NHS BOLTON CLINICAL COMMISSIONING GROUP Public Board Meeting AGENDA ITEM NO: 9. Date of Meeting: 27 th February CCG Corporate Performance Report

Transcription

1 NHS BOLTON CLINICAL COMMISSIONING GROUP Public Board Meeting AGENDA ITEM NO: 9 Date of Meeting: 27 th February 2015 TITLE OF REPORT: AUTHOR: PRESENTED BY: PURPOSE OF PAPER: (Linking to Strategic Objectives) RECOMMENDATION TO THE BOARD: (Please be clear if decision required, or for noting) CCG Corporate Performance Report Fiona Moore Assistant Chief Officer Grace Birch AD Outcomes Delivery & Business Support Jackie Murray Deputy Chief Finance Officer Jackie Bell - Deputy Head of Commissioning Sue Mackie Lead Nurse for Quality & Safety Dr Barry Silvert (other board leads available to answer questions) The purpose of the attached report is to indicate performance against all the key delivery priorities (quality, activity & finance) for the CCG in 2014/15 against which NHS Bolton Clinical Commissioning Group is nationally measured Members are requested to : Note the formal month end position for November 2014/Month 9 (unless stated otherwise) in respect of performance against key delivery priority targets COMMITTEES/GROUPS PREVIOUSLY CONSULTED: VIEW OF THE PATIENTS, CARERS OR THE PUBLIC, AND THE EXTENT OF THEIR INVOLVEMENT: Performance is reported to: CCG Clinical Executive Contract Performance Group Quality and Safety Committee Patients views are not specifically sought as part of this monthly report, but it is recognised that many of these targets such as waiting times are a priority for patients. The report does include performance against the Friends and Family Test at Bolton FT 1

2 1. Executive Summary CCG Corporate Performance Report 1.1. This report highlights NHS Bolton Clinical Commissioning Group s performance against all the key delivery priorities (quality, activity & finance) for the month of December 2014 (Month 9) Appendix 1 contains the detailed reports for each set of performance indicators the CCG is measured against: - Bolton CCG Objectives - NHS Constitution - Outcome & Quality Framework - Finance & Contract Performance - Quality Premium - Quality Indicators - Workforce/HR Performance 1.3. A Community Services Dashboard is in development Section 2 of this report exception reports against all indicators where the CCG is not achieving its targets. 2. Exception Reporting 2.1. Quality & Safety Board Lead, Dr Colin Mercer Friends & Family Test Bolton FT Although Bolton FT are meeting their targets for A&E response rates for the FFT (20.8%), their performance against the Net Promoter Score (NPS) for A&E remains below target at 52%. Detail was presented regarding this in the December Board report along with the changes to the FFT reporting. The actions are continuing to be implemented and the CCG are becoming an active member of the FT s Patient Inclusion and Experience Group Mixed Sex Accommodation (MSA) There was 1 MSA breach in December and the FT has presented feedback regarding this. The patient was on High Dependency Unit (HDU), all Standard Operating Procedures were followed and the incident was escalated to the Chief Operating Officer. Unfortunately a lack of appropriate bed availability restricted the move and the patient breeched for approx 34 minutes. The learning from the incidents has been shared with the HDU team. Bolton FT have acknowledged that while it may be clinically acceptable for HDU to be a mixed environment, once the patient is well enough for 2

3 step down they must be moved to an appropriate single sex area within a specified time or be counted as a breach Serious Incidents There was 1 new serious incident in December. A patient had a fall and sustained a fractured neck of femur and subsequently passed away. This incident is currently being investigated by the FT Workforce Sickness absence increased again in December to 5.39%. Both long term and short term related sickness has increased. There has been an increase in Colds, Flu, Respiratory and Gastro related illnesses reflecting the surge in short term sickness. The FTs challenge is to ensure that sickness absence does not increase to the same levels as last year during the winter months and initiatives are in place to support this. 169 managers and team leaders have now been trained to proactively operate the new attendance management policy which will provide a more consistent application across the Trust Mandatory training Work is continuing on an upward trend and is at 88.4%. The new e- learning system, Moodle, is now operational and should contribute to a steadily improving position. Since the introduction of Moodle in September, over 6000 courses have been completed by staff. This target is being monitored closely as it has failed for 9 consecutive months Appraisal rates BFT have only met the target threshold on two occasions this financial year, falling just short of the target at 79.7% in December. Teams have been focussing on those individuals who, according to the system, do not appear to have had an appraisal for the longest time rather than simply concentrating on the 80% target. Divisions are challenged on all the workforce metrics during their respective performance management meetings. Divisions are taking the target seriously and are going through lists of staff that have not had an appraisal to ensure this is addressed. Bolton FT have recently implemented a new pay progression policy and 3

4 they anticipate that both appraisal and mandatory training rates will significantly improve over coming months. This new policy means that staff need to be fully up to date with their mandatory training, they must have had a satisfactory appraisal, along with no formal procedures in operation such as discipline or capability, in order to receive their annual incremental pay rise Surgical WHO Checklist Compliance (Elective & Emergency) Elective theatres saw a reduction in compliance in December achieving 96%, a reduction in 3% from last month. Team managers have been required to develop action plans to ensure all processes are robust. Emergency theatres achieved 100% compliance. All areas will continue to be monitored monthly and share best practice Falls The number of patients who have received a fall risk assessment is 94.7%, which is just below the target of 95%. The number of falls per 1,000 bed days is continuing to rise and there have been 2 fatal falls in the current financial year. Bev Tabernacle (Acting DoN) has been asked to attend the Quality and Safety committee to provide assurance in relation to falls and the FT s plans in relation to falls prevention Commissioning Board Lead, Dr Barry Silvert Reduce Emergency Admissions The CCG has set a target of reducing emergency admissions by the end of 2014/15. The year to date number of emergency admissions is 25,974. Compared to the recorded 2013/14 outturn, this represents an increase of 5.7% above plan. However, activity which was previously counted under the Bolton Community Unit (BCU) is included in the 2013/14 baseline so analysis is underway to understand and confirm the implications of this Reduce Emergency Readmissions The CCG has set a target of reducing emergency readmissions to 3,634 by the end of 2014/15 (from a baseline of 4, /14 outturn). The year to date number of emergency readmissions is 4,521. This issue is being picked up through the contracting governance process NHS Constitution Bolton FT had one over 52 week waiter in December. This was a dermatology patient who had been removed from the waiting list due to administrative error. The patient was treated in February and an audit of the waiting list has shown that there are no other cases. 4

5 The A&E target was failed in December with performance of 86.3% (against a target of 95%). The significant decrease in performance is due to the sustained emergency pressures across Greater Manchester. The 31 day cancer target for subsequent treatment of radiotherapy was failed in December due to 1 patient breach, the patient was seen at 33 days at the Christie, the delay was due to a requirement for a rescan after an injury. NWAS failed both Category A targets in December with performance of 59.0% for Emergency Response arriving within 8 minutes (Red 1) and 58.8% within 8 minutes (Red 2) - against a target of 75% for both. This is the eighth month in a row in which both targets have failed and is also due to the sustained urgent care pressures across Greater Manchester. December performance for Category A (Red 1 &2) calls resulting in an ambulance arriving at the scene within 19 minutes was 87.7% (against a target of 95%) Contractual Performance There were 279 patient handovers (from ambulances to A&E) over 30 minutes and 197 over 60 minutes in December (against a target of 0 for both). This is an ongoing performance concern which is being monitored by a Remedial Action Plan (RAP) which was brought to the January Board meeting. An update will be included in this report next month. The CCG did not achieve the 50% target for Improving Access to Psychological Services (IAPT) Recovery Rate with performance of 39.9% in and the access rate was not achieved with performance in December of 12.3%. Performance against this metric has improved in January and is being closely monitored as the full year s performance is measured through achievement in Quarter 4. Bolton FT failed the TIA target with 57.1% of cases investigated and treated within 24 hours (against a target of 60%).The Remedial Action Plan is being closely monitored through the Quality and Performance Group and the Contract Review Board Finance Board Lead, Annette Walker Contract Performance (month 10) The CCG is planning to deliver the control total of 3.5m but with some risk due to pressures on Acute contracts. In addition the CCG has been asked to increase the target surplus to 4.4m to reflect the return of CHC funding for restitution cases required for future years. Overall expenditure trends are 1% above plan for NHS contracts, however, Independent Sector Contracts are currently 14% above plan. 5

6 The contract with Bolton NHS Foundation Trust is overall forecasting over performance but the CCG are reviewing and challenging a number of areas. Expenditure on non contracted activity is 9% above plan at month 10 and it is expected to be 9% above plan by the end of the year. AQP expenditure is 2% above plan at month The overall position on contract performance at the end of December is 2,058k over plan. All NHS Acute contracts are over performing apart from Central Manchester and WWL. BMI Beaumont is predominantly the main cause of overspend on the Independent Sector contracts To mitigate the risk of continued over performance an urgent review of contract performance has taken place and has resulted in an action plan being implemented to challenge specific areas of performance with providers. Contract Validation continues on the AQP contracts to ensure pathway payments are adhered to and to provide assurance there is no duplication and more detailed reports have been requested from NW CSU Full details by provider and point of delivery can be found in the data pack at appendix QIPP QIPP is currently behind target with YTD delivery of 66% as at month 9, and as a result reserves are being used to ensure that the required surplus is met. Mitigation plans are in place to ensure that additional schemes are implemented to ensure full delivery of QIPP by the end of the financial year Quality Premium 2014/ The total quality premium available to the CCG for 2014/15 was 1,399, As we are unlikely to achieve the reducing avoidable admissions target this accounts for 25% of the Quality Premium target this reduces our potential achievement to 1,049, As the A&E and ambulance response constitution targets will not be achieved and for each of those there is a further 25% reduction in the potential Quality Premium target, therefore the maximum we are projecting to achieve from the total available is 524,811. 6

7 2.5. CCG Workforce/HR Board Lead, Su Long The sickness absence rate for November for the CCG is still higher than the HSCIC target North West CCG Comparators are awaited to see if this is reflected in all organisations. Managers have been made aware and have been asked to ensure reasons for sickness absence are correctly recorded so themes can be identified and to ensure return to work interviews are undertaken to support staff. 3. Recommendations 3.1. The Board is asked to note the performance in September and the actions being taken the current position with regard to the quality premium payment against 2013/14 performance Fiona Moore Assistant Chief Officer 16 th January

8 Index 2 Corporate Objectives 3-4 NHS Constitution Deliverables 5-7 Performance Report 8 CCG Health Outcome Indicators 9-10 Finance Dashboard Key Contract Performance All Providers 15 Key Contract Performance Bolton FT 16 Quality Premium Quality 20 Workforce/HR

9 BOLTON CCG CORPORATE REPORT Objective Key Measures of Success (Goals) From (2011/12) To 2015 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 YTD 14/15 Forecast 2013/14 for Emergency admissions) Forecast Comments Year End position Improve Health Outcomes For Male 1.8 Female 1.6 Reduce the gap in life expectancy between Bolton and England 1.85 years 2.05 years (2010) (2015) For Male 13.5 Female 11.3 Reduce the gap in life expectancy m13.5 between the most and least deprived areas in Bolton 1 f11.5 m13 f11 Improve quality of care and patient experience of care Achievement of all key targets / NHS Constitution Several failing All achieved Running total Number of failing targets out of 22 See NHS Constitution report Bolton patients and carers would recommend health services Net agree +41% Net agree 50% NB Data no longer comparative as measure description has changed; Friends and Family for A&E and Inpatients. Required to show improvement from Q1 - score of 74 Best Value: All emergency admissions to all providers. Reduce emergency admissions 32,763 31,878 2,662 2,870 2,753 2,880 2,878 2,633 2,870 2,845 3,021 2,773 2,975 2,537 2,827 3,042 2,892 3,062 25,974 34, % Data source - MAR Including BCU data 35,145 33,915 2,902 3,067 2,927 3,036 2,955 2,633 2,870 2,845 3,021 2,773 2,975 2,537 2,827 3,042 2,892 3,062 25,974 34, % BCU activity has been added into the 13/14 baseline to allow like for like comparison Data source - MAR Shift care closer to home Reduce elective & non elective length of stay (Ave LOS) El 3.3 (baseline - strategic plan) NE 4.9 (baseline - strategic plan) El EL 4.17 NE NE 4.8 Admissions to all providers.14/15 Forecast of 3.15 (5 year strategic plan based on NHS Comparators )Revised figure using scale of change 4.17 LOS over 90 days is trimmed to 90 days. Data source: SUS 14/15 forecast 4.8 (5 year strategic plan) Reduce emergency readmissions 2 4,412 3, ,521 6,028 Emergency readmissions within 30 days of previous discharge, as per the PbR definition. Data source: SUS. Taking in to account the number of discharges, the readmission rate increased from 7.6% in 2011/12 to 7.8% in 2012/13 the current YTD for 14/15 is 9.5% Readmissions as % of discharges No Baseline No Target 8.8% 7.8% 8.7% 9.0% 9.1% 8.8% 9.3% 9.9% 9.9% 10.0% 8.6% 9.4% 9.1% 9.2% 9.5% 8.9% 9.4% 8.8% 2 PbR definition for readmissions:- -Excludes spells with a primary diagnosis of cancer - Excludes spells with an obstetrics HRG - Excludes patients aged under 4 - Excludes patients who self discharged from the initial admission - Excludes spells which do not have a

10 NHS Constitution Indicators - December Indicator Target Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 YTD Forecast Achieve/Fail Exceptions Trend (Apr13-Dec14) Referral to Treatment waiting times for non urgent consultant led treatment - All Providers Admitted patients to start treatment within a maximum of 18 weeks from referral 90% 94.0% 96.1% 95.6% 94.9% 93.6% 93.7% 94.4% 94.0% 94.1% 94.5% A Aggregated target achieved, specialties failed for all providers are Orthopaedics (88.9%), Cardiology (71.4%) and Thoracic (87.5%). Bolton FT failed Orthopaedics (82.8%) and Other Specs (89.5%) for December Other breaches for December are Gen Surgery at Salford (80%);Urology at Salford (80%); Orthopaedics at Salford (68.2%) and South Manchester (50%); Plastics at South Manchester (87.5%) and Cardiology at South Manchester (33.3%); Non-admitted patients to start treatment within a maximum of 18 weeks from referral 95% 97.3% 97.7% 97.0% 97.1% 96.1% 96.5% 96.4% 96.0% 96.4% 96.7% A Aggregated target achieved, specialties failed for all providers are Orthopaedics (91.1%), Plastics (92.7%) and Dermatology (92%). Bolton FT failed Orthopaedics (89.7%), Plastics (91.9%) and Dermatology (93.5%) for December Other breaches for December are Gen Surgery at East Lancs (66.7%);Urology at Salford (83%) and WWL (80%); Orthopaedics at Lancs Teaching (83.3%), Pennine (66.7%) and Salford (66.7%); Ophthalmology at East Lancs (50%) and Lancs Teaching (80%); Cardiology at Salford (83.3%); Dermatology at Salford (78.4%); Thoracic at South Manchester (71.4%); Rheumatology at Pennine (75%); Gynaecology at Central Man (85.7%) and Other Specs at Central Man (86.4%) Patients on incomplete non emergency pathways (yet to start treatment) 92% 95.9% 96.3% 96.0% 94.8% 95.1% 96.3% 95.6% 95.3% 95.3% 95.6% A Aggregated target achieved, specialty failed for all providers is Plastics (91.7%). Bolton FT failed Gynaecology (91.7%) for December. Other breaches in month are Gen Surgery at Lancs Teaching (88.9%) and WWL (83.3%); Urology at Central Man (71.4%), Lancs Teaching (50%) and Salford (81%); Orthopaedics at Lancs Teaching (90%), RN Orthopaedic Hospital (66.7%) and Salford (89.9%); ENT at Central Man (84%) and Lancs Teaching (81%); Ophthalmology at Central Man (87%); Plastics at Lancs (62.5%) and St Helens (75%); Gastro at Pennine (72.7%); Cardiology at Blackpool (50%), Lancs Teaching (77.8%) and South Manchester (87%); Dermatology at Mid Yorkshire (40%); Gynaecology at Central Man (91.1%) and Other Specs at Central Man (86.1%) Number of patients waiting more than 52 weeks - (Bolton FT only) F Dermatology patient Number of patients who are not offered another binding date within 28 days Bolton FT Number of patients who are not offered another binding date within 28 days F Diagnostic test waiting times All providers Patients waiting for a diagnostic test should have been waiting less than 6 weeks from referral 1% 0.7% 1.1% 1.1% 0.8% 1.6% 1.01% 1.03% 0.96% 0.94% 1.02% A A & E waits - Bolton FT Patients should be admitted, transferred or discharged within 4 hours of their arrival at an A&E department - Bolton FT 95% 93.6% 97.3% 95.7% 95.4% 96.5% 94.98% 92.60% 90.30% 86.30% 93.60% A 1,216 over 4 hours (breached by 771) Cancer patients - 2 week wait -All Providers Maximum two-week wait for first outpatient appointment for patients referred urgently with suspected cancer by a GP 93% 97.4% 97.5% 97.1% 98.0% 95.9% 97.4% 98.2% 97.0% 98.3% 97.5% A Maximum two week wait for first out patient appointment for patients referred urgently with breast symptoms (where cancer was not initially suspected) 93% 97.8% 94.7% 97.1% 98.4% 95.1% 98.2% 95.0% 98.1% 96.0% 96.8% A

11 NHS Constitution Indicators - December Indicator Target Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 YTD Forecast Achieve/Fail Exceptions Trend (Apr13-Dec14) Cancer patients - 31 day wait -All Providers Maximum one month (31 day) wait from diagnosis to first definitive treatment for all cancers 96% 98.9% 95.7% 99.0% 98.1% 97.8% 96.4% 98.0% 99.1% 96.2% 97.6% A Maximum 31 day wait for subsequent treatment where that treatment is surgery 94% 100.0% 92.9% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 99.2% A Maximum 31 day wait for subsequent treatment where the treatment is an anti-cancer drug regimen 98% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% A Maximum 31 day wait for subsequent treatment where the treatment is a course of radiotherapy 94% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 90.0% 99.3% A 1 breach out of 10 Cancer waits - 62 days - All Providers Maximum two month (62 day) wait from urgent GP referral to first definitive treatment for cancer 85% 94.3% 93.1% 82.0% 89.8% 90.6% 85.1% 84.8% 90.9% 94.2% 89.5% A Maximum 62 day wait from referral from an NHS screening service to first definitive treatment for all cancers 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 90.0% 87.5% 100.0% 97.1% A Maximum 62 day wait for first definitive treatment following a consultants decision to upgrade the priority of the patients (all cancers) Category A ambulance calls NWAS Category A calls resulting in an emergency response arriving within 8 minutes (Red 1) 85% 66.7% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 96.3% A 75% 75.70% 73.40% 71.50% 68.50% 72.70% 71.50% 71.20% 68.00% 59.00% 69.90% F At the present time, the level of demand is outpacing the resource available to NWAS, despite additional resource having been brought in from the private and voluntary sectors. Category A calls resulting in an emergency response arriving within 8 minutes (Red 2) 75% 75.30% 74.70% 73.20% 69.20% 72.10% 73.30% 73.70% 69.60% 58.80% 70.80% F Category A calls resulting in an ambulance arriving at the scene within 19 minutes 95% 96.20% 95.60% 95.40% 94.20% 95.30% 95.10% 93.60% 93.10% 87.70% 93.80% A Mixed sex accommodation breaches - Bolton FT Zero tolerance MSA breaches F 1 Salford CCG patient Mental Health - GMW Care Programme Approach (CPA): The proportion of people under adult mental illness specialties on CPA -Completed 95% 98.40% 96.80% 98.40% 96.90% 96.60% 95.90% 95.70% 96.10% 97.30% 97.00% A Care Programme Approach (CPA): The proportion of people under adult mental illness specialties on CPA - 7 day follow up 95% 98.80% 98.50% % 98.70% 94.30% 97.30% 98.10% 97.60% 98.00% 98.00% A

12 NHS Bolton Key Contract Performance Dashboard - December Commissioner Performance Dashboard Indicator Target Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 YTD Forecast Achieve/Fail Exceptions Trend (Apr13-Dec14) Referral to Treatment waiting times for non urgent consultant led treatment - All Providers Admitted patients to start treatment within a maximum of 18 weeks from referral 90% 93.6% 94.0% 96.1% 95.6% 94.9% 93.6% 93.7% 94.4% 94.0% 94.1% 94.5% A Aggregated target achieved, specialties failed for all providers are Orthopaedics (88.9%), Cardiology (71.4%) and Thoracic (87.5%). Bolton FT failed Orthopaedics (82.8%) and Other Specs (89.5%) for December Other breaches for December are Gen Surgery at Salford (80%);Urology at Salford (80%); Orthopaedics at Salford (68.2%) and South Manchester (50%); Plastics at South Manchester (87.5%) and Cardiology at South Manchester (33.3%); Non-admitted patients to start treatment within a maximum of 18 weeks from referral 95% 97.3% 97.3% 97.7% 97.0% 97.1% 96.1% 96.5% 96.4% 96.0% 96.4% 96.7% A Aggregated target achieved, specialties failed for all providers are Orthopaedics (91.1%), Plastics (92.7%) and Dermatology (92%). Bolton FT failed Orthopaedics (89.7%), Plastics (91.9%) and Dermatology (93.5%) for December Other breaches for December are Gen Surgery at East Lancs (66.7%);Urology at Salford (83%) and WWL (80%); Orthopaedics at Lancs Teaching (83.3%), Pennine (66.7%) and Salford (66.7%); Ophthalmology at East Lancs (50%) and Lancs Teaching (80%); Cardiology at Salford (83.3%); Dermatology at Salford (78.4%); Thoracic at South Manchester (71.4%); Rheumatology at Pennine (75%); Gynaecology at Central Man (85.7%) and Other Specs at Central Man (86.4%) Patients on incomplete non emergency pathways (yet to start treatment) 92% 96.0% 95.9% 96.3% 96.0% 94.8% 95.1% 96.3% 95.6% 95.3% 95.3% 95.6% A Aggregated target achieved, specialty failed for all providers is Plastics (91.7%). Bolton FT failed Gynaecology (91.7%) for December. Other breaches in month are Gen Surgery at Lancs Teaching (88.9%) and WWL (83.3%); Urology at Central Man (71.4%), Lancs Teaching (50%) and Salford (81%); Orthopaedics at Lancs Teaching (90%), RN Orthopaedic Hospital (66.7%) and Salford (89.9%); ENT at Central Man (84%) and Lancs Teaching (81%); Ophthalmology at Central Man (87%); Plastics at Lancs (62.5%) and St Helens (75%); Gastro at Pennine (72.7%); Cardiology at Blackpool (50%), Lancs Teaching (77.8%) and South Manchester (87%); Dermatology at Mid Yorkshire (40%); Gynaecology at Central Man (91.1%) and Other Specs at Central Man (86.1%) Number of patients waiting more than 52 weeks - (Bolton FT only) F Dermatology patient Number of patients who are not offered another binding date within 28 days Bolton FT Number of patients who are not offered another binding date within 28 days F Diagnostic test waiting times All providers Patients waiting for a diagnostic test should have been waiting less than 6 weeks from referral 1% 0.4% 0.7% 1.1% 1.1% 0.8% 1.6% 1.01% 1.03% 0.96% 0.94% 1.02% A A & E waits - Bolton FT 1,216 over 4 hours (breached by 771) Patients should be admitted, transferred or discharged within 4 hours of their arrival at an A&E department - Bolton FT 95% 95.3% 93.6% 97.3% 95.7% 95.4% 96.5% 94.98% 92.60% 90.30% 86.30% 93.6% A Cancer patients - 2 week wait -All Providers Maximum two-week wait for first outpatient appointment for patients referred urgently with suspected cancer by a GP 93% 97.1% 97.4% 97.5% 97.1% 98.0% 95.9% 97.4% 98.2% 97.0% 98.3% 97.5% A Maximum two week wait for first out patient appointment for patients referred urgently with breast symptoms (where cancer was not initially suspected) 93% 95.7% 97.8% 94.7% 97.1% 98.4% 95.1% 98.2% 95.0% 98.1% 96.0% 96.8% A

13 NHS Bolton Key Contract Performance Dashboard - December Indicator Target Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 YTD Forecast Achieve/Fail Exceptions Trend (Apr13-Dec14) Cancer patients - 31 day wait -All Providers Maximum one month (31 day) wait from diagnosis to first definitive treatment for all cancers 96% 98.1% 98.9% 95.7% 99.0% 98.1% 97.8% 96.4% 98.0% 99.1% 96.2% 97.6% A Maximum 31 day wait for subsequent treatment where that treatment is surgery 94% 95.5% 100.0% 92.9% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 99.2% A Maximum 31 day wait for subsequent treatment where the treatment is an anti-cancer drug regimen 98% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% A Maximum 31 day wait for subsequent treatment where the treatment is a course of radiotherapy 94% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 90.0% 99.3% A 1 breach out of 10 Cancer waits - 62 days - All Providers Maximum two month (62 day) wait from urgent GP referral to first definitive treatment for cancer 85% 86.7% 94.3% 93.1% 82.0% 89.8% 90.6% 85.1% 84.8% 90.9% 94.2% 89.5% A Maximum 62 day wait from referral from an NHS screening service to first definitive treatment for all cancers 91.7% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 90.0% 87.5% 100.0% 97.1% A Maximum 62 day wait for first definitive treatment following a consultants decision to upgrade the priority of the patients (all cancers) Category A ambulance calls NWAS 85% 100.0% 66.7% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 96.3% A Category A calls resulting in an emergency response arriving within 8 minutes (Red 1) 75% 75.30% 75.70% 73.40% 71.50% 68.50% 72.70% 71.50% 71.20% 68.00% 59.00% 69.90% F At the present time, the level of demand is outpacing the resource available to NWAS, despite additional resource having been brought in from the private and voluntary sectors. Category A calls resulting in an emergency response arriving within 8 minutes (Red 2) 75% 75.40% 75.30% 74.70% 73.20% 69.20% 72.10% 73.30% 73.70% 69.60% 58.80% 70.80% F Category A calls resulting in an ambulance arriving at the scene within 19 minutes 95% 96.30% 96.20% 95.60% 95.40% 94.20% 95.30% 95.10% 93.60% 93.10% 87.70% 93.80% A All handovers between ambulance and A&E must take place within 15 minutes (no of patients waiting >30 mins<59 mins) Bolton FT Not Available F All handovers between ambulance and A&E must take place within 15 minutes (no of patients waiting >60 mins) Bolton FT Not Available F Report failed for August Mixed sex accommodation breaches - Bolton FT Zero tolerance MSA breaches F 1 Salford CCG patient Mental Health - GMW Care Programme Approach (CPA): The proportion of people under adult mental illness specialties on CPA -Completed 95% 99.00% 98.40% 96.80% 98.40% 96.90% 96.60% 95.90% 95.70% 96.10% 97.30% 97.00% A Care Programme Approach (CPA): The proportion of people under adult mental illness specialties on CPA - 7 day follow up 95% 97.60% 98.80% 98.50% % 98.70% 94.30% 97.30% 98.10% 97.60% 98.00% 98.00% A IAPT Recovery rate - (GMW, 1 point and Think Positive) 50% 51.00% 45.40% 50.96% 47.35% 46.95% 45.80% 47.08% 45.82% 44.84% 39.93% 45.94% A IAPT Access rate - (GMW, 1 point and Think Positive) 15.0% 12.40% 12.70% 12.10% 13.70% 14.40% 13.10% 17.40% 16.10% 16.30% 12.30% 14.50% A For December GMW is at 41.46%, Think Positive at 44.6% and 1 point at 34.9% (Pre validated figs show an increase to 47% for January) The number of patients entering therapy reduced in December, this is due to increase in January however to achieve the 15% target Providers need to maintain the increase for Feb and Mar Number of ongoing waiters >18 weeks A

14 NHS Bolton Key Contract Performance Dashboard - December Indicator Target Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 YTD Forecast Achieve/Fail Exceptions Trend (Apr13-Dec14) HCAI-Healthcare Associated Infections target MRSA-Post 48 hrs (Hospital) A CDIFF-Post 72 hrs (Hospital) A Friends and family A&E Score F A&E Response Rate 15% 8.2% 16.1% 18.7% 15.5% 19.3% 17.8% 17.9% 14.9% 20.2% 20.8% 17.8% A Inpatient Score A Inpatient Response Rate 15% 33.4% 36.8% 41.9% 43.8% 41.3% 37.0% 42.6% 35.2% 39.0% 28.6% 38.5% A Combined Score F 15% 13.9% 20.3% 23.4% 21.1% 23.8% 21.5% 22.8% 18.8% 24.0% 22.4% 22.0% A Combined Response Rate Never events Never events F Stroke - Bolton FT % Stroke admissions spending 90% of time on stroke unit 80% 91.4% 86.8% 87.5% 85.7% 64.8% 88.1% 79.2% 83.7% 81.6% 84.8% 82.50% A Stroke patients arriving in a designated stroke bed within 4 hours 80% 83.3% 80.0% 78.9% 75.0% 57.5% 70.4% 70.0% 82.8% 73.1% 87.5% 75.00% A Transient Ischaemic Attack (TIA) cases with a higher risk of stroke treated within 24 hours 60% 75.0% 62.5% 33.0% 57.1% 71.0% 62.5% 61.5% 21.1% 50.0% 57.1% 52.9% A 4 patients out of 7 (3 breached)

15 OUTCOME AND QUALITY INDICATORS Domain 1 - Preventing people from dying prematurely This domain captures how successful the NHS is in reducing the number of avoidable deaths /15 Target Potential years of life lost (PYLL) from causes considered amenable - healthcare CCG (Direct Standard Rate) GP registered population from NHAIS (Exeter), the Primary Care Mortality Database (PCMD) and Latest data released Sept 14 - next due Sept 15, a revised methodology was introduced in Sept 14 therefore values have been revised ONS mid - year census based England population estimates Domain 2 - Enhancing quality of life for people with long-term conditions This domain captures how successfully the NHS is supporting people with long-term conditions to live as normal a life as possible. GP Patient Survey (GPPS) via HSCIC 2011/ / /14 Health related quality of life for people with long term conditions CCG Latest data for 13/14 released Nov 14 People feeling supported to manage their condition CCG Health-related quality of life for carers, aged 18 and above CCG Latest data for 13/14 released Nov Latest data for 13/14 released Nov 14 Domain 3 - Helping people to recover from episodes of ill health or following injury This domain captures how people recover from ill health or injury and wherever possible how it can be prevented. HES via HSCIC 2010/ / / /14 Emergency admissions for acute conditions that should not usually require hospital admission - CCG (refreshed) Latest data for 13/14 released Feb (provisional) Domain 4 - Ensuring that people have a positive experience of care This domain looks at the importance of providing a positive experience of care for patients, service users and carers. National Inpatient Survey Programme via HSCIC Patient experience of GP Services (released Nov 14) Patient experience of GP Out of Hours (released Nov 14) Patient experience of hospital care (Bolton FT) 2010/ / / / Next version due August Next version due August Next version due May 15 Responsiveness to inpatients' personal needs (Bolton FT) Next version due May 15 Domain 5 - Treating and caring for people in a safe environment and protecting them from avoidable harm This domain explores patient safety and its importance in terms of quality of care to deliver better health outcomes. Indicator in development 2010/ / / /14 *Patient safety incidents (rate per 100 admissions) (Bolton FT) HSCIC November 14 *The Number resulting in severe harm or death HSCIC November 14 * 6 monthly reporting (October to March)

16 Finance Dashboard /15 Month 10 All statutory duties are being achieved. Statutory Duties The CCG is planning to deliver the control total of 3.5m but with some risk due to pressures on Acute contracts. In addition the CCG has been asked to increase the target surplus to 4.4m to reflect the return of CHC funding for restitution cases required for future years. The CCG is operating within its approved maximum cash draw down (MCD) of 358.8m. The running costs target is 7.0m and at month 10 the forecast outturn shows an underspend of 0.5m. The CCG is achieving the Better Payments Practice Code and at month 10 had paid 95.8% of invoices, by volume, within 30 days and 98.6% by value. Indicator Summary Financial Performance All of the indicators used to measure financial performance of the CCG are on track. The CCG has a total allocation of 359.4m, following an increase of 1.3m for supporting innovative practices, demonstrator bids and GM risk share. The underlying recurrent surplus is 1.28% and non recurrent funds are being managed within processes. The year to date surplus in line with plan, however the forecast outturn surplus is 4.4m. QIPP is currently behind target with YTD delivery of 47% as at Indicator Summary Green Amber Red month 10, and as a result reserves are being used to ensure Green Amber Red that the required surplus is met. Mitigation plans are in place to ensure that additional schemes are implemented but the CCG will need to use its contingency to deliver a balanced position at the end of the financial year. Financial Governance Contract Performance The CCG Finance team had 12 Internal Audit Recommendations at the start of the year. At month 10, 10 of these have been completed, revised completion dates have been agreed for 2 remaining low risk recommendations and are on target. The cash drawn down is 81.3% of the MCD and the bank balance is within the tolerance limit. At month 10 the CCG had mitigations in place for all potential risks, but the forecast position is tight. Indicator Summary Overall expenditure trends are 1% above plan for NHS contracts, however, Independent Sector Contracts are currently 14% above plan. The contract with Bolton NHS Foundation Trust is overall forecasting over performance but the CCG are reviewing and challenging a number of areas. Expenditure on non contracted activity is 9% above plan at month 10 and it is expected to be 9% above plan by the end of the year. Indicator Summary AQP expenditure is 2% above plan at month 10. Green Amber Red Green Amber Red

17 Finance Dashboard /15 Month 10 Statutory Duties RAG Rating RAG Rating Threshold No Indicator Plan/ Target Month 1 Month 2 Month 3 Month 4 Month 5 Month 6 Month 7 Month 8 Month 9 Month 10 Month 11 Month 12 Green Amber Red Positive variance to plan or negative variance <= 1 Revenue - delivery of CCG's planned surplus 3.535m 3.535m 3.535m 3.535m 3.535m 3.535m 3.535m 3.535m 3.535m 4,364m 0.1% 0.1% > variance <0.5% (negative variance) Negative variance => 0.5% Cash - Operate within its approved cash maximum drawdown 2 limit in each and every year m 349.5m 349.5m 349.5m 350.9m 350.2m 353.3m 353.3m 353.3m 358.8m <100% N/A >100% Better Payments Practice Code - to pay 95% of invoices N/A 3 by volume within 30 days >95% 97.70% 96.80% 96.43% 96.70% 96.20% 96.16% 95.98% 95.75% 95.8% >95% <95% Better Payments Practice Code - to pay 95% of invoices N/A 4 by value within 30 days >95% 99.60% 99.60% 99.41% 99.50% 99.30% 99.33% 98.97% 98.88% 98.6% >95% <95% Running Costs - Not to exceed the Running Cost 5 Allowance 7.029m 7.029m 6.992m 6.973m 6.673m 6.673m 6.656m 6.568m 6.541m 6.535m <= RCA N/A > RCA Financial Performance (including QIPP) RAG Rating RAG Rating Threshold No Indicator Plan/ Target Month 1 Month 2 Month 3 Month 4 Month 5 Month 6 Month 7 Month 8 Month 9 Month 10 Month 11 Month 12 Green Amber Red Underlying recurrent surplus on exit of 2014/15 1 (monitored quarterly) >=2.5% N/A 2.77% N/A N/A 2.75% N/A N/A N/A 1.28% >=2.5% % <0% 2 Management of 2.5% NR Funds within agreed processes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes N/A No >= 95% >= 95% of plan >=75% of plan and < 95% of plan < 75% of plan 3 QIPP - year to date delivery of plan 33% 27% 100% 100% 100% 100% 100% 100% 100% 4 QIPP - full year forecast 4.7m 4.7m 4.7m 4.7m 4.7m 4.7m 4.7m 4.7m 4.7m 4.7m 5 YTD surplus/(deficit) 6 FOT surplus/(deficit) 7 Movement in FOT surplus/(deficit) 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% +ve / -ve <=0.01% 0% 0% 0% 0% 0% 0% 0% 0% 0% 8 Full year run rate difference 1% 3.29% TBC TBC TBC TBC TBC TBC TBC >= 95% of plan >=75% of plan and < 95% of plan < 75% of plan Positive variance to plan or negative variance <= 0.1% 0.1% > variance <0.5% (negative variance) Negative variance => 0.5% Positive variance to plan or negative variance <= 0.1% 1 Negative variance => 0.5% Positive movement from previous month or negative movement <= 0.1% Negative movement => 0.5% Difference < 1% (positive or negative) 1% > = difference (positive or negative) < 5% Difference (positive or negative) => 5% Financial Governance RAG Rating RAG Rating Threshold No Indicator Plan/ Target Month 1 Month 2 Month 3 Month 4 Month 5 Month 6 Month 7 Month 8 Month 9 Month 10 Month 11 Month 12 Green Amber Red Number of Internal Audit Recommendations that are 1 due - completed 100% 72% 55% 42% 50% 100% 100% 100% 100% 100% 100% 33% - 99% <33% 2 Bank balance within target 9% 0% 0 3.3% 5.7% 2.1% 0% 4.8% 2.2% <=5% 5.1% - 10% >10% 3 Clear identification of risks against financial delivery and mitigations Net risk = Mitigations equal to or greater than risks Risks not fully mitigated and the CCG would be in Risks not fully mitigated but no impact on surplus deficit Contract Performance RAG Rating RAG Rating Threshold No Indicator Month 1 Month 2 Month 3 Month 4 Month 5 Month 6 Month 7 Month 8 Month 9 Month 10 Month 11 Month 12 Green Amber Red 1 All NHS Contracts - Expenditure Trends - year to date <101% of plan 99% 100% 101% 101% 101% 101% 101% 101% <101% of plan <103% of plan >=103% of plan 2 All NHS Contracts - Expenditure Trends - full year forecast <101% of plan 99% 100% 101% 100% 100% 100% 100% 101% <101% of plan <103% of plan >=103% of plan 3 All Independent Sector Contracts - Expenditure Trends - year to date <101% of plan 98% 106% 109% 107% 112% 114% 114% 114% <101% of plan <103% of plan >=103% of plan 4 All Independent Sector Contracts - Expenditure Trends - full year forecast <101% of plan 98% 106% 109% 107% 112% 114% 114% 114% <101% of plan <103% of plan >=103% of plan 5 Bolton FT - Expenditure Trends - year to date <101% of plan 99% 100% 101% 100% 100% 101% 100% 101% <101% of plan <103% of plan >=103% of plan 6 Bolton FT - Expenditure Trends - full year forecast <101% of plan 99% 100% 101% 100% 100% 100% 100% 101% <101% of plan <103% of plan >=103% of plan 7 NCA's - Expenditure - year to date <101% of plan 106% 102% 102% 98% 98% 100% 109% 109% <101% of plan <103% of plan >=103% of plan 8 NCA's - Expenditure- full year forecast <101% of plan 100% 102% 102% 100% 100% 105% 108% 109% <101% of plan <103% of plan >=103% of plan 7 AQP - Expenditure - year to date <101% of plan 144% 148% 120% 128% 127% 129% 117% 102% <101% of plan <103% of plan >=103% of plan 8 AQP - Expenditure- full year forecast <101% of plan 139% 148% 120% 128% 127% 129% 117% 102% <101% of plan <103% of plan >=103% of plan

18 Bolton CCG - Total Contract Summary Report - December 2014 Headline Summary The overall position on contract performance at the end of December is 2,058k over plan. All NHS Acute contracts are overperforming apart from Central Manchester and WWL. BMI Beaumont is predominantly the main cause of overspend on the Independent Sector contracts. HEALTHCARE PROVIDER Budget Value Contract Value Planned Actual Month 9 Position Variance Plan Actual Variance Planned Actual Month 9 Cumulative Position Variance Plan Actual Variance NHS Acute 160,000, ,644,487 34,439 45,393 10,955 14,014,423 14,486, , , ,175 76, ,272, ,653,743 1,381,626 Independent Sector 8,930,215 8,963,215 2,368 1,885 (483) 741, ,350 (28,197) 22,443 22, ,393,626 6,901, ,746 AQP 1,213,062 1,213, , ,294 53, ,797 1,099, ,791 Community Services 39,729,623 39,585,126 1,972,467 1,949,180 (23,286) 29,132,178 29,133,870 1,693 Mental Health 22,831,694 22,831,694 1,902,641 1,957,123 54,482 17,123,771 17,178,253 54,482 Ambulance 8,226,135 8,226, , ,894 (26,617) 6,169,601 6,106,829 (62,773) , ,110 79,759 76,648 (3,111) 717, ,409 (14,424) Grand Total 241,888, ,420,829 36,807 47,278 10,471 19,519,437 20,018, , , ,969 76, ,718, ,777,062 2,058,141 Risks / Actions RISKS: If the current contract performance continues at the same rate, the forecast outturn position will be a 2.7m overspend for 2014/15. ACTIONS: To mitigate the risk of continued overperformance an urgent review of contract performance has taken place and has resulted in an action plan being implemented to challenge specific areas of performance with providers. Contract Validation continues on the AQP contracts to ensure pathway payments are adhered to and to provide assurance there is no duplication and more detailed reports have been requested from NW CSU. KEY Underperformance - Overperformance - Worse Worse than last month than last month Positive variance (red font, no brackets) signify an over plan figure, No Change Underperformance - Better than last month Overperformance - Better than last month Negative variance (black font, in brackets) signify an under plan figure

19 Headline Summary Bolton CCG - Total Healthcare Provider Report - December 2014 Contract Performance in December across all providers was 499k above plan, of which 320k was attributable to the Bolton FT Acute Contract. Cumulative performance as at the end of December 2014 was 2,058k above plan. Detailed work continues each month across all providers to understand the areas of over performance and to identify where contract challenges can be made. Budget Value Contract Value Planned Actual Planned Actual NHS PROVIDERS Variance Plan Actual Variance Variance Plan Actual Variance BOLTON FT 135,838, ,538,566 29,269 39,641 10,372 12,063,726 12,383, , , ,150 71, ,427, ,183, ,795 CENTRAL MANCHESTER 5,368,701 5,329,701 1,107 1, , ,448 (7,922) 9,862 11,332 1,470 3,979,996 3,925,485 (54,511) EAST LANCASHIRE 557, , ,279 41,595 (2,684) 2,296 2, , ,592 70,807 LANCASHIRE TEACHING 1,631,072 1,674, (43) 136, ,925 (10,937) 4,502 4, ,222,942 1,282,697 59,755 LIVERPOOL & BROADGREEN 117, , ,830 15,466 5, , ,039 62,881 PENNINE ACUTE 1,466,935 1,466, (17) 121, ,618 19,591 3,551 3, ,095,224 1,173,327 78,103 SALFORD ROYAL 7,506,848 7,476,848 1,400 1, , ,419 44,482 12,959 13, ,531,132 5,739, ,917 STOCKPORT 82,021 82, (1) 1,983 10,555 8, ,153 82,720 59,567 SOUTH MANCHESTER 1,991,857 1,991, , ,185 68,559 3,467 5,618 2,151 1,492,138 1,668, ,944 WWL 5,440,595 5,409,595 1,164 1, , ,150 27,366 10,524 11, ,996,327 3,961,694 (34,632) Grand Total 160,000, ,644,487 34,439 45,393 10,955 14,014,423 14,486, , , ,175 76, ,272, ,653,743 1,381,626 Budget Value Contract Value INDEPENDENT SECTOR PROVIDERS Planned Actual Variance Plan Actual Variance Planned Actual Variance Plan Actual Variance BMI BEAUMONT 4,883,338 4,883,338 1,230 1, , ,163 10,218 10,814 14,234 3,420 3,662,508 4,272, ,922 OAKLANDS 299, , ,327 32,309 7, , , ,440 EUXTON 140, , (4) 11,409 12,783 1, ,680 80,208 (22,472) CARE UK (85% plan) 2,852,149 2,852,149 1, (689) 233, ,752 (47,409) 10,614 7,348 (3,266) 1,818,151 1,668,917 (149,234) ALLIANCE MEDICAL 601, ,629 52,886 52,440 (446) 475, ,751 (36,221) MARIE STOPES 6,000 6, ,500 4,500 0 FRATERDRIVE 147, ,827 12,319 12, , ,181 (689) Grand Total 8,930,215 8,963,215 2,368 1,885 (483) 741, ,350 (28,197) 22,443 22, ,393,626 6,901, ,746 Budget Value Contract Value Planned Actual Planned Actual AQP PROVIDERS Variance Plan Actual Variance Variance Plan Actual Variance BOLTON FT 770, ,000 64,167 95,851 31, , ,887 (62,613) OTHER PROVIDERS 443, ,062 58,922 80,443 21, , , ,404 Grand Total 1,213,062 1,213, , ,294 53, ,797 1,099, ,791 Budget Value Contract Value Month 9 Position Month 9 Position Month 9 Position Month 9 Position Month 9 Cumulative Position Month 9 Cumulative Position Month 9 Cumulative Position Month 9 Cumulative Position Planned Actual Planned Actual COMMUNITY Variance Plan Actual Variance Variance Plan Actual Variance BOLTON FT 39,568,450 39,423,953 1,959,036 1,956,852 (2,184) 29,011,298 29,009,114 (2,184) BRIDGEWATER 95,346 95,346 7,946 7, ,510 71,510 0 SALFORD 65,827 65,827 5,485 (15,617) (21,102) 0 49,370 53,247 3,877 Grand Total 39,729,623 39,585, ,972,467 1,949,180 (23,286) ,132,178 29,133,870 1,693 Narrative RISKS / ACTIONS Bolton FTs December adjusted position was 320k above plan, the cumulative reported position was a 756k over performance after an adjustment for Critical Care of 503k based on challenge raised to the Trust. The Salford positon has deteriorated in December by 44k due to an increase in Elective and Daycase due to RTT waiting list 16 week additional activity. Funding for RTT has now been incorporated into budgets to reduce this overspend. Narrative RISKS / ACTIONS BMI overperformance trend has slowed down in December with only a 10k increase in month. Oakland position has an overspend of 106k against plan and Care UK has improved in month following a utilisation adjustment applied to the contract. Narrative RISKS / ACTIONS Information has been validated and assurance has now been provided on the Bolton FT AQP position from CSU BI. Narrative RISKS / ACTIONS The overspend on Salford relates to District Nurses but overall performance is capped which has been adjusted in month.

20 Bolton CCG - Total Healthcare Provider Report - December 2014 Month 9 Position Month 9 Cumulative Position MENTAL HEALTH Contract Value Planned Actual Variance Plan Actual Variance Planned Actual Variance Plan Actual Variance GMW 22,069,105 22,069,105 1,839,092 1,839, ,551,829 16,551, BOROUGHS 47,615 47,615 3,968 3, ,711 35,711 0 CALDERSTONES 576, ,457 48,038 48, , ,343 0 MANCHESTER MH 4,233 4, ,175 3,175 0 PENNINE CARE 71,616 71,616 5,968 5, ,712 53,712 0 LANCASHIRE CARE 62,668 62,668 5,222 59,704 54,482 47, ,483 54,482 Grand Total 22,831,694 22,831, ,902,641 1,957,123 54, ,123,771 17,178,253 54,482 Contract Value Contract Value Planned Actual Planned Actual AMBULANCE Variance Plan Actual Variance Variance Plan Actual Variance NWAS - PES 7,004,658 7,004, , ,526 (13,196) 5,253,494 5,230,249 (23,245) ARRIVA - CORE 1,148,831 1,148,831 95,736 82,310 (13,426) 861, ,919 (39,704) ARRIVA - OOHs 72,646 72,646 6,054 6, ,485 54, Grand Total 8,226,135 8,226, , ,894 (26,617) ,169,601 6,106,829 (62,773) Contract Value Contract Value Month 9 Position Month 9 Position Month 9 Cumulative Position Month 9 Cumulative Position Planned Actual Planned Actual 111 Variance Plan Actual Variance Variance Plan Actual Variance BARDOC 517, ,110 43,093 43,075 (18) 387, ,700 (133) NWAS 440, ,000 36,667 33,574 (3,093) 330, ,709 (14,291) Grand Total 957, , ,759 76,648 (3,111) , ,409 (14,424) Narrative RISKS / ACTIONS Mental Health Block Contracts are in place with a 250k risk share cap to manage the financial impact of MH PbR. The overspend on Lancashire Care relates to out of area non contract activity. Narrative RISKS / ACTIONS PES and Arriva contracts continue to underperform in December. However, slight over performance is seen on the OOHs contract. Narrative RISKS / ACTIONS There is slight underperformance on the NHS 111 contract with NWAS and BARDOC. Total 241,888, ,420,829 36,807 47,278 10,471 19,519,437 20,018, , , ,969 76, ,718, ,777,062 2,058,141