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Meeting of the CCG Governing Body to be held from 0900 - 1300 on Wednesday 27 November 2013 at
The Lounge, The Athenaeum, Bury St Edmunds
AGENDA
GENERAL BUSINESS
1. Apologies for Absence 2. Declarations of Interest
To declare any interests specific to agenda items Dr Christopher Browning
3. Minutes of the previous meetings West Suffolk CCG Governing
Body To approve as a correct record the Minutes of the West Suffolk CCG Governing Body meeting held on 25 September 2013
Dr Christopher Browning
4. Matters Arising & Action Log Dr Christopher Browning 5. General Update
To receive a verbal report from the Chief Officer Julian Herbert
6. Chairman/ Chief Officer Action
To ratify the action taken by the Chairman and Chief Officer under delegated powers for Approval of the CCG Policy Development policy and four other Information Governance Policies
Dr Christopher Browning Report No:
WSCCG13/036
CLINICAL SERVICES 7. Stroke Update
To receive and approve a report from the Chief Redesign Officer, Ipswich & East CCG
Sandy Hogg Report No:
WSCCG13/037 8. 111 Closedown Report
To receive and note a report from the Chief Redesign Officer, Ipswich & East CCG
Sandy Hogg Report No:
WSCCG13/038 9. Urgent Care Model Engagement Process
To receive and note a report from the Chief Operating Officer Ed Garratt Report No:
WSCCG13/039 10. Commissioning Intentions
To receive and endorse a report from the Chief Operating Officer Ed Garratt Report No:
WSCCG13/040 11. Psychiatric Liaison Service Update
To receive and note a report from the Lead for Mental Health Dr Roz Tandy
Report No: WSCCG13/041
12. Paediatric Asthma and Epilepsy nurses
To receive and note a report from the Lead for Children & Young People
Dr Rakesh Raja Report No:
WSCCG13/042
FINANCE, PERFORMANCE AND SCRUTINY 13. CCG Health and Safety Report
To receive and note a report from the Chief Corporate Services Officer
Amanda Lyes Report No:
WSCCG13/043 14. Internal Audit Report – Clinical Governance
To receive and note a report from the Chief Corporate Services Officer
Amanda Lyes Report No:
WSCCG13/044 15. Integrated Performance Report
To receive and note a report from the Interim Chief Contracts Officer/ Chief Finance Officer and the Chief Nursing Officer
Wendy Tankard/ Carl Goulton/
Barbara McLean Report No:
WSCCG13/045 Appendix A
GOVERNANCE AND CORPORATE BUSINESS 16. Minutes of Meetings:
To consider and endorse the following minutes of West Suffolk CCG Sub Committee Meetings:
(i) Audit Committee The (un)confirmed minutes of a meeting held on 15 October 2013
(ii) Remuneration and HR Committee The confirmed minutes of a meeting held on 17 September 2013 and (un)confirmed minutes 29 October 2013
(iii) Community Engagement Group The (un)confirmed minutes of a meeting held on 11 November 2013
Bill Banks Report No:
WSCCG13/046
Bill Banks Report No:
WSCCG13/046i
Bill Banks Report No:
WSCCG13/046ii
Jo Finn Report No:
WSCCG13/046iii 17. The unconfirmed minutes of the CCG Collaborative Group
meeting – 3 October 2013 To receive and note a report from the Chief Officer
Julian Herbert Report No:
WSCCG13/047 18. Governing Body Assurance Framework
To receive and endorse a report from the Chief Corporate Services Officer
Amanda Lyes Report No:
WSCCG13/048
19. Freedom of Information Quarterly Update
To receive and note information from the Chief Corporate Services Officer
Amanda Lyes Report No:
WSCCG13/049 20. Haverhill Health Needs Assessment
To receive and note a report from the Lay Member, Patient and Public Involvement
Jo Finn Report No:
WSCCG13/050 21. Market Stalls
To receive and note a report from the Lay Member, Patient and Public Involvement
Jo Finn Report No:
WSCCG13/051 22. Any Other Business Date and Time of future Governing Body meetings
0900 – 1300 Wednesday 29 January 2014, The Lecture Room, St Edmundsbury Cathedral, Bury St Edmunds
Questions from the public – Maximum 15 minutes
Please note questions should relate to the items under discussion and must be a question rather than statement. Where individuals deviate from this requirement they will be asked to stop and will not be invited to take any further part in the meeting.
Papers will be available at the meeting or on www.westsuffolkccg.nhs.uk For enquiries, please contact Colin Boakes on 01473 770057 or [email protected]
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Minutes of the West Suffolk CCG Governing Body meeting held in public on
Wednesday 25 September 2013 in the Lecture Room, St. Edmundsbury Cathedral, Bury St. Edmunds, Suffolk
PRESENT: Dr Christopher Browning Chairman Dr Simon Arthur GP Member Bill Banks Lay Member for Governance David Cripps Member Dr Emma Derbyshire GP Member Jo Finn Lay Member for Patient and Public Involvement Dr Crawford Jamieson Secondary Care Doctor Peter Knights Member Dr Rakesh Raja GP Member Dr Giles Stevens GP Member Dr Rosalind Tandy GP Member Dr Andrew Yager GP Member Dr Ed Garratt Chief Operating Officer Carl Goulton Chief Finance Officer Julian Herbert Chief Officer Amanda Lyes Chief Corporate Services Officer Barbara McLean Chief Nursing Officer Jon Reynolds Interim Chief Contracts Officer Wendy Tankard Chief Contracts Officer IN ATTENDANCE: Colin Boakes Governance Advisor Sandy Hogg Chief Redesign Officer: Ipswich and East Suffolk CCG Dr Mark Lim Associate Director of Clinical Strategy: Ipswich and
East Suffolk CCG Tessa Lindfield Director of Public Health: Suffolk County Council Pam MacBride Committee and Governance Officer Anne Nicholls Interim Chair: Clinical Engagement Group 13/047 WELCOME AND APOLOGIES FOR ABSENCE
The Chairman welcomed everyone to the meeting and introduced
Wendy Tankard who had recently been appointed as Chief Contracts Officer. Jon Reynolds was also thanked for covering the position as Interim Chief Contracts Officer. Apologies for absence were noted from Dr Jon Ferdinand: GP Member
13/048 DECLARATIONS OF INTEREST
There were no declarations of interest in respect of the agenda items.
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13/049 MINUTES OF PREVIOUS MEETING
The minutes of the meeting held on 17 July 2013 were reviewed and subject to the replacement of Dr. Yager’s name with that of Dr. Raja at Minute 13/036, paragraph 7 on page 5, were agreed as a correct record.
13/050 MATTERS ARISING AND ACTION LOG
In regard to the action arising from the Governing Body meeting held on
17 July 2013 at Minute 13/035: Urgent Care Paediatric GP Telephone Advice Line, Dr Raja reported that there had been no overall increase in GP referrals resulting in admissions from the West Suffolk area. There were no other matters arising.
13/051 GENERAL UPDATE
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The Chief Officer provided a general update on key issues: There had been positive outcomes following a recent Quality Surveillance Group (QSG) ‘Risk Summit’ meeting with the West Suffolk Hospital. By way of background he explained that the QSG meets monthly and acts as a virtual team across the East Anglian health economy, bringing together organisations and their respective information and intelligence gathered through performance monitoring, commissioning and regulatory activities. A number of quality concerns had been identified at the West Suffolk Hospital including the management of serious incidents, healthcare acquired infections and accident and emergency response times, all of which had been addressed at the meeting. The CCG has been shortlisted for a number of Health Service Journal (HSJ) awards:
• Staff Engagement: Amanda Lyes • Leadership (Public and Patient Involvement): Dr. Ed Garratt • Leadership (Clinical): Dr. Rakesh Raja
In addition, Anne Sisson, Practice Manager at the Christmas Maltings Surgery in Haverhill had been highly commended. A public meeting to present the Haverhill Health Needs Assessment will be held on Thursday 26 September at 7pm at the Leisure Centre in Haverhill.
13/052 CHAIRMAN/CHIEF OFFICER ACTION
The Chief Finance Officer requested the Governing Body to ratify a
recent action taken by the Chairman and Chief Officer under delegated powers to approve the award of the Data Management and Integration
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Centre (DMIC) contract to North of England, with delegated authority to negotiate within the financial parameters agreed. The action was necessary to ensure compliance with the necessary project plan timeline and had also been agreed by the CCG Executive Committee. The contract is necessary as the legal basis for CCGs to have access to Secondary Uses Service (SUS) information ceases on 31 October 2013 following which they will require an accredited DMIC to store, process and make accessible secondary use information (SUS and local flows) on their behalf.
The DMIC contract award delivers two key objectives:
• To transition West Suffolk CCGs storage, processing, and provision
of secondary use data for core business needs by Q4 2013/14 • To progress the improvements required by the CCGs for system wide
information availability and risk stratification capabilities
Having considered the report, the Governing Body endorsed the action taken by the Chairman and Chief Officer, under delegated powers, to award the contract to the North of England DMIC.
13/053 STROKE – EARLY SUPPORTED DISCHARGE
The Chief Redesign Officer and Associate Director of Clinical Strategy
for Ipswich and East Suffolk CCG attended for this item to provide an update on stroke services and specifically:
• Progress in developing hyper-acute stroke services, with the main improvements being physiotherapy, occupational therapy and consultant ward rounds at weekends.
• That a service specification for Early Supported Discharge
services has been developed. The CCG now seeks to engage with key stakeholders, refine the service specification, and return to the Governing Body in November with its findings. Following the November Governing Body meeting, it is anticipated that that procurement of the Early Supported Discharge service will commence.
By way of background and with useful context from the Stroke Association, it was noted that some 150,000 people each year suffer a stroke in the UK, which equates to one every five minutes. Although predominantly an issue in older age, stroke affects all age groups, including children and whilst some victims recover fully, others have resultant life changing disabilities. In Suffolk, over one thousand patients suffer a stroke each year. In the past decade, there have been significant advances in the treatment of stroke. These include drugs that break down clots in the brain's blood vessels, improved control of risk factors such as blood pressure, a better understanding of the key processes of rehabilitation, and recognised standards for professionals and units treating patients.
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In 2012, the former Midlands and East Strategic Health Authority published a model service specification that incorporated most of the new guidance. The Suffolk CCGs convened a network of local professionals involved in stroke care, which examined existing services against the model specification, and concluded that the two key priorities for implementation were:
• Improving hyper-acute stroke services (care for patients in the first three days following stroke)
• Early supported discharge services (care packages for patients discharged from acute hospitals into their own homes)
The Governing Bodies of both Clinical Commissioning Groups adopted the commissioning strategy, which includes these priorities in January 2013 and from May the Suffolk Stroke Review Project Board has overseen their implementation. The Project Board is a partnership between the following organisations, with representatives at Chair, Chief Executive, Chief Officer and Director level from each: • West Suffolk CCG • Ipswich and East Suffolk CCG • Suffolk County Council • East of England Ambulance NHS Trust • Healthwatch • The Stroke Association • West Suffolk Hospital • Ipswich Hospital • Suffolk Community Health
The Suffolk Stroke Review Project Board subsequently mandated two work streams, comprising patient, senior clinical and senior managerial representation, to work on the details relating to the two key priorities. These are the Acute Clinical Work Stream and the Early Supported Discharge Work Stream and the detailed progress for both was set out. The Chief Redesign Officer went on to emphasise the importance of public engagement and noted that the Suffolk Stroke Review has benefited from input of the Regional Manager of the Stroke Association and the Chief Executive of Health Watch Suffolk. In addition, the work streams have included patient representation. The Project Board and work streams have been especially grateful for the focus group at Eye organised by the Stroke Association, which has discussed how to ensure that the Early Supported Discharge Service specification reflects patients’ wishes. A process of engagement on the Early Supported Discharge service specification has been agreed with the Stroke Association and Healthwatch Suffolk that starts on 24 and 25 September (Ipswich and East Suffolk CCG and West Suffolk CCG respectively) and will last for six weeks. The process includes:
• An online survey and the CCGs will ask to meet groups face to
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face to acquire qualitative feedback on the impact this might have. There are more than 20 groups in Suffolk that exist to support people who have suffered a stroke.
• Healthwatch Suffolk will run and monitor an on-line survey, giving
weekly updates to the CCGs. This survey has been reviewed and updated by the Stroke Association to ensure it is easy to understand.
• The Stroke Association has drafted a discussion document for
use at face-to-face meetings.
• Data will be drawn together in a final report for the Governing Bodies to note and approve prior to the procurement phase.
Responding to a number of questions about the hyper-acute element of the service, the Chief Redesign Officer and Associate Director of Clinical Strategy confirmed that the Consultant Physicians with a special interest in stroke would work across both the Ipswich and West Suffolk Hospitals at weekends but the longer term plans include dual site working. Similarly, whilst there are currently Accident and Emergency Nurses dedicated to stroke care from 9am to 9pm each day, there are plans to increase this to twenty-four hour cover. Regarding an enquiry about the potential cost implications for the CCG, it was confirmed that the improved services are likely to require additional investment by both CCGs. Although the level of necessary funding has not yet been determined, this will be included in the full service specification to be presented to the Governing Body in November. In concluding, the Chief Officer offered his thanks to all those involved and particularly noted the collaboration between both the Ipswich and West Suffolk Hospitals and the contribution of their respective Chief Executives and Medical Directors. The Governing Body noted the report.
13/054 INTEGRATED CARE ACTION PLAN
Dr Derbyshire updated the Governing Body on progress with delivery of the Integrated Care Action Plan, with a particular focus on preparations for winter 2013-14 and sought approval for the allocation of transformation funding to support delivery of the plan. The Integrated Care action plan aims to bring together the whole health and care system to work on a range of service improvement areas to deliver on a set of high-level principles that work towards supporting more people within their own home away from urgent and emergency care. A key marker of a system working effectively is the A&E target of 95%
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compliance for all patients being seen and treated within 4 hours of arrival. This has been a challenge for West Suffolk Hospital with performance falling well below the target at the beginning of this financial year and leading to close scrutiny of the local plan by NHS England. Dr Derbyshire commented that it was reassuring to note that performance since June has improved significantly following a particular focus on the high impact changes within the Action Plan. In August, NHS England gave the plan a green status meaning they were satisfied that the plan met their assessment criteria for A&E performance improvement.
Work will need to continue to embed some of the changes over the next few weeks to secure sustainable improvement in performance in time for winter and the West Suffolk Urgent Care Network is key in driving these changes forward. Winter typically brings with it an increase in demand on all services and very often an increase in complexity of clinical need particularly amongst children and frail elderly. The Action Plan is therefore focused on building in greater resilience within the system ahead of winter to manage any surges in demand and also to agree a whole system management plan when services are under pressure. On 9 September, the CCG re-submitted the system wide Integrated Care Action Plan to the Area Team for assessment of winter preparedness, a copy of which was presented. In early September the West Suffolk Urgent Care Network agreed the allocation of transformation funding to support delivery of the high impact areas of the action plan. This non-recurrent funding aims to support the urgent care system to deliver some of the major changes critical to delivery this year and is only available until 31 March 2014. NHS England launched the national review of Urgent and Emergency Care this year and released the first set of emerging principles for urgent and emergency care in June. These principles will inform a commissioning framework due for publication in autumn 2014 which will be used to shape a local model of delivery of urgent care. This is a critical piece of work and we will want to work with our system partners and local communities to secure the very best outcome for the people of west Suffolk. Dr Derbyshire went on to set out a number of key points around Accident and Emergency performance and key deliverables within the Action Plan, notably around reducing admissions both within the hospital and post hospital stay, together with the winter preparations and use of the transformation funding with details of the specific proposals set out. Responding to a question about what had contributed to the improved A&E performance since June and whether it is sustainable, Dr Derbyshire noted that this was as a result of the system coming together, driven by the Urgent Care Network and using resources more effectively. As such, the improved performance is sustainable given also the better clinical engagement, particularly with the hospital consultants.
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A further question was posed in regard to the return on investment at the West Suffolk Hospital for the digitilisation of patient records and it was confirmed that an update on this would be provided at the next Governing Body meeting in November. The Governing Body noted the progress against delivery of the Integrated Care action plan and the improvement in A&E performance and approved the allocation of transformation funding to the projects as set out, with the exception of the GP Rapid Response proposal that will be approved through a separate governance mechanism.
13/055 AMBULANCE SERVICE – IPSWICH AND EAST SUFFOLK CCG AS LEAD COMMISSIONER
Dr Arthur, GP Lead for Ambulance Commissioning, provided an update on the position with the East of England Ambulance Service Trust (EEAST). He explained that the local ambulance service has experienced considerable problems over the last 18-24 months including:
• Very slow response times in certain areas • Low staff morale • A number of serious incidents • Concerns relating to the competence of the Trust Board • Significant adverse publicity
The joint management team of West Suffolk CCG and Ipswich & East Suffolk CCG took on the lead commissioner role for commissioning emergency services 1 April 2013. This is done on behalf of 19 Clinical Commissioning Groups covering Norfolk, Suffolk, Essex, Bedfordshire & Hertfordshire with the contract is held by Ipswich & East Suffolk CCG. A number of key points, together with accompanying detail were set out, including:
• EEAST are in the process of recruiting a new permanent Board and senior team to take on the work of the current interim Board
• A recovery plan has been developed and agreed • Good initial progress has been made in implementing the plan,
although performance indicators hav e dipped in the last two months
• Extra ambulances have been deployed in the West Suffolk area, although performance remains be low national targets and the regional average
• EEAST will require support and strong commissioning to deliver the improvements set out in the recovery plan and deliver the consistently responsive ambulance service required.
Going forward, Dr Arthur commented that improvements have been made in the ambulance service but considerable work is still required. Commissioners will play an important role as part of this process and as
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such, a strong ambulance commissioning team has been established to which he is providing GP input on behalf of the consortium of 19 CCGs. The team is working closely with EEAST and the Trust Development Authority to ensure that:
• EEAST continue to build a strong Board and senior team and improve the health of the organisation
• Clinical quality is improved and there is learning taken and embedded from any adverse incidents that do occur
• The recovery plan and performance target trajectories are met on a regional and local basis and appropriate contractual action is taken where this falls short
• The Trust is supported whilst it goes through this difficult process of re-organisation and change
As lead for the Consortium, the CCG is also working hard to involve and inform the other CCGs. This work includes breaking down targets to a local level to ensure greater equity in service provision. CCGs will need to make decisions on the level of investment into the ambulance service. This will be informed by the clinical capacity reviews which set out expected performance at a CCG level following delivery of the changes set out. In reply to a question about what the commissioners can do to assist in the process, it was suggested that through leads from each healthcare system across East Anglia linking to their respective Urgent Care Networks, there are significant opportunities for improvement, through a range of priorities, with hospital turnaround times cited as a particular example. The Governing Body noted the report.
13/056 COMMISSIONING INTENTIONS
The Chief Operating Officer presented a report on the development of
the CCGs Commissioning Intentions for 2014-15. He noted that Commissioning Intentions form part of the planning cycle each year and signal the start of the contracting process. The aim of Commissioning Intentions is to share with providers ahead of the formal contractual negotiation period the strategic direction of the CCG and to prepare them in advance of any proposed changes for them to consider. The letter to providers, a copy of which was discussed, outlines the high level proposals from the CCG and has been informed by discussions held with membership practices at the engagement session on 31 August and feedback from the Patient Revolution event in May 2013. The Commissioning Intentions have been developed through the CCG clinical work streams, led by GPs, also involving joint working with the Local Authority and will continue to be progressed through this route. They also take into account the financial challenges in the years ahead and focus significantly on quality of service. The Director of Public
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Health commented that the Commissioning Intentions should also address actual need rather than just reflect a more general equalities agenda. The Governing Body discussed the content of the letter following which it was agreed that some amendments would be necessary. In particular, the Chief Officer suggested that there was a need to amend the wording around activity levels, include issues of workforce planning and add a caveat around the future inclusion of emerging national imperatives. The Chairman suggested and it was agreed that the Governing Body approve the overarching principles outlined in the 2014-15 Commissioning Intentions and that further to amendment, the letter would be signed off by Chairman and Chief Officer Action under delegated powers, to be brought back to the meeting in November for endorsement.
13/057 AUTISM SERVICE
Dr Raja, Clinical Lead for Children, Young People and Maternity and Dr Tandy, Clinical Lead for Mental Health and Learning Disabilities presented a report outlining the requirement and priority to commission an autism assessment and diagnostic pathway for young people aged between 11 and 17 across Suffolk. By way of background they explained that a Suffolk-wide adult autism assessment and diagnostic pathway has recently been commissioned and fully implemented from July 2013. This was commissioned in accordance with the Autism Act 2009 as a mandatory statutory obligation to provide a service. Through the process of considering the needs of people with Autism Spectrum Disorders of all age groups across Suffolk, current commissioning gaps highlight the need for a similar service to be extended to include young people, specifically ages 11 – 17. A jointly funded two-year pilot programme with Ipswich and East Suffolk CCG is therefore proposed with a total service cost of £448k per annum, split 60% to Ipswich and East Suffolk and 40% to West Suffolk CCG. The proposed service would incorporate:
• An autism diagnostic service which is accessible and responsive to all those aged 11 and transitioning to secondary school to 17 years inclusive across Ipswich and East Suffolk and West Suffolk CCG areas
• Expert assessment and diagnosis • Short term intervention to address sensory, communication and
emotional adjustment needs associated with the diagnosis • Signposting people to services that will meet their needs and
maintain their well-being • Seamless transfer into mental health services where needed • Avoidance of current ‘falling between services’ with insufficient
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support • An inclusive approach supporting family carer needs • Consistency with NICE and other Department of Health
guidelines • Referrals received from professional sources including (but not
limited to) GP’s, health visitors, school nurses, social workers, primary mental health workers, educational psychologists or other practitioners and will be via the single point of access through Norfolk and Suffolk Foundation Trust’s (NSFT) Access and Assessment Service.
Dr Raja and Dr Tandy set out a number of key points including:
• The 2013-14 prioritisation processes identified £294k recurrent annual funding required for this service.
• This new provision will sit within the Wellbeing service as part of NSFT’s redesign strategy
• Whilst this is predominantly a crucially important quality initiative, financial savings are also expected in the following ways: Reduction in referrals to other mental health services Reduction in referrals to non-mental health services including criminal justice and social care
• It is not year clear exactly how much saving there will be with the impending introduction of Payment by Results, but this will be very carefully monitored throughout the two-year pilot in order to fully understand social care involvement and financial justification to fully mainstream the service
• This is predominantly a health service, although is expected to include some elements of social care and education. In line with this, outcomes will be evaluated to fully understand joint commissioning potential for future mainstream discussions nearing the end of the two-year pilot
• The introduction of this service aligns with the Health and Wellbeing Board Outcome 1, Priority 1; ‘Every child in Suffolk has the best start in life’ – ‘improve access to services for children and young people with autistic spectrum disorders’.
The Chief Officer, whilst supportive of the service, cautioned that a comprehensive evaluation of outcomes would be required in the face of increasing financial pressures. Demonstrable value for money will be essential and as such, the pilot must be fully reviewed. Further to discussion, the Governing Body approved the necessary investment to fund a two-year pilot in collaboration with the Ipswich and East Suffolk CCG.
13/058 INTEGRATED PERFORMANCE REPORT
The Chief Finance, Nursing and Interim Contracts Officers presented the detailed Integrated Performance Report, providing members with a
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(i)
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summary of performance for 2013-14 against national targets, contractual targets, clinical quality and patient safety issues, financial position and acute activity. Headlines The financial position at Month 4 is showing an underlying adverse variance of £0.2m against a revised forecast with significant risks remaining around Continuing Health Care Acute activity indicates outpatient, elective, emergency non- elective and A&E activity is over plan. Overall ambulance activity is below plan, but validated data is awaited Performance against the Local Quality Premium Indicators relating to both breastfeeding prevalence and stroke care remains below target for the year. Data for the third measure is not available Performance against the suite of national targets is generally good, although performance is not at the required levels in: 6 week waiting time target for diagnostic tests Emergency admissions for acute conditions that should not usually require hospitalisation Ambulance clinical quality indicators and ‘handover’ times MRSA and C.difficile YTD. The CCG has reported 3 MRSA bacteraemia for the year to date to the end of August (un-validated). The CCG has reported 23 C.difficile infections for the year to date to August (un-validated) against a ceiling of 19 Performance against the measures within the West Suffolk hospital contract is generally good, although performance targets were not achieved in: Direct access diagnostics YTD Choose & Book appointment slots A number of stroke quality measures A&E ‘single longest wait’
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Clinical Quality Recent CQC visits have highlighted some concerns There are concerns around Serious Incidents Requiring Investigation (SIRI) reporting at the West Suffolk Hospital. A contract query and remedial action plan is in place A ‘never’ event occurred at the West Suffolk Hospital in August that was reported to the CCG on 3 September.
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Service Performance Initial view of Month 4 acute activity indicates emergency non-elective activity is 1.8% (85) below plan. Other non-elective activity is 34.5% (596) below plan, with significant under- performance at Addenbrookes Hospital, which is being investigated. A&E activity is 11.0% (1,842) above plan. Ambulance Cat. A (Red) call activity is slightly above plan (1.8%), although overall activity is under plan In regard to compliance with national targets, the six-week referral to treatment (RTT) target is off plan as are ambulance response times. Financial Performance Acute: West Suffolk is reporting an overspend of £0.7m, it is across all areas but mainly due to elective cases & outpatient attendance. Other contracted activity is broadly on plan Other NHS: variance relates to underspend on acute activity provision and NCA; YTD is Month 1 & 2 actuals with accruals to budget for months 3 & 4. Non-NHS is an underspend on Minor Surgery within Planned Care Mental Health: favourable due to underspends on Learning Difficulties and Other Pooled Funds Community: favourable variance is mainly due to underspend on Children's ECR & Placements GP Prescribing: was £0.3m un-favourable based on the actual data for April and May with budgeted figures for June and July Continuing Care: shows an overspend of £0.4m due to increased activity Corporate Costs: £0.2m below plan. There are small favourable variances split equally between both pay and non-pay costs Responding to a question regarding poor performance by Serco as demonstrated in the KPI’s, it was reported that the CCG are having senior level discussions with the provider. Reassurances have been provided about their plans to address these issues that include a listening exercise with staff about the proposed changes to models of care and a workshop on 2 October to discuss key issues with them. There is a continuing focus on the contract through ongoing evaluation of the KPI’s. In conclusion, the Chief Officer noted that Serco have embarked upon a major change programme in order to improve service provision and the CCG needs to support this in order to avoid any negative impact on patient care. The Governing Body received and noted the report.
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13/059 EQUALITY AND DIVERSITY
The Lay Member for Patient and Public Involvement outlined the CCGs
proposed equality objectives for 2013-14. She noted that the CCG has a duty to comply with the Public Sector Equality Duty and that the Equality and Diversity Plan 2012-15 was approved in September 2012. A key requirement of the Public Sector Equality Duty is to prepare and publish at least one equality objective at least every four years. CCGs have been given guidance from NHS England and are expected to publish their equality objectives by 13 October 2013. West Suffolk CCG, like most NHS organisations nationally, uses the NHS Equality Delivery System (EDS) toolkit to support the setting of equality objectives and to monitor progress. The EDS consists of a series of measures to assist organisations in assessing their performance on equality and diversity. As part of the authorisation process, the CCG initially adopted the three equality objectives prepared by NHS Suffolk in April 2012:
• Changes across services for individual patients are discussed with them, and transitions are made smoothly
• Patients, carers and communities can readily access services, and should not be denied access on unreasonable grounds
• Middle managers and other line managers support and motivate their staff to work in culturally competent ways within a work environment free from discrimination
To consider whether these objectives were still the most appropriate for the CCG to pursue, evidence of performance was collated across all of the measures included in the EDS (not just for the three areas above). Evidence relating to and affecting patients and the public was presented to members of the CCG’s Community Engagement Group, members of Ipswich and East Suffolk CCG’s Community Engagement Partnership and other individuals and organisations representing diverse groups on Friday 6 September. Evidence relating to and affecting staff was presented to the Joint Staff Partnership Committee on 5 September. This evidence included the results of a short staff survey about equality and diversity in the organisation. Further to a comprehensive grading exercise and the feedback received from discussions, it is proposed that West Suffolk CCG pursues the following equality objectives for at least the remainder of 2013-14:
• Patients and carers experience joined-up healthcare, ensuring access to the right services at the right time
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• The CCG will improve use of equality data and information about
west Suffolk’s diverse population and communities to inform its work
• The CCG will improve the way that the Governing Body and
Executive can learn from healthcare experiences of diverse and marginalised individuals, groups and carers
• Senior leaders and other line managers provide leadership,
support and motivation for their staff to uphold the CCG’s value of equality of opportunity to improve the health of those most in need
There will be a series of specific performance measures under each objective, as well as a detailed action plan to ensure progress is made. In conclusion, the Chief Officer emphasised that it will be important to ensure that the objectives are embedded into the culture of the organisation and thereby influence day-to-day operations. The Governing Body considered and approved the proposed equality objectives for 2013-14 and noted that they will be published by 13 October as required by NHS England.
13/060 MINUTES OF MEETINGS
Presented by the Lay Member for Governance, consideration was given
to the minutes of the following meeting:
• Audit Committee: 3 September 2013 – unconfirmed Presented by the Lay Member for Patient and Public Involvement, consideration was given to the minutes of the following meeting:
• Community Engagement Group: 13 September 2013 - unconfirmed
The Governing Body received and endorsed the minutes.
13/061 GOVERNING BODY ASSURANCE FRAMEWORK
The Chief Corporate Services Officer presented the Governing Body
Assurance Framework (GBAF). Content of the GBAF is reviewed by the Chief Officers Team every month and by the Governing Body and Audit Committee at each of their meetings. Further to review by the Chief Officers Team in August and September 2013, the following amendments/additions have been incorporated: Risk 01: Failure to safely manage surges in patients requiring urgent
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care during the winter period across West Suffolk and impact on ability to deliver 95% A&E target and ambulance turnaround targets: Change to Description of Risk, RAG rating reduced to 16 (red: critical) + additions to action plan/timeline Risk 02: Failure to achieve ongoing financial balance beyond 13/14 and deliver optimum service from the financial resources available: Amendments to key controls + action plan/timeline Risk 03: Contractual breaches with out of hours service (Harmoni) in relation to patient safety and clinical quality: Amendments to action plan/timeline Risk 04: Failure to achieve the national & regional targets for MRSA: Amendments to action plan/timeline
Risk 06: Failure to achieve the national & regional targets for Clostridium difficile as established: Amendments to action plan/timeline Risk 07: Loss of confidence in Serco model of care and transformation as a result of staff consultation + Major change introduces instability: Amendments to key controls and assurance of controls + action plan/timeline Risk 08: Failure to deliver performance standards and quality of care at Addenbrookes Hospital (CUHFT: Amendments to action plan/timeline Risk 09: Service risks as a result of the NSFT proposed service redesign model: Amendments to action plan/timeline Risk 10: Failure to monitor and report key quality metrics impeding early warning systems to inform commissioners and regulators of potential risks and deteriorating standards of care: Amendments to action plan/timeline Risk 11: As a result of the NHS white paper there is no legal basis for CCGs to receive, retain and process patient identifiable data: Amendments to action plan/timeline Risk 12: Implementation of Transforming Pathology Services + Potential cost pressure around anti coagulation, pathology services & phlebotomy: Amendments to key controls and assurance of controls + action plan/timeline Risk 14: Failure to comply with NHS continuing Health care Framework: Amendments to granular risks, key controls + action plan/timeline Risk 15: Reputational risk to the CCG from the role of lead commissioner for the East of England Ambulance Service Trust: Amendments to action plan/timeline
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_____________________________ _______________________ Chairman Date
Risk 16: Risk of sub optimal clinical outcomes for stroke patients: Amendments to action plan/timeline The Governing Body noted the report.
13/062 ANY OTHER BUSINESS
There was no other business.
13/063 DATE OF NEXT MEETING
The next meeting of the West Suffolk CCG in public will be held on Wednesday 27 November 2013 at 09.00 in the Lounge at The Athenaeum, 1 Angel Hill, Bury St. Edmunds, Suffolk.
QUESTIONS FROM THE PUBLIC
(i)
(ii)
(iii)
Commissioning Intentions Responding to a question as to why a move to Payment by Results (PbR) is mentioned in the Commissioning Intentions for mental health services when Monitor have suggested this should not go ahead, it was noted that there is currently a lack of clarity in Monitor’s position but in any event, the CCG would not move to PbR until there is full confidence in the necessary data. Serco Health In response to an enquiry about current data quality issues with Serco, it was confirmed that a contract query is in place because of this. Suffolk Community Healthcare In reply to a question about Suffolk Community Healthcare, the Chief Officer stated that rather than being underfunded over many years, the organisation had struggled with improving efficiencies. However, the new provider, Serco Health have now started to implement more efficient working methods allowing clinical staff to spend more time with patients. The reference to underfunding had been on the basis of the previous organisation of staff for the service provided. The meeting closed at 12.35pm
WEST SUFFOLK CCG Governing Board ACTION LOG: 25 September 2013 2013 MINUTE DETAILS ACTION BY WHOM UPDATE 13/054 25/09/13
Integrated Care Action Plan Update to be provided at the next Governing Body meeting in November in regard to the return on investment at the West Suffolk Hospital for the digitilisation of patient records
13/056 25/09/13
Commissioning Intentions Commissioning intentions letter to providers to be amended in line with discussion and including particular reference to activity levels, issues of workforce planning and add a caveat around the future addition of emerging national imperatives. Once completed, to be signed off by the Chairman and Chief Officer Action under delegated powers, to be brought back to the meeting in November for endorsement.
Dr Ed Garratt Dr Christopher Browning / Julian Herbert
13/035 17/07/13
Urgent Care Paediatric GP Telephone advice line
Dr Raja to consider overall admissions from the West Suffolk area.
Dr Raja Completed
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Agenda Item No. 06 Reference No. WSCCG13-036
REPORT FROM: Colin Boakes, Governance Advisor
SUBJECT: Approval of the CCG Policy Development Policy and four other Information Governance Policies
1. Background
As part of the necessary evidence and assurance in relation to information governance, the CCG is required to approve and place into circulation a portfolio of polices.
Due to the current issues around CCGs ability to handle personal confidential data and the consequent need to become accredited safe havens, the deadline for the completion of a satisfactory information governance toolkit return was brought forward to September 2013, instead of the previous deadline of March 2014. Not having approved information governance policies in place constituted a key risk for the CCG as it would have been unable to meet the required deadline.
It was not permissible for the former PCT’s policies to be directly adopted and as a new organisations the CCG did not have an agreed methodology for the creation, review and approval of policy documents. To resolve this and also to allow further polices to be developed in accordance with a consistent agreed approach, a Policy Development Policy has been produced.
This policy has undergone significant and wide ranging review by the communications team, the Information Governance Group, Head of ICT and Informatics and Chief Officers. Based upon this document a further group of information governance polices have also been produced. The approval of these was required to provide the necessary evidence within the information governance toolkit return that the CCG is addressing the management of information governance in an appropriate manner.
2. Key Points
The Policy Development Policy places the responsibility for future policy approval, under delegated powers, with three Governing Body Sub-Committees; the Remuneration and HR Committee, Audit Committee and Clinical Executive Committee. This is considered an appropriate route which avoids the Governing Body having to approve a significant number of policies, particularly over the next few months as the CCG rebuilds its policy base. Since the proposed policy approval process is not yet embedded within the CCG it was felt appropriate, particularly given the tight timescales required to achieve a
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satisfactory IG toolkit return by the end of September, for the Chief Officers Team to review the Policy Development Policy and the other four relevant information governance policies, all of which have undergone the same extensive review with comments and amendments incorporated where appropriate. Having reviewed the policies, the Chief Officer Team was content that they were fit for purpose and once approved could be reviewed in accordance with the Policy Development Policy if it was felt that further amendments were required.
3. Approval The Chairman and Chief Officer therefore approved under delegated powers:
• The Policy Development Policy
They also approved:
• The Data Protection Policy • The Records Management Policy • The IT Security Policy • The Data Quality Policy
The Governing Body is therefore requested to endorse the Chairman and Chief Officer Action
Author: Colin Boakes Governance Advisor November 2013
Agenda Item No. 07
Reference No. WSCCG13-037
From: Sandy Hogg, Executive Lead for Stroke, Suffolk CCGs
EARLY SUPPORTED DISCHARGE FOR STROKE
1. Purpose
1.1 In September 2013, the Governing Body agreed to conduct a patient and public engagement process in relation to Early Supported Discharge Services for Stroke. The engagement ran across both West Suffolk and Ipswich and East Suffolk CCGs for six weeks, ending 5th November. The Governing Body is asked to note that by the end of the engagement 124 responses had been received, 7 meetings with community groups and 2 radio interviews had taken place.
1.2 The Suffolk Stroke Review Project Board reviewed the report on the engagement, which had been independently compiled by Healthwatch Suffolk. A number of changes were made to incorporate the findings of the engagement exercise, particularly in relation to individualised care plans, training and support for carers should be strengthened. The Governing Body is asked to note that the Project Board has approved the final service specification.
1.3 The Governing Body is asked to note that the revised service specification has subsequently been approved at both CCG Clinical Executives.
1.4 The Governing Body is asked to approve the commencement of procurement against the service specification.
1.5 The Governing Body is asked to note that CCG Officers will continue to work with Healthwatch to ensure that the patient and public are informed as to how their input has informed the development of the service.
2. Background
2.1 In March 2013, the Governing Bodies of both Suffolk CCGs received the results of a local review into stroke services and their comparison to the standard set out in a model service specification published by NHS Midlands and East. The Governing Bodies released a statement of intent which stated that the CCGs wished to (i) commission hyper acute stroke services at both trusts (ii) establish an early supported discharge service. A Project Board was established with oversight of two work streams dedicated to these priorities.
2.2 The original draft was produced by the Early Supported Discharge work stream, supported by public health, clinical, managerial and therapy leads from the CCGs, acute hospitals, community healthcare and social care. Patient involvement consisted of representation on both the work stream and the Project Board.
2.3 In September 2013, the Governing Bodies received a presentation on the service specification and approved the commencement of public and patient engagement.
3. Results of Patient and Public Engagement
3.1 On behalf of the Suffolk Stroke Review Project Board, Healthwatch Suffolk compiled an independent report of the124 responses to the survey (which was formulated with the help of the Stroke Association) and the 7 face-to-face meetings with community groups.
3.2 The report demonstrated a good range of respondents, including former patients from both acute trusts, general public, carers, and persons with the community with expertise and experience in dealing with the issues tackled by the specification. The demographics included a significant physical impairment (61%), sensory impairment (13%), long-term health condition (16%), disability (35%) and delivering support to a significant other (i.e. partner, child, friend etc.) was (18%)
3.3 The overall conclusion of the report was, “In conclusion, the development of the new ESD service is considered practical, achievable, affirmative and progressive and has enthused a largely optimistic cohort on its virtues.”
3.4 The specific recommendations of the report were also considered. The Suffolk Stroke Review Project Board made changes in three major areas:
(a) Development of individual bespoke care plans
(b) Training
(c) Carers
3.5 In respect of individual bespoke care plans, the specification’s provisions has been strengthened. The following patient-reported KPIs, in addition to clauses within the specification, have been developed with the help of the Stroke Association:
• ‘How did you find the service?’
• ‘Were you treated with respect?’ (Always, mostly, seldom, never)
• ‘Did you feel fully involved in setting goals for your treatment?’
• ‘Did you feel that the service helped your recovery?’
3.6 The providers’ responsibilities in relation to training and continuing professional education of its staff has been strengthened, and the role of the clinical psychologist has been aligned to NICE Clinical Guidance.
3.7 Support for carers has been increased – in particular, the following provisions are contained within the specification:
• There is an information requirement in the specification requiring the provider to record the ‘Number of carers receiving a needs assessment using a validated tool (e.g. Caregivers Strain Index)’.
• In addition, the specification states that aim of the service is to “ensure carers are appropriately educated and trained to recognise common causes of illness that result in avoidable admissions e.g. constipation, urinary tract infection”
• ‘Where entry into early supported discharge is dependent on a carer, the provider will in advance telephone or meet the carer to discuss how in detail how stroke affects patients, both physically and cognitively. The service provider is expected to provide full and ongoing training and support to the carer to enable him or her to appropriately support the patient.’
• The following KPI has also been added, “Did you, as the carer, receive sufficient training and information prior to and during the patient’s treatment by the Early Supported Discharge Service?’ A threshold of 85% has been placed on this indicator.
4. Principal Features of Final Service Model
4.1 Under the final service specification, the service provider will work with inpatient Stroke Units to identify patients who are suitable for rehabilitation in their own home. The identification process makes use of evidence-based criteria, particularly in relation to the patient’s ability to transfer from bed to chair (either independently or with the support of a carer) and the Barthel Score, which measures patients’ ability to undertake activities of daily living (such as walking and dressing). It is estimated that approximately 400 patients per year would be suitable.
4.2 The Early Supported Discharge will provide physiotherapy, occupational therapy, speech and language therapy and clinical psychology, as appropriate to identifiable rehabilitation needs, goal-setting by patients and NICE Clinical Guidelines. According to a recent review of clinical trials, this package reduces a patient’s chance of death or admission to a care home to a greater extent than inpatient rehabilitation.
4.3 The service would also provide significant support to carers and be required to collect carer-reported key performance indicators, as outlined in Section 3.
4.4 The full version of the service specification is available from Dr Mark Lim, at Rushbrook House, Paper Mill Lane, Bramford, Suffolk IP8 4DE or alternatively [email protected]
5. Recommendation:
5.1 The Governing Body is asked to approve the commencement of procurement against the service specification.
Author: Dr Mark Lim
Agenda Item No. 08 Reference No. WSCCG13-038
From: Sandy Hogg – Chief Redesign Officer, Ipswich & East CCG Part 1 Part 2 GOVERNING BODY REPORT: 111 Programme Team Closedown Report 1. Purpose
The new 111 service for Ipswich and East Suffolk and West Suffolk was publicly launched on 19th February 2013 on time and within budget.
2. Background
The service has been well received by the public and the patient community as well as by our colleagues in other areas of the local health economy.
3. Key Points
The service has met and continues to meet key performance indicators and the service has performed well overall. The programme has been led on behalf of Ipswich and East Suffolk CCG and West Suffolk CCG, by Sandy Hogg, Senior Responsible Officer and the Clinical Governance Leads Dr Billy McKee and Dr Simon Arthur with formal governance arrangements in place, including a Project Board. The service is provided by Harmoni Healthcare. The 111 project team has been working closely with the contract team and the patient safety and quality teams in managing the implementation programme. The transition of the programme to business as usual has formally been in place since September 2013, with the project team remaining in a supporting role. The transition will be complete at the end of November 2013 when the contract will be managed by the Chief Contracts Officer, as is the case with all other CCG contracts. Other CCG Chief Officers and GPs will support the management of the contract, again as is the case with all other provider contracts.
Reporting requirements to the Area and National teams for all regular reports are prepared and submitted by the provider, Harmoni. This will be managed by the CCG’s Business Intelligence team. As previously reported the service has experienced continuing challenges over the volume of ambulance dispatches and the sustained performance of warm transfers to Clinical Advisors, both of which are being actively addressed through the contract route, as would be the case for any contract queries experienced on provider contracts.
4. Recommendations
The Governing body is asked to note that the formal project arrangements to implement and manage the new 111 service in Suffolk have been successfully achieved and that from 1st December, 2013, the management of the service will be through the usual commissioning and contracting mechanisms.
Author: Sandy Hogg
Agenda Item No. 09 Reference No. WSCCG13-039 From: Part 1 Part 2 BOARD REPORT: Urgent Care Strategy: Engagement Programme Report from: Dr Emma Derbyshire, Clinical Executive Lead for Integrated Care 1. Purpose 1.1 To share with CCG Governing Board members, the engagement programme with local
stakeholders on the future shape of urgent and emergency care in west Suffolk. 1.2 To seek members’ approval to the underpinning principles for an improved urgent and
emergency care system.
2. Background 2.2 Urgent and emergency care is under review nationally as part of a drive by NHS England to
promote more extensive seven day services in the NHS and to improve the way in which services for local people are provided. The national concerns around A&E have been seen as a stimulus and opportunity to take this forward now and as a priority for local systems to examine how services can be organised better. More information about the national review on Urgent and Emergency care can be accessed via the following link: http://www.england.nhs.uk/ourwork/pe/uec-england/.
2.3 Locally we have also had concerns about A&E performance and the increasing demand on all our urgent care services. The CCG recognises, like other health systems across England, that an aging population, more long term health conditions and better technologies to improve healthcare all have an impact. If we continue as we are, our local services are not sustainable. To mitigate against this we have to work closely with our system partners, including Suffolk County Council, to develop different and improved ways of working.
2.4 In 2015 three important contracts come to an end: Serco NHS community services,
Harmoni ‘111’ and Harmoni primary care Out of Hours service. We need to give the providers notice during this year’s contracting period of any changes we want to see in how services are delivered and begin the process of redesign now to meet the procurement timeframe.
3. Key Points 3.1 The CCG has been working with Ipswich and East CCG to develop a set of high level
principles that we believe should underpin an improved urgent and emergency care system. These are in line with the recommendations from the national review and are:
• An integrated model with an overall responsibility for urgent care across the
population – primary, community, mental health, social care, secondary care and the voluntary sector working as part of an integrated system with common objectives, with increased access to a broader range of urgent care responses in the community, to reflect the increased complexity likely to arise from increased multi-morbidity and population changes.
• Available 24/7 with consistently high quality patient outcomes across the Urgent Care System.
• Accessed and coordinated via a single system. • Having shared access to information systems ideally with a single care record. • Urgent Care to be delivered where most appropriate in the system and supported
by a shift in resources. • Facilitating the training and development, long-term, of professionals and leaders
that are well equipped to deal with the greater complexity with which urgent care patients will present in the future. These opportunities would be made available to local professionals in all stages of their careers.
3.2 In October the CCG executive agreed:
• the principles for an Urgent Care System in Suffolk • to work jointly with Ipswich & East Suffolk CCG to design an Urgent Care system
based on these principles, recognising that there will be aspects to the service model which will be common to both CCGs and aspects which may be discrete to each locality
• to work jointly with Suffolk County Council to develop an integrated Health and Social Care Urgent Care System
• to work with key stakeholders in the design of the new Urgent Care System • that the Chief Redesign Officers work with the CCG Clinical Chairs to design an
appropriate governance framework to deliver the new Urgent Care System, for approval by the CCG Clinical Executives. The design will recognise the role of the Urgent Care Board in West Suffolk and the Integrated Care Network in Ipswich and East Suffolk in co-ordinating and managing the current system of Urgent Care
3.3 The CCG is planning to engage with stakeholders and public forums throughout November
and December on the high level principles and what a good Urgent Care System looks like. Local providers have already been invited in a letter sent out by the CCG Chair in October to participate in the redesign through their established clinical and organisation forums.
3.4 The CCG has invited local providers and membership practices to a workshop on the
evening of 5 December. The workshop is a key event in bringing representation from across the health and care system to explore the principles in detail and begin to shape an integrated model for west Suffolk.
4. Recommendations 4.1 The Governing Body is requested to note this important strategic programme of change
and the importance of early engagement with local stakeholders 4.2 The Governing Body is also asked to sign off the high level set of principles. Author: Sandie Robinson, Head of Planning and Delivery 13/11/2013
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From: Part 1 Part 2 BOARD REPORT: Commissioning Intentions 2014/15 Report from: Dr Ed Garratt Chief Operating Officer 1. Purpose
To share with CCG Governing Board members the final version of the CCG Commissioning Intentions 2014/15.
2. Background Commissioning Intentions from part of the planning cycle each year and
signals the start of the contracting process.
The aim of Commissioning Intentions is to share with providers ahead of the formal contractual negotiation period the strategic direction of the CCG. The development of the Commissioning Intentions was progressed through the Clinical Work-streams informed from discussions held with membership practices and feedback from the Patient Revolution event in May.
3. Key Points The final draft of the CCG Commissioning intentions was taken to the CCG
Governing Board on the 25 September and the final version was sent out to Accountable Officers of Suffolk providers on the 30 September.
4. Recommendations
The CCG Governing Board is asked to note the final submission sent to Provider organisations.
Author: Sandie Robinson, Head of Planning and Delivery 12.11.13
Agenda Item No. 10 Reference No. WSCCG13-040
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Date: 30 September 2013
Dear Initial Outline Commissioning Intentions 2014/15 This letter sets out the initial outline commissioning intentions of the West Suffolk Clinical Commissioning Group (WSCCG) for 2014/15. It signals the start of the contracting process and is designed to:
• Outline the CCGs strategic direction; • Give advance warning of changes, opportunities and threats to providers.
The next two years will be financially challenging for WSCCG and it is likely that substantial efficiencies (in the region of 2 – 3% per year) will need to be made particularly in 2015/16. 2014/15 will therefore be a year where radical pathway redesigns are considered and difficult decisions are made about services which could result in decommissioning in some areas. 1. Strategic Initiatives WSCCG aims to deliver the highest quality health service in the west of Suffolk through integrated working with patients and stakeholders. We have worked hard to engage with our local patients and stakeholders through patient revolution events and this feedback has fully influenced our work plan. In addition we have worked closely in developing these commissioning intentions in conjunction with our key statutory partners such as Suffolk County Council. We also work as part of a broader system, County wide, regionally and nationally and our priorities also therefore reflect this. These commissioning intentions will need to reflect existing and emerging national and regional guidance and policy. WSCCG has developed six clinical priorities as set out below which will help deliver our ambition;
St Andrews Castle St Andrews Street South
Bury St Edmunds Suffolk IP33 3PH
Tel: 01284 774794 Fax: 01284 760529
www.westsuffolkcommissioning.co.uk
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• Develop clinical leadership; • Demonstrate excellence in patient experience and patient engagement; • Improve the health and care of older people; • Improve access to mental health services; • Improve health and wellbeing through partnership working; • Deliver financial sustainability through quality improvement.
It should be noted that there are existing projects and programmes of work that WSCCG will continue to implement and develop with providers. This document does not include ongoing review of existing contracts for services which are a recurring requirement. The focus of this document is to signal either a new or extension of existing developments that will be a priority in 2014/15.
i. Public and Patient Involvement Public and patient involvement has been an exceptionally important part of our commissioning intentions process this year. We want to improve how we operate so that patients and the public genuinely have a say in how we plan our work programme. So far we have:
• A vibrant Community Engagement Group, which is a sub-committee of the CCG;
• Held two specific commissioning intentions workshops for integrated care and planned care – the two largest areas which need massive service redesign.
• Held an event attracting 200 members of the community to share their views on services;
• Encouraged 300 members of the community to sign up to a Health Forum, where we share information and ask for views on general services.
In the future we will:
• Make sure all service areas have patient and public representation to meaningfully affect commissioning intentions in the future;
• Grow our Health Forum membership and share our progress; • Ensure our Community Engagement Group guides us to further improve our
patient engagement in all areas.
ii. Patient Safety and Quality
WSCCG fully embraces the recommendations of the ‘Francis Report’ from its development of a direct email address to enable communication from GPs on commissioned services to the development work undertaken on the structure of visits by the Clinical Commissioning Group to services, in reviewing quality and patient safety. We note here our intention to implement the recommendations of the over-arching report by the National Advisory Group on the Safety of Patients in England, A Promise to Learn – a Commitment to Act, Improving the Safety of Patients in
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England. This approach supports that patients and their carers should be present, powerful and involved at all levels of healthcare organisations from wards to the boards of trusts. iii. Healthy Ambitions
In partnership with Public Health and Suffolk County Council (SCC) the prevention programme aims to improve the health and well-being of the population of the west of Suffolk and to reduce health inequalities. Through agreeing performance indicators or incentive schemes the programme will:
• Improve access to Alcohol and Substance Misuse treatment services; • Improve access to psychological therapy for those within alcohol and
substance misuse treatment services increasing their changes of achieving recovery and improving their quality of life;
• Ensure all patients flow through the weight management pathway appropriately and only have bariatric surgery when everything else has failed.
More specifically the programme has the following intentions:
• Previous needs assessment (ARCS, 2008) and current alcohol health needs assessment (2013) identify A&E as an under-utilised source of referrals to drug and alcohol treatment services (including frequent attenders). The introduction of routine alcohol and substance misuse screening, signposting and referral to appropriate services could move individuals with alcohol and substance misuse needs into planned treatment, rather than reactive acute care;
• Improve lower level mental health support to substance and/or alcohol misusers via the Wellbeing service. To aid individuals chances of recovery;
• Reduced ‘did not attend’ rates for individuals referred from the Marginalised Vulnerable Adults Service to CRI (Substance Misuse Treatment Service) or the Suffolk Alcohol Treatment Service (Norfolk and Suffolk Foundation Trust) could decrease demand on A&E services;
• A review of the obesity pathway and weight management treatment services could improve the quality of interventions for those requiring bariatric care and reduce costs. In particular there is a need to establish Tier 3 support in county rather than use Addenbrookes and ensure that all patients should first be offered Tier 2 support before escalation.
iv. Integrated Care
Overarching aims of the Workstream The Integrated Care Workstream aims to improve patients’ experience of urgent care, reduce the number of emergency admissions, length of stay in hospital and the number of people who are placed into long term care by:
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• Bringing all elements of the health and care system together to manage more people away from crises, urgent care support and into planned care interventions including self-management;
• Ensuring that the provision of emergency and urgent care has fully integrated 24/7 services and a simple way for patients to access them.
The Workstream will be focussing on three particular areas of development over the next two years which include:
• Improving the delivery of emergency and urgent care through whole system redesign;
• Further development of primary and secondary prevention of ill health through interventions such as assistive technology and community development programmes that can safely support people at home;
• Enhancing the current provider landscape through joint working with SCC commissioning colleagues to formally recognise the role of family carers, voluntary and independent organisations as partners of care.
As the first key priority initiative, the CCG will work with the urgent care system and, in partnership with Suffolk County Council, develop a new model of Emergency and Urgent Care provision in the west of Suffolk informed by the key principles arising out of the National Review 2013/14. This will include the review of service specifications for primary care out of hours services, Urgent access number ‘111’ and Community Services (in line with contract end dates).The new model will aim to go live in 2015 and will give consideration to:
• Integrated “whole system” care coordination 24/7; • Single point of access; • Access to range of responses including specialist urgent care support outside
an acute hospital 24/7; • Shared information across care pathway; • The use of assistive technology.
As the second key priority initiative, the CCG will work with Ipswich and East CCG to implement the stroke specification for hyper acute stroke care locally. The CCG will procure the early supported discharge element of the stroke pathway in 2014. As the third key priority initiative, the CCG will build on the work programme of 2013/14 around supporting frail people at home with a focus on the development of community networks which will include:
• Further development of the virtual wards with access to Comprehensive geriatric assessment;
• Market development that includes a broader range of services to support primary and secondary prevention of ill health that could be delivered in partnership with local communities;
• Implementation of the self-management strategy; • Implementation of the family carer’s strategy.
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The fourth key priority initiative is for the CCG to improve patient experience and health outcomes by:
• Reducing the length of stay of frail elderly within an acute and community hospital;
• Providing alternatives to long term home care placements by:
• Further development of the pull based discharge pathway across the system;
• Exploring the joint commissioning of episodes/packages of care as a forerunner to Payment by Results (PbR) in Community contracting;
• Develop alternatives with the third sector (voluntary and charitable) for longer term rehabilitation/reablement.
v. End of Life (EoL)
Overarching aims of the Workstream This Workstream aims to:
• Support more people dying in their preferred place; • Ensure EoL care is open and accessible to all within the West Suffolk CCG
Locality; • Ensure the patient experiences the best possible death in the preferred place
or usual place of residence; • Support the development of a well-educated workforce via an agreed EoL
care education and training programme in order to deliver services closer to home;
• Ensure provision of an integrated, 24/7 crisis response service. The following work programmes from 2013/2014 need to be further developed in order to fully embed into everyday clinical practice:
• End of life education across acute/hospice/community care – 95% coverage of training within care homes and primary care by March 2015;
• Electronic Palliative Care Co-ordination System; • Advanced Care Planning (ACP) initiative including Yellow Folders – 95% of
patients identified at end of life to have an ACP agreed; • User involvement.
vi. Planned Care
Overarching aims of the Workstream:
• That services are local, where possible, and clinically appropriate with integration between healthcare providers and timely communication;
• For shared decision making to be throughout the pathways and patients with long term conditions to feel supported;
• That all patients receive the right care in the right place at the right time.
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There are a number of areas which the CCG wish to focus on next year which are outlined below. West Suffolk Pain Model
• Fully implement and monitor the impact of the newly developed Pain Pathway (Tier(s)1-3).
Ophthalmology Service
• Sustain and develop further services for the commissioned model for referral refinement and extended service providers. Develop a community service for the stable Glaucoma and wet Age-related Macular Degeneration (AMD). Review further opportunities to develop services in the community.
Clinical Management Service (CMS)
• CMS is currently operating at West Suffolk Hospital in a number of specialities to provide GPs with electronic advice and guidance on managing patients where clinically appropriate, thereby reducing the need for some patients to visit hospital.
• The CCG plans to extend CMS across all specialties (where appropriate) at West Suffolk Hospital.
• Develop further providers to offer CMS to GPs. • Embed CMS to be the first choice for GPs on routine referrals. • Link CMS with other advice and guidance options with other providers such
as Cambridge University Hospitals Trust (CUHT). Trauma & Orthopaedics (T&O)
• Develop community carpal tunnel opportunities with further providers. • Review opportunities to deliver joint injections in the community. • Review the virtual fracture clinic pilot with consideration to mainstream and
extend to other T&O areas. Diabetes Services
• Review and refresh the diabetic strategy for services in the west of Suffolk for patients with diabetes.
• Work with providers to commission diabetic services in the community as demonstrated from the outcomes of the pilot and review undertaken in 2013/14.
• Develop an urgent integrated diabetic foot service.
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Cardiology
• Review community services for cardiology, especially for heart failure patients.
• Following the review develop community options for an integrated cardiology service.
Respiratory
• Review rehabilitation services in the community to ensure patients are offered an effective, timely and accessible multidisciplinary pulmonary rehabilitation programme.
• Develop services to ensure people with Chronic Obstructive Pulmonary Disease (COPD) are supported to manage their condition.
Dermatology
• Explore the possible development of a community dermatology service. Female Continence Service
• Develop and implement a community based female continence service. “One Stop Shops”/ Multidisciplinary Clinics
• Work with providers to develop clinically appropriate ‘one stop shop’ approaches to treat patients in order to reduce unnecessary clinic appointments and diagnostic procedures.
Development of telemedicine and non-face to face approaches to managing patients (e.g. telephone advice)
• Work with providers to explore opportunities to embrace technology and build on CQUIN digital by default approaches to ensure better use of skill mix and local pricing to deliver outpatient alternatives.
GP Practice Referral Support
• Develop a support package for GPs on the pathways and appropriate services to secondary care.
• To support GPs in reviewing their referrals in relation to their peers and any subsequent outcomes e.g. education events.
vii. Planned Care (High Cost Drugs) Overarching aims of the Workstream
• Ensure that there is a consistent, evidenced-based, cost-effective commissioning programme for the implementation of all tariff excluded high cost drugs;
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• Work collaboratively with acute trusts to create savings for the local health economy as a whole;
• Support the local trusts in repatriating activity. Ensure that only drugs are funded for which consistent evidence exists:
• Work directly with providers to ensure a series of robust terms relating to high cost drugs are incorporated into the contracts;
• Ensure that NICE Technological Appraisals (TAs) are implemented within 90 days;
• Provide horizon scanning to forecast the likely impact of new NICE TAs before their implementation.
Ensure value for money:
• Maintain systems for the facilitation of appropriate payment and checking of all high cost drugs invoicing;
• Work with providers to ensure that patient confidential data issues have minimum impact on our ability to ensure public money is only spent on the most cost-effective treatments.
Improve patient experience and quality:
• Work with providers to review the use of high cost drugs with a view to repatriating care where possible;
• Work with the local providers to increase the basket of drugs available via homecare;
• Take a holistic view to patient care and the heath economy as a whole to look at moving Acute delivered High Cost Drugs into homecare.
viii. Medicines Management Overarching aims of the Workstream
• To encourage safe, appropriate, evidence based and cost effective prescribing;
• To promote adherence to the same prescribing recommendations across primary and secondary care;
• To promote adherence to the Traffic Light System, as developed by the Suffolk CCGs’ Drug and Therapeutics Committee and Clinical Priorities Group;
• To align actual prescribing spends with practice prescribing budgets. Prescribing Recommendations Implementation of the following:
• Metrics developed by the WSCCG Medicines Management Team;
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• Metrics developed by NHS PrescQIPP, including DROP List (drugs of low priority);
• WSCCG ScriptSwitch recommendations; • Dietetic reviews.
Traffic Light System
• Adherence to the classifications posted on the WSCCG Traffic Light System; • Development, ratification and use of Shared Care Agreements for all drugs
that have been classified as amber, i.e. drugs that are recommended for initiation by a secondary care specialist then transferred to GP prescribing under the terms of a Shared Care Agreement;
• Development, ratification and use of checklists, where appropriate, to demonstrate compliance with NICE TAs before the prescribing of green drugs (hospital initiated, GP prescribed) is transferred from secondary care specialists to GPs.
Medicines Optimisation
• Implementation of medication reviews in accordance with guidelines detailed in the NHS PrescQIPP document: Optimising Safe and Appropriate Medicines Use;
• Collaboration with WSCCG sessional pharmacists to optimise drug treatments for patients who are on complex regimes, e.g. those who are prescribed more than ten items. This should include patients in care homes.
ix. Mental Health
Overarching aims of the Workstream
• Mental health provision will be open and accessible to all people who need it regardless of their age and the diagnosis and severity of their mental health condition.
• No mental health service user should need to be returned to their GP for onward referral for another mental health service.
• Commission mental health and learning disability services which are integrated with the wider health and social system and which support the recognition that people’s mental health should be seen as part of their overall physical and mental wellbeing. This will apply to all people regardless of their age including those marginalised from society.
Norfolk and Suffolk Foundation Trust (N&SFT) Service Delivery The CCG will work with Ipswich and East Suffolk CCG in order to recognise our common local mental health provider, whilst reflecting any local differences in service priorities to further embed the new service model with an emphasis on:
• Embedding Mental Health PbR to ensure consistency in care packages so that they meet local needs whilst eliminating financial risk to commissioners and providers.
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• Reviewing the effectiveness of new service pathways and 2013/14 CQUINS to make sure there is a robust crisis response and they meet the needs of people with personality disorders and dual diagnosis.
N&SFT and West Suffolk Hospital Psychiatric Liaison Service
• Work in partnership with N&SFT and West Suffolk NHS Foundation Trust to extend the 2013/14 Psychiatric Liaison Service CQUIN scheme into 2014/15, to include an evaluation of future commissioning arrangements identifying potential areas to further extend the service, possibly children and young people aged under 18, outpatients and long term conditions and medically unexplained symptoms.
Child and Adolescent Mental Health Services (CAMHS) (see also CYP programme)
• Embed and reinforce the new commissioning model and specification for the emotional wellbeing of children and their families through a joint commissioning approach between health and social care for; a comprehensive service across tiers 1 – 4 drawing together the wider network including education, social care and third sector; ensure a broader focus on early intervention and prevention, particularly developing conduct disorders and enhancing Tier 2 Primary Mental Health Workers (PMHW’s).
Dementia
• WSCCG has set a target that by the end of 2015, 66% of those people with dementia will have received a diagnosis evidenced by the numbers on primary care QoF registers.
• To deliver this target, the CCG will commission additional diagnostic capacity and ensure sufficient post-diagnosis support through joint commissioning (with SCC) of community based services from statutory and third sector providers.
• Integrate the Dementia Intensive Support (DIST) service (funded via re-enablement monies) into the N&SFT Complexity in Later Life pathway. This service must then in turn fully integrate with the Suffolk Community Healthcare Community Intervention Service in order to reduce the number of unplanned admissions into acute hospital.
• Agree with all providers a methodology for systematically tracking dementia patients across services.
Joint working with Partners such as Suffolk County Council (SCC)
• Mental Health Pooled Fund: Review the current joint commissioning arrangements with SCC and reach agreement on future plans to commission rehabilitation services that effectively move patients on from inpatient services and repatriate back to the local area.
• CCG will work with SCC to review post-diagnosis dementia support through joint commissioning of community based services from statutory and third sector providers (see dementia section).
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• CCG will work in partnership with SCC to modernise and re-commission our Learning Disabilities services across all ages to promote progression and independence.
x. Children and Young People and Maternity
Overarching aims of the Workstream
• Promotion of early intervention and prevention approaches. • Improved multi-agency/professional working based around the child and
family. • A better experience for patients/service users, their families and carers. • Strong effective partnership working. • Improve outcomes for vulnerable groups such as Looked After Children
(LAC). • Focus on self- care / building resilience.
Management of Long Term Conditions
• Diabetes: Embedding the ‘Year of Care’ PbR tariff for <19s considering the level of avoidable emergency activity for diabetic patients.
• Asthma: Roll out the regional pathway for management of asthma. • Epilepsy & Asthma Community Nurses: Implement and review a pilot for a
community based nursing model. • Looking at other areas to develop community nurse led care e.g.
Dermatology. Development of the Paediatric Urgent Care Pathway
• Review and mainstream the Paediatrician led GP Telephone Advice Line pilot at West Suffolk Hospital (WSH) (13/14 CQUIN).
• Development of a short stay tariff at WSH/ Urgent Paediatric OP clinics. • Production of education and guidance materials with WSH for Primary Care/
Patients (e.g. Eczema / Feverish Child). • Consultant Management Service (CMS): Written Consultant advice to GP’s
for paediatric conditions. • Respond to the findings of the Suffolk Maternity Needs Assessment due to
report in January 2014, focusing particularly on women’s mental health. Joint working with Partners such as Suffolk County Council
• Implementation of the recommendations of the Suffolk Children and Adolescent Mental Health Services (CAMHS) Strategy.
• Respond and implement the statutory requirements of the Children & Families Bill 2014.
• Respond and deliver the actions, with partners, as set out in the Looked After Children review completed in 2013.
• Review/refresh the current Learning Disability Service so that it meets the needs of our population.
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• Continue to support the Suffolk Family Focus programme. • Jointly work together to review and develop Children’s Speech & Language
Services (SALT). Children’s Emotional Health & Wellbeing
• Implement and review an under 18 years Eating Disorders Service in West Suffolk with Norfolk & Suffolk Foundation Trust.
• Commission and implement an age inclusive diagnostic service for Autism (focusing on a current service gap 11-18 years).
• Further develop our CAMHS service focusing on behaviour and conduct disorder (also see Joint working with SCC).
Longer Term Strategic Aspiration (beyond 2014/15)
• To move to a Single Referral Point of Access (SRPOA) for all Children’s Services Providers, be they health or local authority provided, whereby referrals pass through one true conduit. The SRPOA may consist of a multi professional team to review and signpost to the most appropriate intervention first time.
xi. Cancer
Overarching aims of the Workstream
• For Cancer Care provision to be open and accessible to all within the West Suffolk Locality;
• To support cancer survivors and improving cancer survivorship; • To improve early diagnosis and embed cancer as a long term condition; • To provide up to date, quality and personalised cancer information – linking
with the Shared Decision Making process (SDM). • Provision of cancer care closer to home
Building on 2013/14 Commissioning Intentions The following work programmes from 2013/2014 need to be further developed in order to fully embed into everyday clinical practice:
• Acute Oncology Service – to support the delivery of 10% reduction in emergency cancer admissions through implementation of the AOS operational framework;
• Endoscopy – extending access to endoscopy to support the national screening programme;
• Early Access to Diagnostics; • GP Education; • The HOPE programme – 95% of patients at the end of their treatment are
offered a place on the HOPE programme; • User involvement.
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Further Areas for Development 2014/2016
• Expansion of the existing Acute Oncology Service (AOS) – 7/7; • Consideration of the introduction of Complementary Therapies for cancer
patients; • Supporting the whole national survivorship agenda:
o End of treatment summaries and care plans; o Information; o Access to education and Psychological support – HOPE; o Holistic Needs Assessment;
• Support for Carers; • Improvement in early diagnosis; • Evaluation of Community Cancer Nurse Pilot.
xii. Primary Care The West Suffolk CCG GP practices will be commissioned to provide funded, targeted interventions in two ways. The Quality Point element of the Quality Outcome Framework requires the participating GPs to review six pathways, three in planned and three in unplanned care. Once their comments have been considered, and a final pathway decided upon, the West Suffolk CCG GPs that are participating will need to follow the pathway for all eligible patients until 31 March 2014. The pathways chosen in 2013/14 focus on: Planned
• Shoulder Pain: patients accessing physiotherapy before a secondary care referral.
• Lipid modification therapy. • Irritable Bowel Syndrome (IBS) patient pathway.
Unplanned
• Antipsychotic Prescribing in Primary Care. • Identification of a dementia co-ordinator for each GP Practice. • Focus on preventing unnecessary admissions to hospital.
The new pathways for 2014/15 will be suggested by Primary Care in September 2013 GP Practice locality meetings based on the 2012/13 data supplied to them as part of the Quality Point process. These pathways will then be further developed during the remainder of 2013/14. The second set of targeted incentives are in place until 31 March 2014 and were previously called Local Enhanced Schemes (LES). These incentive schemes are currently under review and subject to the outcome will either be terminated or developed further in 2014/15.
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2. Quality, Innovation Productivity and Prevention (QIPP) QIPP remains one of West Suffolk CCG’s key priorities for 2014/15. There is a continuing need for new ideas that will help to sustain the financial health of the Suffolk health economy whilst maintaining or improving quality. Providers with ideas relating to changes in commissioning that will help fulfil this agenda are invited to share their ideas with West Suffolk CCG. 3. Market Reviews West Suffolk will be undertaking the following procurements in 2014/15:
Service Likely tender start Service implementation date
Ophthalmology triage
Underway April 2014
High cost drugs: management support
Winter 2013/2014 April 2014
Out of hours, 111 and potentially urgent care integration areas
April 2014 April 2015
Musculoskeletal physiotherapy
Spring 2014 Early 2015
Stroke early supported discharge
Early 2014 Late 2014
Community services
October 2014 October 2015
In addition there may be further market reviews in the following areas:
• Pain services. • Learning disability services. • Dermatology services. • Community respiratory services. • Myalgic Encephalomyelitis and Chronic Fatigue Syndrome
4. Activity Levels The CCG will:
• Rationalise service tariffs where current mix of pricing mechanisms, i.e. block and cost & volume (includes diabetic nursing, community dietetics);
• Review day case procedures expected to be done as OP procedures and specify commissioning levels for these – not limited to, but including, drug injections (subcutaneous, intramuscular, joints) to be outpatient procedures and not day case (only IV infusions funded as day case, where necessary);
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• Require compliance with national guidance over recording of day cases versus outpatient procedures;
• Require compliance with 2014/15 payment by results guidance and national data definitions;
• Review the pricing of non-consultant led OP and diagnostic tests; • Develop pathways for outpatient services to achieve maximum efficiency and
quality of care, e.g. one-stop clinics, multidisciplinary clinic, parallel clinics and triage to most appropriate clinics;
• Review maternity pathways to ensure compliance with PbR rules and no duplication of payments;
• Identify potential services eligible for Best Practice tariffs and agree plans/timetable for introduction (must have adequate supporting information).
Review of tariffs for emergency care which may require local tariffs to be developed and agreed. In relation to pathology services:
• Subject to Office of Fair Trading ruling WSCCG will commission most of its pathology services from Transforming Pathology Partnerships a joint venture of local acute trusts;
• Any residual pathology that needs to be commissioned from local providers will be commissioned at 2013/14 tariff plus or minus standard NHS inflation net of efficiency;
• WSCCG expects providers to continue to provide the same range of services as available in 2013/14.
5. Performance Data / Information For all contracts WSCCG intend the following:
• Continued on-going compliance with the reporting requirements of UNIFY 2 and SUS, which includes compliance with the required format, schedules for delivery of data and definitions as set out in the Information Centre Guidance and All Information Standards Notices (ISNs), where applicable to the service being provided.
• Where the provider is part of a multi provider pathway then the provider will be expected to proactively participate in the development of integrated information flows that are consistent, complete and timely and compliant with all mandatory data items.
• Any accountable provider who sub contracts out to other providers should provide evidence and assurance to WSCCG that their contracts and schedules with the sub contracted provider are consistent with their contract with WSCCG, so that all providers can be held accountable on the same basis.
• Proactive participation in the provision of daily information to support the system wide urgent care dashboard.
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• Providers are required to submit any patient confidential data to the DSCRO
(Data Service for Commissioners Regional Offices).
For any new Community Contract WSCCG intend the following:
• Completion, as a minimum, of the community Information dataset and on-going development to ensure that the provider is able to submit the Community Information dataset to SUS and as an interim measure will be able to submit it locally to WSCCG through the DSCRO.
For any new Community Contract WSCCG intend the following:
• Where statutory reporting is required to UNIFY2, Choose & Book, Omnibus, Open Exeter and other statutory reporting for a then the Provider should ensure that they are N3 compliant.
• Compliance with ISN 0149- where completion of NHS Numbers is a mandatory requirement.
6. Workforce WSCCG will work to ensure that providers have an appropriate, capable and sustainable workforce. The commissioning of local services will need a workforce fit for purpose, as we change the shape of services and where necessary move them closer to patients’ homes. Our local workforce will need to be highly flexible to respond to changes in how we deliver healthcare. As services across health and social care become more aligned and are delivered in more flexible ways in the community, providers and commissioners must work towards easing the transfer of staff between different employers and ensure they can minimise cost and maximise efficiencies where the workforce overlaps. WSCCG will commission services that are appropriately skilled and competent in providing high quality and safe services for patients. I am sure you will agree that 2014/15 and beyond presents significant challenges to us given the recent changes in NHS structures, the financial environment and the imperative to maintain and improve the quality of services during a period of rapid and fundamental change. WSCCG looks forward to working with you in facing these challenges. Yours sincerely
Julian Herbert Dr Christopher Browning Chief Officer Chairman
Agenda Item No. 11 Reference No. WSCCG 13-041 From: Part 1 Part 2 BOARD REPORT: Update on West Suffolk Hospital Psychiatric Liaison Service From: Dr. Roz Tandy: Clinical Lead for Mental Health and Learning Disability 1. Purpose 1.1 This paper is to inform the Clinical Executive and CCG Governing Body about the
introduction of a new Psychiatric Liaison Service at West Suffolk NHS Foundation Trust. The service has been jointly developed by West Suffolk CCG, West Suffolk Hospital Foundation Trust (WSHFT) and Norfolk and Suffolk Foundation Trust (N&SFT) who will deliver the service in the acute hospital.
2. Background 2.1 There are nationally a number of different Psychiatric Liaison Service models in
acute hospitals which assess and deliver appropriate management of people with psychiatric presentations in both A&E and Inpatient settings. There is clear national evidence1 2i that psychiatric liaison services can improve the quality of care for people with mental ill health in an acute hospital. Benefits include, reduction in the number of breaches of A&E waiting time targets, improved management of older people in particular those with dementia, shorter length of stay and managed discharge of people back into the community, improved confidence and reduced stress for acute hospital staff in the care of people with mental ill health.
2.2 In 2012/13 NSFT had a CQUIN scheme for the delivery of psychiatric assessment
in A&E in hours and supported out of hours by the Crisis Resolution and Home Treatment Service (CRHTT). Although this is a model which is common nationally, Crisis Resolution and Home Treatment Services were not set up to provide dedicated A&E cover which means that it is not always possible to prioritise the service to acute hospitals. There have been no formal arrangements between providers for in-patient cover by mental health services.
1 Royal College of Psychiatrists 2 Economic Evaluation of a Liaison Psychiatry Service – Centre for Mental Health 2011
2.3 WSHFT and NSFT both have CQUIN schemes in place in 2013/14 to fund the development and delivery of a Psychiatric Liaison Service. The two Trusts have been working with the CCG Lead for Mental Health and Learning Disabilities to develop the service model and specification for the new service which is planned to go live in the Autumn.
2.4 The service will comprise a multi-disciplinary team including psychiatry, later life
psychiatry and will include substance misuse expertise. 2.5 The service will be for people aged 18 and above who attend A&E and Clinical
Decisions Unit (CDU) or are admitted to the acute hospital as inpatients. Whilst the service is for all adults with mental health presentations, there will be a strong focus on later life in-patients. Depending on the outcomes of future evaluation the service may extend its delivery to people aged under 18 and people with medically unexplained symptoms and long term health conditions. The service will develop and deliver a programme of formal teaching and informal training on mental ill health to acute staff throughout the hospital.
3. Key Points 3.1 The West Suffolk CCG Mental Health and Learning Disability Clinical work stream
2013/14 has prioritised the development of a Liaison Psychiatry Service at West Suffolk Hospital.
3.2 The Psychiatric Liaison Service offers a comprehensive range of mental health
specialities within one multidisciplinary team of mental health liaison practitioners specialising in general psychiatry, deliberate self-harm, substance misuse and old age psychiatry so that all patients over the age of eighteen can be assessed, treated, signposted or referred appropriately. This group of multidisciplinary professionals works closely with hospital clinicians and managers to ensure that the mental and physical health needs of people are considered and treated together in recognition that there is no health without mental health.
3.3 The service will be fully integrated within the acute medical setting, with a higher
profile mental health team housed close to the ‘hospital front door’, demonstrating the hospital’s acknowledgement that holistic patient care and management of their wellbeing is important
3.4 The Service will work as an integral part of the pathway of care for people from the
community, into the hospital and back to support care in the community, including the voluntary sector, carers or family members.
3.5 The service will:
• Improve the mental health of people attending A&E, CDU and inpatient wards • Improve access to psychiatric assessment and response to patients presenting
in A&E,CDU and inpatients • Support the achievement of the 4 hour A&E target for psychiatric patients • Reduce the length of stay for mental health inpatients including dementia • Improve acute hospital response to people with mental health • Improve the experience for patients and carers
3.6 The new Psychiatric Liaison Service at West Suffolk Hospital will be delivered by
Norfolk and Suffolk Foundation Trust and will become operational from November 2013.
4. Conclusion
4.1 The Clinical Executive and Governing Body are requested to note the progress as to the introduction of the new Psychiatric Liaison Service at West Suffolk Hospital NHS Foundation Trust which will improve the recognition, diagnosis and management of people attending the hospital in A&E, CDU and Inpatient settings.
Author: Karen Wood: Transformation Lead
Agenda Item No. 12 Reference No. WSCCG13-042
From: Dr Rakesh Raja - CYP Clinical Lead for West Suffolk Clinical Commissioning Group Part 1 Part 2 BOARD REPORT: Paediatric Epilepsy & Asthma Community Nurse Posts
1. Purpose
To inform the governing body of the CCG executive approval for two Band 7 Specialist Asthma and Epilepsy Nurses to be appointed, with contractual requirement that the posts are community based in order to support the management of children in the community with these long term conditions.
2. Background 2.1 Asthma
There is no community based asthma nurse service in West Suffolk. Locally information and advice for children and young people with Asthma and their family carers is not standardised. There is variable consistency with regard to appropriate advice, support and points of contact about emergency medication. There is inconsistent information and education on the management of Asthma for Health Visitors, School Nurses, Specialist School Nursing Teams, Community Paediatric Services, DGHs and voluntary groups.
2.2 Epilepsy
A key role of ESNs is to take on mainly patient-related activities that would otherwise fall to epilepsy specialists and consultants or be overlooked. ESNs also play a pivotal role in providing access to information, training and support for patients and their families/carers. They facilitate access to specialist and community services, and are also involved in the education and general welfare of children with epilepsy. The support provided by ESNs may be home-based; this may include helping families and carers to encourage treatment adherence and provide guidance on lifestyle management, and helping patients to achieve their maximum level of independence and choice in lifestyle.
3. Key Points 3.1 West Suffolk are consistent outliers for both Paediatric Asthma and Epilepsy, as below:
2011-12 Asthma Emergency Admissions (U19 years) Emergency admissions Bed days Average length of stay Suffolk PCT 202 217 1.12 Rate per 100,000 pop. 149 160 - Top 25% 108 132 0.90 Significance Worse Worse Worse
Rank (out of 151 PCTs) 40 23 56 2011-12 Epilepsy Emergency Admissions (U19 years)
Emergency admissions Bed days Average length of stay Suffolk PCT 149 200 1.36 Rate per 100,000 pop. 110 147 - Top 25% 58 89 1.13 Significance Worse Worse Worse
Rank (out of 151 PCTs) 127 98 .55 Source: Hospital Episode Statistics (HES) - the Information Centre for Health & Social Care
ASTHMA:
Local prevalence estimations based on a paediatric population of 51,300: Number of asthma patients 0-19 years = 922
West Suffolk Hospital currently provides:
• 1 Paediatric Respiratory clinic per week - of which 80% are asthma patients • 1 Paediatric Asthma clinic per month - this is a joint clinic with the Respiratory Nurse • The consultant does not carry a caseload and the hospital has no dedicated asthma
nurse.
EPILEPSY: Local prevalence estimations based on a paediatric population of 51,300:
• Number of patients 0-19 years currently receiving care = 283 • Expected prevalence of epilepsy = approximately 1 in 220
West Suffolk Epilepsy Leads advise that the numbers of children with epilepsy who are regularly followed up are WSH - 135 / Community Paediatrics - 40. West Suffolk Hospital currently provides 1.0 Paediatric epilepsy clinic per week. The lead Consultant estimates he makes 15 calls per month to give advice and follow up for epilepsy patients. Tariff payments are claimed for those calls that result in a change in management.
4. Recommendations
Implementation of: (a) 1.0wte Community Paediatric Asthma Specialist Nurse (b) 1.0wte Community Paediatric Epilepsy Specialist Nurse
These services would meet the existing gaps in provision in order to: • Meet the NICE guidelines and quality standards • Streamline pathway between home/acute hospital by offering community support • Reduce unplanned admissions to acute hospital • Empower patients/families/community to understand/manage epilepsy with confidence • Optimise treatment adherence by patients • Over time contribute to a reduction in unplanned admissions for adults into acute
hospitals
Benefits • The service will be consistent with NICE and other Department of Health guidance • Supervision and integration within specialist team • Seamless tailored care along the pathway from the hospital and into the community • Opportunity to build links and networks with community support, education • Opportunity for easy access and links with GP surgeries • First point of community contact reducing need for patient to access hospital care
Outcomes • Improved patient satisfaction • Improved number of reviews of children coming to clinic • Reduced inappropriate and unplanned admissions amongst the target group • Reduced readmissions amongst the target group within 30 days of patient discharge • Reduction in attendances at A&E and inpatient services amongst the target group • 30-40% ‘well-controlled’ patients seen by the Specialist Nurse at the point of follow up
Quality Control Name Date
Requested by Dr Rakesh Raja 13/11/13 Author Hannah Neumann-May 14/11/13
Head of Planning & Delivery Eugene Staunton 14/11/13
Clinical Lead Dr Rakesh Raja 14/11/13
Agenda Item No. 13 Reference No. WSCCG 13-043
From: Amanda Lyes – Chief Corporate Services Officer HEALTH AND SAFETY REPORT 1. Purpose
To provide the Governing Body with an update on health and safety management activities within the CCG. Subsequent reports will be presented twice each year.
2. Background
The CCG has made an excellent start in putting in place policies and processes for managing health and safety in the workplace. Whilst as a commissioner rather than a provider of healthcare, undertaking largely office based activities, we are considered to work within a low risk environment, we must never be complacent. Through the CCG leads and our health and safety advisors, we aim to ensure the health, safety and welfare of all our staff and visitors. Confusion is a concept which is common to many regulatory requirements, particularly in the complex world of healthcare and health and safety requirements are no exception. However, confusion usually arises because the terminology used sounds more complicated than the process it describes. The underlying concept of health and safety is, in fact, very simple. As such, a key principle of the CCG health and safety arrangements is simplification.
3. Key Points
Health and Safety Committee A joint Health and Safety Committee for both CCGs in Suffolk has been established and meets every two months. Comprising representation from both CCGs, Health and Safety Advisors, the Governance Advisor and NHS Property Services, the committee is chaired by the Chief Corporate Services Officer. Minutes of the meetings are presented to the Remuneration and Human Resources Committee which, as a sub-committee of the Governing Body, provide corporate oversight. Health and Safety Annual Plan 2013-14 In order to ensure that all relevant health and safety issues are addressed, the first of what will be an annual plan has been produced for 2013-14. The plan addresses both strategic and operational issues and is updated at each Health and Safety Committee meeting. A copy of the most recently updated plan is attached.
Health and Safety Advice Professional advice is now provided by the independent contractor Safetyboss, a local health and safety consultancy and training company based in Melton near Woodbridge. Established over 13 years ago by Tim Randell, a Chartered Fellow of the Institute of Occupational Safety and Health (CFIOSH) it has become firmly established as one of the leading health and safety consultancies in East Anglia. Employing 12 staff, Safetyboss has clients throughout the UK. Tim Randell is an ex Health and Safety Executive (HSE) inspector with experience of enforcement issues while the other members of the team possess a wide range of practical knowledge and experience. The company’s client base has expanded over recent years and includes Suffolk County Council Education, where inspections and audits of many schools are carried out, as well as education and NHS facilities across the UK. Safetyboss is also the leading provider of national training courses for health and safety in Suffolk. Students come from all over East Anglia to study for the NEBOSH Certificate, Diploma and Award. Clients include Suffolk Fire and Rescue, E-on and other major companies. Safetyboss are contracted by the CCGs, through a Service Level Agreement (SLA), to provide on-site and telephone advice and support, training and audit. A key element of the SLA in 2013-14 was the completion of a baseline health and safety audit, the results of which rated the CCG as ‘very good’ in terms of health and safety compliance. A small number of recommendations have been included in the annual plan. Health and Safety Training Given the low risk environment in which CCG staff work but recognising the importance of training, a combined half day training session combining ergonomic manual handling, display screen equipment, risk management and fire is now provided through a series of local workshops. All staff have now either attended a training session or are booked onto one before the end of the year. New staff attend within their first month of commencement in post. Specific training for the senior staff leading on health and safety has also been arranged for January 2014.
Health and Safety Newsletter In order to maintain an on-going awareness, the first ‘Health and Safety Focus’ was published in September and is available on the intranet following circulation in ‘The Buzz’ staff newsletter. It is intended that the ‘Health and Safety Focus’ will be published on a twice yearly basis and Safetyboss will facilitate its production going forward. Health and Safety Risk Assessment Like all organisations, CCGs must manage potential health and safety risks in the workplace. To do this we undertake risk assessment. Once we have identified any risks, we then decide how to control them and put the appropriate measures in place. A risk assessment is not about creating huge amounts of paperwork, but rather about identifying sensible measures to control any risks in the workplace. The law does not expect organisations to remove all risks, but to protect people by putting in place measures to control those risks. The Health and Safety Committee have therefore agreed that for the remainder of the year there will be a focus upon risk identification with all departments completing a risk assessment by the end of December. Of course on its own, paperwork does not reduce risk and is a means to an end, not an end in itself - action is what protects people. So, in line with our drive to simplification, risk assessments will be fit for purpose, updated on a regular basis and acted upon.
Fire and First Aid The CCGs have identified a number of Fire Wardens and First Aiders. The staff members concerned are identified on notice boards and have undertaken relevant training. So far, eight Fire Wardens had completed training with another booked onto the next available course. Training for First Aiders is being provided by St Johns Ambulance. In order to ensure awareness and compliance with the CCGs Fire Policy, an annual fire evacuation exercise is undertaken at both HQ premises. The most recent, undertaken at Rushbrook House in October and overseen by Safetyboss, resulted in a total evacuation of all staff, including one with mobility disabilities, in less than five minutes. Areas for improvement were noted and will be acted upon in order to reduce evacuation times to nearer three minutes, this being an expectation for a building of this type. Incident Reporting The Vantage Technologies Sentinel Incident Reporting System has been installed and is used to record all incidents and accidents. The system allows for on-line entry and follow up of relevant incidents, eliminating the need for paper forms and providing facilities for various reports to be produced. As low risk organisations, the system, which is also used by providers, has been significantly simplified for the CCGs on the basis that as solely commissioners of healthcare, the number of reportable incidents should be small. This has been borne out as since 1 April, only two health and safety incidents have been recorded, neither of which required any follow up.
4. Recommendations
The Governing Body is asked to note the health and safety report.
Author: Colin Boakes
Governance Advisor
HEALTH & SAFETY ANNUAL PLAN 2013 – 2014
Target Area
Action Required
Assurance
Completion Due By + Updates
Responsible
Person Strategic Health & Safety Committee
Attendance at and engagement with the joint Health & Safety Committee by representatives
from both Suffolk CCGs
Attendance by nominated CCG representatives and
relevant H&S issues raised to be recorded in committee
minutes
On-going
AL
Staff Awareness
Development and use of CCG communication channels to raise awareness of risk management,
H&S Issues and pertinent training
H&S and Risk Management information available through
new channels. Methods development for monitoring
user access.
On-going
AL/CB
Health and Safety Policy
Review of Health & Safety Policy
Health & Safety Policy reviewed & approved
Completed
Safetyboss
Fire Policy Review of Fire Policy Fire Policy reviewed and approved
August 2013 – In Progress: to be approved at next meeting in
December 2013
Safetyboss
Health and Safety Advice
Review of the SLA with Safetyboss
SLA reviewed August 2013 – Completed February 2014
AL/CB
Risk Management Strategy & Organisational Framework
Annual Review of CCG’s Integrated Risk Management
Strategy & Organisational Framework
Risk Management Strategy & Organisational Framework
reviewed & approved
Completed
AL/CB
Provision of Integrated Training
Ensure integrated training programme is in place
Training dates agreed & booking process in place
Completed
CB/PM
Incident Reporting Ensure compliance with the Sentinel incident reporting
system, raise staff awareness and monitor uptake
Incident reporting system in place, communications distributed to staff and a
demonstrable shift in practices for incident
Completed
NP
reporting
Health and Safety Baseline Audit
Completion of baseline audit, as outlined within the SLA
Receipt of audit and any recommendations actioned
Completed Safetyboss
Operational Stress Adoption of the NHS Suffolk
Workplace Stress Policy and improved communication through
new channels
Staff aware of & accessing the Workplace Stress Policy. Tracking of online access levels.
Completed
KI
Fire
• Annual Fire Risk Assessment
• Fire Safety Equipment Checks
• Annual Review of Fire Policy
• Annual Fire Evacuation Drill
• Updated fire risk assessment with outstanding actions completed
• Equipment checks completed
• Fire Policy reviewed & approved
• Annual fire evacuation drill completed
March 2014
AL/Safetyboss
Staff Training Ensure attendance by all staff for integrated fire, ergonomic manual
handling & DSE training
• Maintenance of training records
March 2014 AL/PM
Display Screen Equipment (DSE)
• Risk assessment for DSE users
• Eye Test and Appliance Policy to be updated
• Risk assessment process in place
• Updated policy in place
March 2014 AL/KI
Sickness Absence Reporting
Reports to be presented to the Health & Safety Committee
detailing reasons for absence
Absence reports received and reviewed with action taken where appropriate
On-going
AL/KI
Agenda Item No. 14 Reference No. WSCCG13-044 REPORT TO THE GOVERNING BODY – 27 NOVEMBER 2013 From: Amanda Lyes – Chief Corporate Services Officer INTERNAL AUDIT REPORT - CLINICAL GOVERNANCE 1. Purpose
The purpose of this paper is to request that the Governing Body endorse the conclusions of a recent review of clinical governance arrangements undertaken by Internal Audit, the results of which have been reviewed and agreed by the CCG Executive and Audit Committees.
2. Background
The clinical governance audit was included in the Internal Audit plan for 2013-14 and as well as the key objective of providing assurance that clinical governance processes within West Suffolk CCG are effective and ensure that clinical objectives are met, the audit accommodated a specific request from the Audit Committee to review how best it could best engage with clinical audit in order to meet its own need for assurance.
3. Key Points
The key points arising from the audit were:
(i) That improvements need to be made in the CCG’s clinical governance process to ensure that its clinical objectives are met. It was suggested that the main structural change needed is for the Executive Committee to act as a formal Clinical Executive Committee as a sub-committee of the Governing Body so that it meets best practice in terms of enhancing oversight of quality performance and risk. The formalisation of the Committee should include the following:
• Presentation of the Integrated Performance report • Presentation and consideration of the GBAF
• Attendance by Lay Members and the Secondary Care Doctor
• Production of formal minutes, including evidence of scrutiny, challenge, and escalation where necessary
(ii) There should be more clarity within the GBAFs as to which CCG priority
is at risk so that it is clearer which priorities are more likely to be met (i.e. those with less risks)
(iii) Whilst the new Integrated Performance Report includes a lot of
information to ensure that national and local contractual needs are met, an early review of the outcome measures set out in the Integrated Plans should be included to ensure progress against strategic priorities can be easily provided.
4. Audit Committee and Executive Committee Responses
Having initially considered the report at the meeting on 3 September 2013, the Audit Committee suggested that:
• The report & recommendations for formalising a CCG Clinical
Executive Committee as a formal sub-committee of the Governing Body, to address matters of clinical governance, should be put to the Executive Committee. It would then be for it to decide how best to structure and manage the formal sub-committee meetings.
• The Executive Committees decisions should constitute the necessary
response to the draft internal audit report, the finalised version of which would be re-presented to the Audit Committee for approval.
Further to agreement of the report’s recommendations by the Executive Committee and consequent management response to Internal Audit, the Audit Committee reviewed the matter again at the meeting on 15 October 2013 and agreed the updated report.
5. Recommendations In response to the Internal Audit report and the consequent review by the
Executive Committee with oversight by the Audit Committee, the Governing Body is requested to endorse:
• That a Clinical Executive Committee shall meet every two months, in
the months between Governing Body meetings, as a formal sub-committee. This would be in line with the meeting schedule of the other two statutory sub-committees; Audit and Remuneration/Human Resources
• The specific terms of reference for the formal Clinical Executive
Committee meeting, a copy of which is attached
• The constitution of the formal Clinical Executive Committee that shall comprise the existing membership but also includes the Governing Body Lay Members as observers and Secondary Care Doctor
• That as a formal sub-committee of the Governing Body, governance
arrangements shall include the production of specific agendas and
minutes which will be presented at the Governing Body meetings in public.
• That the Governance Advisor or a Committee and Governance Officer
would attend to minute the meetings
• That the GBAF will be updated to include a reference to which of the CCGs priorities the component risks refer
• That whilst the CCG has set up a robust performance framework for
the Transformational Change Programme, it is acknowledged that data comes from a number of sources and therefore a record showing the source and frequency of all priority related measurement data, as set out in CCG’s Integrated Plan, will be prepared
Author: Colin Boakes Governance Advisor
WEST SUFFOLK CLINICAL COMMISSIONING GROUP
CLINICAL EXECUTIVE COMMITTEE
TERMS OF REFERENCE
1. OVERVIEW
Clinical governance is a systematic approach to maintaining and improving the quality of patient care within a health system. It is a framework through which NHS organisations are accountable for continually improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish. 2. PURPOSE OF THE COMMITTEE As a formal sub-committee of the CCG Governing Body, the purpose of the Clinical Executive Committee is to: (i) Provide a dedicated forum for the oversight of clinical governance.
(ii) Provide assurance to the Governing Body and Audit Committee that
the CCG has the necessary clinical governance arrangements in place to meet its objectives.
(iii) Ensure effective clinical engagement in clinical governance processes,
utilising clinician’s specific expertise and knowledge of local communities and public/ patient involvement.
(iv) Facilitate a culture where clinical quality, patient experience and patient
safety are of the highest priority. 3. ROLE OF THE COMMITTEE The role of the Clinical Executive Committee is to: (i) Support the highest standards of clinical quality and patient safety. (ii) Develop and monitor clinical quality standards and scrutinise integrated
performance reports.
(iii) Provide the Governing Body and Audit Committee with demonstrable evidence of scrutiny, challenge and escalation where necessary.
(iv) Receive, review and approve clinical policies and procedures. (v) Monitor providers’ compliance with CQC Essential Standards, National
Service Framework requirements, NICE recommendations/guidance and local performance standards.
(vi) Review Serious Untoward Incident and Child/Adult Safeguarding
Reports monitoring the relevant action plans to identify areas of learning and change.
(vii) Monitor clinical risks, by reference to the Governing Body Assurance
Framework (GBAF), satisfying itself and assuring the Audit Committee that the mitigating actions for each clinical risk identified are reasonable and that action plans are being progressed.
(viii) Ensure commissioned services sustain high quality and patient focused
care. (ix) Support a culture of clinical safety. (x) Ensure that the relevant recommendations arising from external and
internal reviews and guidance pertaining to clinical governance, are implemented in an appropriate and effective manner.
4. AUTHORITY The Committee is accountable to the CCG Governing Body and operates within agreed delegated powers. 5. MEETINGS The Committee will meet every two months. Minutes of its meetings will be presented to the next available meeting of the CCG Governing Body in public. Agendas and any papers for Committee meetings will be circulated to members at least five days in advance. A Committee and Governance Officer will attend to formally minute the proceedings. 6. MEMBERSHIP Membership of the Committee comprises all of the existing Clinical Executive Committee, the Secondary Care Doctor and Governing Body Lay Members as observers. A quorum shall comprise at least four members, two of whom shall be professional members and two officer or other members.
In the absence of the Chairman, those members present shall choose one member to chair the meeting. Where voting is required and in the event of an equality of votes, the Chairman shall have a casting vote. 7. REVIEW The Committee shall review its terms of reference on an annual basis. 8. AUTHOR Colin Boakes Governance Advisor Date: August 2013 Review Date: August 2014
Final Internal Audit Report Clinical Governance
Assignment Number 1302 Clinical Governance
Report Date 16th October 2013
Audit Manager Neil Abbott
Responsible Director Barbara McLean
Recommendations High 0 Medium 3 Low 1
Assurance Level N/A - Advisory
1. Executive Summary
1.1. Overall Objective
1.1.1 To provide assurance that Clinical Governance processes within West Suffolk CCG are effective and ensure that clinical objectives are met.
1.2. Background
1.2.1 As part of the new CCG arrangements and consideration of the requirements of the NHS Audit Committee Handbook, the Chair of the Audit Committee would like to receive assurance that the CCG has the necessary Clinical Governance arrangements in place to meet its healthcare objectives.
1.2.2 The Audit Committee Handbook states that the Audit Committee should consider the clinical objectives and risks in the Assurance Framework and to report on the controls and assurances in relation to these. The Handbook refers to responsibilities of PCTs (which should be replaced with CCGs) and the need for them to take into account the arrangements made by their providers and to the extent to which their Professional Executive Committee (which should be replaced by the CCG Governing Body) can obtain confirmation of assurances.
1.2.3 The CCG already has a Governing Body Assurance Framework (GBAF) and Action Plan and this includes risks, controls and assurances associated with healthcare. To support the Audit Committee in discharging its responsibilities in terms of clinical governance, this audit will assess the process for identification of risks relating to healthcare, and test the effectiveness of the controls set out in the GBAF.
1.2.4 The Handbook also asks: ‘How can clinical audit support the Audit Committee’s work?; and provides examples of case studies and best practice guidance. The Audit Committee would therefore like to know how the Committee should best engage with clinical audit to meet its own need for assurances. This audit will therefore make specific recommendations in response to the Audit committee’s request on this issue.
1.3. Internal Audit Conclusions
1.3.1 Based upon the results of our work, our overall conclusion is that improvements need to be made in the CCG’s clinical governance process to ensure that its clinical objectives are met. The main structural change needed is for the Executive Committee to act as a formal Sub-Committee of the Governing Body on a monthly basis, so that it meets best practice in terms of enhancing the Governing Body’s oversight of quality performance and risk. The formalisation of the Committee should include the following:
- A full Terms of Reference (similar to Ipswich & East Suffolk CCG); - Presentation of the Integrated Performance report; - Presentation and consideration of the GBAF and risks; - Attendance by Lay members (i.e. a member of the Audit Committee); - Formalisation of minutes.
1.3.2 Other improvements identified within this audit were as follows: -
-the positions of Vice chair and Audit Chair need to be reviewed as good practice suggests this should not be the same person as there may be a conflict of interest; --there should be more clarity in the GBAFs as to which objective (or more appropriate for the CCGs, ‘priority’) is at risk so that it is clearer which priorities are more likely to be met (i.e. those with less risks); -whilst the new Integrated Performance Report includes a lot of information to ensure that national and local contractual needs are met, an early review of the outcome measures set out in the Integrated Plans should be done to ensure progress against strategic priorities can be easily provided.
1.3.3 Our conclusions are shown in more detail in Sections 2 and 3 below, with
recommendations for improvement attached.
1.4. Acknowledgement
1.4.1 Internal Audit would like to acknowledge the co-operation and assistance given by all staff during the course of the review.
2. Evaluation of System Activities
2.1. Evaluation
2.1.1 Ordinarily, Internal Audit evaluate separately the different areas of activity within a system, and present the results in the table below to provide an overall assessment of the level of assurance that can be provided to management. As it is relatively early days for the CCG, the audit is advisory only, and as such assessment is not provided on this occasion. This can be done once systems are more embedded.
Activity Evaluation of Systems & Controls Excellent
Good
Satisfactory
Limited
Unacceptable
Constitution, Strategies and Policies
Clinical Governance Structures
Monitoring Clinical Performance
Clinical Governance Assurance
Overall Assessment
3. Summary of Findings
3.1. Constitution, Clinical Aims and objectives
3.1.1 The CCG has a Constitution which sets out the arrangements by which it meets its responsibilities in terms of commissioning care for the people for whom it is responsible. It describes the governing principles, rules and procedures that the group will establish to ensure probity and accountability in the day to day running of the clinical commissioning group; to ensure that decisions are taken in an open and transparent way and that the interests of patients and the public remain central to the goals of the group.
3.1.2 The West Suffolk CCG established its Constitution on 24th October 2012, whilst acting in shadow form and this was subsequently approved by the Governing Body.
3.1.3 Within the Constitution the CCG sets out arrangements for the Governing Body and its Sub-Committees, which include statutory Committees such as Audit Committee and Remuneration Committees, and also a separate CCG Executive Committee. The CCG Executive Committee is stated as being:
‘responsible for delivering the strategy and policies agreed by the governing body and is accountable to that body within agreed delegated powers. The Committee meets three times per month and covers three main strands of activity: corporate governance, internal scrutiny and operational management.’
3.1.4 The Audit Committee remit includes: reviewing the establishment and maintenance of an
effective system of integrated governance, risk management and internal control, across the whole of the organisation’s activities (both clinical and non-clinical), which supports the achievement of the organisation’s objectives: giving the Audit Committee a mandate to receive assurance on the systems in place for monitoring clinical performance and associated risk management.
3.1.5 The Constitution states that the Accountable Officer has overall responsibility for improving Patient Safety and Clinical Quality: further responsibility is delegated to the Chief Nursing Officer.
3.1.6 In addition to their Constitutional documents, the CCGs also have a Patient Safety and Clinical Quality Framework which sets out how the office of the Chief Nursing Officer supports the CCGs to deliver the CCG’s priorities including improvements in the quality of healthcare services in terms of clinical effectiveness, patient safety and patient experience.
3.1.7 The CCGs’ clinical aims and priorities are set out in the 2012-15 Integrated Plans.
3.1.8 West CCG has 6 priorities as follows:
• Develop Clinical Leadership • Demonstrate excellence in patient experience and patient engagement • Improve the health and care of older people • Improve access to mental health services • Improve health and wellbeing through partnership working • Delivery financial sustainability through quality improvement
3.1.9 Within its Integrated Plan, outcome measures and key actions are detailed against each priority. Information will therefore need to be provided to the CCG Governing Bodies and/or
the Clinical Executive Committee to ensure that key actions are taking place and outcomes are being achieved or on track. As part of this Internal Audit, checks will be undertaken to assess the performance information presented to these Committees.
3.1.10 In addition to the Integrated Plan the CCG has set out a ‘Plan on a Page’ which summaries the CCGs’ vision statement; NHS Constitution Principles, Health & Well Being Board’s priorities, CCG’s values and priorities; Transformation Change for 2013/14, End State vision 2014/15, approach to Risk Management and Outcomes from the NHS, Social Services and Public Health Outcome Frameworks.
3.1.11 As stated in paragraph 1.2.3 the CCG has a GBAF and process in place, similar to the format and processes used by the previous PCT. Best practice for Assurance Frameworks is to ensure that the risks can be mapped back to the objective they relates to. It would be useful if the current GBAF accommodated a cross reference to the particular objectives/priorities so that the CCG can have a clearer view as to which objectives/priorities are most at risk (Recommendation 1).
3.1.12 In summary, the documents viewed set an adequate framework by which Clinical aims, priorities and how they will measure and report performance issues, however the GBAF needs to be developed so that the particular objectives at risk are clear within the GBAF.
3.2. Clinical Governance Structures
3.2.1 Clinical governance is a systematic approach to maintaining and improving the quality of patient care within a health system. It is a framework through which NHS organisations are accountable for continually improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish.
3.2.2 A recent publication by the NHS Leadership Academy entitled: ‘The Healthy NHS Board 2013, Principles of Good Governance’, highlighted that whilst ultimate responsibility for (Clinical) quality rests with the Board, recent good practice recommends the establishment of a quality-focused board committee as a means of enhancing board oversight of quality performance and risk by ensuring input from people with particular quality experience and responsibility for frontline clinical leadership.
3.2.3 As stated in 3.1 above, the CCG’s clinical governance structure is set out in its Constitution. There is a brief reference to the role of the CCG Executive Committee as stated in 3.1.3 and is the closest to a quality focused Sub-Committee, however there are no formal terms of reference. Members of the Executive Committee are also members of the Governing Body.
3.2.4 A review of the CCG Executive Committee minutes revealed the following: - The minutes are a good standard; - The EC has been attended by the Audit Chair in his role as Lay member; - Quality is a standard item on the agendas; - On one occasion it was minuted that recommendations should be made to the GB. - Action logs are used which is good practice for monitoring implementation of agreed
actions however they do not include deadline dates. Dates of updates are not provided.
- The GBAF is not reviewed at this Committee, in terms of completeness of clinical risks and accuracy of assessment.
3.2.5 In conclusion, whilst the conduct of the CCG Executive Committee follows some aspects of good practice, it lacks a formal terms of reference and therefore makes it difficult to have a clear understanding of the purpose of the Executive Committee and how its effectiveness
can be measured. The Committee has Quality as a regular item on its agenda, but if the CCG is to meet standard NHS Clinical Governance practice the CCG Executive Committee needs to consider how it can more formally operate as a Sub-committee of the Board to address clinical quality and patient safety issues (see Section 3.5 of this report).
3.3. Monitoring Clinical Performance
3.3.1 Within this section, examination is undertaken of how the CCG has identified clinical performance and patient safety issues for monitoring purposes and identifying risks. It will also look at the relevance of Clinical Audit to the CCGs and how this is monitored.
3.3.2 From a review of the first two months of Board and CEC minutes, the Integrated Performance reports were based on the requirements of 12/13 operating framework. Essentially they were continued to be used to present the full year’s set of data. At the start of this audit, the Head of Planning and Performance Management explained that the new performance report was being devised to accommodate the reporting requirements for 13/14. An early draft of the report was subsequently sent to Internal Audit; and this was checked primarily to ensure that all required clinical quality measures were being reported against to ensure that clinical objectives were being met.
3.3.3 The integrated performance report includes information requirements to support the following:
• National Outcomes Framework • NHS Constitution; • Contractual Performance Measures.
3.3.4 A review of the performance report found that performance indicators align to the priorities for the CCGs in general terms but because of the volume of different measures, it is not easy to determine how the CCGs are progressing specifically against their priorities (or other stakeholder’s priorities such as the Suffolk Health & Well Being Board).
3.3.5 In addition to the Integrated Performance Report, detailed workstream reports are presented to the CEC by lead GPs. Workstreams have been set up to deliver the 2013/14 Transformational Change Programme. The CEC are updated routinely on workstreams and apprised of progress against plans and risks.
3.3.6 From the information provided to date, it appears that whilst the CCG has set up a robust performance framework for the Transitional Programme, further work will need to be done so that the CCG can report more clearly on progress against its 2012-2015 Integrated Plan and its priorities contained therein. It is acknowledged that it is still early days for the CCG, however an early review may highlight any potential difficulties in reporting this information (Recommendation 2).
3.3.7 As stated in the scope of this audit, a review of Clinical Audit and how the process can be used as part of the assurance process for the Audit Committee has been examined. Clinical Audit is defined as’ a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change’. Clinical Audit activity takes place with Provider Services and not Commissioning Groups as by their very nature, their role is to set quality standards and monitor them.
3.3.8 The Chief Nursing Officer stated that as part of her role, her department oversee Clinical Audit programmes, receiving Board notes of inclusion of national and local priorities for audit. It also requires audits as necessary to support assurance of patient safety or clinical quality – eg recent audit baseline of MRSA screening required from one of the providers, which then became a monthly audit, at the CCG’s request due to the low coverage
demonstrated in the baseline. This has been reported directly to the Governing Body as part of a Remedial Action Plan.
3.3.9 An example of more routine monitoring is via attendance at Control of Infection Committees where hand washing audits and screening audits, etc., are considered.
3.3.10 The CCG has also developed a process of Quality Improvements Visits in line with the Patient Safety and Clinical Quality Framework and a paper has been presented to the CCG GBs to explain how this will operate. To all intents and purposes, the schedule of quality improvement visits, is part of an overall ‘clinical audit’ process, and it is this process where the GB will receive assurance. The next section on assurance will consider the options for the Audit Committee with regard to quality assurance.
3.4. Assurance on Clinical Quality
3.4.1 The Audit Committee handbook states that Audit Committees should consider the clinical objectives and risks in the Assurance Framework and to report on the controls and assurances in relation to these.
3.4.2 The Audit Committee receives an update on all risks and controls in relation to meeting the priorities of the CCGs, through the review of the assurance framework (GBAF). This includes clinical risks, but as stated previously these are not specifically linked to the individual priorities of the CCG.
3.4.3 The Audit Committee handbook suggests that assurance can be shown as outcome data, process data or reports from inspections or reviews carried out. Due to the restrictions of space within a framework document it is not always possible to set these details out. The CCG’s reporting and assurance processes includes cross referencing to the risk in the GBAF in the Integrated Performance Report where details of outcome data are provided. The GBAF includes an indication as to whether the risk has changed since the previous version, taking into performance of the providers. The Integrated Performance Report is presented to both the EC, and the Governing Body where Audit Committee Chair attends.
3.4.4 The Audit Committee reviews of the GBAF include challenges of risk assessment based upon performance reported to date and actions needed to address risks raised. Independent assurances on specific controls on, for instance, contract monitoring are covered within the Strategic Internal Audit Plan. However, as implied within the scope of this review, the Audit Committee members do not have arrangements currently to enable detailed independent scrutiny and review of the management of specific clinical risks, apart from public Board meetings. This scrutiny would include review of existing ‘clinical audit’ processes (as set out in 3.3.8 to 3.3.11 above). Such scrutiny would include questions raised as examples in the Audit Committee handbook as follows:
• How the programme of clinical audit work is decided upon • Whether the programme is at an appropriate level and reflects the organisation’s
strategic objectives • The rigour of the processes for conducting clinical audits • Whether all clinical audits are reported, in what form and to whom • How matters arising are dealt with and followed up.
3.4.5 The Executive Committee has received a paper from the Chief Nursing Officer about the Quality Improvement Visits programme; stating that to bring a stronger patient perspective into the care commissioned from providers, the existing programme of Quality Improvement Visits is being further developed to ensure that close partnership working and surveillance is promoted for West Suffolk CCG. The paper provides most of the answers to the questions
above in terms of the CCG’s own Quality Improvement Visits but not necessarily with regards to the providers’ clinical audit processes. The assurance process from the Audit Committee perspective is to satisfy itself and the Governing Body that the overall clinical audit process is working effectively. A further Internal Audit review can provide further assurance that those principals are being followed.
3.4.6 From a review of the current governance structures and EC minutes, it is clear that the EC naturally plays a key role in the clinical governance process. The question posed by the Audit Committee is how it should engage with the Clinical Audit process (and therefore the clinical governance process).
3.5. Options for Audit Committee and Assurance on Clinical Quality
3.5.1 Discussions with officers and review of best practice contained within the Audit Committee Handbook, Internal Audit believe that there are three options:
• A separate Committee for oversight of Patient Safety & Quality; • Formalising a Clinical Executive Committee meeting on a monthly basis; • Adding Quality Assurance to the Audit Committee agenda.
3.5.2 The pros and cons of each option are set out below.
3.5.3 A separate Patient Safety & Quality Committee would more clearly demonstrate/evidence the CCG’s commitment to and scrutiny of clinical quality, and ensuring compliance with latest guidance (e..g by the NHS Leadership Academy, where they recommend such a separate Committee). The downside to adding another Committee is the extra time, cost, potential loss of control of the CEC, unless there is the same membership, in which case there is a potential for duplication. It might also be perceived as putting quality in an isolated box, rather than being an integral part of everything the CCG does.
3.5.4 The Clinical Executive already meets weekly and receive many reports on clinical quality and progress against plans. Because of issues identified in 3.1 above, such as the lack of a terms of reference and the GBAF not being reviewed by that Committee, the CCG is not able to demonstrate it is following best practice in Clinical Governance. This could be rectified fairly simply by ensuring that at least once a month or every two months: Audit Committee members are invited to the EC at the same time as the Integrated Performance Report is presented (to keep their independence the members should not be members of this Committee); minutes are produced more formally, ensuring that scrutiny and challenge is evidenced within those minutes; governance best practice is followed in terms of committee assessment of its performance; matters to be escalated to the Governing Body; minutes are shared with the Audit Committee (and vice versa). There are few disadvantages perceived by this process other than additional time required of Audit Committee members and potentially other competing Committee priorities.
3.5.5 The third option of using the Audit Committee is in line with practice operated elsewhere and suggested in the Audit Committee Handbook, where the Audit Committee drills down into clinical quality risks and controls by inviting management to provide assurance that controls are operating as stated and action plans are being implemented where they are not. The Committee will need to be careful that this process is not seen as duplicating the work of the CEC and they are taking the assurance role not a monitoring role. Other than that and additional time for respective Chief Officers/GP leads, there are few disadvantages with this option.
3.5.6 From a review of the options available and discussions with management, it is recommended that option two is adopted with the proviso that improvements as
recommended from section 3.1 are implemented (Recommendation 3). This should not preclude option 3 also being adopted should the Audit Committee deem it necessary.
4. Assignment Framework
4.1. Scope
4.1.1 In accordance with the Operational Audit Plan for 2013/14, a review of Clinical Governance has been completed. The scope covered
The CCG’s Clinical Objectives; Clinical performance and risk management systems; Controls stated in the GBAF: e.g. Clinical Executive; SLA Monitoring; Clinical governance structures; meetings, reports and assurance.
4.2. Methodology
4.2.1 Internal Audit adopted a risk-based approach to the evaluation of controls, so as to assess the level of assurance provided by the system. Our sample sizes were determined by XXX.
4.2.2 Our work has been performed in compliance with the NHS Internal Audit Standards and CEAC’s own ISO 9001:2008 Quality Management System.
4.3. Conduct
4.3.1 Internal Audit fieldwork was performed by the following staff:
Manager Neil Abbott e-mail: [email protected] Telephone: 01473 702880
4.4. Internal Audit Timescales
4.4.1 The Internal Audit timescales were as follows:
Fieldwork June and July 2013 Draft Report July 2013 Management Response October 2013 Final Report October 2013
4.5. Report Distribution
4.5.1 The report distribution is as follows:
Julian Herbert Chief Officer For Information Barbara Mclean Chief Nursing Officer For Information Ed Garratt Chief Operating Officer For Action Colin Boakes Governance Advisor For Action Bill Banks Audit Committee Chair For Information Andy Eley Head of Planning & Performance Management For Action Carl Goulton Chief Finance Officer For Information
4.6. Rating of Recommendations
4.6.1 Our recommendations are prioritised so as to reflect their potential impact on the organisation as a whole (rather than within the specific system under review). An explanation of the rating scheme is set out in the table below.
Rating Explanation of Risk
High The weakness could have a major impact on the organisation in terms of failing to deliver services, damage to the organisation’s reputation, lost opportunity or loss/waste of resources.
Medium The weakness could have a moderate impact on the organisation in terms of failing to deliver services, damage to the organisation’s reputation, lost opportunity or loss/waste of resources.
Low The weakness could have a minor impact on the organisation in terms of failing to deliver services, damage to the organisation’s reputation, lost opportunity or loss/waste of resources.
4.7. Evaluation of Controls
4.7.1 Internal Audit reviews can never provide complete assurance that systems and controls are robust and operating satisfactorily because resources allow only sample testing. Our work can therefore only provide reasonable assurance, which is limited to the specific control objectives tested as described in this report.
4.7.2 The effectiveness of the controls operating in each system examined has been graded according to the scheme set out below.
Grade Explanation of Rating
Excellent There is a strong system of internal control in place, and the controls are being consistently and effectively applied in all the areas reviewed.
Good There is a generally sound system of internal control in place in the areas reviewed, and the controls are generally being applied consistently and effectively, with only minor improvements identified.
Satisfactory There is a generally sound system of internal control in place in the areas reviewed, and the controls are generally being applied consistently and effectively. However some areas for improvement were identified.
Limited There are weaknesses within the system of internal control, and/or key controls are not being applied consistently or effectively, which may adversely impact on the organisation.
Unacceptable Serious weaknesses in the design and/or, inconsistent or ineffective application of controls in the areas reviewed, which may adversely impact on the organisation.
4.8. Disclosure
4.8.1 This report is addressed to the Trust and has been prepared for the sole use of the Trust. We take no responsibility for any member of staff acting in their individual capacities, or to third parties.
4.8.2 The information contained may be subject to public disclosure under the Freedom of information Act 2000. Unless the Information is legally exempt from disclosure, its confidentially cannot be guaranteed.
5. Recommendation(s)
Recommendation Rating Risk Agreed Yes/ No/ Partial
Manager Responsible and Response Due Date Follow Up
Date
1. Include the priorities at risk in the GBAF document. Medium The CCG does not know which priorities are more at risk.
Yes Ed Garratt Governance Advisor to add a Priorities column to the GBAF.
November 2013
December 2013
2. Whilst the CCG has set up a robust performance framework for the Transitional Programme, further work will need to be done so that the CCG can report more clearly on progress against its 2012-2015 Integrated Plan and its priorities contained therein.
Low The CCG will not have data and information to hand to quickly compile progress against priorities either for an interim report or CCG annual report.
Yes Andrew Eley This data will come from a number of sources; therefore a record showing the source and frequency of all priority related measurement data (as set out in CCG’s Integrated Plan) will be prepared to ensure that this is clear.
October 2013 November 2013
3. Formalise the Executive Committee so that it acts as a Sub-Committee of the Governing body once a month and complies with existing terms of reference and best practice. In doing so the formal Committee meeting should include: - Presentation of the Integrated Performance report; - Presentation and consideration of the GBAF and
risks; - Attendance by Lay members (i.e. a member of the
Audit Committee); - More formal minutes, including evidence of
scrutiny, challenge, and escalation where necessary to the Governing Body
- Assessment of the meeting to ensure it meets its terms of reference.
Medium The Committee does not fulfil or demonstrate its responsibilities in terms of Clinical Governance in line with best practice.
Yes Ed Garratt Further to discussion by the respective CCG Executive Committees it has been agreed that both will formalise meetings every two months as sub-committees of the Governing Body with separate terms of reference that clearly designate the meetings as Clinical Executive Committees & reflect the audit recommendations.
It is anticipated that the first meetings will be held in December 2013, following endorsement by the Audit Committees on 15/10/13 & the Governing Bodies on 26 & 27/11/13
December 2013
1
Agenda Item No. 15 Reference No. WSCCG13-045
From: Carl Goulton, Chief Finance Officer, Barbara McLean, Chief Nursing Officer, Wendy Tankard, Chief Contracts Officer Part 1 Part 2 GOVERNING BODY REPORT: INTEGRATED PERFORMANCE REPORT: November 2013
1. Purpose 1.1 This report provides members with a summary of performance for 2013/14 against national
targets, contractual targets, clinical quality and patient safety issues, financial position and acute activity.
2. Public Engagement Not applicable. 3. Recommendations 3.1 It is recommended that members:
• note the position regarding financial and service performance; • review the actions being taken with regard to patient safety and clinical quality
issues; and • note any actions to mitigate risks or poor performance.
Author: Carl Goulton, Chief Finance Officer
1
Integrated Performance Report
November 2013
2
ContentsCCG Executive ‘dashboard’…………………………………………………................................
Part 1 - Detailed Clinical Quality & Patient Safety Report
Part 2 - Financial and Performance Delivery Report• Financial Summary………………………………………………………………………………....• Overall Acute Activity Summary Position………………………………………………………..• Summary of QIPP Delivery………………………………………………………………………..• NHS Outcomes Framework, NHS Constitution, and Acute Contractual
Performance Measures 2013/14…………………………………………………………………..
Part 3 - Redesign & Clinical Work Streams• CCG Integrated ‘Plan on a Page’……….................................................................................• Clinical Workstream ‘dashboards’:
a. Planned Care……….......................................b. Integrated Care/EoL…………………………...c. Mental Health/LD……………………………….d. Cancer………………………………………......e. Children & Young People……………………...f. Prescribing……………….……………………..
Part 4 - Contractual performance, by provider• West Suffolk hospital…………………………………………………………………………….....• Harmoni HS (Out of hours & ‘111’)……………………………………………………….…..….• Community Services (Serco) Performance Report…………………………………….……....• Norfolk & Suffolk FT ……………………………………………………………..…………………
Part 5 – CCG Assurance Framework Balanced Scorecard Quarter 1 2013/14
Part 6 – Appendices – West Suffolk hospital: Trust Quality Dashboard
3-4
5-24
25-3726-2829-3031-3233-37
38-6339
40-4445-5152-5354-5859-63
64
65-8366-6970-7273-7879-83
84-91
3
Executive Dashboard
Clinical Quality & Patient Safety….
Financial position against plan……
Acute activity levels against plan…
QIPP delivery (* see note below)…..…
Local Quality Premium Indicators ..
NHS Constitution/national targets..
CQUIN…………………………….
Current month
Headlines:Previous 6 months
Overall CCG position:
Notes:
Clinical Quality & Patient Safety• Recent CQC visits are reported on Page 7;• A contract query and remedial action plan is in place for WSH Serious
Incidents Requiring Investigation (SIRI) reporting. There has been animprovement in the number of overdue final reports. A mid year review ofSIRI’s will take place in October 2013. (page 8);
• A never event occurred at West Suffolk Hospital in August 2013 which wasreported to the CCG on the 3 September 2013. A root cause analysis is inprogress. (page 9);
• The CCG has reported 4 MRSA bacteraemia for the year to date to the end ofOctober (unvalidated). Refer to the Clinical Quality section of this report (page9). A Contract Query has been issued and a Remedial Action Plan is in place;
• The CCG reported 33 (target 28) C.difficile infections for the year to date toOctober (unvalidated) reported in full on page 10;
NHS England National TargetsPerformance against the suite of national targets is generally good, althoughperformance is not at the required levels in:• MRSA and C.difficile YTD (Page 22-23);• 6 week waiting time target for diagnostic tests (Page 41);• 52 week Referral to Treatment (RTT) waiting time (Page 41);• Emergency readmissions within 30 days of discharge from hospital (Page 46)• Ambulance clinical quality indicators and ‘handover’ times (Page 47);
Local Quality Premium• Performance against the Local Quality Premium Indicators relating to both
breastfeeding prevalence (page 60) and stroke care remains below target forthe year (Page 46).
• Baseline data for the indicator relating to anti-psychotic prescribing for patientswith dementia has been established (14.3%). The annual target is to reducethis to 12.9%. For quarter 2 performance is above target at 14.5% (year todate 14.4%) (Page 46).
(M6)
(M6)
(Var)
(Var)
(Var)
(M6)
(Q1)
(*) Based on delivery of agreed suite of QIPP KPI’s (Page 31-32)
4
Executive Dashboard (continued)
Current month
West Suffolk hospital…….
Harmoni (OOH)..…………
Harmoni (‘111’)……………
Serco……………………….
NSFT……………………….
Headlines:Previous 6 months
Overall CCG position:
Notes:
Finance & Activity• At month 6 the CCG remains on track to deliver the full year required surplus of £2.6m
(1%) despite big variances within the service lines (page 27)• Re-forecast 2 was undertaken to determine the likely year end position, taking into
account any continuation of variances to date, and the required surplus remainsdeliverable, albeit challenging.
• Significant risks remain in the system, and the full contingency will be required tomitigate these risks, along with some use of funds originally planned for investments ifthe adverse variance on West Suffolk Hospital continues
• At Month 6 the initial view of acute activity indicates over-performance in FirstOutpatients (3.1%), Other non-elective (11.1%) and A&E (6.9%), whilst Elective (3.4%)and Emergency non-elective (15.0%) are below plan. Overall ambulance activity(4.1%) is below plan year to date, although Red (Category ‘A’ calls are above plan by1.0%. (pages 29-30);
Provider Performance• Performance against the key measures within the West Suffolk hospital contract is
generally good, although performance targets were not achieved in the areas set outbelow:
– A maximum two-week wait standard for rapid access chest pain clinic(Page 41);
– Direct access diagnostics YTD (Page 41);– Choose and book, first outpatient booking, including advice letter listing
(Page 41);– Provider cancellation of Elective Care organisation for non-clinical reasons
(Page 41);– Stroke – Increase the proportion of patients admitted to an acute stroke unit
within 4 hours of hospital arrival (Page 47).• Delivery of CQUIN schemes in Quarter 1 was partially met (page 66);• Harmoni did not meet the required standard against 4 contractual Quality standards
across the Out of Hours and ‘111’ services (page 70-71);• Serco did not achieve 5 of its performance targets. Only those areas that are currently,
or have historically failed, are shown by exception in the performance report (page 75-76);
• NSFT did not achieve 9 of its performance targets. Only those areas that arecurrently, or have historically failed, are shown by exception in the performance report(page 81-83)
(M6)
(M6)
(M6)
(Var)
(M6)
5
Part 1 Detailed Clinical Quality & Patient Safety
Report
6
Care Quality Commission (CQC)…
SIRIs…………………………………
Never Events……………………….
Infection Control (HCAI)…………..
Pressure Ulcers…………………....
Patient Advice & Liaison Service..
Net Promoter Score (NPS)………..
Complaints…………………………..
Safeguarding Children……………..
Continuing Health Care (CHC)……
Falls………………………………….
• Recent CQC visits are reported on Page 7;
• A contract query and remedial action plan is in place for WSH Serious Incidents RequiringInvestigation (SIRI) reporting. There has been an improvement in the number of overdue finalreports. A mid year review of SIRI’s will take place in October 2013. (page 8);
• A never event occurred at West Suffolk Hospital in August 2013 which was reported to theCCG on the 3 September 2013. A root cause analysis is in progress. (page 9);
• The CCG has reported 4 MRSA bacteraemia for the year to date to the end of October(unvalidated). Refer to the Clinical Quality section of this report (page 9). A Contract Queryhas been issued and a Remedial Action Plan is in place;
• The CCG reported 33 (target 28) C.difficile infections for the year to date to October(unvalidated). Refer to the Clinical Quality section of this report (page 10).
Notes:
Current position
Executive Dashboard – Clinical Quality & Patient Safety
7
Quality Improvement Visits (QIV)
July, 2013 Newmarker Hospital Completed actions:• There is a new VTE policy• Complaint process• Environment improvements
• All stationery stores now located in new area freeing up space for clinical supplies
• New patient information display board/leaflet racks delivered in September.• Designated relatives room now available
• Unfortunately the suggestion to open up the reception area has been challenged as a fire and safety risk. Therefore this has had to be abandoned however we still plan to put a privacy barrier/shelf around the reception desk to promote patient confidentiality and tidier presentation to the public.
• Awaiting funds to purchase new crockery/pictures aim to complete by 31/10/2013• Face to face Safeguarding Adults training offered at monthly induction and other staff
can also attend. Additional training available from Sept to December 2013 at various locations
• New Adult Safeguarding Lead commenced 1/7/2013 who has been facilitating various workshops including ‘Challenging behaviours’ intended to help staff recognise how to minimise and prevent potential abuse. Local training to be completed end of December 2013.
• Band 5 1.5 WTE commenced 1/10/2013• Further interviews held for Band 5 permanent and bank posts in September • New Matron commenced 1/7/2013• New HCA commenced 1/8/2013• Bank and agency staff used as needed.
8
EEAST Patient safety
Patient Safety InitiativeTo introduce principles of Crisis Risk Management (CRM) and Human Factors into an ambulance service which works remotely and has highpotential for patient harm. This will be in conjunction with a highly-skilled CRM and Human Factors expert from Virgin Atlantic guiding us throughculture change and will enable teams and solo workers to participate in the changing culture therefore seeing a reduction in patient safety issueswhich will enable our patients to have a safer experience as a result. The culture will change from Board to road to ensure it is embedded andwill be measured by a reduction in incidents, complaints, staff sickness and litigation. Whilst CRM and Human Factors are not new to health, ithas never been tested in an ambulance service before and, due to the remote nature of work, will prove pivotal in quality and patient safety forthe future as more is asked of the profession.
Serious Incident Requiring Investigation (SIRI)
West Suffolk Clinical Commissioning Group
Provider No of SIRIs Category Overdue 45 reports up until 31 October 2013 in total
WSH 6 2 Sub-optimal care of the deteriorating patient
1 Grade 3 – Pressure Ulcers 1 Unexpected death (general) 1 Slips/Trips/Fall 1 Failure to act upon test result
0
NSFT 1 1 Unexpected death of Community Patient (in receipt)
2
SCH 2 2 Grade 3 – Pressure Ulcers 0Harmoni 1 1 Unexpected death (general) 2
EEAST (For Info-Regional)
7 3 Ambulance (general) 1 Ambulance Delay 1 Drug Incident 1 Ambulance Accident – Road
Traffic Collision 1 Ambulance medication
3
Please refer to the contractual section on page 69 for further detail;
9
Never Events
• A never event occurred at West Suffolk Hospital in August 2013 which was reported to the CCG on the 3 September 2013. A root cause analysis is in progress. No never events were reported in October.
Infection Control ‐MRSA
MRSA Cases 2013-14Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13
West Suffolk CCG Acute Actual 0 1 0 0 0 0 0West Suffolk CCG Non Acute Actual 1 1 0 0 1 0 0West Suffolk CCG Total 1 2 0 0 1 0 0West Suffolk CCG Target 0 0 0 0 0 0 0
West Suffolk CCG YTD Acute Actual 0 1 1 1 1 1 1West Suffolk CCG YTD Non Acute Actual 1 2 2 2 3 3 3West Suffolk CCG YTD Total 1 3 3 3 4 4 4West Suffolk CCG YTD Target 0 0 0 0 0 0 0
West Suffolk Clinical Commissioning Group (WSCCG) currently (YTD) has 4 cases of MRSA bacteraemia. 1 case being apportioned to the Acute Trustand 2 cases being apportioned to the Community/Non-Acute. This is number is against a trajectory of 0.
West Suffolk Hospital continue to be supervised in the avoidance and management of MRSA bacteraemia by a formal Remedial Action Plan (RAP), theTrust’s on-going progress were re-assessed against the agreed RAP contractual obligations on Wednesday 6th November 2013.
Please refer to the contractual section on page 69 for further detail;
10
Infection Control – C.difficile
C.difficile Cases 2013-2014Apr-13 May-13 Jun-13 Jul-
13Aug-13 Sep-13 Oct-13
West Suffolk CCG Acute Actual 5 2 1 2 3 2 2West Suffolk CCG Acute Target 1 1 1 1 1 2 2
West Suffolk CCG Non Acute Actual 3 4 0 1 2 5 1West Suffolk CCG Non Acute Target 3 3 2 3 3 2 3
West Suffolk CCG Total 8 6 1 3 5 7 3West Suffolk CCG Target 4 4 3 4 4 4 5
West Suffolk CCG YTD Acute Actual 5 7 8 10 13 15 17West Suffolk CCG YTD Acute Target 1 2 3 4 5 7 9
West Suffolk CCG YTD Non Acute Actual 3 7 7 8 10 15 16West Suffolk CCG YTD Non Acute Target 3 6 8 11 14 16 19
West Suffolk CCG YTD Total 8 14 15 18 23 30 33West Suffolk CCG YTD Target 4 8 11 15 19 23 28
Please note: October figures have not yet been validated by the HPA data capture system.
Currently the October C diff numbers for West Suffolk Clinical Commissioning Group (WSCCG) are 3 cases over a monthly trajectory of 5. This isbroken down with 2 cases being apportioned to the Acute Hospital and 1 case apportioned to the Community/Non-Acute, against an accumulative,WSCCG year to date total of 33 cases over a trajectory of 28.
Accumulatively, West Suffolk Hospital (WSH) has a YTD total of 17 cases over a end of year trajectory of 19.Following an external independent C diff review performed at WSH in September 2013, there were some overarching recommendations made to theTrust to address in order to be compliant with current national guidelines and good practice.
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Infection Control – C.difficile (continued)
• Increase the number of single rooms to facilitate timely isolation of patients• Provision of a decant ward to support the rolling programme of deep cleaning.• Increase the provision of hand washing facilities at ward level• Streamline the RCA process• Feedback to individual clinical teams on performance data and key actions from audits• De-clutter
Following discussion, West Suffolk Hospital Hope to, implement the creation of an 8 bedded isolation ward in January 2014, The ClinicalCommissioning Group have expressed a concern and requested that this matter be addressed with some urgency in order to meet anticipated winterpressures.
It is anticipated that the re-introduction of a decant ward to facilitate deep cleaning will also become operational in the New Year.
The Root Cause Analysis (RCA) process needs to be more precise at identifying key issues for escalation and action, with cases demonstrating goodmanagement being openly discussed with the CCG. Where appropriate, cases should be sent for consideration of the appeals process. TheInfection Control Team are currently working with WSH to ensure this process is in place.
WSH have assured the CCG that the matter of ‘clutter’ on wards is being addressed and several wards have now been given covered washablestorage boxes in which to keep equipment.
The CCG ICT have worked with Communications Department and have begum the public awareness campaign on how to prevent the spread ofgastrointestinal infections such as Norovirus. Localized press releases have been scheduled to be published in November, with further input via localradio planned.
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Falls
2013‐14 WSH SCH (NCH) NSFT (East and West)
Total Number of falls
Falls resulting in serious harm
Total Number of falls
Falls resulting in serious harm
Total Number of falls
Falls resulting in serious harm
April 67 2 6 0 20 0May 63 0 5 0 28 0June 60 3 0 0 9 0July 55 1 0 0 23 0August 47 1 8 0 17 0September 49 0 5 0 14 0Total 341 7 24 0 111 0
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Pressure Ulcer Incidents
Pressure Ulcers - October 2013
Provider Grade 2Grade 3 (SIRIs)
Grade 4 (SIRIs)
WSH * 1 0SCH 2 2 0NSFT 0 0 0
Negotiation with providers on avoidable / unavoidable status. Confirmed next month.
* Information not provided at time of request
Actual Avoidable Pressure Ulcer Numbers
This information is not available.
14
Patient Advice & Liaison Service (PALS)
Total PALS activity across county for October 2013 showed 614compared with 903 for October 2012.
These figures include patients accessing the emergency dentalservice. Other figures are hospital transport, pharmacy/prescribingqueries as well as GP, optical, dental and other community providerservices such as SCH/Serco, and Harmoni.
Included in the miscellaneous figures are District Nursing, HealthCosts and signposting to outside organisations and generalinformation.
The appeals process for hospital transport continues to be a PALSfunction.
For locality breakdown, the overall figure for September for WestSuffolk CCG was 176 and for others out of NHS Suffolk area, 14.
The PALS figures include the emergency dental appointments,orthodontics and general dental queries around treatment andcharges. The figures for West Suffolk CCG were 134 and otherareas 5.
There were also concerns raised regarding Shingles vaccination,SCR and alternative therapies.
Dental 134GP query 6Continuing care 0Funding 0Podiatry 0Optical 3Physiotherapy 1Meds/Pharmacy 2Mental health 1Med cert/recs 1Continence 1Screening -bowel/breast/ cervical 0Acute 6PALS - other area 1Prisons 1Transport 12Equipment 0Community Hospitals 1Child Weight Mgt 0Miscellaneous 6
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Contract Issues Log
June 2013
July 2013
Aug 2013
Sept 2013
Oct 2013
Number of queries 20 30 21 32 35Number closed 9 6 9 12 7Overall number outstanding n/a n/a 28 35 39
Queries by Provider
Harmoni 0 0 1 1 1Addenbrookes
0 1 0 0 0
Papworth 0 0 0 0 0Ipswich Hospital
11 19 3 6 8
NSFT 4 6 1 10 8
Serco 2 1 14 13 8West Suffolk Hospital
1 2 1 2 10
Private 0 0 0 0 0
Other 2 1 1 0 0
The new process has now been rolled out to all GP practices in Ipswich and Eastand West CCG’s and to all providers to ensure a more robust and efficient system inresponding to queries raised through the GP Contract Query log.
All queries should now be directed to:
Themes and trends will continue to be raised through the Contract Team and wherespecific patient identifiable information is required to take the query forward, consentwill be required from both the practice in the first instance and then directly from thepatient. This will be facilitated by the Patient Experience Team.
Any outstanding queries are being addressed and any themes are being raisedthrough the Contract Team with the provider on a monthly basis.
Provider Type of Query Open/Closed
Harmoni OOH services Open
WSH Communication x 4 Referral x 2Referral x 4
OpenOpenClosed
NSFT Access to services x 4Communication x 1CAMHS x 2Information x 1
OpenOpenOpenOpen
IHT Referral x 1 Communication x 3Communication x 1Access to information x 1Access to services x 1
OpenOpenClosedClosedOpen
SERCO District Nursing Service x 3District Nursing Service x 1 Access to services x 3 Equipment x 1
OpenClosedOpenOpen
Please see table below for breakdown of queries:
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Serco/Suffolk Community Services
In July of this year, a rise in concerns reported by General Practice via the Contract Issues Log coincided with a fall in positive feedback by patients in the Friends and Family Test.
A letter was then received by the CCG noting concerns on patient safety and clinical quality in our SCH team. Initially this was treated as ‘Whistleblowing’ but was subsequently clarified in a letter to a line manager escalating concerns and copied to the CCG.
The CCG follows the National Quality Board (NQB) principles for quality monitoring:-
The patient comes first – not the needs of any organisation Quality is everybody’s business – from the ward to the
board; from the supervisory bodies to the regulators, from the commissioners to primary care clinicians and managers
If we have concerns, we speak out and raise questions without hesitation
We listen in a systematic way to what our patients and our staff tell us about the quality of care
If concerns are raised we listen and ‘go and look’ We share our hard and soft intelligence on quality with
others and actively look at the hard and soft intelligence on quality of others
If we are not sure what to decide, or do, we seek advice from others
Our behaviours and values will be consistent with the NHS Constitution
Following these principles, the Quality Review of SCH services was first noted and reported to the Clinical Executive in early August. The Patient Safety and Clinical Quality Team held an information sharing meeting with both Ipswich and East CCG, and West Suffolk CCG’s Chief Officer Teams and Serco to establish the intelligence available.
As a result of the review, Key Performance Indicators were reviewed and a Contract Query was raised and a remedial action plan put in place, monitored and managed through the Contracting team.
The Patient Safety and Clinical Quality Team reviewed Incidents and Serious Incidents, themes within the Contract Issues Log and requested information on staffing levels, vacancies and recruitment trajectories.
To enhance the above intelligence and provide clarity on further work necessary, a programme of visits to services was also planned. The programme prioritised service areas where comments/concerns had been raised. In total, not less than twelve visits were planned. The programme has been amended and expanded in response to comments.
The feedback and review of all elements of the Quality Review will take place on Tuesday 19th November at a workshop event involving both CCGs and Serco representation.
17
Net Promoter Score
Friends and Family Test results for September 2013 – West Suffolk Hospital
The Friends and Family Test aims to instigate a culture of continuous improvement in the NHS by providing a simple, headline metric which, when combined with follow-up questions, can provide insight into good practice and lead to improvements in the quality of NHS care. It will enable the views of patients and their families to be heard and provides a platform to shape and deliver better services. The implementation of the FFT across all NHS services is an integral part of Putting Patients First, NHS England’s Business Plan for 2013/14 – 2015/16.
*There is a requirement to ask the Friends and Family question four times across Maternity Services; at the 36 week antenatal appointment, following birth in the delivery suite or birthing unit, post-natally on discharge from the post natal ward and lastly at the time of discharge in the community. The scores for this month are shown below;
Antenatal Birth Post Natal Ward Community77 91 66 90
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Net Promoter Score (continued)
Friends and Family Test results for September 2013 – Community Services
68 74 70
85
65
51.7
88.3 84
9889
77
52
0
20
40
60
80
100
120
Apr‐13 May‐13 Jun‐13 Jul‐13 Aug‐13 Sep‐13
Inpatients
MIU*
HomeCare**CommunityHospital**
* MIU data for April and May 2013 not reported** Home Care and Community Hospital data being reported from September 2013
NB Clinic results currently under development and will be included in future reports
19
Complaints
.
Complaints received during October 2013
A total of 2 complaints were received in October for the West Suffolk CCG. The table below breaks down these complaint volumes by source.
East Complaint Details / Themes Number of complaints
CHC Unhappy with CHC assessment 1
Serco Unhappy with podiatry service 1
TOTAL 2
From 22nd May 2013 any new complaints received by the West Suffolk CCG regarding primary care are now sent directly to the NHS England Customer Contact Centre for processing.
20
Complaints (continued)
September ‐ validated data
West Suffolk Hospital
29 complaints were received during September 2013 for the West Suffolk Hospital. Of the 29 complaints, the breakdown by Primary Directorate is as follows: Medical (15), Surgical (5), Clinical Support (0), Facilities (1) and Women & Child Health (8).
Trust-wide the most common problem areas are as follows:
Complaint issue
Admissions, Discharge and Transfer Arrangements 4
Aids & Appliances, Equipment, Premises (including access) 3
Attitude of Staff 8
All Aspects of Clinical Treatment 20
Communication / Information to patients (written and oral) 12
Serco
7 complaints were received during September 2013 for Serco. A breakdown of these complaints is shown below.
• Delay in receiving District Nurse visits following discharge from Addenbrookes Hospital.• Staff member alleged to have spoken in an inappropriate manner to a patient and their family.• Patient was referred to physiotherapist following discharge from West Suffolk Hospital, but received no contact from service.• Daughter of patient received a patient survey request addressed to her mother, although SCH had been contacted previously and informed that the
patient had passed away.• Patient has waited 5 months for a response to a telephone message from community team.• 2 complaints received relating to the Wheelchair service all concerning the delay in the supply of wheelchair equipment and poor communication from
the wheelchair service.
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Children and young people/ Adult Continuing Health Care/Adult Safeguarding
Children on a Child Protection Plan
On 25.10 2013 there were 533 children who are the subjects of a Child Protection Plan in Suffolk County – there has been a slight increase in the number. Neglect remains the main category under which children are placed on a Plan closely followed by emotional abuse.
Serious Case Review (SCR)
The Suffolk LSCB has held a second ‘learning event’ in relation to the Waveney SCR on 24th October. Frontline practitioners who were directly involved with the children and family were invited to attend and the event aimed to collate information from the practitioners to contribute to the independent overview writers report and Recommendations. The focus of the day was to undertake further analysis of the themes emerging from the case and ask key ‘why’ questions. The LSCB have asked for additional time for completion of the report so the presentation of the findings and learning will now occur on 12th December 2013 (tbc). All LSCB Board members will be invited to attend this meeting. Following this the report will be submitted for publication (January 2014) – a communications strategy will be put in place to manage the media attention this case is likely to attract.
Further learning events for practitioners are planned to be delivered through the LSCB throughout the Spring of 2014 where the learning from the case can be disseminated across the multi-agency networks.
Lessons from the Daniel Pelka SCR have begun to be disseminated throughout the health community. Dr Rycroft has circulated a summary of the case to Paediatricians and Named Nurses. The President of the RCPCH has written to all Paediatricians in the country noting the lessons and urging diligent practice in this field and presentations at multiagency meetings have taken place at WSH and will also happen at IH next week.
CDOP
Progress has been made with reviews of Neonatal Deaths by specially constituted Neonatal CDOPs at both Ipswich Hospital and West Suffolk. Learning in relation to GBSrep prevention policies and a rise in Shoulder dystocia and management of obese mothers and preterm infants with prolonged ruptured membranes was noted.
A half yearly report will be presented to the LSCB which records 19 child and infant deaths in the period 1 April-30 Sept 2013 and compares with 28 deaths reported in the same period last year.
22
Children and young people/ Adult Continuing Health Care/Adult Safeguarding (Continued)
Referrals to Suffolk LSCB Serious Case Review Panel There are two cases that have been raised to the LSCB that will be referred to the SCR Panel for consideration to undertake a Partnership review. One is for a Young person living in the Waveney area of Suffolk, the other for a young infant from the West of the County. The next SCR Panel Meeting is due to be held on 11/11/2013.
Suffolk LSCB Sub-GroupsThere is a proposal to merge the Policy and Practice sub-group with the Communications sub-group and the structure of the Child Sexual Exploitation sub-group is planned to alter so that there is an overarching Strategic Group with three work streams, Gangs and Groups, Child Sexual Exploitation and Missing Children to so work can start in implementing the strategy for each of these areas.
Safeguarding Children Serious IncidentsThere has been one serious incident reported involving a Looked After Young Person placed in a Tier 4 CAMHS provision in Essex. NHS England Specialist Commissioning group were made aware of this incident.
Preparation for CQC inspections for safeguarding Children and Looked After ChildrenThe designated professionals are proposing to form a planning group to ensure Suffolk CCGs and health providers are ready for a CQC inspection. These are ‘unannounced’ inspections in that the CQC write to the Chief Nurse on the Thursday prior to commencing the inspection on the following Monday. There is a detailed format for the inspection which focuses on ‘the child’s journey’ – 12 cases are requested to be ready for the inspection followed by a time table for the visits to speak with frontline practitioners following four main ‘lines of enquiry’.
Multi-Agency Safeguarding Hub (MASH) Gradual progress is being made in the preparation for implementing a MASH within Suffolk; however there remains a significant amount of work to be undertaken prior to completion. Continued work is being undertaken within the work-streams – a working model for the MASH process has been developed, an initial Draft MASH Information Sharing Protocol has been proposed along with a Job description for the MASH manager role. To support the progression of the health agency contribution to the development of the MASH a sub-group for health has been formed and the first meeting held on 21/10/2013.This group aims to co-ordinate the feedback from the health work-steam leads and ensure that health providers are fully informed of what their contribution to the MASH model would look like. There will be resource issues for health in ensuring the right number and quality of health staff are employed within the MASH.
There is a MASH ‘gateway review’ on the 5TH & 6TH of November where the consultant for the MASH project, Nigel Boulton, will take a snapshot analysis of the progress on the project and identify areas of completion and areas that require further development. The Chief Nurse and Designated Nurse will be involved in this review process.
23
Children and young people/ Adult Continuing Health Care/Adult Safeguarding (Continued)
Looked After Children (LAC)
There are currently 712 Suffolk Looked After Children a slight drop from 748 this time last year. Half of these children are the subjects of a Full CareOrder, a further quarter are accommodated under a Section 20 order.
Corporate Parenting Board
The Corporate Parenting Board Meeting on the 4th of November will be a health themed meeting. The Chief Nurse along with the NSFT AssociateOperations Director and the Designated Nurse will be presenting a briefing paper on the how the agency is meeting the health needs of LAC. This willinclude an update on the LAC project.
Looked After Children Project
Both CCG redesign teams have worked in partnership to take this project forward and have formed a Task and Finish group to implement thecomprehensive Action Plan with nine key areas for development.
Achievements to date
• Strategic level joint health/social care governance structures for LAC have been strengthened. The LAC project recommendations will bereported on and overseen by the Children’s Trust joint Commissioning Group.
• All stakeholders have now been circulated the LAC Review Report• The LAC health Network Group will form into the ‘Integrated Working Group’ with a wider membership. The group will be working together
to implement the integrated working actions.• Funding has been agreed for additional designated Dr sessions• A model for including a LAC specialist nurse in the community paediatric team to support their work in undertaking Initial Health
Assessments has been developed.• An additional Designated Nurse has been recruited on a secondment basis. This supports succession planning and also enables the current
post holder to focus on implementing the LAC Action Plan• The current Partnership Service Specification fro LAC is under review by a sub-group of the Task and Finish Group
24
Children and young people/ Adult Continuing Health Care/Adult Safeguarding (Continued)
Safeguarding Adults
No new cases for review
Children and Young People’s Complex Cases
The Complex Case Panel for West Suffolk CCG in October discussed 4 cases. The slight increase in cost was due to a change of package for two young people.
Apr 13 May 13 Jun 13 Jul 13 Aug 13 Sept 13 Oct 13
Number of cases presented 7 1 0 0 5 0 4
Number of cases agreed 6 1 0 0 4 0 4
2012-13 Apr-13 May-13 Jun-13 Jul - 13 Aug-13 Sept 13 Oct 13
No of Children and Young People with packages 20 17 18 18 18 19 20 20
Estimated spend per month (£) 45,629 37,139 37,160 36,585 36,900 38,103 42,806 43,251
Average cost per case/month 2235 2185 2064 2033 2061 2005 2140 2163
Part 2 Financial and Performance Delivery Report
25
26
Financial Summary – Month 6 Position
West Suffolk CCGFinance report for six months ended September 2013
All figures £m Forecast Position Actual Variance Submitted
Plan Forecast Position Variance
RF2 RF2
Acute West Suffolk 51.5 51.5 0.0 99.3 100.9 1.6Cambridge 14.1 14.1 0.0 29.2 29.2 -Acute: Other NHS 6.6 6.6 0.0 14.6 15.1 0.5Acute: Non-NHS 2.1 2.1 -0.0 4.5 4.5 0.0
74.4 74.4 0.0 147.5 149.7 2.2
Ambulance 4.0 4.0 -0.0 8.0 8.1 0.1
Mental Health & LD NSFT 11.9 11.9 -0.0 23.9 23.8 -0.1Other 1.5 1.5 -0.0 4.2 3.6 -0.5
13.5 13.5 -0.0 28.1 27.4 -0.6
Community Serco 9.8 9.8 -0.0 20.0 20.0 -Other 1.8 1.8 -0.0 4.5 4.0 -0.5
11.7 11.7 -0.0 24.6 24.0 -0.5
Primary Care Prescribing 18.3 18.3 -0.0 35.9 35.9 -Other 2.4 2.4 0.0 4.1 4.9 0.8
20.7 20.7 -0.0 40.0 40.8 0.8
Continuing Care Continuing Care 2.9 2.9 0.0 4.3 3.9 -0.4Funded Nursing Care 1.1 1.1 -0.0 2.8 2.5 -0.3CHC Backlog 1.1 1.1 - - 3.2 3.2
5.2 5.2 -0.0 7.1 9.6 2.5
Projects 0.2 0.2 -0.0 0.4 0.4 -Property Recharges - - 1.1 -1.1
0.2 0.2 -0.0 1.5 0.4 -1.1
Phasing Adjustment 2.8 2.8 -Contingency - - - 1.3 0.8 -0.52% Transformational 0.1 0.1 0.0 5.3 2.4 -2.8
Corporate Running Costs 2.8 2.8 -0.0 5.8 5.8 -
CCG EXPENDITURE 135.2 135.2 -0.0 269.0 269.0 -
CCG INCOMEAllocation 132.1 263.0 263.0 -Surplus Brought Forward 1.2 2.3 2.3 -Running Cost Allowance 3.0 5.9 5.9 -Revenue Adjustments M6 (Offender Health, GP IT Costs 0.2 0.4 0.4 -
& Antenatal Screening)Carry Forward Surplus Required -1.3 -2.6 -2.6 -Total Spend Allowance 135.2 269.0 269.0 -
All figures are rounded which may result in differences in totals
YTD Full Year
Headlines:Results based on actuals for M1 to M5 for acute, M4 for Prescribing and M6 for Continued Health Care (CHC). The Forecast Position (RF2) has been calculated and all YTD variances absorbed in the Full-Year Forecast, resulting in nil variances when comparing YTD to RF2.
The notes below refer to the main adjustments between the Submitted Plan and the RF2 position.
1. West Suffolk is adverse against plan by £1.6m, this is mainly due to Planned Care day cases and Non-elective activity.
2. Acute:Other-NHS adverse variance of £0.5m is due to the adjustment of the SCG Baseline Allocation, this is still being challenged.
3. Mental Health expenditure is favourable to plan due to reduced number of Mental Health placements.
4. Savings in Other Community is due to an underspend driven by reduced activity in Children’s Placements.
5. The spend on GP Prescribing is expected to be on plan by year-end but there will be an overall overspend in Primary Care due to additional GP IT costs.
6. The Continuing Care overspend is mainly due to the non-recurrent backlog.
7. Overall, the CCG is still declaring that it will deliver the required surplus of £2.6m.
27
Financial Summary – Variance Analysis and Risks – Month 6
A
Note Variance v Ref RF2
Timing Variances0.7 F 3 Acute: Other NHS ‐ 0.4 F 5 Community ‐ Children's Placements ‐ 0.2 F 5 Community ‐ Other ‐ 0.4‐ A 6 Prescribing ‐ 0.7 F Contingency ‐ 0.1 F Corporate ‐ 1.7 F ‐ 2.6 F Non‐Recurrent Investment ‐ 4.3 F TOTAL TIMING VARIANCE ‐
Real Variances1.1‐ A 1 Acute (West Suffolk) ‐ 0.4 F 2 Acute (Addenbrookes) ‐ 0.6 F 4 Mental Health Placements ‐ 1.1‐ A 8 Continuing Care & FNC ‐ 0.3‐ A 7 Primary Care ‐ Other ‐ 1.5‐ A TOTAL REAL VARIANCE ‐
2.8 F TOTAL VARIANCE YTD ‐
All figures are rounded which may result in differences in totals
(A = Adverse, F = Favourable to plan)
YTD Variance Analysis
Variance v Budget
Notes for Variance AnalysisResults based on actuals for M1 to M5 for acute, M4 for Prescribing and M6 for Continued Healthcare (CHC) No variance exists against RF2 as this has just been implemented.Variances to Budget1 West Suffolk is overspent by £1.1m, mainly due to Planned Care day cases £453k and Non-elective activity £510k.2 Addenbrookes is underspent by £0.4m, there is a general underspend across all areas but particularly outpatients drugs £285k.3 Acute:Other-NHS favourable variance of £0.7m is due to a timing variance on investments, against budget.4 Mental Health is underspent by £0.6m due to a decrease in Mental Health placements, This appears to be an allocation issue from the PCT as I&ESCCG have an adverse variance – This is currently under investigation. 5 Savings in Community represent timing variances on Children's Placements of £0.4m and a timing variance in investments £0.2m.6 GP Prescribing is overspent against plan based on the actual data for April 13 to July 13 and budgeted figures for August and September, however current analysis suggests this is entirely due to the number of prescribing days and therefore a timing difference. 7 Other Primary Care overspend represents additional GP IT costs. 8 The CHC shows an overspend of £1.1m; this is due to an overspend on core activity of £0.8m and CHC backlog of £0.6m offset by a favourable variance on FNC £0.3m.
Action Taken RF2
Remaining %Risk
Weighted
Additional funds required/ Risks:+£2.8 m •Provision for non-recurrent CHC backlog - - -+£0.5 m •Allocation reduction from SCG baseline exercise - - -
- •Provision for CHC Retrospective (Contingent) +£4.2 m 5% +£0.2 m- •Provision for CHC (Core Activity) +£0.7 m 30% +£0.2 m- •UCLH Additional activity ( in dispute-SCG) +£0.7 m 50% +£0.4 m
+£1.6 m •West Suffolk Hospital Adverse variance. - - -+£0.1 m •Ambulance Contract - - -
- •Reduction in QIPP +£0.4 m 25% +£0.1 m- •Community Services +£0.4 m 50% +£0.2 m- •YTD underlying adverse variances - - -
+£0.8 m •GP IT Costs - - -+£5.8 m +£6.4 m +£1.1 m
Funded by:-£0.5 m •Contingency Release -£0.8 m 63% -£0.5 m-£2.8 m •Non-Recurrent 2% funding ring-fenced - - --£1.1 m •Property services allocation - - --£0.6 m •Mental Health Placements and NSFT - - --£0.3 m •Funded Nursing Care - - --£0.5 m •Community Services - - -
- •Active Management of Investements - - -- •CUFT Favourable variance -£0.8 m 75% -£0.6 m- •SCG baseline resolution -£4.0 m 0% +£0.0 m
-£5.8 m -£5.6 m -£1.1 m
28
Investment Tracker – Month 6
FULL YEAR PLAN
(Budget)
FULL YEAR PLAN (RF1)
YEAR TO DATE PLAN
YEAR TO DATE
SPEND
YEAR TO DATE
COMMITTED
YEAR TO DATE
VARIANCELatest Forecast
OCTOBER
FULL YEAR OPP/
RISK
14/15 FULL YEAR
IMPACT£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000
Project Ref NON-RECURRENT INVESTMENT
1 Strategic Review of Stroke Services and Implementation 100 100 50 16 0 34 16 84 02 111 Project (Programme Management) 38 38 19 52 0 -33 60 -22 03.1.1 Admission Prevention in ED 437 437 219 0 0 219 437 0 03.1.2 Enhanced Care Car 153 153 77 0 0 77 153 0 03.1.3 7/7 Dementia Intensive Support Service 230 230 115 0 0 115 230 0 03.1.4 Stay at Home Support Service 92 92 46 0 0 46 77 15 03.1.9 Provision of OOHs social care crises response 150 150 75 0 0 75 60 90 03.1.11 GP Rapid Response 500 500 250 0 0 250 479 21 03.3.1 Extension of Flexible Dementia Service 100 100 50 0 0 50 100 0 03.3.2 Rehab Voucher Scheme 60 60 30 0 0 30 50 10 03.3.4 Community Beds - implementation of ECIST recommendations 153 153 77 0 0 77 152 1 03.3.5 Community IV Therapy 80 80 40 0 0 40 80 0 03.3.6 Plan B Winter Beds 150 150 75 0 0 75 150 0 04 EOL Education 50 87 25 0 0 25 87 0 05 Non-Urgent/Planned Care Pathway Development 134 97 67 0 0 67 97 0 0
Phasing Adjustment 0 0 0 6 0 -6 0 0 0
2,427 2,427 1,213 73 0 1,140 2,227 199 0RECURRENT INVESTMENT (Non-QIPP)
Childrens Autism Service 163 163 81 0 0 81 75 88 180Adults Autism Service 131 131 66 0 0 66 109 22 145Dermatology, T & O, IBS (originally transformation) 100 100 50 0 0 50 100 0 0
Age Inclusive Eating Disorders 58 58 29 0 0 29 46 12 184 Pain Pathway (originally transformation) 135 135 68 0 0 68 135 0 0 Epilepsy & Asthma Nurses 49 49 24 0 0 24 30 19 120 Looked After Children 43 43 21 0 0 21 43 0 102 CAHMS 400 400 200 0 0 200 400 0 400
Stroke Improvement 0 0 0 0 0 0 0 0 250
1,079 1,079 539 0 0 539 937 141 1,381QIPP INVESTMENTSIntegrated Dementia Services 120 120 60 0 0 60 120 0 0Dermatology, T & O, IBS 50 50 25 0 0 25 50 0 0Integrated Care Pathway 100 100 50 0 0 50 100 0 0Non-Urgent/Planned Care Pathway Development 165 165 83 0 0 83 165 0 0
435 435 218 0 0 218 435 0 0
TOTAL PRIORITISED 3,941 3,941 1,970 73 0 1,897 3,600 341 1,381
FUNDED BYTransformation Spend 2,430Other Planned Investment 1,510
3,940
29
Notes: Activity is not fully validated and reconciled with Provider positions Outpatient activity does not include packages of care or unbundled diagnostic imaging, which are no longer counted on an attendance basisEmergency costs are at full tariff, i.e. do not reflect the emergency threshold adjustment, and have not been adjusted for reimbursement of readmissions
Overall Acute Activity Summary Position – Month 6
30
Notes: Activity is not fully validated and reconciled with Provider positions .Outpatient activity does not include packages of care or unbundled diagnostic imaging, which are no longer counted on an attendance basisEmergency costs are at full tariff, i.e. do not reflect the emergency threshold adjustment, and have not been adjusted for reimbursement of readmissions
Overall Acute Activity Summary Position – Month 6 (contd.)
31
QIPP Summary
Summary of QIPP Delivery
32
QIPP Summary
Summary of QIPP Delivery
Notes:
QIPP delivery as shown above is based on actual activity and financial spend against plan for an agreed suite of Key Performance Indicators. These are subject to final review and validation.
Prescribing QIPP target was set at achieving a saving of £600,000. At Month 5, there was a £0.4m overspend against plan (page 64)
33
NHS Outcomes Framework, NHS Constitution, and Acute Contractual Performance Measures 2013/14 ‐@8/11/13
Key: NHSOF – NHS Outcomes Framework, NHS Co - NHS Constitution;NHS Sm – Supporting Measure; OCM – Other Contractual Measure
34
NHS Outcomes Framework, NHS Constitution, and Acute Contractual Performance Measures 2013/14 ‐@8/11/13
Key: NHSOF – NHS Outcomes Framework, NHS Co - NHS Constitution;NHS Sm – Supporting Measure; OCM – Other Contractual Measure
35
NHS Outcomes Framework, NHS Constitution, and Acute Contractual Performance Measures 2013/14 ‐@8/11/13
Key: NHSOF – NHS Outcomes Framework, NHS Co - NHS Constitution;NHS Sm – Supporting Measure; OCM – Other Contractual Measure
36
NHS Outcomes Framework, NHS Constitution, and Acute Contractual Performance Measures 2013/14 ‐@8/11/13
Key: NHSOF – NHS Outcomes Framework, NHS Co - NHS Constitution;NHS Sm – Supporting Measure; OCM – Other Contractual Measure
37
NHS Outcomes Framework, NHS Constitution, and Acute Contractual Performance Measures 2013/14 ‐@8/11/13
Key: NHSOF – NHS Outcomes Framework, NHS Co - NHS Constitution;NHS Sm – Supporting Measure; OCM – Other Contractual Measure
38
Part 3 Redesign & Clinical Work streams
39
CCG Integrated “Plan on a Page”
40
Financial position against plan……(See below)Acute activity levels against plan…
QIPP delivery……………………….(Based on delivery of QIPP KPIs)
Local Quality Premium Indicators ..
NHS Constitution/national targets..
Contractual performance targets:
West Suffolk hospital…….…
Serco………………………..
Current position
Summary: August
Headlines:• Acute Activity - Initial view of Month 6 acute activity (page 42-43) indicates overall year to
date First Outpatients activity is 3.3% (760) above plan for the year to date. West Suffolkhospital is 6.5% (983) above plan for the year to date. There is also over-performance atIpswich hospital and Addenbrookes. Overall elective activity is 3.2% (394) below plan year todate;
• QIPP – Based on the selected suite of QIPP KPI’s (Pages 12-13), there is a shortfall indelivery of £1.3m. Trauma and Orthopedic pathways (T&O): OA hip, OA knee and CarpalTunnel Pathways have been successfully launched and a joint West Suffolk Hospital/CCGeducation session took place on 24th September. The Shoulder Pathway, as part of theQuality and Framework (QOF) Quality points (QP) for 2013/14 has now been agreed andcirculated to Practices;
• Pain Pathway: WSFT 2013/14 CQUIN used as a lever to develop a new pain service modelled by a task and finish group chaired by the CCG Clinical lead. Work continues to develop apatient focused holistic community based pain model. New service specification/model due tobe completed by the end of October 2013 with a view to procuring Tier 2 level pain servicesafterwards;
• Community Management Service (CMS): This service utilises the Choose & Book Systemfunctionality to enable GPs to make a safe electronic referral to WSFT Consultants for adviceand guidance and avoid an outpatient appointment. After a positive review the pilot is beingextended from the seven specialties to a further three specialties, making ten specialties intotal;
• Diabetes: Four Forest Heath practices are engaged in a pilot with community nurses andWSFT to provide diabetic nurse support to primary care nurses in primary care diabetesclinics. The project is designed to up-skill practice nurses and provides a more targetedconsultation for patients with the aim to reduce unnecessary hospital admissions. Existingcommunity diabetes contracts (8 practices) are being reviewed as part of the consideration ofa future community service including the existing community diabetes service specification(due to report in late October 2013 on recommendations);
Dr Jon FerdinandClinical Workstream Dashboard – Planned Care
Budget:QIPP target:Investments:Trans. Fund:
FYE (£m)77.8m0.8m0.4m
-
Budget32.3m
---
Actual32.5m
---
Year to date
41
Headlines:
National Targets - Performance against the national targets remains generally good, although the following targets were not achieved:
• 6 week wait for diagnostics (page 44. ref 16). There were 60 breaches in September for the West Suffolk CCG (equivalent to 2.9% of totaltests provided against a target of 1%). The majority of the breaches were as follows; 29 Echocardiography’s (29 West Suffolk hospital), 28 Nonobstetric ultrasounds (29 West Suffolk hospital, 2 MRI’s (2 Ipswich hospital). Delivery of the annual target will be challenging;
• 52 week Referral to Treatment (RTT) waiting time (Page 44. ref 20). There was one patient waiting over the standard. This was a patienttreated at Cambridge University hospital’s, on the Cardiology waiting list. The patient’s record was identified in July but the patient thendelayed appointments which were offered, meaning they were not seen until August. However, on being seen and following a diagnostic testthe patient was discharged in September.
• The following contractual targets were not achieved:
• For Quarter 2, the maximum two week wait standard for rapid access chest pain clinic was 74.7% (127 out of 170 patients) against a target of100% (Page 44. ref 22);
• Year to date there were 17 direct access diagnostic breaches at West Suffolk hospital against the contractual three working day target fordispatch of results to referrers. There were 7 breaches in September which were broken down as follows, Ultrasound’s (3), CT scan’s (3), X-rays (1) (Page 44. ref 24);
• Current ratios of OP procedure to day case for agreed list of procedures to be maintained or improved – Performance for September wasbelow plan at 88.7% (Target 90.2%). Year to date this measure is also below plan with performance at 89.0% (target 90.2%) (Page 44. ref25);
• Choose and book, first outpatient booking, including Clinical Management System (CMS) referrals. Performance against this local measure forSeptember was 53.0% (2,495 out of 4,709 referrals) against a target of 90%. (Page 44. ref 28);
• Provider cancellation of elective care operation for non-clinical reasons (Page 44. ref 29). There were 42 cancellations at West Suffolk hospitalin September (equating to 2.0%), the key issues were as follows, lack of theatre time - 24, previous operation over running - 4, surgeon off sick- 4, unavailable equipment - 4, other reasons - 6.
Dr Jon FerdinandClinical Workstream Dashboard – Planned Care
42
Dr Jon FerdinandClinical Workstream Acute Activity Position – Planned Care
Notes: Activity is not fully validated and reconciled with Provider positions Outpatient activity does not include packages of care or unbundled diagnostic imaging, which are no longer counted on an attendance basisEmergency costs are at full tariff, i.e. do not reflect the emergency threshold adjustment, and have not been adjusted for reimbursement of readmissions
43
Dr Jon FerdinandClinical Workstream Acute Activity Position – Planned Care
Notes: Activity is not fully validated and reconciled with Provider positions Outpatient activity does not include packages of care or unbundled diagnostic imaging, which are no longer counted on an attendance basisEmergency costs are at full tariff, i.e. do not reflect the emergency threshold adjustment, and have not been adjusted for reimbursement of readmissions
44
Dr Jon FerdinandClinical Workstream Dashboard – Planned Care
45
Financial position against plan……(See below)Acute activity levels against plan…
QIPP delivery……………………….(Based on delivery of QIPP KPIs)
Local Quality Premium Indicators ..
NHS Constitution/national targets..
Contractual performance targets:
West Suffolk hospital…….
Harmoni (OOH)……………
Harmoni (‘111’)……………
Serco……………………….
Current position
Headlines:
• Acute Activity - Initial view of Month 6 acute activity (pages 48-49) indicates Emergency non-elective is below plan by 13.7% (1,338) year to date. Other non-elective is below plan by10.0% (36). A&E activity is 6.9% (1,794) over plan year to date. Overall ambulance activity isbelow planned levels, although Red Cat. ‘A’ calls are 1.0% (28) above plan;
• QIPP - Based on the selected suite of QIPP KPI’s (Pages 12-13), there is a shortfall indelivery of £0.01m. System leadership: The system continues to meet each month to drivedelivery of the action plan through the Urgent Care Network which has senior levelmembership. This group reports formally to the Suffolk Leadership Board chaired by theAccountable Officer. At the last meeting in October the Network signed off the system wideUrgent Care Escalation Plan and application of the whole system winter assurance frameworkfor approval at the November meeting;
• Integrated admission avoidance: The project to bring all elements of the system together intoa coordinated response is well underway with phase 1 involving the range of servicesprovided by Suffolk Community Healthcare now operational and phase 2 which extends thecoordinated response to NSFT, ambulance service Enhanced Care Car, hospice support,social care and A&E. Phase 3 which will involve a comprehensive geriatric assessmentservice which now incorporates the Interface geriatrician function and will be phased in fromthe end of October. Workforce capacity due to recruitment challenges are currently delayingfull implementation and a mitigating plan with WSFT and SCH is being developed to supportflow over winter;
• Community beds: Transformation funding has been secured to support improvedmanagement of community beds with an enhanced focus on discharge and therapy supportover winter. Up to ten additional beds have been also commissioned and three residentialbeds have been converted for nursing and rehabilitation needs;
• Care homes: The targeted approach to 5 care homes in west Suffolk which are high volumeusers of urgent care services has commenced with in- reach from community servicessupported by a GP, clinical pharmacists, ambulance service and OOH. The approach aims toprovide planned care support to the home through MDT case review, advanced care planning,medicines review and optimisation and staff training and support;
Dr Emma DerbyshireClinical Workstream Dashboard– Integrated Care/EoL
Summary: August
Budget:QIPP target:Investments:Trans. Fund:
FYE (£m)83.7m3.3m2.8m
Budget35.0m
---
Actual35.2m
---
Year to date
46
Headlines (contd):
Dr Emma DerbyshireClinical Workstream Dashboard– Integrated Care/EoL
• Complex discharge: Elements of pull based discharge with in-reach from community services has commenced. Further work to extend this pathwaywill be completed by the end of October;
• Ambulatory care pathways: A DVT operational pathway has now been established at WSFT that diverts the activity from A&E. Further pathways arecurrently being introduced and will become operational by the end of October;
• Standardised approach to the medical model supporting inpatient beds at WSFT and seven day working: CQUIN is driving the implementation of 7day access to diagnostics and consultant review. ECIST have supported the implementation of an improved medical model which standardisesareas such as ward rounds and TTO prescribing;
• Short stay assessment unit: The new model of short stay assessment at WSFT is now fully operational;
• Neighbourhood teams: Social care, community and mental health teams now aligned to clusters of GP practices. Case management and careleadership training programmes are in progress. Roll out of MDT working supported by case finding is being progressed for full implementation bymid November;
• Local Quality Indicators – Delivery of the Local Quality Premium Indicator relating to dementia achieved 14.5% (target 12.9%) for Quarter 2. Yearto date performance is 14.4% (target 12.9%). (page 14. ref 7). The Local Quality Premium Indicator relating to stroke care (admitted to a stroke unitwithin 4 hours) remains below target for the year. Performance stands at 84.6% year to date (154 out of 182 patients) against a target of 90% (page14. ref 8). September’s monthly performance was 91.7% (22 out of 24 patients);
• National Targets ‐ Performance against a number of national targets is not being achieved:• Emergency admissions for conditions that should not usually require admission. Year to date performance is 1,582 admissions against a
target of 1,441 (page 50. ref 31);• Emergency admissions within 30 days of discharge from hospital – This was above target in September with performance at 6.06% (target
5.70%). Year to date this measure is below target with performance of 6.20% (target 7.12%) (page 50 ref 34);• A&E and Ambulance clinical quality, handover indicators (‘handover’ times) (page 50. ref 36-38, 41-44). Please refer to the contractual
section on pages 66-67 for further detail;
47
Headlines (contd):
Dr Emma DerbyshireClinical Workstream Dashboard– Integrated Care/EoL
• West Suffolk hospital’s A&E performance year to date to the 5th November stands at 94.9%. West Suffolk hospital met the target for October at 97.5%;
• West Suffolk hospital continues to exceed the target for the single longest time spent by patients in the A&E department (page 51. ref 58);
• East of England Ambulance Trust (EEAST) did not achieve the national clinical quality indicators for response times in September for CCG patients(page 50. refs 36-38);
• Category A (Red 1) 8 minute response time – performance 64.5% (20 responses in 8 mins, out of a total of 31);• Category A (Red 2) 8 minute response time - performance 61.4% (443 responses in 8 mins, out of a total of 721);• Category A 19 minute response time – performance 83.4% (624 responses in 19 minutes, out of a total of 748).
• Ambulance handover delays continue to exceed targets. National requirements specify that all ‘turnarounds’ between ambulance and A&E must takeplace within 30 minutes. During September, there were 31 delays exceeding 30 minutes, 1 of which then exceeded 60 minutes (page 50. refs 41-42);
• Performance of the number of admissions for cellulitis at West Suffolk hospital in September was 33 (target 30). Year to date West Suffolk hospital isbelow target reporting 162 (target 182) (page 51 ref 59);
• The majority of stroke targets were met for September with the exception of the following measures:
• Increase the proportion of patients admitted to an acute stroke unit within 4 hours of hospital arrival - Performance for September was 84.2% (16 out of19 patients) against a contractual target of 90% (page 50. ref 46);
• Proportion of patients in Atrial Fibrillation, presenting with stroke, receiving anti-coagulation - Performance for September was 40.0% (2 out of 5patients) against a contractual target of 60% (page 50. ref 47);
• Please also refer to the contractual section on pages 67-68 for further detail.
48
Dr Emma DerbyshireClinical Workstream Acute Activity Position – Integrated Care
Notes: Activity is not fully validated and reconciled with Provider positions Outpatient activity does not include packages of care or unbundled diagnostic imaging, which are no longer counted on an attendance basisEmergency costs are at full tariff, i.e. do not reflect the emergency threshold adjustment, and have not been adjusted for reimbursement of readmissions
49
Dr Emma DerbyshireClinical Workstream Acute Activity Position – Integrated Care
50
Dr Emma DerbyshireClinical Workstream Dashboard– Integrated Care/EoL
51
Dr Emma DerbyshireClinical Workstream Dashboard– Integrated Care/EoL
52
Financial position against plan……(see below)Acute activity levels against plan…
QIPP delivery……………………….(Based on delivery of QIPP KPIs)
Local Quality Premium Indicators ..
NHS Constitution/national targets..
Contractual performance targets:
NSFT……………………….
Current position
Headlines:• QIPP - Based on the selected suite of QIPP KPI’s (Pages 12-13), there is a shortfall in delivery
of £0.2m. Psychiatric Liaison Development: WSCCG is working with WSH and N&SFT as partners, using 2013/14 CQUIN as a lever, to develop this service which is a known service gap and evidenced base practice. Funding now agreed in September 2013 to underpin the service development with a view to ‘go live’ in November 2013;
• Norfolk and Suffolk Foundation Trust (N&SFT): New service operating model went live from 1st
July. WSCCG is working closely with I&E CCG and N&SFT to co-produce new service specifications through joint workshops with a plan to formally sign off by October 2013;
• Autism: Approval given to commission an Adult assessment and diagnostic service from July 2013. NSFT Service now operational. NSFT and SEPT/SERCO aged 11 – 18 service was agreed by the CCG Governing Body in September 2013;
• Dementia Memory Assessment Service: Review of capacity and demand for N&SFT service underway and business case under completion to support dementia diagnosis target - 66% 2015/16. This was taken to the CCG clinical work stream in October 2013;
• Learning Disabilities: A Learning Disabilities service specification has been developed andNSFT have indicated they wish to work with the CCGs to deliver the new service model. On-going discussions taking place with N&SFT to work though the detail;
• National Targets - Performance against national targets is as follows:
• The proportion of those patients on a Care Programme Approach (CPA) dischargedfrom inpatient care who were followed up within 7 days was 91.7% for Quarter 2(Target 95%). This consisted of 55 patients out of a total of 60 (page 53. ref 67);
• For Quarter 2 the improved access to psychological services (IAPS) for people withdepression and/or anxiety disorders was 2.7% (target 3%). This consisted of 695patients out of a total of 25,949 (page 53. ref 68);
n/a
n/a
Dr Roz TandyClinical Workstream Dashboard – Mental Health & Learning Disabilities
Summary: August
Budget:QIPP target:Investments:Trans. Fund:
FYE (£m)28.1m0.4m0.4m
Budget11.7m
---
Actual11.1m
---
Year to date
53
Headlines:
Dr Roz TandyClinical Workstream Dashboard – Mental Health & Learning Disabilities
• NSFT performance against the contractual targets for September are as follows:
• Dementia – September SQPR show this area is now back on target at 9.4%. The performance for August was the first drop below the contractthreshold;
• IAPT recover - NSFT have been asked to provide a report which has been reviewed. Some queries regarding the report have been sent back tothe Trust and we are waiting their response;
• Psychiatric liaison – Weekly meetings are currently on-going between WSCCG, WSH and NSFT to discuss liaison breaches and review actionagainst their action plan to ensure this area gets back with contract thresholds. The September SQPR show performance has dropped and 4breaches have been reported. NSFT have been asked to provide a report for each breach within the next 7 days for CCG scrutiny;
• Integrated Wellbeing Approach – this is being dealt with in the same RAP as IAPT above. The RAP has been agreed and contract thresholds willbe delivered from 30 September 2013 reported in the October SQPR and submitted to CCGs on the 15th working day of November. Theperformance for September was 72%;
• 7 Day follow up after discharge – The September shows this threshold back on track at 100%;
• Improved inpatient discharge planning – This area is currently under review by both CCGs. Locally there is a lack of suitable accommodation for patients to transition to from inpatient beds. Accommodation may be unsuitable for a variety of reasons such as patient complexity, area, patient choice. The element of supported housing funded within the pooled fund will be reviews specifically to look at:
• Are people able to move on from inpatient and out of county services when they are ready to do so and if not, why not?• What impact do the admission avoidance and respite arrangements within supported accommodation have and do they improve outcomes for
service users?• Are people able to move on from supported housing services when they are ready to do so and if not, why not?
54
Clinical Workstream Dashboard – Cancer
Financial position against plan……(See below)Acute activity levels against plan…
QIPP delivery……………………….(Based on delivery of QIPP KPIs)
Local Quality Premium Indicators ..
NHS Constitution/national targets..
Contractual performance targets:
West Suffolk hospital…….
Current position
Headlines:
n/a
Dr Andrew Yager
Summary: August
Budget:QIPP target:Investments:Trans. Fund:
FYE (£m)6.0m0.2m
-
Budget2.5m
---
Actual2.4m
---
Year to date
• Acute Activity - Initial view of Month 6 acute activity (page 56-57) indicates overall year todate First Outpatients is over plan by 9.7% (51) and Follow-ups are under plan by 6.0% (225).Elective activity is 0.7% (107) under plan year to date. Emergency non-elective activity is onplan;
• QIPP - Based on the selected suite of QIPP KPI’s (Pages 12-13), there is a shortfall indelivery of £0.4m. Telephone Follow-ups: Prostate cancer: Conversion of up to 60 patients permonth from face to face consultant outpatient appointments to nurse led telephone follow upplanned commenced. Evaluation of pathway change will inform potential for extension to othercancer diagnosis;
• AOS: The Acute Oncology Service based on best practice evidence is now fully operational atWest Suffolk Foundation Trust with monthly evaluation of impact from the improved access tospecialist support on patient experience, admission avoidance and length of stay. Plans arebeing considered to extend the service from 5 to 7 days a week;
• Unexplained Weight Loss Pathway: Regional Clinical Network funded project to support directaccess to diagnostics for an agreed client group has now commenced;
• Community Cancer Nurse Pilot: This pilot project, joint funded by the Strategic ClinicalNetwork and Macmillan Cancer Support is testing a new model of community cancer care andwill run for two years from August 2013. The pilot is part of a region-wide programme beingmanaged by the Regional Clinical Network which has commissioned Health EconomicsConsulting at the University Of East Anglia to provide evaluation. The pilot commenced on 1August focusing on three practices (Hardwicke House Group Practice in Sudbury; SiamSurgery in Sudbury and Long Melford Practice). The two post-holders are being hosted bySerco;
55
Clinical Workstream Dashboard – Cancer Dr Andrew Yager
• National Targets –
• The majority of national and contractual cancer targets were achieved in September, and are on track for the full year (page 58. ref 69-78). Thefollowing measures are the exceptions for September;
• Percentage of patients receiving first definitive treatment for cancer within 62 days of an urgent GP referral for suspected cancer – Performancefor September was 79.2% (38 out of 48 patients) against a contractual target of 85% (page 58. ref 75);
• Percentage of patients receiving first definitive treatment for cancer within 62 days of a consultant decision to upgrade their priority status –Performance for September was 66.7% (2 out of 3 patients) against a contractual target of 91.3% (page 58. ref 77);
• Acute oncology service, 1 hour door to needle for all patients presenting with suspected neutropenic sepsis (page 58. ref 78), West Suffolkhospital’s performance was 57.1% for September (8 out of 14 patients) against a contractual standard of 100%.
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Dr Andrew Yager Clinical Workstream Acute Activity Position – Cancer
Notes: Activity is not fully validated and reconciled with Provider positions Outpatient activity does not include packages of care or unbundled diagnostic imaging, which are no longer counted on an attendance basisEmergency costs are at full tariff, i.e. do not reflect the emergency threshold adjustment, and have not been adjusted for reimbursement of readmissions
57
Dr Andrew Yager Clinical Workstream Acute Activity Position – Cancer
Notes: Activity is not fully validated and reconciled with Provider positions Outpatient activity does not include packages of care or unbundled diagnostic imaging, which are no longer counted on an attendance basisEmergency costs are at full tariff, i.e. do not reflect the emergency threshold adjustment, and have not been adjusted for reimbursement of readmissions
58
Clinical Workstream Dashboard – Cancer Dr Andrew Yager
59
Clinical Workstream Dashboard – Children & Young people & Maternity
Financial position against plan……
Acute activity levels against plan…
QIPP delivery……………………….(Based on delivery of QIPP KPIs)
Local Quality Premium Indicators ..
NHS Constitution/national targets..
Contractual performance targets:
West Suffolk hospital…….
Current position
Headlines:
• Acute Activity - Initial view of Month 6 acute activity (page 61-62) indicates overall year todate First Outpatients is under plan by 5.7% (64) and Follow-ups are below plan by 2.0%(33). Elective activity is 17.7% (29) above plan year to date and this is mainly due to over-performance at West Suffolk hospital. Emergency non-elective activity is 24.6% (412) aboveplan year to date;
• QIPP - Based on the selected suite of QIPP KPI’s (Pages 32-33), there is a shortfall indelivery of £0.02m. Pediatric Urgent Care Pathway: GP Telephone advice line for pediatrics'provided by WSH has been successfully implemented through CQUIN since 01.05.12,contributing to an uplift in in overall pediatric non-elective admissions by 2.1% against anational trend of 2.2%% (11/12-12/13). The advice line has been accessed by all WSCCGGP Practices and plans are underway to review the development between October-December 2013 to consider mainstreaming the service in 2014/15;
• Associate GP (Rachel Casey) is working with clinicians at WSH to compile guidelinesadopting a traffic light toolkit approach for gastroenteritis, bronchiolitis and fever from NICEGuidance for roll out to primary care in September, together with a suite of guidance sheetsfor management of common childhood illnesses. The information will be sent to primary careon a bi-monthly basis;
• West Suffolk Pediatric Strategy Group: This group has been established with clinicalrepresentation from WSH, mental health services, primary care, community services andsocial care. The group has given clinical advice on areas for consideration for 2014/2015Commissioning Intentions;
• Eating Disorders and Autism: To address known service gaps, Norfolk and SuffolkFoundation Trust are developing business cases for establishing an <18 years EatingDisorders Service and 11-19 years diagnostic autism service (in collaboration withSERCO/SEPT). The 11-19 years diagnostic autism service was agreed by the CCGGoverning Body in September 2013. The CYPM and Mental Health Clinical work streamsconsidered the Eating Disorders Business Case on 30th October;
Dr Rakesh Raja
Summary: August
Budget:QIPP target:Investments:Trans. Fund:
FYE (£)14.7m0.1m0.4m
-
Budget6.8m
---
Actual6.7m
---
Year to date
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Clinical Workstream Dashboard – Children & Young people & Maternity Dr Rakesh Raja
• CAMHS: a review of commissioning arrangements has been completed for CAMHS services in Suffolk and a refresh of the Suffolk Children andEmotional Well Being Strategy has now been completed. The meetings governance supporting the commissioning of CAMHS services has alsorecently been refreshed and re-launched leading to the establishment of the Suffolk Children Emotional Health & Well Being group designed to alsofocus on services outside of ‘pure traditional’ health CAMHS services;
• Local Quality Indicators - The local quality premium of breastfeeding prevalence at 6-8 weeks (Page 14. ref 6) was not achieved for Quarter 2.Performance was 48.6% against a target of 49.0% (303 out of 623 children were recorded as being fully or partially breastfed). However, this was animprovement on the previous quarter’s performance of 48.0%;
• National Targets – The following national targets were not met for September-13;
• Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19’s – September performance was above target with performance of 30(target 21). However, year to date this measure is below target with performance of 97 (target 136) (page 63. ref 80);
• Emergency admissions for children with Lower Respiratory Tract Infections (LRTI) – September performance was above target with performance of5 (target 3). Year to date this measure is below target with performance of 22 (target 33) (page 63. ref 81);
• The majority of the contractual performance targets are being achieved year to date, with the exception of the following measure;
• Breastfeeding initiation rates – Performance for September was 77.6% (target 80%), this comprised of 114 patients against 147. Year to dateperformance was marginally below target at 79.9% (845 patients out of 1047) (page 63. ref 82).
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Dr Rakesh RajaClinical Workstream Acute Activity Position – CYP/Maternity
Notes: Activity is not fully validated and reconciled with Provider positions Outpatient activity does not include packages of care or unbundled diagnostic imaging, which are no longer counted on an attendance basisEmergency costs are at full tariff, i.e. do not reflect the emergency threshold adjustment, and have not been adjusted for reimbursement of readmissions
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Dr Rakesh RajaClinical Workstream Acute Activity Position – CYP/Maternity
Notes: Activity is not fully validated and reconciled with Provider positions Outpatient activity does not include packages of care or unbundled diagnostic imaging, which are no longer counted on an attendance basisEmergency costs are at full tariff, i.e. do not reflect the emergency threshold adjustment, and have not been adjusted for reimbursement of readmissions
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Clinical Workstream Dashboard – Children & Young people & Maternity Dr Rakesh Raja
64
Clinical Workstream Dashboard – Prescribing
Financial position against plan……(See below)Acute activity spend against plan…
QIPP delivery……………………….
Local Quality Premium Indicators ..
NHS Constitution/national targets..
Current position
Headlines:• QIPP - Based on the selected schemes below, there is a shortfall in delivery of £0.4m
(unvalidated for August). Progress across the key workstreams is as follows:
n/a
n/a
n/a
Dr Emma Derbyshire
Summary: August
Budget:QIPP target:Investments:Trans. Fund:
FYE (£m)37.00.6-
n/a
Budget15.4m
---
Actual15.8m
---
Year to date
Project description Expected savings 2013/14
Key achievements for October 2013
Prescribing recommendations
£380,000 715 prescribing recommendations implemented.1,475 further interventions made by medicines management technicians working in GP practices, e.g. drug quantities altered, review letters sent, medicines archived.Educational event held for all prescribing leads on 9th October : Safe and Appropriate Use of Medicines .Blood glucose testing guidelines completed, in collaboration with secondary care specialists.Baseline audits completed to monitor the prescribing of antipsychotics in dementia. Guidelines distributed on appropriate prescribing of antipsychotics.Letters sent to all practices where a range of ‘simple metrics’ have not yet been implemented. Implementation would release significant savings .Further procedures written to support DROP-List metrics: Lidocaine and Targinact proceduresFurther additions made to ScriptSwitch profile.
PrescQIPP DROP-List (drugs of low priority)
£200,000
Medication reviews/ medicines optimisation
£10,000 Further patients benefitted from medication review/medicines optimisation; 375 interventions made by medicines management sessional pharmacists
Dietetics £10,000 Updated sip feed guidelines signed off by prescribing leads and distributed to all practices. Further dietetic prescribing changes implemented
Total £600,000
Part 4 Contractual Performance, by provider
65
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West Suffolk hospital – CQUIN Delivery: Quarter 1
Q2 not yet finalised: Trust further comments re CCG submission due on 11/11.
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Summary of Contractual Levers –West Suffolk hospital
West Suffolk hospital – Summary of contractual levers
Performance Issue Contract Notice Stage
Current status Key actions within Remedial Action Plan (RAP)
Latest performance(Source - NHSS performance pack):
WSFTStroke:- % patients admitted to a stroke unit in 4 hours (target 90%)- % stroke patients with a joint health and social care plan (target 100%)- % of suspected stroke patients having brain scan within 60 minutes (target 100%)
First Exception report (ER201314-01)
Performance in August has improved for both the % stroke patients with a joint health and social care plan and % of suspected stroke patients having brain scan within 60 minutes targets which are now both 100%.
Performance for % patients admitted to a stroke unit in 4 hours has dropped from the previous two months which achieved over the 90% target due to 4 out of 27 patients not being admitted to the stroke ward in 4 hours. This was due to patients being in A&E for over 4 hours and no capacity on the stroke ward.
-zero tolerance approach to non-availability of ring-fenced beds: Breach reporting on each occasion this situation occurs-continued recruitment to ESOT team to enable 24/7 availability-patient level breach reports
% patients admitted to a stroke unit in 4 hours:Jun-91.7%July-90.9%Aug-85.2%Sept – 91.7%
% stroke patients with a joint health and social care plan:Jun-90.9%July-100%Aug-100%Sept – 100%
% of suspected stroke patients having brain scan within 60 minutes:Jun-100%July-87.5%Aug-100%Sept – 100%
All targets have been met. We will review for a further month with a view to close the notice if performance remains at contractual standard.
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Summary of Contractual Levers –West Suffolk hospital
WSFT Ambulance arrival to handover:
- Target is 90% of patients within 15 minutes or 100% within 30 minutes and 60 minutes
Contract Query(CQ 201213-06)
The RAP has been reset in line with the 30 minute and 60 minute target.Performance has improved in line with the improvement in A&E for the 30 minute and 60 minute target.
The revised RAP requires performance to be at 100% for both targets by November 2013.
30 minute standard:Jun - 93.48%July - 93.56% Aug - 94.42%Sept – 97.2%
60 minute standardJun - 99.71%July - 99.82%Aug - 99.48%Sept – 99.91%
WSFTA&E:- 4 hours from arrival to admission or discharge (95%)
1st Exception Report(ER 1213-01)
This First Exception Report was issued at the beginning of the year as WSFT had failed to meet the Year End Target for the previous year.The RAP requires the Trust to meet seven Milestones by the end of September.They have currently met two Milestones, have failed to meet one Milestone (financial adjustments withheld until Milestone is met) and have reported on the remaining 3 Milestones. A further paper will be submitted to the Clinical Executive Team about these milestones to determine compliance.Overall performance against this target has significantly improved since June with a high of 98% in September making it the best performing month since November 2011, however the Year to Date position is still below target at 94.90%.
The RAP requires the Trust to transform service pathways in seven areas in line with ECIST recommendations:-A&E-Short stay /assessment-Inpatient medical wards & discharge-Frail Elderly-Complex discharges-Communications
4 hour standard:Jun-95.6%July-95.1%Aug-95.8%Sep-95.0%Oct – 97.5%
November (as at 6 Nov)QTD – 97.41%YTD – 94.90%
West Suffolk hospital – Summary of contractual levers (contd.)
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WSFTSerious Incidents Requiring investigation (SIRIs)
Contract Query (CQ201314-02)
A revised RAP has been agreed with the trust and includes recommendations from the NHS England Risk Summit
-all outstanding reports to have been submitted to WSCCG-the quality of the reports to be in-line with the NPSA standards-all new reports to be reported within two days of the incident- any reports open beyond the deadline will be escalated to board level and a plan agreed
RAP recently agreed. Up-date due by mid November.
WSFTMethicillin-resistant Staphylococcus aureus (MRSA)
Contract Query(CQ 201314-03)
The trust has had one incidence of MRSA and a RAP has been agreed to put actions in place to avoid reoccurrence. The RAP also requires improved compliance with levels of emergency and non elective MRSA screening to reach 100% by December 2012
-audit of all wards to ensure 100% hand gel use-review of recording of IV cannulisation-more rapid escalation of compliance issues at ward level- inclusion of swabs in ward admission packs
Regular meetings to review actions:
% MRSA screening , elective admissions:June: 84.41%July: 85.45%Aug: 87.18%Sept: 91.31%
% MRSA screening, non elective admissions:June 92.60%July 93.48%Aug 89.61%Sept 93.03%
West Suffolk hospital – Summary of contractual levers (contd.)West Suffolk hospital – Summary of contractual levers (contd.)
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Harmoni ‘Out of Hours’ – Quality Dashboard
Headlines:• The OoH KPIs have been revised to take into account the
impact of the 111 service. This should address thecurrent performance issues relating to call handling andUrgent (2 hr.) home visits.
• The new KPIs came into effect from 1st October, 2013.
• Harmoni has two month’s to reach full compliance againstthe revised measures.
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Harmoni ‘111’ – Quality Dashboard
Headlines:• Good progress is being made to address the
historic shortfall in Clinical Advisor resourcing.This is the main factor for not achieving thewarm transfer KPIs.
• This issue is being addressed formally via aPerformance Notice and KPI performance isexpected to resolve in October.
• The CCG has applied contractualconsequences (financial) for failure to achieveKPI standards from July to September, 2013.
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Summary of Contractual Levers –Harmoni
Summary of Contractual Levers ‐ Harmoni
Performance Issue Contract Notice Stage Current status Key actions within RAP Latest performance (Source - CCG performance pack):
Harmoni – Out of Hours2 hour standard for urgent home visits (95%)
Performance Notice The Out of Hours service has been adversely impacted by the way 111 prioritises calls. The new OoH KPIs started on Oct 1st
. Harmoni have 2 months to reach compliance against the standards
To improve performance against the 2 hour standard (this should be resolved asnew KPIs are implemented)
July - 90%August – 87%
Harmoni 111Information provision –elements of service performance are not being submitted to the level of detail required in the contract.
Performance Notice Harmoni/Care UK are working on improving their information capability to fulfil the requirement
Harmoni have resolved a large number of issues within the Performance Notice.There is one outstanding action for the CCG to review.
As current status
Harmoni 111Clinical advisers – Harmoni has not recruited sufficient clinical advisers to fulfil standards for call back
Performance Notice Harmoni are continuing to recruit and look at the reasons why retention rates are high
To recruit and retain clinical advisers
August:See 111 Quality dashboard p. 40
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Community Services (Serco) – Service Quality & Performance Dashboard
A summary of the Serco Quality & Performance dashboard isshown at Page 74-75. The CCGs agreed a set of new KPIs inSpring 2013, and Serco were given until June 2013 to ensureperformance and reporting met required standards. There areshortfalls in performance across a number of priority KPIs;
Group 1 These are the high priority KPIs. Resolution of datainaccuracies and performance was required by 30th June.Whilst some progress has been made the Provider is not fullycompliant with data submission and performance, and assuch a Contract Query has been raised. The subsequentRemedial Action Plan (RAP) has agreed actions required toremedy;
Group 2These are considered medium to high priority, and are theKPIs which have been in place since October 2012 and arenot included in the new set of performance indicators outlinedabove, but that are noted as directly impacting on serviceprovision. The CCG is meeting with the Provider to agreeactions to remedy;
Group 3These are the remainder of the KPIs that are not performingagainst the contractual standards. The CCG has agreed ajoint review of all the KPIs in this category to develop anaction plan outlining how both data provision andperformance against the contractual targets will be achieved;;
Headlines:Performance Dashboard:• Serco has been issued a Contract Query (CQ) against failure to comply with
the contractual standards for the group KPIs reporting.• A second CQ has been issued against Community Intervention Service (CIS)
response times for 4 hr. and 72 hr for failure to achieve the necessary responsetime standards.
• The CCGs are undertaking a thorough review of services being commissionedto address potential patient safety and quality issues, namely:
• Staff capacity, skill mix, workload, succession planning andmorale, training, communication, mobile working, carecoordination centre processes, Incidents and near missincidents;
• The CCGs will work with Serco to better understand the issues, and related on-going concerns and understand why various KPI standards are not beingmet. This will take the form of a ‘deep-dive’ – essentially confirming the areasof concern, and agreeing the approach to further explore and understand it;
• Contractual performance is discussed above under the work streams
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Community Services (Serco) – Service Quality & Performance Dashboard (contd.)
67.1%
Qtrly
75
Community Services (Serco) – Service Quality & Performance Dashboard (contd.)
67.1%
Qtrly
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Community Services (Serco) – Service Quality & Performance Dashboard (Continued)
Headlines:• The Remedial Action Plan (RAP) has been agreed for Group 1 KPIs. This encompasses the shortfall in performance and reporting requirements of
the priority KPIs. Highlights of the RAP are included on page 46-47.
• The following performance issues are also being addressed;
• Community equipment service – an action plan to remedy performance has been requested and will be reviewed in October. The CCGs require assurances that the position can be remedied ahead of any ‘winter’ demand increase.
• Wheelchair - time to first assessment – an action plan will be reviewed to improve time to first assessment for high and medium priority referrals
• Community intervention service response times for 4 hr. and 72 hr. response – the CCGs have issued a Contract Query for failure to achieve the necessary response time standards. The CCGs are seeking remedy by December, 2013.
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Summary of Contractual Levers –Serco
Summary of Contractual Levers ‐ Serco
Performance Issue Contract Notice Stage Current status Key actions within RAP Latest performance (Source - CCG performance pack):
SercoFailure to meet data quality and access standards for key services
Contract Query Remedial action plan agreed
(1) Care lead availability• KPI compliance March 2014(2) Care plans shared with GP practice• KPI compliance March 2014(3) Care lead availability and reporting for specific patient groups, i.e palliative care• KPI compliance March 2014(4) Pulmonary rehabilitation complete within 12 weeks• Q4 – 125 patients offered a course and 63
completed• KPI compliance by June 2014 (back stop
date)• Action plan to address backlog (including
legacy backlog from WSFT) by October 2013(5) Stage 2 falls assessments• Monthly clinical audit to begin with
compliance in Jan 2014(6) Joint community rehabilitation care plan• Data collection in Feb 2014 and compliance
by April 2014
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Summary of Contractual Levers – Serco (contd.)
Performance Issue Contract Notice Stage Current status Key actions within RAP Latest performance (Source - CCG performance pack):
(7) Reduction in acute hospital length of stay• Quality requirements agreed with the CCG by
Dec 2013, with compliance by March 2014(8) Care co-ordination centre response times –compliance by Jan 2014(9) Referrer satisfaction – compliance by Jan 2014
Serco – failure toachieve 4 hr. and 72 hr. response time standards
Contract Query The Remedial Action Plan trajectory to meet compliance will be agreed by mid November, for compliance in December.
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Mental Health Services (Norfolk & Suffolk Foundation Trust) – Service Quality & Performance Dashboard
Performance Overview
• Overall the Trust has maintained performance within thresholds for Domain 2 KPI 8, Domain 3 KPI 16 & 17, Domain 4 KPI1, 2 and 9.
• Performance for Step 2 IWA increased again and there was a 24% increase in performance for Step 3 IAPT. Psychiatric liaison is within thresholds overall for 4 hour assessments but one breach was reported for 8 hour assessment – a report has been requested for the breach. West psychiatric liaison performance has dropped. Dawn Barrick-Cook has been emailed with regard to this and an update report on weekly meetings that are held to discuss the breaches.
• There are issues regarding data being refreshed each month within the SQPR report which has been escalated to the Trust. CCGs need reassurance that will not happen in future and that the data submitted is robust. There was particular concern that the July IAPT performance was refreshed from 51.8% to 48.3 and that Domain 5 metric 4 was refreshed from 96.6% to 98.6%
• The breach exception report was reviewed and a response provided to the Trust. A number of queries were discussed at the Q&P and the following actions agreed:
• The waiting times protocol agreed within the RAP will be refreshed to include a further clinical exception code as a number of cases were designated patient choice but were in fact clinical exceptions
• The Trust will not include within the exception report those cases where patients were aware of the waiting times as these are in fact still breaches
• The Trust will develop a set of business rules for exception reporting that will be implemented for Suffolk reporting
• CCGs will be invited to attend the main data quality group and also the new Suffolk information sub group
• ADHD waiting times are increasing – NSFT to provide a report on the numbers waiting and also the current waiting times
• 28 days will be reported as calendar not working days under the new 29 day routine assessment metric
• The RAP would remain open while the above issues are worked through
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Norfolk & Suffolk Foundation Trust – Service Quality & Performance Dashboard
Exception reporting of NSFT’s Contractual KPI’s for September 2013:-
Wellbeing service - Domain 3 indicator 11b IAPT recovery, Domain 4 indicator 5 & 6 Integrated Wellbeing Approach IAPT step 2 & Step 3 waiting times
NB: please note the refreshed activity for July. This area was previously reported as 51.8% and has now been refreshed to 48.3%. An issue regarding refreshing the SQPR was initially raised at the August SQPR. A plan was agreed whereby the report would not be refreshed once submitted unless agreed with CCGs and where performance activity needed to be changed, dialogue would be included in the comments box alongside the metric for discussion at the Q&P. Concerns have been escalated to the Trust and they have been asked to:
• give a presentation (this can be a verbal update) to the SLA group on Friday on how the performance reports are developed, what the internal assurance processes are, and the governance around sign-off of the reports
• Re-submit the September SQPR report to include the same information as reported in the August SQPR• a separate report outlining where performance has changed with the reason for the change
The Q&P acknowledged the continued improvement made for Step 2 therapies (94% up from 91%) to be implemented and also the significant improvement for Step 3 psychological therapies to be implemented 84% up from 60%). CCG specific performance was as follows:Step 2: I&ESCCG – 89% WSCCG – 99%Step 3: I&ESCCG – 90% WSCCG - 72%
IAPT and Wellbeing Contract QueryThe RAP has now been fully agreed. Targets to be delivered from 30 September 2013 and seen in the October report submitted in November.
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Norfolk & Suffolk Foundation Trust – Service Quality & Performance Dashboard
Exception reporting of NSFT’s Contractual KPI’s for September 2013:-
Other service waiting times – Domain 2 indicator 18 – Assertive outreach, domain 4 indicators 8, 10, 14 & 17 – integrated Wellbeing, CMHT, 18 week waits & dementia
East activity shows significant increase on last month – up to 21 weeks from 9.8West activity shows improvement on last month – down to 9.4 weeks from 11.3NSFT advised increase due to referral forms found that had not been processed. ML asked to investigate and provide report for SLA
Decrease from August report; to keep under review and if drops again for further discussion at next Q&P.
Decrease in performance against this metric. Concern regarding activity reported in light of exception report review outcomes detailed below
2 Breaches reported. Both show appointment provided within 18 weeks but cancelled by patient
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Norfolk & Suffolk Foundation Trust – Service Quality & Performance Dashboard
Exception reporting of NSFT’s Contractual KPI’s for September 2013:-
The Trust reported 24 breaches greater than 18 weeks. A number of breaches appeared to not be breaches. NSFT agreed to re-submit another report removing non-breaches.
Psychiatric liaison
NSFT have been asked to provide a report for the 8 hour breach. 2 Breaches reported in East but within contract tolerances, 4 Breaches reported for West. TS to liaise with WSCCG in respect of weekly meetings to see if these have been discussed
Contract Query: waiting times breaches and data quality issuesCCGs had agreed that as along as performance for the CMHT 28 day target was above 98% the RAP could be closed. However followingthe review of the exception report a number of cases were identified that were in fact breaches and should not have been excluded from the SQPR CMHT 28 day metric. Until the CCGs can be reassured the excluded cases are accurate and to review the impact of robust exclusion reporting against new service specification metrics the RAP will remain open
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Summary of Contractual Levers - NSFT
Performance Issue Contract Notice Stage Current status Key actions within RAP Latest performance (Source - CCG performance pack):
NSFTFailure to meet data quality and access standards for key mental health services
Contract Query Data Quality improvements have been made and reporting is now transparent. Performance has also improved but remedial action plan not yet complete.
Identification of clear data counting rules including access criteria
Improvements in waiting list management to bring service performance back in line
Early intervention, crisis resolution, community mental health team (CMHT) urgent targets all met.
CMHT routine target 97.9% against target of 100% (98.1% in August)
NSFTFailure to meet data quality and access standards for key Suffolk well being services
Contract Query Technical guidance and indicator mapping complete. Improvements in reporting and performance in progress.
Complete technical guidance
Improve reporting
Meet waiting time standards
September:10 working days for step 2 therapies 94% against 100% (91% in August)
28 working days for step 3 therapies 84% against 100% (60% in August)
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Part 5 CCG Assurance Framework
Balanced ScorecardQuarter 1 2013/14
85
CCG Assurance Framework: Balanced Scorecard Quarter 1 2013/14
Introduction:• In May 2013 NHS England published their draft proposals for ‘CCG Assurance Framework 2013/14’. The CCG Assurance Framework will provide a
nationally consistent approach to the formal interactions between the CCG and the NHS Commissioning Board’s Area Team in order to make anannual assessment of CCG performance. It also provides a framework for NHS England to assess CCG performance and capability.
• A core component of the Assurance Framework is the Balanced Scorecard, which will be used to assure CCG’s operational delivery. The Scorecard isbuilt around five key domains:
1. Are local people getting good quality care? o Control of infection, friends and family survey, never events, CCG governance of quality and safety matters, response to
Winterbourne review.
2. Are patient rights being promoted under the NHS constitution? o Waiting times for A&E, cancer treatment, elective surgery and ambulance calls; mixed sex accommodation breaches and mental health
care programme approach.
3. Are health outcomes improving for local people? o Preventing premature dying; enhancing life for people with chronic conditions; helping people recover from ill health; positive and safe
experiences of care; and local priorities for quality premium.
4. Are CCGs delivering their financial plans? o Recurrent planned surplus; activity trends; QIPP programmes; running costs and audit opinions.
5. Are CCG conditions of authorisation being addressed?
• Within each domain there are a number of indicators, some of which are completed by NHS England with centrally held data, others of which are self-certified by the CCG. Each domain is rated across a spectrum of Red Amber and Green (RAG), with a set of thresholds particular to that domain determining the final RAG-rating for the domain. There is no overall rating for the scorecard.
• The Scorecard for Quarter 1 is shown overleaf. This will also be published on the CCG’s website.
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CCG Assurance Framework: Balanced Scorecard Quarter 1 2013/14
Headlines:Domain 1: This is based on the CCG self-certification. It has been rated Amber-Red primarily for the response relating to “Does feedback from theFriends and Family test (or any other patient feedback) indicate any causes for concern?” which was self-certified as “Yes – No action plan in place”.
Domain 2: This is based on delivery of the rights under the NHS Constitution. It has been rated Amber-Green due to performance against A&E andambulance clinical quality indicators, diagnostic waiting times, and mixed sex accommodation breaches. Performance against these measures andmitigating actions is detailed within the main body of this report.
Domain 3: This focuses on patient health outcomes. It has been rated Red due to performance against MRSA and C.difficile reduction targets.Performance against these measures and mitigating actions is detailed within the Clinical Quality section of this report.
Domain 4: This focuses on financial performance. It has been rated Amber-Green primarily due to a proportion of the 2% non recurrent funds beingused to support non-recurrent Continuing Healthcare backlog.
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CCG Assurance Framework: Balanced Scorecard Quarter 1 2013/14 – Domain 1
88
CCG Assurance Framework: Balanced Scorecard Quarter 1 2013/14 – Domain 2
89
CCG Assurance Framework: Balanced Scorecard Quarter 1 2013/14 – Domain 2
Indicator RAG:
Domain RAG:
90
CCG Assurance Framework: Balanced Scorecard Quarter 1 2013/14 – Domain 3
91
CCG Assurance Framework: Balanced Scorecard Quarter 1 2013/14 – Domain 4
Release 8.00 : Summer 2013/14
For enquiries please contact: [email protected]
WEST SUFFOLK HOSPITALS NHS TRUST
** These charts are constructed using statistical process control (SPC) principles and use control limits to indicate variation from the national mean. The display shows both two
standard deviation (95%) control limits and three standard deviation (99.8%) control limits. Values within these limits (the light grey section) are said to display 'normal cause variation'
in that variation from the mean can be considered to be random. Values outside these limits (in the light green or orange sections) are said to display 'special cause variation' at a two
standard deviation level, and a cause other than random chance should be considered. Values outside these sections (in the dark green or red sections) also display 'special cause
variation' but against a more stringent test.
Variation at the two standard deviation level can be considered to raise an alert, and variation at the three standard deviation level to raise an alarm.
The chart on the left shows a trust whose performance on this indicator is worse than the national picture by a degree that is
unlikely to be explained by random chance**
The chart on the left is for an indicator that does not have a desired direction for improvement. The Trust shown in this
example is within the expected range based on the national picture.
The Acute Trust Quality Dashboard provides an assessment of quality across the 5 domains of the NHS Outcomes Framework:
1. Preventing people from dying prematurely
2. Enhancing quality of life for people with long-term conditions
3. Helping people to recover from episodes of ill health or following injury
4. Ensuring that people have a positive experience of care
5. Treating and caring for people in a safe environment and protect them from avoidable harm
A sixth domain has been created "Organisational Context" which contains a number of metrics which look at organisational behaviour and measures useful in interpreting other
metrics in the Dashboard.
The chart on the left shows a trust whose performance on this indicator is better than the national picture by a degree that is
unlikely to be explained by random chance**
The two charts on the left shows a trust whose performance on this indicator does not differ from the national picture by
more than can be explained by random chance**
* For a full description of each metric and metadata, please see technical guidance.
Period ValueNational
MeanChart
IH01 Emergency readmission - % within 30 days following non-elective admission Q4 1011 13.0% 13.0%
IH02 Emergency readmission - % within 30 days following elective admission Q4 1011 5.76% 6.37%
IH03 Emergency readmission - % within 2 days following non-elective admission Q4 1011 2.26% 2.46%
IH04 Emergency readmission - % within 2 days following elective admission Q4 1011 1.06% 0.93%
IH31Emergency readmission - % within 30 days following non-elective admission
(Same Specialty)Q4 1011 8.73% 7.08%
IH32Emergency readmission - % within 30 days following elective admission (Same
Specialty)Q4 1011 2.63% 2.79%
IH33Emergency readmission - % within 2 days following non-elective admission
(Same Specialty)Q4 1011 1.47% 1.35%
IH34Emergency readmission - % within 2 days following elective admission (Same
Specialty)Q4 1011 0.44% 0.48%
3. Helping people to recover from episodes of ill health or following injury
Where data is available indicators will have an SPC sparkline' showing the previous 8 data points. These are a condensed way to show variation and trend of Trust position against national expected limits.
SPC Chart displaying variance for each
indicator**
If a trust is in this range their rate is better than expected by chance (2SD or 95%)**
The scale of each chart is dynamic to show a range that enables each measure to be viewed clearly for the trust in question. See Meta data document * for further information.
Indicator reference
Indicator name*
Section title listing NHS outcome framework domain.
Period for which data is displayed
Actual value for this indicator
The mean value for all acute trusts in
England
The vertical bar represents the average value for all acute Trusts in England
If a trust is in this range their rate is much worse than expected by chance (99.8% or 3SD)**
This diamond represents the value for the acute trust.
If a trust is in this range their rate is much better than expected by chance (99.8% or 3SD)**
If a trust is in this range their rate is worse than expected by chance (2SD or 95%)**
Maintained by Methods Insight in partnership with Greater East Midlands Commissioning Support Unit
Acute Trust Quality Dashboard
Report Overview
How to interpret charts
Period ValueNational
MeanChart Trend
PD02 Age / Sex standardised hospital mortality from conditions amenable to healthcare RY Q4 1213 78.6 100.0
PD03 Age / Sex standardised in hospital mortality in low risk HRGs RY Q4 1213 50.1 100.0
PD04 Crude in hospital perinatal mortality per 1,000 births (including still births) RY Q4 1213 2.73 6.33
PD06 Summary Hospital-level Mortality Indicator (SHMI) - Emergency & Elective RY Q3 1213 89.3 100.0
PD07 SHMI - Elective (pending data) xxx xxx xxx
PD08 SHMI - Emergency (pending data) xxx xxx xxx
PD09 SHMI - Stroke (sub-group 66) RY Q3 1213 97.7 100.0
PD10 SHMI - COPD (sub-group 75) RY Q3 1213 94.7 100.0
PD11 SHMI - MI (sub-group 57) RY Q3 1213 90.5 100.0
PD12 SHMI - #NOF (group 120) RY Q3 1213 77.3 100.0
PD13 SHMI - Pneumonia (sub-group 73) RY Q3 1213 82.9 100.0
PD14 SHMI - CHF (sub-group 65) RY Q3 1213 75.6 100.0
PD15 SHMI - Renal (sub-group 99) RY Q3 1213 80.9 100.0
PD16 SHMI - Diabetes (sub-group 34+35) RY Q3 1213 79.4 100.0
PD25 % of patients with a fractured neck of femur operated on within 48 hours Q4 1213 86.1% 80.8%
PD30 Cancer waits – % waiting less than 31 Days from decision to treat to first treatment Q4 1213 100.0% 98.3%
PD31 Cancer waits – % waiting less than 62 days from GP referral to first treatment (HQU15) Q4 1213 89.7% 86.5%
2. Enhancing quality of life for people with long term conditions Period ValueNational
MeanChart
EQ01 % emergency admissions for >65 years old with dementia Q4 1213 16.2% 14.7%
EQ02 LOS (Days) for patients >65 years old admitted in an emergency with Dementia Q4 1213 13.7 14.3
EQ03 LOS (Days) for patients >65 years old admitted in an emergency Q4 1213 10.0 10.4
EQ04Ambulatory care sensitive conditions - % of emergency admissions for cellulitis and
DVT (based on SQU04_01)Q4 1213 2.09% 1.44%
EQ05 % of admissions with zero day LOS for emergency ambulatory care conditions Q4 1213 28.0% 39.5%
Period ValueNational
MeanChart
IH01 Emergency readmission - % within 30 days following non-elective admission Q4 1213 12.58% 13.47%
IH02 Emergency readmission - % within 30 days following elective admission Q4 1213 6.35% 6.40%
IH03 Emergency readmission - % within 2 days following non-elective admission Q4 1213 2.08% 2.58%
IH04 Emergency readmission - % within 2 days following elective admission Q4 1213 0.85% 0.96%
IH31Emergency readmission - % within 30 days following non-elective admission (Same
Specialty)Q4 1213 6.66% 7.05%
IH32Emergency readmission - % within 30 days following elective admission (Same
Specialty)Q4 1213 3.30% 2.67%
IH33Emergency readmission - % within 2 days following non-elective admission (Same
Specialty)Q4 1213 0.98% 1.35%
IH34Emergency readmission - % within 2 days following elective admission (Same
Specialty)Q4 1213 0.37% 0.44%
IH05 Emergency readmission - % within 30 days following discharge - Angina Q4 1213 9.09% 14.73%
IH35 Mean length of stay (LOS) for patients admitted for Angina Q4 1213 3.5 4.0
IH06 Emergency readmission - % within 30 days following discharge - Asthma Q4 1213 13.48% 11.86%
IH36 Mean length of stay (LOS) for patients admitted for Asthma Q4 1213 5.1 6.1
IH07 Emergency readmission - % within 30 days following discharge - CCF Q4 1213 22.22% 18.40%
IH37 Mean length of stay (LOS) for patients admitted for CCF Q4 1213 9.5 10.8
IH08 Emergency readmission - % within 30 days following discharge - COPD Q4 1213 24.21% 22.50%
IH38 Mean length of stay (LOS) for patients admitted for COPD Q4 1213 7.5 7.3
IH09 Emergency readmission - % within 30 days following discharge - Diabetes Q4 1213 10.53% 16.64%
IH39 Mean length of stay (LOS) for patients admitted for Diabetes Q4 1213 12.9 11.0
IH10 Emergency readmission - % within 30 days following discharge - Epilepsy Q4 1213 12.20% 15.45%
IH40 Mean length of stay (LOS) for patients admitted for Epilepsy Q4 1213 5.5 6.5
IH11 Emergency readmission - % within 30 days following discharge - Renal Q4 1213 11.17% 14.58%
IH41 Mean length of stay (LOS) for patients admitted for Renal Q4 1213 8.2 7.7
IH21 % patients discharged to usual place of residence Q4 1213 93.9% 94.6%
IH22 % of eligible patients taking part in PROMS (eligible FCEs) (Apr-Jun 12) 1213 66.5% 56.1%
IH23Patient Reported Outcome Measures - % Patients reporting an improvement following
hip replacement (Apr11-Mar12)1213 79.2% 88.4%
IH24Patient Reported Outcome Measures - % Patients reporting an improvement following
knee replacement (Apr11-Mar12)1213 75.0% 78.9%
IH25Patient Reported Outcome Measures - % Patients reporting an improvement following
varicose vein procedure (Apr-Jun 12)1213 55.6% 51.6%
IH26Patient Reported Outcome Measures - % Patients reporting an improvement following
hernia procedure (Apr-Jun 12)1213 58.7% 51.6%
WEST SUFFOLK HOSPITALS NHS TRUST
The West Suffolk Hospital NHS Trust serves an area of approximately 600 square miles which
encompasses a population of approximately 275,000. The West Suffolk Hospital itself has around 480
beds open at any one time and is set in a 19-hectare parkland site on the edge of Bury St Edmunds.
Outpatient services in the community are provided by the Trust at several sites in the form of
consultant-led clinics.
Release 8.00 : Summer 2013/14
3. Helping people to recover from episodes of ill health or following injury
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Spine Charts SPC Sparklines
1. Preventing People from dying prematurely
Acute Trust Value
National Mean Lower Limit
3SD 2SD Upper Limit 2SD 3SD
Maintained by Methods Insight in partnership with Greater East Midlands Commissioning Support Unit
Acute Trust Quality Dashboard
National Mean Acute Trust
Value
Upper 3SD
Lower 3SD
Maintained by Methods Insight in partnership with Greater East Midlands Commissioning Support Unit
Acute Trust Quality Dashboard
4. Ensuring that people have a positive experience of care Period ValueNational
MeanChart
PE00 95th Percentile wait for elective inpatient treatment (weeks) May-13 17.4 22.4
PE01 Median wait for elective inpatient treatment (weeks) May-13 9.45 9.13
PE02 Diagnostic Waits - % of patients waiting over 5 weeks Q4 1213 0.75% 3.17%
PE03Cancer waits – % seen within 14 days of GP referral to first out-patient appointment
(HQU14)Q4 1213 95.3% 95.7%
PE23 A&E - % of patients admitted, tranferred or discharged within 4 hours of arrival Q4 1213 91.9% 92.7%
PE08 A&E re-attendance - % within 7 days (HQU09) Q4 1213 5.1% 6.8%
PE10Median total time in minutes spent in A&E for admitted and non admitted patients
(HQU10)Q4 1213 161 137.0
PE11 A&E attendances - % of patients who leave without being seen (HQU11) Q4 1213 1.1% 2.7%
PE12A&E - Median Time to initial assessment for patients brought in via ambulance in
minutes (HQU12)Q4 1213 15.0 3.0
PE13 A&E - Median Time to treatment in minutes (HQU13) Q4 1213 43.0 56.0
PE14 A&E - % Admissions with zero day LOS Q4 1213 16.3% 23.8%
PE15 Mixed sex accommodation breach rate per 1000 FCEs (HQU08) Mar-13 0.00 0.16
PE16On the day cancellations of elective surgery per 1000 procedures for non-clinical
reasonsQ4 1213 12.9 12.1
PE17 Overall inpatient experience measure 1112 7.9 7.5
PE18 Overall outpatient experience measure 1011 8.1 7.9
PE19 Overall A&E experience measure 1112 8.1 7.9
PE20 Mother satisfaction measure 2010 87.7 83.8
PE21 Delayed Transfers of Care per 1,000 occupied beds - NHS Responsibility Q4 1213 356.0 625.3
PE22 Delayed Transfers of Care per 1,000 occupied beds - Social Care Responsibility Q4 1213 116.9 167.1
Period ValueNational
MeanChart
SC01 Rate of patient safety incidents reported in trusts per 100 admissions APR12-SEP12 5.72 6.81
SC02 Rate of "serious harm" patient safety incidents reported in trusts per 100 admissions APR12-SEP12 0.34 0.41
SC03 % of all admissions who have venous thromboembolism risk assessment (SQU01) Mar-13 99.8% 94.1%
SC04 Rate of surgical site infections per 10,000 specified orthopaedic operations 1112 73.8 88.2
SC05 HCAI - MRSA bacteraemia rate per 1,000,000 occupied beds (HQU01) Q4 1213 29.1 13.1
SC06 HCAI - C. diff bacteria rate per 100,000 bed days (HQU02) Q4 1213 17.92 21.30
SC20 HCAI - MSSA rate per 100,000 bed days Q4 1213 0.0 7.5
SC07 Adult - BADS Daycase Rate (As per BADS V4 directory thresholds) Q4 1213 85.2 81.0
SC21 Paediatric - BADS Daycase Rate (As per BADS V4 directory thresholds) Q4 1213 79.9 84.2
SC08 % of planned day case procedures that are converted to inpatients on the day Q4 1213 0.0% 4.3%
SC09 % of deliveries via Caesarean Section - Elective Q4 1213 7.53% 10.72%
SC10 % of deliveries via Caesarean Section - Non Elective Q4 1213 10.97% 14.18%
SC12 Emergency readmission - % babies within 30 days following delivery Q4 1213 7.38% 7.41%
SC17 Medication errors per 1,000 bed days APR12-SEP12 5.91 7.23
SC19 Incidence of patients with pressure ulcers per 1000 admissions Mar-13 7.68 3.68
6. Organisational Context Period ValueNational
MeanChart
OQ01 Admitted Patient Care - % Valid data (Average for all fields) Apr-13 90.4% 95.20%
OQ02 Out Patient - % Valid data (Average for all fields) Apr-13 92.4% 94.46%
OQ03 Accident and Emergency - % Valid data (Average for all fields) Apr-13 99.5% 94.98%
OQ21 Admitted Patient Care - % Records submitted with valid HRG on first submission Mar-13 100.0% 94.0%
OQ04 Elective - Depth of coding (mean number of secondary diagnosis) Q4 1213 2.64 2.32
OQ05 Non-elective - Depth of coding (mean number of secondary diagnosis) Q4 1213 5.78 4.67
OQ06 Rate of palliative care (ICD10: Z515) per 1,000 episodes Q4 1213 9.02 9.04
OQ20 Rate of palliative care (main specialty 315) per 1,000 episodes Q4 1213 0.00 0.37
OQ18 Rate of use of integrated palliative care pathway (ICD10: Z518) per 1,000 episodes Q4 1213 3.03 5.06
OQ07 Rate of written complaints per 1,000 episodes 1112 4.10 4.43
OQ08 NHSLA Claims per 10,000 bed days 1112 0.88 1.91
OQ09 Workforce - FTE Nurses per bed day Mar-13 1.84 1.80
OQ10 Workforce - Sickness % - Medical Mar-13 2.09% 1.17%
OQ11 Workforce - Sickness % - Nurse Mar-13 5.2% 4.4%
OQ12 Workforce - Sickness % - Midwife Mar-13 2.4% 4.5%
OQ13 Workforce - Sickness % - Other Mar-13 4.0% 4.2%
OQ14 Staff recommendation of the trust as a place of work (CQC survey) 2011 73.9% 52.4%
OQ15 Staff recommendation of the trust as a place to receive treatment (CQC Survey) 2011 78.4% 62.8%
OQ16 Overall medical trainees global satisfaction score (GMC survey) 2013 81.0 78.5
OQ17 Consultant clinical supervision trainers given to their trainees 2013 90.3 86.7
OQ19 % of A&E attendances which are "inappropriate" (V08 / VB11Z) Q4 1213 11.3% 14.3%
For enquiries please contact: [email protected]
5. Treating and caring for people in a safe environment and protecting them from
avoidable harm
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Release 8.00 : Summer 2013/14
This section of the dashboard is included to allow hospitals to provide notes on the content of the dashboard and indicators where required.
There are no notes for this trust.
For enquiries please contact: [email protected]
Maintained by Methods Insight in partnership with Greater East Midlands Commissioning Support Unit
Acute Trust Quality Dashboard
Agenda Item No. 16 Reference No. WSCCG 13-046
From: Bill Banks, Lay Member for Governance, Vice Chair MINUTES OF MEETINGS 1. Purpose 1.1 This report incorporates for endorsement, minutes of recent meetings of the Audit
Committee, Remuneration and HR Committee and the Community Engagement Group
(i) Audit Committee The (un)confirmed minutes of a meeting held on 15 October 2013
(ii) Remuneration and HR Committee The confirmed minutes of a meeting held on 17 September 2013 and the (un)confirmed minutes of a meeting held on 29 October 2013
(iii) Community Engagement Group The (un)confirmed minutes of a meeting held on 11 November 2013
2. Recommendations 1.2 The Governing Body is asked to endorse the minutes. Author: Colin Boakes Governance Advisor
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Minutes of a Meeting of the West Suffolk Clinical Commissioning Group Audit Committee held on Tuesday 15 October 2013
PRESENT Bill Banks - Lay Member for Governance (Chairman) Peter Knights - Governing Body Member IN ATTENDANCE Neil Abbott - Head of Internal Audit Lorraine Bennett - Local Counter Fraud Specialist Colin Boakes - Governance Advisor Mark Game - Head of Accounting and Control Carl Goulton - Chief Finance Officer Mark Hodgson - Ernst and Young – External Audit Jo Mael - Corporate and Governance Officer Ruth Pritchard-Wooles - Ernst and Young – External Audit 13/040 WELCOME AND APOLOGIES
The Chairman welcomed everyone to the meeting. No apologies for absence were received.
13/041 MINUTES OF THE PREVIOUS MEETING
The minutes of the West Suffolk CCG Audit Committee meeting held on 3 September 2013 were reviewed and confirmed as a correct record.
13/042 MATTERS ARISING AND REVIEW OF ACTION LOG
There were no matters arising from the previous minutes other than those already included within the agenda for discussion. The action log was reviewed and updates provided. As requested at the previous meeting, the Audit Committee was in receipt of a report from the Chief Corporate Services Officer which set out the timescales and method of assuring security and management of the risks associated with the network and services delivery by Norfolk and Suffolk NHS Foundation Trust. Although the Committee noted the content of the report and felt it provided
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reassurance as to the security of NSFT’s IT systems, it agreed that NSFTs quarter two report be presented for review by the Committee when available.
13/043 EXTERNAL AUDIT
Mark Hodgson and Ruth Pritchard-Wooles from Ernst and Young, External Auditors provided a verbal report. External Audit advised that the absence of guidance from the Department of Health in respect of financial statements had meant work on the audit plan was unable to be progressed. Without such guidance everything could be considered an audit risk, although building on the previous year, resolution of the continuing healthcare provision remained one of the more significant risks. The Committee expressed concern at the Department of Health’s delay in providing relevant guidance. The need for clarity from the Department of Health in relation to opening balances was emphasized. Previous advice had been that the PCT balances would close on 31 August 2013 which had not been the case. It had been advised that the Department of Health was intending to set up one ledger for the transfer and management of all PCT balances with CCGs only being accountable for the ‘in year’ position. Whilst there was confidence from within the CCG in respect of management of the ‘in year’ position the uncertainty and lack of guidance surrounding the opening balance process was of considerable concern. The external auditors were asked for their assessment of the main financial risks facing the CCG which were identified as those associated with Continuing Health Care (CHC). The potential national stance that unless CHC provision was utilised during 2012/13 it would not be carried forward, represented a significant Suffolk wide risk in light of the current backlog of cases. As a result of that risk information there was agreement on the need to re-assess Risk 02 in the GBAF. It was noted that the external auditors would be visiting the CCG before Christmas to review key financial systems which should facilitate an improved understanding of the risks involved. It was recognised that the delay in provision of guidance would put additional pressure on both auditors and CCG staff later in the year and the Committee agreed that it continue to receive progress updates at future meetings.
13/044 INTERNAL AUDIT INTERIM REPORT
The Head of Internal Audit reported that the Chief Nursing Officer had now provided agreement for internal audits in respect of Looked After Children (LAC) and Safeguarding to be carried out and that work was expected to be take place during October/November 2013.
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Audit work was also being carried out in respect of the contract monitoring of providers with non-clinical contract audits and financial audits next in line for completion. The CCGs had been allocated 35 audit days during quarter three with 53 days allocated for quarter four. The Committee noted the report and requested that it receive the LAC and safeguarding reports at its meeting to be held on 10 December 2013.
13/045 INTERNAL AUDIT REPORT – CLINICAL GOVERNANCE
The Committee was reminded that the Head of Internal Audit had presented an audit report in respect of clinical governance arrangements at the previous meeting. Since then the report had been presented to the CCG’s Executive Committee for consideration with changes suggested having been incorporated into the revised report presented. Whilst the original report had contained four recommendations, the recommendation in relation to the Vice Chairman of Governing Bodies not also being the Chairman of the Audit Committee, had now been removed in light of NHS England guidance. Revised recommendations were therefore as follows; 1) To include the priorities at risk in the Governing Body Assurance
Framework (GBAF) 2) To report more clearly on progress against its 2012-2015 integrated plan
and its incorporated priorities. 3) To formalise the Clinical Executive Committee so that it acted as a
formal sub-committee of the Governing Body. As a result of the Chief Officer Team having discussed the first recommendation, the format of the GBAF was to be amended to include the CCG priority to which each risk referred. The Head of Planning and Performance Management had yet to respond to Internal Audit in respect of recommendation two and the CCG’s Executive Committee had agreed to act as a formal sub-committee of the Governing Body every two months against specific terms of reference that had also been agreed. The Governing Body was to be asked to endorse the recommendations of the audit report at its meeting to be held on 26 November 2013 which would also need to be incorporated into the Constitution when reviewed. The Committee noted the content of the report and the Chairman specifically highlighted paragraph 3.5.6 which provided opportunity for quality assurance to be added to the Audit Committee agenda should that be felt necessary at any future date. The Chief Finance Officer agreed to liaise with the Head of Planning and
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Performance Management for a response to recommendation two of the audit report.
13/046 COUNTER FRAUD
The Committee was in receipt of a report from the Local Counter Fraud Specialist. It was explained that whilst there was currently no available guidance from NHS Protect, other available guidance had been reflected in the report. It was noted that an Anti-Fraud and Corruption Policy was being finalised, with communication of the policy providing opportunity to highlight the work of CEAC and its local contacts within the CCG. The Local Counter Fraud Specialist agreed to discuss communication of contact information with the communications team, together with how best to keep practice managers informed. The Committee was advised that the ‘hold to account’ section of the report contained details of matters where CEAC had been asked for advice, together with subsequent action being taken. It was reported that the number of days of counter fraud provision provided to date was behind schedule due to the lack of definitive guidance. The Committee asked the Local Counter Fraud Specialist to provide a progress update to the next meeting on 10 December 2013. Work was to be carried out in respect of contracts and exploration of areas of potential conflict of interests. The Committee noted the content of the report.
13/047 RISK MANAGEMENT – GOVERNING BODY ASSURANCE FRAMEWORK
(GBAF) The Governance Advisor introduced the updated Ipswich and East Suffolk CCG GBAF and confirmed that the content was reviewed by the Chief Officers Team every month and by the Governing Body at each of its meetings. Whilst reviewing the GBAF key highlighted points included; Risk 01: Failure to safely manage surges in patients requiring urgent care during the winter period across West Suffolk CCG and impact on ability to deliver 95% A&E target and ambulance turnaround targets. There was no mention within the action plan of the recent risk summit that had taken place with West Suffolk Hospital, which affected risks associated with A&E, stroke and infection control. The Governance Advisor undertook to liaise with the Chief Nursing Officer and suggest that she revise the GBAF to include mention of the risk
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summit and quality improvement visits in the ‘key controls established’ columns within appropriate risks and mention any key ‘actions’ that flowed from those two controls. Risk 02: Failure to achieve ongoing financial balance beyond 13/14 and deliver optimum service from the financial resources available. Although the risk RAG rating had previously been downgraded from 20 to 12, it was felt that consideration should be given to revising the rating (and reviewing the mitigating actions) in light of heightened risk as identified earlier on the agenda. Risk 09: Service risks as a result of the Norfolk and Suffolk NHS Foundation Trust proposed service redesign model. It was noted that in Norfolk, the Trust’s number of deaths had been a matter of public concern. The Chief Finance Officer agreed to raise the matter at the Executive Committee meeting to be held on 16 October 2013. Risk 10: Failure to monitor and report key quality metrics impeding early warning systems to inform commissioners and regulators of potential risks and deteriorating standards of care. The Committee asked that the Governance Advisor revise the narrative for the risk in order that it clearly indicated the risk was associated to West Suffolk Hospital. Risk 12: Implementation of transforming pathology services It was noted that work was required to identify if the project could be progressed prior to determining whether the risk should be escalated.
The Committee endorsed the updated GBAF.
13/048 REVIEW OF THE FORWARD AGENDA
The Committee reviewed and noted the forward agenda for future meetings. The Chairman asked that any suggested updates be directed to the Governance Advisor and that the key dates for reviewing and approving the 2013/14 accounts be included, if possible, in the next version of the forward agenda.
13/049 ANY OTHER BUSINESS
No items of other business were received.
13/050 DATE OF NEXT MEETING
The next meeting of the West Suffolk CCG Audit Committee will be held on Tuesday 10 December 2013 at 2.00pm in the Rowley Meeting Room at
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Rushbrook House. Future meetings:
Date Venue Time 10 December 2013 Rowley 2.00pm 11 February 2014 Paddock 2.00pm 2014 8 April 2014 Paddock 2.00pm 10 June 2014 Paddock 2.00pm 9 September 2014 Paddock 2.00pm 14 October 2014 Paddock 2.00pm 9 December 2014 Paddock 2.00pm 2015 10 February 2015 Paddock 2.00pm
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Minutes of a meeting of the West Suffolk Clinical Commissioning Group
Remuneration and Human Resources Committee Meeting held on Tuesday, 17 September 2013
PRESENT: Bill Banks Lay Member for Governance (Chairman) Jo Finn Lay Member for Patient and Public Engagement IN ATTENDANCE: Amanda Lyes Chief Corporate Services Officer Jo Mael Corporate and Governance Officer 13/031 WELCOME AND APOLOGIES FOR ABSENCE
The Chairman welcomed everyone to the meeting.
No apologies for absence were received.
13/032 MINUTES OF THE PREVIOUS MEETING The Committee noted that whilst, due to the frequency and timing of
meetings, it would continue the practice of presenting unconfirmed minutes of the Remuneration and HR Committee meetings to the CCG Governing Body, the Governing Body would also be advised of any amendments made to the minutes by the Remuneration and HR Committee at a later date. The minutes of the West Suffolk CCG Remuneration and Human Resources Committee meeting held on 13 June 2013 were reviewed and confirmed as a correct record, subject to correction of the title of the Lay Member for Patient and Public Involvement to that of Lay Member for Patient and Public Engagement.
13/033 MATTERS ARISING AND REVIEW OF THE ACTION LOG
The action log was reviewed, with it being noted that most matters were
due to be discussed later on the agenda. 13/034 EQUALITY AND DIVERSITY SYSTEM
The Committee received a report from the Lay Member for Patient and
Part One
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Public Engagement which outlined the CCGs’ progress in meeting equality objectives inherited from the PCT and rolled over by the CCGs to the end of October 2013. It was explained that the CCGs had initially adopted the three equality objectives published by NHS Suffolk in April 2012 (with a minor amendment of the third human resource objective), those being; 1. Changes across services for individual patients are discussed with
them, and transitions are made smoothly. 2. Patients, carers and communities can readily access services, and
should not be denied access on unreasonable grounds. 3. Senior (changed from middle) managers and other line managers
support and motivate their staff to work in culturally competent ways within a work environment free from discrimination.
Detailed information on progress against objective three was contained within the report and, based on the evidence provided, the Committee was advised that Staff Side Partnership representatives had concluded that the CCGs were currently at the amber ‘developing’ stage in respect of that objective. It was noted that a further report covering all three objectives and incorporating any comments made by the Committee in relation to objective three, was to be presented to the CCG Governing Body at its September 2013 meeting. Evidence had also been collected and reviewed for a number of other national Equality Delivery System outcomes not selected as the focus for either Ipswich and East Suffolk or West Suffolk CCG and a table of the conclusions of that evidence was attached to the report as Appendix Two. Most objectives had been positively rated as green (achieving) or amber (developing) although there had been one red objective, that being; ‘That the organisation uses the competency framework for equality and diversity leadership to recruit, develop and support strategic leaders to advance equality outcomes’. The Committee noted the content of the report and in light of the need to focus on the role of senior leaders and line managers in providing leadership, support and motivation for progressing equality outcomes it agreed that the following objective for both CCGs be presented to the CCG Governing Body for consideration; ‘Senior leaders and other line managers provide leadership, support and motivation for their staff to uphold the CCGs’ value of equality of opportunity to improve the health of those most in need’.
13/035
AGENDA FOR CHANGE – PAY PROGRESSION FRAMEWORK
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The Committee received a report from the Chief Corporate Services Officer which sought endorsement of the pay progression framework as attached to the report. It was explained that the framework had been finalised following discussions with Chief Officers and Trade Union representatives and was intended to clarify for employees a revised process for the award of annual incremental pay progression. It was intended that future incremental pay progression for Agenda for Change staff would be dependent upon completion of mandatory training, completed personal development plans and tracked objectives. It was intended that a proforma would be completed by managers for each member of staff indicating whether the staff member should obtain pay progression. The Committee felt that the importance of regular one to one sessions should be communicated to staff and welcomed the intention to introduce six monthly appraisal reviews. It was explained that the Joint Staff Partnership Committee had endorsed the approach, having noted that an appropriate appeals process had been built into the framework. It was hoped that receipt of staff proformas would enable HR to carry out reviews to ensure fairness across the board, together with monitoring any trends in relation to age, gender and directorates. The Committee welcomed the introduction of the annual pay progression framework which it felt had been well developed. It was noted that those individuals not achieving pay progression would be entered into the capability process. The Committee emphasised the importance of ensuring that the personal development review process did not suffer as a result of the introduction of the framework. The Committee endorsed the pay progression framework and noted that an update on progress was to be presented to the January 2014 meeting.
13/036 MANAGEMENT COSTS
The Committee received a report from the Chief Corporate Services
Officer which detailed expenditure to 31 August 2013 in respect of CCG management costs. It was reported that the CCG was underspent against the year-to-date budget and that whilst management costs currently included the cost of nursing staff in respect of continuing care and safeguarding children, those costs could be justifiably reclassified so as to reduce the management cost per head of population for both CCGs.
4
The Committee was asked to note that the year to date overspend in respect of the Corporate Services Directorate (as indicated within the report) was due to the inclusion of costs associated with GP IT. The GP IT agenda was currently being facilitated by the CCGs on behalf of the Area Team and it was expected that this expenditure could be excluded from the management cost total in future and the figure per head of population recalculated, downwards. The Committee noted the content of the report and agreed that the Head of Accounting and Control be asked to advise members (outside of the meeting) of the recalculated figures when available.
13/037 SOCIAL MEDIA POLICY
The Committee was in receipt of a Social Media Policy which had been
developed by the communications team alongside input from the Head of IT, Lay Members, Trade Union representatives, GPs and communications leads from both CCGs. It was explained that previously, social media websites had been blocked for staff use. Now, the CCGs were keen to use these methods of communication and the introduction of such a policy was a necessity. Introduction of the policy had been supported by the facilitation of a lunch and learn session on social media carried out by a representative from a legal company. The work put into developing the policy was recognised. The Committee suggested that the “Top Tips” included within the policy might also be brought together in a separate short document to facilitate communication with staff. The inclusion of an additional “tip” that social media should not be used as a substitute for the whistleblowing policy was also suggested. The Committee was reassured that staff were aware of the times of day when they were able to access websites and that consideration was being given to the future development of a policy in respect of the use of personal media devices for work purposes. The Committee approved the Social Media Policy as attached to the report, subject to the inclusion of advice that social media should not be used as a substitute for the whistleblowing policy.
13/038 WORKFORCE REPORT – QUARTER ONE
The Committee was in receipt of a report from the Chief Corporate
Services Officer which provided information on a wide range of key HR performance indicators in relation to quarter one. It was explained that a review of progress against targets and the monitoring of trends would be possible once quarter two information was available. Key points highlighted from the report included;
5
• Concern at the current sickness absence rate of 3.18% which
was higher than the 2% target. The nursing directorate had been identified as an outlier with three members of staff currently being absent due to anxiety. HR was currently offering support to the directorate which included access to Occupational Health.
• The completion rate for PDRs was 97% with the mandatory
training rate being 90%. Whilst there was concern that the operating office appraisal rate was 81% compared with other directorates that had achieved 100%, reassurance was provided that the Chief Operating Officer was looking to address that figure.
• The age profile information indicated a good mix of age ranges
overall The Committee noted the content of the report and looked forward to the future presentation of quarter two information together with feedback from the introduction of the pay progression framework and staff surveys.
13/039 HEALTH AND SAFETY
The Committee was provided with an update on health and safety
matters. It was reported that the Health and Safety Committee had agreed the content of the CCGs’ Health and Safety Annual Plans for 2013-14 in June 2013 and they had been attached to the report for information. Health and Safety training for all staff continued with courses being well attended and the following additional training had also been arranged;
• In depth health and safety training for the Chief Corporate Services Officer as organizational lead and the CCG committee representative.
• A lunch and learn session for staff on personal safety awareness. Safetyboss had now completed a baseline health and safety audit in respect of the organisation and its report was awaited and expected to be available for report to the October 2013 meeting. It was noted that, whilst the Governing Body was not receiving reports on Health and Safety at every meeting, it did receive updates via the Remuneration and HR Committee minutes. It was intended that from November 2013 the Governing Body would receive twice yearly reports related to progress in respect of achievement of the Health and Safety Annual Plans. A formal review of the Service Level Agreement with Safetyboss had been undertaken on 29 August 2013 at which it had been recognised
6
that whilst, overall the agreement was working well there were some operational concerns which the contractor had agreed to address going forward. In order that awareness of health and safety matters amongst staff was maintained a bi-annual newsletter was to be introduced from September 2013 and published on the CCGs intranet sites. The Committee noted the content of the report.
13/040 JOINT STAFF PARTNERSHIP COMMITTEE MEETINGS – 7 JUNE
2013 AND 5 SEPTEMBER 2013
The Chief Corporate Services Officer summarised the main issues discussed and outcomes to emerge, from the Joint Staff Partnership Committee meetings held on 7 June and 5 September 2013. The Committee was pleased to note that the CCG was a finalist in respect of an award for staff engagement, the outcome of which would be known in November 2013. The committee noted the report and the range of matters discussed.
13/041 CHIEF CONTRACTS OFFICER
The Committee received a report which advised of the appointment of
Wendy Tankard as the new Chief Contracts Officer. Wendy Tankard was due to commence employment on 23 September 2013, and Jon Reynolds who had been ‘acting up’ in the role of Interim Chief Contracts Officer would be returning to his former role. The Committee noted the content of the report.
13/042 LEADERSHIP DEVELOPMENT
The Committee was pleased to receive a report detailing training
opportunities being undertaken by staff over the coming months with particular emphasis on national/local leadership offers. It was reported that in-house personal skills development courses had been oversubscribed with further sessions being arranged. It was expected that the Liberated Leadership Programme run by University Campus Suffolk would commence in October 2013. The importance of continued investment in staff development was emphasized. The Committee noted the content of the report and requested feedback to its next meeting on training participation across the organisation.
7
13/043 REVISED POLICIES FOR APPROVAL
A number of policies were presented to the Committee for approval having been revised due to development of the CCG. The Committee emphasised the need to ensure that, prior to finalisation, the policies were formatted correctly and organisations clearly identified. The Committee went on to review each individual policy with comments made as follows;
• Annual Leave Policy – no changes other than ensuring correct formatting and clear identification of organisations.
• Change Management, Redeployment and Redundancy Policy
– that the policy be revised to replace Non Executive Members with Lay Members throughout.
• Grievance Policy – that reference to old organisations be
removed or replaced.
• Managing Capability Policy – that the acronym KSF on page 5 was extended to ‘Knowledge Skills Framework’. That clarify was provided within Section 10 that monitoring periods would cease in the event that an individual was absent from work and recommence on their return.
• Managing Sickness Absence Policy – that appendices one and
two which provided guidance for managers be strengthened. It was noted that the policy had been reviewed by Occupational Health who had also recently held a meet and greet session for staff and would also be carrying out a ‘lunch and learn’ session on managing stress in the workplace.
• Paternity and Parental Leave - that reference to old
organisations be removed or replaced.
• Stress Policy – that paragraph 4 should be strengthened to clearly define ‘stress’ parameters.
• Travel and Expenses Policy – the policy had been altered to
take account of national changes to mileage rates which had taken effect from 1 July 2013.
The Committee approved all presented policies subject to the above amendments being actioned.
13/044 ANNUAL PRACTICE PAYMENT
The Committee received a report which advised that, whilst in shadow
form, the Remuneration and HR Committee of the West Suffolk CCG
8
29 October 2013 _____________________________ ______________________ Chairman (Bill Banks) Date
had received a report in April 2012 advising of intended annual practice payments to be made to practices. Since that meeting, it had been questioned whether the payment was also applicable to those members of the CCG Governing Body that, whilst employed by practices, were not GP members. Therefore, the Remuneration and HR Committee was being asked to clarify the requirements for the payment. The Committee was advised that the payment had been intended as an inconvenience payment to practices in recognition of the additional administrative work of organising locum cover that would be required due to the absence of GP members. Having discussed the matter in some detail, the Committee agreed that one annual payment of £5k per practice in respect of GP members only, irrespective of the number absent, should be applied.
13/045 ANY OTHER BUSINESS
The Chief Corporate Services Officer reported that the contract for
provision of payroll services, currently held by Serco, would be up for renewal on 31 March 2014 and the CCGs were intending to carry out a retendering exercise. It was envisaged that staff members would be invited to participate in the selection process.
13/046
DATE AND TIME OF NEXT MEETING
It was confirmed that the next meeting of the West Suffolk CCG Remuneration and Human Resources Committee would be held on Tuesday 29 October 2013 at 10.00am at The Farmers Club, Bury St Edmunds.
9
Minutes of a meeting of the West Suffolk Clinical Commissioning Group
Remuneration and Human Resources Committee Meeting held on Tuesday, 29 October 2013
PRESENT: Bill Banks Lay Member for Governance (Chair) Jo Finn Lay Member for Patient and Public Engagement IN ATTENDANCE: Amanda Lyes Chief Corporate Services Officer Jo Mael Corporate and Governance Officer 13/047 WELCOME AND APOLOGIES FOR ABSENCE
The Chair welcomed everyone to the meeting.
No apologies for absence were received.
13/048 MINUTES OF THE PREVIOUS MEETING The minutes of the West Suffolk CCG Remuneration and Human
Resources Committee meeting held on 13 June 2013 were reviewed and confirmed as a correct record.
13/049 MATTERS ARISING AND REVIEW OF THE ACTION LOG
Matters arising that were not to be discussed as part of today’s agenda
included: • It was noted that the newly appointed Chief Contracts Officer had
settled in well to both the organisation and the Chief Officer Team. • The Committee was advised that, as suggested at its previous
meeting, a paragraph had now been added to the Social Media Policy to reflect that the policy should not be used as a substitute for the whistleblowing policy, ‘Top tips’ from the Social Media Policy had also been circulated to staff within ‘The Buzz’ weekly newsletter. The Remuneration and HR Committee felt that it might be useful for its members to be included within the distribution list for ‘The Buzz’ which the Chief Corporate Services Officer agreed to organise.
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• The first edition of the bi-annual Health and Safety newsletter had been published and circulated to staff, with the next edition expected in March 2014.
The action log was reviewed and noted.
13/050 MANAGEMENT/RUNNING COSTS
The Committee received a report from the Chief Corporate Services
Officer which detailed expenditure to 30 September 2013 in respect of CCG management/running costs. NHS England recently agreed that because of underspending against the management cost budget, it could be reduced in-year from £25 to £24.46 per head of weighted population and the saving used to offset other CCG expenditure. It was also reported that the most recent year to date management cost for West Suffolk CCG was running at £23.74 per head of weighted population. It was explained that although the management cost calculation per head of weighted population currently included the cost of nursing staff in respect of continuing care assessments and safeguarding children, together with a GP IT element; those costs should be able to be excluded going forward and the management cost (per head of population) reduced. The Committee stressed the importance of identifying the true management cost (per head of population) and requested that it be reported to the December 2013 meeting. There followed a general discussion about management capacity and its resourcing level and having regard to the sickness/absence issues that were reported in a later paper on the agenda (see minute 13/053), the Committee agreed to ask for a performance report in respect of the Nursing directorate. Having noted the content of the report the Committee agreed; 1) That it be provided with true management cost (per head of
population) figure for its meeting to be held on 17 December 2013. 2) That the Committee be provided with a general performance report
in respect of the nursing directorate at its meeting to be held on 17 December 2103. The report to include a review of capacity/resourcing levels and performance against key performance indicators.
13/051 HEALTH AND SAFETY
The Committee was in receipt of the minutes of the Health and Safety
11
Committee meeting held on 7 October 2013 and was provided with an update on health and safety matters including; • Integrated Health and Safety Training continued and was being well
attended with all staff having now attended or been booked onto courses. New staff were to be automatically issued with a date for training on commencement of employment. Training in respect of Corporate Manslaughter and basic lifesaving skills was also to be incorporated into the training sessions.
• Safetyboss had completed its baseline health and safety audit with
the final version of its report to be included in the first of the twice yearly health and safety updates to the Governing Bodies in November 2013.
• A formal review of the service level agreement held with Safetyboss
on 29 August 2013 had identified some operational amendments. A further review was scheduled for 28 January 2014.
• The Health and Safety Committee had agreed that the production of
departmental risk assessments should be a priority. Safetyboss was to produce a template, and Chief Officers asked to drive the production of the assessments through their respective teams. It was expected that the risk assessments would be completed by the end of December 2013.
• The first Health and Safety newsletter had been published on the
intranet and circulated via ‘The Buzz’. The newsletter was to be produced by Safetyboss on a twice yearly basis with the next edition expected in March 2014.
• A recent fire drill held at Rushbrook House had highlighted the need
for more staff to be trained in the use of the Evac chair in order that the building might be evacuated more efficiently. It was anticipated that fire evacuation concerns at St Andrews Castle would be addressed by the proposed office relocation.
The Committee was supportive of individual teams carrying out their own risk assessments and noted the intention for those risk assessments to be regularly reviewed by the Health and Safety Committee in order that any resulting actions might be identified. The Committee noted the content of the report and that Safetyboss was responding well to requests and actions, and regularly attended Health and Safety Committee meetings.
13/052 EDUCATION AND LEADERSHIP DEVELOPMENT
The Chief Corporate Services Officer reported that training and
education opportunities for staff were now being received positively by
12
all directorates. The Committee advised that the benefit of appropriate external training being made available to staff should not be overlooked.
13/053 NURSING DIRECTORATE SICKNESS ABSENCE
The Committee was in receipt of a report from the Chief Corporate
Services Officer which detailed sickness/absence levels within the nursing directorate. Whist previously levels of sickness/absence had given cause for concern, it was noted that such absences were now being proactively managed within the directorate with advice from HR and occupational health input being sought at appropriate times. The secondment of an external advisor from the Area Team had been seen as a positive step and the situation would continue to be monitored closely going forward. It was intended that a staff survey be drafted for use across the whole workforce in the new year. The Committee noted the content of the report and welcomed receipt of the performance report to its December meeting (as requested under minute 13/050) together with a draft staff survey for approval.
13/054 FINANCE RESTRUCTURE
The Committee received a report which detailed the process being
followed in respect of a proposed restructure of the Finance Directorate. It was explained that a consultation period with staff had commenced on 14 October 2013 and closed on 25 October 2013. During that period, in excess of 80 questions had been raised by affected staff, which included questions in relation to role clarity, qualifications required for roles and process. It was intended that feedback from the consultation period be made available to staff from the end of next week, after which the final structure would be confirmed. The Committee asked about the how the cost of the new Finance structure compared with the old and was informed that the proposal was broadly cost neutral. The process being adopted was consistent with the Change Management Policy and that used during transition from the PCT to CCGs. The Committee noted the content of the report and that a further update would be provided to its meeting on 17 December 2013.
13/055 JOINT STAFF PARTNERSHIP COMMITTEE MEETING – 5
SEPTEMBER 2013
13
_____________________________ ______________________ Chairman (Bill Banks) Date
The Chief Corporate Services Officer summarised the main issues
discussed and outcomes to emerge, from the Joint Staff Partnership Committee meeting held on 5 September 2013. The Committee was pleased to note that good relationships existed with Union Representatives and that the CCG was a finalist in respect of an award for staff engagement, the outcome of which would be known in November 2013. The Committee noted the report and the range of matters discussed.
13/056 CLINICAL CONTRACTS UPDATE
The Committee was in receipt of a report from the Chief Nursing Officer
which whilst detailing the circumstances surrounding the move of contracting quality staff to the nursing directorate, did not provide as requested, an indication as to whether the revised working arrangements were proving successful. The Chief Corporate Services Officer reported that of the two members of staff involved, one had since left the organisation and the other was now more positive about the transfer. The Committee noted the report and felt that the forthcoming contract round would provide a good test to measure the success of the new arrangements..
13/057 ANY OTHER BUSINESS
No items of other business were received. 13/058
DATE AND TIME OF NEXT MEETING
It was confirmed that the next meeting of the West Suffolk Remuneration and Human Resources Committee would be held on Tuesday, 17 December 2013 at 10.00am at Rushbrook House.
Agenda Item No. 16iii Reference No. WSCCG13-046iii
From: Jo Finn, Lay Member for Patient Engagement Part 1 Part 2 BOARD REPORT: Minutes of meetings – draft minutes from Community Engagement Group meeting 11 November 2013
1. Purpose 1.1 This report includes the draft minutes from the Community Engagement Group meeting on
11 November 2013.
2. Recommendations 2.1 The governing body is asked to consider and note the key items of discussion from the
Community Engagement Group. Author: Carla Pinto, Membership Officer
Community Engagement Group Minutes (draft)
Date: 11 November 2013 Time: 1000 - 1200 Venue: Haverhill Art Centre – High Street, Haverhill, Suffolk CB9 8AR Chair: Anne Nicholls (AN- Chair) In attendance: Jo Finn (JF - WSCCG Lay Member), Michael Simpkin (MS), David Dawson (DD),
Carol Mansell (CM), Roy Banks (RB), Mike Hope (MH), Warwick Hirst, Phil Worsley (PW), Barbara McLean (BM - Chief Nurse), Jep Ronah (JRo - Public Health Consultant), Isabel Cockayne (IC - Head of Communications), Carla Pinto (CP - Membership Officer), Adrian Lyne (AL - Engagement and Consultation Officer), Ed Garratt (EG - Chief Operating Officer, WSCCG)
Apologies: Megan Benson (MB) Bob Mynn, Jon Rapley (JR) Absent: Carol Dalton (CD), Louis Gooden (LG),
Item
Discussion/Action Responsible Officer
Due date
1. Welcome, introductions and apologies. AN welcomed everyone to the meeting and apologies were noted. AN gave background information about the Community Engagement Group (CEG) for the benefit of members of the public.
2.
Minutes and Actions arising. MH explained that his general question from the last CEG meeting in relation to Serco and the ‘level playing field’ are not in the minutes. MH agreed to contact CP with a suggested amendment to the minutes. It was noted that the report about the Serco KPIs had not been received from the contracts team, as requested at the last meeting. IC will follow this up and ask for a response.
IC
02/01/14
3.
Matters arising not on the agenda. There were none.
4.
NHS Quality Agenda BM presented a paper on quality and the role of the chief nurse, giving a brief explanation where her department receives guidance and advice (NHS National Quality Board) as well as an overview of the structure. AN asked how can we be sure that this information is accurate. How can we be sure that the safety problems as seen at Mid Staffordshire hospital and the cancer waiting times at Colchester aren’t happening in the West Suffolk CCG area? BM explained that her department have a system of quality improvement visits (QIVs). They go into wards and clinics, spend time looking at systems and processes as well as speaking with service users. Where they receive information, they look at validating this to ensure it is accurate.
Item
Discussion/Action Responsible Officer
Due date
MH asked if there are figures for clinical negligence claims in the West Suffolk CCG area. BM explained that there is information on this but it is generally not used as a quality measure or monitoring standard. The payments are often agreed some time after the event so the issues may well have been resolved. This is managed and monitored by the NHS litigation authority. BM offered to provide further information if considered helpful. The preferred method is to look in real time at all never events. The CCG also looks at serious incidents in real time – the numbers, where they occur and any recurring themes. The CCG works closely with providers on these. DD asked if a patient safety issue is spotted from a QIV, can the CCG advise the provider. BM replied that yes, her department uses a template called the 15 step model. The CCG looks at staffing levels and advises the provider. The CCG requires them to assure us with evidence of how they are achieving proper outcomes for patients. RB said the previous Suffolk PCT patient safety and clinical quality network was a very important meeting. Is this group continuing in some form? It was helpful to have a lay person there, as an outsider can sometimes flag up things that might have been missed. Something that came out of the Francis Report was that recruitment processes should also include consideration of the candidate’s values as well as their clinical skills. All providers in Suffolk have taken the Warner interviews and applied the standard which has been extended from children’s services to adult’s services. PW asked what evidence do members of the public have that the measures of patient safety and quality are actually happening? He added that he’s particularly interested in cancer waiting times given we’re so close to Colchester. BM explained that governing body reports for performance give an overview and that the CCG has been working and challenging the CCG responsible for services in Colchester. PW said the figures appear quite good for West Suffolk, but the Colchester figures also looked quite good initially. BM explained that the CCG will be communicating to the public how we know this is not the case in West Suffolk. EG asked that for the next meeting we should have a paper outlining how the CEG and lay members can get involved in Barbara’s work.
AL / BM
02/01/14
5.
Public health JRo delivered a presentation about the role of public health and how Suffolk County Council (SCC) works together with the CCG. CP was asked to circulate the presentation slides after the meeting The Suffolk Health & Wellbeing Strategy has four key outcomes:
- Every child in Suffolk has the best start in life - Suffolk residents have access to a healthy environment and take
responsibility for their own health and wellbeing - Older people in Suffolk have a good quality of life - People in Suffolk have the opportunity to improve their mental
CP
18/11/13
Item
Discussion/Action Responsible Officer
Due date
health and wellbeing MH asked if SCC are looking to develop a more robust dataset of the prevalence of conditions, particularly those areas nationally and locally where statistics are poor (e.g. long term neurological conditions). Is this likely to be part of the function of public health? JR acknowledged data can be variable – it is good in some areas, but poor in others. Public health are trying to collect as much as possible that’s useful to commissioners. As part of their work, they can give recommendations on collecting additional data. Where data is weak, the best they can do is to use national data for estimates locally. MH explained that in his experience, there are a range of ‘Cinderella conditions’ where prevalence is far in excess of those noted. It’s very important to build on this data locally; using national estimates isn’t always the answer. DD advised that it would be valuable if in Suffolk we adopted the practice of setting up working groups on each of the four themes of the Health and Wellbeing Strategy. CM is interested in the link between health inequalities and income deprivation. Poor diet is often related to low levels of income. Is there a way of health and social care being interlinked? How can pressure be put on bodies to promote a living wage, not a minimum wage? JRo replied that she sees her team as advocates for disadvantaged groups. They are always trying to identify pockets of deprivation and health inequalities to bring to the attention of commissioners. The focus is on children as the first two years of a child’s life has big implications on mental development, school outcomes etc. Her department also tries to influence policy makers wherever they can.
6.
Early supported discharge engagement IC explained that a report would be circulated to the public following the engagement exercise, which finished last week. Early supported discharge is a new service where both Suffolk CCGs are working together to make an improved service for people who have had a stroke. This is the first engagement exercise we’ve run of this kind. It started on 25 September and finished on 5 November. The questionnaire was developed by the CCGs with some input from the Stroke Association and Healthwatch Suffolk. The CCGs based the questionnaire on the service specification. Healthwatch decided to also look very carefully at qualitative feedback. The team visited eight stroke groups (after writing to 20) and Healthwatch have developed a first draft of an independent report. Some of the main findings have been:
- A real need to include training in service specification - Carers need to be supported - Person centred care plans need to be in place - Underline patient centred care - Dissatisfaction about the finances – people feared this
wouldn’t be funded. We need to communicate this to make it clear
Item
Discussion/Action Responsible Officer
Due date
The governing bodies will make a decision whether to support this development at the end of this month and then go through a procurement exercise. AN commented that this reflects the CEG feedback. The CEG is also concerned about the skill mix of people who are going to deliver the service. There should be personalised care plans. CM asked if someone can advise about the length of the visits from carers? AN replied that the specification states that the visits will be 45 minutes a day for five days a week. IC would like to register thanks to Healthwatch Suffolk for excellent support for this exercise.
7. Lay member’s report JF outlined her paper. The next Patient Revolution event will be on 18 June 2014. The CEG agreed with the proposed approach to recruit new CEG members. JF asked those that have taken part in the two CCG workshops recently for any feedback. An annual programme of CEG activities will be developed for 2014 incorporating dates of CEG meetings, conferences, CCG meetings, road shows, newsletter dates, etc. MH explained that the CEG needs to always be a sceptical friend of the CCG. It should never be seen as the engagement front of the CCG. JF agreed. WH asked if a copy of the Forest Heath and St Edmundsbury consultation document can be sent to him.
CP
CP
02/01/14
18/11/13
8.
Market stalls evaluation AL presented the evaluation report and recommendations for next year’s activities. MS proposed the CEG agree to option 2, to run the same event in the towns that worked well, but to explore whether the different methods for roadshows for Brandon and Newmarket could be more suitable. In the past Haverhill had held health days to take blood pressure etc, which were very well attended. MH added there is no substitute for getting out there and meeting people. He added that a theme that cropped up in Haverhill was the delay in accessing GP appointments in the town. AN agreed that this has been a problem in the town for a long time. WH suggested that the market in Newmarket is quite poor at the moment, so may explain the lack of passers-by. It was a bit puzzling to people that we were using a Live Well Suffolk branded gazebo. The Guinea’s shopping centre could work well. CM reported that Bury St Edmunds worked well; it was positive and an easily accessible way for people to engage. RB explained that the most important thing is the evaluation and added his thanks to CP and AL. JF also supported option 2, but suggested that we could add on some of things suggested – i.e. health days, speaking to people in Brandon and Newmarket for what might work well there. NHS branding for the event rather than a name for the CCG or Live Well could be helpful. EG asked if it was a good way to engage with diverse groups rather than conferences. AL replied that we were speaking to people on the street,
Item
Discussion/Action Responsible Officer
Due date
rather than asking them to come to us. PW asked whether Saturdays were a better day to reach more people at the markets. DD mentioned he had realised at the market stall that some NHS staff had no idea about the new NHS structures. He explained that we should look at recruiting NHS staff to the Health Forum to spread the message. AN agreed that overall this was a useful thing to do. The group accepted option 2 with one or two inclusions of people’s ideas.
9
National guidance on patient involvement and engagement IC explained that the purpose of this report is to explain current progress of the CCG against the NHS England guidance document on transforming patient and public engagement. The report was tabled and CP was asked to circulate an electronic copy. DD said he understands there are a series of events for CCG staff on health economics. Could this be extended to CEG members? There should be as much public understanding of health economics as possible. Could this be coordinated into a workshop? MH endorsed what RB and DD said. It was agreed to explore the most suitable approach, perhaps a half day workshop or a longer item at a future meeting.
CP
AL
18/11/13
31/01/14
10 Feedback from CEG members Report from Regional Voices event attended by DD and MS DD presented his report and suggested that it seems sensible to have some sort of CEG involvement in this. There was a guidance document on working with the voluntary and community sector. This included models and checklists of community engagement. The CEG and CCG could check itself against this. DD can circulate the document. MS had since had contact from Wellbeing East about the steering group, to see if a member of the CEG would be interested in joining. DD is fearful of establishing regional bodies without functions or power. They can be talking shops rather than doing actual work. RB added that it is crucial to use the Pareto Principle or the 80/20 rule (80% of benefits by doing 20% of activities). There are lots of activities to get involved in, but we need to be very careful to not spread ourselves too thinly. DD will try to influence the agenda to include joint commissioning (with advice from EG). MH explained that there are certain areas of commissioning and neuro-rehab which straddles both regional and local commissioning arrangements. There is potential that could be achieved through the group. DD and MH to decide how to approach this meeting. MS to circulate presentation from meeting to all CEG members, which explains how the group is planning to engage. Patient Participation Groups (PW) PW encouraged people to get involved with their GP patient participation group. PW reported that he had found the visit to the ambulance trust’s headquarters very interesting.
DD
DD and MH
MS
22/11/13
10/01/14
31/11/13
Item
Discussion/Action Responsible Officer
Due date
Clinical Reference Groups (MH) MH said part of the NHS and Social Care Act was to set up clinical reference groups (CRGs) which cover a range of conditions to inform commissioners at a national and local level. There is a meeting of the neurology, dementia, mental health CRG meeting specifically on neurology services on 15 November in Bar Hill, Cambridge. Failure to attend GP appointments MS said that 100 people in one month did not attend their GP appointments at the Stourview practice in Haverhill. He would like to get figures for this across all surgeries in Haverhill and put in the local papers. EG explained that he is getting the data together at the moment. The cost of missed appointments in Haverhill equates to employing an additional doctor.
MH
15/11/13
11
AOB There was none.
12.
Dates of future meetings: 10th January 2014 – 10:00-12:00 at Moreton Hall Community Association, Bury St Edmunds.
13. Questions from the public: Engagement with ethnic minorities There was a question asking how the CCG is engaging with ethnic minorities and Gypsies and Travellers. JF is trying to recruit members of these communities for the CEG. The CCG also has a contract with the Marginalised and Vulnerable Adults Service. AL added that the CCG also works with the Healthwatch Suffolk subgroup focussed on black and minority ethnic (BME) communities and the Gypsy and Traveller Liaison Service, which are working on a health DVD for this community. Engagement with Eastern European Communities There was a question about how the CCG is engaging with Eastern European communities that may be contributing to the missed GP appointments. IC explained that as part of the winter planning, we need to communicate much better with some of the Eastern European communities. She explained that her team is working with factories, agencies and shops to get these messages out. She will be producing a piece of guidance on this. One of the ways to help the doctors may be to print a booklet. Many practices have nurse practitioners, who don’t always know what services are available. IC explained that the Haverhill services booklet outlines this. We will also be talking to each of the practices to see if there’s anything we need to do to communicate this to patient groups and patients. Closure of walk in centres There was a BBC news story today about how walk in centre closures made A&E and GP waiting times worse. The walk in centre was closed in Haverhill. Is there any way that GPs are going to get help to cut down waiting times? There is a three, four, even six week wait to see your own GP in Haverhill. Is the CCG looking into this? AN replied that Monitor
Item
Discussion/Action Responsible Officer
Due date
have advised caution in the further closure of walk in centres, but have not suggested reopening those already closed. EG said a report from NHS England is due this week on emergency and urgent care. In December the government will advertise the opportunity for GPs to club together to extend GP services. Three Haverhill practices are looking to submit a joint bid. The CCG will help them as much as they can. There is a chance that the East of England as a whole could receive more funding for health services if changes are made to change focus from deprivation to age. The CCG has heard the message many times about waiting times. It is committed to solving the problem. Has the CCG made a difference? Since the inception of West Suffolk CCG, how have you made a difference in West Suffolk and in Haverhill specifically? EG replied that a CCG report will be published this week, which will set out the priorities which were agreed following the Health Needs Assessment. This will show a set of actions that will be taken. We’ve changed the issue around information as many people told us there is not enough awareness of health services in the town. 2000 copies of the services leaflet have been circulated. We can do more of that if want us to do so. The relationship of the NHS has also been an area we’ve improved in Haverhill. Availability of minutes Are minutes from this meeting available publically? How is the CCG recording people’s questions and reporting back? IC said that we now have papers from the CEG meetings on our website. Serco performance The questioner was surprised there was no discussion around the performance of Serco today. AN added that for Serco performance, there appeared to be problems with the formulation of care plans, the delivery of pulmonary rehabilitation, problems with falls assessment, response of care coordination centre and problems about speech and language therapy assessments. There is information in the CCG’s governing body performance report. AN added that the CEG hasn’t had a full report back from Serco but will follow this up. BM said that the team has led a review of the quality of service, staffing levels, activity, staff and patient satisfaction alongside contractual work. MH asked that we have another substantial session where we go through Serco performance rigorously. Child Development Centre The nearest child development centre is in Bury. There are long waiting times to get an assessment and are then seen for half a day a week. BM explained that the CCG has done a lot of work on children’s and young people’s services. We have developed an autism diagnostic service which is now comprehensive and accessible from 0 to adulthood. There are additional resources for 11-18 and for adults. We are happy to look at resourcing of existing service.
AN
17/12/13
Action Log
DATE DETAILS ACTION BY WHOM DUE DATE UPDATE 13/09/13 8 KPIs that Serco failed recently Follow up SCH actions re: KPIs with the contracts team
IC 02/01/14
11/11/13 Paper for next meeting Outlining how the CEG and lay members can get involved in the quality work.
AL / BM 02/01/14
11/11/13 Jep Ronah’s presentation Send out JR’s slides to all CEG members. CP 18/11/13 Completed – 12/11
11/11/13 Annual programme Develop this to map out what’s happening in the year ahead CP 02/01/14
11/11/13 Forest Health consultation Send another copy of any papers to CEG members. CP 18/11/13
11/11/13
Transforming public engagement paper
Tabled report to be circulated to all CEG members CP 18/11/13
11/11/13
Transforming public involvement and engagement
Workshop to be organised Dec 13 / Jan 14 AL 31/01/14
11/11/13
Engaging with the voluntary sector
Guidance document from Regional Voices event to be circulated
DD 31/11/13
11/11/13
Wellbeing East steering group To determine whether a CEG representative should sit on the steering group
DD and MH 10/01/14
11/11/13 Presentation from Regional Voices event
Slides to be circulated to CEG members MS 31/11/13
11/11/13 Neurology CRG meeting MH to attend on 15 November 2013 MH 15/11/13
11/11/13 Agenda item for next meeting Consider a substantial session to go through Serco performance
AN 17/12/13
11/11/13 Previous meetings’ minutes Upload minutes to the website CP 15/11/13
Page 1 of 7
Agenda Item No. 17 Reference No. WSCCG 13-047 From: Julian Herbert, Chief Officer CCG COLLABORATIVE GROUP 1. Purpose 1.1 This report incorporates for endorsement unconfirmed minutes of a recent meeting of the CCG
Collaboration Group held on 3 October 2013. 2. Recommendations 2.1 The Governing Body is asked to endorse the minutes. Author: Colin Boakes, Governance Advisor
Page 2 of 7
Ipswich & East Suffolk Clinical Commissioning Group
West Suffolk Clinical Commissioning Group
Minutes of the CCG Collaborative Group meeting held on Thursday, 3 October 2013, 11.00am in the Pavilion, Rushbrook House
PRESENT Martin Smith (MS) CCG Collaborative Group Chair Dr Christopher Browning (CB) Chair, West Suffolk CCG Governing Body Dr Mark Shenton (MS) Chair, Ipswich and East Suffolk CCG Governing Body Julian Herbert (JH) Chief Officer, Ipswich & East Suffolk and West Suffolk CCGs Bill Banks (BB) Lay Member (Governance) West Suffolk CCG Governing Body Graham Leaf (GL) Lay Member (Governance) Ipswich & East Suffolk CCG Governing Body IN ATTENDANCE Jo Mael (JM) Corporate Governance Officer Minute
Action
13/038 Welcome and apologies The Chairman welcomed everyone to the meeting. No apologies were received.
13/039 Minutes of meeting held on 5 July 2013
The minutes of the meeting held on 5 July 2013 were considered and agreed as a correct record.
13/040 Matters arising and review of action log
Whilst reviewing matters arising and the action log from the meeting held on 5 July 2013, the following points were highlighted;
• 13/032 – Drug and Therapeutic Committee – The Chief Officer reported that, at a meeting with Norfolk, Cambridge and Peterborough CCGs held in July 2013 a joint regional approach in respect of the Drug and Therapeutic Committee had been agreed in principle. The Chairman of the Suffolk Drug and Therapeutic Committee had agreed to develop a proposal for the CCGs to consider at a future meeting.
• 13/033 – Key Performance Indicators for Management Areas – the requirement
for the contracts and redesign teams to work closer together was to be discussed later on the agenda under item 5.
Page 3 of 7
• 13/035 – Regional CCG Meeting – The Chief Officer reported that these
meetings were held bi-monthly, with the last meeting having discussed issues such as the sharing of threshold policies, how to work with the Area Team across all CCGs, the potential for a joined up approach in relation to the Clinical Senate, and the expansion of the GP Federation.
It was agreed that headlines from the Regional CCG meetings would be reported to the Clinical Executives of both CCGs for information.
JH
13/041 Key Performance Indicators (KPIs) for Management Areas
It was explained that KPIs had been set for all members of the Chief Officer’s team as part of their annual objective setting. Progress was reviewed regularly through 1:1 meetings with the Chief Officer. Progress was RAG rated every two months with the individuals concerned prior to it being discussed within the Chief Officer team as a whole. Key points discussed included; Chief Officer • The importance of continued work to ensure that the Chief Officer Team worked
together as a unit going forward was recognised. • Commissioning of the ambulance service contract on behalf of 19 CCGs
continued to be a challenge, with a number of the CCGs not feeling connected to the commissioning process and seeking to explore the introduction of individual contracts with the provider. More work was required by the Contracts Team to ensure that the CCGs were kept informed. There had been no improvement in performance and the Chief Officer was due to meet with the Chairman of the Ambulance Service and representatives from the Trust Development Authority in order to discuss recruitment to the Chief Executive post.
West Suffolk CCG Chief Operating Officer and Chief Redesign Officer. • Key issues identified within the KPIs continued to be the delivery of QIPP,
planned care and prescribing. • Although also relevant to other Chief Officer areas, there was concern that
delivery of a detailed plan in relation to contract renewal had not yet been achieved which, it was explained, was in part due to resourcing issues within the work-streams and the availability of GP input.
The CCG Collaborative Group agreed that a detailed list of contracts and their renewal dates be provided to the Group for its next meeting on 19 December 2013 Ipswich and East Suffolk CCG Chief Operating Officer • Whilst delivery of the prescribing budget was of concern, staff had now been
recruited to vacant posts and development work able to be progressed. • Although Ipswich Hospital had questioned whether membership of the Clinical
Quality Improvement Task Force should be more clinically focused, it was thought that management staff needed to be present in order to follow through any work agreed. The importance of providing clarity as to the purpose of the
JH
Page 4 of 7
meeting was recognised. Ipswich and East Suffolk Chief Redesign Officer • As mentioned previously the development of a detailed plan in respect of
contract renewal was considered a priority. Chief Nursing Officer • The KPI in relation to serious incident reporting was ‘amber’. It was noted that
there was a particular concern at West Suffolk Hospital as, although reporting methods had improved, there remained little evidence of learning from investigations carried out. The quality of serious incident reporting within Trusts where the CCGs were associate commissioners was questioned and the Chief Officer agreed to request such information for presentation to the Group in December 2013.
• There was concern at the quality and timeliness of the reporting of issues arising from quality improvement visits. It was explained that although there was opportunity for the Chief Nursing Officer to provide weekly updates to the WSCCG, the IESCCG did not have a similar opportunity within its agenda and that perhaps space on the agenda should be explored.
The Chief Officer agreed to discuss with the Chief Nursing Officer the level of information that might be reported regularly to both CCG Clinical Executives in respect of Quality Exception reporting. Chief Contracts Officer • It was noted that Wendy Tankard had now commenced the role of Chief
Contracts Officer with the main areas of concern in relation to the KPIs being around the delivery of a detailed contract renewal plan and the use of patient identifiable data for high cost drug work.
Chief Finance Officer • The main issue continued to be in relation to the availability of business
information and the Group was to receive a report later on the agenda. Chief Corporate Services Officer • The Group was to receive a separate report on GP IT mandatory projects later
on the agenda. The Chief Officer reported that it had recently been announced that Commissioning Support Units were currently not in a position to carry out any retendering for services and, as such, permission had been granted for them to roll-over contracts. There was now less pressure to utilize the services of a commissioning support unit. The CCG Collaborative Group expressed its satisfaction with current service levels being provided by the in-house teams.
JH
JH
13/042 Information Update
Page 5 of 7
The Group received a report from the Chief Finance Officer which provided an update on the current position in relation to the provision of business information, which had been impacted by major changes driven by the creation of CCGs and associated previously reported legislative changes. It was noted that the transfer of core processing to the Data Service for Commissioners Regional Officer (DSCRO) data warehouse at Durham continued to move forward. It was expected that SUS data transfer would be complete during November 2013 with local datasets migrated by the end of December 2013, and new service implementation in March 2014. It was anticipated that the implementation of ‘additional services’ from the DSCRO would provide a significantly improved system, although cultural change would be required which would include increased GP practice engagement. Use of the DSCRO was likely to result in a reduction of staffing levels locally. A restructuring exercise was to be carried out across the Finance Directorate with staff invited to apply for those jobs available and appointments made based on relevant skill and expertise. The requirement to outsource services to the DSCRO had resulted in a number of staff having found alternative employment with those vacancies being filled on a temporary basis. The Information Team was currently attempting to focus on the SUS data transfer to the DSCRO which was resulting on provision of intelligence information to support and inform CCG decision making being limited. The Collaborative Group was very concerned at the national initiative for implementation of a new general ledger system which, it was noted, had been resource intensive and resulted in reduced flexibility around financial reporting. The Collaborative Group noted the content of the report. Appreciation was expressed to staff for the difficulties they had faced and they were congratulated on that progress that had been made under such difficult circumstances.
13/043 GP IT Mandatory Projects (Summary Care Record and Electronic Prescribing
Services) The Group received a report from the Chief Corporate Services Officer which provided an update on progress to date in respect of the Summary Care Records (SCR) and Electronic Prescribing Services (EPS2) projects. Whilst noting the content of the report, it was explained that both CCGs would continue to invest in the development of shared information across GP practices within both CCG areas via other solutions. It was however suggested that consideration be given to prioritising those practices not moving to SystmOne, for SCR. The current position with both projects was noted.
13/044 Continuing Health Care
The Group was in receipt of a report from the Chief Nursing Officer which provided clarity on the Continuing Health Care (CHC) National Framework application and the
Page 6 of 7
current retrospective claims position and backlog of applications for CHC and Funded Nursing Care (FNC). The Chief Officer reported that the Clinical Executives of both CCGs were receiving regular updates on the current situation due to a recent rise in complaints from patient representatives at the lack of communication in relation to the processing and managing of claim requests. In an attempt to reduce the backlog, retrospective claimants were being contacted to seek clarity as to their current position. Many of those claimants had now been identified as deceased with their representatives seeking to pursue the applications in order to finalise estates. The processing of retrospective claims necessitated both administrative and nursing input which had been problematic due to a high turnover of staff within the department resulting from previous poor management. Whilst an external organisation engaged to address the situation had reduced the backlog from approximately 800 to 400 claims, the Department of Health had advised against its use as it was not thought to provide value for money. Weekly meetings were currently being held between the Chief Officer, Chief Nursing Officer and Chief Finance Officer in order to closely monitor the situation. GP Leads for CHC within both CCGs had been identified. Following the departure of the previous manager, the Head of Clinical Quality and Patient Experience was now managing the department on an interim basis, with recruitment to the management role being processed. It was mentioned that, in March 2013, the Area Team had indicated that the Suffolk cost per case was higher than Norfolk’s. Although it was felt that may have been due to Suffolk only processing costly cases at that time and declining others, the Chief Officer agreed to investigate the matter further together with attempting to ascertain if the cost of case management was included within the package.
JH 13/045 Media Coverage since July 2013
The Group received a report provided by the Head of Communications which set out press and media coverage since July 2013. The Group welcomed the report and noted that the Head of Communications was now better informed from the workstreams and that work with the Chief Redesign Officers in order to identify potential good news stories was proving to be more effective.
13/046 Any other business
The Group was very concerned to be informed by the Chief Officer of the following end of year forecasts for both acute trusts; Ipswich Hospital - £8m deficit West Suffolk Hospital - £4m deficit It was noted that financial penalties had been included within the forecast and both
Page 7 of 7
hospitals were investigating different ways of working to address the financial situation. The Chairs of both CCGs, Chief Officer, Chief Executives of both hospitals and Andrew Reed from the Area Team were due to meet in the near future to discuss the situation which was likely to include the potential for provider amalgamation.
13/047 Dates of next meeting
19 December 2013 – 1.00pm–3.00pm 20 February 2014 – 11.00am–1.00pm 17 April 2014 – 11.00am-1.00pm 19 June 2014 – 11.00am-1.00pm 21 August 2014 – 11.00am-1.00pm 23 October 2014 – 11.00am-1.00pm 18 December 2014 – 11.00am-1.00pm All meetings to be held in The Pavilion, 1st Floor, Rushbrook House.
Agenda Item No. 18 Reference No. WSCCG 13-048
From: Amanda Lyes – Chief Corporate Services Officer GOVERNING BODY ASSURANCE FRAMEWORK: OCTOBER AND NOVEMBER 2013 1. Purpose
To provide the Governing Body with the updated CCG Governing Body Assurance Framework (GBAF) document for October and November 2013.
2. Background
Content of the GBAF is reviewed by the Chief Officers Team every month and by the Governing Body and Audit Committee at each of their meetings.
3. Key Points
Further to review by the Chief Officers Team on 7 October and 11 November 2013, the following amendments/additions have been incorporated: Risk 01: Failure to safely manage surges in patients requiring urgent care during the
winter period across West Suffolk and impact on ability to deliver 95% A&E target and ambulance turnaround targets: Amendments to granular risks + action plan/timeline
Risk 02: Failure to achieve on-going financial balance beyond 13/14 and deliver
optimum service from the financial resources available: Amendments to granular risks and action plan/timeline
Risk 07: Loss of confidence in Serco model of care and transformation as a result of
staff consultation: Amendments to action plan/timeline Risk 08: Failure to deliver performance standards and quality of care at
Addenbrookes Hospital (CUHFT): Amendments to action plan/timeline Risk 09: Service risks as a result of the NSFT proposed service redesign model:
Amendments to action plan/timeline
Risk 11: As a result of the NHS white paper there is no legal basis for CCGs to receive, retain and process patient identifiable data: Amendments to action plan/timeline
Risk 12: Implementation of Transforming Pathology Services: Amendments to
action plan/timeline
Risk 14: Failure to comply with NHS continuing Health care Framework: Amendments to action plan/timeline
Risk 16: Risk of sub optimal clinical outcomes for stroke patients: Amendments to
action plan/timeline
Risk 17: West Suffolk Hospital finance position adversely impacting on quality and performance at the Trust: New risk added with subsequent amendments to granular risks and action plan/timeline
Additionally, in accordance with the recommendations arising from recent Internal Audit report on Clinical Governance, it was agreed that in order to identify which of the CCGs priorities are most at risk, these will be identified against each of the risks included in the GBAF. A new section for this has been added, in the Assurance of Controls column, after the Internal Audit Plan references.
4. Recommendations
The Governing Body is requested to review and approve the updated GBAF for October and November 2013.
Author: Colin Boakes
Governance Advisor
Governing Body Assurance Framework and
Action Plan
2013/2014
Version Control: MONTH
VERSION No
REVIEWED BY
SUMMARY OF CHANGES
April 2013
1
COT
Amendments Approved
May 2013
2
COT & Governing Body
Amendments Approved
June 2013
3
COT & Audit Committee
Amendments Approved
July 2013
4
COT & Governing Body
Amendments Approved
August 2013
5
COT
Amendments Approved
September 2013
6
COT, Audit Committee & Governing Body
Amendments Approved
October 2013
7
COT & Audit Committee
Amendments Approved
November 2013
8
COT & Governing Body
December 2013
9
January 2014
10
February 2014
11
March 2014
12
Board Assurance Framework
Overview
The Governing Body Assurance Framework (GBAF) provides the NHS West Suffolk Clinical Commissioning Group (CCG) with a simple but comprehensive method for the effective and focused management of risk. Through the GBAF the CCG Governing Body gains assurance that risks are being appropriately managed throughout the organisation. The GBAF identifies which of the organisation’s strategic objectives may be at risk because of inadequacies in the operation of controls, or where the CCG has insufficient assurance. At the same time it encompasses the control of risk, provides structured assurances about where risks are being managed and ensures that objectives are being delivered. This allows the Governing Body to determine how to make the most efficient use of resources and address the issues identified in order to improve the quality and safety of care. The GBAF also brings together all of the evidence required to support the Annual Governance Statement. The GBAF should be seen as a working document and will be updated regularly by the Chief Officers Team, monitored by the Audit Committee and reported to the Governing Body at each of its meetings. The GBAF is linked to the CCG Risk Register, the content of which is also provided for review by the Chief Officers Team. A flow chart setting out how risks are identified and managed is set out overleaf. In order to ensure consistency in the risk assessment process, the likelihood and consequences of all risks on the Risk Register are assessed against the former National Patient Safety Agency (NPSA) 5X5 risk matrix and those scoring 15 and above migrate to the GBAF and thereby inform the Governing Body agenda. Once added to the GBAF, a risk should remain in place until its RAG rating has been mitigated to a score of 1-6 when it is considered manageable and therefore no longer a strategic concern. The 5X5 risk matrix and subsequent red, amber, green (RAG) score identify the level at which identified risks will be managed within the organisation. It also assigns priorities for remedial action, and determines whether risks are to be accepted on the basis of the colour bandings and risk ratings. In terms of evaluation of effectiveness, the RAG rating system is also used to present how well the agreed controls are operating.
RISKS IDENTIFIED THROUGH:
External Assessment & Audit + Guidance & Alerts
Serious Incidents, Complaints, Public Health &
Quality Issues
Public & Stakeholder Engagement
Business & Service Delivery Plans
CCG Governing
Body Own & Manage Risks & the Chief
Officers Team Reviews the Risk Register/GBAF
Governing Body Assurance Framework
Overview & Scrutiny by the Audit Committee
Assurance to the Governing Body
Individual Risks Jointly Managed by Designated Chief
Officers & Clinical Leads
Work Stream Risk Assessments
RAG Score Framework
Likelihood score → 1: Rare 2: Unlikely 3: Possible 4: Likely 5: Almost Certain
Consequence score ↓
5: Catastrophic 5 10 15 20 25
4: Major 4 8 12 16 20
3: Moderate 3 6 9 12 15
2: Minor 2 4 6 8 10
1: Negligible 1 2 3 4 5
The subsequent red, amber, green (RAG) scores identify the level at which identified risks will be managed within the organisation. It also assigns priorities for remedial action, and determines whether risks are to be accepted on the basis of the colour bandings and risk ratings. In terms of evaluation of effectiveness, the RAG rating system is also used to present how well the agreed controls are operating within the following classifications:
In order to determine the likely consequence arising from an identified risk and using the 5X5 matrix:
• Define the risk explicitly in terms of the adverse consequence or consequences that might arise
RAG Score
Progress
Risk Assessment
Revising Risk Ratings
CRITICAL (15-25)
• There may be significant gaps in controls to ensure effective management.
• Controls are in place but insufficient resources
• Controls are in place but external forces may be preventing progress.
• There are insufficient controls in place to address the cause or source of the risk
• Controls are considered insubstantial or ineffective • Controls are being implemented but are not yet in place • If this risk were to materialise, the situation could be
irrecoverable in terms of the CCGs reputational/financial well being and or service continuity.
If controls are inadequate then the revised risk rating increases
If controls are uncertain, the revised risk rating stays the same as the original risk rating
If they are perceived as adequate, then the revised risk rating decreases
CHALLENGING (8-12)
Progress is being made but there is concern that the objective may not be achieved. Additional controls or management action is being taken to improve the likelihood of success.
There are few controls in place, which are considered substantial and/or effective and address the cause of the risk. The consequences of the risk materialising, though severe, can be managed to some extent via contingency plans.
MANAGEABLE (1-6)
Progress is being made in accordance with plans. There are no significant concerns.
The risk is considered to be small and there are sufficient controls in place which address or substantially effective the cause of the risk. The consequences of the risk materialising can be managed via contingency plans.
• Use the table below for examples, by risk domains, to determine the consequence score relevant to the risk identified
Consequence score (severity levels) and example of descriptions
1 2 3 4 5
Risk Domains Negligible Minor Moderate Major Catastrophic 1. Impact on the safety of patients, staff or public (physical/psychological harm)
Minimal injury requiring no/minimal intervention or treatment. No time off work
Minor injury or illness, requiring minor intervention Requiring time off work for >3 days Increase in length of hospital stay by 1-3 days
Moderate injury requiring professional intervention Requiring time off work for 4-14 days Increase in length of hospital stay by 4-15 days RIDDOR/agency reportable incident An event which impacts on a small number of patients
Major injury leading to long-term incapacity/disability Requiring time off work for >14 days Increase in length of hospital stay by >15 days Mismanagement of patient care with long-term effects
Incident leading to death Multiple permanent injuries or irreversible health effects An event which impacts on a large number of patients
2. Quality/complaints/audit
Peripheral element of treatment or service suboptimal Informal complaint/inquiry
Overall treatment or service suboptimal Formal complaint (stage 1) Local resolution Single failure to meet internal standards Minor implications for patient safety if unresolved Reduced performance rating if unresolved
Treatment or service has significantly reduced effectiveness Formal complaint (stage 2) complaint Local resolution (with potential to go to independent review) Repeated failure to meet internal standards Major patient safety implications if findings are not acted on
Non-compliance with national standards with significant risk to patients if unresolved Multiple complaints/ independent review Low performance rating Critical report
Totally unacceptable level or quality of treatment/service Gross failure of patient safety if findings not acted on Inquest/ombudsman inquiry Gross failure to meet national standards
3. Human resources/ organisational development/staffing/ competence
Short-term low staffing level that temporarily reduces service quality (< 1 day)
Low staffing level that reduces the service quality
Late delivery of key objective/ service due to lack of staff Unsafe staffing level or competence (>1 day) Low staff morale Poor staff attendance for mandatory/key training
Uncertain delivery of key objective/service due to lack of staff Unsafe staffing level or competence (>5 days) Loss of key staff Very low staff morale No staff attending mandatory/ key training
Non-delivery of key objective/service due to lack of staff Ongoing unsafe staffing levels or competence Loss of several key staff No staff attending mandatory training /key training on an ongoing basis
4. Statutory duty/ inspections
No or minimal impact or breech of guidance/ statutory duty
Breech of statutory legislation Reduced performance rating if unresolved
Single breech in statutory duty Challenging external recommendations/ improvement notice
Enforcement action Multiple breeches in statutory duty Improvement notices Low performance rating Critical report
Multiple breeches in statutory duty Prosecution Complete systems change required Zero performance rating Severely critical report
5. Adverse publicity/ reputation
Rumours
Potential for public concern
Local media coverage – short-term reduction in public confidence Elements of public expectation not being met
Local media coverage – long-term reduction in public confidence
National media coverage with <3 days service well below reasonable public expectation
National media coverage with >3 days service well below reasonable public expectation. MP concerned (questions in the House) Total loss of public confidence
6. Business objectives/ projects
Insignificant cost increase/ schedule slippage
<5 per cent over project budget Schedule slippage
5–10 per cent over project budget Schedule slippage
Non-compliance with national 10–25 per cent over project budget Schedule slippage Key objectives not met
Incident leading >25 per cent over project budget Schedule slippage Key objectives not met
7. Finance including claims
Small loss Risk of claim remote
Loss of 0.1–0.25 per cent of budget Claim less than £10,000
Loss of 0.25–0.5 per cent of budget Claim(s) between £10,000 and £100,000
Uncertain delivery of key objective/Loss of 0.5–1.0 per cent of budget Claim(s) between £100,000 and £1 million Purchasers failing to pay on time
Non-delivery of key objective/ Loss of >1 per cent of budget Failure to meet specification/ slippage Loss of contract / payment by results Claim(s) >£1 million
8. Service/business interruption
Loss/interruption of >1 hour
Loss/interruption of >8 hours
Loss/interruption of >1 day
Loss/interruption of >1 week
Permanent loss of service or facility
9. Environmental impact
Minimal or no impact on the environment
Minor impact on environment
Moderate impact on environment
Major impact on environment
Catastrophic impact on environment
No
& D
ATE
RIS
K A
DD
ED
AC
CO
UN
TAB
LE O
FFIC
ER &
G
P O
WN
ER
DESCRIPTION OF STRATEGIC RISK
GRANULAR OPERATIONAL
RISKS
IN
ITIA
L R
AG
RA
TIN
G
(LIK
ELIH
OO
D x
CO
NSE
QU
ENC
E)
KEY CONTROLS ESTABLISHED
ASSURANCE OF CONTROLS
RAG RATING OF
GAPS IN CONTROLS
RA
G R
ATI
NG
LA
ST M
ON
TH
R
EVIS
ED R
AG
RA
TIN
G
ACTION PLAN & TIMELINE
01
EG/W
T +
ED
Failure to safely manage surges in patients requiring urgent care during the winter period across West Suffolk and impact on ability to deliver 95% A&E target and ambulance turnaround targets
• Insufficient staffing
and flexible capacity in APS & CIS
• Continued delays in SCH re-organisation impacting on delivery of Integrated Neighbourhood Teams and APS
• Capacity in SCH to accept primary care referrals
• Delays in ambulance handover affects the ability of the ambulance service to respond to emergency calls resulting in a risk of emergency response failure in the community
4x4
16
• Urgent Care Network
(UCN) led by CCG Clinical Chair with Executive Director and Medical Director accountability
• UCN action plan with organisational responsibilities – delivery tracked monthly
• Winter plan agreed by ICN and CCG Governing Body in July 2013 for early implementation
• NHS England has signed off Winter Plan
• Ongoing work with Serco and WSHT on transformation
• Daily monitoring of performance at WSH
• Escalation process agreed system wide
• First Exception Notice issued
• EEAST/IHT/WSH action plans to improve ambulance handover times
• Additional resources and initiatives for winter period
• NHS England risk summit called
• UCN dashboard
monthly • Review
performance and recovery plans at COT and CCG Clinical Executive
• West winter planning action sessions to ensure recovery of performance and sufficient capacity for Q3 and Q4
• Reports to CCG clinical execs and integrated care workstream
• Board to Boards • AT performance
reviews INTERNAL AUDIT PLAN: • 4.2 Monitoring of
Contracts
CCG PRIORITY: • Demonstrate
excellence in patient experience and patient engagement
• Improve health and wellbeing through partnership working
█ MANAGEABLE
4x4
16
4x4
16
Monthly UCN meetings to manage delivery of agreed Winter Plan and overall integrated care plan July – 95.40% Aug – 95.53% Sept – 98.11% Oct – 97.8% (Unvalidated) Ambulance handovers >60mins at WSFT continues to improve Weeks 1-4 = 30 Weeks 5-8 = 23 Weeks 9-12 = 5 Weeks 13-16 = 3 Weeks 17-21 = 3 Weeks 22-25 = 2 Active monitoring at CEO level of implementation of ECIST action plan Work underway with WSH on the Discharge planning project to aid ‘flow’ through the Hospital system, including review of CHC processes. Performance in A&E continues to improve and the Remedial Action Plan (RAP) developed to address performance in readiness for winter is working towards delivering sustained change. With review of the overall plan to be assessed this month. A revised ambulance trajectory has been agreed requiring compliance with contract standard by end December.
02
C
G +
CB
Failure to achieve on-going financial balance beyond 13/14 and deliver optimum service from the financial resources available.
• Failure to deliver
required QIPP levels. Inability to invest in development areas to improve health outcomes, financial overspend
• Cost pressures in continuing care & specialist commissioning budgets & GP IT allocation
• Public / political opposition to QIPP change programmes - delay or prevention of delivery
• Inability to gain support for QIPP changes from providers or clinical groups - Inability to deliver projects as planned
• Failure to meet key community healthcare QIPP targets due to constraints within Suffolk Community Healthcare, especially during the transition period
• Engagement with Addenbrooke’s
• Lack of quality resources Failure to engage wider health providers outside of existing core contract
• Providers require extra financial support to maintain/meet clinical quality and contractual standards.
4x5
20
• Project management
approach to delivery of the QIPP plans
• Focus on activity levels of acute with clear actions to mitigate against over performance
• Close monitoring of the delivery of QIPP initiatives through KPI’s
• Encourage innovative changes principally via CCGs to improve efficiency
• Active scrutiny and challenge of specialist costs through the Specialised Commissioning Group Finance, Commissioning and Performance Committee
• Board review of expenditure prioritisation
• Holding some new investments until savings delivered
• Prioritisation process for QIPP initiative investments and transformational change at Executive Group
• COT • Monthly SLA
meetings • Governing Body • AT performance
reviews • Internal & External
Audit INTERNAL AUDIT PLAN: • 3.1 -3.6: Main
Financial systems; 3.7 -Financial Reporting & Budgetary Control; 2.3 Continuing Healthcare
CCG PRIORITY: • Deliver financial
sustainability through quality improvement
█ MANAGEABLE
3x4
12
3x4
12
• 12/13 plan delivered with
contingency provided for the biggest risk of continuing care
• Monthly identification of risks and opportunities
• Non-recurrent spend utilised to support areas that could create financial risk/pressures
• Clear prioritisation process for investments within available funds
• Active participation in specialist commissioning review
• Review of GP IT priorities and additional funding opportunities
• Ongoing tracking of risks and opportunities
• Ongoing QIPP tracking
04
BM
+ J
B
Failure to achieve the national & regional targets for MRSA
4x3
12
• Definition of avoidable
MRSA agreed and all MRSA RCAs to be reviewed using this tool
• Attendance at all Infection Control meetings by Shared Management Team, reviewing assurance and management systems.
• Review of all audits and contract monitoring information on screening and hygiene programmes.
• Infection Control
audits, including secondary assurance audits/QIVs
• Monthly evidence submission linked to the action plan
• Performance report data to CCG Governing Body
• Monthly reports to COT on progress of action plan
• Details of individual cases reported to CCG with identified actions
INTERNAL AUDIT PLAN: • 4.2 Monitoring of
Contracts ; 1.4 Clinical Governance - Overview
CCG PRIORITY: • Demonstrate
excellence in patient experience and patient engagement
█
CHALLENGING
4x5
20
4x5
20
• Lead GP identified for
WSCCG. • QIV programme taking place • Monitoring and thematic
review of RCAs
• Contract query raised with WSH
• Updated HCAI action plan
5/6/13
06 (N
ovem
ber 2
012)
BM
+ J
B
Failure to achieve the national & regional targets for Clostridium difficile as established
4x4
16
• Robust RCA process with
action planning for each case
• Thematic analysis of cases
• Audit programme for recognised IC standards including antibiotic prescribing
• Infection control education within CCGs
• System wide expert review day – implementation of key actions.
• Ribotyping for all acute cases
• 13/14 trajectory agreed in SLA
• Monitoring of
RCA process and audit results
• Systemwide action plan with regular review and updating in line with RCA outcomes
• CCG GP review of RCAs
INTERNAL AUDIT PLAN: • 4.2 Monitoring of
Contracts ; 1.4 Clinical Governance - Overview
CCG PRIORITY: • Demonstrate
excellence in patient experience and patient engagement
█
CHALLENGING
5x4
20
5x4
20
• Scrutiny of outcomes of audits
and actions for identifying further actions as necessary
• Ribotyping of all specimens • Consider ‘winter pressures’
funding of environment improvements related to HCAI
• Ribotyping of all community cases to be scoped for funding and lab capacity
• GP for infection control to commence enhanced QIV programme with WSH
• Review RCAs for trends and themes to identify further actions
• Presentation on best practice to consider will be provided to clinical Exec by Hertfordshire and LAT - Completed
• Updated HCAI action plan 5/6/13
07 (N
ovem
ber 2
012)
WT
+ SA
Potential impact of Serco model of care and transformation as a result of staff consultation Major change introduces instability and could impact delivery
• Patient care
adversely affected • Reputation damage
to community health service
3x4
12
• Serco invited to meetings
with CCG and stakeholders
• Risk assessment of changes
• Formal presentation to HOSC
• Formal inclusion of KPI’s in performance report from March 2013
• Engagement with Sudbury WATCH
• Discussion of
assessment and risks at CCG clinical Executive
• Reports to CCG Governing Body
• Feedback outcomes of model of care to future HOSC meetings
INTERNAL AUDIT PLAN: • 4.2 Monitoring of
Contracts ; 1.4 Clinical Governance - Overview
CCG PRIORITY: • Improve access to
mental health services
• Improve health and wellbeing through partnership working
• Demonstrate excellence in patient experience and patient engagement
█
MANAGEABLE
4x4
16
4x4
16
• CCG/Serco review of
transformation ongoing. Structures in place
• Further discussion with Serco regarding contract updates & KPI review
• Deep dive review of quality
following concern raised by staff, to include incidents and staffing. Concern remains with workforce planning.
• Review has made progress,
overseen by Lead GPs and Contracting. Update to be reported to Clinical Exec.
• 2 Contract Queries issued for
priority KPI performance and reporting and Response Times. Plan in place to address priority indicators and develop weekly CIS reporting, along with ensuring accurate data on performance. Meeting scheduled with 4/11 to agree plan to remedy response times.
08 (N
ovem
ber 2
012)
WT
+ C
B
Failure to deliver performance standards and quality of care at Addenbrookes Hospital (CUHFT)
• Deterimental to
patient care • Reputation damage • Delays in treatment
affect accuracy of CCG financial planning
5x4
20
• CCG contracts team
active at SLA meetings • Quality lead to join
contract quality meetings • CCG GP lead actively
involved • Joint approach with C&P
CCG now and into 2013/14
• Monthly reports
to WSCCG in performance paper
• Joint GP chairs/Chief Officers meeting to agree approach
• Framework agreement for 2014/15 negotiations and contract management
INTERNAL AUDIT PLAN: • 4.2 Monitoring of
Contracts ; 1.4 Clinical Governance - Overview
CCG PRIORITY: • Improve health
and wellbeing through partnership working
• Demonstrate excellence in patient experience and patient engagement
█
CHALLENGING
3x4
12
3x4
12
• Performance reporting to
AT/cluster • Monitor involvement reduced
to exception only • ENT 18 weeks due to recover
by October 2013 – CQ in place. Slippage noted due to difficulties with recruitment; extended to Jan 14.
• Stroke performance poor, contract query issued
• 18/52 on aggregate achieving however performance concerns with Dermatology and T&O, due to increased demand.
09 (J
anua
ry 2
013)
EG/B
M +
RT
Service risks as a result of the NSFT proposed service redesign model
• Patient care
adversely affected • Reputational
damage to mental health service
3x4
12
• NSFT meeting regularly
with CCG and part of CCG work stream
• Risk assessment of changes
• HOSC scrutiny • Revised quality
monitoring criteria
• CCG Clinical
Executive review • MH work stream
review and discussion
• HOSC meeting review
INTERNAL AUDIT PLAN: • 1.4 Clinical
Governance – Overview.
CCG PRIORITY: • Improve access to
mental health services
█
CHALLENGING
3x4
12
3x4
12
• HoSC have reviewed
proposals • CCG Governing Bodies have
reviewed proposals • Additional safety metrics put
into the Contract • CNO reviewing safety aspects
of CIP. Complete and reported to Workstream and Clin Exec.
• QIV visits and follow up of ligature improvement plans for Wedgewood Unit. Action Plan and timescales for resolution received and monitored at SLA meetings
10 (F
ebru
ary
2013
)
BM
+ C
B
Failure to monitor and report key quality metrics impeding early warning systems to inform commissioners and regulators of potential risks and deteriorating standards of care
• Failure to report
SIRIs in a timely way
• Poor quality RCA reports
• Repeat themes and issues
• Learning from similar incidents not embedded
• Failure to accept avoidable nature of incidents e.g. pressure ulcers
• Never event – wrong site surgery and poor compliance with WHO surgical checklist
• Actions and trajectory agreed with WSH
3x4
12
• Improvements to quality of
SIRI reports and the range of personnel to undertake report writing and investigations is widened
• Evidence of widespread learning and changes to practice required to evidence changes in risks and issues
• Active clinical audit programme
• Evidence of executive level scrutiny of high level issues i.e. never events
• Board reporting to include patient safety and quality items as top priority
• Monitor audits of WHO surgical checklist
• Monitor action plan from Never event – including new strategy for safer surgery
• 1st exception report
• SIRI reporting
process • Clinical Audit
Programme • Learning events
and messaging programme
• Performance
reporting and contract monitoring
• RCA reports
INTERNAL PLAN : • 1.4 Clinical
Governance – Overview.
CCG PRIORITY: • Improve health
and wellbeing through partnership working
█
CHALLENGING
3x4
12
3x4
12
• Scrutiny of compliance with SIRI
reporting process • Analysis of trends and action
plans in place to address issues. • Monthly monitoring of key
quality metrics • Quality Improvement visit to key
areas • Monitor Board reporting
• Reporting to LAT QSG – WSH
escalated at August meeting – outcome risk summit to be convened.
• Increased monitoring and
compliance with WHO surgical checklist following 2nd Never event at WSH.
• Risk Summit held with Regional
Team. Actions agreed
11 (F
ebru
ary
2013
)
CG
+ D
C
As a result of the NHS white paper there is no legal basis for CCGs to receive, retain and process patient identifiable data. Extended period to 31/10/13 Restrictions on use of data are already in force, limiting activity
• Inability to validate
financial transactions. • Inability to conduct
healthcare planning activities.
• Inability to commission the right services for the right people.
• Unable to target support for patients and populations groups at highest risk
• Unable to provide robust contract monitoring and measurement of patient outcomes
• Unable to monitor delivery and success of QIPP initiatives.
4x5
20
• Confirmation received that
CCGs can continue to use data for PCT ‘close down’ phase only
• 6 month extension from 1 April received allowing for use of SUS data (excluding invoice validation).
• Central email address established for queries, reviewed by Information Team & Caldicott Guardian
• Regular communication to organisation on what can and cannot be done
• Programme in place to outsource activities and contract with DMIC
INTERNAL AUDIT PLAN: • 5.1 Information
Governance CCG PRIORITY: • N/A
█
CRITICAL
4x4
16
4x4
16
• Audit of & use of data undertaken
• Programme of work under
review of Information Governance to get to IG toolkit level 2 is in place
• Preferred DMIC now selected
for data processing and storage
• Implementation planned for 31 October 2013
• Confidentiality Advisory Group
(CAG) have now extended exemption until October 2014.
12 (A
pril
2013
)
WT
+ JF
Implementation of Transforming Pathology Services Potential cost pressure around anti coagulation, pathology services & phlebotomy
• Lack of clear
pathways • Lack of
engagement with GP practices
• Lack of clarity about SCH role in community phlebotomy service
• Potential for confusion and gaps in service provision while new pathways embed
• Risk that patient results are delayed resulting in delays in care
• Proposed changes are unaffordable
3x3
9
• COO &C CO teams
attending key meetings with implementation tams
• Comms plan & pathways to
be developed
• Regular recovery meetings with TPP and other CCGs in place to resolve
• Review at COT &
Executive • AT review CCG PRIORITY: • N/A
█
MANAGEABLE
4x3
12
4x3
12
• Delivery date is likely to be
April 2014 • Regular meetings are
attended to review progress • Further discussion with
Special Projects Team • Awaiting outcome of Trust
discussions with TPP and whether OFT will investigate
14 (A
pril
2013
)
BM
+ J
F
Failure to comply with NHS continuing Health care Framework Retrospective claims for CHC for September, 2012 and March 2013 cut off dates.
• Inability to assess
patients for CHC within 28 days
• Currently- up to 19 months delay
• Inability to recruit
qualified staff to review claims without affecting CHC backlog cases.
• Failure to process ‘retrospective’ claims within financial provision made
• Increasing demand for ongoing CHL
4x5
20
• Investment of clinical and
administration personnel, • High attrition, retention of
staff through training and ongoing support framework in development
• Review of operation processes established to target backlog which will not effect on going business continuity
• Policies and processes to be established and agreed by both CCGs
• Establish management and
administration process to review and manage the claims
• Identify claims applicable to Ipswich and East CCG with indicative cost
• Recruitment of personnel to administer clinically review all claims
• Review
performance at COT and CCG clinical execs and Governing Body
• Reports to CCG clinical execs and integrated care work stream
INTERNAL AUDIT PLAN: • 2.3 Continuing
HealthCare CCG PRIORITY: • Demonstrate
excellence in patient experience and patient engagement
• Improve the health and care of older people
█
CHALLENGING
4x5
20
4x5
20
• Policies and processes are
established and embedded to implement a full auditable process for reporting. Complete
• Review backlog cases to ensure all remain eligible for review July 2013.
• Team reconfigured into localities to improve efficiencies. Complete
• Explore Technology required to improve team efficiencies project underway
• Retrospective team established but not have all commenced employment, will be complete December. Cases reviewed and rejected on advice of Reg Team Recruitment to temp staff underway Complete.
• First stage caseload review complete.
• Correspondence with all applicants taking place – second stage. A report to Collaboration Group and clinical exec to provide information on current position and agree process for retrospective cases, complete
15 (A
pril
2013
)
WT
+ SA
Reputational risk to the CCG from the role of lead commissioner for the East of England Ambulance Service Trust
• EEAST is currently
experiencing significant operational issues leading to significant patient risk and high profile interest
• Significant structural and cultural issues within EEAST need to be resolved to improve service levels
• Risk that whilst this work is underway the CCG will be seen as failing in its commissioning role by a range of stakeholders including other CCGs, the Area Teams, press, politicians and the public
• Risk that CCG focus will be diverted onto the EEAST contract at the expense of other work due to high profile nature
4x3
12
• CCG consortium members
engagement plans set out including regular information updates on progress
• Strong links with the Trust Development Authority (the agency responsible for ensuring EEAST develop as an organization)
• Rigorous commissioning of EEAST by a standalone specialist team within the CCG overseen by the CCO
• Involvement of the Area Teams in key areas including ambulance handover times at local trusts
• Clinical summit
reviews at regional level
• Monthly meetings with the TDA and EEAST
• Consortium commissioning meetings with CCGs and EEAST
INTERNAL AUDIT PLAN: • 4.2 Monitoring of
Contracts CCG PRIORITY: • Demonstrate
excellence in patient experience and patient engagement
█
MANAGEABLE
4x3
12
4x3
12
• A detailed turnaround plan has
been produced by EEAST. • Hospital handover times are
being monitored and managed by each CCG system.
• Clinical capacity review
findings being shared with all CCGs in region. Further work to establish targets and trajectories in areas where performance inequality is marked.
• Structure for the review of
Quality and Patient Safety now in place, with all CCGs and E EAST. Additional monthly review meetings taking place with provider and Quality Team.
• CCO now to attend
Programme Board
16 (A
pril
2013
)
WT
+ C
B
Risk of sub optimal clinical outcomes for stroke patients.
WSFT are currently failing the following standards: • Proportion of patients
admitted to an acute stroke unit within 4 hours of hospital arrival ( 2012/13 - 76% against target of 90%)
• % of Stroke patients with access to a brain scan within 24 hours 2012/13 – 95% against target of 100%)
• Proportion of Stroke patients and carers with a joint health and social care plan on discharge (2012/13 – 89% against target of 100%)
4x4
16
• Direct financial
consequences applied • Contract Query issued
and remedial action plan agreed
• Contract
monitoring • Monthly
workstream review
• Reporting to Clinical Executive and governing Body
INTERNAL AUDIT PLAN: • 4.2 Monitoring of
Contracts ; 1.4 Clinical Governance - Overview
CCG PRIORITY: • Demonstrate
excellence in patient experience and patient engagement
• Improve the health and care of older people
• Improve health and wellbeing through partnership working
█
CHALLENGING
4x4
16
4x4
16
• First Exception Report l issued
and revised milestones for remedy
• First milestones met: % patients admitted in <4hrs – 91.7% % patients with a joint health & social care plan – 90.9% % of stroke patients needing an urgent brain scan in <60 mins – 100%
• September Performance 4 hours – 91.7% (v 90%) Joint plan 100% Urgent Scan 100%
17 (O
ctob
er 2
013)
CG
West Suffolk Hospital finance position adversely impacting on quality and performance at the Trust
• Reduction in quality of
service and inability to meet performance and clinical quality targets
• Maintaining adequate staffing levels
• Additional pressures upon whole system
• WSH Board have declared a forecast £4m deficit from 13/14.
4x4
16
• Initiated system wide review
on impact of trusts position • Regular FD meetings
established
• Ongoing
monitoring of performance and quality via SLA, CEO to CEO and CFO to CFO meetings
• Monthly QIVs being undertaken
INTERNAL AUDIT PLAN: CCG PRIORITY: • Deliver financial
sustainability through quality improvement
█
CHALLENGING
4x4
16
4x4
16
• Regular performance meetings
and sharing of plans and assumptions
• Regular meetings with DoN to review quality and patient safety issues
• CIP plans outstanding • WSH over-performance YTD
generates additional incomeCash position agreed to pay in line with over performance.
Agenda Item No. 19 Reference No. WSCCG13-049
From: Amanda Lyes, Chief Corporate Service Officer Author: Pam MacBride Committee and Governance Officer GOVERNING BODY REPORT: FREEDOM OF INFORMATION UPDATE 1. Purpose
To provide the Governing Body with an update on Freedom of Information requests received for Quarter 2 of 2013-14.
2. Background
The Freedom of Information Act 2000, provides a general right of access to information held by public authorities, including the NHS. Anyone can request information and has the right to be told:
• Whether the public authority holds the information, and • If it does, to be provided with the information
Information includes anything held in a recorded form, such as paper files, loose papers, e-mails, electronic documents, photos, plans, maps, CCTV, videotapes, audiotapes, voice mails. Requests must be dealt with promptly and there is a requirement to provide the information within 20 working days unless there is good reason why this cannot be achieved.
There are exemptions to the provision of information covered by the Data Protection Act, including, for example, personal data. In some cases, also a decision has to be made if it is in the public interest to disclose information and if it is not, various exemptions applicable under the Freedom of Information Act can be applied.
3. Key Points 3.1 The number of Freedom of Information requests received was 59. 58 have been answered
in Q2, with the remaining 1 awaiting clarification. Once again, there was considerable interest in which services the Clinical Commissioning Group intends to provide in the Community. There were also a significant number of requests for corporate information.
The statutory 20 working day response compliance was: Q2
Answered within 20 working days 58 (98%) Awaiting clarification 1 (2%) The sources of requests were: Q2
Healthcare Media 16 National Media 4 NHS/ Local Authority 1 Member of Parliament 2 General Business 5 Interest Groups 4 Professional Bodies 3 Legal 2 Unknown 22
3.2 The largest numbers of requests were from healthcare media and unknown sources where the latter provided no information as to their identity save for an e-mail address. The requests from the Healthcare media focussed on Commissioning and Development. The types of information requested were: Q2
Corporate 24 Human Resources 4 Commissioning & Development 10 Clinical 10 Finance 6 Community Services 5
The disclosure categories were: Q2 Full Disclosure 58 (98%) No requests were refused.
4. Future Action
A further report will be presented to the Governing Body in January 2014.
5. Recommendations The Governing Body is requested to note the report.
Agenda Item No. 20 Reference No. WSCCG13-050
From: Jo Finn, Lay Member for Patient Engagement Part 1 Part 2 BOARD REPORT: Haverhill health needs assessment 1. Purpose 1.1 To update the Governing Body on progress made on the health needs assessment for
Haverhill. 1.2 To receive and note the report from the Haverhill health needs assessment public event on
26 September 2013. 2. Background 2.1 The CCG commissioned Public Health earlier this year to complete a detailed report on the
current and future health needs of Haverhill. 2.2 A community event was held on 17 May to ask members of the public for their views on
these topics. This was combined with the views of local healthcare professionals and other factors such as data on the town’s population, deprivation, health conditions, current service provision, and other factors, to create a health needs assessment.
2.3 The final health needs assessment report was shared at a second public event in Haverhill
on 26 September. The purpose of this second event was to look at the key health issues facing Haverhill and to begin to discuss possible solutions.
2.4 The health needs assessment report found that Haverhill compared well to England, Suffolk
and St Edmundsbury for a large number of health conditions. However, the report highlighted some key themes in the town:
• Higher levels for some health problems and chronic diseases, such as;
respiratory illness, mental health, obesity and alcohol • A lack of awareness of health services in the town
2
• Poor transport links to some health services 2.5 There were three discussion tables at the public event on 26 September, which focused on
these areas:
• Healthy lifestyles • Health problems • Information, transport and anything else
2.6 Approximately 50 people attended the event to take part in discussions around possible
solutions.
3. Key Points 3.1 The full report outlining a summary of discussions at the 26 September event is attached at
Appendix A. Some of the headline comments and suggestions made by members of the public were:
3.2 Healthy lifestyles
• There were suggestions that healthy living services need to be tailored to specific
groups (including marginalised groups) and made accessible to them • It was suggested that healthy living interventions should be specifically included in
care packages, particularly for people with learning disabilities, who experience difficulty accessing these services and can often have poorer health
• There was a view that it is important to break cycles of poor health behaviour seen in families by educating children and families
• A suggestion was made for a ‘walking signpost’ in GP practices. One person could be a ‘service information champion’ who keeps up to date with what services are available, their service offer, opening times, referral method etc. They could then signpost people to the most appropriate services
3.3 Health problems
• There was a general feeling that the Haverhill Health Centre is not performing well and
a suggestion that a minor injuries unit would be more beneficial • One suggestion was that some smokers should be referred to mental health services
more quickly, as smoking is sometimes linked to anxiety and stress • There was a view that the walk-in centre was very useful, particularly for marginalised
and vulnerable patients. There were lots of questions asking whether the funding lost from its closure would be reinvested in Haverhill
• Some people felt that there is a need for more ambulances in the area • There was a suggestion that people wouldn’t go straight to A&E if they didn’t feel they
had a two week wait for a routine GP appointment • It was suggested that further investment in health in the town needs to come before
the new houses are built 3.4 Information
• It was suggested that health services information needs to be accessible to all, including
people with poor literacy
3
• One view was that health services information could be provided through the adult education centre, at pharmacies, and through social media
• A suggestion was made that the health services information leaflet should be given out at food banks and when people register with a GP
• A common view was that GP practices could link more with schools to educate children about health services
3.5 Transport
• There was a view that patients are seen more quickly at West Suffolk Hospital than Addenbrooke’s, so if the transport issue was resolved, most patients would probably prefer to go to West Suffolk Hospital
• One comment was that services could be relocated to Haverhill if transport problems cannot be resolved
3.6 Other issues, comments and concerns
• It was suggested that the separation of children’s and adult’s mental health services is
a problem • Some felt that there isn’t enough provision for out-of-hours services in Haverhill • One person claimed that patients can wait up to seven weeks to see their own GP for
a routine appointment at the Haverhill surgeries • The point was made that it is important to make sure that everyone in Haverhill is
registered with a GP, to ensure the maximum amount of funding is coming into the Haverhill area
3.7 At the event the next steps were outlined as:
• Circulating 2000 copies of the Haverhill service directory leaflet • Sharing this report and the full health needs assessment with the ONE Haverhill board • Sharing the CCG’s Child and Adolescent Mental Health Services (CAMHS) review of
mental health services with attendees of the community event • Offering people from Haverhill the chance to be involved in the CCG’s work on the
new urgent care model, which will look at things like out-of-hours GPs, ambulances and NHS 111
• Sharing the health needs assessment and this report with NHS England, who commission primary care services
• Sharing these reports with the Suffolk Health and Wellbeing Board • Where reasonably possible, taking action on the concerns and issues above and
sharing progress with attendees of the event 4. Public Engagement 4.1 The whole process of the health needs assessment in Haverhill has included public
engagement at each stage. 4.2 Progress made against any of the proposed solutions will be reported back to Haverhill
residents.
4
5. Recommendations 5.1 The Governing Body is asked to note the issues raised and solutions proposed at the
health needs assessment event. Author: Adrian Lyne, Engagement and Consultation Officer
5
Appendix A
A healthier Haverhill and you… Summary of views from health needs assessment event
Haverhill Leisure Centre, Thursday 26 September 2013 (7pm – 8.30pm) Introduction
The NHS West Suffolk Clinical Commissioning Group (CCG) and members of Suffolk County Council’s Public Health team held a public event on Thursday 26 September 2013 to share the findings of the Haverhill health needs assessment. The purpose of the event was to discuss the findings of the health needs assessment report with members of the public and to begin to discuss possible solutions and the way forward. About 50 members of the public attended the event. Dr Ed Garratt, Chief Operating Officer at the CCG introduced the meeting and outlined how the evening would run. Dr Victoria Matthews, Public Health Registrar with Suffolk County Council then presented the key findings from the health needs assessment report. Members of the public were then split into three discussion groups, to look at some of the key findings from the report in more detail and to begin discussing possible solutions. The three groups were: • Health problems • Healthy lifestyles • Information, transport and anything else
This document is a draft summary of all the individual views received at the event. Discussions at the first community event on 17 May were primarily around the perceived health issues of the town, but some discussions naturally steered towards possible solutions. Where this was the case, those proposed solutions have been included in this report. Please note, these comments have been grouped into categories for ease of reading only. The comments and issues have not been prioritised in any way. The comments expressed are those of members of the public and not of the NHS West Suffolk Clinical Commissioning Group or Suffolk County Council. For some points, the CCG has made a comment to clarify a particular issue. You can view the full Haverhill health needs assessment report on the CCG’s website at: http://www.westsuffolkccg.nhs.uk/wp-content/uploads/2013/09/FINAL-Haverhill-Health-Needs-Assessment.pdf You can read the summary report from the first community event on 17 May here: http://www.westsuffolkccg.nhs.uk/wp-content/uploads/2013/09/Health-in-Haverhill-event-17-May-2013-Final-Draft.pdf If you have any comments or feedback on this report, please email us at [email protected] or call us on 01284 774 813.
6
A. Health problems
Issues, concerns and comments
• There was a view that the Haverhill Health Centre on Camps Road is not performing well. It is not easy to access and there often isn’t a receptionist
• Some people commented that when there is a receptionist, they often don’t know about all of the departments – it feels quite disjointed and the receptionist isn’t linked in with all of them
Comment from NHS West Suffolk CCG: The reception team at the Haverhill Health Centre are employed by Suffolk Community Healthcare and can help you with any information about the community health clinics run from the centre. Unfortunately, they may not know about clinics that are not run by Suffolk Community Healthcare, but the CCG will share the Haverhill directory of services leaflet with staff at the Health Centre so they are informed of all clinics.
• It was suggested that some smokers should be referred to mental health services more quickly, as smoking can sometimes be linked to stress and anxiety
Comment from NHS West Suffolk CCG: Anyone who is feeling stressed or anxious and would like help can refer themselves to the Suffolk Wellbeing Service. For more information visit: www.readytochange.org.uk or call 0300 123 1781
• There was a view that waiting times for children’s mental health services are very long • Also, it was suggested that the separation of adult and children’s mental health services
is a problem – at the age of 19, users of Child and Adolescent Mental Health Services (CAMHS) can fall through the gaps
Comment from NHS West Suffolk CCG: Child and Adolescent Mental Health Services (CAMHS) are currently being reviewed to make improvements, including things such as links between children’s and adult’s services.
• It was thought the instant access nature of the walk-in-centre was particularly helpful for
marginalised and vulnerable patients, such as Gypsies and Travellers • Some said a lot of people would not go to A&E if they could see their doctor within one or
two days rather than one or two weeks. People go to A&E because they know they will be seen the same day
• It was suggested there isn’t enough provision for out-of-hours services in Haverhill. Out-of-hours GPs come from Ipswich, which means long waiting times
Comment from NHS West Suffolk CCG: Out-of-hours GP services are run from eight clinics across Suffolk, one of which is in the Haverhill Health Centre. This out-of-hours base opens according to need and therefore does not have set opening times. Alternatively, if required, clinicians will visit people in their own homes. Occasionally, clinicians will travel from outside of Haverhill. An out-of-hours service should be accessible within a 30 minute journey. The CCG regularly reviews how quickly people are assessed and seen at contract meetings with the provider of the out-of-hours service.
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• One view was that people in Haverhill don’t know where to turn in an emergency – based on personal experiences, “we can’t rely on NHS 111, the ambulance service or the out-of-hours service”
• There was a view that the ambulance response times to Haverhill are longer than for the surrounding areas. The Haverhill ambulance is often called away to Cambridge. There should be more ambulances based in Haverhill
Comment from NHS West Suffolk CCG: The CCG, along with 18 other clinical commissioning groups, commissions an ambulance service for the East of England, covering Norfolk, Suffolk, Cambridgeshire, Essex, Bedfordshire and Hertfordshire. Each call for an ambulance is triaged and prioritised according to clinical need, so there is a faster response time for more urgent calls. There is one ambulance based in Haverhill full time and one rapid response vehicle for 12 hours per day, which is comparable to other similar sized towns. These will take patients to West Suffolk Hospital in Bury St Edmunds and Addenbrooke’s Hospital in Cambridge, if required. However, when needed, ambulances from surrounding areas can be sent to Haverhill. We know the performance of the East of England Ambulance Service Trust across the East of England could be better. The ambulance service has published a detailed action plan to outline how it will do this: http://www.eastamb.nhs.uk/Downloads/Publications/EEAST%20Board%20turnaround%20plan%20April%202013.pdf
• One person suggested that sometimes nurses don’t have time to deal with minor injuries
requiring stitches or dressing, so patients end up in A&E • A common view was that there needs to be an increased investment in healthcare services
before the expected increase in population, due to housing developments
Ideas for solutions suggested by members of the public
• More outpatient clinics would be helpful, such as an ultrasound at the antenatal clinic • A minor injuries unit would be more useful than the Haverhill Health Centre • Tele-health systems could help people manage their conditions better themselves • There could be a drop-in from drug and alcohol services at the Riverside scheme for young
people
Comment from NHS West Suffolk CCG: The services for drug and alcohol problems are relatively flexible. The Matthew Project provides drug and alcohol services for young people under 18. The nearest fixed base is in Bury St Edmunds, but young people can be seen at any venue of their choice. Young people can refer themselves to The Matthew Project by calling 01473 230 299.
The Suffolk Alcohol Treatment Service provides a drop in service for adults in Bury St Edmunds, as well as a weekly clinic at the Haverhill Health Centre. CRI Suffolk Recovery Services provide drug treatment and support services for adults. The Bury St Edmunds service is walk-in and there is some outreach work in Haverhill. After an initial assessment with CRI, Haverhill residents can access structured
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programmes through Open Road, which has a dedicated outreach centre in Haverhill.
• Voluntary mental health support clubs • Community-based walk-in services e.g. blood testing in the supermarket
B. Healthy lifestyles
Issues, concerns and comments
• It was suggested it is difficult for people with learning disabilities to access healthy living services unless it is explicitly stated in their care package
• There was a view that other marginalised groups that may find it difficult accessing services include: Gypsies and Travellers, people with English as a second language, people with poor literacy, people with physical disabilities and people with alcohol and drug addictions
Comment from NHS West Suffolk CCG: We have commissioned a service for marginalised and vulnerable adults, which will help six identified communities access mainstream primary care services. The communities are:
• Homeless people • Refugees and asylum seekers • Gypsies and Travellers • Other black and minority ethnic (BME) groups • Migrant workers • Ex-offenders
These communities are those most likely to experience significant barriers to accessing health services. This service has recently been made available countywide, after initially launching in Ipswich.
• Some felt that there was a divide in the town between affluent and deprived
communities, and that these groups had different health behaviours and therefore different needs
• It was acknowledged that providing tailored services for specific groups can be resource intensive
• There was a view that Haverhill residents often seek services outside the town. This may be due to a variety of reasons including: they do not know that the services exist in Haverhill, or their friends/families have recommended services outside the town. It wasn’t felt that this was a reflection of the quality of services offered in Haverhill
• There was a view that there is a referral problem with drugs services offered in Haverhill. People have to go to Bury St Edmunds to have an assessment and are then referred back to have the service delivered in Haverhill
Comment from NHS West Suffolk CCG: This is no longer the case. People can now ask to have their initial assessment locally at the Haverhill Health Centre.
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• The importance and difficulties associated with evaluating interventions was discussed. It was felt important to measure co-benefits of healthy living interventions e.g. effect on self esteem
• It was thought that there is an issue with a lack of communication between community services
• The difficulty between balancing patient choice and the promotion of a healthy lifestyle was discussed. It was felt that people need to be made fully aware of the negative consequences of unhealthy behaviours so that they can make an informed choice
Comment from NHS West Suffolk CCG: Our healthy living providers, Live Well Suffolk actively promote healthy lifestyles across Suffolk, including in Haverhill. The CCG is also working on introducing something called ‘shared decision making’, which in the future will give patients support to have much more of a say on their individual treatment and healthcare choices.
Ideas for solutions suggested by members of the public
• Healthy living interventions should be specifically included in care packages • Healthy living services need to be both tailored to specific groups and made accessible to
these groups • It is important to break cycles of poor health behaviour seen in families by educating
children and families • Marginalised groups need to feel safe and that they will be accepted by services • Services need to reach out to marginalised groups and deliver services where it is
appropriate for them. Live Well Suffolk are already taking services to specific locations and delivering targeted services for specific groups
• Advocacy is very important for marginalised groups • Services need to be provided in different languages and in plain English • It was felt important to make efforts to engage with those who do not traditionally engage
with health services. Suggestions included: asking people why they don’t engage, taking services to them, speaking their language and providing some kind of incentive. Live Well Suffolk’s outreach work is also useful for providing intelligence about where there are gaps in services
• Professionals who work with marginalised groups need to be aware of which healthy living services are available and be giving the right message. This is also a workforce development issue. Live Well Suffolk are working closely with GPs in the Haverhill area
• A suggestion was made for a ‘walking signpost’ in GP practices. One person could be a ‘service information champion’ who keeps up to date with what services are available, their service offer, opening times, referral method etc. They could then direct people to the appropriate services for them
Comment from NHS West Suffolk CCG: This signposting idea is a good suggestion and something we will explore.
• Services need to repair any damage that has already been done by previously bad
experiences when engaging with health services
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• Services should be delivered by appropriate staff e.g. it may be appropriate for a woman/man to deliver an intervention to certain groups
• Staff should shadow each other in different agencies to find out about what they do and how they can work better together
• Involve local schools in a commitment to health and healthy lifestyles; • Exercise on prescription (e.g. subsidised gym membership)
Comment from NHS West Suffolk CCG: The Haverhill Leisure Centre offers the ‘Inspire 4 LIFE Exercise on Referral Scheme’, which provides personalised fitness programmes for people whose doctor feels they would benefit from a more active lifestyle. There is also the ‘Active St Eds’ campaign which encourages people to register for a free leisure card and start collecting active points at Haverhill Leisure Centre, which can be exchanged for money off vouchers with high street retailers.
C. Information
Issues, concerns and comments
• There was a strong view that there is a lack of information about health services available in the town
• It was commented that information about health services needs to be accessible to all, including people with poor literacy and language difficulties. A printed booklet does not meet these needs
Comment from NHS West Suffolk CCG: The CCG has been working with ONE Haverhill to develop a booklet showing all of the health services available in Haverhill. Initially there will be 2000 copies printed and distributed across the town. ONE Haverhill plans to distribute a simplified version to every household in Haverhill. The CCG will explore other ways to make the information accessible to everyone.
• It was suggested that local people don’t read the local newspapers • There was a view that many people don’t speak English as a first language in Haverhill
and cannot read printed information in English • It was suggested that the high level of GP use in Haverhill is because people don’t know
about the other health services available in the town • The group discussed the difficulty with keeping information about services up to date
Ideas for solutions suggested by members of the public
• Service information could be provided through the adult education centre, at the GP surgeries, at pharmacies, or via a Facebook page. The first three possibilities could include a face-to-face option, rather than just handing out printed information, to help people with poor literacy or other communication problems
• GP practices should be working more with the local schools to educate children about health services, who in turn often educate the parents and family
• Ensure the Haverhill directory of services leaflet: o Is available in several different formats e.g. online, paper copies o Is widely distributed e.g. delivered to homes, available at libraries, supermarkets etc o Includes things such as ‘Gateway’, learning disability, and wellbeing information
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• Give hospital patients written care plans to take home, which can be updated • Use the most convenient communication methods for the patient (ie consider email, not
just letters) • Consider providing information about health services in different languages, especially
Eastern European languages • The use of social media was proposed as a way to improve communication and
information provision • The health services information leaflet should be given out at food banks and when people
register with a GP
Comment from NHS West Suffolk CCG: This suggestion to contact the food banks is a good idea and something we will explore.
D. Transport
Issues, concerns and comments
• There was frustration that community transport requires people to book in advance, which does not work for urgent trips undertaken at short notice
• The Three Counties Transport service only operates from 9am to 5pm, which was thought doesn’t help with transport outside these hours
• There is no direct bus service to West Suffolk Hospital, and no evening bus service to Bury St. Edmunds
• There was a view that people generally need to travel to Bury St Edmunds to see an out-of-hours GP
• One person commented that patients booked for elective surgery often need to be at the hospital for 7am. There is no public transport to West Suffolk Hospital available at this time
• There was a view that patients are seen more quickly at West Suffolk Hospital than Addenbrooke’s Hospital, so if the transport issue was resolved, most patients would probably prefer to go to West Suffolk Hospital
• However, some suggested people choose to go straight to Addenbrooke’s Hospital as there is a perception that if something goes wrong at West Suffolk Hospital, they are sent there anyway
• There was some frustration that bus passes can no longer be used before 9.30am. This was thought to have caused a lot of problems with getting to hospital appointments
Ideas for solutions suggested by members of the public
• If West Suffolk Hospital requires surgical patients to arrive at 7am, then the hospital should play a part in resolving the transport issue
• Could there be a direct bus route to West Suffolk Hospital subsidised by the council? • The CCG should consider relocating services to Haverhill if transport problems cannot
be resolved • Subsidised car parking at West Suffolk Hospital would help • Consider more use of volunteer drivers, an extension of on-demand systems, or hospital
mini-buses
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E. Other issues, concerns and comments
Primary care
• There was a view that patients can wait up to seven weeks to see their own GP at the Haverhill surgeries. It was suggested that the waiting time is regularly two weeks, but elsewhere in the country it is rarely more than three or four days
Comment from NHS West Suffolk CCG: We understand it can be frustrating to wait to see a specific GP. On average in Haverhill, there is a two week wait to see your own GP for routine appointments. However, same day appointments are available to patients that need them in all three local surgeries.
• It was felt that there is no joined-up after-care service from Addenbrooke’s Hospital. One
view was that it took five weeks to see the GP after discharge from hospital following a stroke
• There was a comment that the Christmas Maltings & Clements surgery has a useful call-back service where a doctor or nurse will determine whether you need a same day appointment or not
• Some commented that people are being told by GP receptionists that only emergencies can be seen on the day, as opposed to urgent problems. This is giving patients the perception that they can never get same day appointments
Comment from NHS West Suffolk CCG: Same day appointments are available to patients that need them in all three local surgeries.
• There was a view that it is important to make sure that everyone in Haverhill is registered
with a GP, to ensure the maximum amount of funding is coming into the Haverhill area. The proportion of Haverhill residents registered with a GP seems to be unknown
• It was commented that it may be that some Haverhill residents are registering at Clare surgery, so their funding is not available to the main Haverhill practices
• It was noted that deprivation has worsened in Haverhill, going from one to three wards and it was suggested that this demonstrates a need for more GP services
• It was felt that dental services are now sufficient, with no access problems • There was a strong view that people need to hear the impact missed GP appointments
have on the health system Comment from NHS West Suffolk CCG: Missed GP appointments have a significant impact on waiting times for patients that need to see a GP. As an example, in August 2013 there were 600 missed GP appointments at the Clements Christmas Maltings practices, which could have been used by patients that needed an appointment.
Other issues
• There was a view that the funding lost from the closure of the walk-in-centre should be reinvested in the town. Local GPs are under a lot of pressure due to its closure as they took on 22,000 patients who were used to instant access to healthcare
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Comment from NHS West Suffolk CCG: When the walk-in centre was open it dealt with approximately 22,000 appointments in total, many of which were repeat visits by the same patient. Many of these patients were also registered with a local GP practice. There were approximately 1000 patients who registered with a GP practice after the walk-in-centre’s closure.
• How does the number of patients per whole time equivalent GPs in Haverhill compare to
the rest of the region and country and does this impact on waiting times?
Comment from NHS West Suffolk CCG: This information is not routinely available, but we will look at the figures.
Ideas for solutions suggested by members of the public
• Health facilities could be grouped together / a one-stop shop / Healthy Living Centre e.g. alternative therapies, NHS and voluntary groups together in the same building
• There could be breastfeeding areas in shops • Consider an automated telephone service to acknowledge receipt of appointment letters
from the hospital. Then if the letter wasn’t received, you won’t be classed as a non-attendee • If people paid towards a local health service, it might cost less than bus, taxi, or car
journeys to services further afield • Consider cross-boundary working between hospitals • Using local volunteers may be a way of providing local services if there is no funding
available e.g. for a walk-in service • Consider drop in centres for preventative / early care support
The next steps…
After considering the full health needs assessment report and the views shared at this community event, NHS West Suffolk Clinical Commissioning Group will:
• Circulate 2000 copies of the Haverhill services directory leaflet • Share this report and the full health needs assessment with the ONE Haverhill board • Share the CCG’s Child and Adolescent Mental Health Services (CAMHS) review of
mental health services with attendees of the community event • Offer people from Haverhill the chance to be involved in the CCG’s work on the new
urgent care model, which will look at things like out-of-hours GPs, ambulances and NHS 111
• Share the health needs assessment report and this report with NHS England, who commission primary care services
• Share these reports with the Suffolk Health and Wellbeing Board • Where reasonably possible, take action on the concerns and issues above and share
progress with attendees of the event Thank you to everyone who has given their time to work with us on the Haverhill health needs assessment. If you have any comments or feedback on this report, please email us at [email protected] or call us on 01284 774 813.
Agenda Item No. 21 Reference No. WSCCG13-051
From: Jo Finn, Lay Member for Patient Engagement Part 1 Part 2 BOARD REPORT: Market stalls 1. Purpose 1.1 The purpose of this report is to:
• evaluate the effectiveness of the CCG’s recent market stalls events;
• consider whether the events were a successful way of engaging with members of
the public;
• consider some of the lessons learned.
2. Background 2.1 NHS West Suffolk Clinical Commissioning (CCG) held a series of market stall events from
August to September 2013 at the six main market towns in West Suffolk:
• Bury St Edmunds
• Mildenhall
• Newmarket
• Sudbury
• Brandon
• Haverhill
2.2 The main objectives of these events were to:
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• Promote and raise awareness of West Suffolk CCG;
• Increase membership of the CCG’s Health Forum;
• Raise awareness of local health services;
• Create opportunities for members of the community to talk with us and to share their
concerns about health services;
• Increase partnership working with other local organisations such as Healthwatch
Suffolk, Live Well Suffolk, Suffolk Community Healthcare, Age UK Suffolk and
Suffolk Family Carers.
2.3 The information presented in this report was mainly collected from our events’ evaluation
forms. We also asked partners for feedback and their views about what we could do better
next time.
3. Key Points 3.1 Overall we estimate that approximately 300 people stopped by the NHS stall to pick up
information, talk with staff about WSCCG and other partners, as well as to share their
concerns/issues with us.
3.2 The main topics people wanted to discuss included:
• NHS 111- some people shared negative experiences they had of using NHS 111, for example not receiving the right information while on the phone;
• Stop smoking services – many people were interested in Live Well Suffolk’s smoking cessation service;
• Age UK Suffolk’s services; • NHS Health Checks; • Diabetes services; • Flu jabs - a number of people asked for information about dates and surgeries that
provide flu jabs; • Hip services; • Blood pressure checks; • Non-emergency transport to hospital - some people shared that there isn’t always
accessible transport to attend appointments at the hospital; • Out-hours base in Newmarket - people asked the reasons for the closure of this out-
hours service. Others asked if there is any future plans to re-open this facility again; • Stroke services - some people mentioned that there is not enough support for
patients after a stroke, as well as a lack of counselling services, not just for patients but also for family members/carers.
3.3 Where possible, the concerns and feedback from members of the public were sent to the
relevant teams and colleagues to be followed up, for example by PALS and the NHS 111 team. For instance, Dr. Billy McKee, a GP working on NHS 111 picked up some of the
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issues from the events and contacted the person in question directly to discuss the issues and learn from them.
3.4 The events resulted in 155 new Health Forum members:
• Bury St Edmunds – 20 new members • Mildenhall – 30 new members • Newmarket – 15 new members • Sudbury – 35 new members • Brandon – 8 new members • Haverhill – 47 new members
3.5 The footfall to the markets was particularly good in Haverhill, Sudbury, Bury St Edmunds
and Mildenhall. The markets at Newmarket and Brandon however, were relatively quiet. 3.6 During the market stalls events we teamed up with Healthwatch Suffolk to sign people up to
both the Health Forum and Healthwatch at the same time. Healthwatch created a joint membership form to avoid the need for people to give their details twice when signing up for both groups.
3.7 After the events, we asked for feedback from everyone who took part. Some of the main
themes from people’s feedback are below. Full feedback is attached at appendix A.
Positive feedback themes: • The events were good opportunities to interact with members of the community in a
very open manner; • They were good opportunities to find out more about different service development
points/gaps; • The events were good for networking with other organisations.
Negative feedback themes:
• Some felt that the events were quite time consuming; • Some suggested that as a lot of the information about the events was sent by email,
they were not entirely clear what they should be doing on the day; • A common theme was that an all-day event was probably too long, as there were
blocks of unproductive time, mainly 12 noon onwards. 3.8 The main costs for these events were the publicity materials and staff time. The costs for
materials were approximately:
Pens £115 Plasters £188 Market stall place £20 NHS t-shirt £11
Total materials costs £334
The estimated staff time was:
Communications and engagement team 91 hours Service redesign team 12 hours
Total staff hours 103 hours 3.9 Some of the lessons learned and suggestions for future engagement events are:
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• An NHS branded gazebo might be a worthwhile investment, rather than using Live Well Suffolk’s;
• Do half day events instead of full day; as from 12 noon onwards the markets were
very quiet and not as productive as in the morning;
• The markets at Brandon and Newmarket had a very low footfall. Consider using different engagement techniques for future events in these towns;
• Consider organising some events on Saturday markets instead of just during the
week in order to reach more people; Saturday markets tend to be busier;
• Consider extending the invitation to other organisations that wish to take part in future events. During our events many other organisations asked us to be invited if we organise similar events in the future. There are also many other organisations that provide health information that we didn’t invite to join us this time;
• Consider offering something practical at the events, for example - blood pressure
checks, glucose test, etc. This might mean more people stop to talk with us;
• Organise planning meetings with all organisations taking part in the market stall events to facilitate cooperation and increase interaction. It will also give everyone a clear idea of what is expected from each organisation and the opportunity to meet everyone before the first event.
4. Public Engagement 4.1 This report gives information about recent public engagement events, as well as
recommendations for future plans. 5. Recommendations 5.1 The Governing Body is asked to consider the evaluation of the market stalls events and the
options for future engagement events:
1. Run the market stalls events at the same locations and in the same way later this year or next year;
2. Review the engagement methods by running the same events in the towns that worked well, such as Bury St Edmunds, Haverhill, Sudbury and Mildenhall, but try different methods for CCG roadshows in the other towns, such as Brandon and Newmarket;
3. Consider the market stalls as one off project and explore other methods to engage
with the public in the future. 5.2 It was suggested at the Community Engagement Group (CEG) meeting of 11 November
2013 that the CCG takes forward option two, while working with CEG members on other ideas.
Author: Carla Pinto, Membership Officer
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Appendix A – full feedback from partners
Organisation What do you think worked well about the
events? Suffolk Community Healthcare
Meeting people with no agenda – your actual public from all walks of life. Also being with other organisations, pooling resources and discussions etc. Seeing and speaking to members of the public. Networking with other people on the stall.
Suffolk Community Healthcare It was useful linking with partner organisations to ‘refresh’ on what they offered and look at potential for joint working. The fact that a partner organisation had organised the locations, gazebos etc. and all I had to do for once was turn up on the day – I am under no illusion how much work goes into this. With no clerical support it is extremely difficult to do. It was good to meet members of the WSCCG and put faces to names.
Age UK Suffolk An important opportunity to interact with the public rather than waiting for them to come to us. We distributed a lot of magazines and spoke to people at all locations. The gazebo was excellent, essential and easy to use (thank you Live Well Suffolk!). It was a real help to have some days when the van could take our leaflets so we did not have to carry them in to each event. Good networking opportunity in quiet moments.
NHS Ipswich & East Suffolk Clinical Commissioning Group and West Suffolk Clinical Commissioning Group
• Dietetic Advisor (Registered Dietitian)
It appeared well organised in being set up, and those on the stalls were friendly and approachable.
Community Engagement Group (CEG) member Direct public contact in a very open manner, revealing a range of different needs and service development points/gaps.
The Befriending Scheme manager and CEG member
I got to chat to some very friendly people and was able to learn how the vulnerable people I work with could have their voice heard about health issues.
Healthwatch Mix of organisations and information available. Really useful to meet people from other organisations and start to build relationships.
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Organisation What do you think could be better?
Suffolk Community Healthcare
Perhaps a coffee caravan sort of idea? I believe these events are worthwhile – from my point of view the longer the advance warning the better and for any future events I could arrange for leaflets to be supplied etc.
Suffolk Community Healthcare It is always good to meet members of the public, but a specific focus and target or even linking with existing events that are planned for the county e.g. the coffee caravan would have been a better use of time and increased the foot fall. Need to be careful that there is no duplication with existing planned events. A strong focus – in the past when I have responded to national falls awareness week – I have identified with what would attract the public, e.g. organisations that can offer a service or offer something practical on the day e.g. Sloppy Slippers – giving free slippers in exchange for old and alongside offering falls prevention, fracture prevention advice, blood pressure checks, county council presence giving out information, assistive technology and how it works, walking aid checks, presence from the sensory team – in effect a ‘one-stop’ shop – offering practical advice and support. This does involve considerable planning and agreement from partners, especially when asking for clinician support and time.
Age UK Suffolk Sometimes the stall was located in a quieter place however that is presumably where casual stalls get put. There was some confusion at Sudbury, but I think it was caused by the market manager double booking, so beyond your control. It is important that staff on the stall make an effort to interact with the public, having said that, if too many are trying to thrust information at people it becomes too daunting for the public!
NHS Ipswich & East Suffolk Clinical Commissioning Group and West Suffolk Clinical Commissioning Group
• Dietetic Advisor (Registered Dietitian)
Fewer people on the stall - there was approx. 10 people in Sudbury at the start so I left after an hour as I felt people didn’t know who to turn to for information, and Live Well Suffolk were able to give the information that I would have.
CEG member Points to learn from – we need to be even more seamlessly accessible and less like a bunch of NHS bureaucrats trying to adopt the popular touch!
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The Befriending Scheme manager and CEG member
It would have been helpful to have a clear idea of what I was going to do as to start with I did feel like a spare part, and it would have been nice to have been fully introduced to all the other people on the stand so I felt part of the team. Also it was a hot day and there was nowhere to sit and no bottles of water available.
CEG member I suppose if the idea is to meet people where there is footfall we could think of Christmas fairs, the Apex matinees, supermarkets and the larger health centres.
Healthwatch Suffolk As ever, some people were more generous in their approach than others. All day was probably too long as there were blocks of unproductive time, mainly 12 noon onwards.
Organisation Did they achieve what you/your organisation had hoped?
Suffolk Community Healthcare.
Yes, they did.
Community Healthcare Not really – it was an expensive and time consuming exercise. I was able to give out falls and fracture prevention advice and ensure walking aid safety for those we met, but I think in general there should be better ways of doing this, by expanding/building on existing service provision e.g. all walking aids checked yearly at the social/day centre/luncheon clubs provided by Age UK and other providers.
Age UK Suffolk Yes, it was an important opportunity to interact with the public rather than waiting for them to come to us.. About 250 AUKS magazines distributed plus about 50 service guides. Good networking opportunity in quiet moments.
NHS Ipswich & East Suffolk Clinical Commissioning Group and West Suffolk Clinical Commissioning Group
• Dietetic Advisor (Registered Dietitian)
Not for me, but If there had been more stalls / fewer people on the stall then I would have been able to give more personalised dietetic advice.
Healthwatch Yes, I think so. We recruited members as well as building relationships with other organisations involved, and promoted awareness of the Healthwatch brand and role.
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Organisation Would you/your organisation be interested in taking part in similar events in the future?
Suffolk Community Healthcare
Just give us a call and we will be there!
Suffolk Community Healthcare I cannot speak for Suffolk Community Healthcare/SERCO – but personally it was a time consuming exercise for me, it generated a lot of mileage and I would be looking to deliver it differently.
Age UK Suffolk I am retiring end of October so have forwarded this e-mail to Sharron Cozens, who will be managing this role then. She will contact you about possible involvement in future events.
NHS Ipswich & East Suffolk Clinical Commissioning Group and West Suffolk Clinical Commissioning Group
• Dietetic Advisor (Registered Dietitian)
Probably not – I think Live Well Suffolk are best suited to this kind of event
CEG member Yes, I would (on behalf of the CEG) be interested in similar future events.
The Befriending Scheme manager and CEG member
The organisation I work for ‘The Befriending Scheme’ would really like to be involved in future events.
Healthwatch Yes. I think we would always look at any joint working, particularly where we can effectively ‘kill two birds with one stone’.
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