1. Planning Round 2014/15 Ambitions and Trajectories Sutton CCG Board – Wednesday 5 th March

2. Planning timetable Draft submission on 14 th February 2014: Quality and Performance Assurance Ambitions for Improving Outcomes Quality Premium Measures Other Measures Activity Trajectories Final submission required by 4 th April 2014

3. Sutton CCG Board decision The Governing Body is asked to approve the outcome ambitions and activity assumptions required for the final submission on 4 th April 2014.

4. Quality and Performance Assurance i)Do your plans ensure that the performance standards in the NHS Constitution will be delivered throughout 2014/15 and 2015/16? Yes ii)Have you assured provider CIPs are deliverable without impacting on the quality and safety of patient care from 2014-15 till 2018-19? No iii)Do you plan to manage HCAIs so that your local population have no cases of MRSA in 2014-15 and 2015-16? Yes

5. Ambitions for Improving Outcomes What is your ambition for securing additional years of life from conditions considered amenable to healthcare? Sutton CCG in top 30% nationally BetterWorse

6. Ambitions for Improving Outcomes What is your ambition for securing additional years of life from conditions considered amenable to healthcare? Assumptions: 3.2% reduction to 2013/14 and again for 14/15 as per Quality Premium target Reductions for subsequent years taken from NHSE "Anytown" suburban model

7. Ambitions for Improving Outcomes What is your ambition for securing additional years of life from conditions considered amenable to healthcare? NHSE’s “Anytown” planning model suggests a 10.9% reduction from 2013 to 2018 on a “do nothing more” model: “Outcome ambition 1 (preventing premature mortality) are greatly affected by health behaviours throughout life (e.g. smoking). As there is a strong positive trend reduction in mortality and potential years of life lost, because the cohorts of people entering the highest-risk age- range are progressively healthier, it seems sensible to make an adjustment for that trend before setting levels of ambition.” [Setting 5- year ambitions for improving outcomes: the commissioners how-to guide]

8. Ambitions for Improving Outcomes What is your ambition for securing additional years of life from conditions considered amenable to healthcare? Potential years of life lost per 100,000: Baseline 12/131898 13/141837-3.2% 14/151778-3.2% 15/161723-3.1% 16/171673-2.9% 17/181628-2.7% 18/191586-2.6%

9. Ambitions for Improving Outcomes What is your ambition for improving the health-related quality of life for people with long-term conditions? Sutton CCG in top 10% nationally WorseBetter

10. Ambitions for Improving Outcomes What is your ambition for improving the health-related quality of life for people with long-term conditions? Assumption:0.5% improvement per year Average EQ-5D score for people reporting having one or more long- term condition: Baseline 12/1377.1 13/1477.6+0.5 14/1578.1+0.5 15/1678.6+0.5 16/1779.1+0.5 17/1879.6+0.5 18/1980.1+0.5

11. Ambitions for Improving Outcomes What is your ambition for reducing emergency admissions? Sutton CCG in top 25% nationally BetterWorse

12. Ambitions for Improving Outcomes What is your ambition for reducing emergency admissions? Reducing the amount of time people spend avoidably in hospital through better and more integrated care in the community, outside hospital – a composite measure per 100,000 population of: Unplanned hospitalisation for chronic ambulatory care sensitive conditions Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s Emergency admissions for acute conditions that should not usually require hospital admission Emergency admissions for children with lower respiratory tract infections (LRTI)

13. Ambitions for Improving Outcomes What is your ambition for reducing emergency admissions? Assumption:Maintain current good performance - no increase as per Quality Premium target 2014/15 Note rising trend since 2009:

14. Ambitions for Improving Outcomes What is your ambition for reducing emergency admissions? Assumption:Maintain current good performance - no increase as per Quality Premium target 2014/15 Composite admissions per 100,000 population: Baseline 12/131682 13/141682 14/151682 15/161682 16/171682 17/181682 18/191682

15. Ambitions for Improving Outcomes What is your ambition for increasing the proportion of people having a positive experience of hospital care? Sutton CCG in top 20% nationally BetterWorse

16. Ambitions for Improving Outcomes What is your ambition for increasing the proportion of people having a positive experience of hospital care? Assumption:Maintain current good performance The proportion of people reporting poor patient experience of inpatient care: Baseline 12/13134.4 13/14134.4 14/15134.4 15/16134.4 16/17134.4 17/18134.4 18/19134.4

17. Ambitions for Improving Outcomes What is your ambition for increasing the proportion of people having a positive experience of care outside hospital, in general practice and the community? Sutton CCG at approx mid-point nationally BetterWorse

18. Ambitions for Improving Outcomes What is your ambition for increasing the proportion of people having a positive experience of care outside hospital, in general practice and the community? Assumption:Improve by 3% per year to achieve top quartile performance The proportion of people reporting poor experience of General Practice and Out-of-Hours Services: Baseline 12/135.8 13/145.6-3% 14/155.5-3% 15/165.3-3% 16/175.1-3% 17/185.0-3% 18/194.8-3%

19. Quality Premium Measures Trajectories for 2014/15 for these measures included in “Ambitions for Improving Outcomes” Reducing potential years of lives lost through causes considered amenable to healthcare and addressing locally agreed priorities for reducing premature mortality (15 per cent of quality premium - £140k) Reducing avoidable emergency admissions (25 per cent of quality premium - £230k)

20. Quality Premium Measures Improving access to psychological therapies (15 per cent of quality premium - £140k) Target is 15% by March 2015 Propose maintaining at 15% for 2015/16  2014/15 Q113%  2014/15 Q213%  2014/15 Q314%  2014/15 Q415%  2015/1615%

21. Quality Premium Measures Addressing issues identified in the 2013/14 Friends and Family Test (FFT), supporting roll out of FFT in 2014/15 and showing improvement in a locally selected patient experience indicator (15 per cent of quality premium - £140k) Addressed through FFT CQUIN Local indicator: Improving patient experience of hospital care – measured by CQC Adult Inpatient Survey

22. Quality Premium Measures Improving the reporting of medication-related safety incidents based on a locally selected measure (15 per cent of quality premium - £140k) Have agreement with Chief Pharmacist at Epsom & St Helier NHS Trust to increase reporting of medication errors by 10% from 2013/14 Q4 to 2014/15 Q4.

23. Quality Premium Measures A further local measure (15 per cent of quality premium - £140k) Proposed measure is improvement in patient experience of GP Out of Hours (OOH) services. Sutton performs at a midpoint level nationally on the indicator of GP OOH satisfaction (based on the GP survey). Sutton CCG has recently changed provider for GP out of hours services so this is a good opportunity to drive improvements in patient experience for this service. Links with the CCG’s “Out of hospital care” priority to improve the quality of out of hours services. Proposal is to increase “good” experience to a minimum of 72% (last reported rate was 70%)

24. Other Measures What is the trajectory for maximum number of Clostridium Difficile infections in 2014/15? Public Health England are to provide CCG thresholds, however in the absence of these we have been advised by NHS England to set at 35 (threshold for 2013/14 was 37)

25. Other Measures What dementia diagnosis rate are you aiming for in 2014/15 and 2015/16? For the 2013/14 Planning Round Sutton CCG agreed a trajectory to move from 37% in 2011/12 to 58% by 2015/16 Everyone Counts (Dec 2013) gives target of 67% by March 2015 Proposal is for Sutton to continue to move towards 58% by March 2016

26. Other Measures What dementia diagnosis rate are you aiming for in 2014/15 and 2015/16? Proportion of estimated prevalence of dementia diagnosed: Baseline 12/1340.2% 13/1443% 14/1550% 15/1658%

27. Other Measures What level of Psychological Therapies recovery are you aiming for in 2014/15 and 2015/16? 50% recovery rate by March 2015 (Everyone Counts) Maintain 50% recovery rate for 2015/16

28. Activity Trajectories 5 year trajectories are required for the following types of activity, by provider: Elective inpatient admissions Elective daycase admissions Non-elective admissions GP referrals Other referrals GP-referred first outpatient attendances Other-referred first outpatient attendances Subsequent outpatient attendances 5 year trajectories are also required at aggregate level for: A&E attendances

29. Activity Trajectories Assumptions: Baseline of April – November 2013, extrapolated for full year Activity growth of 2.8% per year due to demographic growth 2014/15 - Activity shifts planned through QIPP workstreams applied

30. Activity Trajectories Assumptions: 2015/16 – 2018/19 - Activity shifts applied as agreed through South West London Out of Hospital Strategy group, accelerated due to Better Care Fund workstreams to achieve in 3 years from 2013/14, rather than the previously planned 5 years: o A & E 10% avoid o Non-Elective Admissions 17.5% avoid o Outpatients Attendances 5% avoid