Board Report – Performance June 2009 Produced by Business Intelligence (Performance)

Cleanliness and HCAI Considerable work is being undertaken in Western Sussex Hospitals Trust to turn this adverse situation around. The number of pre 48 hour bacteraemia is the biggest risk to the PCT. To address this a health economy wide HCAI task force has been set up. This is meeting monthly to maintain momentum and focus This is the highest priority for the Infection Prevention and Control Team. A process for conducting RCA’s for all community acquired bacteraemia has been agreed with primary care providers. The learning from these and the changes that need to be made in clinical practice can thus be implemented more expediently. A review of all pre 48 hour bacteraemia for 2008/09 has been undertaken. This has identified that soft tissue damage and urinary tract infections are the two most common causes.(41% and 18% respectively of all cases) Targeted work is now taking place in these areas. A LES payment to further engage independent contractors is currently being agreed. Mona Walker – Interim Director of Quality Lead: Mona Walker (Interim Director of Quality)

SECAMB is commissioned to deliver both Category A 8 minutes and 19 minutes performance at the National Target and Category B 19 minutes standard. SECAMB failed to deliver Category B 19 minutes in 2008/09 and their performance remains low for 2009/10. Action being taken to improve Category B performance this year are: ODA performance meetings are planned on a bi monthly basis. These will focus on a detailed forensic analysis of both Category A and Category B performance. Robust data validation processes for all emergency incidents are in place and will be continually reviewed. A single meal break policy for SECAmb is being developed during 09/10. Reporting of “true” Category B performance via info.secamb is being developed and implemented. The continued review of deployment plans will ensure that a maximum 19 minute response for all incidents is considered. Ring back processes for all potential out of time incidents to ensure pre arrival instructions are given to support both the caller and patient will be considered. Quarterly meetings between the PCT and SECAMB will take place to discuss contracting and performance issues, the first one has been booked for the first week in August. Action plans will be requested and monitored to ensure we jointly work together to achieve the targets set. Lead: Helen Medlock Head of Ambulance Commissioning Emergency Care

Delays in turnaround continue to be over 25% higher than the average monthly delay last year (and that level of delay was considered to be a significant problem last year). Although principally a quality issue concerning patient safety and experience, the reports on turnaround delay now include the cost of hours lost, by hospital site, to help raise the profile further. Recording handover rather than just overall turnaround time is the first critical step to identifying the reasons for the problem and taking action. Data completeness for this is now being monitored and will become part of the standard report which is shared across all parties. West Sussex PCT will be arranging meetings with the locally commissioned acute trusts and SECAmb to follow this up and ensure systems are put in place and embedded in good time for next winter. Positive meetings at East Surrey Hospital, with the ‘top 6’ hospitals have resulted in agreements about how the recording of data will be carried out and how that information will be used to stimulate local discussion on the reasons for delay. Lead: Helen Medlock Head of Ambulance Commissioning Emergency Care

Number of patients waiting >= 6weeks for diagnostic tests Most of this months diagnostic breaches are at Park Surgery and due to capacity issues. This is being raised by the Community Contracting team. 2 breaches are at London Providers and there is one breach at West Sussex Hospitals for which an action plan is in place in order to prevent further breaches. Maximum wait of 13 weeks for an out-patient appointment The 13-week breaches continue to relate to the Bariatrics service at St Richards Hospital. Although there remain breaches as a result of the issues highlighted previously, they are reducing as expected. The will be a number of breaches in May (approximately 17) with none in the months following. All patients currently on the waiting list have appointment dates and all patients will be seen by the end of June. Lead: Mike Lander Acute Contracts Manager – 18 weeks 18 weeks / Waiting times

The April numbers are only 39% of trajectory due to resourcing and systems issues which have impacted their ability to capture all screens onto the system. To ensure improved performance in the coming months a daily activity action plan with be devised and monitored. Currently the screening team are experiencing system problems so the information is being entered into the system manually, but it is being reported in the usual way so all reports are accurate. The new co-ordinator has now started and is carrying out a full review of all systems. This will have an impact on screening numbers as the new staff will need to be skilled up to work independently. Testing kits provision is being reviewed this is currently done in house and is expensive and time consuming, several bought in options are available and are being appraised. The new IT system is being procured. Practice within community contraception settings will be changed to ensure maximal uptake of Chlamydia screening. Hub and spoke services will provide a proportion of the treatment for patients, leaving Chlamydia staff to reach more vulnerable groups more effectively. The co-ordinator will be working with the practice nurse forum to increase participation. HPV catch up LES requires the offer of Chlamydia screening to year olds. Lead: Paul Woodcock Sexual Health

Appendix 1 - Individuals who complete immunisation

West Sussex PCT is not currently achieving the Immunisation targets but the following measures have been put in place to ensure that this will be rectified in 2009/10. Comparison graphs are provided at GP and locality level across West Sussex. There is particularly room for improvement in the Adur and Arun localities with regards to Hib Men C and MMR for aged 2 and DTaP/IPV and MMR for 5 year olds, where performance has declined in the second half of 2008/09. An MMR catch up programme was introduced last year. A Band 6 post has now been recruited to and has started working with practices to increase uptakes by looking at practice systems etc. This post will also implement a package of training for practice nurses to increase their knowledge of immunisations so nurses will be better able to discuss concerns about immunisation with parents. We are investigating how to link COVER (CHB data) with GP payment data and harmonising the two sources. The data is obtained quarterly, however it was felt appropriate to report back to the Board in 6 months to review the immunisation post action plan. Lead: Nicholas Kendall