Argyll and Bute Health and Social Care Partnership Performance Report - Fq1 2024/25
Argyll and Bute Council · 3 December 2024
Back to Bute and Cowal Area Committee — 3 December 2024 and its agenda
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Bute and Cowal Area Committee Date of Report: 21 November 2024 Title of Report: Health & Social Care Partnership - Performance Report – FQ1 2024/25 (Apr – Jun) Presented by: tbc The committee is asked to: • Acknowledge performance for FQ1 2024/25 (April - June) • Acknowledge performance update on the National Health & Wellbeing Outcomes and Ministerial Steering Group Integration Indicators (Appendix 1) • Note Delayed Discharge Sitrep as of 01 July 2024 (Appendix 2) EXECUTIVE SUMMARY This report details performance for Financial Quarter (FQ)1 2024/25 (April – June), the performance outputs are taken from the Integrated Performance Management Framework (IPMF) Reporting Dashboard with the focus on twelve key service areas. Overall performance for FQ1 notes 42 of 84 measures reporting as on target (50%). The report details performance against each of the service areas and the 84 supporting Key Performance Indicators. Analysis of the KPI’s is supported by performance commentary from the Heads of Service and Service Leads. National Health & Wellbeing Indicators performance is included alongside latest performance from the National Delayed Discharge Sitrep. The use of the new performance Dashboard within SharePoint is designed to offer a more focussed approach to the access and analysis of data, offering scope for self-service. 2. RECOMENDATIONS The committee is asked to acknowledge current FQ1 24/25 performance. 3. DETAIL OF REPORT The report details the HSCP (Health and Social Care Partnership) performance for FQ 1 2024/25 (April - June) highlighting key performance trends across the 84 KPIs (Key Performance Indicators). In addition, the report includes performance updates from Heads of Service and Service Leads across the twelve service areas. The latest performance against the National Health and Wellbeing Outcomes Indicators is reported (Appendix 1). Also included is the latest national update on Delayed Discharges (Appendix 2).
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4. RELEVANT DATA & INDICATORS 4.1 FQ1 2024/25 (April - June) Performance Summary Overall performance for FQ1 notes that 84 KPI’s are scoring against target, with 42 (50%) reporting as on-track and 42 (50%) off-track. The KPI’s report performance against the target and include the target, actual and variance and is a mix of both quantitative and qualitative indicators. The use of the green, amber and red graphics within the Dashboard is used to give an overview of the HSCP’s total performance for each of the twelve services and 84 KPI’s. The use of only green and red for the KPI’s is used to focus delivery with regards to sustaining performance on or above target. 4.2 Analysis of Key Performance This analysis identifies performance across the 12 service reporting categories within the Integrated Performance Management Framework (IPMF) and performance commentary is provided by Heads of Service and Service Leads as part of their one-to-one sessions with analysts. 4.2.1 Children & Families Performance across 7 Key Performance Indicators (KPIs) for Children & Families & Justice shows 2 KPIs (29%) on track, with 5 KPIs (71%) reported as off track against the targets set in FQ1 24/25. Performance on or above target: • Child Protection Register with an allocated worker met the target of 100% • Child Health assessments started within 4 weeks of coming into care exceeded the target of 96% in FQ1 (100%)
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Performance below target & areas for improvement: • CAHMS referrals seen within 18 weeks of referral fell short of the target of 75% by 15% (Actual: 60%) • Universal Health Visiting Pathway fell short of the target of 75% by 14% (Actual: 61%) • Violence Against Women & Girls basic training failed to meet the target of 30 by 2 (Actual: 28) • Criminal Justice social work reports submitted on time failed to reach the target of 90% by 3% (Actual: 87%) • Child Protection Planning Meetings held within 28 days of referral failed to meet the target of 90% with Actual of 0% 4.2.2 Telecare and Digital Performance across 13 Key Performance Indicators (KPIs) for Strategic Planning, Performance & Technology Services shows 4 KPIs (31%) on track, with 9 KPIs (69%) reported as off track against the targets set for FQ1 24/25. It should be acknowledged that nationally waiting time breaches are measured against a zero target. Local targets have been set to monitor progress and improvements to reduce the number of patients on waiting lists across varied health specialties. Performance on or above target: • Significant progress has been made in the digitalisation of telecare equipment, now reaching 52%. • Implementation of Just Checking activity monitoring equipment has been successfully carried out in six homes during Q1. • Usage of digital blood pressure monitoring in Primary Care has seen a consistent rise, increasing from 36 to 40 users. • E-health service successfully resolved 100% of support requests this quarter. Performance below target & areas for improvement: • The number of new telecare clients reduced from 203 in Q4 to 198, narrowly missing the increased target of 200. • Consultations delivered via Near Me missed the target by 10 consultations, showing little growth over the last four quarters. • The number of telecare clients overdue for their annual review continues to increase, now at 63%. • Silvercloud referrals missed the target again, though referral rates remain stable compared to the decreases in previous quarters with 57 referrals this quarter. • Two FOI requests were not submitted within the statutory timescale, achieving only 93%. However, the total number of FOIs was 29, a higher-than-normal volume of requests. • Currently, 42% of telecare clients have enhanced packages, below the desired target. • Waiting Times for Cancer Appointments at 31 & 62 Days reports 1 against target of zero. • New Outpatient Waiting Times breaches over 12 weeks noted 51% against 46% target. • Outpatient Long waiting over 52 weeks noted3.7% against a 2.8% target 4.2.3 Primary Care Performance across 10 Key Performance Indicators (KPIs) for Primary Care shows 6 KPIs (60%) on track, with 4 KPIs (40%) reported as off track against the targets set for FQ1 24/25.
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Performance on or above target: • 80% of children who received Fluoride Varnish treatment did not require be referred for further dental treatment. • 66% of eligible residents received their Spring Covid 19 booster. This is 3% higher than the national average. • HSPC run practices met their target of 14 by recording on 7 instances practices had to operate under contingency measures. • No GP practices were returned to HSCP Control during Q1 • GP practices remained at level zero during Q1 resulting in no reduction in services provided. • Primary Care Out-of-Hours Services covered 62% of all recorded out of hour consultations during Q1 exceeding their 45% target. Performance below target & areas for improvement: • The Oral Health Improvement Team only managed to deliver 95% of their planned activity. • HSCP Dental services only utilised 52% of clinic appointments missing their 90% target. • 4.7% of consultations by GPs and other HSCW within the primary care setting were done digitally, narrowly missing the 5% target. • 93% of children at 12 months of age received their 6 in 1 vaccination missing the 95% national target (data for this indicator is 1 quarter behind due to availability of statistics) 4.2.4 Public Health Performance across 5 Key Performance Indicators (KPIs) for Public Health shows 4 KPIs (80%) on track, with 1 KPI (20%) below the rolling target against the targets set for FQ1 24/25 Performance on or above target: • Increase the monthly number of quit dates set, supported by NHS smoking cessation advisors or jointly through shared care with pharmacy, by people in the most deprived 40% areas in Argyll. Performance this quarter was slightly above target, achieving 11 quit dates set against a target of 10. • Increase the number of engagement activities delivered in communities and supported through Living Well Networks. Performance was slightly above target, with an actual of 23 against a target of 20. • Increase the number of referrals to community link workers supported by “We Are with You”. Performance exceeded itself this quarter by achieving approximately 49% above the target, with an actual performance of 150 against a target of 101. • Number of instances working with Scottish Government or National Agencies on National Strategy and Policy Development. This is a new measure for 24/25 with a target initially set as 1. We surpassed expectations with 11 instances of working with Scottish Government or National Agencies on National Strategy and Policy development. Performance below target & areas for improvement:
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• Increase the number of people in Argyll and Bute attending training in the following areas, Money Counts, Behaviour Change, Mental Health and Suicide Prevention. The rolling target from 23/24 continues into 24/25, with the expectation of 17 additional clients each quarter. We fell marginally short, with an actual of 83 against a target of 85, approximately 2.35% below the target. 4.2.5 Finance Performance across 6 Key Performance Indicators (KPIs) for Finance shows 3 KPIs (50%) on track, with 3 KPIs (50%) reported as off track against the targets set for FQ1 24/25. Performance on or above target: • GP prescribing expenditure with actual spend being 1% lower than target. • Older People External Residential actual spend being 18% below target. • Older People Homecare actual spend being 2% below target. Performance below target & areas for improvement: • Cost of Hospital Delayed Discharges actual spend being 29% above target. • Staffing expenditure with actual spend (11%) being 1% above target. • Older People Internal Residential actual spend being 21% above target. 4.2.6 Carers Performance across 4 Key Performance Indicators (KPIs) for Carers Services shows 4 KPIs (100%) on track, against the targets set for FQ1 24/25. Performance on or above target: • Adult Carer Support Plans continues to be on target, with 137 completed against target of 133 • Young Carer Statements completed continues to be above target, with 26 completed in FQ1. • The number of Unpaid Carers Supported across A&B’s Carers Centres was reported at 3296 for FQ1 and continues to exceed the target of 3000. • The ACSP reviews completed now include welfare contacts and these continue to be above target of 700, with 913 completed in FQ1. Performance below target & areas for improvement: N/A 4.2.7 Allied Health Professionals Performance across 7 Key Performance Indicators (KPIs) for Allied Health Professionals shows 4 KPIs (57%) on track, with 3 KPIs (43%) reported as off track against the targets set for FQ1 24/25. It should be acknowledged that nationally waiting time breaches are measured against a zero target. Local targets have been set to monitor progress and improvements to reduce the number of patients on waiting lists across varied health specialties
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Performance on or above target: • MSK Outpatient Referral waits breaching >4 weeks are down significantly this quarter to 1118 (-9%) and meeting target of 1120. • AHP Outpatient Completed Waits are now on target this quarter with 977 reported against the 945 target. • Community Patient Discharges continue increasing this quarter to 1878, against the target of 1672. • The percentage of New versus Return Outpatient Physio AHP Referrals remains above the 30% target, with 31% noted in FQ1. Performance below target & areas for improvement: • Outpatients waiting over 12 weeks for AHP services have increased this quarter – these had been decreasing over recent quarters, with FQ1 reporting 552 against a target of 500. • The AHP Priority 1&2 referrals breaching > 4 weeks in FQ1 reported 58 against a target of 48. • Community Patient Referrals breaching over 12 weeks have been increasing quarter on quarter, with FQ1 reporting 558 against a target of 400. 4.2.8 Delayed Discharges Performance across 6 Key Performance Indicators (KPIs) for Delayed Discharges shows 1 KPI (17%) on track, with 5 KPIs (83%) reported as off track against the targets set for FQ1 24/25. For FY 2024/25 Delayed Discharges KPIs, we are using a count at the end of quarter census point instead of full month data. Cleansing of data at the census point is improving the accuracy of the delay codes recorded, and this also aligns better with national reporting. It should be acknowledged nationally, Delayed Discharges are measured against a zero target. Local targets have been set to monitor progress and improvements to reduce the number of patients showing as a Delayed Discharge. Performance on or above target: • Reduce the Number of people delayed in hospital with AWI code at Monthly Census Point. Performance was above target having achieved actual of 4 against a target of 6. We set the target based on the average over the last four quarters of 23/24, where the actual ranged between 3 and 9. In this quarter, the number of people delayed with AWI code increased from 4 in April to 7 in May, then returned to 4 in June. Performance below target & areas for improvement: • The number of overall people delayed in hospital at Monthly Census Point as at the end of Q1 was 39, compared to a target of 31. The target was set based on the average over the last four quarters of 23/24, where client numbers ranged between 29 and 34. Notably, there has been an increase this quarter, especially in May and June, with client numbers rising to 41 and 39 respectively, up from 32 in April.
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• At the end of Q1 census point, the overall length of stay in a hospital (Delayed Discharge Bed Days) at Monthly Census Point was 820, exceeding the target of 634. The target was set based on the average bed days over the past four quarters of 23/24, which ranged from 598 to 695. This quarter saw an 18% increase in bed days between May and June (694 to 820) reflecting the rise in client numbers during the same period. • The number of people delayed awaiting a Care Home Placement was 8, representing 21% of census clients, compared to a target of 4. The target was set based on the average from the previous four quarters of 23/24, which ranged from 0-5. In March 24, we reported zero people delayed awaiting place availability, which is unusual and may suggest a recording issue. This quarter delays were consistently 5 in both April and May, increasing to 8 in June. • At the end of Q1, the number of people delayed in hospital awaiting care at home availability was 16, representing 31% of census clients, compared to a target of 12. The target was based on the average of the last four quarters of 23/24, which ranged from 8 to 14. May reported the highest number of delays at 18, 38% increase from April, before decreasing by 12.5% to 12 in June. • At the end of Q1, the number of people delayed in hospital awaiting assessment (Codes 11A and 11B) was 13, which is 33% of census clients, against a target of 10. The target was based on the average from the previous four quarters of 23/24, which ranged 9 to 11. This quarter, the reported increase was from 9 in April to 18 in May before reducing to 13 in June. 4.2.9 Adult Social Care Performance across 4 Key Performance Indicators (KPIs) for Adult Social Care shows 3 KPIs (75%) on track, with 1 KPI (25%) reported as off track against the targets set for FQ1 24/25. Performance on or above target: • The number of Unplanned Admissions to A&B hospitals directly from a care home in FQ1 was reported at 36, exactly on target. • FQ1 Performance on increasing the occupancy rates across A&B Care Homes was above target, achieving 96% occupancy against a target of 95%. This KPI is now measured against available places (previously all empty beds). • The FQ1 performance looking to reduce the value of assessed unmet need for care at home was £11,409.72, which is 12% below the target of £12,991.74. Target is set as previous quarter’s value. Performance below target & areas for improvement: • Performance in FQ1 for increasing the % of Older People who had their homecare monitoring review completed within 6 months was 31% against a target of 49%. This KPI was briefly above target in FQ3 2023/24 but has otherwise remained below target across the previous year. 4.2.10 Community Hospitals
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Performance across 5 Key Performance Indicators (KPIs) for Community Hospitals shows 2 KPIs (40%) on track, with 3 KPIs (60%) reported as off track against the targets set for FQ1 24/25. Performance on or above target: • FQ1 A&E Attendances in A&B Community Hospitals meeting the 4 hrs wait target reported 97% performance which is 2% above 95% target. This measure was above target throughout the previous reporting year. • Maintaining A&B Community Hospitals Bed Occupancy Rates reported below 80% target, with FQ1 actual noted as 73.6% occupancy. Performance below target & areas for improvement: • Reduce the rate of unplanned admission to Community Hospitals for 65+ population. The FQ1 total of 467 admissions is 3% off track and above the target of 452. • Reduce the average Length of Stay for inpatients in A&B Community Hospitals. Performance for FQ1 was 8.7 days average across the whole quarter, against a target of 7.8 days. • Reduce the number of Falls being reported in a Community Hospital setting in A&B. This KPI remains above target for the second quarter, with FQ1 at 63 falls against a target of 54. 4.2.11 Adults with Long Term Conditions / Adult Support & Protection / Alcohol Drugs Partnership Performance across 8 Key Performance Indicators (KPIs) for Adults with Long Term Conditions/ ASP/ADP shows 3 KPIs (38%) on track, with 5 KPIs (62%) reported as off track against the targets set for FQ1 24/25. It should be acknowledged that nationally waiting time breaches for New Mental Health Outpatients (12 weeks) and Psychological Therapy (18 Weeks) are measured against a zero target. Local targets have been set to monitor progress and improvements to reduce the number of patients on waiting lists across varied health specialties Performance on or above target: • 12 Adults reported on the dynamic support register with a category red or amber status • 383 Adults are waiting for a Mental Health outpatient service achieving the target of 390 or less. • 164 Adults are waiting for a psychological therapy service achieving the target of 175 or fewer Performance below target & areas for improvement: • 7% of 18-64 people with a Learning Disability were reported as overdue an Adult Review against 3% target • 56% of Adult Support and Protection 'duty to inquire' procedures were completed within the 5 working day target. • 65% of Adult Support and Protection inquiries requiring investigative powers were completed within the 15 working day target. • 70% of Case Conferences began within 20 days of referral or within 12 weeks of the initial conference for review.
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• 80% of individuals referred to Alcohol and Drug treatment services were seen within the target waiting period. 4.2.12 Rural General Hospitals (Lorn & Island Hospital) Performance across 9 Key Performance Indicators (KPIs) for Rural General Hospitals (LIH) shows 6 KPIs (67%) on track, with 3 KPIs (33%) reported as off track against the targets set for FQ1 24/25. Performance on or above target: • Reduce the rate of unplanned admissions to LIH 65+ population. For FQ1, the actual number of unplanned admissions was 341, with performance below the target by 4 (1.16%). The target set for this KPI was 345 based on average from 23/24. • Reduce the total number of unplanned bed days in LIH. The actual number of unplanned bed days reported was 3076, with 247 (7.43%) unplanned bed days below the target of 3323, based on the 23/24 average. • Reduce the Average Length of Stay for inpatients in LIH. FQ1 Performance noted we achieved an actual rate of 4.0. This was 0.8 better than the target of 4.8. • Maintain LIH Bed Occupancy Rates below 90% target. FQ1 performance noted an actual rate of 81.8%, bettering the target by 8.2%. • Reduce the number of LIH A&E Attendances that result in an unplanned admission. The FQ 1 performance for reducing unplanned admission from A&E attendances was 17.9 against a target of 19.2 and approximately 6.8% better than target. • Reduce the number of medication errors in LIH. Quarterly indicative target was set at no more than 6 per reporting period, 6 based on 23/24 average. In FQ 1 we achieved an actual of 3. Performance below target & areas for improvement: • Our FQ1 target is for 95% of A&E attendances to meet the 4-hour target. Actual FQ1 performance noted 93.8%, only 1.2% off the 95% target. • Reduce the number of falls being reported in a hospital setting in LIH. FQ1 target was to reduce reported falls to no more than 26 per quarter, however the actual recorded was 45. This indicates the number of falls was higher than expected. • Reduce number of instances of tissue viability in Lorn & Islands Hospital. The target was to reduce the number of tissue viability instances to no more than 9. However, FQ1 performance on actual instances was 16. 4.2.13 National Health & Wellbeing Outcome Indicators & Ministerial Steering Group Integration Indicators The National Health and Wellbeing Outcomes provide a strategic framework for the planning and delivery of health and social care services. This suite of outcomes serves to focus on improving the experiences and quality of services for people using those services, carers, and their families. These indicators form the basis of the annual reporting requirement for Health and Social Care Partnerships across Scotland.
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The national indicators will be updated and reported within A&B HSCP’s Integrated Performance Management Framework to provide the national performance position alongside the local service Key Performance Indicators suite. The latest data in relation to 26 HWBOI and MSG Indicators reports 50% on track, with 13 on track and 13 off track. An overview of A&B HSCP’s latest performance against the 26 measures is reported in Appendix 1. It should be noted that reporting periods vary across the suite of national indicator measures, with some measures reported quarterly affected by national reporting data lag. 5. CONTRIBUTION TO STRATEGIC PRIORITIES The monitoring and reporting against Key Performance Indicators using the Integrated Performance Management Framework and Dashboard ensures the HSCP is able to deliver against key strategic priorities. This in-turn is aligned with the Strategic Plan and key objectives. 6. GOVERNANCE IMPLICATIONS 6.1 Financial Impact Financial performance is evidenced within the IPMF Dashboard ensuring best value as well as evidencing the impact and performance against organisational budget savings. 6.2 Staff Governance Key performance indicators within the IPMF ensure that staff governance requirements continue to be progressed and developed include health and safety, wellbeing and new service redesign and working practices. 6.3 Care and Clinical Governance Clinical Governance and patient safety remain at the core of prioritised service delivery against the new IPMF Dashboard and National Health & Wellbeing Outcomes Indicators. The new governance structure supporting the IPMF ensures that the Clinical & Care Governance Committee remain central to performance improvement. The development of the IPMF is focussed on moving away from previous traditional styles of reporting to a fully collaborative approach with Head of Service and Service Lead commentary. 7. PROFESSIONAL ADVISORY Data used within the performance dashboard is fully accessible in SharePoint with data trends and forecasting are identified to give wider strategic context. This provides the HSCP professional
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advisors with self –service performance information to inform their role in maintaining professional standards and outcomes. 8. EQUALITY & DIVERSITY IMPLICATIONS The Integrated Performance Management Framework captures relevant indictors used to inform the HSCP E&D work. 8.1 PROTECTED CHARACTERISTICS Performance detailed within this report acknowledges the rights of the Child (UNCRC), Islands. Fairer Scotland, Socio-economic Duty, Equalities - protected characteristics. 9. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE Data use and sharing within this report and IPMF performance dashboard is covered within the Argyll and Bute Council & NHS Highland Data Sharing Agreement 10. RISK ASSESSMENT Risks and mitigations associated with performance data sources and reporting are managed and identified within the monthly Performance & Improvement Team- Work Plan. 10.1 STRATEGIC, OPERATIONAL OR CLIMATE RISK Performance reports are used by operational management to identify service delivery risk and to inform mitigation action accordingly. 11. PUBLIC & USER INVOLVEMENT & ENGAGEMENT Performance reporting is available for the public via Argyll and Bute Council and NHS Highland websites. The IPMF dashboard utilises SharePoint to support manager and staff access across the HSCP. 12. CONCLUSION The committee is asked to considerer and acknowledge FQ1 2024/25 (April - June) 2024 performance as detailed in the IPMF Dashboard 13. 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 14. PREVIOUS REVIEW OF THE REPORT Meeting Title of report Date Output (if relevant)
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REPORT AUTHOR AND CONTACT Author Name: Douglas Hunter- Senior Manager Performance & Improvement Email: douglas.hunter@argyll-bute.gov.uk
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Appendix 1 – HWBOI & MSG Integration Indicators. Core Suite of Integration Indicators Data notes 67% (6 of 9) HWBOI Outcomes measures reporting as above the national Scotland Rate. It is worth noting that performance will be influenced and vary in line with the total number of respondents participating in this voluntary survey. As such, caution should be noted with regards to previous comparison and trends
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HWBOI - Performance Data notes 55.5% (5 of 9) HWBOI Performance measures reporting as above the national Scotland Rate. *Indicators 12, 13, 14, 15, 16, 18 Calendar year 2023 is used here as a proxy for 2023/24 due to the national data for 2023/24 being incomplete. This is in line with guidance issued by Public Health Scotland which was communicated to all Health and Social Care Partnerships. Using more complete calendar year data for 2023 should improve the consistency of reporting between Health and Social Care Partnerships.
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Ministerial Steering Group Integration Indicators Data notes 25% (2of 8) MSG Indicators reporting as above the national Scotland rate. MSG Indicators data notes that all MSG measures have increased in the last reporting year. Activity around Emergency Admissions, Unplanned Bed Days, A&E attendances and Delayed Discharge Bed Days all noted performance exceeding pre –Covid levels. This highlights the necessity to consider approaches to alleviate systems pressures around Urgent and Unscheduled Care and expedite hospital flow.
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Appendix 2 - Delayed Discharge Sitrep – 1st July 2024