Finance

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Finance Performance ReportMonth 3 2009-10
30 July 2009 PCT Board
Jonathan Wise, Director of Finance Performance

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1. Reduce premature mortality and increase life
expectancy
CORPORATE OBJECTIVES MAPPED TO F P REPORT
SECTIONS
2. Reduce health inequalities
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Promote good health and prevent ill-health
CORPORATE OBJECTIVES MAPPED TO F P REPORT
SECTIONS

• Increase the quality and safety of services
  commissioned from providers

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CORPORATE OBJECTIVES MAPPED TO F P REPORT
SECTIONS

• Develop NHS Brent as a World Class Commissioning
  organisation

• Increase patient satisfaction rates and patient
  experience for all commissioned service

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NHS BRENT FINANCE PERFORMANCE REPORT 09/10 -
CONTENTS

• Financial Performance Slides 6-53
• 1.1 Summary
• 1.2 Year to date variances
• 1.3 Forecast outturn
• 1.4 Actions
• Service Performance Slides 54-78
• CSP initiatives and OD Plan implementation
  Slides 79-82
• Use of Resources plan not yet included
• Appendices
• Detailed finance schedules
• Detailed performance schedules

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SECTION 1 FINANCIAL PERFORMANCE
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1.1 FINANCIAL SUMMARY
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PART 1 FINANCIAL PERFORMANCE SUMMARY (1)

• Statutory duties
• Underspend against revenue resource limit
• Achievement of capital resource limit
• Underspend against cash limit
• Achievement of public sector payment policy
• SHA finance risk rating
• Achievement of Operating plan surplus
• within SHA defined tolerances
• Underlying recurrent position
• Savings/disinvestment programme
• BCS full cost recovery

09/10 YTD FOT
G
G
G
G
G
G
R
A
n/a
n/a
A
A
A
R
A
R
G
G
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PART 1- FINANCIAL PERFORMANCE SUMMARY (2)

• At month 3 there is a total YTD net overspend of
  1.3m the main elements of
• which are overspends on
• Acute commissioning (1.9m)
• HQ budgets (0.5m)
• Initial forecasts suggest that the potential full
  year impact could result in a potential full year
  overspend in Acute commissioning of 8.0m and HQ
  budgets of 0.6m.
• There are offsetting favourable forecasts
  relating to Primary Care 0.4m and Brent
  Community Services 0.2m which result in a net
  forecast overspend on commissioning services of
  8.0m.
• The Board on 2/4 agreed the financial plan for
  09/10 which stated that if risk on acute
  contracts exceeds current estimate, it will be
  balanced by re-profiling of investments
• To the extent that these adverse variances cannot
  be contained, planned investments will therefore
  need to be curtailed to ensure delivery of the
  09/10 financial plan
• As a result a forecast reduction in in-year
  investments of 7.9m has been assumed.
• In addition the recurrent position for 10/11
  onwards needs to be addressed through the
  development of a savings / disinvestment
  programme, if planned investment in 10/11 onwards
  is to be supported

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OVERVIEW OF BUDGET POSITION AT MONTH 3 Initial
budgets issued April 09 updated

• Access to Contingency as agreed by CE
• Investments as agreed by Investment Panel
• Allocation increases reflect new allocations /
  adjustments

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1.2 YEAR TO DATE VARIANCES
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SUMMARY OF YEAR TO DATE VARIANCES

• At month 3 there is a net adverse variance
  against plan of 888k
• gross overspends 2,390k
• gross underspends 1,502k

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ACUTE COMMISSIONING YEAR TO DATE VARIANCES

• Contract variances
• Month 2 data has been received from most acute
  providers.
• Extrapolating this data to month 3 indicates an
  in-year adverse variance of 1,944k (3.6). There
  are adverse variances on 11 out of the 22 acute
  providers. The largest absolute adverse variance
  values are at NWLHT 1,293k (4.9), Barts 250k
  (88.2), Barnet Chase Farm 156k (16.7),
  Ealing 135k (66.2) and Imperial 131k (0.8).
• At month 3 the variance is split PbR 1,196k and
  non-PbR 748k.

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ACUTE COMMISSIONING CLAIMS MANAGEMENT

• Month 1
• The variance reported above includes an
  assumption reflected within the NWLHT contract
  that the PCT will lodge successful claims for
  50k per month.
• NWLHT has responded to month 1 challenges
• Audiology and anti-coagulation challenges have
  been agreed
• Attribution challenges of 17k have been agreed
• AE attribution challenges have been rebuted.
• Other challenges relating to pathology the Trust
  have agreed to investigate or in the case of
  consultant to consultant referrals and multiple
  first attendences and specific outpatient
  speciality overspends in respiratory medicine and
  diabetic medicine we have agreed to jointly
  progress.
• Outstanding issues will be followed up within the
  NWLHT technical group.
• Imperial have accepted 5k of attribution
  challenges, they have not yet calculated their
  first to follow-up ratio.
• In addition we have made successful attribution
  challenges of 19k in month 1 with other Trusts
• Month 2 challenges have been issued to Trusts.
• Queries on specific patients outliers e.g. high
  cost and/or long lengths of stay have been
  circulated to relevant practices for review.
• For NWLHT , the PCT has stated its right to seek
  an activity management plan in areas where
  activity is real and to dispute and challenge
  where it is due to coding and counting changes.
• Specific challenges refer to issues raised at
  month 1 (raised before response to month 1 was
  received form the Trust)

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ACUTE COMMISSIONING VARIANCES (MONTH 2)
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ACUTE COMMISSIONING VARIANCE (month 2) BY PbR
non-PbR
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NORTH WEST LONDON HOSPITALS TRUST
VARIANCESAnnual Contract Value 104.6m (49 of
acute spend)

• Current Variance 862k over
• PbR 559k over
• Electives, including day cases 192k over
• Non-Electives 76k over
• OP 181k over (respiratory medicine 62k,
  diabetic medicine 39k, ophthalmology 37k)
• AE 102k over (8 up mainly standard/minors)
• Non PbR 303k over
• Anti-coagulation pricing 26k (paediatric
  phlebotomy agreed but not all anti-coagulation)
• OP Procedures 10k over
• Pathology 97k over (15 growth)
• Excluded drugs 13k over
• Critical care 93k over (1 patient with 3 organs
  supported for 67 days and 1 patient with 2 organs
  supported for 32 days)
• Direct access - speech therapy, dietetics, OT,
  ECG 28k over potential counting and coding
  challenge

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IMPERIAL HEALTHCARE VARIANCESAnnual Contract
Value 62.2m (29 of acute spend)

• Current Variance 88k over
• PbR 55k over
• Electives 37k over (TO)
• Non-electives 10k over
• Out Patients 60k under (mainly first GP
  referrals)
• AE 57k over
• Non PbR 33k over
• Excluded drugs and devices 44k over
• Renal 45k over

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ROYAL FREE HOSPITAL VARIANCESAnnual Contract
Value 12.9m (6 of acute spend)

• Current Variance 69k over
• The over spend is mainly due to non-electives and
  partly offset by under performance on critical
  care.
• There is an imbalance between PbR and non-PbR
  reported activity which appears to be due to
  coding delays as the Trust has included
  unallocated HRGs under non PbR.
• The Trust advise that critical care is an
  estimate based on month 1.
• PbR 63k over
• Electives 24k over
• Planned same day 6k under
• Non-Electives 80k over
• Non-elective Non-emergency 10k over
• Non PbR 6k over
• Non-elective Non-emergency 18k over
• Uncoded activity accrual 88k
• Critical Care 71k under

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UCL HOSPITALS VARIANCESAnnual Contract Value
7.9m (4 of acute spend)

• Current Variance 28k over compared to budget
  (awaiting UCLH final agreed proposal)
• PbR 36k under
• Electives 44k under
• Non-Electives 15k over
• AE 1k under
• Non PbR 64k over
• Outstanding issues to be resolved - OP
  procedure/diagnostic scale back
• Excluded drugs and devices 14k under
• Critical Care 87k over

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OTHER PROVIDERS WITH ADVERSE VARIANCES

• Barts The London 166k over
• ITU 69k over
• HEMS (Helicopter Emergency Service) Consortia
  58k over higher than expected number of
  journeys reported
• One high cost cardiology treatment 25k
• Barnet Chase Farm 104k over
• Breast Screening contribution outstanding
• PbR emergencies over by 42k
• SCBU over by 13k
• Ealing 90k over
• April plan profile less than average month by
  11k
• PbR non-elective 47k over (32 extra patients)
• PbR OP 14k over
• SCBU 14k over (2 patients)

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OTHER PROVIDERS WITH FAVOURABLE VARIANCES

• Royal Brompton and Harefield Hospitals 144k
  under
• Lower cardiac activity levels than plan
• ITU 42k under
• RNOH 80k under
• No high cost spinal procedures undertaken in
  April/May review waiting list

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PRIMARY COMMUNITY COMMISSIONING YEAR TO DATE
VARIANCE

• Medical Contracts - Year to date favourable
  variance of 136k(1.3). Most of this is due to
  slippage in enhanced services due to delay in
  commencement.
• Dental Contract - Year to date favourable
  variance of 76k(2.2) in the dental investment
  budget for increased access. Additional
  investment dental access would commence in
  September /October.
• Pharmacy Contract Year to date adverse variance
  of 5k (0.6)due to the increase in the number of
  items of drugs dispensed, which was more than
  anticipated at the budget setting.
• Prescribing Year to date favourable variance of
  400k (4.3) due to under spend in April 09
  Prescribing and expenditure in Central Drugs.
• Community SLA Year to date favourable variance
  of 36k(0.4) due to CQUIN Adjustment for Brent
  Community SLA

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PRIMARY COMMUNITY COMMISSIONING YEAR TO DATE
VARIANCE
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OTHER ACUTE SEXUAL HEALTH YEAR TO DATE
VARIANCE
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OTHER ACUTE SEXUAL HEALTH YEAR TO DATE
VARIANCE
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JOINT WORKING - YEAR TO DATE VARIANCE
Substance Misuse - 36k underspend relating to
both vacant posts and training budgets
Continuing care is shown as an underspend
position of 35k work is still on going on the
review of the accuracy of commitments on the
database. Variances for other joint working
budgets are minor or break even.
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JOINT WORKING YEAR TO DATE VARIANCE
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JOINT WORKING - CONTINUING CARE BUDGET COST
ANALYSIS
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INVESTMENT PROGRAMME

• All budgets shown at breakeven or better at
  month 3, resulting in a total underspend at
• month 3 of 300k(see appendix A).The main areas
  of underspend are
• Smoking Cessation (scheme 26) 107k
• Organisation Restructuring (scheme 94) 91k
• Improve Vascular Health (scheme 82) 49k
• For 09-10 a separate investment directorate has
  been created to make transparent
• 1.The budgets for approved schemes and,
• 2.the expenditure incurred against the budgets
• Schemes will still have dedicated SROs and be
  managed by the persons delegated responsibility
  by the SRO for delivery of the scheme.

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PCT MANAGEMENT COSTS YEAR TO DATE VARIANCE

• All Headquarters budget lines except Human
  Resources and Estates are overspending at month 3
  by in excess of 5.
• The overspends are mostly due to a reliance upon
  temporary / interim staff and are subject to
  ongoing investigation with Directors
• In total there is an overspend of 453k (12.7)

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Note Prior to IRFS restatement
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CASH POSITION
000

• The cash position for months 1 to 3 is in line
  with plan.
• The cash plan will be re-profiled after M3/Q1.

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PUBLIC SECTOR PAYMENT POLICY (PSPP)

• The target is to pay 95 of invoices within 30
  days.
• Although the PCT has not met the target, April
  June in terms of the value of all invoices paid
  is an improvement on the 2008/09 position

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1.3 FORECAST OUTTURN
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FORECAST OUTTURN 09-10 OBJECTIVES METHODOLOGY
CONTEXT

• Objectives
• Provide an updated assessment on a monthly basis
  of the forecast outturn for 09/10
• from the Operating Plan/budgets
• Identify actions required as a result of the
  analysis
• Link the monthly year-end forecasting process to
  the MTFS for 10/11 onwards
• Methodology
• Assessed the best/mid/worst case for each budget
  area, taking into account all known factors,
  including where relevant
• trends
• seasonality
• Explicitly set out key assumptions / variables /
  constraints
• Incorporation of best practice advice from NHS
  London

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SUMMARY FORECAST OUTTURN

Acute forecast is made on a straight-line
extrapolation of the in-year variance, the main
cause of the adverse movement is a worsening
reported position at NWLHT. The PCT Management
variance has improved due to formulation of
recovery plans An increased slippage on the
reserves is due to the PCT needing to deliver its
planned surplus in the context of an increasing
pressure in acute commissioning.
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ACUTE COMMISSIONING - FORECAST OUTTURN VARIANCE

• The forecast outturn of 7,776k (3.6) adverse
  variance at month 3 is based upon a straight line
  projection of month 2 data received from acute
  trust and FT providers.
• The overspend has increased since the forecast
  outturn adverse variance of 5,208k (2.4)
  against contracts with acute trust and FT
  providers reported at month 2.
• The over-performance forecast at month 3 is on
  both PbR and non-PbR activities, whereas at month
  2 it was predominantly on non-PbR.
• The 2009/10 contracts have been set on the basis
  of projected 08/09 outturn activity plus an
  allowance for population growth. However the
  continuation of the rate of underlying activity
  trends demonstrated by the analysis of inpatient
  and outpatient activity at NWLHT and Imperial
  indicates that the over-performance is being
  driven by activity increases rather than
  under-budgeting or counting or coding issues e.g.
  the move to HRG4.

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INVESTMENT RESERVES FORECAST OUTTURN VARIANCE

• The following areas are planning to spend more
  than 0.5m during the rest
• of 2009-10 and are probably the areas where the
  unidentified slippage of 6.3m
• will need to be targeted. These are
• NICE reserve EIS and Crisis Intervention BCS
  investments
• OD Plan and CSP project costs Vascular Health
  new structure.

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Achievement of Statutory Financial Duties

• The revenue resource variance to plan at M3 is
  mainly due to pressures in acute commissioning
  and headquarters offset by favourable variances
  in primary care and the investment programme. To
  achieve the planned outturn this pressure is
  offset by slippage within the investment
  programme.
• Capital plan represents the latest notified
  resource limit from the SHA. Some schemes are
  awaiting approval, resulting in a current
  underspend of 0.7m (approx).
• The planned cash underdrawing of 2.4m reflects
  difference between the planned 09/10 surplus of
  16.0m less the 08/09 planned brought forward
  surplus of 12.5m and less the cash payment
  relating to interest on leased assets of 1.1m.

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IN-YEAR RISKS (UPSIDES / DOWNSIDES -)

• There remain a number of significant risks to the
  forecast outturn, not yet reflected in the above
• Swine Flu pandemic (-) depending on the
  severity and length of the pandemic and depending
  on national , London and local responses to the
  pandemic the PCT could be exposed to costs
  ranging from 0.5m to upwards of 3m.
• Acute position is based upon month 2 data and
  therefore may not be good indicator of year-end
  position due to the potential for fluctuation in
  activity and for the actual impact of HRG4 (/-)
• No specialist consortia data yet received (/-)
• Prescribing based upon month 1 data, PPA normally
  wait until month 4 data before publishing
  year-end forecasts (/-)
• Value of LD transfer to LBB not yet confirmed (-)
• Balance Sheet / technical issues (/-)

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1.4 ACTIONS
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ACTIONS TO ENSURE ACHIEVEMENT OF 09/10 FINANCIAL
PLAN AND CONTINUED FINANCIAL STABILITY (1)
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ACTIONS TO ENSURE ACHIEVEMENT OF 09/10 FINANCIAL
PLAN AND CONTINUED FINANCIAL STABILITY (2)
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ACUTE COMMISSIONING NEXT STEPS

• NWLHT
• elective / planned same day / outpatients
  activity seek activity management plan (but
  understand impact on 18 week target)
• Pathology finalise analysis to understand where
  the pressure is. Seek activity management plan.
• AE
• Review effectiveness with Harrow PCT of UCC in
  diverting patients away from AE. Anecdotally the
  main NWLHT AE pressure is at the NPH site.
  However there is AE over-performance at Imperial
  as well indicating that a review of AE at all
  providers should be undertaken.
• Excess bed days
• undertake analysis primarily NWLHT
• Barnet Chase Farm
• Further analysis required to understand whether
  this is an HRG4 issue (i.e. complex cases with 0
  or 1 day lengths of stay)
• Barts and the London
• Understand with Hillingdon PCT (former lead
  commissioner) impact of devolving HEMS as
  activity is not consistent with 08/09
• PBC
• Ensure plans are in place to deliver 09/10 demand
  management targets e.g. including admission
  avoidance
• Work with PBC to manage budgets esp. emergency
  admissions and AE attendances

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ACUTE COMMISSIONING - NEXT STEPS (2)

• It is clear that a projected overspend on this
  scale jeopardises our investment programme for
  this year and undermines our strategy. The
  organisation needs to respond by re-ordering its
  activities and making sure an immediate programme
  is put in place to deal with the issue. We shall
  
• advise acute providers that we do not accept the
  variation from plan and shall be invoking
  contract terms that oblige them to work with us
  to bring activity back to plan
• hold investment decisions which have a
  significant recurring element until the acute
  spend is under control
• establish an acute spend task force chaired by
  the CEO and comprising of the FD, DSC, DPC, DPH,
  PEC chairs and PBC lead.
• the task forces role will be to ensure measures
  are put in place to get the acute spend under
  control. This will include
• Securing additional resources for acute
  commissioning until the NWL ACV is operational
• Ensuring the right information is received by PBC
  and the management team to address the acute
  spend
• Reviewing demand management activity and PBC
  engagement in it
• Ensuring PBC is set appropriate objectives and
  resources are aligned to enable them to undertake
  their role, including freeing up senior clinical
  time if appropriate
• Ensuring the appropriate contact challenge is
  presented to providers are the right
  representation is achieved at contract review
  meetings
• All appropriate external support is accessed
• Ensuring links are made, and concerted action is
  taken, with other local commissioners e.g. Harrow
  PCT
• Mark Easton Chief Executive

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APPENDIX A
48
Appendix A
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Appendix A
50
Appendix A
51
Appendix A
52
Appendix A
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Appendix A
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SECTION 2 SERVICE PERFORMANCE
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2008-09 performance

• The initial 2008-09 predicted ratings went to
  the June 09 Board.
• Since then, recent data for some of the
  indicators has been finalised, and therefore,
  predicted scores for these have changed.
• Overall, the PCT is still predicted as achieving
  a Fair rating.
• The following 2 slides show the most recent
  predicted scores for both National Priorities and
  Existing Commitments.

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PCT predicted ratings National Priorities 2009/09
57
PCT predicted ratings Existing Commitments
2008/09
58
2009-10 Performance

• The 2009-10 Performance report is monitoring 2
  main areas as set out in the Care Quality
  Commissions Performance Management framework.
  Existing commitments and National Priorities are
  used to assess whether levels of service set
  through the 2008-2011 planning round are being
  maintained.
• Current status for each indicator is based on the
  thresholds the SHA has provided. Forecast outturn
  for each indicator is based on an assessment made
  by the SRO/McKinsey, of the level of risk to
  achieving the year-end target. For indicators
  with Performance Improvement Plans, the RAG
  status is based on the scoring against Stage of
  delivery (current score) and Likelihood of
  delivery (forecast). See slide 7- Overview of
  performance in priority areas, June 2009.
• Areas currently identified as high risk of fail
  (based on year end forecast) are
• Access to Primary Care
• Access to Maternity Services
• Childhood immunisations
• Breast screening of women aged 53-70 yrs
• Patient experience
• Ambulance response - Cat. B in 19 mins
• Based on Stage of Delivery, the following
  indicators are also at high risk
• Smoking quitters
• Chlamydia screening
• Access to Dental services
• Breastfeeding 6-8 weeks

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Summary - Performance
Current Performance
Forecast Performance
60
PCT Rating- National Priorities
Key for indicators
61
PCT Rating- Existing Commitments
Key for indicators
62
PCT Rating- Other Corporate Objectives
Key for indicators
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Performance Grid
Degree of challenge
Degree of understanding
Quality of Delivery Plan
Progress against plan
Likelihood of delivery in timescale
Stage of delivery

• Delivery challenge is significant, requiring a
  step change in performance in an area that is
  very difficult to address

• Little or no understanding of specific target or
  how it is measured and poor understanding of root
  causes

• Poor set of initiatives defined with little or no
  understanding of impact or resources

• Little evidence of progress and without radical
  intervention little chance that situation can be
  rectified

• Little or no confidence that will deliver this
  year

• No track record of delivery in year

Red

• Reasonable set of initiatives defined but lack
  detailed planning and open questions of impact
  and resources

• Delivery challenge is substantial, requiring a
  large improvement in performance in an area that
  is tough to address

• High level understanding of specific target and
  root causes

• Progress off current delivery plan but with focus
  and effort good be put on track

• Significant risks to delivery but sustained
  effort and focus could turn situation around

• One to three months of proven delivery (i.e.,
  meeting trajectory numbers)

Amber

• Delivery requires continuous improvement in
  performance, with a track record of having
  delivered previously

• Specific target, how it is measured and
  calculated, KPIs and root causes of problem are
  all well understood

• Robust set of initiatives defined with quantified
  impact and resource requirements, strong
  trajectory constructed

• Progress matches current delivery plan for impact
  as agreed

• Confident in delivery if performance is tracked
  and monitored

• Three to six months of proven delivery

Green
SOURCE Adapted from Instruction to Deliver,
Michael Barber, London 2007
64
Overview of performance in priority areas, June
2009 (1/2)
Degree of challenge
Degree of understanding
Quality of Delivery Plan
Progress against plan
Likelihood of delivery in timescale
Stage of delivery
Indicator
Access to antenatal assessment prior to 12 weeks
and 6 days
1
Stroke patients spending 90 of time on a stroke
unit
2
Chlamydia screening for 15 to 24 year olds
3
Access to dental services
4
5
4 week smoking quitters
6
Breastfeeding coverage at 6-8 weeks
7
Breast cancer screening for women 53-70 yrs
8
Childhood immunisations
Number of mental health incidents treated by CRHT
at patients homes
9
Patient satisfaction with access to primary
medical care
10
SOURCE McKinsey Assessment/ SROs
65
Overview of performance in priority areas, June
2009 (2/2)
Progress against plan
Likelihood of delivery in timescale
Stage of delivery
Indicator
Rationale

• No clear actions in Delivery Plan and dependent
  on poor performing GPs

Access to antenatal assessment prior to 12 weeks
and 6 days
1

• Good plans but significant external risks as
  dependent on HASU start up

Stroke patients spending 90 of time on a stroke
unit
2

• Current provider off trajectory and good
  initiatives require further development

Chlamydia screening for 15 to 24 year olds
3

• Successful implementation should result in
  delivery of target this year

Access to dental services
4

• Successful implementation should result in
  delivery of target this year

5
4 week smoking quitters

• Clear actions and evidence that can be done
  (Harrow moved 40-85 in 1yr)

6
Breastfeeding coverage at 6-8 weeks

• Potential to deliver but issue on degree of
  understanding and quality of plans

7
Breast cancer screening for women 53-70 yrs

• Good understanding plans, but challenge v.
  great not planning to deliver

8
Childhood immunisations

• Good understanding and plans, but highly
  sensitive to provider performance

Number of mental health incidents treated by CRHT
at patients homes
9

• Huge challenge, limited resources, and great
  complexity

Patient satisfaction with access to primary
medical care
10
SOURCE McKinsey Assessment/SROs
66
What it would take to move up a level
Progress against plan
Likelihood of delivery in timescale
What it would take
Indicator
Access to antenatal assessment prior to 12 weeks
and 6 days

• Greater focus on actions that impact target in
  delivery plan and broader improvements to primary
  medical care

1

• Significant senior support to assure that HfL
  stroke pathway is successfully implemented this
  year

Stroke patients spending 90 of time on a stroke
unit
2

• Greater specificity in the planning of
  initiatives and plan to catch up on Q1 delivery
  milestones that have been missed

Chlamydia screening for 15 to 24 year olds
3

• Monitor and track delivery

Access to dental services
4

• Monitor and track delivery

5
4 week smoking quitters

• Greater specificity in the planning of
  initiatives and broader improvements to primary
  medical care

6
Breastfeeding coverage at 6-8 weeks

• Plan requires significant further work on
  understanding of the target and detailed planning
  of each initiative

7
Breast cancer screening for women 53-70

• Current plan is high quality and realistic but
  will not deliver this year could throw
  everything at it and hope for the best

8
Childhood immunisations
Number of mental health incidents treated by CRHT
at patients homes

• Difficult past relationship with provider may
  require close senior involvement to ensure
  delivery happens

9

• Radical approach required to achieve a step
  change significant boost to capacity and
  capability necessary

10
Patient satisfaction with access to primary
medical care
SOURCE McKinsey Assessment/ SROs
67
McKinsey observations
Challenges
Strengths

• Some Delivery Plans show detailed thinking,
  robust initiatives, and specific, quantified
  impact and should deliver e.g., Dental, Smoking,
  CRHT
• Strong engagement from all of the teams who have
  devoted considerable time and energy into
  preparation of the plans
• Recognition of the value of a structured process
  and approach to delivery planning
• Open and receptive to learning new skills,
  approaches and methods and able to apply relevant
  lessons to new areas

• Mindset issues
• Lack of an ownership mentality for targets
• Insufficient bias to action in some important
  areas
• Resourcing issues
• Mismatch in scale of improvement required and
  capacity and capability of some key teams e.g.,
  GP access
• Capacity of SROs to provide significant support
  and challenge to project teams
• People issues
• Substantial capability gaps in some teams
• Many posts held by Interims or external
  consultants who may move on shortly
• Issues around engagement between different levels
  of the organisation
• Information
• Quality, timeliness and relevance of data
• Degree of integration according to provider
  segments

68
Specific recommendations for NHS BrentEndorsed
by EMT
EMT should dedicate at least one of its weekly
meetings every month to performance
management SROs should spend at least 2-3 hours
with Project Teams per month for each
priority Implement a performance management
system that focuses on action and
delivery Delivery plans should be live documents
that are regularly updated Teams should review
their progress on a weekly basis and focus on
actions that have tangible impact Delivery
Planning process should be applied more broadly
in the organisation and integrated into annual
planning and CSP processes
1
ME
2
TS/JO/JC
3
ME/JW/TS/JO/JC
4
TS/JO/JC
5
TS/JO/JC
6
TS/JW
SOURCE McKinsey
69
Trend charts

• Charts have been included for those indicators
  which underperformed in 2008-09 and/or have
  Performance Improvement Plans. These are
• Smoking quitters
• LAS Cat A 8 mins
• LAS Cat B 19 mins (Achieved in 08-09 but
  currently underperforming)
• Breastfeeding 6-8 weeks
• Chlamydia screening
• Immunisations
• Stroke
• Breast cancer screening
• Access to maternity services
• Teenage conception rates
• Early intervention in psychosis
• Crisis resolution services
• As we only have current year data for a few of
  the indicators, only a few of the charts above
  have been included this month
• Further detail on the performance of all
  indicators is show in the Appendix

70
4 week smoking quitters

• Reasons for underperformance
• The latter months of Q4 08-09 saw a rise in
  number of smokers not using medication support to
  help them quit and therefore, quit rates fell as
  a consequence in April 09.
• There is a delay in paperwork returning back
  from providers, preventing early capture of
  quitters on our information system. May figures
  may rise in the next few months once all data has
  been captured on our system.
• Action taken
• A performance improvement plan has been produced
  describing key initiatives which will be
  implemented throughout the year to increase
  performance. Delivery of this is being overseen
  by the Smoking Cessation Performance Board.

71
Ambulance Cat B 19 minute response rate

• Reasons for underperformance
• YTD June 09 performance is 85.1 against a
  target of 95.
• Hospital waits to handover increasing with
  resultant impact on availability of ambulances.
• High call volumes especially for flu like
  symptoms
• Action taken
• Reliant on new staff - recruitment is active but
  takes time to train

72
Ambulance Cat A 8 minute response rate

• Reasons for underperformance
• YTD June 09 performance is 73.3 against a
  target of 75.
• Hospital waits to handover increasing with
  resultant impact on availability of ambulances.
• High call volumes especially for flu like
  symptoms
• Action taken
• Reliant on new staff - recruitment is active but
  takes time to train

73
Data Quality

• Data quality is being addressed for many of the
  indicators in their Performance Improvement
  Plans.
• Below is a summary of actions proposed in their
  Performance Improvement Plans

74
APPENDIX B
75
Appendix B
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SECTION 3 CSP INITIATIVES OD PLAN
IMPLEMENTATION
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PART 3- CSP INITIATIVES AND OD PLAN Reporting
period 10 June 2009 10 July 2009
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PART 3- CSP INITIATIVES AND OD PLAN
82
PART 3- DEFINITIONS