/KPCT-09-25%203%20Performance%20Report

Performance Report February 2009

Produced by: Performance Team

Content Page No.

7

Performance Accelerator - Explanation Sheet

RAG

EC

Existing Commitments

EC01

Guaranteed access to a GUM clinic within 48 hours of contacting a service

8

EC02

All ambulance trusts to respond to 95 percent of Category A calls within 19 minutes

10

EC03

All ambulance trusts to respond to 75 percent of Category A calls within 8 minutes

11

EC04

All ambulance trusts to respond to 95 percent of Category B calls within 19 minutes

12

EC05

Access to Crisis Resolution Services

14

EC06

Access to Early Intervention in Psychosis Services

16

EC07

Data quality on ethnic group

17

EC08

Delayed Transfers of Care

19

EC09

Diabetic Retinopathy Screening

20

EC10

A maximum wait of 26 weeks for in-patients appointments

21

EC11

A maximum wait of 13 weeks for an outpatient appointment

23

EC12

Maximum wait for revascularisation

25

EC13

Thrombolysis 'call to needle'

26

EC14

4-hour maximum wait in A&E from arrival to admission, transfer or discharge (QMAE)

27

EC14A

4-hour maximum wait in A&E from arrival to admission, transfer or discharge (Weekly for KPCT)

29

Page 1 of 79

Content Page No. NPA

National Prioroity Area

NPA01a

Percentage of patients seen within 18 weeks for admitted and non-admitted pathways (Weekly Unvalidated Data)

31

NPA01b

Percentage of patients seen within 18 weeks for admitted and non-admitted pathways (Monthly Validated Data)

32

NPA02a

Guaranteed access to a primary care doctor within 48 hours

33

NPA02b

Guaranteed access to a primary care professional within 24 hours

35

NPA03

Access to NHS Dental Services

37

NPA05a

A maximum waiting time of one month from diagnosis to treatment for all cancers

39

NPA06a

A maximum waiting time of two months from urgent referral to treatment for all cancers

41

NPA07a

A two-week maximum wait from urgent GP referral to first outpatient appointment for all urgent suspected cancer referrals

43

NPA08a

Proportion of women aged 47-49 and 71-73 offered screening for breast cancer

45

NPA08b

Breast cancer screening for women aged 53 to 64 and 65 to 70 years (Linked to VSA09 / NPA08a Breast cancer screening for women aged 53 to 70 years)

46

NPA09 (LAA)

Obesity among primary school age children (National Child Measurement Programme (NCMP))

47

NPA10

Prevalence of Chlamydia

48

RAG

Page 2 of 79

Content Page No.

RAG

NPA

National Prioroity Area Continued

NPA11

Effectiveness of Children and Adult Mental Health Service (CAMHS)

49

NPA13 (LAA)

Smoking prevalence

50

NPA14

Rates of Clostridium Difficile - Kirklees

52

NPA15

NHS staff survey scores based measures of job satisfaction

53

NPA16 (LAA)

Number of drug users recorded as being in effective treatment

54

NPA17 (LAA)

Prevalence of infants breastfed at 6-8 weeks

56

NPA18

Proportion of children who complete immunisation by recommended ages

58

NPA21

Stroke Care

59

NPA22 (LAA)

Under 18 Conception Rate

60

NPA23 (LAA)

Percentage of women who have seen a midwife or a maternity healthcare professional, for

61

Page 3 of 79

Content Page No.

OPM

Other Performance Measures

RAG

OPM01 MRSA number of infections

62

OPM02 Supporting measures: Extended opening hours for GP practices, Increased capacity in primary care, Patient reported access to out-of-hours care

63

OPM03 Convenience and choice - GP Referrals (PCT Booking)

64

OPM04 Convenience and choice - Patient Recollection of Choice

66

OPM05 Patient reported measure of choice of hospital (VSC16)

67

OPM06 Emergency Bed Days (LAA)

69

OPM07 Hospital admissions for ambulatory care sensitive conditions

71

OPM08 Diagnostics

73

Page 4 of 79

Content Page No.

LAA

Local Area Agreement

RAG

1 LOCAL TARGET - Number of women of child bearing age who are hazardous drinkers

74

2 LOCAL TARGET - Percentage increase in adult dependent drinkers exiting structured specialist treatment through care planned discharges

75

3 Emotional health of children

76

4 Smoking Prevalence - % of women known to be smoking at birth in Dewsbury and Batley

77

5 VSC25 and LAA NIS 137 - Healthy life expectancy at age 65

78

6 NPA09: Obesity among primary school age children (National Child Measurement Programme (NCMP)) (VSB09)

47

7 NPA13: Smoking prevalence among people aged 16 or over and, aged 16 or over in routine and manual groups (quit rates locally 2008) (VSB05)

50

8 NPA16: Number of drug users recorded as being in effective treatment (VSB14)

54

9 NPA17: Percentage of infants breastfed at 6-8 weeks (VSB11)

56

10 NPA22: Under 18 conception rate per 1,000 females aged 15-17 (VSB08)

60

11 NPA23: Percentage of women who have seen a midwife or a maternity healthcare professional, for assessment of health and social care needs, risks and choices by 12 completed weeks of pregnancy.

(VSB06)

61

12 VSC11: Proportion of people with long-term conditions supported to be independent and in control of their condition. Proxy is - Other Performance Measure 06: Number of emergency bed days per head of weighted population (VSC20)

69 & 79

Page 5 of 79

Content Page No.

RAG

WCC

World Class Commissioning

WCC 1

Health Inequalities Average IMD (deprivation index) score

N/A

WCC 2

Life Expectancy Life expectancy at time of birth, in Years

N/A

WCC 3 LAA Smoking During Pregnancy VSMR Actual percentage of women known to be smokers at the time of delivery

N/A

WCC 4 LAA Smoking Quitters 7 NPA13 Rate per 100,000 population aged 16 and over

50

WCC 5 NPA21

Stroke Care Percentage of people admitted with a stroke given a brain scan within 24 hours

59

WCC 6

Alcohol harm Rate of hospital admissions per 100,000 for alcohol related harm

N/A

WCC 7 QOF

CHD controlled BP Percentage of people with Coronary Heart Disease in whom the last BP reading was 150/90 or less in the past 15 months

N/A

WCC 8 LAA Childhood Obesity NPA 09 Percentage obesity among primary school age NIS 56 children in Year 6

47

WCC 9 LAA Emotional health of children NIS 50 Baseline to be established through national Tellus Survey in Summer 2008. Targets will be set for 09/10

76

WCC 10 LAA NIS 24 VSC11

People with LTC supported to be independent and in control of their condition, definition to be confirmed by central gov. "Currently using VSC20 as a proxy"

NB N/A indicates not available from Performance Accelerator

Page 6 of 79

69 & 79

9 September 2008

PERFORMANCE ACCELERATOR - EXPLANATION SHEET The Title of the Existing Commitment or Vital Sign Accountability

Period

The Title of the Existing Commitment or Vital Sign Owner Sponsor Key Achievements Since Last Report:

(1) (4)

The period the report relates to

The Lead Manager The Director who sponsors the accountability A detailed description of what has been achieved since the last report. This would include how the target has been achieved or significant milestones that are on target to deliver the accountability.

Current Concerns:

A detailed description of any concerns that are or might affect the acheivement of the accountability. Breaches associated with waiting times should be detailed here chronilogical with most recent breaches first.

Reasons for Variance and Actions Taken:

A detailed description as to why there is variation from trajectory and corrective actions being taken to achieve the year end position

PI

Due Date

Planned (value)

Latest YTD

Variance (8) (9) Comments

The Title of the Performance Indicator

The date the numbers relate to

The The The plan To be actual differnece removed number usually between relating to from year to plan and PI Date report date actual

A space for Owners to write specific commentary regarding the data for this period to be removed from report in future.

Data Source and Period Explanation / Guidance Dates the Health Care Commission Technical Guidance has been updated Key (1) Overall RAG (4) PI Status (8) PI Milestone RAG (9) PI Milestone Status Key (1) Overall RAG - A status determined by the Owner taking into account all known information and using there experience and determining the status from 1 or more of the PI's included Key (4) PI Status - A calculated status determined based on actual performance against trajectory. Currently this can only be either Red or Green Key (8) PI Milestone RAG - A status determined by the Owner taking into account all known information and using there experience regarding the Performance Indicator Key (9) PI Milestone Status - A calculated status determined based on actual performance against trajectory.

Currently this can only be either Red or Green

Page 7 of 79 Š Dynamic Change Limited 2008 Vital Signs and Existing Commitments Board Report

8 February 2009

Performance Report - Existing Commitments EC01: Guaranteed access to a GUM clinic within 48 hours of contacting a service Accountability Period (1) (4) 30-Nov-2008 EC01: Guaranteed access to a GUM clinic within 48 hours of contacting a service Rachel Spencer Owner Judith Hooper Sponsor Key Achievements Both Genito Urinary Medicine (GUM) clinics offer a mixture of drop in and booked appointments at a variety of times.

Since Last Report:

Current Concerns:

The GUM clinics continue to improve their performance in relation to access. The clinics comfortably offer 100% of appointments within 48 hours of contacting the service ('offered'). The take up of those appointments ('seen') has increased to 89.36% in November which is above the trajectory of 88.54%.

CHFT have highlighted continuing staffing issues which may affect the 'seen' target despite this month’s improvement, although they are managing to consistently meet the 100% offered.

Reasons for Variance and

A consultant is due to start on 1st April.

Continuing to roll out sti services within primary care.

Planned Latest Variance (8) (9) Comments (value) YTD Percentage: first attendances who were seen within 48 hours of contacting a GUM service Nov 08 30-Nov-2008 88.54 89.3567 0.8167 Percentage: people attending a GUM service who were offered an appointment to be seen within 48 hours of contacting a service Nov 08 30-Nov-2008 100 100 0 PI

Due Date

DH GUM clinics waiting times collection (GUMAMM) (financial year 2008/2009 (quarters 1 to 4)) Annual numbers of sexually transmitted diseases diagnosed in genito-urinary medicine (GUM) clinics in England rose by 43% between 1996 and 2002, with an overall increase in clinic workload of 79% for the same period. The white paper, 'Choosing health: making healthier choices easier' (Department of Health, 2004), included a number of commitments, including improved access to GUM clinics, and efficient and convenient screening services.

Additional Information This indicator relates to the offer of an appointment for the patient to be seen within 48 hours of contacting the service rather than an offer of an appointment that is made within 48 hours of contacting the service but to be seen at a later date HC - 18th June 2008

Š Dynamic Change Limited 2009 Performance Report - Existing Commitments

Page 8 of 79

EC01: Guaranteed access to a GUM clinic within 48 hours of contacting a service PI

Apr 08

May 08

Jun 08

Jul 08

Aug 08

PI Target TRG Actual TRG Actual TRG Actual TRG Actual TRG Name EC01: Guaranteed access to a GUM clinic within 48 hours of contacting a service Percentag e: first

88.54

85.08

88.54

89.27

88.54

91.27

88.54

89.73

88.54

Sep 08 Actual

92.72

TRG

88.54

Oct 08 Actual

87.55

TRG

Nov 08 Actual

88.54

83.09

TRG

88.54

Dec 08 Actual

89.36

TRG

Jan 09 Actual

88.54

TRG

Feb 09 Actual

88.54

TRG

Mar 09 Actual

88.54

TRG

Actual

88.54

Percentage: people attending a GUM service who were offered an appointment to be seen within 48 hours of contacting a service

PI

Apr 08

May 08

Jun 08

Jul 08

Aug 08

Sep 08

Oct 08

Nov 08

Dec 08

Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual PI Target TRG Name 100 100 100 100 100 100 100 100 100 100 100 100 100 99.89 Percentag 100 100 100 e: people

Page 9 of 79

Jan 09 TRG 100

Feb 09 Actual

TRG 100

Mar 09 Actual

TRG 100

Actual

8 February 2009

Performance Report - Existing Commitments EC02: Category A calls meeting 19 minute standard Accountability Period (1) (4) 31-Dec-2008 EC02: Category A calls meeting 19 minute standard Rachel Carter Owner Carol Mckenna Sponsor Key Achievements Category A 19 minute performance remains above the 95% target (both in-month and YTD), although there was a drop in performance in December.

Since Last Report:

Current Concerns:

Category A 19 minute performance for YAS in December was 95.1% (95.5% for Kirklees) (November: YAS 96.5%, Kirklees 97.1%) (October: YAS - 96.7%, Kirklees - 95.9%) (September: YAS - 97.2%, Kirklees 97.4%), (August: YAS - 96.4%, Kirklees - 98.1%) (July: YAS - 96.4%, Kirklees 97.9%), (June: YAS - 94.9%, Kirklees - 96.6%), with YTD performance 95.4% (96.3% for Kirklees) (July: YAS 95.2%, Kirklees 95.8%), (June: YAS - 94.7%, Kirkless 95.1%) against a target of 95%.

Planned Latest Variance (8) (9) Comments (value) YTD Percentage of category A calls resulting in an emergency response arriving at the scene of the incident within 19 YAS YTD performance - HC Indicator Dec 08 31-Dec-2008 95 95.9 0.9 PI

Due Date

KA34 ambulance services (financial year 2008/2009) This indicator measures performance in response to category A calls requiring transport. The Department of Health's requirement is that a minimum of ninety five per cent of category A calls (defined as ""immediately life-threatening"") that require transport should be met within 19 minutes of the request being made for a vehicle capable of transporting the patient.

All PCTs will be aware that from 1 April 2008 the ‘clock’ for measuring the response times standards starts from the connection of the call to the ambulance control room, a change which formed one of the recommendations of the report 'Taking Healthcare to the Patient'. The category A 19 minute standard is measured from the time the request for transport is made; either when the initial responder makes a request for transport to the control room, or from the point the call is connected if the information received from the 999 caller indicates that transport is needed, whichever is the earlier. The category A 19 minute target is expected to be much less affected by the change than the category A 8 minute target.

HC - 18th June 2008

© Dynamic Change Limited 2009 Performance Report - Existing Commitments

Page 10 of 79

8 February 2009

Performance Report - Existing Commitments EC03: All ambulance trusts to respond to 75 percent of Category A calls within 8 minutes Accountability Period (1) (4) EC03: All ambulance trusts to respond to 75 percent of Category A calls within 8 minutes 31-Dec-2008 Owner Rachel Carter Sponsor Carol Mckenna YAS did not achieve 75% Cat A target for in-month performance in December. This is not in line with the agreed recovery plan, which predicted month-on-month achievement of 75% from September. Performance for Kirklees patients has improved in January but remains the worst of all Y&TH PCT. January month-to-date Key performance at 22nd January was 62.82% (12th of 12 PCTs). December performance was 55.1% (12th of 12 Achievements PCTs). November performance was 65.2% (12th of 12 PCTs). October performance was 63.3% (12th of 12 Since Last PCTs), September performance was 72.3% (12th of 12 PCTs), August performance was 65.09 (11th of 12 Report: PCTs), July performance was 65% (8th out of 12 PCTs), 61.4% in June (8th of 12), 59% in May (12th of 12) and 52.7% in April (12th of 12).

The target is 75% within 8 minutes from the time at which the call is connected to the ambulance service. YAS will not meet the 8 minute target for 2008/09.

The SHA had sought assurance from the Co-ordinating Commissioner (Bradford & Airedale Teaching PCT) Current that performance would not drop below 75% in any month for the remainder of 2008/09 - this 75% Concerns: performance was not sustained in October, November or December and is not expected in January. Additional non-recurrent funding has been agreed in-year and negotiations are being finalised to maintain this to the end of the financial year.

Overall demand across YAS is higher than plan, but for Kirklees it is actually below plan for both December and YTD. Total demand for December: YAS +6.2%; Kirklees -0.2% Total demand YTD at end December: YAS +1.0%, Kirklees -1.5%

Reasons for Variance and Actions Taken:

NHS Kirklees work to support YAS continues: Frequent callers – · Work is being led by the Community Matrons to lesson the numbers of calls from frequent callers. · Working closely with Annette Strickland from YAS · Successfully reducing the numbers of calls from individuals and care homes · Initial work from Kirklees is being picked up by other areas across YAS area (Leeds, Wakefield etc). E.g. patients on Community Matron caseload that have potential to be frequent callers have an agreed Emergency Care Plan, kept at their homes, that paramedics know to ask for and which sets out alternative emergency management arrangements (i.e. other than transport to A&E).

Performance Improvement Project · Project team formed (Kirklees, Calderdale and YAS) – focus on geographical areas with regularly worst YAS performance · Project plan being updated, work in progress collecting data/information. · Also addressing Turnaround and Community Paramedics (via project re-evaluation, changes necessary, etc.)

Turnaround – HRI – audit undertaken, Plan/Do/Study/Act review and service improvement work underway with A&E and YAS staff DDH – work initiated via NHS Wakefield District (lead Commissioner for MYHT) – ToRs include DDH.

Planned Latest Variance (8) (9) Comments (value) YTD Percentage of category A calls resulting in an emergency response arriving at the scene of the incident within 8 minutes. YAS Monthly Performance mapped against local trajectory Dec 08 31-Dec-2008 75 65 -10 Percentage of category A calls resulting in an emergency response arriving at the scene of the incident within 8 minutes. YAS Performance Year to Date (AHC Measure) Dec 08 31-Dec-2008 75 68 -7 YTD performance for YAS - this is the Percentage of category A calls resulting in an emergency response arriving at the scene of the incident within 8 minutes. NHS Kirklees Monthly Performance mapped against YAS Dec 08 31-Dec-2008 55.1 YAS in-month performance 65.0% Percentage of category A calls resulting in an emergency response arriving at the scene of the incident within 8 minutes. NHS Kirklees Performance Year to Date Dec 08 31-Dec-2008 62.1 YAS YTD performance 68.0%

PI

Due Date

KA34 ambulance services (financial year 2008/2009 This indicator measures performance in response to category A calls. The Department of Health's requirement is that a minimum of seventy five per cent of category A calls (defined as ""immediately life-threatening"") should receive an emergency response at the scene of the incident within eight minutes.

All PCTs will be aware that from 1 April 2008 the ""clock"" for measuring the response times standards starts from the connection of the call to the ambulance control room, a change which formed one of the recommendations of the report 'Taking Healthcare to the Patient'. This will ensure that the measurement of the response time is aligned with the caller’s experience and lead to greater consistency between trusts in how the standards are measured. The change will make the response time standards more difficult to achieve, and the impact will be greatest for the category A 8 minute measure. It is expected that PCTs and ambulance trusts will have been working together and will have jointly agreed their strategy for achieving this.

HC - 18th June 2008

Page 11 of 79 © Dynamic Change Limited 2009 Performance Report - Existing Commitments

8 February 2009

Performance Report - Existing Commitments EC04: All ambulance trusts to respond to 95 percent of Category B calls within 19 minutes Accountability Period (1) (4) 31-Dec-2008 EC04: All ambulance trusts to respond to 95 percent of Category B calls within 19 minutes Rachel Carter Owner Carol Mckenna Sponsor Category B performance has deteriorated in December. Please also refer to Cat A target report.

April performance for YAS against the target of 95% response within 19 minutes from call connect was 89.9% against a trajectory of 90.4%.

May performance was 89.6% against a trajectory of 90.7% (YTD performance 89.7%) June performance was 89.6% against a trajectory of 91.0% (YTD performance 89.6%) Current July performance was 90.7% against a trajectory of 91.3% (YTD performance 89.9%).

August performance was 92.1% against a trajectory of 92.2% (YTD performance 90.3).

Concerns: September performance was 92.9% against a trajectory of 92.2% (YTD performance 90.8%).

October performance was 90.7% against a trajectory of 92.2% (YTD performance 90.7%).

November performance was 91.0% against a trajectory of 92.2% (YTD performance 90.8%).

December performance was 86.9% against a trajectory of 92.2% (YTD performance 90.3%).

Performance within Kirklees area for December was 81.1% (November 86.5%).

See Cat A 8 minute report.

Reasons for Planned Latest Variance (8) (9) Comments (value) YTD The percentage of category B calls resulting in an emergency response arriving at the scene of the incident within 19 minutes YAS YTD performance (HC indicator) Dec 08 31-Dec-2008 95 90.3 -4.7 PI

Due Date

KA34 ambulance services (financial year 2008/2009) This indicator measures performance in response to category B calls. The Department of Health's requirement is that a minimum of ninety five per cent of all category B calls (defined as ""serious but not immediately life-threatening"") should receive an emergency response at the scene of the incident within 19 minutes.

All PCTs will be aware that from 1 April 2008 the ""clock"" for measuring the response times standards starts from the connection of the call to the ambulance control room, a change which formed one of the recommendations of the report 'Taking Healthcare to the Patient'. The change will make the response time targets more difficult to achieve, but the change in relation to the category B 19 minute target will have a considerably lesser impact than for the category A 8 minute measure, and therefore should not result in a significant change in reported levels of performance HC - 18th June 2008

Š Dynamic Change Limited 2009 Performance Report - Existing Commitments

Page 12 of 79

EC03: All ambulance trusts to respond to 75 percent of Category A calls within 8 minutes Percentage of category A calls resulting in an emergency response arriving at the scene of the incident within 8 minutes. YAS Monthly Performance mapped against local trajectory PI

Apr 08

May 08

Jun 08

Jul 08

Aug 08

Sep 08

Oct 08

Nov 08

Dec 08

Jan 09

PI Target TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual Name 59.2 61.3 62.9 63.8 66.8 63 70.2 67.03 74.2 71.36 75 76.2 77.5 72.13 77 72 75 65 77 Percentag e of

Feb 09 TRG

Mar 09 Actual

76.5

TRG

Actual

77.8

Percentage of category A calls resulting in an emergency response arriving at the scene of the incident within 8 minutes. YAS Performance Year to Date (AHC Measure) PI

Apr 08

May 08

Jun 08

Jul 08

Aug 08

Sep 08

Oct 08

Nov 08

Dec 08

Jan 09

Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual PI Target TRG Name 75 61.3 75 62.6 75 62.7 75 63.9 75 65.4 75 67.3 75 68 75 68.5 75 68 75 Percentag e of

Feb 09 TRG

Mar 09 Actual

TRG

75

Actual 75

EC04: All ambulance trusts to respond to 95 percent of Category B calls within 19 minutes The percentage of category B calls resulting in an emergency response arriving at the scene of the incident within 19 minutes PI

Apr 08

May 08

Jun 08

Jul 08

Aug 08

Sep 08

Oct 08

Nov 08

Dec 08

Jan 09

PI Target TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual Name 95 89.9 95 89.7 95 89.6 95 89.9 95 90.3 95 90.8 95 90.7 95 90.8 95 90.3 95 The percentag

Page 13 of 79

Feb 09 TRG

Mar 09 Actual

95

TRG

Actual 95

8 February 2009

Performance Report - Existing Commitments EC05: All patients who need them, to have access to crisis services with delivery of 100,000 new crisis resolution home Accountability Period (1) (4) 31-Jan-2009 EC05: All patients who need them, to have access to crisis services with delivery of 100,000 new Vicky Dutchburn Owner Carol Mckenna Sponsor Ongoing work with South West Yorkshire Mental Health Trust (SWYMHT) to try to meet the Intensive Home Key Base Treatment (IHBT) trajectories.

Achievements The Trust, in partnership with its commissioners, has already worked hard to meet required targets.

Since Last Additional IHBT episodes are been reported & there continues to be a positive move towrads the final Report: trajectory .

Current Concerns:

At this stage it is not expected that the final trajactory can be achieved by year end. ongoing progress and review of the agreed action plan will be monitored on a monthly basis through the monthly contract meetings.

Reasons for Variance and Actions Taken:

The proposed Action Plan covers: -Data collection; To continue to review/refine assessment and treatment codes on RiO ,To set up additional ‘crisis centre location codes’ To increase the focus on the timely recording of discharge on RiO,To record the activity of all practitioners involved in joint visits.

-Review of practice; To continue to explore the potential for community clinical teams (e.g. AOT, CMHTs) referring to the Crisis Teams when supporting the delivery of more clinically intensive care.To explore the potential of undertaking additional face to face contacts within the care pathway -Delivery of ageless services;To explore how work within current older peoples services could be included in IHBT figures.

-General; To liaise with organisations currently meeting trajectories to share best practice.

Planned Latest Variance (8) (9) Comments (value) YTD Number of separate episodes of home treatment provided by crisis resolution teams Dec 08 31-Dec-2008 850 564 -286 Number of separate episodes of home treatment provided by crisis resolution teams as a percentage of allocated national target Dec 08 31-Dec-2008 100 66.35 -33.65

PI

Due Date

Percentage of separate episodes of home treatment provided by crisis resolution teams of allocated national target Dec 08

31-Dec-2008

9999

66.3529

-9932.65

Department of Health Vital Signs Returns (financial year 2008/2009) Healthcare Commission special data collection (financial year 2008/2009) Crisis resolution services provide intensive support in the home for people in mental health crisis. The Priorities and Planning Framework (2003-2006) set out the following national target: 'Offer 24-hour crisis resolution to all eligible patients by 2005'. This target was based on the NHS Plan (2000) which envisaged 100,000 people being treated by crisis resolution/home treatment services each year once services were fully implemented. As set out in the 2008/2009 Operating Framework, each PCT is required in each year after the target date to continue to deliver its allocated share of the 100,000 HC - 18th June 2008

© Dynamic Change Limited 2009 Performance Report - Existing Commitments

Page 14 of 79

EC05: All patients who need them, to have access to crisis services with delivery of 100,000 new crisis resolution home treatment episodes each year

Number of separate episodes of home treatment provided by crisis resolution teams PI

Apr 08

PI Target TRG Actual Name 100

May 08 TRG

Jun 08 Actual

100

TRG 850

Jul 08 Actual 127

TRG

Aug 08 Actual

100

TRG

Sep 08 Actual

100

TRG 850

Oct 08 Actual 253

TRG

Nov 08 Actual

100

TRG

Dec 08 Actual

100

TRG 850

Jan 09 Actual

TRG

564

Feb 09 Actual

TRG

100

Mar 09 Actual

100

TRG

Actual

850

Number of separate episodes of home treatment provided by crisis resolution teams as a percentage of allocated national target PI

Apr 08

Actual PI Target TRG Name 100

May 08 TRG

Jun 08 Actual

100

TRG 100

Jul 08 Actual 14.9

TRG

Aug 08 Actual

100

TRG

Sep 08 Actual

100

TRG 100

Oct 08 Actual 29.76

TRG

Nov 08 Actual

100

TRG

Dec 08 Actual

100

TRG 100

Jan 09 Actual

TRG

66.35

Mar 09

Feb 09 Actual

100

TRG

Actual

100

TRG

Actual

100

Percentage of separate episodes of home treatment provided by crisis resolution teams of allocated national target PI

Apr 08

Actual PI Target TRG Name 9999

May 08 TRG 9999

Jun 08 Actual

TRG 9999

Jul 08 Actual

TRG 9999

Aug 08 Actual

TRG 9999

Sep 08 Actual

TRG 9999

Oct 08 Actual 29.76

TRG

Nov 08 Actual

9999

Page 15 of 79

TRG 9999

Dec 08 Actual

TRG 9999

Jan 09 Actual 66.35

TRG 9999

Mar 09

Feb 09 Actual

TRG 9999

Actual

TRG 9999

Actual

8 February 2009

Performance Report - Existing Commitments EC06: Deliver 7,500 new cases of psychosis served by early intervention teams per year Accountability Period (1) (4) 31-Dec-2008 EC06: Deliver 7,500 new cases of psychosis served by early intervention teams per year Vicky Dutchburn Owner Carol Mckenna Sponsor For year 2 (Financial Year(FY) 08/09), the trajectory identifies total case load of 128, with 96 new cases – a Key higher delivery rate than the required 64, Full Year Investment into Southwest Yorkshire Mental Health Trust Achievements (SWYMHT)has ensured that this is achievable. The balance of the trajectory of 191 will be achieved in year 3 Since Last of the commissioning plan (FY 09/10), with a guaranteed delivery date by December 2010, though SWYMHT Report: are working to an anticipated delivery date of End September 2010.

New cases are currently been identified to achieve the target as defined. However, this is been monitored Current monthly as the incidence rate & associated targets are based on a 3 year prevelance & the stretch target may Concerns: prove to be excessive.

Reasons for Increased promotion of the service, including inclusion criteria is ongoing within the Kirklees community, across health, social care & other professionals, including police & schools etc.

Variance and Planned Latest Variance (8) (9) Comments (value) YTD Number of people with newly diagnosed cases of first episode psychosis receiving early intervention in psychosis services Qtr 3 08/09 31-Dec-2008 128 89 -39 Percentage of people with newly diagnosed cases of first episode psychosis receiving early intervention in psychosis services Qtr 3 08/09 31-Dec-2008 9999 69.5313 -9929.469

PI

Due Date

Department of Health Vital Signs Returns (financial year 2008/2009)

Psychosis is a debilitating illness with far-reaching implications for the individual and his/her family. It can affect all aspects of life education and employment, relationships and social functioning, physical and mental wellbeing. Without support and adequate care, psychosis can place a heavy burden on carers, family and society at large. The mean age of onset of psychotic symptoms is 22 with the vast majority of first episodes occurring between the ages of 14 and 35. The onset of this disease is therefore often during a critical period in a person’s development.

Early treatment is crucial because the first few years of psychosis carry the highest risk of serious physical, social and legal harm. One in ten people with psychosis commits suicide - two thirds of these deaths occur within the first five years of illness.

Intervening early in the course of the disease can prevent initial problems and improve long-term outcomes. If treatment is given early in the course of the illness and services are in place to ensure long-term concordance (co-operation with treatment), the prospect for recovery is improved. There is evidence that early intervention can be helpful in reducing suicidal behaviour.

Early intervention in psychosis services provide quick diagnosis of the first onset of a psychotic disorder and appropriate treatment including intensive support in the early years. A fully operational early intervention service typically serves a total of 450 people, but the caseload builds up over a 3-year period. (The service covers a population of 1 million, in that population there would be expected to be 150 new cases per year, and each person who is taken on by an early intervention service will remain on the books for 3 years.) As set out in the 2008/2009 NHS Operating Framework, each PCT is required to continue to deliver its locally agreed share of the 7,500 people to be taken on as new cases by early intervention services throughout England.

HC - 18th June 2008

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8 February 2009

Performance Report - Existing Commitments EC07: Data quality on ethnic group Accountability EC07: Data quality on ethnic group Owner Helen Bridges Sponsor Peter Flynn Key Achievements Since Last Report:

Period (1) (4) 31-Dec-2008

Performance at 32 2008/2009 remains above the stretch target of 90%.

PI Due Date Planned Latest Variance (8) (9) Comments Percentage of care spells for inpatients (bed days greater than 0) recorded for the PCT (commissioner basis) on

Qtr 3 08/09

31-Dec-2008

90

95.88

5.88

The Q3 indicative position is 95.88%.

Cumulative performance reported as at November 2008 is 94.35%. Please note that this information is unvalidated and is likely to change once national freeze dates have passed. Last updated January 2009

Percentage of Finished Consultant Episodes (FCEs) for the PCT (commissioner basis) on Hospital Episode Statistics The Q3 indicative position is 94.12%.

Cumulative performance reported as at November 2008 is 93.80%. Please note that this information is unvalidated and is Qtr 3 08/09 31-Dec-2008 90 94.12 4.12 likely to change once national freeze dates have passed. Last updated January 2009

Hospital episodes statistics (April 2008 to December 2008) In order to monitor the reduction of health inequalities related to ethnic diversity, it is essential that data sources used for this purpose include adequate information on ethnic group. This indicator underpins local and national monitoring of performance against the target. Service planning and delivery must be appropriate for the needs of local communities to reduce barriers to healthcare. Data should be used to monitor if there are unequal outcomes between different ethnic groups, and public authorities have a statutory obligation to promote greater equality and to prevent direct and indirect discrimination. In addition to providing crucial information to support individualised patient care which takes account of the different risks of disease and the cultural appropriateness of services, good quality data on patient ethnicity are essential at a population level for service planning and to monitor progress on health inequalities across ethnic group.

HC - 18th June 2008

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EC07: Data quality on ethnic group Percentage of care spells for inpatients (bed days greater than 0) recorded for the PCT (commissioner basis) on Mental Health Minimum Data Set (MHMDS) with valid 2001 census coding for ethnic category (excluding 'not stated' and 'not known').

PI

Apr 08

May 08

Jun 08

PI Target TRG Actual TRG Actual Name EC07: Data quality on ethnic group

TRG

Jul 08 Actual

90

TRG

Aug 08 Actual

TRG

Sep 08 Actual

TRG

94.58

Oct 08 Actual

90

TRG

Nov 08 Actual

TRG

Dec 08 Actual

TRG

92.58

Jan 09 Actual

90

TRG

Feb 09 Actual

TRG

Mar 09 Actual

TRG

95.88

Actual

90

Percentage of Finished Consultant Episodes (FCEs) for the PCT (commissioner basis) on Hospital Episode Statistics (HES) data with valid 2001 PI

Apr 08

PI Target TRG Name

May 08 Actual

TRG

Jun 08 Actual

TRG

Jul 08 Actual

90

93.71

TRG

Aug 08 Actual

TRG

Sep 08 Actual

TRG

Oct 08 Actual

90

TRG

Nov 08 Actual

93.71

Page 18 of 79

TRG

Dec 08 Actual

TRG

Jan 09 Actual

90

94.12

TRG

Mar 09

Feb 09 Actual

TRG

Actual

TRG

Actual 90

8 February 2009

Performance Report - Existing Commitments EC08: Delayed transfers of care to be maintained at a minimal level Accountability Period (1) (4) EC08: Delayed transfers of care to be maintained at a minimal level 30-Jun-2008 Lesley Delaney Owner Sponsor Jim Barwick Robust systems and processes established between the PCT and the Delayed Discharge Teams within the Key local acute trusts.

Achievements PI Due Date Planned Latest Varianc (8) (9) Comments Percentage of patients occupying an acute hospital bed whose transfer of care was delayed Jun 08

30-Jun-2008

0

0.1

0.1

Total number of patients occupying an acute hospital bed - 658, the number of patients with delayed discharge - 1.

Not yet finalised This indicator measures the impact of community-based care in facilitating timely discharge from hospital and the mechanisms in place within the hospital to facilitate timely discharge. People should receive the right care in the right place at the right time and primary care trusts must ensure, with acute trusts and social services partners, that people move on from the acute environment once they are safe to transfer. The Community Care (Delayed Discharges, etc) Act 2003 facilitates joint working with social services and requires partners to identify the causes of delay, and implement the actions required to tackle delays within their local system. Although this is an all adult indicator the vast majority of those delayed are patients aged over 75 years.

The 2008/2009 NHS Operating Framework reiterates that this target should continue to be maintained.

HC - 18th June 2008

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8 February 2009

Performance Report - Existing Commitments EC09: 100 percent of people with diabetes to be offered screening for the early detection (and treatment if needed) of diabetic retinopathy Accountability Period (1) (4) EC09: 100 percent of people with diabetes to be offered screening for the early detection (and 31-Jan-2009 treatment if needed) of diabetic retinopathy James Williams Owner Judith Hooper Sponsor Key The PCT has been able to complete installation of DRS management software in new screening sites.

Achievements Contracting team are putting in place SLA's with Acute providers to ensure they comply with NSC requirements Since Last Connectivity issues between the new screening sites and the new DRS server managed by the THIS have Current delayed transfer of patient call and recall systems to new software system that was due in February 2008. This Concerns: will cause additional costs for dual use of DRS systems to be incurred.

Reasons for Have liaised with the THIS project manager and informed PCT primary care manager of the issues.

Appropriate representation has been made to THIS to resolve this matter ASAP Variance and Planned Latest Variance (8) (9) Comments (value) YTD Percentage of patients with diabetes identified by practices in the PCT who where offered screening The number of people with diabetes offered screening for the early detection (and treatment if needed) of diabetic retinopathy The numbers offered screening 15,765.

The numbers excluded from screening 1,442. The numbers receiving screening 100 100 0 Sep 08 30-Sep-2008 12,132. The total numbers on the register 17,207 PI

Due Date

Vital Signs returns (financial year 2008/09 (quarters 1 to 4))

National Standards, Local Action (Department of Health, 2004) states that by March 2006 a minimum of 80% of people with diabetes are to be offered screening for the early detection (and treatment if needed) of diabetic retinopathy over the preceding 12 months as part of a systematic programme that meets national standards, rising to 100% coverage of those at risk of retinopathy by December 2007.

The operating framework for the NHS in England 2008/09 states that many PCTs need to redouble their efforts to ensure delivery of the existing commitment, so that all people with diabetes are offered screening for early detection (and treatment if necessary) of diabetic retinopathy. Where PCTs are failing to deliver this standard, they should agree recovery plans with their SHAs to ensure improvement.

Additional information Screening must be to national standards. The screening test must be digital photography. For further details on the national standards and what can be counted towards the diabetic retinopathy screening target, please follow the link to: http://www.nscretinopathy.org.uk/.

There are some people who will choose to opt out of screening or will not benefit from the offer of screening. Detailed information on whether or not individuals properly fall within the groups of people who can legitimately be excluded from the screening programme can be found in the document ""Excluding patients from the NHS diabetic retinopathy screening programme temporarily or permanently"" available on the website: http://www.nscretinopathy.org.uk/.

HC - 14th January 2009

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8 February 2009

Performance Report - Existing Commitments EC10: A maximum wait of 26 weeks for in-patients appointments Accountability Period (1) (4) 31-Dec-2008 EC10: A maximum wait of 26 weeks for in-patients appointments Rachel Carter Owner Carol Mckenna Sponsor Key The current waiting time guarantee for inpatient treatment is 26-weeks. The PCT has breached this limit on 22 occasions (to end of December) in 2008/09. There were five additional breaches during December, 3 in Achievements plastics and 2 in Neurosurgery. Four of these five patients had TCI dates in January.

Since Last Current expectation is a further 6 breaches in January.

Current Previous Breaches (all at LTHT): December - 4 (2 Plastics, 2 Neuro). November - 4 (2 Plastics, 2 Neuro).

October - 1 (Plastics). September - 2 (1 Plastics, 1 Neuro). August - 1 (Plastics). July - 2 (Neurosurgery).

Concerns: June - 2 (Neurosurgery). May - 3 (Neurosurgery). April - 2 (Neurosurgery) LTHT performance is affecting a number of PCTs across Y&TH and is being picked up collectively, both at Chief Executive level and via SCG. Leeds PCT has advised overall position for LTHT for January as: Plastic Surgery 15 x 26 weeks outpatient breaches Neurosurgery 34 x 26 weeks outpatient breaches Reasons for Leeds PCT has met with the plastic surgeons positive meeting, confirming strategic intent to enhance plastic Variance and surgery within Leeds Health Economy and that a capacity review is being firmed up within LTHT. Actions Taken: In the meantime some positive discussions were held to reduce the current risk of breaches, which includes finding more capacity wherever possible and further clinical triage.

There have been issues with obtaining timely and reliable information from LTHT and/or Leeds PCT and parties are working to address these.

In spite of repeated assurances from LTHT there are still concerns about possible further breaches taking place in January to March. The SHA has now confirmed that (contrary to our previous understanding) it has not agreed a trajectory for reduction in 26 week breaches with LTHT. PI Due Date Planned Latest Variance (8) (9) Comments Number of inpatients waiting 26 weeks or more at the date of measurement Dec 08 31-Dec-2008 0 22 -22 Percentage of inpatients waiting 26 weeks or more at the date of measurement

Monthly activity return (financial year 2008/2009) Public consultation prior to the production of the NHS Plan indicated that the public wanted to see reduced waiting times in the NHS. The NHS Plan (July 2000) set out the goal that from December 2005 the maximum wait for inpatient treatment is 26 weeks. Urgent cases would continue to be treated in accordance with clinical need.

The implementation of the 18-week referral to treatment target has subsequently become the most important waiting time priority for the NHS, however, this indicator remains as an existing commitment to be maintained.

HC - 18th June 2008

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EC10: A maximum wait of 26 weeks for in-patients appointments PI

Apr 08

May 08

Jun 08

Jul 08

Aug 08

Sep 08

Oct 08

Nov 08

Dec 08

Jan 09

PI Target TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual Name Number 0 2 0 5 0 7 0 9 0 10 0 12 0 13 0 17 0 22 0 of

Page 22 of 79

Feb 09 TRG

Mar 09 Actual

0

TRG

Actual 0

8 February 2009

Performance Report - Existing Commitments EC11: A maximum wait of 13 weeks for an outpatient appointment Accountability Period (1) (4) 31-Dec-2008 EC11: A maximum wait of 13 weeks for an outpatient appointment Rachel Carter Owner Carol Mckenna Sponsor There was one further 13 week breach (Neurosurgery) at LTHT in December.

Current There were 0 breaches in November, 2 in October, 3 in September, 2 in August, 3 in July, 3 in June, 0 in May, Concerns: 0 in April. All breaches have been in Neurosurgery.

PI Due Date Planned Latest Variance (8) (9) Comments Numbers of outpatients waiting 13 weeks or more at the date of measurement Cumulative YTD Dec 08 31-Dec-2008 0 14 -14 Percentage of outpatients waiting 13 weeks or more at the date of measurement

Monthly monitoring return (financial year 2008/2009) Public consultation prior to the production of the NHS Plan indicated that the public wanted to see reduced waiting times in the NHS. The NHS Plan (July 2000) sets out the goal that from December 2005 the maximum wait for an outpatient appointment is 13 weeks. Urgent cases would continue to be treated in accordance with clinical need.

The implementation of the 18-week referral to treatment target has subsequently become the most important waiting time priority for the NHS, however this indicator remains as an existing commitment to be maintained.

HC - 18th June 2008

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EC11: A maximum wait of 13 weeks for an outpatient appointment PI

Apr 08

May 08

Jun 08

Jul 08

Aug 08

Sep 08

Oct 08

Nov 08

Dec 08

Jan 09

PI Target TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual Name Numbers 0 0 0 0 0 3 0 6 0 8 0 11 0 13 0 13 0 14 0 of

Page 24 of 79

Feb 09 TRG

Mar 09 Actual

0

TRG

Actual 0

8 February 2009

Performance Report - Existing Commitments EC12: Three month maximum wait for revascularisation Accountability EC12: Three month maximum wait for revascularisation Owner Sara Fletcher Carol Mckenna Sponsor Key Achievements Still achieving target.

Since Last Report: Current None Concerns: Reasons for Variance and Actions Taken:

Period (1) (4) 31-Aug-2008

N/A

Planned Latest Variance (8) (9) Comments (value) YTD Number of patients waiting greater than 13 weeks for CABGs Aug 08 31-Aug-2008 0 0 0 Number of patients waiting greater than 13 weeks for PTCAs. Aug 08 31-Aug-2008 0 0 0 Percentage of patients waiting less than 13 weeks for PTCAs or CABGs Aug 08 31-Aug-2008 0 0 0

PI

Due Date

Monthly monitoring return (financial year 2008/2009) The National Service Framework for Coronary Heart Disease states that there is good evidence that many people with atheromatous plaques and narrowed coronary arteries can have their symptoms relieved and/or their risks of dying reduced by restoring blood flow through blocked coronary arteries - revascularisation. The Government target was to deliver a maximum wait of three months for revascularisation by March 2005.

Data are now collected in weekly timebands, and hence 13 weeks is now used in this indicator.

HC - 18th June 2008

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8 February 2009

Performance Report - Existing Commitments EC13: Thrombolysis “call to needle” of at least 68 percent within 60 minutes, where thrombolysis is the preferred local treatment for heart attack Accountability Period (1) (4) EC13: Thrombolysis “call to needle” of at least 68 percent within 60 minutes, where thrombolysis is 31-Aug-2008 the preferred local treatment for heart attack Owner Sara Fletcher Carol Mckenna Sponsor Key Primary Angioplasty now performed on the majority of MI patients, very few patients are requiring thrombolysis.

Achievements Less than 5 done this year to date.

Since Last Due to the small number undertaken, any breaches in the 60 minute call to needle target are more likely to result in the PCT not meeting our overall target that 'at least 68% of patients receiving thrombolysis should receive it Current within 60 minutes'.

Concerns: That those patients receiving thrombolysis have incured delays whilst being considered for Primary Angioplasty and have not met the 60 minute call to needle target.

The West Yorkshire Cardiac Network is closely monitoring the situation and working with the DoH to develop Reasons for targets for PCT's who have implimented Primary Angioplasty.

Despite the delays incurred as a result of patients being considered for Primary Angioplasty, the PCT is still Variance and achieving above the national average.

Actions Taken: Current figures for this year to date predict we will achieve the 68% target.

Planned Latest Variance (8) (9) Comments (value) YTD % of eligible patients with acute myocardial infarction receiving thrombolysis treatment either by injection or by infusion within 60 minutes of calling for professional help Aug 08 31-Aug-2008 68 100 32 not yet validated PI

Due Date

Myocardial Ischaemia National Audit (financial year 2008/09) Cardiovascular disease (CVD) is a preventable disease that kills nearly 198,000 people in the UK every year. Approximately half of all deaths from CVD are from coronary heart disease and more than a quarter are from stroke. The Government is committed to reducing the death rate from coronary heart disease and stroke and related diseases in people under 75 by at least 40% (to 83.8 deaths per 100,000 population) by 2010.

There are two treatment strategies for heart attacks, thrombolysis and primary angioplasty. To date the majority of patients have been treated using thrombolysis although this is increasingly changing as a result of a wider use of primary angioplasty to treat heart attack patients. Currently, 22% of all eligible patients are treated using primary angioplasty.

The key to improving outcomes after heart attack is to re-establish coronary artery flow as quickly as possible and limit damage to the heart muscle.

Thrombolysis, or treatment with thrombolytic drugs, helps reverse the effects of a heart attack by lysing blood clots blocking the coronary artery and returning blood supply to the affected part of the heart again. Thrombolytic treatment can be given up to twelve hours after the onset of t of a heart attack but it is most effective when given within the first two hours. The CHD National Service Framework sets a standard to a thrombolysis to all eligible patients within one hour of calling for professional help (60 minute call to needle).

HC -24th October 2008 HC - 18th June 2008

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8 February 2009

Performance Report - Existing Commitments EC14: 4-hour maximum wait in A&E from arrival to admission, transfer or discharge as per QMAE quarterly return and HCC mapping Accountability Period (1) (4) EC14: 4-hour maximum wait in A&E from arrival to admission, transfer or discharge as per QMAE 30-Sep-2008 quarterly return and HCC mapping Owner Jim Barwick Sponsor Carol Mckenna Please refer to the weekly report EC01a 4-hour maximum wait in A&E from arrival to admission, transfer or discharge for the latest key acheivements, current concerns, reasons for variance and actions taken. The Key figures on this accountability are per the Health Care Commission Guidance and represent the figures they will Achievements use taken from the statutory report "Quarterly Monitoring Accident & Emergency" report to rate NHS Kirklees.

Since Last As we have two acute hospitals within our geographic boundary based on historic costed activity our Report: performance is based on 54% of MYHT activity and 46% of CHfT activity as well as including 100% of KCHS Walk In Centre activity Planned Latest Variance (8) (9) Comments (value) YTD 1. Year to date percentage of patients spending four hours or less in all types of A&E department AHC measure as per Health Care Commission mapping Based on 54% MYHT and 46% CHfT and 100% of WIC activity. Excludes 187 Sep 08 30-Sep-2008 98 97.2558 -0.7442 patients where no time recorded from both numerator and denominator 2. Year to date percentage of patients spending four hours or less in all types of A&E department - MYHT Excludes 3 patients where no time Sep 08 30-Sep-2008 98 96.1064 -1.8936 recorded from both numerator and denominator 3. Year to date percentage of patients spending four hours or less in all types of A&E department - CHfT Excludes 184 patients where no time Sep 08 30-Sep-2008 98 98.219 0.219 recorded from both numerator and denominator 4. Year to date percentage of patients spending four hours or less in all types of A&E department - Walk In Centre Sep 08 30-Sep-2008 98 100 2 PI

Due Date

QMAE quarterly return (financial year 2008/2009) The NHS targets for 2003-2005 required that trusts ensure that, from January 2005 onwards, at least 98% of patients spend four hours or less in any type of A&E from arrival to admission, transfer or discharge. The NHS Operating Framework for 2008/2009 reiterates that this standard should continue to be maintained and notes that the Healthcare Commission would continue to assess trusts' performance. PCTs will be assessed on their commissioning of A&E services and on any A&E services they may provide, such as minor injuries units and Walk-In Centres.

With an increasing number of PCTs commissioning Walk-In Centres and minor injuries units from the independent sector and recognising the role of commuter walk in centres, it is expected that the QMAE data collection will include performance in these centres where appropriate, subject to approval. We expect to be able to provide an update on this later in the year.

Concerns have emerged that in some trusts guidelines relating to the start time of the clock for the four-hour measure may not be being strictly adhered to, particularly where queues of ambulances outside A&E are occurring. Commissioning PCTs will be expected to identify such practices and take steps to address it. The Healthcare Commission operates a principle of maintaining the highest data quality and where it is found that this is not the case the standard penalties will be invoked.

HC - 18th June 2008

Page 27 of 79 Š Dynamic Change Limited 2009 Performance Report - Existing Commitments

EC14: 4-hour maximum wait in A&E from arrival to admission, transfer or discharge as per QMAE quarterly return and HCC mapping 1. Year to date percentage of patients spending four hours or less in all types of A&E department AHC measure as per Health Care Commission mapping PI

Apr 08

PI Target TRG Name

May 08 Actual

TRG

Jun 08 Actual

TRG

Jul 08 Actual

98

TRG

Aug 08 Actual

TRG

Sep 08 Actual

TRG

96.63

Oct 08 Actual

98

TRG

Nov 08 Actual

TRG

Dec 08 Actual

TRG

97.26

Jan 09 Actual

TRG

Feb 09 Actual

TRG

Mar 09 Actual

TRG

98

Actual 98

2. Year to date percentage of patients spending four hours or less in all types of A&E department - MYHT PI

Apr 08

PI Target TRG Name

May 08 Actual

TRG

Jun 08 Actual

TRG

Jul 08 Actual

98

TRG

Aug 08 Actual

TRG

Sep 08 Actual

TRG

95.17

Oct 08 Actual

98

TRG

Nov 08 Actual

TRG

Dec 08 Actual

TRG

96.11

Jan 09 Actual

TRG

Mar 09

Feb 09 Actual

TRG

Actual

TRG

98

Actual 98

3. Year to date percentage of patients spending four hours or less in all types of A&E department - CHfT PI

Apr 08

PI Target TRG Name

May 08 Actual

TRG

Jun 08 Actual

TRG

Jul 08 Actual

98

TRG

Aug 08 Actual

TRG

Sep 08 Actual

TRG

97.98

Oct 08 Actual

98

TRG

Nov 08 Actual

TRG

Dec 08 Actual

TRG

98.22

Jan 09 Actual

TRG

Feb 09 Actual

TRG

Mar 09 Actual

TRG

98

Actual 98

4. Year to date percentage of patients spending four hours or less in all types of A&E department - Walk In Centre PI

Apr 08

PI Target TRG Name 4.

Year to

May 08 Actual

TRG

Jun 08 Actual

TRG

Jul 08 Actual

98

100

TRG

Aug 08 Actual

TRG

Sep 08 Actual

TRG

Oct 08 Actual

98

TRG

Nov 08 Actual

TRG

Dec 08 Actual

100

TRG 98

date

Page 28 of 79

Feb 09

Jan 09 Actual

TRG

Actual

TRG

Mar 09 Actual

TRG

Actual 98

8 February 2009

Performance Report - Existing Commitments EC14A: 4-hour maximum wait in A&E from arrival to admission, transfer or discharge (Weekly for KPCT) Accountability Period (1) (4) EC14A: 4-hour maximum wait in A&E from arrival to admission, transfer or discharge (Weekly for 18-Jan-2009 KPCT) The NHS target requires that at least 98% of patients spend four hours or less in any type of A&E from arrival to admission, Jim Barwick Owner Carol Mckenna Sponsor The 4 hour standard performance for NHS Kirklees has improved very slightly however the fluctuations in performance in reality means performance as a whole has remained static. During the end of December and January there have been significant challenges at all acute trust with high levels of A&E attendance, emergency admissions and ward closed due to infection. Performance at Calderdale and Huddersfield Key Foundation Trust has improved significantly, however the Huddersfield site remains the most fragile. The Achievements performance position at Mid Yorkshire Hospital Trust is less favourable and is particularly an issue at Since Last Pinderfields. However performance over the last tow weeks of January at all MYHT sites has been exceptional Report: with occasional breaches. Unfortunately MYHT are no longer able to achieve an end of year position of 98%.

We continue to work with MYHT on the ‘Aiming for excellence’ action plan. We have introduced a GP and nurse minors stream to A&E at Dewsbury which is supporting delivery of the 4 hour standard, this will be enhanced in the coming weeks.

Current Concerns:

Reasons for Variance and Actions Taken:

Performance at MYHT and whether this can improve despite the various actions taken by the trust and the PCT to improve performance. The main issues relate to bed waits as apposed to high attendance rates.

Sustaining performance at CHFT in order that this compensates for poor performance at MYHT and gives an overall NHS Kirklees position of 98% or over.

All actions taken are to support and maintain the delivery of the 4 hour standard whilst improving quality of care and the experience for the people of Kirklees. For MYHT there is a full and comprehensive actions plan we has been ratified by external support. We are working on our commissioning intensions in relation to the new Out of Hours contract, improved ambulance service delivery and implications of equitable access to maintain and exceed the 4 hour standard. A facilitated workshop to this effect will be held on the 24th February.

At Dewsbury Hospital we have put in place a primary care led service to see patients with simple complaints, this is being further enhanced. We are implementing a similar service at Huddersfield Royal Infirmary. Both services having integrated working with both primary care, GPs and A&E departments.

Planned Latest Variance (8) (9) Comments (value) YTD Year to Date percentage of patients spending four hours or less in all types of A&E department This is KPCT year to date percentage based on Health Care Commission mapping of 54% MYHT, 46% of CHfT and 100% of KPCT WIC 11 Jan 09 98 97.46 -0.54 11-Jan-2009 Year to Date Percentage of patients spending four hours or less in all types of A&E department - CHfT This is CHfT performance of which we attribute 46% of actual numbers to KPCT performance 11 Jan 09 98 98.31 0.31 11-Jan-2009 Year to Date Percentage of patients spending four hours or less in all types of A&E department - MYHT This is MYHT performance of which we attribute 54% of actual numbers to KPCT performance 11 Jan 09 98 96.43 -1.57 11-Jan-2009 Year to Date Percentage of patients spending four hours or less in all types of A&E department - Walk In Centre This is KPCT WIC performance of which we attribute 100% of actual numbers to KPCT performance 11 Jan 09 98 100 2 11-Jan-2009 PI

Due Date

© Dynamic Change Limited 2009 Performance Report - Existing Commitments

Page 29 of 79

EC14A: 4-hour maximum wait in A&E from arrival to admission, transfer or discharge (Weekly for KPCT) Year to Date percentage of patients spending four hours or less in all types of A&E department PI

Apr 08

May 08

Jun 08

Jul 08

Aug 08

Sep 08

Oct 08

Nov 08

Dec 08

Jan 09

Feb 09

PI Target TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual Name Year to 98 96.36 98 96.4 98 96.62 98 96.85 98 97.09 98 97.25 98 97.37 98 97.55 98 97.44 98 97.46 98 Date

Mar 09 TRG

Actual 98

Year to Date Percentage of patients spending four hours or less in all types of A&E department - CHfT PI

Apr 08

May 08

Jun 08

Jul 08

Aug 08

Sep 08

Oct 08

Nov 08

Dec 08

Jan 09

Feb 09

Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual PI Target TRG Name 98 97.44 98 98.3 98 98.04 98 98.24 98 98.18 98 98.24 98 98.4 98 98.45 98 98.3 98 98.31 98 Year to Date

Mar 09 TRG

Actual 98

Year to Date Percentage of patients spending four hours or less in all types of A&E department - MYHT PI

Apr 08

May 08

Jun 08

Jul 08

Aug 08

Sep 08

Oct 08

Nov 08

Dec 08

Jan 09

Feb 09

Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual PI Target TRG Name 98 94.55 98 94.61 98 95.12 98 95.39 98 95.85 98 96.08 98 96.22 98 96.51 98 96.41 98 96.43 98 Year to Date

Mar 09 TRG

Actual 98

Year to Date Percentage of patients spending four hours or less in all types of A&E department - Walk In Centre PI

Apr 08

May 08

Jun 08

Jul 08

Aug 08

Sep 08

Oct 08

Nov 08

Dec 08

Jan 09

Feb 09

Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual PI Target TRG Name 98 100 98 100 98 100 98 100 98 100 98 100 98 100 98 100 98 100 98 100 98 Year to Date

Page 30 of 79

Mar 09 TRG

Actual 98

8 February 2009

Performance Report - National Priorities NPA01a: Percentage of patients seen within 18 weeks for admitted and non-admitted pathways (Weekly Unvalidated Data) Accountability Period (1) (4) NPA01a: Percentage of patients seen within 18 weeks for admitted and non-admitted 14-Dec-2008 pathways (Weekly Unvalidated Data)

To ensure that, by December 2008, no one waits more than 18 weeks from referral to the start of hospital treatment or other clinically appropriate outcome (for clinically appropriate patients who choose to start their treatment within 18 weeks).

Owner Sponsor

Jim Barwick Carol Mckenna

Planned Latest Variance (8) (9) Comments (value) YTD Percentage of eligible (*) admitted patients whose adjusted RTT clock stopped during the month who waited 18 weeks or less (<127 days) PI

Due Date

14 Dec 08

14-Dec-2008

90

93.541

3.5412

Percentage of eligible (*) non-admitted patients whose RTT clock stopped during the month who waited 18 weeks or less (<127 days) 28 Dec 08 95 97.154 2.1536 28-Dec-2008

National referral to treatment time data collection (January to March 2009) The NHS improvement plan (June 2004) set out the requirement that, by December 2008, there would be a maximum acceptable waiting time of 18 weeks from referral to start of hospital treatment. Providing fast, convenient access will reduce pain and anxiety for patients and ensure that waiting times for treatment are no longer the major issue for patients and the public. In 2008/2009 trusts will be expected to have achieved, by December 2008, a maximum waiting time of 18 weeks from referral to start of treatment for 90 per cent of admitted patients and 95 per cent of non-admitted patients. Trusts will be assessed on having maintained this performance during the final quarter of the year (January to March 2009). Trusts will also be expected to maintain high levels of data completeness.

HC - 24th July 2008 The NHS Improvement Plan and subsequent PSA targets set out that, by December 2008, no one waits more than 18 weeks from GP referral to the start of hospital treatment or other clinically appropriate outcome (for clinically appropriate patients who choose to start their treatment within 18 weeks).

Reduction of diagnostic waiting times is central to delivering the 18 week pathway.

“No local health system will be credible in claiming success on 18 weeks if it does not make excellent progress in tackling long waiting times affecting large numbers of its local population, including those waits that are technically outside the target.” Extract from the national audiology framework document “Improving Access to Audiology Services in England”, which is available at www.18weeks.nhs.uk.

© Dynamic Change Limited 2009 Performance Report - National Priorities

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8 February 2009

Performance Report - National Priorities NPA01b: Percentage of patients seen within 18 weeks for admitted and non-admitted pathways (Monthly Validated Accountability Period (1) (4) NPA01b: Percentage of patients seen within 18 weeks for admitted and non-admitted 31-Jan-2009 pathways (Monthly Validated Data) To ensure that, by December 2008, no one waits more than 18 weeks from referral to the start of hospital treatment or other clinically appropriate outcome (for clinically appropriate patients who choose to start their treatment within 18 weeks).

Jim Barwick Carol Mckenna

Owner Sponsor

The validated November 2008 data (most recent validated data) position shows 88% Admitted patients treated within 18 weeks and 98% Non admitted treated within 18 weeks. Targets 90 and 95% respectively for December. Recent intelligence suggest that the validated position for the end of December for both acute trusts will be 90% or greater.

Key Achievements Since Last Report:

However looking at the weekly non validated reports for December and January that give a strong indication of validated performance the following can be reported; CHFT have achieved 92.7% performance with MYHT at 87.1%. The Admitted position remains a concern for MYHT but through indications from MYHT and the PCTs own modelling which balances overall performance, it indicates that the 90% admitted target will be sustained for 2009/10 therefore NHS Kirklees meeting the 18 week standard.

Acute Trusts report that they are optimistic that they will achieve the end of December standard.

However moving into 2009 there will still be significant challenges in maintaining the 18 week standard.

Calderdale and Huddersfield Foundation Trust CHFT have given reassurance that they will achieve the standard through January, February and March and this is borne out by current performance.

Current Concerns:

Mid Yorkshire Hospital Trust MYHT have given assurances that they will meet the January standard, however performance will need to improve through January for this to happen. We have seen this happen in December. We continue to work with the Trust to support and monitor the treatment of patient waiting over 18 weeks.

However moving into 2009 there will still be significant challenges in maintaining the 18 week standard.

Calderdale and Huddersfield Foundation Trust: Divisions have produce action plans to reduce risk, these are being monitored by the PCT on a weekly basis. The PCT continues to meet with the Trust on a weekly basis to support and monitor progress.

Reasons for Variance and Actions Taken:

Mid Yorkshire Hospitals Trust: Delivery on 18 weeks has two main components, ensuring that patients waiting over 18 weeks are treated over and above the activity that is required to maintain activity and not create further long waits. Both of these aspects are being monitored closely.

Work has commenced to understand the size of the back log, by speciality and procedure in order to influence commissioning intensions so that the 18 week position is sustained. In addition further modelling work and intensive support has been implemented for particular pressured specialities including Orthopaedics and Ophthalmology.

Planned Latest Variance (8) (9) Comments (value) YTD The percentage of eligible (*) admitted patients whose adjusted RTT clock stopped during the month who waited 18 weeks or less (<127 days)

PI

Sep 08

Due Date

30-Sep-2008

87.5

87.685

0.185

The percentage of eligible (*) non-admitted patients whose RTT clock stopped during the month who waited 18 weeks or less (<127 days) Sep 08

30-Sep-2008

92.5

97.255

4.7552

The NHS Improvement Plan and subsequent PSA targets set out that, by December 2008, no one waits more than 18 weeks from GP referral to the start of hospital treatment or other clinically appropriate outcome (for clinically appropriate patients who choose to start their treatment within 18 weeks).

Reduction of diagnostic waiting times is central to delivering the 18 week pathway.

“No local health system will be credible in claiming success on 18 weeks if it does not make excellent progress in tackling long waiting times affecting large numbers of its local population, including those waits that are technically outside the target.” Extract from the national audiology framework document “Improving Access to Audiology Services in England”, which is available at www.18weeks.nhs.uk.

Page 32 of 79 © Dynamic Change Limited 2009 Performance Report - National Priorities

8 February 2009

Performance Report - National Priorities NPA02a: Guaranteed access to a primary care doctor within 48 hours Accountability Period (1) (4) 31-Dec-2008 NPA02a: Guaranteed access to a primary care doctor within 48 hours Mark Jenkins Owner Carol Mckenna Sponsor Key Achievements For guaranteed access to a primary care doctor within 48 hours 100% acheived in Oct 08.

Since Last Report: Planned Latest Variance (8) (9) Comments (value) YTD Percentage of Patients responding to the GP survey able to see GP within 2 working days Percentage of population able to see GP within 2 working days Oct 08 31-Oct-2008 100 100 0 Year to date percentage of population able to see GP within 2 working days PI

Due Date

GP Patient Survey: Your doctor, your experience, your say Primary Care Access Survey (to be finalised).

The NHS 'Vital Signs' framework (2008/2009 to 2010/2011) includes a goal in the top tier of indicators to measure patient experience of access to primary care. This builds on the target in the Priorities and Planning Framework (20032006) to ensure that all patients who wish to do so can see a primary care professional within one working day and a GP within two working days.

PCTs are expected to work to ensure that patients are satisfied with the level of access to primary care, including the ability to see a GP outside normal working hours.

The Healthcare Commission and Department of Health have continued to work towards incorporating the views of patients into the assessment of this target. This indicator is based on results from the Primary Care Access Survey (PCAS) and the GP Patient Survey which forms part of the general practice contract agreement between NHS Employers and the British Medical Association.

HC - 24th October 2008

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NPA02a: Guaranteed access to a primary care doctor within 48 hours Percentage of population able to see GP within 2 working days PI

Apr 08

May 08

PI Target TRG Actual TRG Name 100 98.5

Jun 08 Actual

TRG

Jul 08 Actual

TRG 100

Aug 08 Actual 100

TRG

Sep 08 Actual

TRG

Oct 08 Actual 100

TRG

Nov 08 Actual

100

Page 34 of 79

100

TRG

Dec 08 Actual

TRG

Jan 09 Actual

TRG 100

Mar 09

Feb 09 Actual

TRG

Actual

TRG

Actual

8 February 2009

Performance Report - National Priorities NPA02b: Guaranteed access to a primary care professional within 24 hours Accountability NPA02b: Guaranteed access to a primary care professional within 24 hours Mark Jenkins Owner Carol Mckenna Sponsor Key Achievements PCAS took place during Oct 08. 100% achievement .

Since Last Report:

Period (1) (4) 31-Oct-2008

Planned Latest Variance (8) (9) Comments (value) YTD Percentage of population able to see a Primary Care Professional within 1 working day Qtr 3 Oct 08 31-Oct-2008 100 97.4 -2.6 Year to date percentage of population able to see a Primary Care Professional within 1 working day PI

Due Date

GP Patient Survey: Your doctor, your experience, your say Primary Care Access Survey (to be finalised).

The NHS 'Vital Signs' framework (2008/2009 to 2010/2011) includes a goal in the top tier of indicators to measure patient experience of access to primary care. This builds on the target in the Priorities and Planning Framework (20032006) to ensure that all patients who wish to do so can see a primary care professional within one working day and a GP within two working days.

PCTs are expected to work to ensure that patients are satisfied with the level of access to primary care, including the ability to see a GP outside normal working hours.

The Healthcare Commission and Department of Health have continued to work towards incorporating the views of patients into the assessment of this target. This indicator is based on results from the Primary Care Access Survey (PCAS) and the GP Patient Survey which forms part of the general practice contract agreement between NHS Employers and the British Medical Association.

HC - 24th October 2008

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NPA02b: Guaranteed access to a primary care professional within 24 hours Percentage of population able to see a Primary Care Professional within 1 working day PI

Apr 08

May 08

PI Target TRG Actual TRG Name 100 98.5

Jun 08 Actual

TRG

Jul 08 Actual 97.41

TRG 100

Aug 08 Actual 97.4

TRG

Sep 08 Actual 97.4

TRG

Oct 08 Actual

TRG

Nov 08 Actual

100

Page 36 of 79

100

TRG

Dec 08 Actual

TRG

Jan 09 Actual

TRG 100

Mar 09

Feb 09 Actual

TRG

Actual

TRG

Actual

8 February 2009

Performance Report - National Priorities NPA03: Primary dental services, based on assessments of local needs and with the objective of ensuring year-onyear improvements in the numbers of patients accessing NHS dental services Accountability Period (1) (4) NPA03: Primary dental services, based on assessments of local needs and with the objective of ensuring year-on-year improvements in the numbers of patients accessing NHS dental 30-Sep-2008 services Clare Priestley Owner Carol Mckenna Sponsor

Key Achievements Since Last Report:

Despite additional growth funding investment to reduce the NHS Kirklees dental waiting list from April 2008 and the allocation of over 10,000 patients to dental practices in Kirklees, the waiting list continues to grow beyond all expectations.

The actions that have been taken to date include:• on-going discussions with existing primary care dental providers in relation to the provision of additional capacity within practices • trial of an emergency dental service in a dental practice in Central Huddersfield – the majority of these patients are without a regular dentist and the first three appointments are for patients who require further treatment following an out-of-hours appointment • follow-on treatment sessions are being rolled-out across Kirklees to continue from emergency treatment received in the out-of-hours service • the trial of domiciliary care is being undertaken for assessment prior to implementation across Kirklees • in-hours emergency access sessions have been increased to deal with patients who only request emergency treatment and do not wish to receive continuous treatment.

The allocation of new patients to dental practices takes longer than anticipated. Patients are allocated in manageable batches, at requested times from the practices with growth funding, therefore it is unrealistic to allocate the total agreed of say 1,000 new patients from the list in, on one batch. This will delay the increase in expected access.

Often patients do not complete their treatment and merely wish to be seen when they have a dental emergency. One practice being allocated 2,000 patients has had an unexpected delay in recruiting dentists. Although allocated to the practice, the patients have yet to be seen and this will delay the figures showing on the Dental Practice Board (DPB) system.

Current Concerns:

The volume of patients waiting in excess of a year are in the Dewsbury and Batley areas, where capacity has been increased, but, demand exceeds this. Suggested ways to deal with this are being put forward to the Primary Care Commissioning Group in October.

Main reasons that people are unable to readily access an NHS dentist locally is owing to demand outstripping capacity; as part of the new dental contact practices are no longer paid for the number of patients registered and treated at their practice, they are paid for units of dental activity, so patient

The reality is that if a patient has not been seen or treated within the 36 month period then dental practices have removed patients from their list for NHS treatment and the patients need to be re-assign Reasons for Variance and Actions Taken:

It would appear that trajectory is set at 5% increase in access for new patients by March 2009, when realistically this was suggested to be 0.5%. Currently the PCT has increased access by 0.25% to date.

This is being investigated within the PCT.

Planned Latest Variance (8) (9) Comments (value) YTD Number of patient receiving NHS primary dental services located within the PCT area within a 24 month period Sep 08 30-Sep-2008 252997 248894 -4103 PI

Due Date

Number of patient receiving NHS primary dental services located within the PCT area within a 24 month period (Proposed New Plan) Sep 08 30-Sep-2008 249375 248894 -481 The number of treated patients seen within the 24 months prior to Mar 2009, expressed as a percentage of patients seen within the 24 months prior to 2006.

NHS Dental Statistics, England, financial year 2008/2009 According to guidelines issued by the National Institute for Clinical Excellence (NICE, 2004), the recommended longest period a patient over the age of 18 should go without an oral review is 2 years. However, many patients experience difficulty in accessing a NHS dentist, and recent figures show that during the 24 months leading up to 31 March 2008, only 53.3% of the total population of England were seen by an NHS dentist (NHS Dental Statistics England, 2007/2008, published by the Information Centre). Of the remaining population, some patients will opt to receive private treatment, a proportion of which, in itself, is likely to be a direct result of difficulty accessing an NHS dentist. A recent survey commissioned by the Citizens Advice Bureau estimated that approximately 7.4m people in England and Wales say they would like to access NHS dentistry, but cannot. Of these, 2.7m say they are not able to access a dentist at all.

Consultations by two SHAs have shown that the public consider this to be a major problem for the NHS to resolve.

The Government has responded to this issue of access by increasing funding for NHS dentistry in England from April 2008, by 11 per cent, as part of the comprehensive spending review. The NHS 'Vital Signs' framework HC - 15th December 2008 HC - 18th June 2008

Measure is designed to focus benefits from new local commissioning strategy for NHS dentistry and increased funding over the planning period on tangible improvements in patient access. This improvement should be achievable through both more effective commissioning and management of contracts, and investment of extra resources included in PCT primary dental service allocations.

Page 37 of 79 © Dynamic Change Limited 2009 Performance Report - National Priorities

NPA03: Primary dental services, based on assessments of local needs and with the objective of ensuring year-on-year improvements in the numbers of patients accessing NHS dental services Number of patient receiving NHS primary dental services located within the PCT area within a 24 month period PI

Apr 08

PI Target TRG Actual Name 247862

May 08 TRG

Jun 08 Actual

248889

TRG

Jul 08 Actual

TRG

Aug 08 Actual

249916 247672 250943

TRG

Sep 08 Actual

251970

TRG

Oct 08 Actual

TRG

252997 248894 254023

Nov 08 Actual TRG 255050

Dec 08 Actual TRG 256077

Jan 09 Actual TRG 257104

Feb 09 Actual TRG 258131

Mar 09 Actual TRG

Actual

259158

Number of patient receiving NHS primary dental services located within the PCT area within a 24 month period (Proposed New Plan) PI

Apr 08

PI Target TRG Actual Name 248965 Number of patient

May 08 TRG 249047

Jun 08 Actual

TRG

Jul 08 Actual

TRG

249129 247672 249211

Aug 08 Actual

TRG 249293

Sep 08 Actual

TRG

Oct 08 Actual

TRG

249375 248894 249456

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Nov 08 Actual TRG 249538

Dec 08 Actual TRG 249620

Jan 09 Actual TRG 249702

Feb 09 Actual TRG 249784

Mar 09 Actual TRG 249866

Actual

8 February 2009

Performance Report - National Priorities NPA05a: A maximum waiting time of one month from diagnosis to treatment for all cancers Accountability Period (1) (4) NPA05a: A maximum waiting time of one month from diagnosis to treatment for all cancers 30-Nov-2008 Owner Loraine Turner Sponsor Carol Mckenna In November 08 we have acheived 98.1% against 98% target Key Achievements Since Last Report: Year to date performance is is 98.96% against 98% target. Out of 965 we have had 10 breaches 2 Breaches in November 08 1 breach Head and Neck MYHT Patient needed diagnostic lobectomy therefore, delay to surgery.

1 Lung LTHT Elective capacity inadequate. No information as yet.

No breaches in October 08 Breaches September 08 - 1 breach Head and Neck LTHT - Due to surgeon on A/L and paternity leave Breaches August 08 - 2 Breaches both at Leeds teaching hospitals 1 sarcoma 1 brain/central nervous system Current Concerns: Breaches July 08 - 2 Breaches 1 Lung & 1 Urological No breaches June 08 Breaches May 08 1 breach Leeds Teaching Hospitals sarcoma Breaches April 08 2 breaches Leeds Teaching Hospitals one Upper Gastrointestinal Bradford Teaching Hospitals one Head & Neck Reasons for Variance and Actions Taken:

Contact to be made with Cancer manager at LTHT to discuss reasons for inadequate capacity for Lung surgery.

Planned Latest Variance (8) (9) Comments (value) YTD Percentage of patients receiving their first definitive treatment within one month (31 days) of a decision to treat (as a proxy for diagnosis) for cancer

PI

Due Date

Nov 08

30-Nov-2008

98

98.1

0.1

Cancer waits database (financial year 2008/09) The NHS Cancer Plan sets the ultimate goal that no patient should wait longer than one month (31 days) from diagnosis of cancer to the beginning of treatment, except for good clinical reasons.

The publication of the Cancer Reform Strategy, in December 2007, set new, more ambitious standards for the NHS. Specifically for the one month wait, the standard will be widened to cover all cancer treatments, including second or third treatments and treatment for recurrence of cancer, with achievement of this for all patients receiving surgery or drug treatment required by December 2008. The financial year 2008/09 will be a year during which trusts will be required to update systems and ensure capacity is available to meet the new standard, maintain existing commitments throughout the year and achieve the new standard for patients receiving surgery or drug treatment in the fourth quarter of the year. PCTs will be assessed as commissioners HC - 24th October 2008

Page 39 of 79 Š Dynamic Change Limited 2009 Performance Report - National Priorities

NPA05a: A maximum waiting time of one month from diagnosis to treatment for all cancers Percentage of patients receiving their first definitive treatment within one month (31 days) of a decision to treat (as a proxy for diagnosis) for cancer PI

Apr 08

May 08

Jun 08

Jul 08

Aug 08

Sep 08

Oct 08

Nov 08

Dec 08

PI Target TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual Name 98 98.65 98 98.88 98 99.23 98 98.99 98 98.82 98 98.9 98 100 98 98.1 98

Page 40 of 79

Jan 09 TRG 98

Mar 09

Feb 09 Actual

TRG

Actual 98

TRG

Actual 98

8 February 2009

Performance Report - National Priorities NPA06a: A maximum waiting time of two months from urgent referral to treatment for all cancers Accountability Period (1) (4) NPA06a: A maximum waiting time of two months from urgent referral to treatment for all 30-Nov-2008 cancers Owner Loraine Turner Sponsor Carol Mckenna

Key Achievements For the month of November we have acheived 85.71% against a target of 95% Since Last Report: Year To Date 92.82% acheived against a target of 95% which is a decrease on October 08 7 Breaches November 08 2 Lung breaches shared with MYHT and LTHT, 2 Sarcoma (Soft tissue) shared with CHfT and LTHT, 1 Urological shared with MYHT and LTHT, 1 Lower Gastrointestinal CHfT, 1 Head and Neck MYHT

Current Concerns:

2 Breaches October 08 1 Urological (excluding testicular) MYHT, 1 Upper GI shared with MYHT and LTHT 4 Breaches for September 2008 1 upper GI apportioned to LTHT and MYHT Patient had co-morbidities that needed assessing and treating before operation could be booked.

1 Lung apportioned to LTHT and MYHT PET positive uptake in Colon and required investigation prior to transfer to LTHT 1 Head and Neck apportioned to LTHT and MYHT - Surgeon on A/L and Paternity Leave 1 Other CHFT - Reason for breach is being further investigated 2 Breaches August 2008 2 at MYHT and Leeds both Lung and apportioned 1 to each 7 Breaches July 2008 1 Lung apportioned to CHfT and LTHT, 3 Lung apportioned to MYHT and LTHT 1 Lung CHfT, 1 Other apportioned to MYHT and LTHT, 1 Upper GI apportioned MYHT and LTHT 4 Breaches June 2008 1 MYHT Lung, 1 Other CHfT, 1 apportioned between MYHT and LTHT Lung 1 apportioned between CHFT and LTHT Sarcoma 3 Breaches May 2008 2 at MYHT both Lung, 1 apportioned between LTHT and MYHT Upper Gastrointestinal 1 Breach April 2008 1 Breach in Lung apportioned 0.5 at Mid Yorkshire Hospital Trust as place where patient first seen and 0.5 at Leeds Teaching Trust 2 Lung breaches shared with MYHT and LTHT Patient 1. Ref day 49.Initial MDT delayed due to delay in CT Scan, histoloy had to be chased and some of the original treatment details uploaded were incorrect and still need to be uploaded. Breach reasons have yet to be agreed.

Patient 2. Referral between Trusts. Elective capacity for surgery at SJUH was inadequate and delayed the treatment and follow up. Histology reporting was also delayed resulting in unclear direction for treatment.

Reasons for Variance and Actions Taken:

2 Sarcoma (Soft tissue) shared with CHfT and LTHT Patient 1. Referred originally to haematology. No delays originally and reffered to Leeds early on but took 90 days to diagnose.

Sarcomas are notoriously difficult to diagnose in particular soft tissue ones which was the case for this patient and need multiple tests to confirm diagnosis which often creates delays. It is not uncommon for a sarcoma patient to be first seen in haematolgy because of symptom presentation.

Patient 2. First thought feasible to operation but now going to have chemo to reduce before attempting surgery.Soft tissue sarcoma's are difficult to diagnose and took 74 days in total to treatment. Reffered to Leeds early on in the pathway.This was a complexed pathway.

1 Urological shared with MYHT and LTHT Ref day 46. Delay due to referral between trusts MYHT & SJUH although treatment episode ended 25/11/08 but updated 23/12/08 creating an error in reporting 1 Lower Gastrointestinal CHfT Delay to diagnostic tests. No information as yet and being further investigated. This is an unusual area for a breach at CHFT

1 Head and Neck MYHT 1st FNA histo - insufficient for dx - delays due to leave - FNA X 2 - delay to histo - dealy for surg - delay waiting for histo report from Leeds. The patient had several attempts failed samples which could not be used

Planned Latest Variance (8) (9) Comments (value) YTD Percentage of patients receiving their first definitive treatment for cancer within two months (62 days) of GP or Nov 08 30-Nov-2008 95 85.71 -9.29 PI

Due Date

Cancer waits database (financial year 2008/09) The NHS Cancer Plan sets the ultimate goal that no patient should wait longer than two months (62 days) from a GP urgent referral for suspected cancer to the beginning of treatment, except for good clinical reasons.

The publication of the Cancer Reform Strategy, in December 2007, set new, more ambitious standards for the NHS. Specifically for the two month wait, the standard will be widened to cover both referrals from the national screening programmes and from consultants where they request that the patient is managed on the two month pathway. The financial year 2008/09 will be a year during which trusts will be required to update systems and ensure capacity is available to meet the new standard, while continuing to meet the existing commitment throughout the year. PCTs will be assessed as commissioners.

HC - 24th October 2008

Page 41 of 79 Š Dynamic Change Limited 2009 Performance Report - National Priorities

NPA06a: A maximum waiting time of two months from urgent referral to treatment for all cancers Percentage of patients receiving their first definitive treatment for cancer within two months (62 days) of GP or dentist urgent referral for suspected PI

Apr 08

May 08

Jun 08

Jul 08

Aug 08

Sep 08

Oct 08

Nov 08

Dec 08

PI Target TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual Name 95 98.44 95 97.48 95 95.38 95 93.21 95 93.51 95 93.38 95 96.15 95 85.71 95

Page 42 of 79

Jan 09 TRG 95

Mar 09

Feb 09 Actual

TRG

Actual 95

TRG

Actual 95

8 February 2009

Performance Report - National Priorities NPA07a: A two-week maximum wait from urgent GP referral to first outpatient appointment for all urgent Accountability Period (1) (4) 30-Nov-2008 NPA07a: A two-week maximum wait from urgent GP referral to first outpatient appointment Loraine Turner Owner Carol Mckenna Sponsor Key Achievements We are achieving a target of 99.86% against a set target of 100%, which is the equivelant of 4 patients breaching to date.

Since Last Report: November 08 - No breaches

Current Concerns:

October 08 - No breaches September 08 - No breaches August 08 1 Breach at MYHT in Upper Gastrointestinal due to the diagnostic procedure being booked outside of the 14 day cohort July 2008 - No breaches June 2008 - No breaches May 2008 1 patient out of 334 were not seen within 14 days of standard due to patient choosing alternative hospital and no appointment being available within the 14 day target.

MYHT 1 Breast April 2008 Two patients out of three hundred and eighty five were not seen within the 14 day standard.

MYHT 1 upper gastrointestinal delayed by GP due to medication issues & 1 breast unable to be seen due to bomb alert at the hospital at time of appointment.

Planned Latest Variance (8) (9) Comments (value) YTD Percentage of patients first seen by a specialist within two weeks (14 days) when urgently referred by their GP Nov 08 30-Nov-2008 100 100 0 PI

Due Date

Cancer waits database (financial year 2008/09) The NHS Cancer Plan sets the ultimate goal that by 2008 no patient should wait longer than one month from an urgent referral for suspected cancer to the beginning of treatment except for good clinical reasons. A series of staged milestones and targets have been set out between 2000 and 2005 including ""a maximum two week wait from an urgent GP referral for suspected cancer to date first seen for suspected cancers by end of 2000"".

The publication of the Cancer Reform Strategy, in December 2007, set new, more ambitious standards for the NHS. Specifically for the two week wait, all referrals with breast symptoms, regardless of whether cancer is suspected, will be subject to a maximum two week wait, with full implementation expected by December 2009. The financial year 2008/09 will be a year during which trusts will be required to update systems and ensure capacity is available to meet the new standard. Within its scored assessments, the Healthcare Commission will retain its requirement for trusts to maintain the existing commitment on urgent referral to first outpatient appointment, for which PCTs will be assessed as commissioners.

HC - 24th October 2008

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NPA07a: A two-week maximum wait from urgent GP referral to first outpatient appointment for all urgent suspected cancer referrals Percentage of patients first seen by a specialist within two weeks (14 days) when urgently referred by their GP or dentist with suspected cancer PI

Apr 08 TRG

Percentag e of

100

May 08 Actual 99.48

TRG 100

Jun 08 Actual 99.58

TRG 100

Jul 08 Actual 99.72

TRG 100

Aug 08 Actual 99.79

TRG 100

Sep 08 Actual 99.78

TRG 100

Oct 08 Actual 99.82

TRG

Nov 08 Actual

100

Page 44 of 79

100

TRG 100

Dec 08 Actual 100

TRG 100

Jan 09 Actual

TRG 100

Feb 09 Actual

TRG 100

Mar 09 Actual

TRG 100

Actual

8 February 2009

Performance Report - National Priorities NPA08a: Proportion of women aged 47-49 and 71-73 offered screening for breast cancer Accountability NPA08a: Proportion of women aged 47-49 and 71-73 offered screening for breast cancer NHS Breast Cancer Screening Programme will be extended to all women aged 47 to 73 by 2012 Nicky Hoyle Owner Carol Mckenna Sponsor Key Achievements Since Last Report:

Current Concerns:

Reasons for Variance and Actions Taken:

Period (1) (4) 31-Jan-2009

The round length target, an indicator of resource capacity, has been a concern and additional funding has been agreed by the commissioning PCTs in support of a recovery plan to achieve round length targets by 2009. This has resulted in recovery to 94% for the quarter Oct/Dec 2008, exceeding the target of 90%. This will need to be sustained to secure the continued achievement of coverage targets.

This is a new target as set out in the Cancer Reform Strategy of Nov. 2007. Breast screening for the Kirklees, Calderdale and Bradford population is carried out by the Pennine Breast Screening Unit. The commissioners and provider are implementing a Cancer Reform Strategy Implementation Plan which includes planning to implement the age extension from the start of next three-year screening round (mid-2011 i.e. financial year 2011/12). Finance needs to be secured from the commissioning PCTs in order to implement the Cancer Reform Strategy, including the extension to the age range. This needs to commence in 2009/10 with the purchase of digital mammography equipment.

The Commissioners are meeting regularly with the providers and an Action Plan is being implemented to ensure delivery of the age extension in accordance with the Cancer Reform Strategy during the 2011/12 financial year, and to consolidate sustainability of the round length target as a resource indicator. A Business Case to secure the required investment from NHS Kirklees for purchase/leasing of digital mammography equipment in 2009/10 is currently in preparation, although key financial and other information is still awaited.

Planned Latest Variance (8) (9) Comments (value) YTD The percentage of eligible 50 year-old women with a breast screening test result The percentage of eligible women aged 50-73 screened for breast cancer in the last three years The percentage of eligible women aged 53-64 screened for breast cancer in the last three years The percentage of eligible women aged 65-70 screened for breast cancer in the last three years

PI

Due Date

KC63 breast cancer screening return (financial year 2007/08)

"Around 130,000 people die from cancer every year of whom 65,000 are aged under 75. In 2006/2007, over 1.6 million women were screened for breast cancer in England, and nearly 13,500 cancers were detected. In February 2006, a report from the Advisory Committee on Breast Cancer Screening (Screening for Breast Cancer in England: Past and Future, NHSBSP Publication No 61) estimated that the breast screening programme in England is saving 1,400 lives per year.

The International Agency for Research on Cancer (IARC) of the World Health Organisation (WHO) evaluated the evidence on breast cancer screening in March 2002. IARC concluded that trials have provided sufficient evidence for the efficacy of mammography screening of women between 50 and 70 years, and that the reduction in mortality from breast cancer among women who choose to participate in screening programmes was estimated to be about 35%.

The age group of women invited for routine screening was extended to 50 to 70 from 50 to 64, and all PCTs have been inviting women of the extended age group for screening by March 31st 2006. The three year screening cycle should thus b

HC - 24th October 2008

Around 130,000 people die from cancer each year, of whom about 65,000 are aged under 75. In 2005/2006, 1.63 million women were screened for breast cancer in England, and over 13,500 cancers were detected. In February 2006, a report from the Advisory Committee on Breast Cancer Screening (Screening for Breast Cancer in England: Past and Future, NHSBSP Publication No 61) estimated that the breast screening programme in England is saving 1,400 lives per year.

The International Agency for Research on Cancer (IARC) of the World Health Organisation (WHO) evaluated the evidence on breast cancer screening in March 2002. IARC concluded that trials have provided sufficient evidence for the efficacy of mammography screening of women between 50 and 70 years, and that the reduction in mortality from breast cancer among women who choose to participate in screening programmes was estimated to be about 35%.

At present, women are invited for screening seven times at three yearly intervals between 50 and 70 years. Over time, this will be extended to nine screening rounds between 47 and 73 years with a guarantee that women will have their first screening before the age of 50 â&#x20AC;&#x201C; at present some women wait until nearly their 53rd birthday before they receive their first The Cancer Reform Strategy (December 2007) stated that the extension of the breast screening programme will start from

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8 February 2009

Performance Report - National Priorities NPA08b: Breast cancer screening for women aged 53 to 64 and 65 to 70 years (Linked to VSA09 Breast cancer Accountability Period (1) (4) 31-Dec-2008 NPA08b: Breast cancer screening for women aged 53 to 64 and 65 to 70 years (Linked to Substantially reduce mortality rates by 2010 from cancer by at least 20% in people under 75, with a reduction in the Nicky Hoyle Owner Carol Mckenna Sponsor

Key Achievements Since Last Report:

For the financial year 2007-08, Kirklees achieved the national target as 78.2% of the eligible population of 53-64 year old women (target 70%)and 73.9% of 65-70 year old women (target 65%)were screened in the previous 3 years. This compares favourably against comparator PCTs with similar deprivation scores. N.B. the data used to inform the 08/09 Healthcare Commission assessment will be presented by the DH in February 09 and will relate to the period 1 April 07 to 31 March 08.

A locally implemented recovery plan has resulted in improving round length achievement to 94% for the period Oct-Dec 2008 (target 90%).

Current Concerns:

There are current national and local concerns over the increase in the '36 month round length' targets for invitation to screening in the eligible population, as this has has a knock-on effect in delaying the actual screening appointment. A locally implemented recovery plan has resulted in improving round length achievement to 94% for the period Oct-Dec 2008 (target 90%).

Reasons for Variance and Actions Taken:

The Pennine Breast Screening Unit which covers much of West Yorkshire is currently commissioned by a lead commissioner (Calderdale) to provide screening for the local population. The Unit has identified a number of factors which contributed to the increase in round length targets over the last 18 months.

Additional funding from participating PCTs has been identified and an action plan has been developed for 2008-09, which is addressing the shortfall in the round length target. The longer term implications of an increase in the age range to be screened as required by the Cancer Reform Strategy will put further strain on the service and the commissioners are working with the SHA to plan for the increased capacity and resources required.

Planned Latest Variance (8) (9) Comments (value) YTD Percentage of eligible women aged 53-64 screened for breast cancer in the last three years 2007/2008 31-Mar-2009 70 78.174 8.1737 Percentage of eligible women aged 65-70 screened for breast cancer in the last three years PI

Due Date

A two part indicator combined using a matrix to give an overall level of performance. Part 2: The number of women aged 65-70 screened for breast cancer divided by the number of women aged 65-70 eligible for screening, expressed as a percentage. Performance banding thresholds for part 1 and part 2 will be set separately to allow for their respective stages of implementation 2007/2008

31-Mar-2009

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65

73.856

8.856

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8 February 2009

Performance Report - National Priorities NPA09: Obesity among primary school age children (National Child Measurement Programme (NCMP)) (VSB09) Accountability Period (1) (4) NPA09: Obesity among primary school age children (National Child Measurement 31-Jan-2009 Programme (NCMP)) (VSB09) Owner Liz Messenger Sponsor Judith Hooper Preparation has commenced for this years data collection. Plans have been put in place to address Key the issues faced last year which will result in an efficient data collection and submission process. Data Achievements for school year 07/08 became available on 11th Dec; the key differences when comparing results for Since Last 2006/07 and 2007/08 are: Report: â&#x20AC;˘ Prevalence of overweight pupils in reception has decreased from 13% to 12.5% â&#x20AC;˘ Prevalence of obese pupils in year 6 has increased from 16.8% to 18.9% Prevalence of obese pupils in year 6 has not met the target. Nationally it is thought that the 2006/07 Year 6 obesity prevalence may have been underestimated by as much as 1.3% due to the effect of children opting out of being measured. Participation in Kirklees increased this year; in year 6 rose from Current 86% to 94%, this increase is likely to have had an impact on the obesity prevalence rate.

Concerns: We will continue to work closely with related Public Health programmes to address the incidence of childhood obesity. Weight management services and care pathways for children who are overweight and obese are currently being developed.

Planned Latest Variance (8) (9) Comments (value) YTD Percentage of children in Reception with height and weight recorded who are obese.

This is a calculated field using [Line 1] / [Line 3]*100, Dec 08 31-Dec-2008 10 9.7 0.3 Percentage of children in Reception with height and weight recorded.

This is a calculated field using [Line 3] / [Line 4]*100 Dec 08 31-Dec-2008 91 100 9 Percentage of children in Year 6 with height and weight recorded who are obese.

This is a calculated field using [Line 8] / [Line 10]*100 Dec 08 31-Dec-2008 17 18.9 -1.9 Percentage of children in Year 6 with height and weight recorded.

This is a calculated field using [Line 10] / [Line 11]*100 Dec 08 31-Dec-2008 87 94 7 PI

Due Date

Local Delivery Plan (2007/08 school year)

Obesity is a complex public health issue. Children who have a poor diet or are not physically active enough, or both, might become overweight or underweight either of which can have a substantial effect on health both in childhood and in later life. Being overweight or obese can have a severe impact on an individual's physical health both are associated with an increasing risk of diabetes, cancer, and heart and liver disease, among others.

The Health Survey for England 2006 showed that rates of obesity are rising in children. In boys and girls aged 2 to 10 years, rates of obesity increased from 11% in 1996 to 15% in 2006. A further 12% of boys and 13% of girls were overweight in 2006. Almost two-thirds of adults (62%) and a third of children (30%) are either overweight or obese, and work by the Government Office for Science's Foresight programme suggests that, without clear action, these figures will rise substantially by 2050.

In October 2007, the Government announced a new ambition on obesity, which forms part of the Government's PSA 12: to improve the health and wellbeing of children and young people. In addition, Healthy Weight, Healthy Lives - A Cross Go

This indicator highlights a high priority area with a challenging ambition to reduce the proportion of overweight and obese children to 2000 levels, within the wider context of ensuring that everyone is ab

HC - 14th January 2009

Childhood obesity is closely linked with early onset of preventable disease, including diabetes. In October 2007, the Government set a new long-term ambition to tackle obesity. Our ambition is to reverse the rising tide of obesity and overweight in the population, by enabling everyone to achieve and maintain a healthy weight. Our initial focus will be on children: By 2020, we aim to reduce the proportion of overweight and obese children to 2000 levels. At a national level, progress towards this aim will be measured with obesity prevalence data from the Health Survey for England. Local progress towards this aim is measured with NCMP obesity prevalence data.

PCTs and SHAs should develop robust and effective care pathways to prevent and tackle obesity in children.

Additionally, although the focus of the indicator is on obesity, PCTs and SHAs should be aware that future plans will need to encompass overweight as well as obese children, as part of meeting the long-term ambition to ensure that everyone can maintain a healthy weight. SHA plans should reflect the aggregate of local PCT plans.

For comparisons to be made between years and between PCTs with sufficient confidence, it is important that a high percentage of children participate to reduce the risk of non-participation bias in the f

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Performance Report - National Priorities NPA10: Prevalence of Chlamydia (VSB13) Accountability NPA10: Prevalence of Chlamydia (VSB13)

Period (1) (4) 30-Nov-2008

Owner Sponsor Key Achievements Since Last Report:

Rachel Spencer Judith Hooper

Current Concerns:

The PCT is not currently meeting the November trajectory of 5262 screens. The total number of screens performed to date is 4053 (inclusive of those screens obtained direct from the lab)

Reasons for Variance and Actions Taken:

Kirklees PCT has committed to funding a television advert to be shown in february with other PCT's in the region following a very successful campaign in Northumberland. This is expected to hit 5-10% of the 15-24 year old population.

The postal pilot in North Kirklees is well underway and showing an increase in numbers. The Locally Enhanced Service for Chlamydia has been launched on 1st of december and 24 practices are now signed up, although the majority of these are in South Kirklees.

Planned Latest Variance (8) (9) Comments (value) YTD Percentage of the population aged 15 - 24 screened or tested for chlamydia Nov 08 30-Nov-2008 9.55 7.356 -2.194

PI

Due Date

Chlamydia screening programme returns (financial year 2008/09) Vital Signs plans (financial year 2008/09) Chlamydia is the most common sexually transmitted infection (STI) and there is evidence that up to one in 10 young people aged under 25 may be infected. It often has no symptoms, but if left untreated can lead to pelvic inflammatory disease, ectopic pregnancy and infertility. Chlamydia is very easily treated. The national chlamydia screening programme (NCSP) has a community focus and concentrates on opportunistic screening of asymptomatic sexually active men and women under the age of 25 who would not normally access, or be offered a chlamydia test, and focuses on screening in non-traditional sites.

HC - 24th October 2008 HC - 18th June 2008

The public health White Paper, Choosing Health: Making healthy choices easier, identified sexual health as a new priority area. Unacceptably high levels of sexually transmitted infections, particularly chlamydia, require a step change in the way sexual health services are organised and delivered, building on the recommendations in the Governmentâ&#x20AC;&#x2122;s National strategy for sexual health and HIV launched in 2001. The Choosing Health White Paper indicated that the final phase of the rollout of the national chlamydia-screening programme would be achieved by 2007.

The more recent health and social care White Paper, Our health, our care, our say, has also highlighted that access to health services needs to be faster. Increases in the demand for sexual health services mean it is no longer sensible or economic to deliver sexual health care only in hospital-based specialist services. To meet the needs and preferences of service users, PCTs should commission a full range of services, which provide different levels of sexual health care in a variety of settings.

There is considerable evidence indicating a high prevalence of chlamydia and subsequent disease burden in young people Due to the high proportion of asymptomatic infection, the National Chlamydia Screening Programme (NCSP) offers opport Since the NCSP started in 2003 over 180,000 screens have been performed with a 10% positivity rate. There has been a steady increase in the numbe Additional information on planning and delivery of the NCSP is provided through the Further Information links provided belo There is evidence from the United States and Sweden that those areas that achieved high volumes in their screening programmes had the highest redu

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8 February 2009

Performance Report - National Priorities NPA11: Effectiveness of Children and Adolescent Mental Health Service (CAMHS) (percentage of PCTs and Local Authorities who are providing a comprehensive CAMHS) (VSB12) Accountability Period (1) (4) NPA11: Effectiveness of Children and Adolescent Mental Health Service (CAMHS) (percentage 31-Dec-2008 of PCTs and Local Authorities who are providing a comprehensive CAMHS) (VSB12) Owner Debi Hemingway Sponsor Carol Mckenna Key The NHS Kirklees is 'green' against the current Child and Adolescent Mental Health Services (CAMHS) Achievements proxy indicators . The Emotional Wellbeing and Mental Health Partnership Board have developed a DRAFT Joint Commissioning Strategy which sets out the strategic direction for the delivery of a Since Last comprehensive CAMHS over the next three years Report: Current The Strategy aims to bring greater coherence to services building on a range of pervention and early Concerns: intervention initiatives and ensuring provision for those with more complex mental health conditions Reasons for Variance and Actions Taken:

A wider consultation event is being planned for February 2009 with key partner agencies to jointly develop the action plan for kirklees in relaton to the deivery of the Strategy in providing a comprehensive CAMH service

PI Due Date Planned Latest Variance (8) (9) Comments Are arrangements in place for the council area to ensure that 24 hour cover is available to meet urgent mental health needs of children and young people and for a specialist mental health assessment to be undertaken within 24 hours or the next working day where indicated (rate 1-4) Nov 08

30-Nov-2008

4

4

0

Do 16 and 17 year olds from the council area who require mental health services have access to services and accommodation appropriate to their age and level of maturity? (rate 1-4) Nov 08

30-Nov-2008

3

3

0

Has a full range of CAMH services for children and young people with learning disabilities been commissioned for the council area? (rate 1-4)

Nov 08

30-Nov-2008

3

3

0

The national CAMHS review published in November has given further recommendations on the commissioning of services for children and young people with learning disabilities and mental health problems

Is a full range of early intervention support services delivered in universal settings and through targeted services for children experiencing mental health problems commissioned by the Local Authority and PCT in partnership?

(Indicator in Development (rate 1-4) Nov 08

30-Nov-2008

2

3

1

Vital Signs returns (as at 31 December 2008) Mental health problems in children are associated with educational failure, family disruption, disability, offending and antisocial behaviour, placing demands on social services, schools and the youth justice system. Untreated mental health problems create distress not only in the children and young people but also for their families and carers, continuing into adult life and affecting the next generation. The National Service Framework for Children, Young People and Maternity Services set out the standards and milestones for improvement in child and adolescent mental health services, including year on year improvements in access.

The 2008/2009 NHS Operating Framework and the 2007 Public Service Agreement 'Improve the health and wellbeing of children and young people' describe four proxy measures for a truly comprehensive child and adolescent mental health service: 24 hour/seven days a week cover to meet the urgent mental health needs of children and young people a full range of CAMHS for children and young people who also have a learning disability a full range of CAMHS for 16 and 17 years olds, appropriate to their age and level of maturity a full range of early intervention support services jointly commissioned by the Local Authority and PCT in partnership HC - 24th October 2008 HC - 18th June 2008 The maintenance of a set of proxy measures for the delivery of comprehensive CAMH service has broad acceptance amongst health commissioners and providers at local and national levels. It is clear, from feedback received from commissioners, and those involved in delivering a support/challenge role (National CAMHS support service for example) of the significant impact that the current PSA service development measure for CAMHS has had on stimulating and promoting the recent improvements in CAMHS (ie services for 16/17 year olds; comprehensive CAMHS for children and young people with learning disabilities and the delivery of 24 hour emergency services.) Without such a focus, there is a substantial risk that recent improvements in services will not be sustained; with services for vulnerable groups such as children with disabilities, and looked after children, where developments have been from such a low starting point in many areas, being most at risk.

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Performance Report - National Priorities NPA13: Smoking prevalence among people aged 16 or over and, aged 16 or over in routine and manual groups Accountability Period (1) (4) NPA13: Smoking prevalence among people aged 16 or over and, aged 16 or over in routine 31-Oct-2008 Rachel Spencer Owner Judith Hooper Sponsor Key The stop smoking service is now up to full staff complement. Service specification has been written Achievements and PI indicators identified and shared with Kirklees Community Healthcare services. Targets have also been set with other providers. Insight into routine and manual workers and young people has Since Last been completed and a project plan is being written to help design appropriate services.

Report: Current Concerns:

The PCT performance for October is 1261 against a trajectory of 1260. This appears to be close but the deadline for submission of monitoring forms in relation to this month is March so i am confident we will continue to meet and exceed this target

Reasons for Variance and Actions Taken:

Social marketing insight with Women of Child bearing age will have an impact on referrals in this group by ensuring that services for pregnant women provide direct referral to stop smoking advisers.

The Locally enhanced service in GP practices and pharmacies is currently being revised with a view to increase numbers accessing the services. Kirklees community healthcare services are following the recommendations in Healthy Ambitions and are piloting a voucher scheme for provision of nicotine replacement therapy for group members. A Mapping exercise is underway to look at service provision against areas of high smoking prevalence. 71 health professionals have been trained in brief interventions since April 08

Planned Latest Variance (8) (9) Comments (value) YTD Number of 4-week smoking quitters who attended NHS Stop Smoking Services Oct 08 31-Oct-2008 1260 1261 1 Population aged 16 and over Oct 08 31-Oct-2008 317609 317609 0 Smoking quitters per 100,000 population aged 16 and over Oct 08 31-Oct-2008 396.71 397.02 0.31 PI

Due Date

Stop smoking services return (financial year 2008/09) Vital Signs plans (financial year 2008/09) Smoking is the single greatest cause of preventable illness and premature death in the UK (http://www.dh.gov.uk/en/Publichealth/Healthimprovement/Tobacco/index.htm). The effects on health from smoking have been known for many years and are well documented with 80% of the deaths from lung cancer being related to smoking. There has been a steady decline in the number of people who smoke in England over the last three decades. For smokers who give up, the chances of developing serious conditions or diseases are greatly reduced.

This indicator is crucial to securing improvements in public health.

There are many approaches to tobacco control and treatments to help people quit smoking are constantly evolving.

The NHS Stop Smoking Services are implemented by targeting smokers and supporting them to quit within four weeks. The monitoring of the progress made within this programme provides a proxy for the level of performance on reducing smoking prevalence in the population.

HC - 24th October 2008 HC - 18th June 2008 Stop Smoking Services are a key NHS intervention to reduce smoking in all groups, with particular focus on routine and manual groups. They are currently monitored through assessment of 4-week smoking quitters.

The NHS Stop Smoking Services are part of a programme of action needed to meet the national target to tackle the underlying determinants of ill health and health inequalities by reducing smoking rates to 21% or less by 2010, with a reduction in prevalence among routine and manual groups to 26% or less.

In planning and monitoring delivery, SHAs may wish to consider PCT level plans for targeting smokers in routine and manual groups and the information required to monitor this.

As recommended in the NHS Smoking Cessation Guidance 2001-02, longer term success can be measured in local audits, including 52 week follow-up.

Page 50 of 79 Š Dynamic Change Limited 2009 Performance Report - National Priorities

NPA13: Smoking prevalence among people aged 16 or over and, aged 16 or over in routine and manual groups (quit rates locally 2008) (VSB05) Number of 4-week smoking quitters who attended NHS Stop Smoking Services PI

Apr 08

May 08

Jun 08

Jul 08

Aug 08

Sep 08

Oct 08

Nov 08

PI Target TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual Name 177 206 354 389 556 584 758 747 935 865 1112 1002 1260 1261 1408

Dec 08 TRG

Jan 09 Actual

1556

TRG

Feb 09 Actual

1789

TRG

Mar 09 Actual

2006

TRG

Actual

2223

Smoking quitters per 100,000 population aged 16 and over PI

Apr 08

May 08

Jun 08

Jul 08

Aug 08

Sep 08

Oct 08

Nov 08

Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual PI Target TRG Name 55.73 64.85 111.46 122.47 175.06 183.87 238.66 235.19 294.39 272.35 350.12 315.48 396.71 397.02 443.31

Page 51 of 79

Dec 08 TRG 489.91

Jan 09 Actual

TRG 563.27

Mar 09

Feb 09 Actual

TRG 631.59

Actual

TRG 699.92

Actual

8 February 2009

Performance Report - National Priorities NPA14: Rates of Clostridium Difficile - Kirklees Accountability Period (1) (4) 31-Dec-2008 NPA14: Rates of Clostridium Difficile - Kirklees C Diff reduction by 30% by 2011, differential SHA envelopes to deliver a 30% reduction nationally by 2011 Jane O'Donnell Owner Judith Hooper Sponsor 21 cases of C.difficile infections were reported in December 2008 in Kirklees residents.The number of Current cases reported:- 6 from Leeds Teaching Hospitals Trust, 5 from MYHT, 4 cases from CHFT, 1 case Concerns: from Bradford royal Hospital and 5 GP reports.

Planned Latest Variance (8) (9) Comments (value) YTD Number of C. Difficile infections - Kirklees (Cumulative) Dec 08 31-Dec-2008 224 203 21 Number of C. Difficile infections - Kirklees (Monthly) Dec 08 31-Dec-2008 25 21 4 PI

Due Date

Trajectories for C. difficile reduction (financial year 2008/09) Health Protection Agency (financial year 2008/09)

Tackling healthcare-associated infections, such as Clostridium difficile (C. difficile), continues to be a key patient safety issue and is a priority for the NHS, as set out in the 2008/2009 NHS Operating Framework and the 2007 Public Service Agreement ‘Ensure better care for all’.

Mandatory surveillance of C. difficile was introduced in England in January 2004 with all acute and specialist NHS trusts in England required to report all diarrhoeal samples (defined as those that take the shape of their container) from people 65 years of age or older who have not been diagnosed with C. difficile associated disease (CDAD) during the preceding four weeks. Trusts are required to report all positive results, including those received from people in the community.

Since April 1st 2007, trusts are also required to report all positive results in patients aged two years and over.

The national target (a 30% reduction nationally in 2010/2011 compared with the 2007/2008 baseline figure) requires effective working across health communities to tackle infections in both healthcare settings and the community. Primary care trusts are therefore expected to work effectively with acute trusts to tackle C. difficile infections. As such, primary care

HC - 24th October 2008 HC - 18th June 2008

© Dynamic Change Limited 2009 Performance Report - National Priorities

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Performance Report - National Priorities NPA15: NHS staff survey scores based measures of job satisfaction Accountability Period (1) (4) 31-Dec-2008 NPA15: NHS staff survey scores based measures of job satisfaction Carolyn Dixon Owner Sue Ellis Sponsor The 2008 Staff Survey fieldwork ended on 12 December 2008. The final response rate is still being Key collated by The Picker Institute, but as at 24/12/08 the following figures are reported: 66.9% of all PCT Achievements staff have completed their surveys (a decision was taken by SMT to survey the whole organisation).

Since Last However, the figure that will be presented to the Healthcare Commission, and entered on the PA is Report: currently 65.4% (as the HCC only require organisations to carry out a consensus) Planned (value) National NHS staff survey: Job Satisfaction H2 08/09 31-Mar-2009 3.47 PI

Due Date

Latest YTD 65.4

Variance (8) (9) Comments 61.93

Exceeded HCC target of 60%

National NHS Staff Survey (fieldwork to be undertaken in Autumn 2008) Improving staff satisfaction is one of the five key areas of the 2008/2009 NHS Operating Framework. The NHS Staff Survey has been carried out annually since 2003 and changes in the reported levels of NHS staff job satisfaction can be compared year on year from this time. This provides a survey-based measure of job satisfaction for NHS staff. A more satisfied workforce is likely to be more sustainable and provide better patient care, with motivated and involved staff being better placed to know what is working well and how to improve services for the benefit of patients and the public.

The 2008/2009 NHS Operating Framework set out the expectation that NHS organisations help staff understand their role in delivering a better NHS and encouraging staff to participate in the NHS Staff Survey and act on the findings.

HC - 18th June 2008 This provides a survey-based measure of job satisfaction for NHS staff. A more satisfied workforce is likely to be more sustainable and provide better patient care.

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8 February 2009

Performance Report - National Priorities NPA16: Number of drug users recorded as being in effective treatment (VSB14) Accountability Period (1) (4) 31-Jan-2009 NPA16: Number of drug users recorded as being in effective treatment (VSB14) Tony Cooke Owner Carol Mckenna Sponsor Key There has been a renewed focus and additional investment and this has pushed the target from amber to Achievements green. The additional clinical investment will free up keyworker time, this should have an impact in Since Last quarter 4.

Report: Current We are currently expanding clinical capacity to better respond to new guidance, and this will have a positive impact on successful treatment figures.

Concerns: Reasons for Variance and Actions Taken:

We have restructured services to make them better placed to meet new targets whilst continuing to deliver improvements to patient care required under new clinical and prescribing guidance.

Planned Latest Variance (8) (9) Comments (value) YTD The number of drug users using crack and/or opiates recorded as being in structured drug treatment in a financial year who were discharged from treatment after 12 weeks or more, or who were discharged from treatment in a care planned way.

PI

Due Date

Note: Monthly data is available and is published on the National Treatment Agency (NTA) website for performance monitoring purposes www.nta.nhs.uk Nov 08

30-Nov-2008

1507

1504

-3

On track to meet target due to targeted approach and dedicated action plan

The percentage change in the number of drug users using crack and/or opiates recorded as being in structured drug treatment in a financial year who were discharged from treatment after 12 weeks or more, or who were discharged from treatment in a care planned way Note: Monthly data is available and is published on the National Treatment Agency (NTA) website for performance monitoring purposes www.nta.nhs.uk Nov 08

30-Nov-2008

3

2.8

-0.2

On track to meet target, which is above trajectory

National Drug Treatment Monitoring System (National Treatment Agency) (financial year 2008/09)

An estimated 3.764 million people in England and Wales use at least one illicit drug each year (British Crime Survey), and around one million people use at least one of the most harmful drugs (such as heroin and cocaine).

For most people this will be a passing phase and they will not continue to take drugs or require any special treatment in order to deal with it. The Home Office however estimate that approximately 330,000 people in England experienced a serious drug problem involving crack and/or opiates in 2005/06 (homeoffice.gov.uk/rds/pdfs06/rdsolr1606.pdf (PDF, 55KB, Opens in a new window).

Drug use causes a wide range of health and social harms. It causes short and long-term damage to physical and mental health, it affects unborn babies and it exposes drug users to risk of death from overdose and blood borne viruses. Drug use also causes wider public health risks as a result of discarded drug paraphernalia, drug driving and unprotected sex.

Drug use also limits the ability to work, to parent and to function effectively in society. It contributes to social exclusion and makes it difficult for people to play full and active roles in society.

The government's ten-year drug strategy 2008-2018 (http://drugs.homeoffice.gov.uk/drug-strategy/overview/) aims to restrict the supply of illegal drugs and reduce the harm caused by illicit A major strand of the new National Drug Strategy is the provision of effective and high quality drug treatment. The Drug Stra

HC - 14th January 2009 HC - 24th October 2008 HC - 18th June 2008 This indicator will drive a reduction in harm caused by the misuse of those drugs known to case the highest harm to individuals, their families and the communities in which they live.

It focuses attention on meeting both the demand for and the effectiveness of drug treatment and reinforces the gains made in the last drug strategy in improving the capacity and the quality of drug treatment. Progress on this indicator will have a wider impact on ill health, crime and social cohesion.

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NPA16: Number of drug users recorded as being in effective treatment (VSB14) The number of drug users using crack and/or opiates recorded as being in structured drug treatment in a financial year who were discharged from treatment after 12 weeks or more, or who were discharged from treatment in a care planned way.

PI

Apr 08

May 08

Actual TRG Actual PI Target TRG Name 1507 1463 1507

Jun 08

Jul 08

TRG

Actual

1507

1492

Aug 08

TRG

Actual

1507

TRG

Sep 08 Actual

1507

1504

TRG

Oct 08 Actual

1507

Nov 08

TRG

Actual

1507

TRG

Dec 08 Actual

1507

1504

TRG

Jan 09 Actual

1507

Feb 09

TRG

Actual

1507

TRG

Mar 09 Actual

1507

TRG

Actual

1507

The percentage change in the number of drug users using crack and/or opiates recorded as being in structured drug treatment in a financial year who were discharged from treatment after 12 weeks or more, or who were discharged from treatment in a care planned way PI

Apr 08

May 08

Actual TRG Actual PI Target TRG Name 3 1.7 3

Jun 08

Jul 08

TRG

Actual 3

2.1

Aug 08

TRG

Actual 3

TRG

Sep 08 Actual

3

2.8

TRG

Oct 08 Actual

3

Nov 08

TRG

Actual 3

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TRG

Dec 08 Actual

3

2.8

TRG

Jan 09 Actual

3

Mar 09

Feb 09

TRG

Actual 3

TRG

Actual 3

TRG

Actual 3

8 February 2009

Performance Report - National Priorities NPA17: Percentage of infants breastfed at 6-8 weeks (VSB11) Accountability Period (1) (4) 31-Jan-2009 NPA17: Percentage of infants breastfed at 6-8 weeks (VSB11) Julie Tolhurst Owner Judith Hooper Sponsor Kirklees BF prevalence Q2 is highest in Region(43%). Coverage rates Q2=55%(ie. number of Key children with breastfeeding status recorded as a percentage of all infants due for 6-8 week check)are Achievements underperforming in relation Q4 rate needed 85%. Action plan to address this has included targetting GP practices with low return rate of Child Health records for prompt submission to Child Health. Report Since Last to GP consortia exec group has been prepared to reinforce this requirement. Explanatory letters have Report: been sent to all GP practices.

Current Concerns:

Kirklees breastfeeding coverage rates still significantly below the expected HCC target. Ensure that action taken above will impact on change of practice to improve submission of child health records.

Reasons for Variance and Actions Taken:

This is a new target needing to establish robust data collection system between GP and Child Health.

There has been a breakdown of data to identify GP practices with lowest return rates with follow up those with low return rates, reinforcing need to submit this within each quarter and to split partial and total breastfeeding status .

Planned Latest Variance (8) (9) Comments (value) YTD Coverage: The number of children with a breastfeeding status recorded as a percentage of all infants due for a 6Dec 08 31-Dec-2008 85 51.5 -33.5 Prevalence; The number of infants recorded as being totally breastfed at 6-8 weeks during quarter 4 plus the Dec 08 31-Dec-2008 43 29.2 -13.8 The number of children being recorded as not at all breastfed at 6-8 weeks during quarter 4.

Dec 08 31-Dec-2008 556 256 -300 The number of children recorded as being partially breastfed (receiving both breast milk and infant formula) at 6Dec 08 31-Dec-2008 378 88 -290 The number of infants due for a 6-8 week check during quarter 4.

Dec 08 31-Dec-2008 1324 1149 -175 The number of infants recorded as being totally breastfed at 6-8 weeks during quarter 4.

Dec 08 31-Dec-2008 191 194 3

PI

Due Date

Vital Signs returns (financial year 2008/09 (quarter 4)) Vital Signs plans (financial year 2008/09 (quarter 4)) Vital Signs returns (financial year 2008/09 (quarters 1 to 3)) There has been significant evidence showing the benefit of breastfeeding including lowering the risks of breast and ovarian cancer for the mother and gastro-intestinal and respiratory infections for the infant. Infants who are not breastfed are also five times more likely to be admitted to hospital with infections in their first year of life. The measurement of prevalence of breastfeeding at 6 to 8 weeks is taking place in 2008/09 as a new data collection. In the first year of data collection, trusts need to ensure that a high level of data coverage is achieved and that they set up systems which enable prevalence rates in future years to be based on robust data. This indicator measures a key public health issue which will impact on infant health.

HC - 15th December 2008 HC - 24th October 2008 HC - 18th June 2008 There is clear evidence that breastfeeding has positive health benefits for both mother and baby in the short- and longerterm (beyond the period of breastfeeding). Breastmilk is the best form of nutrition for infants and exclusive breastfeeding is recommended for the first six months (26 weeks) of an infant's life.

For infants, it reduces the incidence of gastrointestinal and respiratory infections, otitis media and recurrent otitis media and reduces the risk of allergies. There is also some evidence that it protects against neonatal necrotizing enterocolitis, respiratory and urinary tract infection, and that it reduces the risk of auto-immune disease, such as diabetes mellitus type I, and of adiposity later in childhood.

For mothers, it promotes maternal recovery from childbirth, reduces the risk of pre-menopausal breast cancer and possibly of ovarian cancer, accelerates weight loss and a return to pre-pregnancy body weight and prolongs the period of postpartum infertility.

(See WHO Regional Publications, European Series, No.87 on Feeding and Nutrition of Infants and Young Children.)

There is evidence indicating that the longer the duration of breastfeeding, the greater the health benefits in later life. Brea Breastfeeding has an important contribution to make towards reducing infant mortality, childhood obesity and health inequalities.

Page 56 of 79 Š Dynamic Change Limited 2009 Performance Report - National Priorities

NPA17: Percentage of infants breastfed at 6-8 weeks (VSB11) Coverage: The number of children with a breastfeeding status recorded as a percentage of all infants due for a 6-8 week check.

PI

Apr 08

PI Target TRG Name

May 08 Actual

Jun 08

TRG

0

Actual

TRG

0

Jul 08 Actual

85

Aug 08

TRG

56.8

Actual

Sep 08

TRG

0

Actual

TRG

0

Oct 08 Actual

85

Nov 08

TRG

55.23

Actual

Dec 08

TRG

0

Actual

TRG

0

Jan 09 Actual

85

Feb 09

TRG

51.5

Actual

Mar 09

TRG

0

Actual

TRG

0

Actual 85

Prevalence; The number of infants recorded as being totally breastfed at 6-8 weeks during quarter 4 plus the number of children recorded as being partially breastfed (receiving both breast milk and infant formula) at 6-8 weeks during as percentage of the number of infants due for a 6-8 week check.

PI

Apr 08

PI Target TRG Name

May 08 Actual

Jun 08

TRG

0

Actual

TRG

0

Jul 08 Actual

43

Aug 08

TRG

43.86

Actual

Sep 08

TRG

0

Actual

TRG

0

Oct 08 Actual

43

Nov 08

TRG

38.8

Actual

Dec 08

TRG

0

Actual

TRG

0

Jan 09 Actual

43

Feb 09

TRG

29.2

Actual

Mar 09

TRG

0

Actual

TRG

0

Actual 43

The number of children being recorded as not at all breastfed at 6-8 weeks during quarter 4.

PI

Apr 08

PI Target TRG Name The

May 08 Actual

Jun 08

TRG

0

Actual

TRG

0

Jul 08 Actual

556

Aug 08

TRG

175

Actual

Sep 08

TRG

0

Actual

TRG

0

Oct 08 Actual

556

Nov 08

TRG

240

Actual

Dec 08

TRG

0

Actual

TRG

0

Jan 09 Actual

556

Feb 09

TRG

256

Actual

Mar 09

TRG

0

Actual

TRG

0

Actual 556

number of

The number of children recorded as being partially breastfed (receiving both breast milk and infant formula) at 6-8 weeks during quarter 4.

PI

Apr 08

PI Target TRG Name

May 08 Actual

Jun 08

TRG

0

Actual

TRG

0

Jul 08 Actual

378

Aug 08

TRG

30

Actual

Sep 08

TRG

0

Actual

TRG

0

Oct 08 Actual

378

Nov 08

TRG

76

Actual

Dec 08

TRG

0

Actual

TRG

0

Jan 09 Actual

378

Feb 09

TRG

88

Actual

Mar 09

TRG

0

Actual

TRG

0

Actual 378

The number of infants due for a 6-8 week check during quarter 4.

PI

Apr 08

PI Target TRG Name The

May 08 Actual

Jun 08

TRG

0

Actual 0

TRG

Jul 08 Actual

1324

Aug 08

TRG

1352

Actual

Sep 08

TRG

0

Actual 0

TRG

Oct 08 Actual

1324

Nov 08

TRG

1425

Actual

Dec 08

TRG

0

Actual 0

TRG

Jan 09 Actual

1324

Feb 09

TRG

1149

Actual

Mar 09

TRG

0

Actual 0

TRG

Actual

1324

number of

The number of infants due for a 6-8 week check during quarter 4.

PI

Apr 08

PI Target TRG Name The

May 08 Actual 0

Jun 08

TRG

Actual 0

TRG

Jul 08 Actual

191

563

Aug 08

TRG

Actual 0

Sep 08

TRG

Actual 0

TRG

Oct 08 Actual

191

207

Nov 08

TRG

Actual 0

Dec 08

TRG

Actual 0

TRG

Jan 09 Actual

191

194

Feb 09

TRG

Actual 0

Mar 09

TRG

Actual 0

number of

Page 57 of 79

TRG

Actual 191

8 February 2009

Performance Report - National Priorities NPA18: Proportion of children who complete immunisation by recommended ages Accountability Period (1) (4) 30-Jun-2008 NPA18: Proportion of children who complete immunisation by recommended ages Jane O'Donnell Owner Judith Hooper Sponsor COVER at 1 year primary vaccines there has been an increase of 2% on quarter 4 07/08.

As at Q4 07/08 when benchmarking against other Yorkshire and Humber Organisations Kirklees Key COVER at 2 years had the highest uptake for MMR first dose. For COVER at 5 years across Yorkshire and Humber we had the highest uptake for second dose MMR and second highest uptake for pre Achievements school booster.

Since Last Report: Child Health Services have run the report early for Q1 so unable presently to compare against other Yorkshire and Humber Organisations Current COVER at 2 years for all primaries including first dose MMR vaccine are down on quarter 4 07/08.

Concerns: Reasons for Due to the Department of Health allocating Primary vaccines and issues regarding the availability of pre Variance and school vaccines this could be a contributing factor on vaccine uptake.

Actions Taken: Planned Latest Variance (8) (9) Comments (value) YTD Immunisation rate for children aged 1 who have been immunised for Diphtheria, Tetanus, Polio, Pertussis, Haemophilus influenza type b (Hib) - (DTaP/IPV/Hib)

PI

Due Date

Jun 08 30-Jun-2008 93 93.384 0.3835 Target Acheived Immunisation rate for children aged 2 who have been immunised for Haemophilus influenza type b (Hib), meningitis C (MenC) - (Hib/MenC) Jun 08 30-Jun-2008 95 84.97 -10.0302 Immunisation rate for children aged 2 who have been immunised for measles, mumps and rubella (MMR) (MMR) Jun 08 30-Jun-2008 89 86.48 -2.5196 Immunisation rate for children aged 2 who have been immunised for Pneumococcal infection (PCV) - (PCV) Jun 08

30-Jun-2008

88

82.1

-5.9003

Immunisation rate for children aged 5 who have been immunised for Diphtheria, Tetanus, Polio, Pertussis (DTaP/IPV) Jun 08

30-Jun-2008

95

96.541

1.5411

Primary

Immunisation rate for children aged 5 who have been immunised for measles, mumps and rubella (MMR) Jun 08

30-Jun-2008

Š Dynamic Change Limited 2009 Performance Report - National Priorities

95

93.631

-1.3694

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Primary

8 February 2009

Performance Report - National Priorities NPA21: Stroke Care Accountability Period (1) (4) 31-Dec-2008 NPA21: Stroke Care Hayley Haycock Owner Sheila Dilks Sponsor We have started to receive data from CHFT and some estimated data from MidYorks. Work is underway to establish more formal data collection and reporting mechanisms. The plan for quarter 3 was that 45% Key Achievements of patients admitted with a stroke to spend 90% of their time on a stroke unit. We have achieved 47% Since Last Report: which meets the plan and work is underway to continue to improve on this figure to meet end of year plan of 65% of patients.

It has not been possible to collect or successfully estimate data for high risk TIAâ&#x20AC;&#x2122;s. This data has not been recorded up to present and work is underway to develop the pathway and set up data collection Current Concerns: processes to address this. Some PCTs are estimating numbers based on intelligence but this approach would not be meaningful in terms of performance management as it would be based on a guess rather than evidence/records.

Reasons for Variance and Actions Taken:

There is a Joint Kirklees and Calderdale Information group continuing to work on resolving some of the issues at local level. Also, concerns have been flagged up to the SHA and DH and we are awaiting further guidance.

PI Due Date Planned Latest Variance (8) (9) Comments Proportion of people who have a TIA who are scanned and treated within 24 hours Proportion of people who spend at least 90% of their time on a stroke unit Qtr 3 08/09 31-Dec-2008 45 47.0588 2.0588

Vital Signs return Cardiovascular disease (CVD) is a preventable disease that kills nearly 198,000 people in the UK every year. More than a quarter of these deaths from stroke (British Heart Foundation, 2008). A stroke is caused by a disturbance to the flow of blood to the brain by one of two main means, either as a result of a clot that narrows or blocks blood vessels or where blood vessels burst causing bleeding into the brain.

The National Stroke Strategy, 2007, sets out a quality framework and identifies examples of excellent care to help local services make improvements to stroke services. These examples include the treatment of stroke patients within specialist stroke units and the provision of rapid access to services for people who have had a minor stroke or transient ischemic attack (TIA).

HC - 24th October 2008 HC - 18th June 2008 110,000 people have a stroke each year, around a third of who die. Stroke is the largest single cause of adult disability, around 300,000 in England live with moderate to severe disabilities as a result of a stroke.

Good stroke unit care is the single most effective way to improve outcomes for stroke patients. Early initiation of treatment of TIAs or minor stroke can reduce the number of people going on to have a full blown stroke by 80%. Higher risk TIA cases are defined as those with an ABCD2 score of 4 or above.

These indicators are a good proxy for reducing disability and death due to stroke.

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8 February 2009

Performance Report - National Priorities NPA22: Under 18 conception rate per 1,000 females aged 15-17 (VSB08) Accountability NPA22: Under 18 conception rate per 1,000 females aged 15-17 (VSB08) Owner Rachel Spencer Sponsor Judith Hooper

Period (1) (4) 30-Sep-2008

Both prevention and support for Teenage Parents is of critical importance. Therefore, using the toolkits from Government Office, two self assessments have been carried out - one around prevention of teenage Key Achievements conceptions and the other to assess support for teenage parents. The information gathered has informed Since Last Report: the TPS Action Plan for 08/09.

From a PCT perspective, a locally enhanced service for Long Acting Reversible Contraception has been launched with training taking place in October.

The annual conception data for 2006 was released by the ONS on 29th February 2008.

The Under 18 conception rate in Kirklees has increased from 43.4 in 2005 to 43.9 in 2006. The increase is not significant albeit that it is heading in the wrong direction.

Overall, Kirklees has achieved a reduction in its 2006 Under 18 conception rate of 9.7% (since the Current Concerns: baseline year of 1998).

It is unlikely that Kirklees will achieve the Government's ambitious target to reduce Under 18 conceptions by 50% by 2010 (year end 2011/2012). In order to achieve a 50% reduction in its conception rate, Kirklees would need to reduce its rate by 10% per year (from 2006 - 2010).

Reasons for Variance and Actions Taken:

From a PCT perspective the following actions are being implemented to help reduce teenage conceptions: A C Card scheme is in development for condom distribution around the district.

A locally enhanced service is being written for the provision of emergency hormonal contraception in pharmacies.

Finally a RSHE toolkit has been created for use in schools which is being implemented and evaluated

Planned Latest Variance (8) (9) Comments (value) YTD Conception rate per 1,000 females aged 15-17 2006 31-Mar-2008 36.26 43.9241 -7.6641 PI

Due Date

Local delivery plan (calendar year 2007) Office for National Statistics (calendar year 2007) Britain's teenage birth rates are among the highest in Europe (http://www.rcog.org.uk/resources/public/pdf/RCOGTeenagePregnancySummaryReview.pdf). Teenage mothers are more likely to suffer poor health outcomes. The teenage pregnancy strategy seeks to halve the under-18 conception rate by 2010 (from the 1998 baseline) through a wide- ranging programme of coordinated activity, including improved advice and contraceptive services for young people.

In addition, local under-18 conception rate targets have been agreed with teenage pregnancy partnership areas, which are coterminous with top tier local authority areas in England. These local targets range between a 40% to 60% reduction by 2010. Each PCT is signed up to the target for their teenage pregnancy partnership area.

HC - 24th October 2008 HC - 21st August 2008

Reduce the under-18 conception rate by 50 per cent by 2010 as part of a broader strategy to improve sexual health. The under 18 conception rate is one of five national indicators monitoring progress of the 2008-2011 Public Service Agreement 14: Increasing the number of children and young people on the path to success. PSA 14 is supported by a joint DCSF/DH Delivery Agreement.

We expect SHA’s to develop plans to improve young people’s access to and uptake of contraception and sexual health advice in order to deliver their contribution to the National PSA. Teenage pregnancy is a cause and consequence of social exclusion and health inequalities. England’s under 18 conception rate is reducing but remains high compared with other Western European countries. Under 18 conceptions are strongly associated with deprivation and low educational attainment. Teenage mothers and their children face poor outcomes in health, emotional well being and later economic independence. Almost 50% of under 18 conceptions end in abortion. The Teenage Pregnancy Strategy seeks to halve the under-18 conception rate by 2010 through delivery of local strategies implemented jointly by Local Authorities and PCTs. Teenage Pregnancy Next Steps: guidance to LAs and PCTs on

To underpin the national target, all top tier local authority areas in England have a 2010 reduction target for their under 18 con

Page 60 of 79 © Dynamic Change Limited 2009 Performance Report - National Priorities

8 February 2009

Performance Report - National Priorities NPA23: Percentage of women who have seen a midwife or a maternity healthcare professional, for assessment of health and social care needs, risks and choices by 12 completed weeks of pregnancy. (VSB06) Accountability Period (1) (4) NPA23: Percentage of women who have seen a midwife or a maternity healthcare 31-Dec-2008 professional, for assessment of health and social care needs, risks and choices by 12 completed weeks of pregnancy. (VSB06) Owner Keith Henshall Sponsor Carol Mckenna Key Achievements Since Last Report:

Now getting data from providers reflecting the new guidance issued to change reporting requirements to percentage of women being assessed by 12 weeks 6 days against all women being assessed at any time during pregnancy. This gives a better indication of the percent of women booking in early. Q3 data shows overall just about achieving the target for 08/09 which is 65%.

Current Concerns:

There are no existing robust systems and processes in place to verify that women are getting assessed at 12 weeks 6 days in line with NICE guidance. There is substantial difference between the performance of the two acute trusts providing maternity services for Kirklees. Also performance varies month to month.

Reasons for Variance and Actions Taken:

Action taken to verify provider compliance with NICE guidance through discussion with Governance and Contracting Teams. Monitoring data month by month.

Planned Latest Variance (8) (9) Comments (value) YTD Percentage of women who have seen a midwife or a maternity healthcare professional, for health and social care assessment of needs, risks and choices by 12 completed weeks of pregnancy

PI

Due Date

Dec 08

31-Dec-2008

49

64.579

15.5785

NHS maternity statistics (financial year 2008/2009) The 'Vital Signs', published as part of the 2008/2009 NHS Operating Framework, include an indicator on the percentage of women who have seen a midwife or maternity healthcare professional, for assessment of health and social care need, risks and choices, by 12 completed weeks of pregnancy. This indicator also appears as a PSA target indicator as part of the 2007 Comprehensive Spending Review.

This requirement is also included in the Department of Health document 'Maternity Matters' (2007) as a key element in delivering maternity choice. This indicator assesses the number of first maternity appointments which occur within the first 12 weeks of pregnancy.

HC - 18th June 2008

All women should access maternity services for a full health and social care assessment of needs, risks and choices by 12 completed weeks of their pregnancy to give them the full benefit of personalised maternity care and improve outcomes and experience for mother and baby.

Reducing the % of women who access maternity services late through targeted outreach work for vulnerable and socially excluded groups will provide a focus on reducing the health inequalities these groups face whilst also guaranteeing choice to all pregnant women.

Completion of the assessment ensures that women are supported in making well informed decisions about their care throughout pregnancy, birth and postnatally.

Page 61 of 79 Š Dynamic Change Limited 2009 Performance Report - National Priorities

8 February 2009

Performance Report - Other Performance Measures Other Performance Measure 01: MRSA number of infections Accountability Period (1) (4) 31-Dec-2008 Other Performance Measure 01: MRSA number of infections MRSA levels sustained, locally determined stretch targets taking us beyond the national target.

Jane O'Donnell Owner Judith Hooper Sponsor Key Achievements The target for Kirklees and Calderdale health economy continues to be achieved.

Since Last Report: Current The health economy of Kirklees and Wakefield reported 6 MRSA bacteraemia cases in December, this is 2 cases over the monthly target.

Concerns: Reasons for Variance and Actions Taken:

A review is being undertaken of themes from cases, to see if new themes are emerging from the root cause analysis investigations. Action plans are in place for each new case. One of the 6 cases reported was a pre 48 hour case attributed to Kirklees in fact this was a patient from another Trust, an appeal will be submitted to the Health Protection Agency for this case to be removed from MYHT trajectory.

Planned (value) Number of infections (CHFT) cumulative Dec 08 31-Dec-2008 16 Number of infections (MYHT) cumulative Dec 08 31-Dec-2008 34 Number of infections in period (CHFT) Dec 08 31-Dec-2008 1 Number of infections in period (MYHT) Dec 08 31-Dec-2008 4 PI

Due Date

Š Dynamic Change Limited 2009 Performance Report - Other Performance Measures

Latest YTD

Variance

9

7

32

2

1

0

6

-2

Page 62 of 79

(8) (9) Comments

8 February 2009

Performance Report - Other Performance Measures Other Performance Measure 02: Supporting measures: Extended opening hours for GP practices, Increased capacity in primary care, Patient reported access to out-of-hours care (indicator to be developed) Accountability Period (1) (4) Other Performance Measure 02: Supporting measures: Extended opening hours for GP 31-Dec-2008 practices, Increased capacity in primary care, Patient reported access to out-of-hours care (indicator to be developed) At least 50% of GP practices in each PCT offer extended opening to their patients.

100 new GP practices, including up to 900 GPs, nurses and healthcare assistants into the 25% of PCTs with the poorest provision; 150 new health centres Mark Jenkins Owner Carol Mckenna Sponsor Key Achievements 81% of GPs signed up to the DES'.

Since Last Report: Planned Latest Variance (8) (9) Comments (value) YTD The percentage of GP practices in the PCT offering extended opening in compliance with Department of Health Sep 08 30-Sep-2008 27 81.0811 54.0811

PI

Due Date

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8 February 2009

Performance Report - Other Performance Measures Other Performance Measure 03: Convenience and choice - GP Referrals (PCT Booking) Accountability Other Performance Measure 03: Convenience and choice - GP Referrals (PCT Booking)

Period (1) (4) 31-Jan-2009

Ensure that by the end of 2005 every hospital appointment will be booked for the convenience of the patient, making it easier for patients and their GPs to choose a hospital and consultant that best meets their needs. By December 2005, patients will be able to choose from at least four different health care providers for planned hospital care, paid for by the NHS. Rachel Carter Owner Carol Mckenna Sponsor There has been a significant improvement in performance in January - 12% improvement on December. For NHS Kirklees , performance was 50% (38% in December); this is the best Key performance to date. NHS Kirklees is now 8th out of 14 PCTs in Y&TH. Achievements Roll-out of Directly-Bookable Services (DBS) is progressing well at MYHT, with all services except Since Last Orthopaedics now directly-bookable - 83% of C&B referrals were booked via DBS in January (82% in Report: December, 74% in November, 58% in October, 46% in September, 40% in August, 26% in July, 20% in June).

Current Concerns:

January performance for Kirklees was 50% (April 46%, May 43%, June 37%, July 43%, August 41%, September 45%, October 42%, November 41%, December 38%) against a target of 90%. The SHA aggregate performance has improved in December from 43% to 53% but remains below the National performance which has also improved from 46% to 58%. Performance relating to our two main providers was CHFT: 53%(December 42%, November 47%, October 47%, September 51%, August 48%, July 53%, June 50%), MYHT: 42% (December 35%, November 36%, October 39%, September 38%, August 34%, July 32%, June 29%).

It had been expected that DBS roll-out at MYHT would increase overall C&B usage and it may be that we are now starting to see this result (but too early to be sure). Now that DBS is generally available at MYHT there will be a publicity campaign to try to reinvigorate GP usage. It now appears that DBS rollout at CHFT will not start until April 2009; we are working with them to understand a detailed delivery plan.

Reasons for Variance and Actions Taken:

We are continuing to implement the action plan to deliver 90% by April 2009 - although delivery to this level is unlikely. Regular contact with practices is being maintained, with performance being escalated where it is not improving.

Planned Latest Variance (8) (9) Comments (value) YTD Percentage of referrals received by providers for first consultant outpatient appointments that are made through choose and book PI

Due Date

The number of patients added each month to the outpatient waiting list for first outpatient appointment, where the source is GP written referral, and where the patient was booked through Choose and Book. The value is the sum of the months from April 2006 to March 2007. Expressed as a percentage. Performance will be assessed against the planned percentage in the 2006/2007 PCT Choose and Book Utilisation Plan.

Jan 09

31-Jan-2009

90

Š Dynamic Change Limited 2009 Performance Report - Other Performance Measures

50

-40

Page 64 of 79

Other Performance Measure 03: Convenience and choice - GP Referrals (PCT Booking) Percentage of referrals received by providers for first consultant outpatient appointments that are made through choose and book PI

Apr 08

May 08

Jun 08

Jul 08

Aug 08

Sep 08

Oct 08

Nov 08

Dec 08

Jan 09

Feb 09

PI Target TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual Name 90 46 90 43 90 37 90 43 90 41 90 45 90 42 90 41 90 38 90 50 90

Page 65 of 79

Mar 09 TRG

Actual 90

8 February 2009

Performance Report - Other Performance Measures Other Performance Measure 04: Convenience and Choice - Patient Recollection of Choice Accountability

Period

Other Performance Measure 04: Convenience and Choice - Patient Recollection of Choice

31-Mar-2009

(1) (4)

Ensure that by the end of 2005 every hospital appointment will be booked for the convenience of the patient, making it easier Rachel Carter Owner Carol Mckenna Sponsor Kirklees performance remains above the SHA average (below National average). Performance has dropped from a peak in March - May of 52%(co-oinciding with National and local media campaigns)back to 44% for August - September (against a target of 80%).

There are some inconsistencies in the data. For example the choice recollection for our main providers in August - September was 52% for CHFT and 45% for MYHT; it is hard to understand how the overall Key PCT performance can be below that of our two main providers given that it is more likely that our Achievements patients going elsewhere will have been offered choice.

Since Last Performance October - November 2007 was 37% (SHA 39%) Report: Performance November - February 2008 was 41% (SHA 39%) Performance January - March 2008 was 44% (SHA 42%).

Performance March - May 2008 was 52% (SHA 46%, National 49%) Performance June - July 2008 was 45% (SHA 43%, National 47% Performance August - September was 44% (43%, National 48%) Reasons for We are continuing work to improve awareness of choice. The PCT is funding a local media campaign to Variance and reinforce the current national campaign.

Actions Taken: PI Due Date Planned Latest Variance (8) (9) Comments Percentage of eligible patients who answered positively: "Before you visited your GP, did you know that you now have a choice of hospitals that you can go to for your first hospital appointment?"

This is a two part indicator, the results from the two indicators will be combined to give an overall indicator score. The data will be sourced from National Patient Choice Survey (Financial year 2007/2008) Percentage of eligible patients who answered positively: "Were you offered a choice of hospital for your first hospital appointment?"

This is a two part indicator, the results from the two indicators will be combined to give an overall indicator score. The data will be sourced from National Patient Choice Survey (Financial year 2007/2008) 2007/08

31-Mar-2008

100

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44

-56

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8 February 2009

Performance Report - Other Performance Measures Other Performance Measure 05: Patient reported measure of choice of hospital (VSC16) Accountability Other Performance Measure 05: Patient reported measure of choice of hospital (VSC16) Rachel Carter Owner Carol Mckenna Sponsor

Period (1) (4) 31-Oct-2008

PI Due Date Planned Latest Variance (8) (9) Comments Percent of patients aware that they have a choice of hospital for their first hospital appointment 1st Aug to 30th Sept 30-Sep-2008 0 44 44 2008 Percent of patients who went to the hospital they wanted, or had no preference 1st Aug to 30th Sept 30-Sep-2008 0 88 88 2008

To measure patient experience of choice in the NHS

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Other Performance Measure 05: Patient reported measure of choice of hospital (VSC16) Percent of patients aware that they have a choice of hospital for their first hospital appointment PI

Apr 08

PI Target TRG Name

May 08 Actual

TRG

Jun 08 Actual

0

TRG

52

Jul 08 Actual

Aug 08

TRG

52

Actual 0

TRG

Sep 08 Actual

TRG

45

Oct 08 Actual

0

TRG

Nov 08 Actual

TRG

44

Dec 08 Actual

TRG

Jan 09 Actual

Feb 09

TRG

0

Actual

TRG

Mar 09 Actual

TRG

0

Actual 0

Percent of patients who went to the hospital they wanted, or had no preference PI

Apr 08

PI Target TRG Name

May 08 Actual

TRG

Jun 08 Actual

0

TRG

Jul 08 Actual

Aug 08

TRG

Actual 0

TRG

Sep 08 Actual

TRG

Oct 08 Actual

0

TRG

Nov 08 Actual

88

Page 68 of 79

TRG

Dec 08 Actual

0

TRG

Jan 09 Actual

Mar 09

Feb 09

TRG

Actual 0

TRG

Actual

TRG

Actual 0

8 February 2009

Performance Report - Other Performance Measures Other Performance Measure 06: Number of emergency bed days per head of weighted population (VSC20) Accountability Period (1) (4) Other Performance Measure 06: Number of emergency bed days per head of weighted 30-Nov-2008 population (VSC20) (Also used as proxy for Longer Term Conditions in first year) Cross Referenced VSC11 Joanne Crewe Owner Sheila Dilks Sponsor Assistive technology (telehealth monitors)will be available across Kirklees from April 2009.

Generic Workers have now been employed into the rapid response teams in the local authority and will directly support individuals with low level health and social care needs to prevent hospital admission.

Early supported discharge for COPD will commence in the next 2 months and will affect performance against this target.

Key Achievements The variance has dropped compared to the last report due to lower activity in November across all Since Last sites: Report: CHFT 9191 (Nov 07) 8444 (Nov 08) a variance of -747 MYT 6256 (Nov 07) 5629 (Nov 08) a variance of -627 Other 3316 (Nov 07) 3235 (Nov 08) a variance of -81 Overall activity has dropped by -1455 compared to Nov 07. The largest decrease at CHFT has been in general medicine which has decreased 268 bed days compared to Nov 07 and Elderly Medicine (242 reduction compared to Nov 07).

Current activity continues to show no improvement despite the investment in services to support a Current reduction in bed day usage. Further analysis of the data is required to understand the reasons for increases - this increase in bed day usage is not necessarily attributed to individuals with Long Term Concerns: Conditions Proposed investment in Long Term Conditions has not all been realised and is therefore partially effecting performance on this target. Recruitment of additional community matrons is complete but staff are not fully operational until training and development programme has been completed. Training will be complete by September 2010.

Reasons for Variance and Actions Taken:

PI

In future bed days activity due to Long Term Conditions will be reported separately from bed day usage due to other reasons for admission. This will enable us to understand where investment in Long Term Conditions is having an impact on bed day usage and where additional service development and redesign may be required.

Further work to establish high intensity service usage including the use of predictive risk tools are vital to intelligent commissioning that will directly impact on this target.

Due Date

Number of Emergency Bed Days Nov 08 30-Nov-2008

Planned (value)

Latest YTD

119026

144740

Variance (8) (9) Comments -25714

This is a measure of improved pro-active care of patients, particularly those with chronic conditions. Reducing the number of emergency bed days requires input from range of stakeholders to avoid admissions and to ensure appropriate time in hospital. There is a clear measure of success and requires improvements in performance from a range of organisations in health and social care to achieve it.

Š Dynamic Change Limited 2009 Performance Report - Other Performance Measures

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Other Performance Measure 06: Number of emergency bed days per head of weighted population (VSC20) PI

Apr 08

May 08

Jun 08

Jul 08

Aug 08

Sep 08

Oct 08

Nov 08

Dec 08

PI Target TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual Name Number 14878 18400 29757 36259 44635 54017 59513 74146 74391 91083 89270 110324 104148 127432 119026 144740 133904 of

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Jan 09 TRG 148783

Feb 09 Actual

TRG 163661

Mar 09 Actual

TRG 178539

Actual

8 February 2009

Performance Report - Other Performance Measures Other Performance Measure 07: Rates of hospital admissions for ambulatory care sensitive conditions per 100,000 population (VSC21) Accountability Period (1) (4) Other Performance Measure 07: Rates of hospital admissions for ambulatory care sensitive 31-Jan-2009 conditions per 100,000 population (VSC21) Joanne Crewe Owner Sheila Dilks Sponsor Key Achievements Since Last Report: Current Concerns:

Reasons for Variance and Actions Taken:

Recruitment of generic workers within adult social care - respond rapidly to low level health and social care difficulties as a result of long term conditions Recruitment of programme manager for stroke Validation of data may be required at data freeze point.

A regular update will be added monthly following the work now completed by the information and data quality team to provide assurance that data being submitted is consistent and reliable to support accurate performance reporting Schemes to impact on LTC management and the rate of hospital admissions due to ambulatory conditions per 100,000 continue to be implemented.

Long Term Condition Health Improvement Teams are developing pathways for the disease specific pathways for primary care management - implementation of these pathways will directly impact on rate of admissions for ambulatory conditions.

A workstream to address work force development will be meeting for the first time at the end of January this is crucial to delivering the LTC programme Planned Latest Variance (8) (9) Comments (value) YTD 2001 Census based mid-year population estimates for the respective calendar years Sep 08 30-Sep-2008 402757 402757 0 Rate of hospital admissions for ACS conditions per 100,000 population Sep 08 30-Sep-2008 967 1045 -78 Total number of hospital admissions for ACS conditions Sep 08 30-Sep-2008 3896 4208 -312 PI

Due Date

Avoidable hospitalisations are those conditions that could have been avoided if proper ambulatory care had been received and can thus be seen as a measure of access to appropriate care. The rate of ambulatory care sensitive hospitalisation is considered a measure of access to adequate primary care and quality of chronic disease management to prevent complications. A disproportionately high rate is presumed to reflect problems in obtaining access to primary care.

Š Dynamic Change Limited 2009 Performance Report - Other Performance Measures

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Other Performance Measure 07: Rates of hospital admissions for ambulatory care sensitive conditions per 100,000 population (VSC21)

Rate of hospital admissions for ACS conditions per 100,000 population PI

Apr 08

May 08

Jun 08

Jul 08

Aug 08

Sep 08

Oct 08

PI Target TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual TRG Actual Name Rate of 159 195 324 374 479 561 646 727 802 898 967 1045 1133 hospital

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Nov 08 TRG

Dec 08 Actual

1298

TRG 1496

Jan 09 Actual

TRG 1677

Feb 09 Actual

TRG 1840

Mar 09 Actual

TRG 2018

Actual

8 February 2009

Performance Report - Other Performance Measures Other Performance Measure 08: Supporting measures: number of diagnostic waits > 6 weeks, Percentage of patients seen within 18 weeks for direct access audiology treatment, Activity levels, Patient reported experience of 18 week pathways (VSA05) Accountability Period (1) (4) Other Performance Measure 08: Supporting measures: number of diagnostic waits > 6 weeks, Percentage of patients seen within 18 weeks for direct access audiology treatment, 30-Nov-2008 Activity levels, Patient reported experience of 18 week pathways (VSA05) To ensure that, by December 2008, no one waits more than 18 weeks from referral to the start of hospital treatment or Owner Abigail Tebbs Sponsor Carol Mckenna Review of referral trends continues. Remedial actions will be recommended as appropriate, and referral plans will be agreed with relevant providers as part of neotiations to agree 2009/10 standard Key contracts. Activity levels are broadly in line with plan however, it is known that some providers, Achievements particularly Mid Yorkshire NHS Trust, continue to have problems in managing waiting times doen to Since Last agreed trajectory rto meet December mont hend targets for 18 Weeks RTT. Weekly monitoring Report: continues and trust is contracting for additiona lactivity in the independent sector to manage the position supported by local PCTs. Work to understand the nature and implications of the increase continues with main providers in order to determine if referrals are converting to elective activity and if sufficient capacity is available to meet demand and deliver 18 week /RTT targets in December. This increase is not a local phenomenon, and similar rises are being reported across England. Levels of GP referrals reduced again in November but it is not yet clear if this upward trend will continue, however, this increased level will put furhter pressure on providers who are undertaking additiona llevels of outpatietns and elective activity to achieve the December 18 week target. Weekly acces smeeting continue with Mid yorkshire Trust to monitor the position and performacne at Calderdale & Huddersfield Trust are addressed through the 18 Week Board and contracting meetings. This report deals with the period to end Nob=vember but it should be noted that elective capacity in December and early January was compromised by increased acute admissions as a result of bad weather and ward closures as a result of viral infections (D&V) these affected in particular MYHT. Current First outpatient attendances continue to exceed planned levels, probalby in response to rises in Concerns: referral rates (and additional work to sustain and deliver 18 week targets - the PCT and trusts hope that work on referral levels will identify if increased demand in sort term or ongoing and how additional capacity can best be provided.

Reasons for Variance and Actions Taken:

Elective ordinary activity remains slightly below targetted levels. This is a cause for concern as plans identify levels of activity required to deliver 18 week targets, however while both local trusts report that they are unlikely to deliver the SHA September stretch 18 week target, 18 Week Project Boards report confidence in achieving December national targets. Performance continues to be measured closely by 18 week leads and contracting team and remedial actions are being taken, with Mid Yoekshire Hospitals NHS Trust (MYHT), where concern is greatest, to ensure sufficient capacity is available for the achievement of the 18 Week target in December. Work is also ongoing to ensure sustainable levels of activity are generated to deliver the 18 week waiting time target in the longer term.

Referrals - a detailed analysis and investigation is underway to understand the reasons for increases in referrals.

Activity - levels continue to be monitored against delivery of RTT targets and remedial actions will be taken if the postion deteriorates.

Weekly review meetings with MYHT to review capacity and 18 week wait process and expedite remedial action.

With regard to diagnosting activity, although this remains below plan providers are delivering the 6 week wait in all but a small number of cases (7 breaches in November).

PI Due Date Planned Latest Variance (8) (9) Comments Activity for 15 key diagnostics tests Nov 08 30-Nov-2008 8841 7968 -873 Non-elective G&A FFCEs, excluding well babies Nov 08 30-Nov-2008 3467 3365 -102 Number of all first outpatient attendances (consultant led) in general and acute specialties Nov 08 30-Nov-2008 7971 8181 210 Number of first outpatient attendances (consultant led) following GP referral in general & acute specialties Nov 08 30-Nov-2008 5177 5172 -5 Number of other referrals for a first outpatient appointment in general & acute specialties Nov 08 30-Nov-2008 3071 2453 -618 Number of written referrals from GPs for a first outpatient appointment in general & acute specialties Nov 08 30-Nov-2008 5435 5503 68 Planned elective G&A day case FFCEs Nov 08 30-Nov-2008 636 730 94 Planned elective G&A ordinary admission FFCEs Nov 08 30-Nov-2008 212 206 -6 Total elective G&A day case FFCEs Nov 08 30-Nov-2008 2725 2724 -1 Total elective G&A ordinary admission FFCEs Nov 08 30-Nov-2008 1165 1067 -98

Commissioners need to show that plans for delivering the 18 week target are based on realistic assumptions.

Commissioners need to show that realistic plans for delivering the 18 week target are in place.

Commissioners need to show that the underpinning activity required to deliver the 18 week target is in place.

Commissioners need to show that the underpinning activity required to deliver access plans is in place.

Commissioners need to show that the underpinning activity required to deliver access plans is in place. Activity will be assessed against the number of patients waiting more than 6 weeks for these 15 tests (DSO 2.35a, lines 7). By comparing the number of long waiters with activity we will be able to infer clearance times.

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8 February 2009

Performance Report - Local Area Agreement Health Indicators not already included in previous Performance Report Sections Local Area Agreement LOCAL TARGET - Number of women of child bearing age who are hazardous drinkers Accountability Period (1) (4) LOCAL TARGET - Number of women of child bearing age who are hazardous 31-Dec-2008 drinkers New indicator - the baseline will be established through the local health & Lifestyle Survey. Work will begin to deliver against this indicator in 2008/09 but targets will not be set until 2009/10.

Cathy Munro Owner Carol Mckenna Sponsor Alcohol is a key component of the WOCBA programme, and as such is being addressed by the COI social marketing work.

Key Achievements Maternity services/midwives have been updated on the current DH guidance around alcohol Since Last Report: and pregnancy by WOCBA team.

Alcohol screening & brief intervention training identifies women of child-bearing age as a target group.

Current Concerns: Baseline data unavailable in Q3.

Reasons for Variance and Actions Taken:

CHIK data analysis to be undertaken and baseline data available in Jan 09 (Q4) to enable indicator to be set in conjunction with WOCBA Programme Lead.

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8 February 2009

Performance Report - Local Area Agreement Health Indicators not already included in previous Performance Report Sections LOCAL TARGET - Percentage increase in adult dependent drinkers exiting structured specialist treatment through care planned discharges Accountability Period (1) (4) LOCAL TARGET - Percentage increase in adult dependent drinkers exiting structured specialist treatment through care planned discharges Percentage increase in adult dependent drinkers exiting structured specialist treatment through care planned discharges Tony Cooke Owner Carol Mckenna Sponsor

Š Dynamic Change Limited 2009

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8 February 2009

Performance Report - Local Area Agreement Health Indicators not already included in previous Performance Report Sections NI 50 - Emotional health of children Accountability

Period

(1) (4)

NI 50 - Emotional health of children

This is a new indicator and a programme of development is ongoing to finalise the method of calculation. At this stage it is proposed that answers of young people will be combined into a single performance measure based on the proportion of young people responding positively to each item.

Each item will be equally weighted. The TellUs survey data are weighted and grossed up to match local area profiles based on PLASC data.

The local authority indicator will be the percentage of children who enjoy good relationships with their family and friends. The definition of 'good' will need to be determined after an initial analysis of the TellUs 3 Survey data.

Owner Sponsor

Debi Hemingway Carol Mckenna

Š Dynamic Change Limited 2009

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8 February 2009

Performance Report - Local Area Agreement Health Indicators not already included in previous Performance Report Sections Smoking Prevalence - % of women known to be smoking at birth in Dewsbury and Batley Accountability

Period

(1) (4)

Smoking Prevalence - % of women known to be smoking at birth in Dewsbury and Batley 30-Sep-2008 Owner Sponsor Key Achievements Since Last Report: Current Concerns: Reasons for Variance and Actions Taken:

Rachel Spencer Judith Hooper A stop smoking group has been running in the antenatal department of mid Yorkshire hospitals (MYHT), however this has not been well attended. The service is looking at the reasons why this might be to look to changing times or increase publicity. A fast track referral system is in place for all pregnant smokers and is used effectively. All midwives in MYHT have been trained in brief interventions.

Because of the small numbers involved, the data will be reported at the end of March 09 for the whole year.

Through the Women of Child Bearing age project, social marketing insight has suggested a pilot ‘pregnancy salon’ which will give pregnant women the opportunity to meet healthcare professionals in non healthcare settings. This will be evaluated with a view to commissioning effective services.

Kirklees are looking to participate in a regional project which supports women for the duration of their pregnancy and beyond to tackle the high relapse rate in pregnancy.

Planned Latest Variance (8) (9) Comments (value) YTD % of women known to be smoking at birth in Dewsbury and Batley

PI

Due Date

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8 February 2009

Performance Report - Local Area Agreement Health Indicators not already included in previous Performance Report Sections VSC25 and LAA NIS 137 - Healthy life expectancy at age 65 Accountability

Period

(1) (4)

VSC25 and LAA NIS 137 - Healthy life expectancy at age 65 People are living longer but healthy life expectancy is not increasing at the same rate. It is clearly desirable for increased life expectancy to be spent in good health. This measure uses a self-reported health assessment, applied to life expectancy data. This is thus in part a subjective measure and the meanings attached by respondents to the categories may have changed over time due to medical advances or other factors.

However, it captures the effects of the full range of interventoins to improve objective health status on subjective states of health, and thus whether efforts are being appropriately targetted at conditions or behaviours that improve people's lives. The methodology is well established, with a baseline for local areas of 2001 from census data.

Biennial collection will be through the new Place Survey. Local authorities will submit data to the Audit Commission, who will weight it and submit it to CLG directly, and provide authorities with weighted copies of their own data sets.

Owner Sponsor

Deborah Collis Judith Hooper

Š Dynamic Change Limited 2009

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8 February 2009

Performance Report - Local Area Agreement Health Indicators not already included in previous Performance Report Sections VSC11: Proportion of people with long-term conditions supported to be independent and in control of their condition Accountability Period (1) (4) VSC11: Proportion of people with long-term conditions supported to be independent and in control of their condition The percentage of people with a long-term condition who "had enough support from local services or organisations Joanne Crewe Owner Sheila Dilks Sponsor PI

Due Date

Planned (value)

Latest YTD

Variance (8) (9) Comments

Number of emergency bed days

This indicator focuses attention on patient experience against exact national policy aims for people with longterm conditions. People with long-term conditions want greater control of their lives, to be treated sooner before their condition causes more serious problems and to enjoy a good quality of life. This means transforming the lives of people with long-term conditions to move away from the reactive care based in acute settings toward a more systematic patient-centred approach, where care is rooted in primary and community settings and underpinned by strong partnerships across the whole health and social care spectrum.

Š Dynamic Change Limited 2009

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