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23 April 2008

Key Performance Indicators Key (1) Overall RAG (2) Action Plan Status (3) Financial RAG (4) PI Status (5) Overall Risk (6) Milestone RAG (7) Milestone Status (8) PI Milestone RAG (9) PI Milestone Status

Acc Ref

Accountability

Completion Date

1.a.6 Total time in A&E: 4 hours or less

31-Mar-2008

(1)

(4)

Maintain the four hour maximum wait in A&E from arrival to admission, transfer or discharge. Owner Jim Barwick Sponsor

Carol Mckenna Due Date

PI

Planned (value)

Latest YTD

Variance

(8) (9) Comments

YTD Percentage of patients spending four hours or less in all types of A&E department The number of patients spending four hours or less in all types of A&E department divided by he total number of patients attending all types of A&E department, expressed as a percentage for the financial year 2007/2008 This includes attendances at all types of A&E department either run by the commissioned acute trust or a partner PCT to the acute trust (partner PCTs may provide type 2 or 3 A&E services) This is worked out on a percentage split of activity Dec 07 31-Dec-2007 98 97.47 -0.53 as per Annual Health Check mapping exercise requirements YTD Percentage of patients spending four hours or less in all types of A&E department CHFT This is purely CHFT Activity. Dec 07

31-Dec-2007

98

97.77

-0.23

This figure is only A&E Attendances at CHFT

YTD Percentage of patients spending four hours or less in all types of A&E department MYHT This figure excludes KPCT and WPCT Walk in Centre Attendances YTD Percentage of patients spending four hours or less in all types of A&E department WIC KPCT Dec 07

31-Dec-2007

98

97.08

-0.92

Dec 07

31-Dec-2007

98

98.72

0.72

QMAE Quarterly Return (Financial year 2007/2008)

28th March 2007 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, transfer or discharge from January 2005 onwards. 'National Standards, Local Action' sets out that NHS organisations are required to maintain achievement of this target. 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. Acc Ref

Accountability

Completion Date

PSA13h

1.a.9 PSA13h: Number of patients waiting longer than the standard for 15 key diagnostic tests and procedures for period April 2007 to March 2008

31-Mar-2009

(1)

Owner

Abby Tebbs

Sponsor

Carol Mckenna

Current Concerns:

Waitig times reducing satisfactorily against profile for 6 week target overall, however, 11 breaches of the 13 week target Due Date

PI

Planned (value)

Latest YTD

Variance

(4)

(8) (9) Comments

Number of patients waiting 13 weeks or more, for 15 key diagnostic tests and procedures, at the date of measurement Dec 07

31-Dec-2007

0

11

-11

Number of patients waiting 6 weeks or more, for 15 key diagnostic tests and procedures, at the date of measurement Unvalidated February 2008 data available at time of Feb 08 29-Feb-2008 118 79 39 reporting

23rd July 2007

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Acc Ref

Accountability

Completion Date

1.b.2 Access to a primary care professional

31-Mar-2009

(1)

(4)

Guaranteed access to a primary care professional within 24 hours and to a primary care doctor within 48 hours Owner Mark Jenkins Sponsor

Carol Mckenna

Key Achievements Since Last Report:

Achievement increased from 98.6 % to 99.4% UPDATE March 08 - PCAS takes place Quarterly, next survey to take place during April with figures made available to performance accelerator early May 08.

Current Concerns:

One Kirklees practice did not meet the 24hr target for accessing a Primary Care Professional. The practice concerned was contacted on a Thursday and does not have a Primary Care Professional in post on Fridays. On this occasion an appointment was not available with the practice GP within 24hrs so the practice failed to meet the target. UPDATE March 08 - The only practice that didn't meet the PCT target in the previous Quarterly PCAS has now confirmed that there is now access to a Nurse Practitioner on Fridays so it is expected that they will acheive the target in future surveys.

Reasons for Variance and Actions Taken:

See 'Current Concerns' above. The contracting team are to approach the practice concerned to discuss the issue and ensure that arrangements are put in place to guarantee that the practice meets the target in future. The acheivement of this target has improved each Quarter and the PCT is confident that 100% of the target will be met in future. UPDATE March 08 - Practice who didn't meet the PCP target have been approached and it is expected that they will meet PCT targets in future surveys. Due Date

PI

Planned (value)

Latest YTD

Variance

(8) (9) Comments

Percentage of population able to see a Primary Care Professional within 1 working day For each month: total practice list size for those practices within the PCT with an appointment system who can offer an appointment to see a primary care professional within one working day divided by the total practice list size for those practices within the PCT with an appointments system in place to see a primary care professional. The indicator value will be the weighted average of the 12 monthly figures, i.e. the sum of all the 12 monthly numerators divided by the sum of the 12 monthly denominators. Jan 08

31-Jan-2008

100

99.4

-0.6

Primary care access survey (Financial year 2007/2008)

28th March 2007 There is a Priorities and Planning Framework (2003 - 2006) target to ensure that from December 2004 100% of patients who wish to do so can see a primary care professional within one working day and a GP within two working days. The NHS in England: the Operating Framework for 2007/2008 (2.4) reaffirmed that PCTs need to ensure they continue to meet existing Government commitments, and that progress on this would continue to be assessed by the Healthcare Commission. This indicator measures activity in practices with an appointment system to see a primary care professional. It allows such practices to include access under an agreement with a local NHS Walk-In Centre (or local access clinic) covering referring or diverting patients, that has been signed off by the PCT as offering appropriate access. This indicator is based on results from the Primary Care Access Survey (PCAS). The Healthcare Commission and Department of Health have been working towards incorporating views of patients into the assessment of this target. In 2007/2008 this has been achieved for the part of the target which relates to 48 hour access to a GP, through the use of data from the new GP Patient Survey. For the part relating to 24 hour access to a primary care professional, primary care trusts are encouraged to work with practices to ensure that PCAS results more accurately reflect the experience of patients.

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Acc Ref

Accountability

Completion Date

1.d.1 Category A calls meeting 8 minute target

31-Mar-2008

(1)

(4)

All ambulance trusts to respond to 75% of category A calls within 8 minutes. Owner Rachel Carter Sponsor

Carol Mckenna

Current Concerns:

Performance in February improved slightly, with monthly performance for YAS at 73.3% (January 73.2%) against a target of 75%. This is an annual target; year to date performance has remained static at 73.7%. The cumulative annual 75% target has not been achieved for 2007/08. The Kirklees position is worse than the YAS overall performance. There is a change in the Category A 8 minute target for 2008/09. In 2007/08 the "clock" started when 3 key pieces of information had been taken from the caller (address, phone number, nature of complaint); from 2008/09 the clock starts when the call is connected to the ambulance service. The impact is that YAS will need to shave a further 90 seconds off their response times for Category A calls. YAS will not achieve this target from April 2008 (performance figures for 1st week in April were at 57.4%). During the 2008/09 contract round additional funding has been agreed from all Y&TH PCTs to accelerate YAS progress towards achieve 75%. The SHA has become closely involved and an action plan has been agreed that should achieve 75% from July 2008; this involves actions from YAS but also from PCTs and acute trusts; PCTs and acutes will be reporting against a majority of their required actions by 16th April. Due Date

PI

Planned (value)

Latest YTD

Variance

(8) (9) Comments

Percdentage of category A calls resulting in an emergency response arriving at the scene of the incident within 8 minutes The number of category A calls receiving a first response within eight minutes divided by the number of category A calls. KA34 Ambulance Services (Financial Year 2007/2008), expressed as a percentage. Performance of the ambulance trusts will be mapped to the PCTs Performance is monitored against YAS overall Feb 08 29-Feb-2008 75 73.7 -1.3 performance, not PCT specific

KA34 ambulance services (Financial year 2007/2008)

28th March 2007 This indicator measures performance in response to category A calls. Department of Health requirements are that seventy five per cent of category A calls (defined as urgent and life-threatening) should receive an emergency response at the scene of the incident within eight minutes. Acc Ref

Accountability

Completion Date

1.d.3 Category B calls meeting national 19 minute target

31-Mar-2008

(1)

(4)

All ambulance trusts to respond to 95% of category B calls within 19 minutes. Owner Rachel Carter Sponsor

Carol Mckenna

Current Concerns:

Performance in February further recovered to 93.3% in-month (January 93%) against a target of 95%. This is an annual target and year to date performance is 92.4%. The 95% target has not been achieved for 2007/08. As this is a YAS-wide target, this will reflect on most PCTs within Y&TH. Performance for Kirklees PCT patients is below overall YAS performance.

Reasons for Variance and Actions Taken:

Wakefield PCT, as lead commissioner, and the SHA have been working closely with YAS in developing action plans to address both this and the Category A 8 minute target. Due Date

PI

Planned (value)

Latest YTD

Variance

(8) (9) Comments

The number of category B calls resulting in an emergency response arriving at the scene of the incident within 19 minutes Number of category B calls receiving a response (as defined in the 2007/2008 KA34 technical guidance) within 19 minutes divided by number of category B calls receiving a response (as defined in the 2007/2008 KA34 technical guidance). KA34 Ambulance Services (Financial Year 2007/2008), expressed as a percentage. Performance of the ambulance trusts will be mapped to the PCTs Feb 08

29-Feb-2008

95

92.4

-2.6

KA34 ambulance services (Financial year 2007/2008)

28th March 2007

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This indicator measures performance in response to category B calls. Department of Health requirements are that ninety five per cent of all category B calls (defined as urgent but not immediately life-threatening) should receive an emergency response at the scene of the incident within 19 minutes. Acc Ref

Accountability

Completion Date

1.e.1 Convenience and choice - PCT booking

31-Mar-2008

(1)

(4)

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. Owner Rachel Carter Sponsor

Carol Mckenna

Key Achievements Since Last Report:

Performance has remained static against January performance at 40% C&B utilisation.

Current Concerns:

Continued under-achievement will impact on the PCT’s 2007/08 Performance Rating. February performance for Kirklees was 40% against a target of 90%. The SHA aggregate performance was 45%. Referrals relating to CHFT were at 54% and referrals relating to MYHT were at 30%. MYHT performance is expected to improve following the introduction of directly-bookable services (2 services at the end of March; 4 further services during April). There is a discrepancy between monthly SHA reports and weekly specific Choose and Book reports. The SHA is aware of this discrepancy and it is understood that in the future data used in the weekly Choose and Book reports will be taken consistently. The figures used in this report are taken from the weekly Choose and Book reports - the monthly SHA report shows a worse performance figure for Kirklees, of 37.1% Performance on recognition of offer of Choice is reported quarterly. Official figures are not yet available for the Nov 07 - Feb 08 period, but early data suggests an improvement in performance for Kirklees PCT. Previously reported data (October - November 07) was 39% recollection amongst definitive responses (i.e. excluding don't knows and not stated) compared to national performance of 47%. Indicative figures for Nov 07 - Feb 08 show Kirklees performance as 44% against national performance 46% and Y&TH performance of 41%.

Reasons for Variance and Actions Taken:

As previously reported, an action plan has been implemented. Due Date

PI

Planned (value)

Latest YTD

Variance

(8) (9) Comments

Percentage of referrals received by providers for first consultant outpatient appointments that are made through choose and book 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. Feb 08

29-Feb-2008

90

40

-50

Monthly monitoring return (Financial year 2007/2008) Choose and Book Extracts (Financial year 2007/2008) 28th March 2007 Building on the NHS Plan commitments, this target aims to drive improvements in the experience of patients of the NHS by making it more responsive to the needs of the patients. It focuses on improving convenience and choice, mainly through the choose and book programme which is intended to enable patients to work with GPs and general dental practitioners to choose from a number of outpatient services and book their appointments in advance, and also by ensuring that inpatient appointments are booked in advance. The NHS Plan sets the target that by the end of 2005 all patients will go through a booking system giving a choice of a convenient time within a guaranteed maximum waiting time to replace the current waiting list for appointments and admission. 'The NHS in England: Operating Framework for 2006/07' set a milestone for the use of Choose and Book of 90% by March 2007. This indicator assesses trusts performance against the milestone during 2007/2008.

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Acc Ref

Accountability

Completion Date

2.a.1 GP recording of body mass index (BMI) status

31-Mar-2009

(1)

(4)

Tackle the underlying determinants of ill health and health inequalities by halting the year on year rise in obesity among children under 11 by 2010 (from the 2002/2004 baseline) in the context of a broader strategy to tackle obesity in the population as a whole. Owner Tim Fielding Sponsor

Judith Hooper

Key Achievements Since Last Report:

LES implemented in attempt to increse the proportion of 16+ patients that have had their BMI recorded. Results indicate this has been relatively successful when measured against the 'plan' figure. In the early stages of planning a clinical audit of obesity across practices that will include looking at the measuring and recording of BMI.

Current Concerns:

While figures appear to be a 'success' against the 'plan' figures, there are still less than 40% of 16+ patients on GP lists with a recorded BMI in the last 15 months which is too low to be considered representative of the whole practice population. This presents issues with being able to use this data as adult prevalence of obesity. Due Date

PI

Planned (value)

Latest YTD

Variance

(8) (9) Comments

The proportion of people aged 16 and over on GP list, with a BMI recorded in the last 15 months, recorded as having a BMI of 30 or greater. 2007/08

31-Mar-2008

54.73

28.2

-26.53

The proportion of people aged 16 and over on GP list, with a BMI recorded in the last 15 months. Actual performance percentage will be assessed against the planned performance percentage in the 2007/2008 local delivery plan. 2007/08

31-Mar-2008

29.5

38.9

9.4

Total number of people aged 16 and over on GP list, recorded as having a BMI of 30 or greater in the last 15 months. This measure is intended to act as a proxy for prevalence of obesity in the population, as two thirds of the population visits the GP at least annually. 2007/08

31-Mar-2008

52912

34284

-18628

Total number of people aged 16 and over on GP list, with a BMI recorded in the last 15 months. The actual number of people aged 15 to 75 years on a GP register, with a BMI recorded in the last 15 months divided the actual number of people aged 15 to 75 years on a GP register, expressed as a percentage. Performance will be assessed against planned percentage in the 2006/2007 local delivery plan (LDP) 2007/08

31-Mar-2008

96679

121760

25081

333867

6141

Total Number of people aged 16 and over on GP list. 2007/08

31-Mar-2008

327726

LDPR standard collection (2007/2008) PCT local delivery plans (2007/2008) 23rd July 2007 Obesity is associated with many illnesses and is directly related to increased mortality and lower life expectancy. Prevalence of obesity has trebled since the 1980s, and well over half of all adults are either overweight or obese, the Department of Health suggest almost 24 million adults. It is not possible to assess progress on reducing the percentage of patients with a BMI>30 unless the number of patients with a BMI recorded is as complete as possible. This indicator focuses on the broader strategy to tackle obesity through the use of BMI recording of adult population. As a key priority of the white paper 'Choosing health: making healthier choices easier' Department of Health, 2004), tackling obesity is a national priority. This is also reflected in the local delivery plan (LDP) technical note on childhood obesity, and is further emphasised in relation to the wider strategy required. This measure is intended to act as a proxy for prevalence of obesity in the population, as two thirds of the population visits the GP at least annually.

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Acc Ref

Accountability

Completion Date

2.b.2 Smoking status among the population aged 16 and over

31-Mar-2008

(1)

(4)

Reducing adult smoking rates (from 26% in 2002) to 21% or less by 2010, with a reduction in prevalence among routine and manual groups (from 31% in 2002) to 26% or less. Owner Unallocated Sponsor

Unallocated Due Date

PI

Planned (value)

Latest YTD

Variance

(8) (9) Comments

Number of people aged 16 and over on a GP list, who are recorded as being a smoker in the last 15 months. Healthcare commission will assess PCT performance against PCT plans for 2005/2006 as set out in the local delivery plan. New data collection, PCT Local Delivery Plans (2005/2006) 2006/07

31-Mar-2007

67100

72690

-5590

Number of people aged 16 and over on a GP list, with a smoking status recorded in the last 15 months. 2006/07

31-Mar-2007

216450

257385

40935

The proportion of smokers among people with their smoking status recorded, (a proxy for smoking prevalence) Actual performance percentage will be assessed against the planned performance percentage in the 2007/2008 local delivery plan 2006/07

31-Mar-2007

0

32.8

-32.8

The proportion of the GP list who have their smoking status recorded. 2006/07

31-Mar-2007

0

72.2

72.2

306908

-26092

Total number of people aged 16 and over on a GP list. 2006/07

31-Mar-2007

333000

LDPR standard collection (2007/2008) PCT local delivery plans (2007/2008) 23rd July 2007 This will provide a proxy measure, in support of obtaining information on the prevalence of smoking. Smoking is a major contributor to ill health, including coronary heart disease and cancer. Plans that will reduce the level of smoking in the population will assist in the delivery of a wider strategy to tackle inequalities and address specific targets in support of the Public Service Agreement. PCTs should have plans that support the reduction of smoking, including consideration of accurate identification of smokers and provision of stop smoking advice and services. They will need to be provided in the context of an overall policy to tackle smoking, including for example increased prescribing of stop smoking products and encouragement of more smoke free local public/workplaces, particularly in the NHS. Plans should target at risk groups, including those with comorbidity and groups with higher prevalence rates.

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Acc Ref

Accountability

Completion Date

2.c.1 Teenage conception rates

31-Dec-2009

(1)

(4)

Reducing the under-18 conception rate by 50% by 2010 (from the 1998 baseline), as part of a broader strategy to improve sexual health. Owner Rachel Spencer Sponsor

Judith Hooper There were 10 factors identified in the 'Deep Dive' Reviews which characterised the successful areas in England where teenage conception rates have reduced significantly. The Kirklees Strategy is working towards ensuring that all these factors (around prevention) are in place, to affect change.

Key Achievements Since Last Report:

Current Concerns:

In one area – Communication – we have initiated a Media and Communication subgroup as a joint venture between Teenage Pregnancy and Sexual Health. Effective communication is seen as central to partnership working, access to services and informed choice. A joint strategy can tailor information to the needs of young people, parents and communities, ensuring that it is culturally sensitive as well as accurate and timely. The subgroup is in the process of developing Terms of Reference, a M & C Strategy and a plan of action. 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 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). As the overall England rate (2006) has reduced by only 13.3% since the baseline year of 1998, it seems that Kirklees is in line with the majority of other Local Authorities in achieving smaller than expected reductions in its Under 18 conception rate. In Kirklees the average % change in rate between 1998 and 2006 is 1.2%.

Reasons for Variance and Actions Taken:

Both prevention and support for Teenage Parents is of critical importance. Therefore, using the toolkits from Government Office, two self assessments are being carried out - one around prevention of teenage conceptions and the other to assess support for teenage parents. The information gathered will inform the TPS Action Plan for 08/09. The Kirklees Teenage Pregnancy Strategy is working to actively engage all of the key mainstream delivery partners who have a role in reducing teenage pregnancies and supporting teenage parents, to accelerate its progress towards achieving the 2010 target. Due Date

PI

Planned (value)

Latest YTD

Variance

(8) (9) Comments

Conception rate per 1000 females ages 15-17 The difference between planned and actual under-18 conception rates for calendar year 2006 divided by the planned under-18 conception rate for calendar year 2006, expressed as a percentage 2006

31-Dec-2007

36.26

43.9

7.64

288

349

-61

7942

7942

0

Number of conceptions to under-18 year olds 2006

31-Dec-2007

Population of females aged 15 to 17 2006

31-Dec-2007

PCT local delivery plans (Calendar year 2006) ONS (Calendar year 2006) 23rd July 2007 Britain’s teenage birth rates are the highest in Western Europe. 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 basline) through a wide ranging programme of coordinated activity, including improved advice and contraceptive services for young people. The NHS Plan also set an interim target of achieving a 15 percent reduction in the under-18 conception rate by 2004. In addition to national targets, local under-18 conception rate targets have been agreed with teenage pregnancy partnership areas, which are co-terminous 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.

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Acc Ref

Accountability

Completion Date

2.c.2 Access to GUM clinics

31-Mar-2009

(1)

(4)

Access to genito-urinary medicine (GUM) clinics within 48 hours Owner Rachel Spencer Sponsor

Judith Hooper

Key Achievements Since Last Report:

Numerous changes have been implemented in the Princess royal clinic including the introduction of nurse led clinics. CaSH staff are being trained in tier 2 STI work to enable them to offer tier 2 by April 08 thereby reducing the pressure on GUM. A business case has recently been provisonally approved for the University Practice to provide Tier 2 STI services.

Current Concerns:

Chadwick clinic is meeting 100% 48 hour access for offered appointments. Recently an IT issue at Princess Royal has resulted in inaccurate data being reported through the UNIFY process. Figures released this week suggest that the clinic has been offering 100% 48 hour access since December 07, although this is still to be officially submitted to the commissioner for sign off. To this end, the PCT are confident that 100% 48 hour access will be achieved by 31st March 08

Reasons for Variance and Actions Taken:

Recruitment still in progress to fill consultant vacancies, although there has been no interest in the post. A locum consultant has been recruited which should ensure progress towards target is continued as the reliance on one person will be less. A nurse consultant vacancy has been created which should reduce some of the pressure. Additionally, health advisers are being employed to support the less consultant focussed approach to the GUM service. CaSH on target to provide tier 2 STI screening by April 08 Due Date

PI

Planned (value)

Latest YTD

Variance

(8) (9) Comments

Number of first attendances at a GUM service who were offered an appointment to be seen within 48 hours of contacting a service Jan 08

31-Jan-2008

654

841

187

Number of first attendances at a GUM service who were offered an appointment to be seen within 48 hours of contacting a service Chadwick Clinic Jan 08

31-Jan-2008

0

355

0

Number of first attendances at a GUM service who were offered an appointment to be seen within 48 hours of contacting a service Princess Royal Jan 08

31-Jan-2008

0

418

0

Number of first attendances who were seen within 48 hours of contacting a GUM service Jan 08

31-Jan-2008

620

737

117

Number of first attendances who were seen within 48 hours of contacting a GUM service Chadwick Clinic Jan 08

31-Jan-2008

0

304

0

Number of first attendances who were seen within 48 hours of contacting a GUM service Princess Royal Jan 08

31-Jan-2008

0

378

0

Percentage: first attendances who were seen within 48 hours of contacting a GUM service Jan 08

31-Jan-2008

90.1

84.9

-5.2

Percentage: first attendances who were seen within 48 hours of contacting a GUM service Chadwick Clinic Jan 08

31-Jan-2008

90.1

85.6

0

Percentage: first attendances who were seen within 48 hours of contacting a GUM service Princess Royal Jan 08

31-Jan-2008

90.1

85.5

0

Percentage: people attending a GUM service who were offered an appointment to be seen within 48 hours of contacting a service HC will assess performance will be assessed against planned percentage in the 2007/2008 local delivery plan (LDP). Jan 08

31-Jan-2008

95.1

96.9

1.8

Percentage: people attending a GUM service who were offered an appointment to be seen within 48 hours of contacting a service Chadwick Clinic Jan 08

31-Jan-2008

95.1

100

0

Percentage: people attending a GUM service who were offered an appointment to be seen within 48 hours of contacting a service Princess Royal Jan 08

31-Jan-2008

95.1

94.6

0

868

180

Total number of first attendances at the GUM service Jan 08

31-Jan-2008

688

Total number of first attendances at the GUM service Chadwick Clinic Jan 08

31-Jan-2008

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Total number of first attendances at the GUM service Princess Royal Jan 08

31-Jan-2008

0

442

0

Health Protection Agency (Financial year 2007/2008) DH GUM clinics waiting times collection (GUMAMM) (Financial year 2007/2008) PCT local delivery plans (Financial year 2007/2008) 23rd July 2007 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. The percentage of patients attending GUM clinics who are offered an appointment within 48 hours of contacting a service should increase with time and reach 100% by 2008. The percentage of patients attending GUM clinics who are seen within 48 hours of contacting a service should also increase with time. (The target of 100% 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.) Acc Ref

Accountability

Completion Date

2.c.3 Access to reproductive health services - Part two - chlamydia screening

31-Mar-2008

(1)

(4)

Access to chlamydia screening Owner Rachel Spencer Sponsor

Judith Hooper

Key Achievements Since Last Report:

Marketing campaign ran from January to March with an increase seen in screening as a result. however this has not been significant so a social marketing approach is being explored to help reduce the sigma associated with young people accessing screening. Screening has commenced in TOP services which is producing significant numbers of screens for the service. Screening in antenatal services is also being explored.

Current Concerns:

The screening programmes will not meeting the march 08 trajectory of 15% of the 15-24 year old population to be screened.

Reasons for Variance and Actions Taken:

Following a PEC meeting it was highlighted that a significant number of chlamydia screens were being requested through GPs but that these were not being recorded through the programme as the specific form was not being completed. This was supported by an audit performed in the labs. the GPs felt that it was time consuming to complete another form, particularly when allot of the screens were part of a triple swab. As a result the commissioner has worked with the lab in CHFT to make sure that all pathology forms contain a proviso that for any chlamydia screen within the required age group the information will be passed to the chlamydia screening office. This will be beginning in April 08. The screening programme that covers North Kirklees is currently taking this up with MYHT Due Date

PI

Planned (value)

Latest YTD

Variance

(8) (9) Comments

Percentage of 15 - 24 year old persons screened or tested for chlamydia HC will assess actual performance will be assessed against planned performance as set out in the 2007/2008 local delivery plan (LDP). Qtr 3 07/08

31-Dec-2007

5

1.1

-3.9

The number of 15 - 24 year old persons screened or tested for chlamydia Qtr 3 07/08

31-Dec-2007

2650

598

-2052

The number of 15 - 24 year old persons screened or tested for chlamydia Calderdale and Huddersfield Program Q3 07/08

31-Dec-2007

0

535

0

The number of 15 - 24 year old persons screened or tested for chlamydia Wakefield and North Kirklees Program Q3 07/08

31-Dec-2007

0

143

0

53002

53002

0

The population aged 15 - 24 years Q3 07/08

31-Dec-2007

Needs to be validated on Exeter System

PCT local delivery plans (Financial year 2007/2008) Chlamydia Screening Programme Returns (Financial year 2007/2008) Special data collection (As at March 31st 2008) 28th March 2007

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Ensuring wide and appropriate access to reproductive health services for the sexually active population is vital to the successful delivery of any local strategies to improve sexual health, and will in turn help to deliver national objectives for improved sexual health. In November 2004, the Government published the white paper ‘Choosing Health: Making Healthy Choices Easier’. The white paper highlights that the provision of contraception is an essential health care service and plays a pivotal role in protecting against both unplanned pregnancies and sexually transmitted infections (STIs). Both ‘The national strategy for sexual health and HIV commissioning toolkit’ (Jan 2003) and the Department of Health commissioned and endorsed ‘Recommended standards for sexual health services’ (March 2005) also highlight the importance of provision of open access services that offer the full range of contraceptive methods. 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 (youth services, military bases, universities, contraception services, primary care). Acc Ref

Accountability

Completion Date

2.d.1 Infant health & inequalities: smoking during pregnancy

31-Mar-2009

(1)

(4)

Reduce health inequalities by 10% by 2010 as measured by infant mortality (from a 1997 - 1999 baseline) and life expectancy at birth (from a 1995 - 1997 baseline Owner Rachel Spencer Sponsor

Judith Hooper

Key Achievements Since Last Report:

The specialist midwife has been in post since January and is working towards reducing the numbers of women smoking during pregnancy.

Current Concerns:

The PCT has a very challenging trajectory, which is the lowest across Yorkshire and Humber. The other PCTs trajectories range from 12.0% to 32.1%. In terms of actual performance the range across the SHA area is from 9.9% to 29.4%, with Kirklees PCT performing slightly better than the SHA average of 17.7%. The smoking at delivery by locality figures (which exclude South Asian women) reflect a target that has been set to to reduce the percentage smoking by 1% over the course of 07/08 in those localities that are at or under the SHA figure of 18% and to reduce those localities that are over this figure to 18%. The data shows quite significant quarterly fluctuations, which do not necessarily reflect a significant change in behaviour. it is anticipated that the annual total will reflect activity more accurately.

Reasons for Variance and Actions Taken:

Throughout Q4, awareness raising and training have been taking place within childrens centres to facilitate more access to the local stop smoking service. Additionally, a cohort of midwives have been trained in brief interventions within both Mid Yorkshire and CHFT. Finally, a stop smoking drop in clinic has been set up in within Mid Yorkshire on the acute ante natal ward. Due Date

Planned (value)

Latest YTD

Variance

31-Dec-2007

1314

1353

-39

31-Dec-2007

0

80

0

0

39

0

31-Dec-2007

0

0

0

31-Dec-2007

0

123

0

0

0

0

CHFT do not provide broken down by locality

31-Dec-2007

0

0

0

CHFT do not provide broken down by locality

31-Dec-2007

0

34

0

0

136

0

0

0

0

PI

(8) (9) Comments

Number of Maternities Q3 07/08 Number of Maternities Batley Q3 07/08

Number of Maternities Birstall and Birkenshaw Q3 07/08

31-Dec-2007

Number of Maternities Denby Dale & Kirkburton Q3 07/08

No Data Available from CHFT

Number of Maternities Dewsbury Q3 07/08

Number of Maternities Huddersfield North Q3 07/08

31-Dec-2007

Number of Maternities Huddersfield South Q3 07/08 Number of Maternities Mirfield Q3 07/08

Number of Maternities Spenborough Q3 07/08

31-Dec-2007

Number of Maternities The Valleys Q3 07/08

31-Dec-2007

© Dynamic Change Limited 2008 Key Performance Indicators

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Number of mothers with smoking status not known Q3 07/08

31-Dec-2007

0

0

0

Number of women known not to be smokers at the time of delivery Q3 07/08

31-Dec-2007

1205

1148

57

Number of women known not to be smokers at the time of delivery Batley Q3 07/08

31-Dec-2007

0

49

0

Number of women known not to be smokers at the time of delivery Birstall Q3 07/08

31-Dec-2007

0

29

0

Number of women known not to be smokers at the time of delivery Denby Dale and Kirkburton Q3 07/08

31-Dec-2007

0

0

0

CHFT do not provide broken down by locality

Number of women known not to be smokers at the time of delivery Dewsbury Q3 07/08

31-Dec-2007

0

78

0

Number of women known not to be smokers at the time of delivery Huddersfield North Q3 07/08

31-Dec-2007

0

0

0

CHFT do not provide broken down by locality

Number of women known not to be smokers at the time of delivery Huddersfield South Q3 07/08

31-Dec-2007

0

0

0

CHFT do not provide broken down by locality

Number of women known not to be smokers at the time of delivery Mirfield Q3 07/08

31-Dec-2007

0

26

0

Number of women known not to be smokers at the time of delivery Spenborough Q3 07/08

31-Dec-2007

0

106

0

Number of women known not to be smokers at the time of delivery The Valleys Q3 07/08

31-Dec-2007

0

0

0

205

-96

CHFT do not provide broken down by locality

Number of women known to be smokers at time of delivery Q3 07/08

31-Dec-2007

109

Number of women known to be smokers at time of delivery Batley Q3 07/08

31-Dec-2007

0

31

0

Number of women known to be smokers at time of delivery Birstall Q3 07/08

31-Dec-2007

0

10

0

Number of women known to be smokers at time of delivery Denby Dale and Kirkburton Q3 07/08

31-Dec-2007

0

0

0

CHFT do not provide broken down by locality

Number of women known to be smokers at time of delivery Dewsbury Q3 07/08

31-Dec-2007

0

45

0

Number of women known to be smokers at time of delivery Huddersfield North Q3 07/08

31-Dec-2007

0

0

0

CHFT do not provide broken down by locality

0

CHFT do not provide broken down by locality

Number of women known to be smokers at time of delivery Huddersfield South Q3 07/08

31-Dec-2007

0

0

Number of women known to be smokers at time of delivery Mirfield Q3 07/08

31-Dec-2007

0

8

0

Number of women known to be smokers at time of delivery Spenborough Q3 07/08

31-Dec-2007

0

30

0

Number of women known to be smokers at time of delivery The Valleys Q3 07/08

31-Dec-2007

0

0

0

CHFT do not provide broken down by locality

Percentage of mothers known to be smokers during pregnancy The actual number of women known to be smokers at the time of delivery divided by the actual number of maternities, expressed as a percentage. Performance will be assessed against the planned percentage in the 2007/2008 local delivery plan (LDP). PCTs should note that a high percentage of mothers with smoking status not known will impact upon performance against this indicator Q3 07/08

31-Dec-2007

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Percentage of mothers known to be smokers during pregnancy Batley Q3 07/08

31-Dec-2007

0

39

0

Percentage of mothers known to be smokers during pregnancy Birstall Q3 07/08

31-Dec-2007

0

26

0

Percentage of mothers known to be smokers during pregnancy Denby Dale and Kirkburton Q3 07/08

31-Dec-2007

0

0

0

CHFT do not provide broken down by locality

Percentage of mothers known to be smokers during pregnancy Dewsbury Q3 07/08

31-Dec-2007

0

37

0

Percentage of mothers known to be smokers during pregnancy Huddersfield North Q3 07/08

31-Dec-2007

0

0

0

CHFT do not provide broken down by locality

Percentage of mothers known to be smokers during pregnancy Huddersfield South Q3 07/08

31-Dec-2007

0

0

0

CHFT do not provide broken down by locality

Percentage of mothers known to be smokers during pregnancy Mirfield Q3 07/08

31-Dec-2007

0

24

0

Percentage of mothers known to be smokers during pregnancy Spenborough Q3 07/08

31-Dec-2007

0

22

0

Percentage of mothers known to be smokers during pregnancy The Valleys Q3 07/08

31-Dec-2007

0

0

0

0

0

0

0

0

0

CHFT do not provide broken down by locality

Percentage of mothers with smoking status not known Q3 07/08

31-Dec-2007

0

Percentage of mothers with smoking status not known Batley Q3 07/08

31-Dec-2007

0

Percentage of mothers with smoking status not known Birstall Q3 07/08

31-Dec-2007

0

Percentage of mothers with smoking status not known Denby Dale and Kirkburton Q3 07/08

31-Dec-2007

0

0

0

Percentage of mothers with smoking status not known Hudderfield North Q3 07/08

31-Dec-2007

0

0

0

Percentage of mothers with smoking status not known Huddersfield South Q3 07/08

31-Dec-2007

0

0

0

0

0

Percentage of mothers with smoking status not known Mirfield Q3 07/08

31-Dec-2007

0

Percentage of mothers with smoking status not known Spenborough Q3 07/08

31-Dec-2007

0

0

0

Percentage of mothers with smoking status not known The Valleys Q3 07/08

31-Dec-2007

0

0

0

LDPR standard collection (Financial year 2007/2008) PCT local delivery plans (Financial year 2007/2008) 23rd July 2007 Infant mortality numbers are too low to use as a basis for setting PCT plans. Smoking during pregnancy is a good proxy indicator for infant health. Smoking during pregnancy is a key determinant of low birth weight which in turn is the single most important risk factor in perinatal and infant mortality. It is much more prevalent among young mothers, and those that are from more disadvantaged groups.

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Acc Ref

Accountability

Completion Date

2.d.2 Infant health & inequalities: breastfeeding initiation rates

31-Mar-2009

(1)

(4)

Reduce health inequalities by 10% by 2010 as measured by infant mortality (from a 1997 - 1999 baseline) and life expectancy at birth (from a 1995 - 1997 baseline) Owner Julie Tolhurst Sponsor

Judith Hooper

Key Achievements Since Last Report:

Targets have been exceeded since last quarter and 06-07 year end. Improvements in recording breastfeeding status on maternity wards. Continued implementation of Kirklees PCT Breastfeeding policy. Service level agreement for Huddersfield Baby cafe implemented with consistent numbers of women attending for BF support. Baby cafe at Batley Childrens centre has commenced with launch during breastfeeding awareness week May 08.

Current Concerns:

Increase of almost 10% from 06-07 needs to be verified Due Date

Planned (value)

Latest YTD

Variance

31-Mar-2008

1328

1366

38

471

279

-192

857

963

106

4

4

PI

(8) (9) Comments

Number of maternities Q4 07/08

Number of mothers known not to initiate breast feeding Q4 07/08

31-Mar-2008

Number of mothers known to initiate breast feeding Q4 07/08

31-Mar-2008

Number of mothers with breastfeeding status not known Q4 07/08

31-Mar-2008

0

Percentage of mothers known to initiate breastfeeding The actual number of mothers known to initiate breastfeeding divided by the actual number of maternities, expressed as a percentage. Performance will be assessed against the planned percentage in the 2007/2008 local delivery plan (LDP). PCTs should note that a high percentage of mothers with breastfeeding status not known may impact upon performance against this indicator. 69.7% is the yearly figure. This is an increase of Q4 07/08 31-Mar-2008 64.53 70.5 5.97 almost 10% from 06-07 exceeding targets. Percentage of mothers with breastfeeding status not known 29.5% is the yearly figure with consistent quarterly Q4 07/08 31-Mar-2008 0 20.4 -20.4 reductions since 06-07

PCT local delivery plans (Financial year 2007/2008) LDPR standard collection (Financial year 2007/2008) 23rd July 2007 Infant mortality numbers are too low to use as a basis for setting PCT plans. Breastfeeding initiation is a good proxy indicator for infant health, but is much less prevalent amongst more disadvantaged groups. In general, mothers who do not initiate breastfeeding tend to be younger, less well educated and from lower income groups. Infants who are not breastfed are five times more likely to be admitted to hospital with infections in their first year of life. NHS staff should be following best practice in increasing initiation and duration of breastfeeding.

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Acc Ref

Accountability

Completion Date

2.d.3 Data quality on ethnic group

31-Mar-2009

(1)

(4)

Reduce health inequalities by 10% by 2010 as measured by infant mortality (from a 1997 - 1999 baseline) and life expectancy at birth (from a 1995 - 1997 baseline). Owner Helen Bridges Sponsor

Peter Flynn

Key Achievements Since Last Report:

The Healthcare Commission Target for monitoring ethnicity coding is separated into two parts:1. Etnicity codes recored against Mental Health Care Spells (Apr-Jan)and 2. Ethnicty codes recorded against acute Finished Consultant Episodes (Apr-Jan) The combined % achievement in 06/07 was 84.83% and the national threshold for achievement of the target was 80%. The Healthcare Commission has not stipulated a target % that should be achieved by January 2008. The PCT has set its own internal milestone to slightly improve on already high performance. The % achieved between April 2007 and February 2008 is 92.23% (March data will not be available until May 2008).

Current Concerns:

None

Reasons for Variance and Actions Taken:

Not Applicable Due Date

PI

Planned (value)

Latest YTD

Variance

(8) (9) Comments

% of care spells (commissioner basis) for PCT on Mental Health Minimum Dataset (MHMDS) with valid 2001 census coding for ethnic category A two part indicator, the overall value is the weighted mean of the values calculated in parts 1 and 2 expressed as a percentage. Part 2: The number of care spells (commissioner basis) for PCT on Mental Health Minimum Dataset (MHMDS) with valid 2001 census coding for ethnic category (excluding 'not stated' and ‘not known') divided by the number of care spells (commissioner basis) for PCT on MHMDS, expressed as a percentage. Cumulative performance as at February 2008 Q4 07/08 31-Mar-2008 90 92.3 2.3 (March data not available until May 2008) % of first consultant episodes (FCEs) (commissioner basis) for PCT on Hospital Episode Statistics (HES) with valid 2001 census coding for ethnic category A two part indicator, the overall value is the weighted mean of the values calculated in parts 1 and 2 expressed as a percentage. Part 1: The number of Finished Consultant Episodes (FCEs) (commissioner basis) for PCT on Hospital Episode Statistics (HES) with valid 2001 census coding for ethnic category (excluding 'not stated' and ‘not known'). (FCEs with mental health specialties will be excluded as this activity is covered in part 2 of the indicator) divided by the number of FCEs (commissioner basis) for PCT on HES, expressed as a percentage Cumulative performance as at February 2008 Q4 07/08 31-Mar-2008 90 92.2 2.2 (March data not available until May 2008)

Hospital Episode Statistics (HES) (April 2007 to January 2008) MHMDS (Financial year 2007/2008, quarter 1 to quarter 3 data only, as provided Nov 2007 and Mar 2008) 23rd July 2007 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 are required to take action 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. Acc Ref

Accountability

Completion Date

2.e.2 Practice based registers - patients called for review

31-Mar-2009

(1)

(4)

In primary care, update practice-based registers so that patients with coronary heart disease and diabetes continue to receive appropriate advice and treatment in line with national service framework standards and, by March 2006, ensure practice-based registers and systematic treatment regimes, including appropriate advice on diet, physical activity and smoking, also cover the majority of patients at high risk of coronary heart disease, particularly those with hypertension, diabetes and a BMI greater than 30. Owner Sara Fletcher Sponsor

Judith Hooper

PI

Due Date

Planned (value)

Latest YTD

Variance

(8) (9) Comments

% of patients with diagnosed CHD called for review in last 12 months This indicator contains two measures. The results from parts 1 and 2 will be combined to produce an overall score. Part 1: The number of people at risk of coronary heart disease who have been called for review within the last twelve months divided by the number of people at high risk of coronary heart disease, expressed as a percentage. Performance will be assessed against the planned percentage in the 2005/2006 local delivery plan.

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Percentage of patients on registers of people with diabetes in practices in the PCT called for review in the last 12 months Actual percentage performance in 2007/2008 will be assessed against the planned percentage performance in the 2005/2006 local delivery plan, expresses as a percentage Oct 07

31-Oct-2007

100

98.4

-1.6

PCT local delivery plans (2005/2006) LDPR standard collection (2007/2008) 28th March 2007 Both the coronary heart disease and diabetes national service frameworks have standards on the establishment of registers in all practices of people with and at risk of coronary heart disease and diabetes. GPs and primary health care teams should identify all people with or at significant risk of cardiovascular disease and diabetes but who have not yet developed symptoms and offer them appropriate advice and treatment. Primary healthcare teams will be better able to offer systematic care to all patients to maximise their quality of life, to minimise their incidence of disease, and to predict future service requirements if they have an effective means of identifying (and intervening with) patients at risk - registers are the means by which these patients will be identified. As an existing commitment to be maintained, this indicator is based on plans submitted by PCTs for 2005/2006 as part of the 2003-2006 local delivery plan round. Following changes to the approved methodology for identification of people at risk of CHD, from those with a 30% risk of CHD over the next ten years to those with a 20% risk of cardiovascular disease (CVD) over the next ten years, the plans for CHD risk set for 2005/2006 are no longer directly applicable for action in 2007/2008. Therefore this indicator has been amended to focus only on registers of patients with diabetes. A key purpose of these registers is still to enable GPs systematically to address risk assessment and management for patients at risk of CHD. Paragraph 3.4 of the Diabetes National Service Framework Delivery Strategy says ‘To deliver this target PCTs will need to update diabetes practice based registers using them as the basis for systematic treatment regimens with advice and treatment in line with Diabetes National Service Framework Standards.’ This includes regular reviews (at least annual) involving a named contact offered measurement of blood pressure (BP), blood sugar (HbA1c), cholesterol, urinary microproteinuria, foot examination, recording of smoking cessation, referral to structured education which meets National Institute for Health and Clinical Excellence (NICE) and Department of Health/Diabetes UK consensus criteria including information on reducing cardiovascular risk, and an agreed care plan offered. Acc Ref

Accountability

Completion Date

3.a.1 Community matrons & Additional Case Managers

31-Mar-2008

(1)

(4)

To improve health outcomes for people with long term conditions by offering a personalised care plan for vulnerable people most at risk; and to reduce emergency bed days by 5% by 2008 (from the expected 2003/2004 baseline) through improved care in primary care and community settings for people with long term conditions. Owner Monica Plested Sponsor Key Achievements Since Last Report:

Sheila Dilks In November 2007 interviewed for Community Matron, two Discharge Co-ordinators and a Lead Community Matron. Four Community Matron applicants were offered positions. 3 have accepted and are progressing to appointment. As at 9th January referneces had been received for two of the candidates with the thirds being followed up by HR. In Janaury interviewed and appointed to Case Manager post and it is hoped they will commence at the beginning of March Unable to appoint to Discharge Co-ordinator post and Lead Community Matron.

Current Concerns: As of the mid January one of the Case Managers left the team following promotion. The Discharge Co-ordinator posts are now to be covered by short term secondments whilst permanent appointments are made. Reasons for Variance and Actions Taken:

Discussions are on going regarding The Lead Community Matron as to whether to immediately readvertise or to offer a short term secondment. Discussions with Social Service are ongoing as regards appointment to the imminient Case Manager vacancy. Due Date

PI

Planned (value)

Latest YTD

Variance

(8) (9) Comments

Number of Community Matrons (whole time equivalent) at date of measurement The actual number of whole time equivalent (WTE) staff in the community matron role providing case-management in primary and community settings for people with complex long term conditions and high intensity needs, as at March 31st 2008. Actual performance percentage will be assessed against the planned performance percentage in the 2007/2008 local delivery plan Q4 07/08

31-Mar-2008

25

13.4

-11.6

11.4 Community Matrons, plus, 2 Case Managers

Number of Other Case Managers (whole time equivalent) at date of measurement The actual number of whole time equivalent (WTE) staff in the additional case managers role providing case-management in primary and community settings for people with complex long term conditions and high intensity needs, as at March 31st 2008. Actual performance percentage will be assessed against the planned performance percentage in the 2007/2008 local delivery plan Q4 07/08

31-Mar-2008

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2

2

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LDPR standard collection (As at March 31st 2008) PCT local delivery plans (As at March 31st 2008) 23rd July 2007 Patients with complex long-term conditions who are not managed effectively in a primary and secondary care setting are more likely to become frequent unscheduled users of secondary care services. By managing this cohort of patients effectively, PCTs can contribute to reducing the number of emergency bed days. The initial focus of the long term conditions strategy is on proactive case management of very high intensity users (VHIUs). There is a need to build upon the existing good practice of care for patients with long term conditions. As set out in both ‘Supporting People with Long Term Conditions – an NHS and Social Care Model’ and 'Supporting people with long term conditions - liberating the talents of nurses who care for people with long term conditions' (Department of Health, 2005), we would expect whole health systems should work together to deliver a more systematic care planning approach to better benefit all patients with long term conditions. Community matrons and additional case managers will provide case management. Within the cohort of VHIUs there is a group of patients who can only be managed by community matrons, who will be nurses. Other practitioners may also work as additional case managers where there is strong evidence that they will deliver similar outcomes both for patients and in terms of bed day reductions. Case management is also the first step to creating an effective delivery system and implementing the wider NHS and Social Care Long Term Conditions Model. Community matrons and very high intensity users are both process indicators that provide a suitable environment for personalised care plans to be developed and supported. It is the intention of the Healthcare Commission that our assessment evolves further to incorporate a measure of how many applicable patients are offered a personalised care plan, thus avoiding a proxy measure of the target. We anticipate being in a position for future assessments of having Department of Health guidance on personalised care plans to support such an assessment. Acc Ref

Accountability

Completion Date

3.a.2 Number of very high intensity users

31-Mar-2008

(1)

(4)

To improve health outcomes for people with long term conditions by offering a personalised care plan for vulnerable people most at risk; and to reduce emergency bed days by 5% by 2008 (from the expected 2003/2004 baseline) through improved care in primary care and community settings for people with long term conditions. Owner Monica Plested Sponsor

Sheila Dilks Due Date

PI

Planned (value)

Latest YTD

Variance

(8) (9) Comments

Number of VHIUs at date of measurement Actual performance percentage will be assessed against the planned performance percentage in the 2007/2008 local delivery plan. The indicator is the actual value divided by the planned value, expressed as a percentage. Q4 07/08

31-Mar-2008

2031

1970

-61

data currently being validated as at 21st Apri.l 2008

LDPR standard collection (2007/2008) PCT local delivery plans (2007/2008) 23rd July 2007 Patients with complex long term conditions who are not managed effectively in a primary and secondary care setting will become frequent unscheduled users of secondary care services. By measuring and managing this cohort of patients effectively, this will have a direct positive impact on the emergency bed days target. Whole health systems should work together to deliver more systematic care planning to better benefit all patients with long term conditions. The initial focus of the long term conditions strategy is on proactive case management of very high intensity users (VHIUs). There is a need to build upon the existing good practice of care for patients with long term conditions. We would expect whole health systems to work together to deliver a more systematic care planning approach to better benefit all patients with long term conditions. Community matrons and very high intensity users are both process indicators that provide a suitable environment for personalised care plans to be developed and supported. It is the intention of the Healthcare Commission that our assessment evolves further to incorporate a measure of how many applicable patients are offered a personalised care plan, thus avoiding a proxy measure of the target. We anticipate being in a position for future assessments of having Department of Health guidance on personalised care plans to support such an assessment.

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Accountability

Completion Date

3.a.3 Emergency bed days

31-Mar-2008

(1)

(4)

To improve health outcomes for people with long term conditions by offering a personalised care plan for vulnerable people most at risk; and to reduce emergency bed days by 5% by 2008 (from the 2003/2004 baseline) through improved care in primary care and community settings for people with long term conditions. Owner Jim Barwick Sponsor

Carol Mckenna Due Date

PI

Planned (value)

Latest YTD

Variance

(8) (9) Comments

Number of emergency bed days in period The actual number of emergency bed days for April 2007 to January 2008 in Hospital Episode Statistics (HES) data minus the planned number of emergency bed days in the local delivery plan for ten months of the financial year 2007/2008 divided by the planned number of emergency bed days in the local delivery plan for ten months of the financial year 2007/2008, expressed as a percentage. PCTs are assessed on a commissioner basis. Q3 06/07

31-Dec-2006

170812

145500

-25312

AHC Figure used in 2006/07 assessment

Hospital Episode Statistics (HES) data (April 2007 to January 2008) PCT local delivery plans (Financial year 2007/2008) 23rd July 2007 The provision of proactive and co-ordinated care in primary and community settings for the most at risk people should help to maintain their health and avoid unnecessary use of acute inpatient hospital services. The focus of the long term conditions strategy is on proactive case management for very high intensity users (VHIUs). Whole health systems should work together to deliver more systematic care planning to better benefit all patients with long term conditions.

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Accountability

Completion Date

4.b.1 Infection Control

31-Mar-2008

(1)

(4)

Achieve year on year reductions in methicillin resistant Staphyloccus aureus (MRSA) levels, expanding to cover other health care associated infections as data from mandatory surveillance becomes available. Owner Jane O'Donnell Sponsor

Judith Hooper

Key Achievements Since Last Report:

Infection Control presentations by MYHT with the support of Kirklees and Wakefield PCT have been delivered to 680 staff. This was about professional standards and to clarify misunderstanding and to enable MYHT to avoid preventable infections. None of the content was negotiable. MYHT, MRSA Bacteraemia. The number of MRSA bacteraemia reported to 31.3.2008 was 72; this includes all hospital acquired cases ( post 48 hour) and the community cases ( pre 48 hours).In february 12 cases were reported these were distributed as follows, PGH 4 cases ( 3 cases post 48 hours, 1 pre 48 hours), PGI 4 ( 3 post 48 hours, 1 pre 48 hours), DDH 4 ( 1 post 48 hours, 3 pre 48 hours). Additional targeted infection prevention and education and support has been provided. Action plans from the Root Cause analysis findings have been developed and are regularly monitored. Clostridium difficile infections MYHT The total for february was 44, of which 27 cases were 65 years and over, for both hospital and Community Cases. of the 44, 14 resided in Kirklees PCT, 8 were inpatients and 6 community infections. There was no links between the 6 community case. The slight increase in C.difficile infections over the past 2 months is likely due to an increase in norovirus which increases sampling uptake.

Current Concerns:

CHFT, MRSA Bacteraemia. The total number of cases reported up to the 31.3.08 was 32. In february 1 case reported and up to the 31.3.08 2 cases reported in March.The case in february was a post 48 hour case in the surgical division. The 2 cases in March were pre 48 hour cases, 1 of the cases resided in Kirklees PCT however this patient had been an inpatient in Leeds with no community involvement between discharge from Leeds and re admission to HRI. Clostridium difficile infections The total of 220 cases were reported for February of these 183 cases are against trajectory which monitors those aged 65 yrs and over. This means that CHFT are 4 case over trajectory April- February2008. 1 Community case reported in Kirklees PCT resident in 65years and older. and no cases in the 2-64 years. CHFT have reviewed their case definition in line with the CMOs and CNOs letter dated january 2008.

Reasons for Variance and Actions Taken:

Kirklees PCT Provider Services The Provider services action plan was agreed at Kirklees Infection Control committee, this will be monitored by Committee. Due to the outbreak of Norovirus on the ward at Holme Valley Memorial Hospital the deep clean will now take place on the 25th, 26th and 27th April. The SHA have been informed of the delay the response from the SHA " sensible to defer until outbreak over". Due Date

PI

Planned (value)

Latest YTD

Variance

(8) (9) Comments

1. Has the organisation board approved an agreement outlining its collective responsibility for minimising the risks of infection and the general means by which it prevents and controls such risks? (100=Yes, 0=No). The responses to the six questions will be combined to give an overall indicator score, with each answer carrying equal weight. All questions relate to the position as at 31st March 2008 Q4 07/08

31-Mar-2008

100

100

0

2. Does the organisation have a Director of Infection Prevention and Control (DIPC) accountable directly to the board? (100=Yes, 0=No) The responses to the six questions will be combined to give an overall indicator score, with each answer carrying equal weight. All questions relate to the position as at 31st March 2008 Q4 07/08

31-Mar-2008

100

100

0

3. Does the organisation have a programme of audit to ensure that key policies and practices are being implemented appropriately? (100=Yes, 0=No) The responses to the six questions will be combined to give an overall indicator score, with each answer carrying equal weight. All questions relate to the position as at 31st March 2008 Q4 07/08

31-Mar-2008

100

100

0

4. The organisation has made a suitable & sufficient assessment of risks patients may encounter whilst receiving care, identified steps to control these risks & recorded its findings? (100=Yes, 0=No) The responses to the six questions will be combined to give an overall indicator score, with each answer carrying equal weight. All questions relate to the position as at 31st March 2008 Q4 07/08

31-Mar-2008

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100

100

0

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5. Has the organisation appropriate methods in place to monitor the risks of infection ? (100=Yes, 0=No) The responses to the six questions will be combined to give an overall indicator score, with each answer carrying equal weight. All questions relate to the position as at 31st March 2008 Qtr 4 07/08

31-Mar-2008

100

100

0

6. Has the organisation made available suitable and sufficient information on the organisation's general systems and arrangements for preventing and controlling healthcare associated infection? (100=Y The responses to the six questions will be combined to give an overall indicator score, with each answer carrying equal weight. All questions relate to the position as at 31st March 2008 Qtr 4 07/08

31-Mar-2008

100

100

0

Cumulative number of MRSA blood stream infections - Calderdale & Huddersfield Foundation Trust (CHFT) Mar 08

31-Mar-2008

15

32

-17

Cumulative number of MRSA blood stream infections - Mid Yorkshire Hospital Trust (MYHT) Mar 08

31-Mar-2008

35

72

-37

183

21

the 183 figure is for February data

300

207

the 300 cases is for February cases community and hospital over 65 years

Number of Clostridium Difficile infections in period at CHFT Mar 08

31-Mar-2008

204

Number of Clostridium Difficile infections in period at MYHT Mar 08

31-Mar-2008

507

Special data collection (As at March 31st 2008)

23rd July 2007 Tackling healthcare associated infection cannot be left to clinical staff alone; senior management commitment, local infrastucture and systems are also vital. The code of practice for the prevention and control of health care associated infections was introduced under the Health Act (2006) and published on October 1st 2006. The code of practice will help NHS organisations to plan and implement how they can prevent and control healthcare associated infections. It sets out criteria by which managers of NHS organisations are to ensure that patients are cared for in a clean environment and where the risk of healthcare associated infections is kept as low as possible. The code of practice is available from the Department of Health website, publications and statistics section. http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/en? CONTENT_ID=4139336&chk=6oAPfi This indicator is intended to reinforce the self assessment that must be conducted by NHS organisations for the 2007/2008 assessment of core standards. The National Institute for Health and Clinical Excellence (NICE) guideline G2: 'Infection control' sets out how organisations should deal with the prevention of healthcare associated infection in primary and community care. Acc Ref

Accountability

Completion Date

5.a.3 All cancers: two month GP urgent referral to treatment

31-Mar-2008

(1)

(4)

Achieve a maximum waiting time of two months from urgent referral to treatment for all cancers by December 2005. Owner Janet Cawtheray Sponsor

Carol Mckenna

Key Achievements Since Last Report:

LTHT have put additional outpatient sessions on and increased clinical capacity

Current Concerns:

Half the breaches are at both trusts MYHT & CHFT relating to Leeds Teaching Hospital Trust. Even with the additional outpatient sessions on at LTHT and increased clinical capacity we are still expecting breaches due to the backlog of work. Despite the additional capacity Leeds are still forecasting breaches in Feb and March due to backlog of activity. The Cancer Network and the Strategic Health Authority are aware.

Reasons for Variance and Actions Taken:

THere has been a lot of operational disruption for LTHT with the tranfer of services from Cookridge to Jimmys in December and January Due Date

PI

Planned (value)

Latest YTD

Variance

(8) (9) Comments

Percentage of patients receiving their first definitive treatment for cancer within two months (62 days) of GP or dentist urgent referral for suspected cancer. Number of patients receiving their first definitive treatment for cancer within two months (62 days) of GP urgent referral for suspected cancer divided by the total number of patients receiving their first definitive treatment for cancer who were GP urgent referrals for suspected cancer. Performance will be calculated based on the managed population of the PCT, using the NHS number to link patients to their PCT. Patients who cannot be linked to a PCT are excluded from the indicator. Jan 08

31-Jan-2008

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95

94

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Cancer waits database (Financial year 2006/2007 - quarterly returns)

28th March 2007 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. PCTs are assessed as commissioners of services and are expected to maintain the target throughout 2007/2008. Acc Ref

Accountability

Completion Date

NT09

5.b.1 Breast cancer screening for women aged 50 to 70 years

31-Mar-2009

(1)

(4)

Substantially reduce mortality rates by 2010 from cancer by at least 20% in people under 75, with a reduction in the inequalities gap of at least 6% between the fifth of areas with the worst health and deprivation indicators and the population as a whole. Owner Jini D'Cruz Sponsor

Carol Mckenna Due Date

PI

Planned (value)

Latest YTD

Variance

(8) (9) Comments

Percentage of eligible women aged 53-64 screened for breast cancer in the last three years Q3 07/08

31-Dec-2007

27293

19866

-7427

Percentage of eligible women aged 65-70 screened for breast cancer in the last three years 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 Q3 07/08

31-Dec-2007

9943

4068

-5875

KC63 breast cancer screening return (Financial year 2005/2006)

23rd July 2007 Around 130,000 people die from cancer each year, of whom about 65,000 are aged under 75. In 2004/2005, over 1.48 million women were screened for breast cancer in England, and nearly 12,000 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, so all PCTs should have been inviting women of the extended age group for screening by March 31st 2006. The three year screening cycle should be completed for all PCTs by March 31st 2009. The revised age group will be used for assessing the coverage of women eligible for the screening programme by means of part 2 of the indicator.

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23 April 2008

Acc Ref

Accountability

Completion Date

5.d.2 Commissioning of crisis resolution/home treatment services

31-Mar-2009

(1)

(4)

Improve life outcomes of adults and children with mental health problems by ensuring that all patients who need them have access to crisis services by 2005 (and a comprehensive Child and Adolescent Mental Health service by 2006). Owner Vicky Dutchburn Sponsor

Carol Mckenna The number of people receiving a service through Crisis Resolution Team is currently being under-achieved. Clarity on definitional guidance has been sought from the SHA and they are in discussion with National Leads.

Current Concerns:

Reasons for Variance and Actions Taken:

The number of people receiving a service through a Crisis Resolution Team is currently being under-achieved. Clarity on definitional guidance has been sought from the SHA and they are in discussion with National Leads.A number of issues have been raised relating to the crisis activity targets, many of which had been reported by other mental health providers and commissioners. The SHA have advised that there will be no change to the definition or agreed counting against this target until feedback from the regional and national reviews has been received. A national review has been undertaken to review crisis activity. NIMHE have been tasked to undertake the regional review looking at crisis activity in Yorkshire & The Humber. SWYMHT representatives met with NIMHE on 31st August, to review how crisis services are delivered. Due Date

PI

Planned (value)

Latest YTD

Variance

(8) (9) Comments

Number of separate episodes of home treatment provided by crisis resolution teams The number of separate episodes of home treatment provided by crisis resolution teams to people for which the PCT has commissioning responsibility divided by the PCT's allocation of national target number of people to receive crisis resolution services (December 2005) (For the purposes of performance assessment, this target is taken to be equivalent to the number of separate episodes of home treatment.). Expressed as a percentage. Mar 08

31-Mar-2008

850

506

-344

Number of separate episodes of home treatment provided by crisis resolution teams as a percentage of allocated national target The number of separate episodes of home treatment provided by crisis resolution teams to people for which the PCT has commissioning responsibility divided by the PCT's allocation of national target number of people to receive crisis resolution services (December 2005) (For the purposes of performance assessment, this target is taken to be equivalent to the number of separate episodes of home treatment.). Expressed as a percentage. Dec 07

31-Dec-2007

100

46

-54

Agreed PCT allocation of national target (As at December 2005, reallocated to match new PCT) LDPR standard collection (Financial year 2007/2008) 28th March 2007 Crisis resolution services provide intensive support in the home for people in mental health crisis. The Priorities and Planning Framework (2003-2006) sets out the following national target: 'Offer 24-hour crisis resolution to all eligible patients by 2005'. This target is 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. Each PCT is required in each year after the target date to continue to deliver its allocated share of the 100,000.

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Accountability

Completion Date

5.g.1 Community Equipment

31-Mar-2008

(1)

(4)

To improve the quality of life and independence of vulnerable older people by supporting them to live in their own homes where possible by: increasing the proportion of older people being supported to live in their own home by 1% annually in 2007 and 2008; and increasing by 2008 the proportion of those supported intensively to live at home to 34% of the total of those being supported at home or in residential care. Owner Gwen Ruddlesdin Sponsor

Unallocated Performance on all but joint contingency is now at a high level. Performance against the 7 day target is as follows:

Key Achievements Since Last Report:

health equipment (south) 98.39% health equipment (north) 90.31% continuing care (south) 100.00% continuing care (north) 100.00% joint contingency (south) 82.50% joint contingency (north) 45.83% Overall performance: 94.44% 5420 items delivered during 12 months, 4786 within 7 day period

Current Concerns:

Joint contingency equipment provision continues to reduce the percentage achievement for community equipment

Reasons for Variance and Actions Taken:

Joint contingency will always be a difficult area as it incorporates equipment that has to be specifically made to meet an individual client's needs and cannot be held in stock with either KICES or the manufacturer. Due Date

PI

Planned (value)

Latest YTD

Variance

(8) (9) Comments

% of items of equipment or minor adaptations for use by adults and older people delivered within seven days percentage achievement includes joint contingency. Q4 07/08 31-Mar-2008 100 94.44 -5.56 Perfoemance excluding joint contingency = 98%

Special data collection (Financial year 2007/2008)

28th March 2007 Equipment plays a vital role in enabling disabled people of all ages to maintain health and independence, and preventing inappropriate hospital admissions. Improving the service has links with both the National Service Framework for Older People and with Valuing People, the strategy for services for people with learning disabilities.The priorities and planning framework 2003/2006 stated that by December 2004 all community equipment for older people (aids and minor adaptations) would be provided within seven working days of a decision to supply the equipment. The Healthcare Commission is committed to work with the Commission for Social Care Inspection (CSCI) to agree further shared indicators linked to the new national target to support more older people to live in their own homes. The construction below is already tightly aligned with the current Personal Social Services Performance Assessment Framework indicator, ‘AO/D54 Percentage of items of equipment and adaptations delivered within 7 working days’ (http://www.csci.org.uk/council_performance/paf/performance_indicators.htm) Acc Ref

Accountability

Completion Date

5.h.1 Patients waiting longer than three months (13 weeks) for revascularisation

31-Mar-2008

(1)

(4)

Three month maximum wait for revascularisation by March 2005. Owner Sara Fletcher Sponsor

Jim Barwick

Key Achievements Since Last Report: Current Concerns:

No breaches last year none Due Date

PI

Planned (value)

Latest YTD

Variance

(8) (9) Comments

Number of patients waiting greater than 13 weeks for CABGs The total number of patients who have been waiting more than 13 weeks for either a CABG (OPCS4 codes K40-46) or PTCA (OPCS4 codes K49-50, K75 and K78). The value will be made up of the number of patients waiting 13 weeks or over on the monthly returns summed across the months April 2007 to March 2008 divided by the total number of patients that have received a CABG (OPCS4 codes K40-46) or PTCA (OPCS4 codes K49-50, K75 and K78), expressed as a percentage. This value will be the sum of the number of patients in the CABG and PTCA activity columns for 2007/2008 using the cumulative activity figures reported in the March 2008 Monthly Monitoring Return. Mar 08

31-Mar-2008

0

0

0

Number of patients waiting greater than 13 weeks for CABGs - CHFT

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23 April 2008

Number of patients waiting greater than 13 weeks for CABGs - Mid Yorks Jan 08

31-Jan-2008

0

0

0

Number of patients waiting greater than 13 weeks for PTCAs - CHFT Jan 08

31-Jan-2008

0

0

0

Number of patients waiting greater than 13 weeks for PTCAs - Mid Yorks Jan 08

31-Jan-2008

0

0

0

Number of patients waiting greater than 13 weeks for PTCAs The total number of patients who have been waiting more than 13 weeks for either a CABG (OPCS4 codes K40-46) or PTCA (OPCS4 codes K49-50, K75 and K78). The value will be made up of the number of patients waiting 13 weeks or over on the monthly returns summed across the months April 2007 to March 2008 divided by the total number of patients that have received a CABG (OPCS4 codes K40-46) or PTCA (OPCS4 codes K49-50, K75 and K78), expressed as a percentage. This value will be the sum of the number of patients in the CABG and PTCA activity columns for 2007/2008 using the cumulative activity figures reported in the March 2008 Monthly Monitoring Return. Mar 08

31-Mar-2008

0

0

0

Percentage of patients waiting less than 13 weeks for PTCAs or CABGs The total number of patients who have been waiting more than 13 weeks for either a CABG (OPCS4 codes K40-46) or PTCA (OPCS4 codes K49-50, K75 and K78). The value will be made up of the number of patients waiting 13 weeks or over on the monthly returns summed across the months April 2007 to March 2008 divided by the total number of patients that have received a CABG (OPCS4 codes K40-46) or PTCA (OPCS4 codes K49-50, K75 and K78), expressed as a percentage. This value will be the sum of the number of patients in the CABG and PTCA activity columns for 2007/2008 using the cumulative activity figures reported in the March 2008 Monthly Monitoring Return. Mar 08

31-Mar-2008

100

100

0

Percentage of patients waiting less than 13 weeks for PTCAs or CABGs - CHFT Mar 08

31-Mar-2008

0

100

-100

Percentage of patients waiting less than 13 weeks for PTCAs or CABGs - Mid Yorks Mar 08

31-Mar-2008

0

100

-100

Monthly monitoring return (Financial year 2007/2008)

28th March 2007 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.

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Acc Ref

Accountability

Completion Date

5.h.2 Thrombolysis - 60 minute call to needle time

31-Mar-2009

(1)

(4)

Deliver a ten percentage point increase per year in the proportion of people suffering from a heart attack who receive thrombolysis within 60 minutes of calling for professional help. Owner Sara Fletcher Sponsor

Jim Barwick

Key Achievements Since Last Report:

Primary Angioplasty now operational across the whole of West Yorkshire.

Current Concerns:

Call to Needle times have increased over the last few months since the introduction of Primary Angioplasty. This is due to: 1. Far fewer patients recieving Thrombolysis which means that when a patinet breaches it has a greater impact on the overall percentage that did/did not achieve the target. 2. Most patients are concidered and assessed for PPCI prior to thrombolysis which increases the time from door to needle.

Reasons for Variance and Actions Taken:

The West Yorkshire Cardiac Network Board are aware of the issues and continue to speak to the SHA and HCC on this matter. It is expected that in the future the HCC will develop additional targtes to monitor those PCT'S who have PPCI in operation. Due Date

PI

Planned (value)

Latest YTD

Variance

(8) (9) Comments

Percentage of eligible patients with acute myocardial infarction receiving thrombolysis treatment either by injection or by infusion within 60 minutes of calling for professional help The number of eligible patients with acute myocardial infarction receiving thrombolysis treatment either by injection or by infusion within 60 minutes of calling for professional help divided by he number of eligible patients with acute myocardial infarction who received thrombolysis, expressed as a percentage. 4 patients were thrombolysed this month and all 4 Jan 08 31-Jan-2008 68 100 32 were excluded from the target as all were considered for PPCI.

Myocardial Infarction National Audit Project (Financial years 2003/2004, 2005/2006 and 2007/2008)

28th March 2007 The NSF standard is that people suffering from heart attack should receive thrombolytic therapy within 60 minutes of calling for professional help. The Priorities and Planning Framework (2003-2006) set a target of delivering a 10% point increase per year in the proportion of people who receive thrombolytic therapy within 60 minutes of calling for professional help. This equates to a national level of 68% from 2005/2006 onwards. Currently approximately 85% of eligible patients are treated with thrombolysis and 15% of patients receive the alternative treatment of primary angioplasty. There is still a place for developing pre-hospital treatment with thrombolysis to reduce call to needle times in areas with long journey times and where primary angioplasty services are not available. Trusts that did not achieve either 68% in 2005/2006 or the target increases between 2003 and 2006 will be expected to achieve improvement beyond 2006 in order to contribute to achievement of the expected national level. As a proxy measure for overall improvement during 2003 to 2006, trusts will be assessed on achievement of a 20% point improvement between 2003/2004 and 2005/2006. This is an interface indicator shared between acute trusts and ambulance trusts as well as PCTs in their commissioning role. Acc Ref

Accountability

Completion Date

5.h.6 Practice-based registers

31-Mar-2009

(1)

(4)

Substantially reduce mortality rates by 2010 from heart disease and stroke and related diseases by at least 40% in people under 75, with a 40% reduction in the inequalities gap between the fifth of areas with the worst health and deprivation indicators and the population as a whole. Owner Sara Fletcher Sponsor

Jim Barwick

Current Concerns:

Many practices have yet to develop registers as not incentivised to do so and have higher priorities. A number of practices which had developed registers in Nth Kirklees have not updated and/or used their registers and therefore can not be included in the final numbers. So actual numbers of practices with validated registers has now fallen. Target number of practices for March 2008 is 58 (75%).

Reasons for Variance and Actions Taken:

A paper is to be taken to SMT in the next couple of weeks to discuss the whole primary prevention of CVD agenda and a review of the current Primary Prevention Nursing Service. This National target is unlikely to be in the vital signs submission for next year, however the PCT will be expected to develop and impliment local targets and standards around the Primary Prevention of CVD. Due Date

PI

Planned (value)

Latest YTD

Variance

(8) (9) Comments

Number of GP practices with PCT- validated registers of patients without symptoms of cardiovascular disease with an absolute risk of CVD events greater than 20% over the next 10 years. 2007/08

31-Mar-2008

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58

32

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Percentage of GP practices with PCT- validated registers of patients without symptoms of cardiovascular disease with an absolute risk of CVD events greater than 20% over the next 10 years Performance will be assessed against the planned percentage in the 2007/2008 local delivery plan. Q4 07/08

31-Mar-2008

100

43

-57

31-Mar-2008

74

74

0

The number of GP practices 2007/08

PCT local delivery plans (Financial year 2007/2008) LDPR standard collection (Financial year 2007/2008) 28th March 2007 The establishment of registers of at risk patients in all practices is a standard in the National Service Framework for Coronary Heart Disease: 'general practitioners and primary health care teams should identify all people at significant risk of cardiovascular disease, but who have not yet developed symptoms and offer them appropriate advice and treatment to reduce their risks'. The local reviews by the Commission for Health Improvement (CHI) and Healthcare Commission have found implementation to be patchy. Primary care teams will be better able to offer systematic care to all patients to maximise their quality of life, to minimise their incidence of disease, and to predict future service requirements if they have an effective means of identifying (and intervening with) patients at risk - registers are the means by which these patients will be identified. Effective disease prevention in at risk patients will make an important contribution to the overall public service agreement (PSA) mortality target. In previous years risk registers have been based on identifying patients with a greater than 30% risk of CHD over the next ten years. Recent guidance from the National Institute for Health and Clinical Excellence (NICE) and from the Joint British Societies suggests the threshold for at risk patients should be a 10-year cardiovascular (CVD) risk of 20% or greater (which equates to a 10-year CHD risk of 15% or greater). The expectation, therefore, is that plans and performance in 2007/2008 will have moved to the 20% CVD risk model. Key (1) Overall RAG (2) Action Plan Status (3) Financial RAG (4) PI Status (5) Overall Risk (6) Milestone RAG (7) Milestone Status (8) PI Milestone RAG (9) PI Milestone Status

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