Birmingham Community Healthcare NHS Trust 201314 CQUIN Progress

Birmingham Community Healthcare NHS Trust 2013/14 CQUIN Progress Report December 2013 Introduction The CQUIN payment framework makes a proportion of providers’ income conditional on quality and innovation. Its aim is to support the vision set out in High Quality Care for All of an NHS where quality is the organising principle. The CQUIN schemes are agreed between the Trust and Commissioners on a yearly basis and comprise 2. 5% of the contractual value. Each CQUIN scheme has goals and targets to be achieved throughout the year in order to secure the payment from Commissioners. BCHC CQUIN schemes form part of the following contracts: 1. Multi-Lateral Agreement (MLA) 2. Birmingham Dental Hospital 3. Combined Community Dental Services (CCDS) 4. Rehabilitation Services 5. Learning Disabilities For 2013/14 the combined value of all CQUIN schemes is £ 4, 902, 203.

MLA Contract CQUINS Overview MLA CQUIN Schemes – total value £ 3, 676, 638 Divisions involved Name Corporate Adults & Communities Children & Families Weighting Value 5% £ 183, 832 1 Friends & Family Test 2 Patient Safety Thermometer 7. 5% £ 275, 748 3 Dementia 20% £ 735, 328 4 VTE Risk Assessment & RCA 7. 5% £ 275, 748 5 Pharmaceutical Risk Assessment 10% £ 367, 664 6 Formulary Adherence 10% £ 367, 664 7 Pressure Ulcers 20% £ 735, 328 8 Common Assessment Framework 20% £ 735, 328

MLA Contract CQUINS Scheme 1. FRIENDS & FAMILY TEST - comprised of three indicators, 1 A, 1 B & 1 C Indicator 1 A - Improved performance on the staff Friends & Family Test. Value £ 75, 533 Requirement Q 4 By July produce an action plan detailing the staff survey results, broken down by directorate & milestones for actions to be completed. The goal for payment is an improved score in the annual staff survey by the end of Quarter 4 Payment 100% - Forecast Amber Risk. Organisational Development has worked with Divisions to implement: Staff Survey Action Plan Focus Groups; they identified 4 themes for improvement: 1. Management engagement & communication. 2. Promoting our commitment to patient care. 3. Recognising the value of individuals and 4. Job satisfaction Comprehensive action plans identifying transformational & transactional actions & ‘quick wins’ for each theme have been progressed throughout the year. Significant work to reduce work related stress; month of activity in November to recognise National Stress Awareness Day. Resilience Toolbox Training & Be Well Roadshows were organised at various sites across the patch. The success of the indicator will not be known until the staff survey results are available, this uncertainty creates an amber risk considering previous performance. Value £ 75, 533 Indicator 1 B - Use of the Friends & Family Test to drive improvements across BCHC. Value £ 75, 533 Requirement Oct 13 Provide action plan with specific measureable outcomes with timescales for improvement. Apr 14 Provide report & action plan with completed trajectories for improvement. The final action plan & achievements must be agreed by Commissioners Payment 50% - Achieved The action plan is being monitored via Patient Safety & Experience Group. Value £ 36, 766 50% - Forecast Compliance - improvements are being made as per the action plan Areas for improvement: Staff attitude / Interpreters Availability / Patient boredom Noise & responsiveness at night / Communication / Staffing levels Actions: Promote i. Care training & ‘Dignity Champions’ / Reissue interpreter process / Volunteer programme / Undertake night time audit / Recruitment plan £ 36, 766

MLA Contract CQUINS Indicator 1 C - Vulnerable Patient Group Increased response rate. Value £ 36, 766 Requirement Develop methodology for all patient to be asked FFT: Q 1 include all who may have been previously excluded i. e. dementia, learning disability, frailty. Implement FFT for all patients. Data to be presented Q 2 broken down using national template & using amended template Implement FFT for all patients. Data to be presented Q 3 broken down using national template & using amended template Show an increase in the response rate for FFT across all inpatient units. This will be the cumulative figure for pts Q 4 responding using both the nation FFT & the locally amended FFT. Payment 20% - Achieved 20% - Forecast Compliance The response rate for the vulnerable patient group is continuing to show improvement Value £ 7, 353 £ 14, 706 Scheme 2. NHS SAFETY THERMOMETER - Increase in Harm Free Care in line with National Guidance. Value £ 275, 748 Requirement Oct 13 Apr 14 Payment Value The goal for the first 6 months was met as we achieved the required improvement in the median value of harm-free care. 50% - Achieved £ 137, 874 The goal for the second 6 months will be met if we achieve the required improvement in the median value of harm-free care. 50% - Forecast Amber Risk. In October the target was met, but it was not met in November. Work is ongoing to minimise new harms but it is not possible to influence the number of old harms. Therefore the risk of not achieving the median target for October to March is amber. £ 137, 874

MLA Contract CQUINS Scheme 3. DEMENTIA – the scheme is comprised of three indicators, 3 A, 3 B & 3 C Indicator 3 A - Finding, assessing & investigating Dementia. Value £ 367, 664. Identify new patients with dementia using agreed screening tool. Inform GP with a discharge summary that includes blood test results & screening results within 48 hours of discharge. Support patient & carers by signposting to community services. Excluded patients: (<75/ delirium / sepsis / end of life /previous known diagnosis, patients who are discharged within 72 hours) Payment Value 10% - Achieved £ 36, 766 40% 30% - Achieved £ 110, 299 70% 30% - Forecast Compliance - A comprehensive procedure has been implemented to screen inpatients and provide the screening results to GPs upon discharge. A data collection process is in place to monitor all aspects of compliance and follow up any underperformance where needed. £ 110, 299 90% 30% - Forecast Amber Risk because Nov compliance was 87% (just short of the Q 4 90% target). Compliance is being regularly monitored and actions taken to ensure 90% is achieved and maintained. £ 110, 299 Requirement Q 1 Audit tool to be agreed with commissioners Q 2 Q 3 Quarterly targets for the below criteria: 1. % applicable in-patients screened for dementia 2. % of patients with a working diagnosis of dementia whose GP is informed of screening results via a discharge summary Q 4 Indicator 3 B - Clinical Leadership - Training of staff. Value £ 183, 832 Requirement Mar 14 Identify all relevant staff requiring access to relevant dementia training programme based on a Training Needs Analysis. By March 2014 90% of identified staff to have completed the training programme. Resources for patients & carers to improve signposting to relevant service Payment Value 100% - Forecast Compliance. 310 staff were identified for training in July. As of 5 th Dec >80% staff have attended either the Dementia Care facilitated workshop or the University of Worcester Leadership course. Feedback is being gathered & analysed from both to assess usefulness and improve where needed. The Leadership course in particular has had very positive feedback from staff. £ 183, 832

MLA Contract CQUINS Scheme 3. DEMENTIA – the scheme is comprised of three indicators, 3 A, 3 B & 3 C Indicator 3 C - Supporting Carers of People with Dementia - Inpatients. Value £ 183, 832 Requirement Payment Value Q 1 Audit agreed & commenced 10% - Achieved £ 18, 383 Q 2 Monthly audit report in place, results reported to Trust Board. 30% - Achieved £ 55, 150 Full year audit report detailing monthly audit results & identifying areas for improvement. Evidence results have been reported to Trust Board 60% - Forecast Compliance The Carer Support Team & dedicated Carer Support Officer have the following in place: - a Carer Questionnaire to identify if carers feel supported whilst their cared for person is on the ward/unit - Individual home visits - Liaison with the Alzheimer’s Society - Signposts to other relevant voluntary organisations on behalf of carers - Liaison with all wards/units to ensure that carers are aware of the support that is available in the Trust for them to access - Provision of promotional material for signposting on the wards Audits are being carried out monthly and the results will be included in Quality report for Performance to the Board monthly £ 110, 299 Q 4

MLA Contract CQUINS Scheme 4. VTE is comprised of 2 indicators Indicator 4 A - VTE Risk Assessment - 95% compliance target for risk assessment. Value £ 137, 874 Requirement Payment Value Q 1 Monthly audits demonstrating 95% compliance target for risk assessment 25% - Achieved £ 34, 468 Q 2 Monthly audits demonstrating 95% compliance target for risk assessment 25% - Achieved £ 34, 468 Q 3 Monthly audits demonstrating 95% compliance target for risk assessment 25% - Forecast compliance £ 34, 468 Q 4 Monthly audits demonstrating 95% compliance target for risk assessment 25% - Forecast compliance £ 34, 468 Indicator 4 A - VTE Root Cause Analyses- 100% of VTEs have a root cause analysis. Value £ 137, 874 Requirement Payment Value Q 1 100% of VTEs have a root cause analysis 25% - Achieved - 1 VTE case £ 34, 468 Q 2 100% of VTEs have a root cause analysis 25% - Achieved - 1 VTE case £ 34, 468 Q 3 100% of VTEs have a root cause analysis 25% - Forecast compliance £ 34, 468 Q 4 100% of VTEs have a root cause analysis 25% - Forecast compliance £ 34, 468 Scheme 5. Pharmaceutical Risk Assessment - audits to highlight medication risks. Value £ 367, 664 Aim is to increase communication with Primary Care & reduce medicines-related admissions. Requirement Payment Value Q 1 60 inpatient records to be risk assessed of findings reported. Commissioner & Provider Heads of Medicines Management to validate & agree Q 4 audit criteria 25% - Achieved £ 91, 916 Q 2 60 inpatient records to be risk assessed and report of findings provided 10% - Achieved £ 36, 766 Q 3 60 inpatient records to be risk assessed and report of findings provided 10% - Forecast compliance £ 36, 766 Q 4 Provide full audit report of patients assessed in 13 -14 in order to evaluate the re-attendance rates & identify any interventions to mitigate future risk 55% - Forecast compliance £ 20, 215

MLA Contract CQUINS Scheme 6. Formulary Adherence - the % of prescribed items that are prescribed in line with the local formulary. Value £ 367, 664 Requirement Payment Value Q 1 audit & action plan setting a final year target & trajectory. Peer review between Commissioner & Provider Medicines Management to validate & agree. 25% achieved £ 91, 916 Q 2 Report of progress achieved against trajectory & action plan. 10% achieved £ 36, 766 Q 3 Report of progress achieved against trajectory & action plan. 10% forecast compliance £ 36, 766 Q 4 Audit report with supporting evidence & details of final score & improvements achieved throughout the year. Agreed target must be achieved for full payment. A Prescribing request / discharge summary will be deemed as non adherence if any of the definitions are breached for any medication contained on the request 55% forecast compliance £ 20, 215 Scheme 7 Common Assessment Framework - this is a national approach to providing a way of assessing children with additional needs, in the areas of growth & development, educational requirements, family & environmental issues, and/or specific needs of the parent/carer. The purpose is to initiate and support early intervention and improved joint working and communication between children’s practitioners from a variety of agencies. Value £ 735, 327 Requirement Payment Value Q 1 15% of staff trained in CAF 5% achieved £ 36, 766 Q 2 36% of staff trained in CAF 5% achieved £ 36, 766 Q 3 65% of staff trained in CAF 5% forecast compliance £ 36, 766 85% forecast compliance – training compliance is 80% and 174 CAFs have been initiated as of 2 nd Dec A task & finish group was set up to engage & encourage all staff as to the value of initiating CAFs. A dedicated project manager has provided team support, information visits and forum presentations, to keep staff up to date. Relating the value of CAFs in terms of protecting children in light of recent serious case reviews and previous and forth coming Ofsted inspections, as well as clarity on the financial drivers, have been integral and consistent in all communication £ 625, 028 i) 85% of staff trained (worth 5%) Q 4 ii) Initiation of 200 CAF assessments by the Health Visiting service, Family Nurse Partnership and Childrens Specialist Services during 13/14 (worth 80%)

Dental Hospital and CCDS Contract CQUINS Dental Hospital CQUIN Schemes – total value £ 280, 758 Divisions involved Name 1 Friends & Family Test 2 Managed Clinical Networks for • Oral Medicine & • Restorative Dentistry Weighting Value 40% £ 112, 303 60% £ 168, 455 £ 47, 634 Corporate Dental Hospital CCDS CQUIN Schemes – total value £ 95, 347 1 Managed Clinical Networks for • Special Care Dentistry & • Paediatric Dentistry 50% 2 Patient Experience 50% £ 47, 634

Dental Hospital and CCDS Contract CQUINS Scheme 1. FRIENDS & FAMILY TEST - comprised of two indicators, 1 A & 1 B Indicator 1 A - Improved performance on the staff Friends & Family Test. Value £ 56, 152 Requirement Q 1 Q 4 Produce comprehensive action plan detailing the staff survey results, broken down by directorate & milestones for actions to be completed Improved score in the annual staff survey by the end of Quarter 4 Payment 50% - Achieved 50% - Forecast Amber Risk. The same work applies as to the MLA staff survey CQUIN; Organisational Development has worked with Divisions to implement: Staff Survey Action Plan Focus Groups & Significant work to reduce work related stress. The success of the indicator will not be known until the staff survey results are available, this uncertainty creates an amber risk considering previous performance. Value £ 28, 076 Indicator 1 B - Use of the Friends & Family Test to drive improvements across BCHC. Value £ 56, 152 Requirement Payment Oct 13 Report including what actions have been taken as a result of the analysis of the FFT data in order to improve the quality of service provided to patients 50% - Achieved – brief report was submitted advising that the compilation and agreement of the survey questions, including the Friends and Family question was completed September 2013 Apr 14 Report including what actions have been taken as a result of the analysis of the FFT data in order to improve the quality of service provided to patients 50% - Forecast Compliance – surveys are in place and ongoing through the year. Patient Experience to work with BDH operational management to develop action plan to be implemented through Q 4 and into 2014/15 Value £ 28, 076

Dental Hospitaland CCDS Contract Dental Hospital Contract. CQUINS Managed Clinical Networks Continuing Development: Value £ 216, 127 Oral Medicine & Restorative Dentistry (BDH Scheme 2) £ 168, 455 Special Care Dentistry & Paediatric Dentistry (CCDS Scheme 1) £ 47, 673 The Development work for the four MCNs is taking place as a combined project. Objectives for the Network CQUINS are broad at this stage, as networks will define their own objectives and plans to be delivered. These are expected to include integration of pathways as per integration project. The requirement for each MCN is the same as per the below: Requirement Production of 2013 -14 objectives: Report detailing specific objectives for 13 -14 for each network to be submitted the Bham Solihull & Black Country Local Dental Network (LDN). One objective should relate to July 13 expanding the remit of the network to include other West Midland Area Teams & providers & clinicians across the West Mids. LDN will sign off objectives in July meeting. Jan 14 Progress Report: to be submitted to January LDN meeting to review progress of networks. (Chairs required to attend LDN as required). Production of Report demonstrating achievement of objectives: to be Mar 14 submitted detailing the achievement of the network against objectives. Endorsement of MCN report required for payment. Mar 14 Production of Report demonstrating MCN work to ensure remit of the network is representative of Birmingham and the Black Country. E. g. items of discussion from minutes of meetings, group memberships etc. Payment Value 25% - Achieved Report detailing objectives was sent to commissioners as there was no Local Dental Network meeting to submit to at the time. The LDN has since met. BDH £ 42, 114 CCDS £ 11, 918 25% - forecast compliance. There are 11 objectives across the MCNs, 3 are completed and the others are forecast to be completed to schedule BDH £ 42, 114 CCDS £ 11, 918 40% -Forecast Compliance Total £ 54, 032 Total: £ 54, 032 BDH£ 67, 382 CCDS £ 19, 068 Total £ 86, 450 10% - Forecast Compliance BDH £ 16, 845 CCDS £ 4, 767 Total: £ 21, 612

Rehabilitation Contract CQUINS Rehabilitation Services CQUIN Schemes – total value £ 442, 010 Name Weighting Value 1 NHS Safety Thermometer – Improvement 5% £ 22, 101 2 VTE Root Cause Analyses 5% £ 22, 101 3 Access to Specialist Spinal Rehabilitation 45% £ 198, 905 4 Access to Specialist Neuro Rehabilitation 45% £ 198, 905

Rehabilitation Contract CQUINS Scheme 1. NHS SAFETY THERMOMETER – Reduction in harm-free care; focusing on old or new pressure ulcers. Value £ 22, 100 Requirement Oct 13 Apr 14 Payment Value The baseline median of grade 2 -4 pressure ulcer (PU) harms from Oct-Mar was zero. This median of zero had to be maintained from April to Sept to achieve the payment 50% - Achieved There were 3 old PU harms in May and 1 old PU harm in August. This left 4 months with zero PU harms, therefore the median was zero. £ 11, 050 The median of zero of grade 2 -4 pressure ulcers has to be maintained from October to March 50% - Forecast Amber Risk. In October 1 patient was admitted with a pressure ulcer so the target was not met. The target was met in November as there were zero pressure ulcers. Extensive work is ongoing to minimise new pressure ulcers but it is not possible to influence the number of patients admitted with old harms. Therefore the risk of not achieving the median target for October to March is amber. £ 11, 050 Scheme 2. VTE Risk Assessment and Root Cause Analyses. Value £ 22, 100 Requirement Payment Value Q 1 VTE Risk assessment compliance target of ≥ 95% 100% of VTEs have a root cause analysis 25% - Achieved £ 34, 468 Q 2 VTE Risk assessment compliance target of ≥ 95% 100% of VTEs have a root cause analysis 25% - Achieved £ 34, 468 Q 3 VTE Risk assessment compliance target of ≥ 95% 100% of VTEs have a root cause analysis 25% - Forecast compliance £ 34, 468 Q 4 VTE Risk assessment compliance target of ≥ 95% 100% of VTEs have a root cause analysis 25% - Forecast compliance £ 34, 468

Rehabilitation Contract CQUINS Scheme 3 Access to Specialist Spinal rehabilitation. Value £ 198, 905 This scheme aims to improve the access to specialised rehabilitation for patients with spasticity. This will include: • Providing a nominated spasticity support service with advice & outreach service to local DGH’s across the region • Clear management for those patients who suffer this debilitating side effect of CNS damage Acting as a hub, providing expertise, skills, mentoring and training & were necessary referring patients to WMRC • Training resources available in a number of different media – including online and electronically for team members to access Requirement Q 1 Q 2 Q 3 Q 4 Quarterly progress reports detailing: Clinical lead for service & benchmarking in Q 1 Numbers of: - spasticity patients referred for rehab & their postcodes - referrals not accepted & reason why & referrals to other rehabilitation services due to being out of area - patients admitted to INRU with complications Pathway identification, drafting & completion. Development of a referral form & rehabilitation assessment process for Outreach team In Q 3, number assessed by the Spasticity Outreach Team plus programme of advice and support for DGHs, rehabilitation centres, nursing homes & community services Identification of training needs for outreach staff, education material & by Q 4 appropriate training undertaken by Spasticity Outreach Team In Q 4 identification and confirmation of clinical outcome measure (FIMFAM) Payment Value 25% - Achieved £ 49, 726 25% - Achieved - initial phase consisted of establishing the core team, ensuring governance and reporting processes were in place and starting a gap analysis. A database has been established to record all outcome measures for future audit. £ 49, 726 25% - Forecast compliance A range of promotional materials will be developed. DGH’s and nursing homes will be approached to establish the base-line needs. We will be defining new business processes to deliver the benefits. Physio now in post, OT to start early December £ 49, 726 25% - Forecast compliance Working to establish a database for outcome measures Outreach activity proforma being linked with TRIMS Awaiting arrival of laptops for remote working pilot £ 49, 726

Rehabilitation Contract CQUINS Scheme 3 Access to Specialist Spinal rehabilitation. Value £ 198, 905 This scheme is a continuation from the pilot in 11/12. The aim is to continue improving access to specialised rehabilitation through delivering a regional outreach service to DGHs to support patient assessment & suitability for rehabilitation. This includes • Maintaining an up-to-date regional rehabilitation directory, sharing it with key stakeholders and users of the pathway. • Providing an advice service & outreach service to local DGH’s across the region. Signposting for patients not suitable for access to their service. • Acting as hub advising MTC’s & DGH’s on rehabilitation, providing expertise, skills, mentoring & training • Maintaining a central referral centre for its referrals only to operate a ‘pull’ system for patients to access rehabilitation from MTC’s and DGH’s. Requirement Q 1 Q 2 Q 3 Q 4 Quarterly progress reports demonstrating that: 100% of referrals received & recorded electronically via referral hub and tracked through the rehabilitation database. Where an outreach visit is requested by the referring hospital or in order to determine suitability for referral to the unit 100% should have been undertaken by a member of the MDT team. 100% of patients waiting to come into INRU to have an outreach visit and a pre admission rehab management plan. 100% of referrals received and recorded electronically via referral hub. Average time (days) to transfer patient to the unit, should be an improvement on the 12 -13 baseline. Payment 25% - Achieved Value £ 49, 726 25% - Achieved Average time to transfer has improved from 2. 7 days (Q 2 12/13) to 0. 5 days (Q 2 13/14). £ 49, 726 25% - Forecast compliance Awaiting arrival of laptops for remote working pilot. We will be defining new business processes to deliver the benefits. £ 49, 726 25% - Forecast compliance £ 49, 726

Learning Disabilities Contract CQUINS Learning Disabilities CQUIN Schemes – total value £ 407, 478 Name Weighting Value 1 Patient Experience 20% £ 81, 495. 60 2 NHS Safety Thermometer – Improvement 20% £ 81, 495. 60 3 Access to Healthcare 20% £ 81, 495. 60 4 Bed Management Performance 20% £ 81, 495. 60 5 MECC Year 2 20% £ 81, 495. 60

Learning Disabilities Contract CQUINS Scheme 1. Patient Experience– To capture the Experience of the Patient on Discharge by using a patient survey questionnaire for Identified Services. Value £ 81, 495 Requirement Q 1 Q 2 Q 3 Q 4 Quarterly progress reports demonstrating: Number. of service users that received an Exit Questionnaire & number that declined. Summary analysis of results to include identification of changes to be made & their progress For Q 4 full report which demonstrates changes made / present a business case to implement changes to services as a result of the exit questionnaires in 13/14. Commissioners to undertake quality review of service changes to confirm changes have been made at Q 4. Payment Value 100% - Forecast compliance. Reports have been submitted for Q 1 and Q 2. £ 81, 495 Scheme 2. NHS SAFETY THERMOMETER – Focus on Pressure Ulcer prevalence & serious falls. Value £ 81, 495 Requirement Q 1 Q 2 Q 3 Q 4 Data collection requirement only. Payment will be triggered by submission of 3 consecutive months’ worth of survey data covering a single quarter, provided each of the surveys reflects data for 100% of appropriate patients. This will allow the establishment of quality improvement aims for year two and contribute to the provision of data required for the Outcomes Framework and Government Transparency Agenda. Slips trips and falls often result in a surgical Intervention. Data collection will assist in determining improvements for year two. Payment Value 100% - Forecast compliance Data has been collated locally using the NHS Safety Thermometer tool on a single day per month. This monthly data has been uploaded to the NHS Information Centre on a quarterly basis £ 81, 495

Learning Disabilities Contract CQUINS Scheme 3. Access to Healthcare for People with Learning Disabilities - Coding and Flagging People with Learning Disabilities. Value £ 81, 495 Requirement Q 1 Q 2 Q 3 Q 4 Quarterly reporting of data on the following: 1. Number of new referrals to SPA for patients with a Learning Disability (LD) 2. Number of referrals received for patients with a LD in the quarter by acute hospital, broken down by those referred & those identified in service "sweeps". 3. Number of patients the Health Facilitation service assisted/ advised hospitals in fulfilling their obligation to make necessary adjustments to ensure people with a LD receive the care & treatment they require. 4. Breakdown of how many patients with a LD required reasonable adjustments. 5. Q 3 Submission of Further Improvement plan for this Service 6. by Q 3 Protocol in place for regular review of practices for people with a LD Payment 100% - Forecast compliance. Reports have been submitted for Q 1 and Q 2. Value £ 81, 495 Scheme 4. Bed Management Monthly Performance Reporting. Value £ 81, 495 Requirement Q 1 Q 2 Q 3 Q 4 Further development of Bed Management Monthly Performance Reporting. To include separate reports on Inpatient information – contracted and non contracted. Respite bed based services activity. • Complete the dataset with effect from 1 Apr 13 • Submissions for all performance data (data sets)to be made by 10 th working day from May 2013 • Meet monthly at CQRG • CQRG will analyse performance, quality & CQUIN. Ensure attendance of 1 performance manager 1 clinical lead • When mutually agreed the content of the dataset shall be amended & revised data to then be made available on the following months dataset Payment Value 100% - Forecast compliance £ 81, 495

Learning Disabilities Contract CQUINS Scheme 5. Making Every Contact Count. Value £ 81, 495 Requirement Q 1 Payment Q 2 Quarterly reports to CQRG showing number of people offered LD Specific Healthy Lifestyles Brief Advice across the 5 healthy lifestyles & the referrals made to health facilitation specialists services across any of the 5 Healthy Lifestyles (weight management, smoking, alcohol and substance misuse). Q 3 Reports should also show the number of patients refusing the Healthy Lifestyles Brief Advice Intervention. Q 4 In Q 4 report show the number of staff trained in delivering lifestyle advice. A Year end Month on Month trend for the total number of people referred on to Specialist healthy lifestyle clinics for 2013/14 will provide a baseline for 2014/15. End of Report 100% - Forecast compliance Reports have been submitted for Q 1 and Q 2. Value £ 81, 495