Argyll and Bute HSCP Performance Report - November 2022
Argyll and Bute Council · 23 November 2022
Back to Argyll and Bute HSCP Integration Joint Board (IJB) — 23 November 2022 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
Page 1
1 Clinical & Care Governance Committee Agenda item: Date of Meeting: 26th October 2022 Title of Report: Health & Social Care Partnership- Performance Report (Nov 2022) Presented by: Stephen Whiston - Head of Strategic Planning, Performance & Technology The Clinical & Care Governance Committee is asked to: Acknowledge performance against target with regards to the Outpatient & Inpatient Long Waiting Times for November and previous month. Note the performance with regards to the Treatment Time Guarantee (TTG) - Inpatient/Day Case Waiting List Note the update with regards to progress with the development of the Integrated Performance Management Framework(IPMF) Acknowledge Delayed Discharge performance and forecasting Acknowledge progress against CAMHS & Psychological Therapies 18 week LDP standard EXECUTIVE SUMMARY New Key Performance Indicators (KPI’s) have been established in relation to long waiting times across both inpatient and outpatient specialities for 2022, 2023 & 2024. This report details current performance against the new targets building on previous remobilisation performance. In addition this report also focusses on performance with regards to Treatment Time Guarantee (TTG), Delayed Discharge and CAMHS/Psychological Therapies 18 Week Local Delivery Plan (LDP) Standards with an update on the Integrated Performance Management Framework (IPMF). 1. INTRODUCTION This report details performance against the six new targets set for reducing Long Waiting Times across Scotland, the focus of which is to eliminate: two year waits for outpatients in most specialities by the end of August 2022 18 month waits for outpatients in most specialities by the end of December 2022 one year waits for outpatients in most specialities by the end of March 2023 two years waits for inpatient/day cases in the majority of specialities by September 2022 18 month waits for inpatient/day cases in the majority of specialities by September 2023 one year for inpatient/day cases in the majority of specialities by September 2024
Page 2
2 2. DETAIL OF REPORT The report details performance for November 2022 with regards to the Health & Social Care Partnership, Greater Glasgow & Clyde and NHS Highland. 3. RELEVANT DATA & INDICATORS 4.1 Long Waiting Times Performance The table below details current performance against Long Waiting Times targets for August and September 2022 and is extracted from New Outpatient Monthly Management Information. The RAG (Red, Amber & Green) status bar identifies performance against current and future targets. Performance Indicator Target August 2022 (Actual) September 2022 (Actual) RAG Eliminate two year waits for outpatients in most specialities by the end of August 2022 0 0 0 Eliminate 18 month waits for outpatients in most specialities by the end of December 2022 0 3 3 Eliminate one year waits for outpatients in most specialities by the end of March 2023 0 6 4 Eliminate two years waits for inpatient/day cases in the majority of specialities by September 2022 0 0 0 Eliminate 18 month waits for inpatient/day cases in the majority of specialities by September 2023 0 0 0 Eliminate one year for inpatient/day cases in the majority of specialities by September 2024 0 0 0 Total Waits 0 9 7 (MMI Data- August & September 2022) The table below identifies the new outpatient speciality waits greater than 1 Year as at 4th September 2022. Specialities >1Yr >18 Months >2 yrs. Total Endoscopy 1 1 0 2 Gynaecology 0 1 0 1 Neurology 1 0 0 1 Pain Management 1 1 0 2 Trauma and Orthopaedic 1 0 0 1 Total Waits 4 3 0 7 (MMI Data- 4th September 2022) Performance Assessment: There are no waits estimated longer than 2 years for current Consultant and Nurse led specialities against a (0) target by August 2022 With regards to waits longer that 18 months data for September note 3 waits, 1 Endoscopy, 1 Gynaecology and 1 Pain Management for consecutive months against a target of (0) by December 2022 Performance with regards to outpatients waits exceeding 1 year note (6) August against a reduction of (4) in September, this equates to an overall 40% reduction against the target of (0) for March 2023
Page 3
3 4.5 Treatment Time Guarantee (TTG) - Inpatient/Day Case Waiting List Argyll & Bute Inpatient/Day Case Activity The graph below identifies current performance with regards to Inpatient /Day Case -12 week breaches and current overall performance as at 4th August 2022 in Argyll and Bute at LIH, Oban (TTG Performance Report- 4th August 2022) Performance Assessment: Currently 3 breaches with regards to TTG Inpatient/ Day Case waits greater than 12 weeks For September (47.4%) booked appointment performance has seen a 9.6% increase at the same time on the previous month August (37.8%) NHS Highland Board performance is noted in both Appendix 1 & 2 Greater Glasgow & Clyde The graph below identifies TTG Inpatient/Daycase Patient Waiting Times by Length of Wait (July 2021 – June 2022) (Greater Glasgow & Clyde Performance Assurance Information- August 2022) Performance Assessment: At the end of June 2022, there were 39,595 patients on the overall waiting list. Of this total 10,776 patients were waiting >1 year, 5,419 were waiting >18 months and 2,810 were waiting >2 years. Targets have recently been set for long waiting patients in each of these time 26.3% 25.9% 26.7% 27.3% 27.2% 27.0% 27.0% 27.2% 27.6% 28.0% 28.2% 28.3% 0 5,000 10,000 15,000 20,000 25,000 30,000 35,000 40,000 45,000 24.5% 25.0% 25.5% 26.0% 26.5% 27.0% 27.5% 28.0% 28.5% Jul-21 Aug-21 Sep-21 Oct-21 Nov-21 Dec-21 Jan-22 Feb-22 Mar-22 Apr-22 May-22 Jun-22 TTG Patients Waiting List: July 2021 - June 2022 0-12 Weeks 12-26 weeks 26-52 Weeks >52 Weeks % of NHS Scotland Waiting List
Page 4
4 bands including no patients waiting >104 weeks by end of September 2022 and no patients waiting >78 weeks by September 2023. Local management information shows a further reduction in the number of patients waiting >2 years in that there are currently 2,519 patients waiting >104 weeks as at 27 July 2022. Currently 29.9% of the over 12 week’s national waiting list at the end of June 2022. (Trajectories are currently being developed for the new planned care targets that have been set.) There are a number of challenges in the adult pathway around Orthopaedics, Urology and Neurosurgery (Spinal) and within paediatrics there are challenges within Ear Nose and Throat and Paediatric Surgery. There is a risk that the targets will not be met without additional capacity. 4.6 Integrated Performance Management Framework (IPMF) Update IPMF Development Sessions have been completed with all Service Leads and Heads of Service Work for October will focus on bringing together the draft KPI’s to form the first iteration of the performance dashboard- analyst will be engaging with Heads of Service and Service Leads to further refine and finalise indicators. Target setting will be across November and December with the first draft presented to the Senior Leadership Team in January 2023 5. Delayed Discharge The table below notes performance with regards to the total monthly delays and associated bed days occupied, the local target is 12 and the national target is 0 delays, the data below includes the breakdown of HSCP and Greater Glasgow & Clyde Hospital delays. (Weekly DD Census Reporting April- September 2022) The data forecasting table below identifies the current total delays data and projects this forward for the rest of the financial year with up and below trend modelling. 12 12 17 21 22 14 9 13 14 16 11 15 0 10 20 30 40 0 500 1000 1500 Apr-22 May-22 Jun-22 Jul-22 Aug-22 Sep-22 Apr-22 May-22 Jun-22 Jul-22 Aug-22 Sep-22 GGC DD 9 13 14 16 11 15 AB DD 12 12 17 21 22 14 Bed Days Total 474 471 683 1075 1193 1309 Delayed Discharges at Census Point (April-September 2022) AB DD GGC DD Bed Days Total
Page 5
5 (Weekly DD Census Reporting April- September 2022- Excel Forecast Data Smoothing Algorithm) Performance Assessment: Performance against the local monthly target of 12 remains consistently above, for both delays in Argyll & Bute Hospitals and Greater Glasgow Hospitals. Alongside this, the data notes that bed days occupied by those delays has significantly increased month on month. From April (474) the beds days occupied has seen a 94% increase as at September (1309), effectively identifying that more people are being delayed in hospital for longer Argyll & Bute specific delays have an average number of delays (16) this is against an average number of delays for GG&C (13) Forecast performance notes the potential for an increasing trend using the current data projected forward to March 2023. This is in-turn modelled against upper and lower confidence boundaries to show a better and worse case scenario, this is not definitive but designed to identify potential future performance informed by actual monthly data. 21 25 31 37 33 2929 31 33 35 36 38 39 41 29 23 21 21 20 20 20 20 29 40 44 48 52 56 59 62 0 10 20 30 40 50 60 70 Apr-22 May-22 Jun-22 Jul-22 Aug-22 Sep-22 Oct-22 Nov-22 Dec-22 Jan-23 Feb-23 Mar-23 Mar-23 Actual & Forecast Delays Forecast Delayed Discharge Performance (April 2022-March 2023) DD Total Forecast(DD Total) Lower Confidence Bound(DD Total) Upper Confidence Bound(DD Total)
Page 6
6 6. CHILD & ADOLESCENT MENTAL HEALTH & PSYCHOLOGICAL THERAPIES 6.1 CAMHS Waiting Time Performance Completed Waits The table below identifies the quarterly percentage of patients starting treatment within 18 weeks from Jan 2021 to June 2022 (TrakcarePMS & manual team data collection via NHS Highland) Performance Assessment: For the quarter ending June 2022, 74% of patients were seen within 18 weeks of referral, an increase from 60% in the previous quarter ending March 2022 and an increase from 43% in the same quarter ending June last year. Performance against the 90% target continues to improve. September 2022 data is yet to be released but indications from July and August look to be consistent around circa 70%. The number starting treatment has remained relatively consistent at an average of 30 patients per quarter. Referral Rates The table below identifies the quarterly number of accepted CAMHS referrals January 2021 to June 2022 (TrakcarePMS & manual team data collection via NHS Highland)
Page 7
7 Performance Assessment: 103 patients were referred to CAMHS in the quarter ending June 2022, the referral rate up to and including August 2022 remains steady and shows a slight increase from 2021. Ongoing Waits The table below identifies the number of patients each quarter waiting to start CAMHS treatment, March 2021tp June 2022 (TrakcarePMS & manual team data collection via NHS Highland) Performance Assessment: 168 patients were waiting to start treatment as at June 2022, a 25% reduction in waiting list size from the quarter ending March 2022. Around half of all those waiting have waited longer than 18 weeks and this has been the case since the beginning of 2021. The number waiting over 36 weeks has decreased by 40% from the previous quarter and looks to be continuing to improve. August 2022 data indicates that the longest waiting patients are being tackled/data quality exercises to cleanse the list may be ongoing. The service is now wholly on the TrakcarePMS system which will help with this going forward.
Page 8
8 6.2 Psychological Therapies Waiting Time Performance Completed Waits The table below identifies the quarterly percentage of patients starting treatment within 18 Weeks from January 2021 to June 2022 (TrakcarePMS & manual team data collection via NHS Highland) Performance Assessment: For the quarter ending June 2022 81% of patients were seen within 18 weeks of referral, a decrease from 91% in the previous quarter ending March 2022 and from 91% in the same quarter ending June last year. There was a slightly smaller number of patients starting treatment this quarter, possibly due to clinician summer leave etc, and as such percentage attainment can show greater variation due to small sample size. September 2022 data is yet to be released but July and August data indicate close to 100% compliance with the 18 week target. On average the numbers starting treatment has remained constant at around 90 patients per quarter. Referral Rate The table below identifies the number of quarterly referrals accepted for Psychological Therapies from January 2021 to June 2022
Page 9
9 (TrakcarePMS & manual team data collection via NHS Highland) Performance Assessment: 125 patients were referred to Psychological Therapies in the quarter ending June 2022, the referral rate up to and including August 2022 remains steady and shows a slight decrease from 2021. Ongoing Waits The table below identifies the quarterly number of patients waiting to start Psychological Therapies from March 2021 to June 2022 (TrakcarePMS & manual team data collection via NHS Highland) Performance Assessment: 288 patients were waiting to start treatment as at June 2022 and the waiting list size has been around this level since the beginning of the year and shows an increase since 2021. Although performance against the 90% target is positive, waiting times experienced by those yet to be seen have increased with 79% of all those on the list waiting 18 weeks and above, an increase from circa 50% during 2021. 57% of all those waiting to be seen have waited over 36 weeks and the number of longest waiting patients continues to rise, this trend is also consistent with the August 2022 data. The service continues to work on waiting list prioritisation to ensure patients are being booked in order of length of wait. 7. CONTRIBUTION TO STRATEGIC PRIORITIES The monitoring and reporting of performance with regards to Argyll & Bute HSCP, Greater Glasgow & Clyde and NHS Highland ensures the HSCP is able to deliver against key strategic priorities.
Page 10
10 8. GOVERNANCE IMPLICATIONS 8.1 Financial Impact Performance data is required in order to evidence service level performance and activity in line with cost and service efficiency as well as evidence the impact of additional funding provided to reduce waiting times. 8.2 Staff Governance There has been a variety of staff governance requirements identified and continue to be progressed and developed include health and safety, wellbeing and new service redesign and working practices. 8.3 Clinical Governance Clinical Governance and patient safety remains at the core of prioritised service delivery against the National Health & Wellbeing Outcomes Indicators (Appendix 3) 9. PROFESSIONAL ADVISORY Data used within this report is a snapshot of a month and data period, where possible data trends and forecasting are identified to give wider strategic context. 10. EQUALITY & DIVERSITY IMPLICATIONS EQIA not required 11. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE Data use and sharing within this report is covered within the A&B & NHS Highland Data Sharing Agreement 12. RISK ASSESSMENT Risks and mitigations associated with performance data sources and reporting are managed and identified within the monthly Performance & Improvement Team- Work Plan 13. PUBLIC & USER INVOLVEMENT & ENGAGEMENT Not applicable with regard to this performance report, but access to this report for the public is via Argyll and Bute Council and NHS Highland websites. 14. CONCLUSION The Clinical Care Governance Board is asked to consider the transitional work ongoing with regards to the new Long Wait performance indicators focussed on continuing to improve long waiting times across Scotland. Work continues in the development of the Integrated Performance Management Framework of the HSCP. Current Delayed Discharge performance with forecasting ahead of Winter Pressures is also presented. 15. DIRECTIONS Directions required to Council, NHS Board or both. Directions to: tick No Directions required x Argyll & Bute Council NHS Highland Health Board Argyll & Bute Council and NHS Highland Health Board REPORT AUTHOR AND CONTACT Author Name: Stephen Whiston Email: stephen.whiston@nhs.scot
Page 11
11 Appendix 1- Board Level KPI’s – 26th September 2022
Page 12
12 Appendix 2- Proportion of Outpatients Waiting Over 12 Weeks by Health Board (26th September 2022)
Page 13
13 Appendix 3- Health & Wellbeing Outcome Indicators (HWBOI’s) - September 2022 Core Suite of Integration Indicators - Annual Performance Important: Please read the following notes carefully prior to using the figures provided in this worksheet. Select Partnership of Residence Indicator Title Partnership rate Scotland rate Year of latest data NI - 1 Percentage of adults able to look after their health very well or quite well 90.8% 90.9% NI - 2 Percentage of adults supported at home who agreed that they are supported to live as independently as possible 75.0% 78.8% NI - 3 Percentage of adults supported at home who agreed that they had a say in how their help, care, or support was provided 66.9% 70.6% NI - 4 Percentage of adults supported at home who agreed that their health and social care services seemed to be well co-ordinated 66.0% 66.4% NI - 5 Percentage of adults receiving any care or support who rate it as excellent or good 68.6% 75.3% NI - 6 Percentage of people with positive experience of care at their GP practice 77.6% 66.5% NI - 7 Percentage of adults supported at home who agree that their services and support had an impact on improving or maintaining their quality of life 76.7% 78.1% NI - 8 Percentage of carers who feel supported to continue in their caring role 38.0% 29.7% NI - 9 Percentage of adults supported at home who agreed they felt safe 76.4% 79.7% NI - 10 Percentage of staff who say they would recommend their workplace as a good place to work NA NA NA NI - 11 Premature mortality rate per 100,000 persons 386 466 2021 NI - 12 Emergency admission rate (per 100,000 population) 12,139 11,641 2021/22 NI - 13 Emergency bed day rate (per 100,000 population) 108,810 111,293 2021/22 NI - 14 Emergency readmissions to hospital within 28 days of discharge (rate per 1,000 discharges) 89 106 2021/22 NI - 15 Proportion of last 6 months of life spent at home or in a community setting 90.8% 89.8% 2021/22 NI - 16 Falls rate per 1,000 population aged 65+ 29.8 22.9 2021/22 NI - 17 Proportion of care services graded 'good' (4) or better in Care Inspectorate inspections 80.0% 75.8% 2021/22 NI - 18 Percentage of adults with intensive care needs receiving care at home 71.9% 64.9% 2021 NI - 19 Number of days people spend in hospital when they are ready to be discharged (per 1,000 population) 584 761 2021/22 NI - 20 Percentage of health and care resource spent on hospital stays where the patient was admitted in an emergency 22.5% 24.2% 2019/20 NI - 21 Percentage of people admitted to hospital from home during the year, who are discharged to a care home NA NA NA NI - 22 Percentage of people who are discharged from hospital within 72 hours of being ready NA NA NA NI - 23 Expenditure on end of life care, cost in last 6 months per death NA NA NA Data indicators The rates presented below relate to the year for which data is most recently available and generally complete for most areas. The individual indicators contain more specific information. Outcome indicators 2021/22