1. QIPP Dashboard March 2012 position Healthier Horizons

2. Work stream level Medicines Management: Chart 1 Benchmarked overall prescribing costs to March 2012 The overall costs for primary care prescribing are high in the NW compared to the England average, except for 3 PCTs.

3. Work stream level Medicines Management: (2a) Performance on national QIPP indicators Q4 Prescriber NameScore ACE inhibitor % items Low cost lipid modifying drugs Low cost PPIs % items Hypoglycaemic agents NSAIDs ADQ/STAR PU NSAIDs: Ibuprofen & Naproxen % Items ASHTON,LEIGH & WIGAN 1171.69  69.52  93.29  81.28  1.53  70.36  BLACKPOOL 3076.19  79.81  97.60  85.45  1.26  70.08  BOLTON 1166.45  73.92  95.05  80.75  1.14  69.08  BURY 2368.95  76.58  97.07  80.92  1.15  70.65  CENTRAL & EASTERN CHESHIRE 2873.23  76.74  95.88  85.62  0.92  69.55  CENTRAL LANCASHIRE 2374.67  72.82  95.47  84.19  0.91  65.09  CUMBRIA TEACHING 3172.37  78.31  98.24  87.88  1.05  47.39  EAST LANCASHIRE TEACHING 1970.46  79.50  95.95  83.79  1.13  58.74  HALTON & ST.HELENS 1471.64  70.26  96.19  85.01  1.34  65.02  HEYWOOD, MIDDLETON & ROCHDALE 1167.81  73.77  96.39  79.35  1.91  56.76  KNOWSLEY 873.56  66.32  96.28  85.72  1.30  56.68  LIVERPOOL 1275.24  66.65  95.73  82.56  1.21  67.08  MANCHESTER 1871.74  71.38  96.95  81.44  1.25  64.45  NORTH LANCASHIRE TEACHING 2469.86  75.84  96.15  82.67  1.08  66.27  OLDHAM 865.82  67.69  93.71  80.59  1.56  55.16  SALFORD 2674.71  76.02  97.73  77.40  1.00  60.70  SEFTON 1572.90  65.60  95.48  85.20  1.06  67.07  STOCKPORT 2371.79  73.02  97.18  83.37  0.94  56.27  TAMESIDE & GLOSSOP 1569.07  71.26  95.55  82.88  1.45  46.54  TRAFFORD 1572.48  66.39  94.00  80.85  1.14  48.96  WARRINGTON 1469.68  72.98  96.86  84.42  1.26  63.71  WESTERN CHESHIRE 2371.24  75.23  96.11  83.46  0.97  70.34  WIRRAL 1570.01  74.35  97.81  80.30  1.24  62.59  BLACKBURN WITH DARWEN CTP 2371.56  81.77  96.99  80.57  1.46  68.18 

4. Work stream level Medicines Management: (2b) Performance on national QIPP indicators Q4 Prescriber NameScore Antibacterial items/STAR PU Cephalosporin s & quinolones % items Inhaled Corticosteroid s NIC/ADQ Alendronate as % of all biphosphonate s Long/Intermediat e Insulin Analogues Enteral Feeds (SIPS) Cost Per PU Hypnotics ADQ/STAR PU ASHTON,LEIGH & WIGAN11 0.38  5.67  £0.57 83.83  92.17  £0.51  1.90  BLACKPOOL30 0.37  4.04  £0.66 85.44  75.01  £0.39  0.95  BOLTON11 0.38  8.13  £0.56  77.07  86.70  £0.45  1.42  BURY23 0.36  5.67  £0.53  84.04 80.58  £0.28  1.45  CENTRAL & EASTERN CHESHIRE28 0.35  5.50  £0.51  85.50  90.73  £0.33  1.04  CENTRAL LANCASHIRE23 0.35  6.53  £0.50  85.49  85.10  £0.41  1.02  CUMBRIA TEACHING31 0.35  5.76  £0.50  85.68  85.89  £0.20  1.21  EAST LANCASHIRE TEACHING19 0.39  5.38  £0.56  82.83  77.78  £0.49  1.71  HALTON & ST.HELENS14 0.40  8.41  £0.65  83.97  82.00  £0.52  1.60  HEYWOOD, MIDDLETON & ROCHDALE11 0.42  6.24  £0.55  83.62  85.72  £0.50  1.69  KNOWSLEY8 0.38  7.98  £0.65  82.13  91.85  £0.74  1.41  LIVERPOOL12 0.35  8.30  £0.60  79.32  92.54  £0.81  1.32  MANCHESTER18 0.35  4.17  £0.56  84.45  92.59  £0.43  1.66  NORTH LANCASHIRE TEACHING24 0.33  6.19  £0.60  83.64  83.22  £0.35  1.21  OLDHAM8 0.40  4.52  £0.54  75.86  96.90  £0.48  1.74  SALFORD26 0.35  5.70  £0.53  90.57  55.36  £0.40  1.16  SEFTON15 0.36  9.11  £0.60  82.63  91.98  £0.64  1.32  STOCKPORT23 0.35  4.08  £0.58  84.43  86.11  £0.18  1.40  TAMESIDE & GLOSSOP15 0.33  6.70  £0.57  86.67  95.81  £0.27  1.40  TRAFFORD15 0.35  5.75  £0.50  86.78  96.00  £0.26  1.19  WARRINGTON14 0.37  6.22  £0.62 79.62  82.04  £0.35  1.68  WESTERN CHESHIRE23 0.35  6.83  £0.51  85.78  91.49  £0.39  1.10  WIRRAL15 0.38  8.71  £0.57  85.48  96.82  £0.38  1.48  BLACKBURN WITH DARWEN CTP23 0.38  5.37  £0.53  87.53  83.15  £0.32  1.70 

5. Work stream level Medicines Management (3) PCT cost growth 11/12 (compared to 10/11) The NW has good reduction in PCT ongoing cost growth, ranging from -5.98% in Bury to -0.46% in ALW. Increasing investment maintained in treatments for hypertension and vaccinations as part of the Quality improvements.

6. Work stream level Medicines Management: (4) PCTs (Specials) Year on Year Change (% reduction) to Q4 11 /12 Special formulations highlighted as a key cost pressure in 09/10. PCTs have taken action to reduce costs. DH have introduced drug tariff prices from Nov 11 to mitigate the ongoing risks.

7. Work stream level Medicines Management: (5) PCTs (Antibacterial Drugs) Change (%) to Q4 11/12 The PCTs have been working to reduce the use of antibacterial drugs in primary care as part of initiatives to reduce C. Diff incidence –(1.2% down), BUT Q4 figures for most PCTs have risen

8. Work stream level Medicines Management: (6) PCTs (Nutritional Supplements) Year on Year Change (%) to Q4 11/12 PCTs identified this as a cost pressure in 2010/11 and took measures to reduce expenditure in 2011/12. Outcome small growth of 1% across the NW at year end

9. Work stream level Better Care Better Health Better Life Informatics – Choose & Book for 3 months ending at 31 st March 2012 Whilst Choose & Book continues to perform well the opportunity remains to save a further £2m per quarter if at least 90% of referrals are conducted via this route

10. Work stream level Better Care Better Health Better Life Informatics – Electronic prescription service at 31 st March 2012 Some clusters still not engaging fully with this initiative. Further development work is required to maintain momentum

11. Work stream level Better Care Better Health Better Life Informatics – Summary Care Record at 31 st March 2012 Only 20 % (152 out of 763) of practices have uploaded Summary Care Records. An increase from Dec 2011 (14.5 % of practices) Cluster % of patients with records created PCT Name Map Ref # of Practices PCT Population Awareness & Engagement PlanningAdoption In progress / Not done Project Manager In Post Business Case Developed Project Board Established SCR Clinical Lead In Place # Potential GP Practices (EMIS LV, iSoft Synergy, InPS or TPP) % of Potential total GP Practices # Practices Where Patient PIP Letters Sent (Public Information Programme) # of PIP Letters Sent (To Patients > 16yrs) #patient opt outs Patients surveyed for opt out % Patient Opt Out (of practices reporting) # Practices Uploaded # Patient Records Created # Practices Entered into Provisional Business Go Live Field Cheshire 20% Central and Eastern CheshireA53470,829  3974%53385,62563474645031.37% 0 WarringtonB25208,801 2392%28 167641 19452068370.94%22172,2060 Western CheshireC40261,783 3485%40215,81434382604971.32%725,39517 WirralD61331,710  4879%62269,94045723330081.37%1158,8720 Cumbri a 0%CumbriaE86513,923  5564%00 0.00% 0 Lancashire 1% Blackburn With DarwenF29168,874  1655%31130,7297491673080.45% 27 BlackpoolG22153,069 n Nnn 1255%00 0.00% 0 Central LancashireH89473,015  4955%89385,06327004715730.57% 0 East LancashireI66388,318  3553%67314,27420043879850.52% 60 North LancashireJ37339,752  1849%39293,43719043374240.56%222,5820 Manchester 17% Ashton, Leigh & WiganK66320,418 5786%66262,37819493204290.61%31146,2020 BoltonL45296,358 4396%44237,75931272898641.08%19144,7550 BuryM33195,942 33100%32159,07314551603590.91%26147,6317 Heywood, Middleton & RochdaleN40224,321 2768%50 0.00% 0 ManchesterO103568,105 3231%103450,63327275584900.49%19,16892 OldhamP49240,857 2551%49187,082192282940.68%643,41342 SalfordQ56250,190  4071%00 2474880.00% 0 StockportR52299,487 1733%00 0.00% 10 Tameside & GlossopS43240,706 2456%00 0.00% 15 TraffordT40234,400 2563%41187,76228872333961.24% 0 Merseyside 10% Halton & St HelensU55321,194  n 2545%55261,04524593195910.77% 0 KnowsleyV33158,349 2885%3107801585140.49%27127,9680 LiverpoolW97492,835 nnn 3637%98401,48941804900810.85% 0 SeftonX55280,117  nnn 2240%55232,058 2791960.00% 0 N/West Total 12757,433,353 76360%9884,541,80243,4155,714,8370.76%152898,192270

12. Work stream level Demand & Threshold Management : Increased number of patients dying at home Better Care Better Health Better Life Slight increase in the number of patients dying at home overall (0.35%) but not in Warrington, HMR, Stockport, Tameside & Glossop, Trafford, Blackburn with Darwen and Halton & St Helens.

13. Cluster Q4 Self Assessment of QIPP Programme Milestones SHA Triangulation May 2012 Cumbria PCTA/RWatching brief: Outpatients and electives, recognise improvements made on finance and sickness absence. Confidential North West SHA Cumbria Cluster QIPP Update Q4 Self Assessment R SHA Triangulation A/R Cluster Self Assessment Exceptions Activity for unscheduled care at month 10 is 7.8% above the contract plan (but about level with the outturn for 2010/11). Each of the six localities is focused on putting in place the local community based actions which are now required in these areas Urgent Care This section of the QIPP Programme is RAG rated Amber/red because the month 10 activity monitoring for the C2H condition groups reveals Cumbria to be 7.8% above plan for the C2H LTC condition groups ( but performance varies across the six localities) Long Term Conditions Planned Care Activity at month 10 is now below the contract plan by 1.6% (but in value is up by 4%, £2.5m). NCUHT is below plan by 9% but UHMBFT is above plan by 8.3%. The Planned Care Turnaround workstream has a remit to confirm the operational plans to deliver the changes required in planned care and the delivery of the activity and financial targets over the next three years. Transition Planning A GP-led Clinical Commissioning Group has been operational since April 2011 and a Managing Director and the senior team have been appointed. Six Locality Directors have been appointed and the locality commissioning teams are in place. The QIPP plan brings together the commissioning intentions of all six localities and has been led by the Clinical Senate, which have also conducted the 2012/13 contracts negotiation. The CCG and Cluster jointly oversee operational delivery of the QIPP programme. A/R

14. The 4 th quarter saw some reductions in a trend of rises across a number of areas. But, growth continued for; other referrals (7.5%), All referrals (1.7%) elective day cases (7%) all electives (4.7%) Cluster level Better Care Better Health Better Life Activity - Cumbria March 2012

15. Cluster Level - Cumbria Workforce – March 2012 RAG Dec 11 RAG Mar 12