Item 13 - Performance Report - Quarter 4
North Lanarkshire Council · 21 June 2023
Back to IJB Performance, Finance and Audit Committee — 21 June 2023 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
Page 1
1 REPORT Item No: 13 SUBJECT: Performance Update – Quarter 4 (January – March 2023) TO: Performance, Finance & Audit Committee Lead Officer for Report: Morag Dendy, Head of Planning, Performance and Quality Assurance Author of Report: Stephen Forrest, Performance Manager DATE: 21 June 2023 1. PURPOSE OF REPORT 1.1 This paper is coming to the Committee: For approval For endorsement To note 1.2 The purpose of the report is to provide an update to the Committee on the areas for improvement which have been identified as part of the Quarterly Performance Review for the period 1 January 2023 to 31 March 2023 (Quarter 4). 2. ROUTE TO THE BOARD 2.1 This paper has been: Prepared By: Performance Manager Reviewed By: Senior Manager, Strategy & Performance Endorsed By: 3. RECOMMENDATIONS 3.1 The Committee is asked to note the contents of the report and its appendix. 4. BACKGROUND/SUMMARY OF KEY ISSUES 4.1 The Chief Officer has joint quarterly performance review meetings with the Chief Executive of NHS Lanarkshire and the Chief Executive of North Lanarkshire Council. These meetings are supported by a Chief Executive Performance Framework comprising a range of performance measures from across both health and social work systems, including relevant targets and trajectories.
Page 2
2 4.2 Based on a traffic-light system there are areas for improvement identified within the performance framework each quarter for those that are flagged as Red or Amber. The performance review meetings are used as a means for jointly agreeing corrective actions. 5. AREAS FOR IMPROVEMENT 5.1 The areas for improvement and corrective actions are attached as Appendix 1. 6. CONCLUSIONS 6.1 The areas for improvement identified in Appendix 1 are being progressed as a matter of priority, and progress updates will be reported at future meetings of the Board and the Performance, Finance & Audit Committee. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES The Chief Executive Performance Review process is structured in a way to allow performance levels to be assessed against each of the 9 national outcomes. 7.2 ASSOCIATED MEASURE(S) None 7.3 FINANCIAL None 7.4 PEOPLE None 7.5 INEQUALITIES EQIA Completed: Yes No N/A 8. BACKGROUND PAPERS None 9. APPENDICES Appendix One - Areas for Improvement (Quarter 4, January – March 2023) ............................................................................. CHIEF OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Stephen Forrest on telephone number 07810155410.
Page 3
3 Appendix 1 – Areas for Improvement (Quarter 3, October - December 2022) 1. Alcohol Brief Interventions Target 2022/23 2022/23 Q3 2022/23 Q4 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Alcohol Brief Interventions (all settings) NHSL 7381 n/a 647 - Narrative & Corrective Action As services within the HSCP/NHSL move toward the use of the Electronic Patient Recording (EPR) system MORSE, it is suspected that the practice of routinely conducting and recording ABI may have decreased. It is also possible that there is some inconsistent practice whilst the transition to MORSE is facilitated and teams are required to maintain dual EPR. The numbers included within these reports include all interventions recorded via Morse and all manual returns which are entered via an Access database. A steering group has been formed to facilitate the development of a SOP and devise a suitable training product for staff to encourage the use and proper recording of ABI. The ABI Steering Group has agreed a new reporting structure and this has been adopted. A highlight report has been made available to the steering group indicating services/teams that have low or no interventions recorded. 2. Cervical Screening Target 2022/23 2022/23 Q3 2022/23 Q4 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Cervical Screening Uptake 80% 72.9% 72.5% Narrative & Corrective Action The position remains similar to Q3. Work is ongoing to promote Cervical Cancer Screening Awareness Week in June. This supports training being delivered in partnership with all sectors (NHSL/Locality Level) to promote cancer screening programmes and early detection. An increase of 0.2 WTE for the Public Health Quality Improvement Facilitator offers some additional capacity for the service to improve the current position. Targeted campaign work is taking place to increase screening awareness and the uptake of cervical screening and HPV in the lowest uptake areas (Bellshill and Airdrie) and also with specific populations in the community (SIMD 1&2). Cancer Screening Workshops continue to be carried out with Lanarkshire Carers BAME group.
Page 4
4 The Practice Cervical Screening Audit is now being conducted across the North Partnership, which involves GP Clinical Leads and Quality Coordinators auditing the process in each practice to inform a briefing promoting best practice and recommending improvements, where necessary. 3. Immunisations Target 2022/23 2022/23 Q3 2022/23 Q4 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Immunisations – % of 5 year olds 95% 92.7% 92.2% Narrative & Corrective Action Performance in Lanarkshire is reflective of a wider trend being experienced across Scotland where there is a gradual and slight decline in uptake of immunisation. The decline in uptake appears more significant in 2022 when compared with previous years.
Page 5
5 The data is being reviewed by colleagues in Public Health to identify any drivers of the decline, the potential implications and to link these findings to Health Improvement work streams. Ongoing work to improve the position includes the use of media campaigns, improved access to local clinics and better parent/carer contact prior to appointments. 4. 6-8 Week Reviews Target 2022/23 2022/23 Q2 2022/23 Q3 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Percentage of people who have completed 6-8 week review 90% 74.7% 69.5% Narrative & Corrective Action Performance remains below target and there is continued decline through 2022, resulting in a level of completion that is among the lowest experienced in NHSCP. This performance metric and the associated risk is monitored by the North Health & Social Work Managers, Associate Medical Director and Senior Nurse. Initial analysis of the underlying data has found a significant issue in the distribution of late and/or missed checks among a relatively small group of practices. Further investigation and analysis is required to fully understand the proportionality of reviews that were completed late and those were no assessment was carried out. Further investigation and analysis is also required to also understand where the issue may relate to the non, or misreporting of reviews that have taken place as required. Initial analysis has been carried out by locality:
Page 6
6 The monitoring and analysis is providing some intelligence on hotspots associated with GP Practices and Health Visitors. It should be noted that there is a significant increase at 10 weeks, which could be relating to recording practice, or reviews out with 6-8- week window. There is local practice and control measures in place to ensure reviews are carried out, however significant variation in recording practice across the North HSCP make this a time consuming and inefficient task, as hard-copy forms have to be physically located and checked against patient records. At a locality level, specific issues have been identified, such as individual practices storing and not returning forms and therefore their data was not being captured. Changes have been made to improve returns and collections, however it is possible that such practice may be more widespread and contributing to poor performance. The Local initiatives, such as that in Bellshill to understand waiting times information from GP's has found that enough appointments are being offered and there are no waits for those practices who do not participate in CHS; this is continually monitored by the locality to reduce the rate of breach. Further initiatives are also in place in Bellshill, Motherwell and Wishaw to improve the quality of the assessment, reduce the level of returns and improve engagement with GP practices A multi-disciplinary meeting has been called for the North HSCP to analyse and provide context to all of the underlying data, gauge the clinical risk presented by the performance and to inform the planning of the corrective actions required. This complements and supports ongoing recovery and improvement work within the wider service to understand the performance across the Universal Pathway. Use of a digital platform is actively being investigated and would assist with recording practice and operational management, although this is not expected to be live for some time. 5. Delayed Discharge / Home Support / Reablement Target 2022/23 2022/23 Q3 2022/23 Q4 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Delayed discharge bed days - standard delays 31,796 Q1 – 7184 Q2 – 8966 Q3 – 8166 Q4 – 7531 8,309 8,178 Narrative & Corrective Action In Q4 of 2022/23 the delayed discharge performance continued to be significantly above target; 8178 bed days is 2328 days above the target of 5850. The “Fire Break” and associated Op Flow works are likely to have impacted and improved the Q4 position, with significant multi- disciplinary work undertaken to improve patient flow during Q4. The longer-term impact of the continued work of Op Flow is not known and will be quantified as part of the project evaluation.
Page 7
7 There remains sustained pressure on services supporting discharge, with reduced capacity in Reablement services and challenges with recruitment and retention to posts at all grades within Home Support. The level of turnover and difficulties with recruitment of the roles Home Support Worker, Support Officer and Service Delivery Coordinators have placed significant strain on supporting discharge as the North HSCP are experiencing some of the highest referral rates recorded – w/c 16th January, the North partnership received 158 referrals (peak winter pre-pandemic average was 77). Sickness absence within the Home Support workforce continues to impact on the capacity of the service to support timely discharge. Several improvement actions are in place to address the issues currently being experienced. Additional Healthcare Support Workers are being recruited so that District Nursing Teams can enhance the care offering to those on both Home Support and District Nursing caseloads, freeing up further Home Support capacity to concentrate on other cases. The service has also made some amendments to the workforce model to offer additional review capacity, which will release capacity to the mainstream Home Support service. Ongoing work is in place to develop the operating model for Reablement; to increase and protect capacity within the service for dedicated Reablement and rehabilitation as key priorities. Local and national work continues to support improved performance in discharge, including further development of the PDD process and the continued progress of the Discharge without Delay project. Local improvement work, including the development and expansion of the Rapid Response, Home Assessment and Hospital at Home teams is expected to impact positively on DD performance. 6. Reablement / Integrated Equipment & Adaptation Service / Home Assessment Team Target 2022/23 2022/23 Q3 2022/23 Q4 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Reablement - Number Of People Completing Reablement Process 2,000 (500 per quarter) 1049 1418 Reablement - % Of New or Increased Home Support Packages Which Are Reablement 70% 55.0% 61.2% Reablement - % Of People With No or Reduced Home Support Service Required At End Of Process 70% 50.3% 56.1% IEAS - % Deliveries Achieved Within 7 Working Days 80% 63.4% 51.5% Narrative & Corrective Action
Page 8
8 IEAS continues with a Programme of improvement works, with improvements to premises and focussed recruitment activity in progress at the time of reporting. Sustained workforce challenges, specifically recruitment and retention of suitably skilled and experienced IEAS staff have resulted in challenges with the delivery and uplift of equipment. Specific resources have been assigned to addressing outstanding uplifts within the areas of highest demand and this, alongside other focussed activity has released pressure and some capacity in the system to address performance with timely deliveries. It should be noted that whilst such services continue to support Delayed Discharge improvement works, such activity naturally requires a reduced focus and capacity to support Community Services. The service is undertaking an exercise to self-assess their performance, using Scottish Government baseline figures for Equipment/Adaptations. It is hoped that a more integrated Performance Framework can be developed for services in this area, showing how the services complement and interact with each other, such as combined and/or complementary metrics for Reablement and the Home Assessment Team (HAT). It is notable that whilst the percentage of Reablement Home Support packages is below target that the HAT received increasingly more referrals. A Home Assessment Team Development Plan is in place to streamline and reduce duplication of service from the teams working in this area. The dynamic between Integrated Rehabilitation, Hospital Social Work, Home Assessment Team and Reablement has been recognised as allowing an opportunity to provide one seamless combined service. The development plan is currently focussed on services to support discharge, however a second phase is planned looking at the interaction with Hospital at Home and other services placed to support admission prevention and avoidance
Page 9
9 Multi-disciplinary and multi-agency focus groups are planned to look at the available resources and patient/client pathways, which will inform the implementation of the development plan. A governance framework has been developed to support this work, which is overseen by the Home Support Programme Board. An Assistive Technology was implemented in February 2023 to support further innovation in this area and is actively working with services across the North HSCP, including a trial of the KOMP system for medication prompts as an alternative to in-person visits. At May 2023, the team have received 187 referrals and 57 of these have resulted in the supply/purchase of technology that has benefitted the person in regaining independence in an area of their life; the impact on wider services will be quantified as the new service is developed and then evaluated. 7. CAMHS Target 2022/23 2022/23 Q3 2022/23 Q4 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status 21 24 18 18 9 3 43 4 1 31 0 5 10 15 20 25 30 35 40 45 50
Page 10
10 Percentage of patients commencing treatment within 18 weeks of referral 90% 19.1% 28.7% Narrative & Corrective Action The introduction of the CAPA (The Choice and Partnership Approach) for Child and Adolescent Mental Health Service (CAMHS) should see some improvement in managing the available capacity within the service. Consultant availability has been more closely aligned to demand and the CAPA model allows for more patient input in how their appointments are managed, which should also reduce wastage in the system. From 22nd August 2022 -16th April 2023, the waiting list initiative have offered an additional 1499 appointments, with 1099 attendances, 389 not brought, 7 patients transferred and 153 patients meaningfully redirected to other more appropriate supports. The waiting list for the Neurodevelopmental Service remains an issue for the service, however an increase in WTE, formal induction process and completion of staff training and development has prompted some positive movement. Adoption of Trakcare is also allowing for better monitoring of demand and capacity within the service, and will provide the evidence needed to build a sustainable future service capable of meeting demand. There is ongoing work to validate and correct the waiting list, primarily to provide assurance that the right children on list but also to identify any other support that can be put in place for those on the list whilst they wait. A Test of Change is planned with wider partners (education, GP’s and SW) to improve on understanding of neuro specific challenges for children and how they can be supported through Child’s Plan whilst they wait to be seen. A range of groups have also been developed to support parents. These groups focus on sleep, behaviour and eating. The service has also completed a commissioning process to secure neurodevelopmental assessments from an independent company. The first group of patients will begin their assessments in August 2023. A NDS Operational Group and NDS Steering Group have been established. The first will manage the practicalities of delivering the service in collaboration with an outside provider, as well as internal capacity and demand challenge. The second will provide assurance to the CAMHS Recovery and Renewal Programme Board that the commissioned provider is delivering ask of initial tender as well as delivery of learning achieved from Tests of Change. 8. Psychological Therapies Target 2022/23 2022/23 Q3 2022/23 Q4 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Percentage of patients commencing treatment within 18 weeks of referral 90% 85.1% 85.8% Narrative and Corrective Action
Page 11
11 Trajectories, completed by the PHS embedded analyst using the recommended methodology from PHS, indicate that the RTT is likely to be achieved by the end of the calendar year. Of note, these projections are based on a number of assumptions including retention of current staffing and recruitment to vacant posts, levels of demand, continuation of funding. Psychological Services have focused on addressing the longest waits through various means. A Consultant Psychologist is now in post to coordinate the management of longest waits in Adult Psychological Therapies Teams (PTT). Sharing out longest waits across localities, where appropriate, allows patients to be seen more quickly and reduces variation across geographical boundaries. Early screening appointments for patients referred to Adult PTT are now routinely offered to ensure that patients are directed to services that will best meet their needs at the earliest point in time. A stepped care approach to delivering evidence based therapies is now established utilising online therapy programmes, digital therapies and group-based interventions, and offering face-to-face psychological therapies where this is deemed the most appropriate form of psychological therapy. A focus on staff wellbeing continues in order to support our workforce and promote staff retention. Consultants are now in place to lead on Quality Improvement and Research which, in addition to service improvement and adding to the evidence base, will also create and maintain an enthusiastic workforce. Centralisation of recruitment processes and the creation of generic job descriptions has led to a noticeable improvement in reducing vacancies across the service. Performance for March shows 86.7% with 739 patients waiting over 18 weeks. Longest wait is 51 weeks. 9. Adult Mental Health Target 2022/23 2022/23 Q3 2022/23 Q4 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Consultant Outpatient WT - Adult Mental Health - 12wks (NHSL) (NORTH HOSTED) 90% 63.8% Consultant Outpatient WT - Older Adult Psychiatry - 12wks (NHSL) (NORTH HOSTED) 90% 80.2% Narrative & Corrective Action Both Adult MH and OA Psychiatry services have yet to recover performance to the target set, largely owing to increasing demand and significant backlog effected by lockdown restrictions. A programme of recovery commenced in 2021 and has seen progress where there a no patients waiting in excess of 52 weeks for PT. The Scottish Government Target for Psychological Therapies is for 90% of patients to commence therapy within 18 weeks of referral (RTT) by 31/3/23 – at March 2023 NHS Lanarkshire had achieved 86.72, which represents an improvement in spite of clinical vacancies (clinician vacancy rate 8% - 14.65WTE vacancies of 177.82WTE) and increased complexity of cases presented.
Page 12
12 Some increase in overall staffing and use of hybrid delivery has allowed for some improvement, however analysis suggests that continued improvement is contingent on maintaining or improving current staffing levels, therefore the service focus is currently on retention of staff within NHS Lanarkshire Psychology services. A large MDT Research conference planned for January 2024 in collaboration with University partners and provides current staff with continued professional development and engagement with the wider professional network. It is anticipated that such events will assist in the recruitment and retention of staff, however it should be noted that whilst efforts to recruit and retain staff should yield some improvement, performance in Psychiatry services is also heavily impacted nationally by challenges around recruitment and retention of Consultants, which is recognised and managed as a risk on the MH & LD Risk Register. 10. Waiting Times Performance - Medical Children & Young People (Consultant Led) Target 2022/23 2022/23 Q3 2022/23 Q4 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Medical Paediatrics WT - 12 wks (NHSL) (NORTH HOSTED) 90% 46.4% 49.2% Narrative & Corrective Action Acute Paediatrics have started to realise some recovery in their medical waiting time target. Focussed work has been carried out to address this challenge. This includes ongoing robust vetting and allocation of experienced colleague time to address longest waits. It is anticipated that the level of acuity within acute paediatrics will reduce over summer months. This will secure planned appointment capacity is met within months ahead to further progress current performance position.
Page 13
13 A Paediatric Consultant post was successfully recruited in March. Unfortunately, they will not take up post until after summer. Meantime, additional capacity is being provided by a locum consultant and extension of a temporary contract to a retired consultant colleague. The Paediatric Programme Board is in process of being re-established. They are being supported with dedicated project leadership time. An initial workshop has been undertaken and information gathered will inform focus of work going forward. Particular attention will be required on sustainability of service delivery due to concurrent challenges in consultant level workforce (age demographic of colleagues, reduced number of whole time equivalency training places and changes to shape of speciality training which provides additional capacity within current rotas). Performance for April shows 49.3% with 898 children waiting over 12 weeks. Longest wait is 49 weeks. 11. Waiting Times Performance – AHP and Community Services Target 2022/23 2022/23 Q3 2022/23 Q4 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status SLT - Paediatrics - 12wks (NORTH HOSTED) 50% 27.1% 28.8% Narrative & Corrective Action Speech and Language Therapy continue to face significant challenges around meeting of waiting time target. A service improvement plan is in process and the management team have been provided with support. A service improvement workshop was facilitated on April 25th by a project lead and service improvement colleague who have been provided with ongoing dedicated time to support service improvement change capable of addressing this challenge. The workshop was led by the professional lead and colleagues invited included SLT Senior Management Team, Team Leads, SLT Service Improvement colleagues, Practitioners and representation from aligned university. The workshop focussed on mapping of current pathways into and through the service. This has provided the detail needed that will appropriately inform next steps. A formal work plan will be able to be shared in months going forward. The SLT management team should be acknowledged for their transparency and positive approach to the process and leadership of SLT colleagues. This facilitated positive contribution from all involved. It should be noted that significant work has already been undertaken and the workshop used that as a benchmark of current position of strengths and weaknesses to identify what wider organisational support could provide to progress position.
Page 14
14 EHealth The current limitation of eHealth systems makes it difficult to robustly report performance and presents a challenge as info is collated through local arrangements.Trakcare is not being used to full potential across the service. However, it is being used with success in one area. Small changes will be required to ensure that fully fit for present and future purpose. This will then be tested prior to being expanded into other teams. Morse- SLT are currently not on MORSE. They are on the MORSE work plan. This will be an important piece of work as it will provide transparency of intervention and will align with wider children’s services aspiration of having a system that is capable of sharing information of children across our scope of care and within NHS Lanarkshire. This will also support team leaders to have provide organisational assurance of the quality of work being delivered across teams and by individuals Processes Wide variance of process across the system (and individual teams). Standardised and consistent processes require to be developed that reflect pathway and support a consistent measure of locally agreed 12 week treatment target. Waiting List coordinator colleagues are working with team to offer support needed that will improve local systems. Work Force A review of current workforce demographic is required to inform our future planning. Consideration required of :- Age – succession planning for retirements in 2 year, 5 year, 10 year plan Challenging landscape of newly registered staff recruitment- links require to be built with Universities. A university colleague attended on day and will continue to link in with future work force planning. Opportunities for expansion of Band 4 roles. Environment SLT are spread across multiple sites facilitate collaborative working with other health care colleagues and education. This will require further mapping to ensure we continue to have capacity to deliver future care in right place at right time by right people. Performance for April remains at 28.8% with 1407 children waiting over 12 weeks. Longest wait is 75 weeks. 12. Stop Smoking Service Target 2022/23 2022/23 Q1 2022/23 Q2 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status
Page 15
15 Sustain and embed successful smoking quits, at 12 weeks post quit, in 40% of SIMD areas. 902 82 304 Narrative & Corrective Action There is an intention to review all NHSL Board targets in this area. It should also be noted that there is a delay in receiving validated smoking cessation data. Lanarkshire Stop Smoking Service Local Delivery Plan performance In 2021/22, LDP performance in NHS Lanarkshire was 85.0% of target which was better than the Scottish average figure of 78.3% and was the 5th highest figure across all NHS Boards. Extrapolating quarter one 2022/23 figures indicates that the % of the LDP target achieved will reduce across all NHS Boards. Quarter two figures will be available by the end of May at which point the forecast of performance against the LDP target will be updated for all NHS Boards. Lanarkshire Stop Smoking Service overall performance In terms of overall performance, the service is ranked 9th across Scotland. The areas of strength in comparison with other boards include our performance with regard to LDP targets and the delivery of Stop Smoking services within community pharmacies. The areas for improvement in comparison with other boards include our delivery of Stop Smoking Specialist services. There are outline plans to introduce additional Local Improvement Targets (LITs) and to implement the recommendations from the deep dive review. A full report will be published end of June 2023 in response to National review. The national review of stop smoking services is due to report in June 2023, which will inform further improvements, particularly within specialist services. It is expected that this report will recommend revisions to LDP targets and a more focused approach on priority areas such as Pregnant women, people living in deprived areas, people who smoke who also have mental health problems and people who are hospitalised. Vaping NHS Lanarkshire is working with partners including ASH Scotland, Fast Forward, Landed and University of Edinburgh to develop resources with regards to youth vaping. The prevalence of vaping is influencing the wider national discussion and media focus on Tobacco control and has prompted a proposal from Scottish Government to establish a national expert group for E-cigarettes and vaping.
Page 16
16 13. Sickness Absence Target 2022/23 2022/23 Q3 2022/23 Q4 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Sickness Absence (NHSL, North) 8.31% 7.41% Sickness Absence (NLC) - days lost per person 11.32 8.56 11.96 Narrative & Corrective Action All long and short-term sickness absence continues to be managed in accordance with the relevant policies for NHSL and NLC, with monitoring of policy application managed within each service and organisation. The performance in this area reflects wider performance within the partner organisations; in NHSL, Nursing and Midwifery continues to be the most challenged cohort of staff. Within NHSL, sickness absence is being targeted within the Sustainability & Value Programme as a key area of focus. Anecdotal evidence supports a management view that some grip and control in this area was lost during the C19 pandemic due to significant changes in practice and changes in operational management post-pandemic. Additional analysis and improvement planning has been commissioned through the North HSCP. In NLC monthly meetings are taking place between Senior Managers, Service Managers, and HR Business Partners where monthly absence performance is reviewed within the respective teams.