To consider a report on performance monitoring by NHS Herefordshire Clinical Commissioning Group.

The chairperson said that the purpose of this item was to consider a report on performance monitoring by NHS Herefordshire Clinical Commissioning Group (CCG), as requested by the committee following consideration of ‘The future of the Herefordshire and Worcestershire Clinical Commissioning Groups consultation’ item at the 24 June 2019 meeting; minute 7 refers.  In addition, details of the One Herefordshire priorities and outcome measures had been requested by the committee following consideration of the ‘One Herefordshire and Integration Briefing’ item at the 18 October 2019 meeting; minute 17 refers.  Scott Parker, director of performance, was invited to present this report on behalf of the CCG; presentation slides had been circulated in a supplement to the agenda.

The principal points of the presentation included:

a.         The differences between Appendix 1 (CCG performance dashboard 2019/20) and Appendix 3 (presentation slides) were partly due to variations in timing and the distinction between CCG data (for services provided for the population of Herefordshire) and Wye Valley NHS Trust data (including attendances by patients from Herefordshire, Wales, and elsewhere).

Arrangements for performance oversight

b.         With the merger of the four Herefordshire and Worcestershire CCGs, assurance was provided that performance information for Herefordshire (and the other constituent areas) would still be recorded and there would be an oversight structure which would consider quality, performance and finance, overseen by the Governing Body.

c.         A brief overview was provided of the development of Primary Care Networks, including oversight by a local performance forum.

d.         It was reported that there was a Sustainability and Transformation Partnership (STP) performance forum, involving system partners with collective ownership and responsibility for the delivery of performance.

Presentation slides

Urgent care

e.         Accident and Emergency (A&E) four hour waits performance (c. 76%-78%) was below the national target (95%) but performance for the most severely unwell patients was stronger.

f.          For overall performance, Wye Valley NHS Trust was c. 14-16^th out of the 21 trusts in the West Midlands.  It was reported that there were challenges with substantive post fill but vacancies were being managed and recruitment plans were in place.

g.         Within national guidance, there was a 92% general and acute bed occupancy benchmark and it was one of the functions of the A&E delivery board to achieve this.

h.         In order to achieve 92% acute bed (general and acute) occupancy there was a projected bed gap of approximately 20 beds.  The bed gap was being closed through opening additional beds and initiatives to support reduced length of stay.  It was reported that Wye Valley NHS Trust was performing well at ‘zero day’ length of stay, i.e. working with the patient to help them to return home, avoiding the need for admission to an inpatient bed.

i.           Ambulance conveyance was a key challenge for the system, with Herefordshire having the highest conveyance rate for West Midlands Ambulance Service (WMAS).  The causal factors, including geographic size and population sparsity, and alternatives to conveyance were being examined for the purposes of service  ...  view the full minutes text for item 46