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Paper N1LLR PCT Cluster Board meeting14 June 2012LEICESTER, LEICESTERSHIRE AND RUTLAND PCT CLUSTERBOARD MEETINGFront SheetTitle of the report:Report to:Section:Leicester, Leicestershire and Rutland PCT Cluster AcuteContracts Summary Report - April 2012Leicester, Leicestershire and Rutland PCT Cluster BoardMeetingPublicDate of the meeting: 14 June 2012Report by:Sponsoring Director:Presented by:Alison Hassell, Associate Director Contracts and ProviderPerformanceDr Simon N Freeman, Managing Director, Leicester CityClinical Commissioning GroupDr Simon N Freeman, Managing Director, Leicester CityClinical Commissioning Group & Lead Director for UHLContractReport supports the following corporate objective(s) 2012 – 2013:Handing over a good legacy to thesuccessor organisations Continue to improve health outcomes,clinical quality, patient safety andEnsure safe transition to successororganisationspatient experienceOversight of performance andassurance.Purpose of Paper:Please state reason why this paper isbeing presented to the LLR PCTCluster Board (rather than elsewheree.g. a CCG Board)This is a high level summary of the performanceof the acute contracts as at April 2012. Moredetailed reports are being presented to the CCGBoards.EXECUTIVE SUMMARY:1. The purpose of this summary report is to inform the PCT Cluster Board of theperformance of NHS Leicestershire County and Rutland’s (LCR) and NHS LeicesterCity’s (LC) contracts, in particular, the contract with the University Hospitals of LeicesterNHS Trust (UHL). It is based on the detailed report submitted to the PerformanceTransition Management Team on 30 May 2012.2. Agreement of 2012/13 contractsThe UHL, Urgent Care Centre, Leicester Nuffield, Leicester Spire and LeicesterDisablement Services Centre contracts for 2012/13 were all agreed by the nationaldeadline. Out of county acute contracts to which LCR and LC commissioners areAssociates have also been agreed. Contract data for month 1 (April 2012) is notavailable yet so all contracts are being reported as breaking even in month 1.1

Paper N1LLR PCT Cluster Board meeting14 June 20123. UHL 2011/12 out turn position and performance3.1 Financial position - the estimated month 12 financial variance for NHS LCR of £5.4mover plan and for NHS LC of £0.96m over plan was reported last month. Followingadjustments to the contract value and activity plans for the additional ‘Access’ fundingprovided to UHL, the month 12 contract monitoring shows LCR over plan by £2.88m andLC by £0.6m. The final position once a number of contractual challenges have beenresolved is likely to be further reduction in the over spend.3.2 Quality and PerformanceCommissioners have been closely managing recovery of a number of key performanceindicators using, where necessary, the formal process in the NHS contract which canultimately lead to financial penalties for failure to recover performance. While it isrecognised that a lot of hard work has been carried out by staff in UHL and progressmade in improving performance, close performance management of the followingindicators is on-going:18 weeks referral to treatment (RTT) standard62 day cancer waiting time standardA&E four hour maximum waitCancelled operations.Breast screening age extensionIn respect of UHL’s 18 weeks RTT performance, the standard of 95% for non-admittedpatients was achieved while for admitted patients performance was 83.29% against thetarget of 90% at March 2012. As previously reported, the backlog clearance wasrequired in 2011/12 to position UHL to comply with 90% standard at specialty level in2012/13, and during quarter 4 it was acknowledged that UHL would sacrifice theadmitted bottom line performance to achieve this. The provisional position for April2012 is that the RTT standards will be achieved at specialty level except for nonadmitted ophthalmology, and commissioners have asked UHL for a recovery plan.There are still several specialties where there is a risk that backlogs will increase againin 2012/13 therefore commissioners will maintain close scrutiny of the backlogs andpursue contractual remedies if necessary.62 day standard for cancer treatment; UHL’s cumulative performance for April 2011to March 2012 shows 83.6% against the 85% target. The March 2012 monthly positionis reported as 85.6%.UHL has given assurances that the internal standards and operational managementimprovements in the Remedial Action Plan have been implemented and quality leadshave agreed with UHL that all long waits will be subject to root cause analyses, withexternal scrutiny to determine any clinical risk or detriment to patient outcomes. UHL isalso establishing an internal Cancer Board, which will have GP representation, to meetmonthly and review all waits for treatment of 90 or more days. Despite the improvementin aggregate performance in quarter 4 of 2012/13, commissioners have on-goingconcerns regarding Lower GI tumour site performance and have asked again forconfirmation of actions to reduce waits sustainably.A&E maximum wait of 4 hours: the final outturn position for 2011/12 was 92.22% ofpatients being seen within 4 hours against the target of 95%. A £300k contract penaltyhas been applied to UHL as per the contract terms, against the 2011/12 performance.2

Paper N1LLR PCT Cluster Board meeting14 June 2012examination in clinic it was established that a healthy tooth had been mistakenlyremoved.The number of incidents reported in Quarter 4 has increased by 8.6% from Quarter 3.This increase is mostly due to an increase in the number of incidents reported by theAcute Care Division. UHL reports that analysis of incident themes and trends acrossthe Trust will continue and lessons learnt will be shared across the organisation.Incident reporting will continue to be monitored via the CQRG.UHL's sickness rate during March 2012 was 4.3% which is an increase fromFebruary, and higher than the previous 11 months. UHL reported that the actual rateis likely to be around 0.5% lower as absence periods are closed. Figures forprevious months have been revised to reflect this. The 12 month rolling sickness rateis maintained at 3.5% and UHL’s Human Resources team continue to work withDivisions to performance manage areas with the highest sickness ratesPerformance against both 4hr ED targets have deteriorated further to March 2012,therefore the end of year targets have been missed. UHL reported that attendancelevels in March 2012 were 5.6% above 2010/11 levels. Performance for this indicatorand work to improve performance continues to be monitored by the ContractPerformance Group.During April 2012 UHL reported a further three incidents of clinically unjustified SameSex Accommodation breaches, affecting 7 patients. Both breaches occurred in theacute medical unit (AMU) at LRI and full RCAs (root cause analysis) are currentlybeing carried out. Findings will be reported to commissioners at the June 2012CQRG. UHL has informed commissioners that there have been no breaches to datein May 2012.Following the unannounced Care Quality Commission (CQC) visit to the LRI AcuteMedical Units during March 2012, resulting in a warning notice being issued due tothe high level of concerns; the CQC revisited the site on 4 May 2012. During the visitthe CQC found that all concerns raised in the earlier visit had been addressedincluding; no longer using trolleys on the ward and improving communicationbetween staff teams. The CQC review of compliance report following the visitincludes the judgement that ‘people experienced care, treatment and support thatmet their needs and protected their rights’ in this area. The warning notice has beenlifted.A commissioner team including Quality, CCG and PCT Cluster representativesvisited the ED and AMU areas of the LRI in the evening of 24 th May 2012 to gainfurther assurance of quality of care provided. The findings will be reported at theJune 2012 CQRG.All other indicator performance remains relatively static.RECOMMENDATIONS:The PCT Cluster Board is requested to:RECEIVE the report for information5

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