Quality, Performance and Finance Update – June

•      Finance: Running leaner than comparative ICBs. Predicting a break even position at end of year (significantly fewer junior docs and nurses taking action); Particular areas of risk include Prescribing and Continuing Healthcare where there are challenging efficiency programmes to be delivered as well as managing cost-pressures and run rates within the budgets planned for.

•      Performance: Community Paediatric services –  Recent rapid increase in referrals for preschool children on top of a similar long-term trend for all services. Several children with complex physical disability needing to be held in the community with the increasing input from the multidisciplinary team due to lack of specialist support in the local district general hospital and long wait for this specialist respiratory, gastroenterology and paediatric surgical input from specialist hospitals. Prioritisation process identified and in place.

•      Mental Health Inappropriate Out of Area placemats continue to be of concern with the number and length of stay for patients continues to rise with 1080 in Mar 23 ( 2,660 bed days Jan-Mar 23)  There are routinely 5 patients with a LOS greater than 91 days. CPFT have plans in place to recommence opening some inpatient beds in July 23.

•      Clearance of 78 week waits by end of June – performance is reported weekly through NWAFTs tiering meeting and CUHFT reporting. The system is expecting,  based on unvalidated data, 143 >78 weeks worst case at the end of June, broken down as below:

•      39 breaches due to patient choice, clinical complexity or unfit for treatment

•      104 capacity breaches (23 CUHFT and 81 NWAFT)

•      Industrial action (April and June) has impacted on clearance rates. 68 long wait patients (>78 weeks) have had their appointment rescheduled directly as a result of IA during Q1, which accounts for 65% of our worst-case capacity breaches. Nationally, the expectation is clear that all long waits are expected to be eliminated before the end of June 23 but locally we do not expect to achieve this, rather we are aiming for clearance by the end of July 23.

•      C&P ICS performance remains below national ambition for health checks for people aged 14+ with a learning disability. The achievement for 2022/23 was 72%, while lower than the national ambition was considerable improvement from previous years. Current performance places C&P as third in the region by the end of 2022/23 though EoE performance remains significantly below national average performance

Dementia tour bus has been V successful

Children and Young People with Complex Behavioural Issues and Children’s Multi Agency Safeguarding Hub (MASH). Children’s speech and language therapy has long waiting lists. New Paediatric programme starting soon.  (Duplicated boards have happened with the “de coupling” from the LA). Community paediatrics = 65 week wait.

Dentistry Services Overview. (biggest area of complaint for Healthwatch)  Severe shortage because most want to work near or in London. Pandemic halted a  lot of new initiatives to try to address this. Neighbouring ICB having same issues but looking to set up a dentistry school. Brexit has had a very negative impact because a lot of dentists worked here and in the Eu during the week before this. Noted that you do not have to register with a dentist unlike a GP so should be able to go anyone but most have closed their doors – especially to complex children’s cases. Noted that the funding system is basically flawed – it encourages dentists to see people for 6 month check ups when in fact they only ned to be seen every 2 years. There is no financial incentive to do the more complex work.  The way that funding is allocated is a national matter so out of local hands.

QPF Feeder Groups Overview – Ethical Framework for Clinical Policies Forum and Cambridgeshire and Peterborough Joint Prescribing Group. These make decisions on what interventions/medicines are available to the local population e.g. should we pay for the new obesity drug or not? They need to make £15mill savings.

“Digitech” group: looking at AI but have not yet got to grips with using photos to help with diagnostics – especially about skin cancer.

Will the need for savings impact on community care initiatives i.e. is that an easy route to take to make cuts?

Can we help with the digital agenda/ why are they not looking to neighbouring authorities that are readily using these systems? If they do become more digitised we need to beware of the digital poverty/ exclusion agenda

Need to be making the case for the negative impact that cutting any community funds will have in £s

Feed in case/system studies to illustrate the impact of what we do and what great partnerships we have from primary care to community and back

28-7-23    Rachel Talbot