Mental Health Watch

Mental Health Watch
Royal College of Psychiatrists

• A tool to help track how well the mental health system in England is performing. It provides current data on indicators that help track and analyse trends.
• Themes include: Access, Care, Finance, Leadership, Quality and Workforce.

Financial performance of English NHS trusts and variation in clinical outcomes

Financial performance of English NHS trusts and variation in clinical outcomes: a longitudinal observational study.
BMJ Open 2019;9:e021854. doi: 10.1136/bmjopen-2018-021854

• A longitudinal, observational study in 149 acute NHS trusts in England between the financial years 2011 and 2016 correlated a range of clinical outcomes (readmissions, inpatient satisfaction score and the following process measures: emergency department (A&E) waiting time targets, cancer referral and treatment targets and delayed transfers of care) with financial performance.
• The analysis found that operating margins in English NHS trusts progressively worsened during 2011–2016, and this change was associated with poorer performance on several process measures but not with hospital readmissions or inpatient satisfaction. Significant variation exists between the best and worst financially performing Trusts.

Trusted measures: analytical resources for integrated care

Trusted measures: analytical resources for integrated care
Nuffield Trust 24 July 2018

• This new toolkit pulls out the most relevant resources on the impact of integrated services from Nuffield Trust research reports into one place, going through the analytical approaches and explaining how they could be used by integrated care systems. 
• The resources are presented in four groups:
• Defining what to measure
• Identifying data sources
• Using predictive models
• Monitoring for change

NHS Indicators - an overview

NHS Indicators: England, October 2017
House of Commons Library Briefing October 2017

• A summary of data on demand for and performance of NHS services in England, as well as information on the supply of beds and staff including:
• Accident & Emergency attendance and performance
• Ambulance demand and response times
• Waiting times and waiting lists for routine treatment
• Waiting times for cancer diagnosis and treatment
• Cancelled operations
• Delayed discharges and transfers of care
• Diagnostic waiting times and activity
• Waiting times for mental health treatment
• Workforce numbers for doctors, nurses and other staff
• Hospital activity, referrals and admissions
• Bed availability and occupancy

STP Progress dashboard

STP progress dashboard - baseline view
NHS England Board meeting 21 July 2017 Item 11

• STPs have been given an overall baseline rating based on performance across nine domains and have been categorised as ‘outstanding’, ‘advanced’, ‘making progress or ‘needs most improvement.
• Overall baseline ratings derive from performance across nine domains:
• Hospital performance
• i. Emergency Care
• ii. Elective Care
• iii. Patient Safety
• Patient focused change
• iv. General Practice
• v. Mental Health
• vi. Cancer
• Transformation
• vii. Demand Management
• viii. Leadership
• ix. Finance

NHS England Annual Report and assessment of performance 2016/2017

NHS England Annual Report 2016/17
Department of Health 18 July 2017

NHS England: assessment of performance 2016 to 2017
NHS England 18 July 2017

• Annual assessment of NHS England against its mandate and business objectives for 2016 to 2017 regarding improve the quality of services, reduce inequalities, secure public involvement.

Single Oversight Framework for providers

Single Oversight Framework for providers
NHS Improvement 30 September 2016

• The Framework will help NHS Improvement identify NHS providers' potential support needs across five themes:
• quality of care
• finance and use of resources
• operational performance
• strategic change
• leadership and improvement capability
• NHS Improvement will segment individual trusts according to the level of support each trust needs.
• The framework applies from 1 October 2016, replacing the Monitor 'Risk Assessment Framework' and the NHS Trust Development Authority 'Accountability Framework'.

Guide to Annual Reporting on Patient and the Public Participation

A Guide to Annual Reporting on the Legal Duty to Involve Patients and the Public in Commissioning
NHS England July 2016

• The Guide sets out the organisations’ responsibilities to report on how they meet their legal duties to involve patients and the public in their work. 
• The guide includes useful tools, resources and good practice examples to support the development of annual reports. It also provides advice on making reports accessible and appealing.
• CCGs are advised to use the guide to inform their annual reporting processes for 2016/17

CCG assessment and stakeholder survey results

CCG Improvement and Assessment 2016/17
NHS England 21 July 2016

• For 2016/17 NHS England are introducing a new CCG Improvement and Assessment Framework (CCG IAF) to replace both the existing CCG assurance framework and CCG performance dashboard. 
• This new framework  aligns with NHS England’s Mandate and planning guidance, with the aim of unlocking change and improvement in a number of key areas.
• The framework is intended as a focal point for joint work and support between NHS England and CCGs and draws together the NHS Constitution, performance and finance metrics and transformational challenges. It will play an important part in the delivery of the Five Year Forward View (see CCG improvement and assessment framework 2016/17)
• Using criteria announced last year, the CCG annual ratings for 2015/16 show how each CCG has discharged its responsibilities. 10 CCGs were rated ‘outstanding’, a further 82 ‘good’, 91 were found to ‘require improvement’ and 26 CCGs rated as ‘inadequate’. (See Year-end CCG Assurance Annual assessment 2015-16)
• NHS England have also published the latest 360 stakeholder survey results for 2016

See also "Strengthening Financial Performance and Accountability in 2016/17" (NHS England  21 July 2016)

CCG Financial Performance and Accountability - The "Financial Reset Plan"

Strengthening Financial Performance and Accountability in 2016/17
NHS England 21 July 2016

• NHS England has set out a series of actions designed to support the NHS to achieve financial sustainability and improve operational performance.
• A wide-ranging seven-point set of actions is being taken by NHS Improvement, NHS England with the support of the Department of Health and the Care Quality Commission. 
• They have:
• allocated an extra £1.8 billion to trusts, with the aim set by NHS Improvement of cutting the combined provider deficit to around £250 million in 2016/17 and the ambition that, in aggregate, the provider position commences 2017/18 in run-rate balance;
• replaced national fines with trust-specific incentives linked to agreed organisation-specific published performance improvement trajectories, so as to kick-start a multi-year recovery and redesign of A&E and elective care;
• agreed ‘financial control totals’ with individual trusts and CCGs, which represent the minimum level of financial performance, against which their boards, governing bodies and chief executives must deliver in 2016/17, and for which they will be held directly accountable;
• introduced new intervention regimes of special measures which will be applied to both trusts and CCGs who are not meeting their financial commitments;
• set new controls to cap the cost of interim managers and to fast track savings from back office, pathology and temporary staffing;
• published the 2015/16 performance ratings for CCGs; and
• launched a two-year NHS planning and contracting round for 2017/18-2018/19, to be completed by December 2016, and linked to agreed STPs.
• The document is described as "the financial reset document" in the NHS Finance report to the NHS England Board meeting 28 July 2016.

New CCG improvement and Assessment Framework 2016/17

CCG improvement and assessment 2016/17
NHS England 31 March 2016

• A new CCG Improvement and Assessment Framework 2016/17 replaces both the existing CCG assurance framework and CCG performance dashboard. 
• From June, an initial assessment of CCG performance will be available online that will cover six crucial areas including cancer, dementia, diabetes, mental health, learning disabilities and maternity care. This will be followed by an annual assessment in June 2017.
• The Technical Annex (published 23 May 2016)  of provides details of the construction and purpose of each of the 60 indicators across 29 areas  in the Framework. 
• Also published is the OperatingManual Part One which describes the first part of a phased approach to operationalising CCG improvement and assessment for 2016/17
• To track updates see  CCG improvement and assessment 2016/17

CQC, NHS England and GMC to work together to reduce GP Practice workload

Reducing the workload and duplication associated with the regulation of General Practice in England
Primary Care Commissioning (NHS England), CQC and GMC, 21 April 2016

• This document describes the approach being adopted by NHS England, the Care Quality Commission and the General Medical Council to reduce the administrative workload requirements associated with regulation from both the perspective of GP practices and GPs individually. 
• Adoption of recommendations made in the Primary Care Foundation report "Making Time in General Practice"
• Key Outputs include:
• Clarification of the evidence required from practices by the three organisations with a focus on  Significant Event Audits (SEAs), Clinical audit, and Complaints reviews. 
• Alignment of information requests and development of more integrated systems that move towards self-reporting
• Development of practice and individual GP level metrics that can support the development of a prepopulated practice level dashboard showing trends and comparative practice outcome data, developed as a tool to support personal and practice reflection and audit. 
• Development of a joint Programme Board to provide oversight and coordination for the regulation of general practice. The Programme Board will be set up immediately with implementation by April 2017.

National Library of Quality Assured Indicators

User requirements for the Library of Quality Assured Indicators

• HSCIC are working to develop a National Library of Quality Assured Indicators. 
• The team would welcome the input of any users of indicators – involving data quality; researchers; developing national or local dashboards; or involved in assessing the quality of care - through a short survey which will close at 5pm on Friday 15th January.

Actions in place around early discharge and DTOC

Actions in place to drive improved early discharge and reduce delayed transfers of care
NHS England Board meeting, NHS Performance paper Appendix B, 17 December 2015

A summary of actions in place to drive improved early discharge and reduce delayed transfers of care: (Appendix B in full)

• Refreshed DTOC guidance: NHS England, DH, ADASS and ECIST colleagues have worked collaboratively to publish refreshed guidance on reporting delays providing clarity on definitions and processes, underpinned by practical resources that areas can use to implement and spread good practice.
• Toolkit for Independent Care Sector: NHS England is developing a Toolkit for Independent Care providers (both care homes and care at home) to support patient discharge from acute trusts to the care sector.
• ECIP support: Each system will have a length of stay (LoS) review – clinical deep dive looking at every patient with a length of stay > 7 days – to identify where blockages are. See http://www.ecip.nhs.uk/  
• Increased nurse training: Health Education England has increased adult nursing education and training 4.2%; and the number of training places for district nurses by 16.5% for 2015/16.
• Community nursing commissioning framework: A Framework for commissioning community nursing has been developed by NHS England to support:
• Moving limited resource from hospital to community-based care;
• Understanding how community nurses can contribute to the effective commissioning of services;
• Effective discussion about the community nursing workforce including an understanding of workforce planning.
• Standards for district nurse education and practice: The new Queen’s Nursing Institute (QNI/QNIS) Voluntary Standards for District Nurse Education and Practice place district nursing at the centre of community healthcare.

Indicators of quality in general practice

Indicators of quality of care in general practices in England 

Health Foundation October 2015

• An independent review for the Secretary of State for Health of indicators of the quality of care provided by general practices in England.
• The report makes a number of recommendations including:
• developing a small set of indicators that show information about what matters most to the public, health care professionals and those accountable for the quality of general practice
• consolidating the multiple existing websites currently sharing information about general practice quality, with information selected and presented to meet the differing needs of health care professionals and the public
• developing a national strategy for improving the quality of general practice and primary care that guides indicator development, with progress assessed through the Secretary of State’s annual report
• providing support to those working in general practice about how to understand and use information to improve patient care

How to measure the performance of local health systems

Measuring the performance of local health systems
Kings Fund 12 October 2015

• Following a review of approaches to measure the performance of health services within CCG areas, the Kings Fund makes a number of recommendations including:
• a radical simplification and alignment of existing NHS performance frameworks including merging of the three national Outcomes Frameworks into a single framework covering the NHS, public health and adult social care. 
• a small set of headline indicators are selected to present key performance information to the public with a larger set of indicators should be available to enable patients and the public to drill down into population groups and medical conditions of particular interest to them and to support commissioners and providers in quality improvement.
• a reduction in the national bodies involved in assessing performance
• a wide variety of data should be made available for the purpose of transparency

Indicators for community services

The Community Indicators Programme - Demonstrating the Value of Community Services

• A number of indicator templates for different community services including adult audiology, falls prevention services, MSK physiotherapy and wheelchair services, are available for testing and discussion through work by the FTN aspirant Community Foundation Trust (aCFT).
• The aim of the  programme is to develop a common, evidence based clinical effectiveness service level indicators bespoke to community services. 
• Based on work by Southern Health NHS Foundation Trust and Bridgewater Community Healthcare NHS Trust.

Kirkup report highlights failure of lead commissioner arrangements

Morecambe Bay Investigation report
Department of Health, 3 March 2015

• The Morecambe Bay Investigation looked at the maternity and neonatal services in University Hospitals Morecambe Bay NHS Foundation Trust.
• Covering January 2004 to June 2013, Kirkup Report concludes the maternity unit at Furness General Hospital (FGH) was dysfunctional with serious problems in 5 main areas:
• Clinical competence of a proportion of staff fell significantly below the standard for a safe, effective service.
• Poor working relationships between midwives, obstetricians and paediatricians. 
• Midwifery care became strongly influenced by a small number of dominant midwives whose ‘over-zealous’ pursuit of natural childbirth ‘at any cost’ led at times to unsafe care.
• Failures of risk assessment and care planning resulted in inappropriate and unsafe care.
• Grossly deficient response from unit clinicians to serious incidents with repeated failure to investigate properly and learn lessons.
• CCGs had not inherited a service specification from the PCTs and the absence of lead commissioning arrangements inherited from PCTs was found to have resulted in  lack of effective communication between commissioners and performance issues being missed.

Summary of NHS Indicators

NHS Indicators, February 2015
House of Commons Library Research Paper, 17 February 2015

• Summary of statistical indicators for NHS England in the following areas: 
• accident and emergency attendance and performance; 
• ambulance call volume and response times; 
• waiting times for routine treatment; 
• waiting times for cancer diagnosis and treatment; 
• cancelled operations; 
• delayed transfers of care; 
• diagnostic waiting times and activity; 
• waiting times for mental health treatment; 
• workforce numbers for doctors, nurses and other staff; 
• hospital activity, referrals and admissions;
• bed availability and occupancy. 
• In each case, the report includes data frequency, source and trends over the past few years.

NHS Performance data available through MyNHS website

MyNHS http://www.nhs.uk/mynhs
19 November 2014

• The MyNHS website http://www.nhs.uk/mynhs was formally launched today by Jeremy Hunt.
• In response to the Francis Report, this new site on NHS Choices allows people can compare the performance of their local NHS hospital, their care services and their local authority with up-to-date information. 
• The site includes data about hospitals, adult social care services, public health services, public health outcomes, mental health hospitals and consultant performance. Data relating to General practice will be available soon.
• Read about the launch here.