199 1,228 1, ,146 11, CCG Mthly E.M.5 15,321 1,255 1,309 1,273 1,287 1,275 1,277 1,346 1,366 1,272 1,395 13,055 Non-Elective Spells (specific acute) 3.12 CCG Mthly E.M.11 12,506 1,045 1,085 1,046 1,019 1,023 1,040 1,086 1,111 1,054 1,172 10,681 Elective Beddays (total activity) 3.16 CCG Mthly 20,995 1,383 1,648 1,665 1,726 1,908 1,518 1,773 1,964 1,369 1,471 16,425 Elective Beddays (specific acute) 3.17 CCG Mthly 20,985 1,383 1,648 1,665 1,726 1,908 1,518 1,773 1,959 1,369 1,471 16,420 Non-Elective Beddays (total activity) 3.18 CCG Mthly 69,723 5,835 5,678 5,621 5,329 5,403 5,308 5,850 5,725 5,622 6,894 57,265 Non-Elective Beddays (specific acute) 3.19 CCG Mthly 64,095 5,451 5,257 5,226 4,843 4,895 4,791 5,384 5,268 5,172 6,449 52,736 Total Beddays (total activity) Total Beddays (specific acute) Diagnostic tests No. of Endoscopy diagnostic tests No. of diagnostic tests (excluding Endoscopy) No. of diagnostic tests Cancer waiting times Cancer two week waits % of patients seen within 2 weeks of urgent GP referral for suspected cancer No. of patients seen following an urgent GP referral for suspected cancer % of patients seen within 2 weeks of urgent referral for breast symptoms Cancer 31 day waits % of patients receiving 1st definitive treatment within one month (31 days) of a cancer diagnosis % of patients receiving subsequent treatment for cancer within 31 days (Surgery) % of patients receiving subsequent treatment for cancer within 31 days (Drug therapy) % of patients receiving subsequent treatment for cancer within 31 days (Radiotherapy) Cancer 62 day waits 3.20 CCG Mthly 90,718 7,218 7,326 7,286 7,055 7,311 6,826 7,623 7,689 6,991 8,365 73, CCG Mthly E.J.3 85,080 6,834 6,905 6,891 6,569 6,803 6,309 7,157 7,227 6,541 7,920 69, CCG Mthly E.M.13 3, , CCG Mthly E.M.14 44,731 3,283 3,544 3,588 3,303 3,347 3,219 3,148 3,233 2,853 3,379 32, CCG Mthly E.M.15 48,450 3,559 3,854 3,880 3,592 3,636 3,501 3,462 3,516 3,086 3,648 35, CCG Mthly E.B.6 93% 98.4% 97.0% 98.3% 97.5% 97.8% 98.6% 96.8% 96.8% 98.4% 94.3% 94.6% 97.1% 5.2 CCG Mthly E.M.16 2, , CCG Mthly E.B.7 93% 98.0% 90.0% 93.9% 85.4% 95.1% 94.1% 100.0% 95.6% 92.9% 85.1% 68.1% 89.8% 5.4 CCG Mthly E.B.8 96% 98.6% 100.0% 100.0% 100.0% 97.5% 97.9% 100.0% 100.0% 100.0% 97.0% 96.4% 98.8% 5.5 CCG Mthly E.B.9 94% 96.6% 100% 100% 80% 100% 100% 80% 100% 100% 100% 100% 95% 5.6 CCG Mthly E.B.10 98% 98.7% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 5.7 CCG Mthly E.B.11 94% 97.6% 100% 100% 100% 100% 100% 95% 100% 100% 100% 100% 99% Open Exeter Open Exeter Page 123 of 220

12 CCG performance scorecard - Vale Royal CCG Reporting period: January % of patients receiving 1st definitive treatment within two months (62 days) of an urgent GP referral No. of patients receiving 1st definitive treatment following an urgent GP referral % of patients receiving 1st definitive treatment within 62 days of a Screening Service referral % of patients receiving 1st definitive treatment within 62 days of a Consultant upgrade Other Constitution measures Mixed Sex Accomodation No. of MSA breaches HCAI No. of MRSA cases No. of C Difficile cases Cancelled operations % of operations cancelled for non-clinical reasons, with a new date offered within 28 days No. of urgent operations cancelled for non-clinical reasons or the 2nd time Mental health IAPT % of people who have depression/anxiety who receive psychological therapies % of people who complete treatment who are moving to recovery % of people that wait 6 weeks or less from referral to entering a course of treatment (finished course) % of people that wait 18 weeks or less from referral to entering a course of treatment (finished course) Psychosis % of people experiencing a first episode of psychosis treated within two weeks of referral CPA % of patients on CPA discharged from inpatient care who are followed up within 7 days Dementia Estimated diagnosis rate for people with dementia Better Care Fund Delayed transfers of care per 100,000 population Transforming care No. of patients with a learning disability and/or autistic spectrum disorder in IP care for mental health needs No. of inpatients with a learning disability and/or autistic spectrum disorder reviewed in last 26 wks % of people with a learning disability on the GP register receiving an annual health check Level Freq. const Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Q1 Q2 Q3 Q4 5.8 CCG Mthly E.B.12 85% 91.7% 96.0% 95.8% 92.9% 85.7% 92.3% 81.3% 93.9% 100.0% 90.0% 73.1% 90.1% 5.9 CCG Mthly E.M CCG Mthly E.B.13 90% 89% 100% 100% 100% 100% 100% 100% 50% 100% 100% 100% 97.9% 5.11 CCG Mthly E.B.14 n/a 88.3% 80.0% 100.0% 88.9% 83.3% 80.0% 87.5% 88.9% 100.0% 83.3% 91.7% 88.5% Comments 6.1 CCG Mthly E.B.S CCG Mthly E.A.S CCG Mthly E.A.S MCHFT Qtrly E.B.S.2 0% 9.1% 6.9% 7.8% 4.1% 18.8% 6.5 MCHFT Mthly E.B.S CWP Mthly E.A.3 17% 16.0% 1.2% 1.2% 1.7% 1.4% 1.5% 1.0% 1.6% 1.4% 1.0% 1.1% 1.3% 7.2 CWP Mthly E.A.S.2 50% 51.6% 54.2% 52.5% 55.4% 50.0% 55.7% 46.9% 52.2% 50.0% 51.0% 44.4% 51.1% 7.3 CWP Mthly E.H.1_A1 75% 93.0% 85.4% 77.0% 84.9% 85.5% 90.0% 74.5% 76.9% 86.0% 81.8% 74.7% 81.5% 7.4 CWP Mthly E.H.1_A2 95% 99.4% 100.0% 98.4% 98.6% 98.2% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 99.5% 1.42% per month; 4.2% per quarter 7.9 CCG Mthly E.H.4 50% 88% 100% 100% 100% 100% 100% 100% 67% 0% 0% 50% 67% 7.10 CCG Qtrly E.B.S.3 95% 97.7% 100.0% 95.8% 94.1% 97.1% 7.11 CCG Mthly E.A.S.1 67% 59.4% 62.7% 62.2% 61.9% 62.1% 61.7% 62.0% 65.2% 64.7% 64.6% 65.0% 63.2% Published data HSCIC 4.1 MCHFT Mthly E.J.1 TBC 5, , CCG Qtrly E.K.1 To reduce CCG Qtrly E.K.6 100% 100% 100% 100% 100% 8.3 CCG Annual E.K.7 Helping people recover following episodes of ill health or injury Readmissions Emergency Re-admissions - % within 30 days of discharge from hospital To improve 9.1a CCG Mthly TBC 16.2% 15.2% 13.1% 14.4% 19.1% 16.5% 15.9% 16.0% 16.6% 17.3% 17.6% 16.1% 74.8% 1617 Data Source Open Exeter HCAI website CWP reports CCG US Page 124 of 220

13 CCG performance scorecard - Vale Royal CCG Reporting period: January Emergency Re-admissions - % within 30 days of discharge from hospital (MCHFT) Emergency admissions Chronic Ambulatory Care Sensitive Conditions (rate of emergency admissions per 100,000) Asthma, Diabetes & Epilepsy in under 19s (rate of emergency admissions per 100,000) Acute Conditions that should not usually require hospital admission (rate of emergency adms per 100,000) Children with Lower Respiratory Tract Infections (LRTI) (rate of emergency admissions per 100,000) Emergency Admissions - Composite measure (rate of emergency admissions per 100,000) Preventing people from dying prematurely Other measures 9.1b Level CCG - MCHFT Freq. const Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Q1 Q2 Q3 Q4 Mthly TBC 16.8% 16.2% 13.5% 15.1% 19.8% 17.2% 16.4% 16.7% 17.0% 17.9% 18.0% 16.7% 9.2i CCG Mthly TBC 2, , i CCG Mthly TBC 1, , i CCG Mthly TBC 4, , i CCG Mthly TBC 1, , i CCG Mthly TBC 7, ,878 Maternal smoking at time of delivery CCG Qtrly 15% 16.8% 14.8% 20.3% 13.8% 20.3% Patient experience Friends and Family Test Friends and Family Test - A&E Friends and Family Test - IP Friends and Family Test - OP Friends and Family Test - Maternity combined Friends and Family Test - Community combined Friends and Family Test - Mental Health combined Friends and Family Test - Ambulance PTS Friends and Family Test - Ambulance SAT Friends and Family Test - Staff (care) Friends and Family Test - Staff (work) Better health Other measures Use of e-referral service to enable choice at 1st routine elective referral Comments 11.1 MCHFT Mthly 94.5% 94.1% 92.5% 94.0% 90.8% 89.5% 89.4% 93.1% 91.0% 90.8% 83.8% 93.6% Published data 11.2 MCHFT Mthly 98.1% 95.6% 98.2% 98.3% 97.7% 98.8% 98.0% 97.9% 0.0% 98.6% 97.0% 97.2% Published data 11.3 MCHFT Mthly 95.1% 95.1% 95.4% 94.3% 94.9% 95.7% 96.1% 96.2% 95.7% 94.6% 96.6% 95.5% Published data 11.4 MCHFT Mthly 95.6% 98.6% 97.9% 99.1% 97.6% 96.8% 93.0% 97.0% No data 81.8% 97.7% 98.5% Published data 11.5 ECT Mthly 90.4% 91.8% 92.4% 94.1% 91.9% 92.6% 91.4% 92.1% 95.1% 92.9% 95.1% 93.2% Published data 11.6 CWP Mthly 61.8% 86.0% 89.3% 88.7% 87.7% 88.6% 84.8% 87.9% 91.1% 93.8% 94.3% 89.3% Published data 11.7a NWAS Mthly 94.8% 95.1% 94.0% 96.2% 94.9% 94.9% 93.8% 93.0% 93.6% 93.6% 95.0% 94.4% Published data 11.7b NWAS Mthly 86.1% 87.5% 75.0% 100.0% 90.0% 100.0% 79.2% 89.3% 80.6% 62.8% 60.7% 79.5% Published data 11.8a MCHFT Qtrly 85.7% 93.7% 88.1% FFT Survey for Staff is not carried 90.7% Published data 11.8b MCHFT Qtrly 73.2% 79.4% 69.2% out for Quarter % Published data 13.5 CCG Mthly 80% 52% 72% 71% 72% 73% 70% 73% 76% 75% 74% 73% Published data HSCIC Source SU Provider reports Eng Page 125 of 220