Board Report - Performance October 2008 Produced by Business Intelligence (Performance)

Whilst the total numbers of infections is of concern in our acute trusts, the number of preventable hospital acquired infections is within the trajectory. Worthing Hospital received an inspection visit from the SHA and DH team in September. The Hospital received a very good overall assessment. The standards of care, reported on the High Impact Interventions dashboard, was very high. All Staff have been asked to attend regular urinary catheter training. The PCT will take forward the issue of pre- hospital admission information with the out-of-hours service. Worthing and Southlands hospitals have reviewed their MRSA screening policy. There is now screening of all admissions (including emergencies), with the exception of day cases. Communications are being improved by identifying MRSA positive patients on the Worthing patient access system (the PAS system). A comprehensive audit of 2007/08 Root Cause Analysis has been produced by Nick Kendall. A number of process improvements are being implemented in response to this review. Cleanliness and HCAI

Ambulance Response times for Cat A - % within 8 minutes has achieved trajectory for the first time at 76% based on the new call connect standards. Response times to Cat A - % within 19 minutes has continued to be above target. Performance for Response times to Cat B - % within 19 minutes has seen an improvement from last month now stands at 93.4%, just 1.6% below plan. SECAMB and West Sussex PCT have agreed a list of schemes that will be prioritised for delivery later this year and in the future, to improve overall performance in the PCT area. The developments encompass the commitments made by the PCT in the FFF consultation and will incorporate the national and local performance and quality targets. The list of schemes is within a paper submitted to the board separately. Emergency Care

Achievement of the RTT target for admitted and non-admitted patients remains on trajectory to achieve the agreed PCT stretch targets in October and November respectively. Direct Access Audiology remains below target but has seen significant improvement in performance in August. All Audiology providers with exception of Portsmouth Hospitals and Brighton & Sussex University Hospitals have given confirmation they will have met the 18 week target at the end of September. Portsmouth Hospitals have agreed to meet the 18 week target by the end of October, Brighton & Sussex University Hospitals by December. 18 Weeks

The majority of breaches are against the 6 week diagnostic target (table above) and relate to audiology assessments at Action for Deafness. Clearance of the backlog is going according to plan. PCT is working with the relevant practice to ensure that 18 week rules are applied to patients waiting data for non-obstetric ultrasound. Therefore the current number of reported breaches are subject to data validation. Preliminary data from Paediatric audiology services in the North East have highlighted potential risk of several breaches. Confirmation and clarity will be received during October. 18 Weeks

Demand Actual referrals for August YTD is 10.1% higher compared to last year and 9.8% up against plan. Brighton and Sussex University Hospital NHS Trust 38.7% increase in referrals against Plan and 23.9% from Aug YTD. Royal West Sussex NHS Trust 1.4% up from plan and 27.7% increase against 07/08. Queen Victoria Hospital NHS Trust up by 28% against plan and 20.4% from last year. Worthing and Southlands Hospitals NHS Trust 18.8% increase against Plan and 17.2% from 07/08. Surrey and Sussex Healthcare NHS Trust up by 9.5% compared to Plan and 0.9% against last year.

Demand Actual referrals for Q1 is 17% lower compared to last year and 19% lower than plan. PCT has requested that specific trusts significantly change the way that outpatient data is counted in terms of down grading and therefore this should be considered when reviewing GP referral data between and Please note the totals in MAR 2008/09 include an estimate for SASH, as they have not submitted any data.

99.9% of patients contacting G.U Medicine services are now being offered appointments within 48 hours, but the number seen within that time is below the target of 95%. Patient choice of appointment is a factor but there is considerable variation between providers as shown above. Only change in August sees Surrey PCT achieve 100% seen. West Sussex Health is achieving 98.7%. Variation elsewhere is being taken up via contract discussions. Performance of those Trusts will be raised at the next Contract Manager’s meeting. Sexual Health

The results of the ‘Target Chlamydia’ programme are currently being analysed and will be available shortly. Paul Woodcock has advised the September numbers have rose to 510 being screened for the month, largely due to screening at fresher's fairs in the universities and colleges. Work is currently being planned with General Practice to ensure that Chlamydia screening is offered with the HPV vaccine offer to year old women. The 3 Micro labs are looking at ways to extract information on testing done outside the screening programme which could be counted within the vital signs data. A meeting has been arranged for the DH to look at the screening programme to seek improvements. Sexual Health

Health Improvement – Smoking Cessation Smoking Cessation now has a comprehensive action plan to improve take up. Nationally all PCTs are struggling with this target as we now begin to tackle the entrenched smokers. The enhanced service with pharmacists is ready to be taken up and we have offered to pay in arrears for any smokers that pharmacists have helped to stop smoking in the last year. We are also trying to persuade more dentists both General Dental Practitioners and our own community dentists to give more brief interventions around smoking. Advertising of Stop Smoking Services in outdoor sites are planned in Q3, this includes Radio campaigns, Face to Face project at Supermarkets and Posters. Quarterly - No. of 4- week smoking quitters who attended NHS Stop Smoking Services Target no. of 4-week smoking quitters who attended NHS Stop Smoking Services Quarterly - No. of 4- week smoking quitters per 100,000 population aged 16 and over Target no. smoking quitters per 100,000 population aged 16 and over. June September December March

Health Improvement - Diabetic Retinopathy Good progress has been made with improving practice transfer of data to providers. WASH national informal review in July highlighted significant problems, PCT establishing formal programme board to implement action plan prior to formal review in October. There is a risk performance will deteriorate in Q2 due to complete overhaul of systems. Reporting systems and performance needs to be maintained during implementation. The county is covered by two programmes – the East and the West. Coverage is higher in the East there have been problems with capturing patients in the West. This has now been rectified. The Worthing programme will receive a QA visit from the national programme in December.

Quality The next few slides are taken from the Clinical Quality Dashboard, The main objective of the dashboard was to provide a new set of indicators for the South East Coast SHA Board which attempt to provide an overview of the quality of clinical care across Acute Trusts in NHS South East Coast. To maintain the usability of a dashboard it was preferable to keep the number of indicators to a minimum. As there are therefore relatively few indicators included to represent the whole healthcare service it is important to consider the context of these indicators when interpreting the data and making comparisons between Trusts. The five domains of quality are: effectiveness, efficiency, safety, patient experience and timeliness. As a result, clinical indictors have been identified to encompass all of these aspects in an effort to give a rounded view of service quality in the South East Coast. Although there are a number of caveats that need to be considered around the individual indicators, the dashboard should provide clues to quality of care and focus attention on variations in outcome that may have otherwise been undetected. It may also highlight possible examples of good practice.

Quality