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2. 2 Existing Commitments The drop in performance this year has been due to Outpatient waiting times, which relates to the Bariatric breaches, Diabetic retinopathy screening where a performance notice has been issued to Western Hospital NHS Trust, Category B Ambulance response times and Delayed transfer of care (a new way of counting was introduced this year). National Priorities NHS West Sussex has improved by 2 positions this year from Weak to Good due to achievement in 8 and Under achievement in 4 of the 12 new indicators introduced this year. Improvement has also been made in 18 weeks and Drug Users in effective treatment to achieved status. Results for our host acute trusts was not available at time of print, however the Strategic Health Authority has predicted Weak for Royal West Sussex Hospital NHS Trust, Fair for Worthing and Southlands Hospital NHS Trust and Excellent for Queen Victoria Hospital NHS Trust for their Quality of Service. Annual Health Check 2008/09 Results – NHS West Sussex health and wellbeing, for life

3. 3 Western Sussex Hospital Trust MRSA numbers are at 12 at the end of August cumulatively. The 3 bacteraemia for August were acquired post 48 hours and were therefore attributable to the patient’s hospital stay. The causes of 2 of the cases have been identified and these were to do with arterial lines and the incorrect catheter being used after 24 hours as per policy guidance. The 3rd case is under investigation for the cause presently. Over the previous 3 months, all recorded cases had been post admission so this will be raised with the Trust. The HCAI Taskforce have agreed to concentrate on care homes and patients in their own homes and work will commence imminently. Lead: Mona Walker – Interim Director of Quality Cleanliness and HCAI health and wellbeing, for life

4. 4 There have been 26 cases for August which is a 100% increase from last month within the Community. There are particular issues around the management of c diff at one care home site in the Horsham area and the infection control team have instituted measures to address these and will continue to monitor regularly. HCAI LES will come imminently into force. The HCAI Taskforce have also agreed to send out c diff questionnaires to GPs which will give more information to the infection control team on where to focus their efforts. Lead: Mona Walker – Interim Director of Quality Cleanliness and HCAI health and wellbeing, for life

5. 5 Both cumulatively and monthly, the 95% target has not been achieved. Underachievement has occurred for 5 consecutive months, however the cumulative position has very slightly improved this month. The Programme Director will be submitting a SECAmb performance Improvement plan separately to the Board. Lead: Tina Wilmer, Programme Director Unscheduled Care Emergency Care – Category B within 19 minutes response time health and wellbeing, for life

6. 6 77.5% of Category A calls answered within 8 minutes for August month, highest total this year which gives a cumulative August position of 75.3%. Further analysis has been sent to SECAmb for review that looks at how many of those calls were required in order to achieve 75% performance per Ward. In summary both Petworth and Billingshurst and Shipley were 52 calls short of the 75% target so far this year, this is reflected in their low % success rate of 13% and 25% respectively. The 3 rd Ward with the highest number of responses greater than 8 minutes was Southbourne, where they are 44 calls short of reaching 75% success rate up to August of this year. Lead: Tina Wilmer, Programme Director Unscheduled Care Emergency Care – Category A within 8 minutes response time health and wellbeing, for life

7. 7 Other findings include: Two other Wards North of the county are also struggling to attend to calls within 8 minutes being Itchingfield, Slinfold (31 calls missed) and Southwater (28 calls missed). In the North East of the county performance of two neighbouring Wards are quite different. Crawley Down and Turner’s total calls has fallen from last year, but their % performance has not improved. Compared to Ardingly and Balcombe who are receiving more calls this year (13 additional) and their % performance has improved from last year. Lead: Tina Wilmer, Programme Director Unscheduled Care Emergency Care – Category A within 8 minutes response time health and wellbeing, for life

8. 8 There were a total of 22 diagnostic breaches for August of which 13 were non-obstetric Ultrasound at Park Surgery due to lack of capacity. This issue has been raised again with the Community Contracting Team and they are investigating the continued breaches. The others breaches were split between Echotech, Guys and St Thomas’, Great Ormond St, UCLH and Barts for Echocardiology, Cystoscopy, Sleep Studies, Gastroscopy, MRI and Colonoscopy. 5 of which were patient choice and 4 were due to capacity. Where the issue was capacity, Guys did not send an action plan, however UCLH have sent an update that they have added weekend sessions and are outsourcing to ensure compliance from September. Lead: Bianca Kokkolas, Head of Performance and Programme Management Waiting times health and wellbeing, for life

9. 9 The IT system for the Chlamydia Screening Programme will be installed by the end of November. An initial Action Plan has been produced by WSHT in which the numbers of estimated screens appears under-ambitious and this will be raised with the Trust. A LES for use with primary care is being developed, the favoured model pays £4 for completed tests rising to £5 if more than 10% of the target population is reached. Evidence of the effectiveness of a ‘mail out’ to the target group is being assessed. The SHA has established a monthly performance monitoring teleconference and will be meeting with John Wilderspin on 14 th October. Weekly progress meetings are on-going with the Trust Lead: Paul Woodcock Public Health Programme Manager Sexual Health health and wellbeing, for life

10. 10 Cancer Waiting Times The main reason for the change in performance is the change in counting methodology which came into effect at the end of Q3 in 2008/09. Analysis of the breaches shows that the vast majority are due to patient choice i.e. a patient has declined an offer of an appointment which was within the 2 week window. NHS West Sussex has taken remedial action by writing to all GPs to remind them that patients need to be aware that they are on an urgent pathway. Sussex Cancer Network have re-issued their patient leaflet explaining the process which can be given to patients and lastly each trust is writing to GPs when a patient declines an offer to raise their awareness of the problem. Lead: Alison Hempstead health and wellbeing, for life

11. 11 Performance Notices Four of the eight performance notices for the Sussex Partnership NHS Foundation Trust have now been removed, however two more have been issued. The Trust has now sent the required information to the Programme Director at NHS West Sussex, as per the requirement of the notice. The Programme Director and his team are working with the Trust to remove the remaining six notices. None of the performance notices for Western Sussex Hospitals Trust have been removed as yet but by the end of October it is planned that two will be removed. Lead: Bianca Kokkolas, Head of Performance and Programme Management health and wellbeing, for life

12. 12 Quality The next few slides are taken from the Clinical Quality Dashboard, The main objective of the dashboard is 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 is 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. Please note: due to merger of Worthing & Southlands Hospital NHS Trust and Royal West Sussex Hospital NHS Trust data is currently not available at an aggregate view of Western Sussex Hospitals NHS Trust. However the dashboard is available at Hospital level. health and wellbeing, for life

13. 13 Quality

14. 14 Quality

15. 15 Quality

16. 16 Quality