Cannock Chase CCG Governing Body Meeting (In Public)

Enc 00

Cannock Chase CCG Governing Body Meeting (in public) to be held on Thursday 6th November 2014 14:00 – 16:30 Aquarius Ballroom, Victoria Shopping Park, Hednesford, WS12 1BT

AGENDA A=Approval R=Ratification D=Discussion I=Information

Enc Lead A/R/D/I JM I 1. Welcome by the Chairman Verbal

2. Apologies for Absence Verbal JM I

3. Declaration of Conflicts of Interests Enc 01 JM I

4. Glossary of Terms Enc 02 JM I

5. Minutes of the meeting held on 4th September Enc 03 JM A 2014

6. Action List Enc 04 JM A

7. Cannock Chase Hospital, Minor Injuries Unit Enc 05 LM/MH A (MIU) Consultation Feedback

8. Quality Impact Assessment – Minor Injuries Enc 06 VJ I Unit To follow

9. Personal Health Budgets Enc 07 RL A

10. Medicines Waste Campaign Enc 08 LM A

11. NHS Health Checks (NHSHC) in Cannock Enc 09 David I Chase CCG 2013/14 Sugden, Public Health Enc 00

Enc Lead A/R/D/I

12. Human Resources Policies Enc 10 SY R

13. Chair’s Report Verbal JM I

14. Quality Report Enc 11 VJ D/I

15. Performance Report Enc 12 RL D/I

16. Finance Report Enc 13 PS D/I

17. Chief Officer Report Verbal AD I

18. Items for information Audit Committee Minutes 13th August 2014 Enc 14 NC I Finance, Performance & Contracting Minutes Enc 15 PS I Communications & Engagement Committee Enc 16 PG I Minutes 16th July 2014

19. Any Other Business Verbal All I

20. Questions from members of the public Verbal All I

Date of Next Meeting to be held in public: Thursday 5th February 2015 (14:00 – 16:30) The Aquarius Ballroom, Hednesford

Item: 03 Enc: 01 Declarations of Interest Register for Cannock Chase Governing Body

Name Date of Position/Role Designation Potential or actual area where interest Declaration could occur Dr Johnny McMahon 01.09.2014 Chair Cannock Chase Director Fransen Investments Ltd GP CCG Partner at Newhall Street Practice Newhall Street Spouse Nurse Director at Dudley Group of Surgery Hospitals Shareholder - Astra Zeneca Shareholder - Galaxo Smith Klein Shareholder Cache Box TU Ltd - Maternity & Children's Watershed Secute Chippawa LLP (Member) North America Partner in MIDISIE (a pan European Breast Screening Project using innovative non- molecular technology) Shareholder Run3D based at Nuffield Orthopaedic Centre, Oxford Cambridge Cognition Holdings plc TrialReach Ltd Step-son Mental Health Nurse SSOTP, Tamworth Step-daughter District Nurse SSOTP, Cannock Practice registered in GP First Dr Tim Berriman 16.07.2014 GP Red Lion Surgery Berrifree Limited Spouse works for SSSFHT Trust GP First Red Lion Surgery Dr Murray Campbell 30.08.2014 GP Newhall Street Partner - Newhall Street Surgery Sessional Employment NHS England - Offender Health Practice Member GP First GP Appraiser Dr Mohammed Huda 01.07.2013 GP Aelfgar Surgery Partner Aelfgar Surgery Practice registered with GP First Dr Anna Onabolu 06.05.2014 GP Nile Practice Partner at Nile Practice Practice Member GP First President of Lions Club International, Castle Bromwich (not related to NHS Contracts) Neil Chambers 31.03.2014 Lay Member for CC & SaS CCG Working across both CCGs. Governance Non Exec Board Member Wyre Forest Community Housing Group

02 July 2014 Page | 1

Item: 03 Enc: 01 Declarations of Interest Register for Cannock Chase Governing Body

Paul Gallagher 18.03.2014 Lay Member for Cannock Chase Chair IFR (individual funding request) PPI CCG Chair NHS England Performers List Decision Panel Janet Toplis 04.10.2013 Lay Member Cannock Chase Vice Chair of Adoption Panel for Walsall (Non Statutory) CCG Borough Council Paul Woodhead 30.10.2014 Lay Member Cannock Chase PEW Consultancy Limited (Non Statutory) CCG Practitioner – Tutor De Montfort University Faculty of Health & Life Sciences Chair of Governors, St Peter’s C of E (VC) Primary School, Hednesford Consultant through PEW Consultancy engaged by Staffordshire County Council via Entrust Support Services Ltd to support Governor Development within the County PEW Consultant Ltd also engages in Environmental & Waste Consultancy Services for a private client base principally through Albion Environmental Ltd Parent Governor Representation of Staffordshire County Council – Prosperous Staffordshire Select Committee Member Staffs School Forum Presenter on Cannock Radio Paul Simpson 06.10.2014 Director of CC & SaS CCG Working across both CCGs Finance Andrew Donald 17.03.2014 Chief Officer CC & SaS CCG Spouse - Chief Operating Officer North division Staffordshire & Stoke on Trent Partnership Trust. Working across both CCGs. Val Jones 24.03.2014 Director Quality CC & SaS CCG Working across both CCGs. & Safety/ Chief Nurse Non- voting – In attendance Lynn Millar 18.03.2014 Head of Strategic CC & SaS CCG Working across both CCGs Change Tim Rideout 22.04.2014 Director of CC & SaS CCG MD/Owner, Tim Rideout Ltd Transition Director, Hazel Court Management Company Chair of Governors, Reepham Primary School Acting Chair of Governors, Ellison Boulters Academy Working across both CCGs 02 July 2014 Page | 2

Item: 03 Enc: 01 Declarations of Interest Register for Cannock Chase Governing Body

Name Date of Position/Role Designation Potential or actual area where interest Declaration could occur Sally Young 15.04.2014 Head of CC & SaS CCG Working across both CCGs Governance Alex Bennett 22.07.2013 Director of CC & SaS CCG Working across both CCGs. Delivery Tamsin Carr 15.04.2014 Locality CSU Work for the CSU Communications Work across both CCGs & Engagement Freelance as a newsreader at Signal Radio Lead Adele Edmondson 09.04.2014 Communications CC & SaS CCG Working across both CCGs. & Engagement Manager

02 July 2014 Page | 3

Acronyms

1. A&E Accident & Emergency 2. ALE Auditors Local Evaluation 3. AED Automated External Defibrillator 4. ADP Accelerated Development Programme 5. AHP Allied Health Professional 6. ALAN Adult Literacy and Numeracy 7. ALOS Average Length of Stay 8. ANNP Advanced Neonatal Nurse Practitioner 9. APMS Alternative Provider Medical Services 10. AQP Any Qualified Provider 11. BCH Birmingham Children’s Hospital 12. BEN Birmingham East and North PCT 13. CAG Commissioning Advisory Group 14. CAMHS Children and Adolescent Mental Health Service 15. CAS Clinical Assessment Service 16. CBSA Commissioning Business Support Agency 17. CC Cannock Chase 18. CCG Clinical Consortia Group 19. CGA Comprehensive Geriatric Assessment 20. CHAI Commission for Health Auditing Inspection 21. CHI Commission for health Improvement 22. CHPP Children’s Health Promotion Programme 23. CIAMs Commissioning Investment Asset Management Strategy 24. CIG Clinical Informatics Group 25. CIP Cost Improvement Programme 26. CNST Clinical Negligence Scheme for Trusts 27. CoE Care of the Elderly 28. COPD Chronic Obstructive Pulmonary Disease 29. CPN Community Psychiatrist Nurse 30. CQC Care Quality Commission 31. CQR Care Quality Review Meetings 32. CQUIn Commissioning for Quality and Innovation 33. CQINS Cancer Quality Improvement Network System 34. CMT Contract Management Team 35. CRT Crisis Response Team 36. CSIP Clinical Services Implementation Programme 37. CSW Clinical Support Worker 38. CWG Clinical Working Group 39. DC Day Care 40. DCC Direct Clinical Care 41. DES Direct Enhanced Service 42. DIPC Director of Infection Prevention & Control 43. DN District Nurse 44. DoH Department of Health 45. DoLs Deprivation of Liberty Standards 46. DPD Dental Practice Division 47. DPP Developing Patient Partnerships 48. DQF Data Quality Facilitator 49. DRS Dental Reference Service 50. DTC Delayed Transfer of Care 51. EAU Emergency Admissions Unit 52. ECDL European Computer Driving Licence 53. ECIST Emergency Care Intensive Support Team 54. EDD Expected Discharge Date 55. EL Elective 56. EMS Escalation Management System 57. ENT Ear Nose Throat 58. ESR Electronic Staff Record 59. EWISS Emotional Well Being in Stafford & Surrounds 60. EWTD European Working Time Directive 61. FE Frail Elderly 62. FIG Financial Improvement Group 63. FIMS Financial Information Management System 64. FIT Funding Individual Treatment – now FET 65. FET Funding Exceptional Treatment 66. FNOF Fractured Neck of Femur 67. F&P Finance and Performance 68. GAAP Generally Accepted Accounting Principles 69. GDC General Dental Council 70. GDS General Dental Services 71. GMS General Medical Services (Practice) 72. GPWSI GP with special interest 73. GSF Gold Standard Framework 74. HALO Hospital Ambulance Liaison Officer 75. HCC Healthcare Commission 76. HCIA Healthcare Acquired Infection 77. HEFCE Higher Education Funding Council for England 78. HEFT Heart of England Foundation Trust 79. HIS Health Informatics Service 80. HPA Health Protection Agency 81. HPS Health promoting Schools 82. HPSS Health promoting Schools Scheme 83. HRG4 Healthcare Resource Group 4 84. HROD Human Resources Organisational Development 85. HSJ Health Service Journal 86. IFRS International Financial Reporting Systems 87. IP Inpatients 88. IPC Infection Prevention & Control 89. IPR Individual Performance Review 90. ISA Intermediate Support Assistant 91. ITT Invite to Tender 92. IV Intravenous Therapy 93. IWL Improving Working Lives 94. JCI Joint Clinical Investigation 95. JCU Joint Commissioning Unit (SCC) 96. JSP Joint Staff Partnership 97. KPI’S Key Performance Indicators 98. LAA Local Area Agreement 99. LCCB Local Collaborative Commissioning Boards 100. LCP Liverpool Care Pathway 101. LDP Local Delivery Plan 102. LES Local Enhanced Service 103. LH Local Hospital 104. LHE Local Health Economy 105. LIN Local Intelligence Network 106. LINks Local Involvement Networks 107. LMC Local Medical Council 108. LMS Local Medical Services 109. LOC Local ophthalmic Committee 110. LSC Learning Skills Council 111. LSP Local Strategic Partnership 112. LTC Long Term Conditions 113. LTFM Long Term Financial Model 114. MAU Medical Assessment Unit 115. MAT Maternity 116. MDT Multidisciplinary Team 117. MFCA Multi Factorial Comprehensive Assessment 118. MHRA Medicines & Healthcare products Regulatory Agency 119. MICOT Minor Injuries Community Outreach Team 120. MLU Midwife-led Unit 121. MORI (Market & Opinion Research International) 122. MOI Memorandum of Information 123. MPIG Medical Practice Income Guarantee 124. MSFT Mid Staffordshire Foundation Trust 125. MUR Medicine Use Review 126. NCAS National Clinical Assessment Service 127. NCB National Commissioning Board 128. NCT National Childbirth Trust 129. NEL Non-Elective 130. NES National Enhanced Service 131. NICE National Institute for Clinical Excellence 132. NHSU NHS University 133. NRPSI National Register of Public Service Interpreters 134. NTDA NHS Trust Development Authority 135. OBD Occupied Bed Days 136. OOH Out of Hours, also Out of Hospital 137. OP (D) Outpatients (Department) 138. OT Occupational Therapist 139. PA Programmed Activities 140. PAED Paediatrics 141. PALS Patient Advice and Liaison Service 142. PASS Professional Advice and Support Service 143. PAU Paediatric Assessment Unit 144. PBC Practice Based Commissioning 145. PBR Payment By Results 146. PC Planned Care 147. PCR Patient Charge Revenue 148. PCT Primary Care Trust 149. PCTDS PCT Dental Service 150. PEAT Patient Environment Action Team 151. PEC Professional Executive Committee 152. PRF Patient Report Form 153. PiP Partners in Paediatrics 154. PIP Productivity Improvement Programme 155. PIS Prescribing Incentive Scheme 156. PLT Protected Learning Time 157. PMO Programme Management Office 158. PMS Personal Medical Services 159. POPP Partnerships for Older People Projects 160. PPI Patient and Public Involvement 161. PPV Post Payment Verification 162. PQQ Pre Qualifying Questionnaire 163. PRISM Personnel Resource Information System for Management 164. PROMs Patient Related Outcome Measures 165. PT Physical Therapist 166. PTL Patient Target List 167. PWSI Pharmacist with Special Interest 168. QIF Quality Improvement Framework 169. QIPP Quality, innovation, productivity and prevention. 170. QOF Quality and Outcomes Framework 171. RAG Responsible Authorities Group 172. RAG Red Amber Green 173. RCA Root Cause Analysis 174. RWHT Royal Wolverhampton Hospital Trust 175. SALT Speech & Language Therapist 176. SARC Sexual Assaults Referrals Centre 177. SCC Staffordshire County Council 178. SCG Strategic Commissioning Group 179. SCR Strategic Change Reserve 180. SCIO Staffordshire Consortium of Infrastructure Organisations 181. SCBU Special Care Baby Unit 182. SCWP Social Care Workforce Planning 183. SDB Service Delivery Board 184. SHA Strategic Health Authority 185. SI Serious Incident 186. SIB Service Improvement Board 187. SIC Statement of Internal Control 188. SLAM Service Level Agreement Model 189. SPA Supporting Programmed Activities 190. SPEC Strategic Public Engagement Committee 191. SSHLF South Staffordshire Health Libraries Federation 192. SSOTP Staffordshire & Stoke on Trent Partnership Trust 193. SSPAU Short Stay Paediatric Assessment Unit 194. SSSHCFT South Staffs & Shropshire Healthcare Foundation Trust 195. SUI Serious Untoward Incident 196. SUS Secondary User Services 197. UCC Urgent Care Centre 198. UDA Units of Dental Activity 199. UHB University Hospital Birmingham 200. UHNS University Hospital North Staffordshire 201. UOA Units of Orthodontic Activity 202. VT Vocational Trainee 203. VFM Value for Money 204. VO Variation Order 205. WIC Walk in Centre 206. WCC World Class Commissioning 207. WMQRS West Midlands Quality Review Service 208. WMSCG West Midlands Strategic Commissioning Group 209. WTE Whole Time Equivalent

Item: 05 Enc: 03

Cannock Chase CCG Governing Body Meeting

Thursday 4 September 2014 2.00 pm – 4.30 pm Aquarius Suite, The Aquarius Ballroom and Banqueting Suite, Victoria Shopping Park, Hednesford, WS12 1BT

Present Johnny McMahon (JM) Chair – CCG Chair, Cannock Chase Dr Tim Berrimen Clinical Lead Jacqueline Brown (JBr) Director of Finance Neil Chambers (NC) Lay Member Andrew Donald (AD) Chief Officer Paul Gallagher (PG) Lay Member Dr Mohammed Huda (MH) Clinical Lead Val Jones (VJ) Director of Quality & Safety and Chief Nurse Dr Anna Onnabolu (AO) Clinical Lead Paul Woodhead (PW) Lay Member

In attendance Jonathan Bletcher (JBl) Director of Strategy and Transformation Adele Edmondson (AE) Communications and Engagement Manager Claire McHugh (CLM) Executive Assistant – Minute Taker Lynn Millar (LM) Head of Primary Care Sally Young (SY) Head of Governance

Action

1. Welcome

JM welcomed attendees and the members of public attending. JM confirmed the meeting time as actually 2.00 pm – 4.30 pm, not 5.00 pm shown on the agenda.

JM informed the meeting that AD would be joining the meeting following his attendance at Local Transition Board (LTB).

2. Apologies

Alex Bennett (AB) Dr Murray Campbell (MC) Dr Peter Gregory (PG) Jan Toplis (JT)

3. Declaration of Interest

Action

All Governing Body Members confirmed no conflict of interest in relation to items on the Agenda, however, conflict of interest was noted for all GPs should GP First related items arise.

4. Glossary of Terms

The Glossary of Terms was noted for information by the Governing Body and members of the public.

5. Minutes of the Meeting held on 3 July 2014

The Committee considered the minutes and the following was noted:

Page 4: Item 8 – Primary Care Strategy Committee expressed concern about item relating to reduction in the number of practices. Minutes should be amended to show that it is the consideration of the CCG that practices will reduce from 27 to 20 in coming years. This is not a directive and needs further consideration.

Page 3: Item 7 – Staffordshire and Stoke on Trent Five Year Strategic Plan AO drew the Committee’s attention to the paragraph:

“Discussions were held in relation to improving the approach to prevention and further engagement with Staffordshire Public Health to identify areas for improvement will be required.”

JBl explained that there should be engagement between Staffordshire Public Health and the Borough Councils. AO asked if there should be an action associated with this element of the minutes and JM confirmed that this is part of the Five Year Plan and consequently not an action for this Meeting.

The minutes of the last meeting were noted as a true and accurate record subject to the appropriate clarification to Item 8 detailed above.

Action: Revise minutes of 03/07/2014 and record as approved. CLM

6. Actions

SY identified that actions within the minutes had not been included on the Action List.

Action: Copy all actions from 03.07.2014 to Action List CLM

6.1 Actions were reviewed and updated. SY asked members to ensure that 2

Action

they identify if an item is ‘complete’ to ensure that things do not remain on the Action List.

7. Board Assurance Framework (BAF)

SY explained that the BAF will be presented at the next GB when she has had opportunity to discuss with the individual Directors because there is further work to be done. JM asked if this could be shared prior to the GB to enable members to give due thought and consideration to the BAF. SY suggested that the BAF should be issued prior to the GB papers.

Action: SY share BAF with GB at least two weeks prior to the SY GB

PG wanted to congratulate the CCG on the quality of the work that has been/is being done to produce the document. NC reiterated by explaining that it could have been brought to GB some time ago but it would not have been good use of the GB time to present the document in its raw state. NC wanted to assure Members that the risks are still being managed whilst the BAF is being produced.

PW added that Audit Committee would welcome the opportunity to review this and JM/SY agreed that the document should be a ‘live’ document. NC explained that Executive Directors will be called to account with regard to the BAF.

8. Chairs Report

8.1 Primary Care Strategy (PCS) Networks described in the PCS are now in place and they will be meeting in October 2014. Some networks are progressing more quickly than others.

As expected, there was concern from Members regarding the suggestion of a reduction from 27 to 20 practices.

There is a strategy to go to one computer system, this will enable practices to support each other. Work is being done to establish what hardware is needed.

8.2 Secondary Care Consultant An advert has been placed for one Consultant for each CCG, and there has been some interest registered. This role will be especially useful in working with RWT.

8.3 Dissolution of MSFT This takes effect 01/11/2014 and JM believes that this will be a very

Action

difficult time. AD is meeting weekly with Comms colleagues from all involved Trusts and partners to ensure that information to patients is consistent and accurate. This meeting will be Chaired by a member of NHS England who is experienced in this field. JM suggested that AD will report on this within his Agenda item.

TB asked if there is any value to inviting Wolverhampton GPs/Consultants to meet with Cannock Chase GP/Consultants.

JM confirmed to NC that the reduction of practices is not within the CCG legal powers to undertake. JM also explained that although there are contracts in place it is the decision of the Membership Board to make any reductions.

AO reiterated that this is not about patients and asked to note that there is no evidence that larger practices are better for patients. NC clarified that this is about the work needed to improve practices for patients.

JM talked about the Local Medical Committee (LMC) and explained their role to those present. JM suggested to the LMC that they should encourage Members input to decision making.

9. Quality Report

VJ presented her report assuming that members had digested the content previously and highlighted key points within the report. VJ reported that since the report, some areas have improved.

JM identified that in Q4 Assurance Cancer was highlighted as an issue and it appears that this has not improved.

JM asked about the Ambulance diverts and whether there is any performance improvement. JBl explained that the diverts started mid July 2014 and so figures are not yet available regarding this. More resources are being put in, however, there needs to be capacity to accommodate the increased resources ie, staffing.

JBr asked VJ about MSFT recruiting issues and how much of the performance issues are relative to the staffing issues. VJ agreed that the fragility of the staffing at the Trust will affect performance and will be more acute as the transition date approaches. Staffing levels are being monitored on a daily basis. New national standards for transparency require the Trusts to display wards staffing levels and this is being implemented at MSFT. In addition there is national benchmarking for each Trust on the numbers and skill mix and acuity of patients.

Complaints and incidents at MSFT have reduced and part of this is due to the fact that Ward 11 is now closed. Some complaints previously were 4

Action related to the capacity issues where staff did not feel they had the time to speak with patients.

VJ reassured TB where RWT and UNHS are recruiting overseas nurses which is happening across the country there is a verification process to ensure that staff have the requisite qualifications and skills. This is generally a shared responsibility between the recruiting Trust and the NMC. There is also an extensive orientation/induction process where the overseas nurses are also subject to supervision regimes to monitor competency.

PG asked for clarification regarding the figures for Friends and Family Test because the information was not available at the CCG Joint Quality Meeting in the previous week. He understood that Walsall had not held a CQRM in either July or August and was concerned that this would affect the level of assurance for the GB. VJ responded that Walsall have not missed or cancelled July or August CQRM however RWT did cancel August due to number of apologies.

Action: VJ to provide up to date FFT figures for RWT and WHT VJ for the next meeting.

VJ informed the meeting that the CCG transition process for MSFT services included a transitional CQRM from November 2014 until March 2015 for each of the receiving Trusts which would be attend respectively by representation from RWT and UNHS. This would involve meeting with the lead CCGs for each provider to agree commissioner priorities and actions in relation to the providers. The proposal for Cannock CCG to lead on the associate commissioning for RWT for all the South CCGs will provide a stronger negotiating position.

Action: VJ to provide a paper to the GB on role of CCG in the VJ assurance process for the transition of services for MSFT to RWT and UHNS.

TB queried the fact that UHNS have not any reported pressure ulcers (PUs) for more than two months. VJ confirmed this and reminded Members that only Grade 3 & 4 PUs are reportable as serious incidents. TB asked whether this was a recording error and VJ suggested that it is more probable that this is due to good detection of PU rusk. Early identification at Grade 2 should prevent them escalating to a Grade 3 or 4.

Action: VJ to confirm reporting of pressure ulcers from UHNS VJ at the December meeting

NC talked to Members about a recent visit conducted with HealthWatch which encountered difficulties. It appeared that HealthWatch had an agenda for the visits. VJ is aware of this visit and is aware of this previously.

Action

Action: VJ to liaise with Health Watch regarding future visits VJ

JM reiterated concern regarding RWT and whether they would commit to a transitional CQRM and JBl explained that he is in discussion with key members.

JM identified that the RWT/WHT breakdown of complaints is by hospitals whereas MSFT also provide a breakdown by Wards, which is more helpful.

Action: VJ to explore the possibility of complaints from RWT/WHT to also include in addition to the global numbers break down by Ward.

10. Performance Report

JBl presented the report on behalf of AB. Effort is being focused around

the performance of Cancer 62 day wait and Ambulance Services.

JBl believes that Urology is a problem across the CCGs ie, not isolated to CC and Stafford & Surrounds. JM highlighted the importance of this issue, but does not want to duplicate. Problems relating to this should be addressed through performance to identify what the problems are.

Secondary Care Consultants have to refer to tertiary services within 42 days but this is not happening. Late onward referral is also affected by patient choice. JM identified that following the dissolution, referrals will potentially be made ‘in-house’. JBl confirmed to AO that more information will be reported to GB next month.

Action: Full cancer report regarding referrals to be brought to AB next GB if there is not board assurance.

Ambulances

An additional 4% growth has been invested in the contract but this has been surpassed to 9%. There will be a re-established commissioning group for West Midlands Ambulance Service (WMAS) and there will be a shift from service improvement to performance improvement. An Action Plan is required during September 2014 and JBl recommends that Quality is represented at that meeting. There continues to be deterioration in Red 1.

PW reported that AB presented to Finance, Performance and Contracts Committee (FPC) in August and this is an active agenda item which she will report on and FPC will monitor.

Action

JBr informed that additional monies were funded around the closure of A&E and the diverts to assist the service. She expressed concern that continued investment is not necessarily improving the service. JM suggested that more consideration needs to be given about options for the future and whether the service need to be delivered in a different way.

JBl key message is that since Quarter 1 performance has not improved

and the CCQ are increasing their monitoring of this. NC asked how many

Ambulances service Staffordshire and whether this is part of the problem.

Action: Establish how many Ambulances are in service AB

11. Finance Report

JBr presented the report.

JBr sought approval for additional costs regarding the dissolution of MSFT. This is the cost relating to the closure of some contracts against other contracts, there is currently no budget but JBr identified that the risk associated with not approving this cost is greater than if it is not approved. John Doyle, Director of Finance – MSFT, has been informed that the cost will be assigned to him.

JBr informed NC that some of the costs relate to CSU costs, amongst others and JBr confirmed to NC that there is an indication that funds will be made available from other sources for these extra-ordinary costs that are being incurred. This is the first occasion when a Foundation Trust has been dissolved and there is no precedent for the costs involved.

JBr explained to TB that from 01/11/2014, the budgets allocated to MSFT will be reassigned to UHNS and RWT appropriately.

NC left the meeting

The Members approved the additional budgets for transition costs.

12. Chief Officer Report

JM presented the report for AD in his absence.

Mid Staffordshire NHS Foundation Trust (MSFT) AD’s role will be key to the transition and JM reiterated the importance of the Communications being done effectively.

NC returned to the meeting

Action

Local Transition Board (LTB)

AD/JM attended LTB earlier and have informed by LTB that the Stemming the Flow/Winter Monies is not available. AD/JM have informed LTB that the CCG are not willing to finance this.

15:48 AD joined the meeting

Work is now undergoing for the dissolution of MSFT. There is a lot of work that must take place by 26/09/2014. It has been agreed today that a meeting will take place on 10/09/2014 that AD and JBr will be required to attend.

Discussion followed regarding new ways of working and the meeting were informed that more money will need to be invested in community services to facilitate the reduction in beds.

AO asked for reassurance that the LTB have considered the risk of the dissolution taking place over the critical months of November-January, historically difficult months. AD explained that it is the responsibility of the CCG to carry out Quality Impact Assessments.

JM asked AD to update regarding the Communications meeting that he had attended. This has not previously been the responsibility of the CCG, however, AD was asked to bring Communications leads from all partners involved and today the Trust Development Authority have joined the meeting. There is now a very clear narrative around communications relating to services and patients, and a shared strategy to prevent situations such as the news around obstetrics that was not effectively communicated recently.

It is clear what Cannock GPs want and it has been agreed that PALs will co-ordinate communications to patients in this area, particularly for gastroenterology and neurology.

JM suggested that blogs are produced that are shared with GP surgeries so that it can be displayed on their live noticeboards. AO expressed concern regarding patients who do not have access to the internet and AD explained that it has been agreed that there will be a leaflet drop to all households.

PG expressed concern that surgeries are not sharing information eg, recent communication was not shared with patients from GP practices. AD said that communication has not been good and that there are some good things happening that are not being shared eg, Cannock Hospital are providing excellent services and this is not being shared.

AD said that consistent messages need to be shared with the public, 7,000 patients who will be affected by the change, GPs, staff within providers plus significant others such as MPs, Councillors etc. 8

Action

JBr recommended that different routes are considered such as posters in public places such as hairdressers, bill boards etc.

13. Items for Information

13.1 Finance, Performance and Contracts Committee Minutes – 12/06/2014 NC asked for an update of QIPP, particularly in light of the Q1 Assurance taking place on 05/09/2014. PW identified that this may be necessary to bring to the November 2014 GB.

Action: PW to bring QIPP update to November 2014 GB PW

13.2 Communications & Engagement SY explained that at the September 2014 meeting, there will be a review of how C&E will move forward

13.3 Joint Quality Committee AD highlighted that the CQRM will handle the legacy of the transition.

14. Any Other Business

14.1 Scheme of Delegation SY informed the meeting that the Scheme of Delegation has been updated.

Agenda Item 06/11/2014 Scheme of Delegation SY

14.2 Minor Injuries Unit (MIU) Consultation There will need to be a formal session as part of the October GB.

Agenda Item 02/10/2014 MIU Consultation LM

14.3 Extra-Ordinary Governing Body There will be a meeting w/c 22/09/2014 and must be quorate. CLM asked if quoracy can be achieved with some members allowed to dial in.

17. Questions from Members of the Public

Questions from members of the public are recorded by Communications Team.

18. Next Meeting

The next meeting ‘in public’ will be:

Action

Date: Thursday 6 November 2014 Time: 2.00 pm – 4.00 pm 4.00 pm – 4.30 pm – public questions Venue: The Aquarius Room, Aquarius Ballroom and Banqueting Suite, Victoria Shopping Park, Hednesford WS12 1BT

Item: 06 Enc: 04

Cannock Chase Clinical Commissioning Group Governing Body Meeting

ACTION LIST

Date Agenda Item Action Required by Date Due Comments/Actions Raised

Actions from 04.09.14

5. Minutes of the 06.11.14 COMPLETE Revise minutes of 03/07/2014 and record as Meeting held on 3 04.09.14 CLM 06.11.14 approved. Item 8 – Primary Care Strategy July 2014 amended accordingly. 06.11.14 COMPLETE 6. Actions 04.09.14 Copy all actions from 03.07.2014 to Action List CLM 02.10.14 All actions transferred from minutes of 03.07.14 7. Board Further work on the document SY share BAF with GB at least two weeks prior Assurance 04.09.14 SY 23.10.14 following Audit Committee, SY to the GB Framework (BAF) to meet NC. VJ to provide up to date FFT figures for RWT 29.10.14 COMPLETE figures 9. Quality Report 04.09.14 and WHT for the next meeting. VJ 06.11.14 are in this month’s quality report. VJ to provide a paper to the GB on role of CCG in the assurance process for the transition of 9. Quality Report 04.09.14 services for MSFT to RWT and UHNS. VJ 4.12.14

VJ to confirm reporting of pressure ulcers from 9. Quality Report 04.09.14 UHNS at the December meeting VJ 4.12.14

VJ to liaise with Health Watch regarding future 29.10.14 Jan Sensier has been 9. Quality Report 04.09.14 visits VJ 06.11.14 contacted in regards to visits to the SAS site. Page 1 of 4

Item: 06 Enc: 04

Date Agenda Item Action Required by Date Due Comments/Actions Raised VJ to explore the possibility of complaints from RWT/WHT to also include in addition 9. Quality Report 04.09.14 to the global numbers break down by Ward. VJ 4.12.14

06.11.14 COMPLETE Full cancer report regarding referrals to be 10. Performance 04.09.14 brought to next GB if there is not board AB RWHT will provide data and a Report assurance. full report to be submitted at November GB 10. Performance AB contacted WMAS for 04.09.14 Establish how many Ambulances are in service AB Report information 13. Items for Information – FPC 04.09.14 PW to bring QIPP update to November 2014 GB PW 06.11.14 Minutes 12/06/2014

Actions from 03.07.14

LM to discuss with JM to finalise arrangements 04.09.14 This needs further 6.0 Matters Arising 03.07.14 (informal session for public to meet with the GB LM discussion. – 17.0 AOB 16.03.14 Members) AD to clarify with VJ (RAG rating for Rowley 11. Quality Report 03.07.14 AD/VJ Hall) 12. Performance JBl to identify waiting/order times for RWHT to 04.09.14 JBl reported this 03.07.14 JBl Report source replacement robot. matter is ongoing 14. Risk Register – 03.07.14 SY to obtain update and amend SY Risk 62 14. Risk Register - 03.07.14 SY to update register for approval at EMT SY MSFT SY to obtain updates for the register and 14. Risk Register – 03.07.14 distribute an e-mail to all staff highlighting the SY Review Dates requirement to amend review date.

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Item: 06 Enc: 04

COMPLETED ACTIONS (completed actions will be removed the meeting following their completion) Date Agenda Item Action Required by Date Due Comments/Actions Raised 04.09.14 COMPLETE 6.0 Matters Arising JBl to obtain formal note from AB (regarding This forms part of ongoing – 7.0 Performance 03.07.14 changes to clinical pathways and GPs JBl Report – 03.04.13 requesting emergency admissions) discussions and is not required on the action list. 9. Committee 04.09.14 COMPLETE SY to amend Joint Quality Committee ToR to Terms of Reference 03.07.14 SY include JT. The ToR has been revised (ToR) - Revised 9. Committee 04.09.14 COMPLETE SY to remove Manjit Obhrai from the ToR as the Terms of Reference 03.07.14 SY names Secondary Care Consultant. The ToR has been revised (ToR) - Revised Jan Topliss to supply AB with additional 04.09.14 COMPLETE 6.0 Matters 03.07.14 information re: RWHT Waiting Times, if required JT VJ 04.09.14 This matter will be pursued by Arising/Action List outside Governing Body Joint Quality. COMPLETE 04/09/14: SY will inform when the Board Meeting ‘in public’ is to take place. 01/09/14: Response received SY to confirm dates and times of the RWHT from Adrian Sargent, Board 6.0 Matters 03.07.14 Board of Directors to be held in public in the SY 04.09.14 Secretary, to confirm a Arising/Action List Cannock Chase area. meeting is being arranged for the autumn and the date is yet to be released. RWHT welcome the attendance of members of the public, Governing Body and Membership Board members. 5.0 Minutes of the 03.07.14 PW highlighted that JT is recorded as having ADMIN 04.09.14 04.09.14 - Complete as per Page 3 of 4

Item: 06 Enc: 04

COMPLETED ACTIONS (completed actions will be removed the meeting following their completion) Date Agenda Item Action Required by Date Due Comments/Actions Raised Meeting held on given apologies and in attendance. JT confirmed action. 01.05.14 her attendance at the meeting held on the 1st May 2014.

PW also queried whether Colin Groom, Deputy Chief Finance Officer attended the meeting on behalf of JBr and whether the minutes should reflect this. The Governing Body agreed to the above changes.

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Item No: 07 Enc: 05

REPORT TO THE Clinical Commissioning Group Governing Body Meeting TO BE HELD ON: Thursday 6th November 2014

Subject: Proposal to reduce the hours of the Minor Injuries Unit Board Lead: Dr Mo Huda Officer Lead: Lynn Millar For For For For Recommendation:  Approval Ratification Discussion Information PURPOSE OF THE REPORT:

• To outline the proposal to reduce the hours of the Minor Injuries Unit in Cannock (MIU) • To detail the CCGs statutory requirements with regards to service reconfiguration • To describe the preferred option for change • To report the outcomes of the consultation exercise on the proposed change • To set out the learning and mitigating actions to the consultation • To outline recommendations and next steps

KEY POINTS:

• The CCG currently has a £9m financial deficit. The CCG has a duty to report under Section 19 of the Audit Commission Act 1998 the breach in the revenue resource limit and to therefore act effectively, efficiently and economically.

• Cannock Chase CCG has a statutory role for carrying out consultations in relation to proposed service change.

• The CCG’s Disinvestment and Decommissioning Strategy outlines the need to review service provision in order to ensure we commission high quality services that are cost effective and financially sustainable. The MIU was one of the services identified for review with a view to delivering a £250,000 per annum saving.

• Four options have been considered:

1. Do nothing 2. Closure of the MIU 3. GP led MIU 4. Reduced opening times – preferred option

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Item No: 07 Enc: 05

• The preferred option is to reduce the opening hours to 10.30am to 6.30pm to reflect when the highest numbers of patients attend the Unit.

• The proposed reduction in hours have been led clinically and supported by the Cannock Chase Membership Board.

• The preliminary Quality Impact Assessment demonstrates that overall the quality and safety impact of reducing the MIU operation hours is very low.

• The 4 week consultation period was approved by the Healthy Staffordshire Select Committee on 11th August 2014.

• The consultation ran from 1st September until 28th September.

• Responses to the proposed reduction in hours highlighted a number of key themes:

• Access to GPs and appointments/GP recruitment • Signposting to services and knowing where to go/Communications and engagement with the public and patients/Self-care and education • Additional pressures on A&E • Safety concerns • Efficacy of current GP Out of Hours service • MIU opening hours

• The CCG has listened to the public and has put actions in place now to ensure the quality of care is maintained and there is minimal disruption to services.

Relevance to Key Goals To reduce health inequalities across Yes, the Choose well campaign, primary care strategy Cannock Chase through targeted and the work to improve access to primary care aims to interventions. reduce variation between practices

To identify and support patients with N/A Long Term Conditions to ensure care delivery closer to home.

To improve and increase overall life N/A expectancy.

To develop integrated services with Yes, the introduction of localities will improve access; simple, easy access. deliver better coordinated and integrated services.

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Item No: 07 Enc: 05

Implications Legal and/or Risk Risk that the consultation process does not meet statutory requirements. However, four ‘Lansley’ tests have been met in relation to service reconfiguration. CQC N/A Patient Safety Mitigating actions have been put in place to improve access in primary care. Alternative services are in place 24/7 365 days per year for patients with an injury. Patient Engagement Four week consultation carried out as recommended by the Healthy Staffordshire Select Committee Working Group and ratified by the full Healthy Staffordshire Select Committee Financial The proposed reduction in hours of MIU delivers a QIPP saving to the CCG. Sustainability The proposed reduction in hours of MIU is deemed to be the most sustainable option Workforce / Training N/A

RECOMMENDATIONS / ACTION REQUIRED: The CCG Governing Body is asked to:

1. Note the report and the response to the consultation. 2. Approve the recommendation in the case for change to reduce the hours of the MIU to 10.30am until 6.30pm from 1st December 2014 subject to the following:

• The ‘Choose Well’ campaign is launched so all residents of Cannock Chase are able to make the most appropriate choices when they are unwell. • Further focused engagement with parents and young adults is conducted. • Feedback to the Governing Body, demonstrating measures put in place to improve access in primary care. • A robust monitoring process is put in place to ensure the reduction in hours does not have an adverse impact on other services. • A review of progress and benefits is undertaken by the CCG at six and twelve months.

Not KEY REQUIREMENTS Yes No Applicable Has a quality impact assessment been undertaken? Y Has an equality impact assessment been undertaken? Y Has a privacy impact assessment been completed ? N/A Have partners / public been involved in design? N/A Are partners / public involved in implementation? Y Are partners / public involved in evaluation? N/A

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Item: 07 Enc: 05 Outcome of the consultation on the proposals for changes to the Cannock Minor Injuries Unit

1.0 Purpose

• To outline the proposal to reduce the hours of the Minor Injuries Unit (MIU)in Cannock • To detail the Clinical Commissioning Group’s (CCG) statutory requirements with regards to service reconfiguration • To describe the preferred option for change • To report the outcomes of the consultation exercise on the proposed change • To set out the learning and mitigating actions to the consultation • To outline recommendations and next steps

2.0 Statutory Requirements

Cannock Chase CCG currently has a £9m financial deficit. It has a duty to report, under Section 19 of the Audit Commission Act 1998, the breach in the revenue resource limit and, therefore, to act effectively, efficiently and economically to pay back the cumulative deficit over the next 3 years. On this basis, the CCG must put actions in place to deliver the agreed financial control total in 2014/15 and beyond.

Cannock Chase CCG has a statutory role for involving patients and the public in relation to proposed service change. Section 242 of the NHS Act 2006 and Sections 13Q and 14Z of the NHS Act 2006 (amended 2012) set out CCGs’ duty to involve the public in commissioning decisions, including:

• The planning of commissioning arrangements. • The development and consideration of proposals for changes in commissioning arrangements where implementing the proposals would have an impact on the range or manner of delivery of services. • Decisions affecting the operation of commissioning arrangements that, if implemented, would have a significant impact as above.

The CCG has undertaken consultation concerning proposed changes to the Minor Injuries Unit. The consultation process was approved by NHS England Shropshire and Staffordshire Area Team.

This report demonstrates how the CCG has discharged its statutory responsibilities.

3.0 Background

Cannock Chase CCG’s Disinvestment and Decommissioning Strategy outlines the need to review service provision in order to ensure we commission high quality services that are cost effective and financially sustainable. The MIU was one of the services identified for review with a view to delivering a £250,000 per annum saving.

The MIU was opened in 2006 at Cannock Chase Hospital and is provided by Staffordshire and Stoke on Trent Partnership Trust (SSOTP). It is a nurse-led unit, open seven days a week, 365 days a year, from 8am until midnight.

1 Item: 07 Enc: 05 Members of Cannock Chase CCG attended Staffordshire County Council’s Healthy Staffordshire Select Committee (HSSC) to present the CCG’s two-year Operational Plan in the context of the organisation having a £9 million financial deficit. The CCG’s proposals were outlined to County Councillors including the intention to decommission Cannock’s Minor Injuries Unit. At the request of the HSSC, a workshop was held with members of the HSSC on 24th July 2014 to discuss the review and the proposed options:

1. Do nothing 2. Closure of the MIU 3. GP led MIU 4. Reduced opening times – preferred option

On the 11th August, the HSSC agreed that the proposal to reduce the hours was deemed a service change that required the CCG to undertake a four week public consultation exercise to gain the views of other organisations, service users, carers and members of the public.

4.0 Four Tests for Service Reconfiguration

The previous Secretary of State for Health, Rt Hon Andrew Lansley MP, identified four key tests for service change, which were designed to build confidence within the service, with patients and communities. The tests were set out in the revised ‘NHS Operating Framework for 2010-11’ and require existing and future reconfiguration proposals to demonstrate:

• Support for change by local GP Commissioners • Plans are based on sound clinical evidence • Strong public and clinical engagement on any proposals • Promoting choice for patients

The four tests were assessed at the start of the consultation and have also been revisited to ensure that the tests have been met:

4.1 Support for change by local GP Commissioners

The proposal to review MIU was debated by clinical leads at the Quality Improvement Productivity and Prevention (QIPP) Delivery and Accountability workshop on 15th May 2014.

GP clinical leads and practice teams have been closely involved in the ongoing development of the proposal and the consultation exercise, having weekly meetings and conference calls.

A local workshop was held on 10th June 2014, facilitated by the NHS Improving Quality Programme and attended by practice managers, practice nurses and GPs from all localities in Cannock Chase, along with CCG staff.

Cannock Chase CCG Membership Board is formed of a representative from each of the 27 GP practices across the Cannock Chase area. The Board meets monthly to discuss the commissioning of services to deliver better outcomes for patients. The Board has been fully involved in the development of the proposals for the MIU in Cannock. The preferred option to reduce opening hours was supported by the majority of member practices (26 out of 27) at the Cannock Membership Board on 9th July 2014.

The Cannock Chase CCG Membership Board met on the 14th October 2014, where they were informed of the findings of the public consultation with regards the proposed changes to MIU. The Board discussed the feedback at length and a number of GPs raised concerns about the proposed opening hours of 11am until 7pm. It was proposed that 10.30am until 6.30pm would provide a better patient experience. 2 Item: 07 Enc: 05

4.2 Plans are based on sound clinical evidence

The proposals to reduce the hours of the MIU are based on a wide range of clinical and activity data, including attendances by hour/day/month, diagnosis, demographic data, discharge outcome and geographical location.

The plans for change have been led by GPs and shared with SSOTP who run the service to ensure the assumptions around activity are sound.

As with any service transformation, the CCG Quality Team has completed a preliminary Quality Impact Assessment (QIA) to understand the quality and safety implications of the proposal. The QIA identifies that reducing the hours poses minimal clinical risk and affects a relatively low number of people.

4.3 Strong public and clinical engagement on any proposals

Prior to the public consultation, the CCG engaged with a number of stakeholders. A ‘Quality Improvement Productivity and Prevention (QIPP) Delivery and Accountability’ workshop was held on 15th May 2014, where a range of clinical leaders and governing body members were present. The Healthy Staffordshire Select Committee were informed from the early stages, including the discussions regarding decommissioning the MIU and the subsequent changes to the plans for the Unit, and approved the four week consultation on the CCG’s preferred option of reduced hours.

A patient survey was carried out in the MIU at Cannock Chase Hospital before the consultation period began which aimed to seek patient views on current use of the service. The outcome of this fed into the proposals for change at the Unit.

Further detail about actions taken by the CCG can be found at section 6.1.

The consultation process has demonstrated that there has been strong public and clinical engagement on the proposals, for example through public attendance at engagement events, the Governing Body and Annual General Meeting (AGM), media interest and petition.

The CCG has been committed to ensure the consultation was fully debated by the public and other bodies and has been responsive to public feedback. For example, following public feedback, the CCG provided an additional evening consultation session to give working adults in Cannock town the opportunity to feed into the process. The public reported that they had heard about the consultation largely through word of mouth and GP practices, therefore, the CCG paid for further advertising in local media to ensure that events were widely circulated to the public.

The consultation has involved a wide range of interested parties including members of the public, general practitioners (GPs), providers, Healthwatch, local authorities, Overview and Scrutiny Committees, other statutory and voluntary sector organisations and local Members of Parliament.

4.4 Promoting choice for patients

The proposal to reduce the opening hours does not reduce service user choice during the opening hours. Service users will continue to be able to access the MIU during the proposed new hours and will have access to other services when the unit is closed, they may choose to self-care or decide to wait until the unit is open to seek treatment for their minor injury. Patients with a minor illness are not affected by the reduced hours as they will continue to have access to a GP in hours as well as a GP out of hours service based in Cannock Hospital. Patients with more serious injuries or acute illness will continue to be able to access A&E.

3 Item: 07 Enc: 05 5.0 Proposal for Change

After detailed consideration, it was proposed that the preferred option would be to reduce the opening hours to 11am until 7pm but to maintain a 7 day service, 365 days per year (Option 4).

The proposal to reduce the opening hours were driven by the lower volume of patients that attended the unit after 7pm (Table 1).

Table 1. Average Number of MIU attendances by hour of arrival

In addition, while the majority of patients attending the unit had a minor injury, data shows that up to 40% of patients attended for a minor illness and could have been more appropriately treated by a GP, pharmacist or managed at home caring for themselves.

In the 5 hours between 7pm and midnight, on average, only 6 people are seen for a minor injury. This is not a cost-effective use of nursing time, particularly when others services are available during this time.

The majority of patients currently attend the Unit between the hours of 9am and 7pm, however, remaining open for that time would span more than one standard shift pattern and would therefore incur higher costs and would be operationally difficult.

The option to include a GP in the MIU was withdrawn as it was felt that the nurse led model was most appropriate to treat the identified cohort of patients and would not deliver the required efficiency requirements.

On this basis, the preferred option would be to reduce the opening hours to 11am until 7pm, covering one standard shift pattern when the majority of patients (62%) attend the Unit.

4 Item: 07 Enc: 05

5.1 Quality Impact Assessment (QIA) of the Proposed Reduction in opening Hours

A Quality Impact Assessment of the proposed reduction in opening hours of MIU has been carried out by the CCG’s Director of Quality and Safety. The assessment demonstrates that overall the quality and safety impact of reducing the MIU operation hours is very low. Each potential risk has a planned mitigation and therefore a low residual risk score.

The low impact is centred on 2 facts:

1. The service is commissioned for MINOR injuries and therefore is not considered a high risk service, clinically. 2. There are a range of services that can offer appropriate support to patients who would have otherwise attended the MIU.

Assuming that the mitigations are enforced as planned, and the additional recommendations are completed, there is no reason to believe that this service change will negatively affect the quality and safety of care given to patients.

6.0 The Consultation Process

6.1 How we engaged with patients prior to the Consultation

The CCG uses a range of mechanisms to continually engage with patients and the public. This ongoing engagement enables the CCG to understand some of the wider issues that matter to local residents prior to any specific engagement activity.

In 2013, Cannock Chase CCG and Stafford and Surrounds CCG launched ‘Conversation Staffordshire’ to get a clearer perspective of what the public would like to see from local health services in the future. This was followed by a number of listening events in 2014 under the banner of ‘A Call to Action’, which looked at how patients could be supported to help themselves and how services delivered from different providers could be better integrated.

The consensus from these events was that people supported a drive towards more self-care and prevention, with an increased focus on delivering more services in the community rather than in hospital settings.

The CCG invites regular contributions from its network of Patient Participation Groups (PPGs) and attends a range of community and voluntary sector organisations to update them on CCG activities and any opportunities for them to feedback on specific projects or consultations.

The CCG Governing Body is held in public on a bi-monthly basis and MIU has generated discussion in the public questions. Further debate regarding MIU was also had at the Cannock Chase CCG AGM held on 4th September 2014.

In addition to monitoring clinical data, the CCG specifically sought feedback from people attending the MIU at various times of day, to understand the reasons for patients attending and their knowledge of alternatives places to seek treatment. The CCG surveyed nearly 200 patients at the MIU prior to the consultation in order to understand why people chose to go to the Unit. The three most common reasons were:

• ‘Closer to home’ • ‘Injury was only minor so most appropriate place’ • ‘Unable to get same day GP appointment’

5 Item: 07 Enc: 05 Patients attended for a variety of reasons including minor injuries and minor illness. 71% of patients surveyed had considered or tried their GP prior to attending, highlighting the need to ensure patients know where to go when they are unwell.

6.2 The Consultation

A consultation document was produced which outlined three options, including the preferred option to reduce the opening hours of the MIU from 11am until 7pm (Option 4). The option of a GP-Led unit (Option 3) was not included due to the decision to withdraw this option as explained in section 5.0. The consultation ran from the 1st September 2014 to the 28th September 2014 and prompted a significant amount of debate.

Cannock Chase CCG has endeavored to ensure that all residents of Cannock Chase have had the opportunity to comment on the proposals throughout the process. A number of responses were received after the consultation period closed, however, the CCG wanted to seek as many views as possible and so these have been included in the final evaluation.

The consultation revealed that there was limited feedback from the under 35 age group. The activity data shows that this group is a high user of the MIU and therefore there will be a need for further focused work with parents and younger adults.

The detailed comments and responses to the consultation have been compiled in a separate report which is available to view at www.cannockchaseccg.nhs.uk. This report has been circulated to Governing Body Members electronically for information.

6.3 Petition against the closure of MIU

On 29th September, a petition was submitted to the CCG containing circa 828 signatures against Option 2 Closure of the MIU:

1. The petition asks specifically for signatures against the closure of the MIU. 2. The forms received clearly state that the petition has been led by a local political party.

In response, the CCG supports Option 4, the reduction in hours, as a more sustainable option.

7.0 Learning from the Consultation

The MIU Consultation Report compiled by Midlands and Lancashire Commissioning Support Unit (MLCSU) identified a number of themes, they are:

• Access to GPs and appointments/GP recruitment • Signposting to services and knowing where to go/Communications and engagement with the public and patients/Self-care and education • Additional pressures on A&E • Safety Concerns • Efficacy of current GP Out of Hours service • MIU opening hours

The CCG has put measures in place to ensure that the quality of patient care is maintained. These actions are described below:

7.1 Access to GPs and appointments/GP recruitment Access to primary care has been a consistent theme throughout the consultation discussions. However, Cannock Chase CCG performs well when compared to other CCGs nationally. The latest National GP Survey highlights that 75% of patients in Cannock Chase are able to get an appointment to see or speak to someone compared to 73% nationally. 48% are able to get a 6 Item: 07 Enc: 05 same day or next day appointment compared to 49% nationally. 48% of respondents found the appointment offered ‘very convenient’ compared to 46% nationally.

We recognise that access to a GP can be variable across the Cannock Chase CCG area and that access can be an issue in some practices. We have introduced a number of initiatives that are in place now with the aim of increasing capacity in primary care.

• Acute Visiting Service - providing urgent afternoon visits for patients unable to wait for a GP to visit after evening surgery, who would otherwise go to A&E or call an ambulance. • Primary Care Strategy - approved by Cannock Chase CCG member practices to improve quality and increase capacity and capability in primary care. • Locality networks - collaborative working between practices across three locations; Cannock Town, Great Wyrley/Cheslyn Hay and Rugeley areas, to improve quality and access to services, for example, extended hours, flu vaccinations. • Locality business case demonstrating how local GP practices will collaboratively achieve locally agreed targets • The introduction of locality Patient Participation Groups to ensure local primary care services are responsive to local needs. • Care facilitators assigned to every practice to support patients with dementia and their carers. • Unplanned Care Direct Enhanced Service – Care planning and direct access phone line to patients with a long term condition. • Extended Hours Direct Enhanced Service - providing planned evening and weekend appointments • Attracting GPs to Cannock - discussions with Health Education West Midlands regarding increasing the numbers of training practices in the Cannock area, creating a rotational programme for trainee GPs and promoting the allocation of trainees to the Cannock practices. • Improving Access project - Workshop held on 22nd October 2014 to identify the key issues with access and to introduce systems and processes for improving access across all practices in Cannock Chase, including ways that practices can work more collaboratively to address the issues. Initial actions from the group include an advanced access audit and full support of the ‘Choose Well’ campaign to educate patients.

7.2 Signposting to services and knowing where to go/Communications and engagement with the public and patients/Self-care and education A common theme throughout the consultation relates to patients being unclear where to go when they are unwell. As a result of this, the CCG has launched the ‘Choose Well’ campaign to raise awareness of where to go to access healthcare when they need it. The CCG has commenced the campaign in GP practices, pharmacies, supermarkets and other public places, such as council buildings and leisure centres. The CCG is also working closely with South Staffordshire Council, Cannock Chase District Council and Stafford Borough Council to promote the ‘Choose Well’ campaign. A full communications strategy will support the roll out of the campaign, including leaflets sent to every household in Cannock Chase in early December 2014.

7.3 Additional pressures on A&E The CCG has engaged with Mid-Staffordshire NHS Foundation Trust, Walsall Healthcare NHS Trust and the Royal Wolverhampton NHS Trust as part of the consultation process.

On average, 13 minor injury patients per day could attend A&E at three neighbouring hospitals, by hour this would equate to:

• 1 to 2 patients between 8am and 9am • 2 to 3 patients between 9am and 10am • 2 to 3 patients between 10am and 11am • 2 to 3 patients between 7pm and 8pm 7 Item: 07 Enc: 05 • 1 to 2 patients between 8pm and 9pm • 1 to 2 patients between 9pm and 10pm • 0 to 1 patients between 10pm and 11pm • 0 to 1 patients between 11pm and 12am

Based on previous service reconfigurations and the fact that these patients have a minor injury, it is expected that the majority of patients will not decide to attend A&E. Instead, they may wait until the MIU is open, self-care or go to their GP (as indicated by the patient survey). For those patients who do go to A&E, it is expected that most patients would not all attend the same A&E and therefore the operational impact on neighboring services would be minimal.

7.4 Safety Concerns Safety concerns have been raise by patients and MIU staff around patients who do present with a minor illness which requires urgent, same day treatment. While the CCG expects this to reduce in the future, patients will continue to be treated by MIU staff or triaged to an appropriate alternative service in the short term.

7.5 Efficacy of current GP Out of Hours service The reduced opening hours largely effects the period when practices are closed and the GP out of hours service takes over. Therefore, patients with a minor illness will continue to receive advice or to be seen by a GP if they need it.

The CCG has met with the current provider to discuss some of the issues raised by the consultation and has put in place a number of measures:

• Healthcare professional phone line - for MIU staff to triage patients with a minor illness if they need urgent medical attention out of hours. • Response car based in Cannock town - to improve response times for Cannock Chase patients.

In addition, the CCG is in the process of procuring a new GP out of hours service which will commence in April 2015. The new service will be based in Cannock Hospital and will offer a number of benefits to patients.

7.6 MIU opening hours Feedback from a neighbouring Trust suggested that the new opening time of MIU should be brought forward to 10am until 6pm to reduce the operational impact of patients waiting for the unit to open and also to reflect the slightly higher volume of patients in the morning.

Other providers, including GP practices indicated that 10.30am until 6.30pm would be a better compromise as there would be a smoother transition into the GP Out of Hours service which, overall would result in a better patient experience. Consequently, the proposed opening hours will now be 10.30am until 6.30pm.

8.0 Conclusion

The Secretary of State for Health, Rt Hon Jeremy Hunt MP, requires the CCG to demonstrate that it has reviewed the outcome of the consultation alongside the four “Lansley” tests; Support from GP Commissioners, plans are based on sound clinical evidence, strong public and clinical engagement on any proposals and that patient choice of where they want to be treated is considered.

All of the above have been addressed as part of this consultation process.

8 Item: 07 Enc: 05 The CCG is required to demonstrate that it has carried out the consultation, regarding the proposed changes to reduce the hours of the MIU, in line with statutory requirements which include consulting for a period of four weeks (agreed by the HSSC).

The consultation has demonstrated that there are a range of issues that need to be addressed in implementing the proposed reduction in opening hours.

The CCG has listened carefully to the debates undertaken through the consultation process and believe that many of the matters raised can and have been addressed. These measures will ensure that the recommended option to reduce opening hours can be implemented safely and in an appropriate timescale to assure the public that access to high quality, safe services are maintained.

The option to do nothing is not seen as a credible option as it is not financially viable.

The second preferred option to close the Unit was not considered viable as data showed that there are a significant number of people with a minor injury who would otherwise go to A&E. Again this would not be appropriate or financially viable.

In conclusion, the preferred option is to reduce the opening hours to 10.30am until 6.30pm.

When making a final decision, the CCG Governing Body members should consider the following:

• The CCG has a responsibility to ensure health services are financially viable. • The CCG has completed is statutory responsibilities to consult widely with the public • The outcome of the consultations was that the preferred option was ‘do nothing’. • The Petition led by a local Councillor opposed the closure of the unit. • There is support for the reduction in MIU hours from the majority of the CCG’s Member Practices.

9.0 Recommendations

1. The Cannock Chase CCG Governing Body note the report and the response to the consultation. 2. The Cannock Chase Governing Body approve the recommendation in the case for change to reduce the hours of the MIU to 10.30am until 6.30pm from 1st December 2014 subject to the following:

9 Item: 07 Enc: 05

Minor Injuries Unit in Cannock Consultation

1st September to 28th September 2014 – Outcomes Report

1.0 Background

This report provides a summary of the process and outcomes of the formal public consultation undertaken by Cannock Chase CCG between 1st September 2014 to 28th September 2014.

The consultation concerned a proposal to reduce the hours at the Minor Injuries Unit (MIU) in Cannock from 8am until midnight to between 11am and 7pm.

The proposals for change were presented to the Healthy Staffordshire Select Committee (HSSC) on 9th June 2014, at this meeting it was decided a joint workshop between the HSSC and the CCG would take place to examine in details the proposals which included closure of the MIU. Following that workshop which took place on 24th July 2014 the HSSC Working Group recommended to the full HSSC that the CCG consult on a proposal to reduce opening hours and that the formal consultation should last for four weeks starting on 1st September and finishing on 28th September. This was ratified by the HSSC on the 11th August 2014.

The consultation process was verified by the NHS England Staffordshire and Shropshire Local Area Team in line with their assurance processes.

The consultation was conducted in line with the requirements under NHS Act 2006 (amended 2012) Section 242 sections 13Q and 14Z.

The report will provide the information from the consultation to the CCG governing body, staff, patients and members of the public. It aims to summarise the many views which were given. HealthWatch Staffordshire members in their independent scrutiny role have given their approval of the methodologies used in the summation and analysis of the consultation feedback.

The Cannock Chase CCG governing body will make the decisions on the future for the MIU services which have been the subject of this consultation. These decisions will be informed by the recommendation of commissioning managers and clinical leads, taking into account the outcomes of the consultation.

Cannock Chase CCG will give feedback where possible to the many organisations and local people who contributed to the consultation. This feedback will explain what has been said during the consultation and what the CCG has decided. This report in full and the report to the board will be public documents available through the internet on the website of the CCG and hard copies will be sent to anyone who requests them. This can be done by contacting [email protected] or calling 0300 404 2999 ext 6852.

Item: 07 Enc: 05

1.1 The Proposals

The consultation asked patients, the public and key stakeholders to record their agreement or disagreement to a proposal to reduce the MIU opening from 8am until midnight to 11am until 7pm. The survey asked people to record their answer using a Likert scale rating via a survey and asked for suggestions about how services could be improved.

The consultation document explained that:-

• The service was neither affordable or sustainable in its current form • 40% of the attendances were for minor illness NOT minor injury • That the attendance drops significantly after 7pm and that only 63% of people who attend after 7pm attend with a minor injury.

We received 19 formal responses from the stakeholders and the public, 124 completed surveys and received feedback from the four public meetings and the 54 attendees where the proposal was discussed.

In the survey we asked whether consultees agreed or disagreed with the proposal and invited them to offer feedback, comments and suggestions for future improvements.

This report has been prepared to provide an overview of all the feedback received via surveys, meetings and formal response letters.

1.2 The Consultation Process

We aimed to engage as many people as possible about our proposal using a wide range of communication methods.

A 12-page consultation document was produced which included the survey and this was distributed widely to key stakeholders along with an explanatory letter from the Chair of the CCG. A full list of formal stakeholders can be found in (Appendix 1).

A dedicated section of the CCG’s website was created about the MIU consultation at www.cannockchaseccg.nhs.uk where details of the proposal, the consultation document and an on-line survey were available to complete.

A dedicated email ([email protected]) was also created so people could submit further questions about the consultation or send in a response to the survey.

A freepost address was available so that people were able to send in hard copies of the survey free of charge.

Item: 07 Enc: 05

1.3 Publicity

Four press releases were issued in relation to the consultation to the media on the following dates: (Appendix 2)

• 28th April 2014 – Announcing Public Consultation on future of Cannock Chase MIU. • Monday 11th August 2014 – announcing that the Healthy Staffordshire Select Committee has asked the CCG to carry out a four week public consultation into the MIU proposal • Tuesday 26th August 2014 – Details of the consultation meetings • Tuesday 9th September 2014 – Details of further evening meeting announced

This resulted in coverage in the Cannock Chronicle, Staffordshire Newsletter, the Express and Star and Signal Radio.

Full-page adverts were also placed in the Express and Star on September 11th 2014 and in the Cannock Chronicle on September 12th 2014 (Appendix 3)

1.4 Meetings

Three public meetings were held where the CCG gave a presentation and then answered questions from the public (Appendix 3.) The meetings were held throughout September and people who attended the consultation events were asked to fill in an individual survey response at each event:

• Wednesday September 3rd 2014, 2pm – 4pm, Avon Business and Leisure Centre, Avon Road, Cannock, WS11 1LH - 13 people attended, including a representative from HealthWatch Staffordshire, an Express and Star reporter 3 members of MIU staff and a GP. • Wednesday September 10th 2014, 10am – 12 noon, the Aquarius Ballroom, Victoria Shopping Park, Hednesford, WS12 1BT - 11 people attended, including a representative from HealthWatch Staffordshire, 2 representatives from Cannock Chase District Council and one member of MIU staff • Thursday September 18th 2014, 6pm - 8pm Rugeley Rose Theatre and Community Hall, Taylors Lane, Rugeley, WS15 2AA – 5 people attended, including a representative from HealthWatch Staffordshire, a representative from Rugeley Town Council, 2 members of MIU staff and a member of the public

The CCG also arranged a further evening meeting in Cannock in response to public feedback. This was held on:

• Wednesday September 24th 2014, 6pm - 8pm, Civic Ballroom, Cannock Chase Civic Centre, Beecroft Road, Cannock. 25 attended, including 2 members of MIU staff, a representative of HealthWatch Staffordshire, and 4 Councillors

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The CCG also met with those stakeholders who asked for specific meetings including: South Staffordshire District Council on Wednesday 17th September and the Health Overview and Scrutiny Committee of Cannock Chase District Council on Thursday 25th September.

The public and stakeholders were also given an opportunity to ask questions at the CCG’s Annual General Meeting on Thursday September 4th at the Aquarius Ballroom, Victoria Shopping Park, Hednesford, WS12 1BT.

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2.0 Consultation Outcomes

2.1 Analysis of the information

All of the comments received from surveys whether sent electronically or handwritten, as well as comments noted at meetings and submitted in any other form have been entered into an excel database.

The database allows comments to be searched and segmented by self-described nature of the respondent, e.g. service users, carer, organisation etc.

The Midlands and Lancashire Commissioning Support Unit (MLCSU) have supported the CCG throughout the consultation process, including full analysis of the consultation feedback and data.

The CSU on behalf of the CCG invited HealthWatch Staffordshire in their role as independent scrutiniser to a meeting to discuss and review the analysis methodologies and HealthWatch Staffordshire were supportive of them and found them to be open and transparent.

2.2 Overview

The report is categorised into the following feedback sections

• Survey respondent feedback • Respondent feedback from public meetings • Respondent feedback via e mail, letter or from formal consultees

The main themes that come from the aggregated feedback from the three areas are in order of feedback priority:-

• Access to GPs and appointments • Signposting to services and knowing where to go • Additional pressures on A and E • Holistic approach to urgent care with joined up services • Safety concerns • Asking for enhanced services at the current MIU including plastering and X- Ray facilities • Finance • Communications and engagement with the public and patients • Efficacy of current GP out of hours service • Alternative services availability • Self-care and education • Transport access • GP recruitment • Involvement of stakeholders and patients from outside the Cannock area

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• Robustness of evidence base

2.3 Survey Respondent Feedback

There were 124 surveys returned in total, of which 94 were completed in every section (including the free text response, question 4).

• 94.2% of the respondents said they were completing the survey as an individual 5.8% as an organisation

Those responding described themselves as:

Member of the NHS staff % Service user % Unpaid carer % public % 49.2 13.1 36.1 1.6

2.4 Demographics

2.4.1 Location

• 75.0 % said they lived in Cannock • 10.0 % in Stafford • 5.3% in Walsall • 4.5% in Rugeley

2.4.2 Ethnicity

• 94.2% of respondents described themselves as White British/Irish/Scottish/Welsh • 2.5% preferred not to say • 0.9% gypsy or Irish Travellers • 0.8% Asian

2.4.3 Gender

• 75.8% of respondents described themselves as female.

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In terms of age, the breakdown was as follows:

Prefer not to Up to 17 years % 25 - 34 years % 35 - 44 years % 45 – 54 years % 55 – 64 years % 65 – 74 years % 75 + % sa y % 1.7 3.4 18.1 19.8 21.6 22.4 12.1 0.9

It is noted that there is lower response rate for people under the age of 35 years however this is in line with the local population distribution.

There is also a lower response rate from men and the response rate from minority ethnic populations is 0.17% versus a local population average of 4%

We also asked people how they heard about this consultation – and the responses were as follows:

Where did you hear about this consultation?

30.0 26.3 25.0 19.3 20.0 15.8 15.0 13.2 9.6 10.0 4.4 3.5 3.5 3.5 5.0 0.9 0.0

It is clear that local communications are most valued by the respondents with most people gaining their information via word of mouth and the local newspaper.

2.5 Summary of responses

The percentages disagreeing with the proposal were significantly higher than those agreeing, and this applied across all interest groups, with NHS Staff having the smallest difference and members of the public the highest:

Member of the All NHS staff Service user Unpaid carer public Strongly disagree or disagree 71.7 37.5 6.7 25.8 1.7 Strongly agree or agree 17.5 6.7 5.8 5.0 0.0 There were 10.8% who neither agreed nor disagreed with the proposal.

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2.6 Overall Results

I neither agree nor I strongly agree I agree with the I disagree with the I disagree strongly disagree with the with the plans % plans % plans % with the plans % plans %

5.0 12.5 10.8 22.5 49.2

2.7 Members of the public

I neither agree nor I strongly agree I agree with the I disagree with the I disagree strongly disagree with the with the plans % plans % plans % with the plans % plans %

8.5 5.1 10.2 27.1 49.2 43 comments

Eight of these comments related to accessing GPs, respondents felt that the MIU is used due to ‘not getting appointments with their GP’ and ‘the GP service not having the capacity to cover what the public need’. This is the current position without extra pressure from the MIU closing.

Access to alternative services was raised by eight respondents who felt that if the MIU was not available they would struggle to access alternatives due to “stress of financial and travelling’” this being a particular problem for “young families’’.

Eight comments raised financial concerns, these ranged from ‘stop paying the decision makers top money’ to the proposal being a ‘cost cutting exercise’.

Increasing the pressure on A&E provision was stated in seven comments, the ‘knock on effect’ of the proposals will be ‘to increase the numbers of patients to A & E’, that are already ‘stretched’.

Five comments related to adequate staffing and the need to ‘ensure adequate staffing’ is in place and not reduced which would put ‘extra stress and pressure’ on the staff.

Five comments suggested to extend the current services in place, two of these comments included the suggestion for ‘xray facilities’ and the other comments related to ‘opening longer hours’.

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2.8 NHS Staff

I neither agree nor I strongly agree I agree with the I disagree with the I disagree strongly disagree with the with the plans % plans % plans % with the plans % plans %

6.3 37.5 6.3 0.0 50.0 12 comments

Five comments related to the theme access to GP in terms of ‘improving support for local GP’ and ‘making access to GP easier so appointments are available within 24- 48 hours’.

Improving and extending the current service was raised in four comments, two of these comments suggested that the service would benefit from offering “x-ray and interpretation” The other two comments were more general to ‘improve the service rather than reduce it’ and to ‘open for more than 11-7’.

Patient Safety was raised in two comments, firstly ‘turning patients away without proper triage and assessment’ and overall risking ‘public healthcare’.

One comment supported the proposal describing the current service as ‘a total waste of time’.

2.9 Service User

I neither agree nor I strongly agree I agree with the I disagree with the I disagree strongly disagree with the with the plans % plans % plans % with the plans % plans %

0.0 14.0 14.0 23.3 48.8 33 comments

Twelve of these comments raised the need for adequate staffing in the MIU, respondents felt that ‘nursing numbers should remain at full staffing level’ and ‘should not be reduced drastically’.

Four of the twelve respondents raised concerns over staffing and patient safety. Patient safety was raised in seven comments, detailing that cutting access is ‘dangerous’ and one respondent raised concerns that ‘people will suffer and people will die!’.

Seven comments from respondents stated that the current service in place needs extending and developing to include ‘xray and plastering’.

Increasing the pressure on A & E was a concern captured in six comments stating that if no alternative was in place then ‘they would have to go to A&E’ and this was commented to be ‘counter-productive’.

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Access to GPs was identified by six respondents who felt that ‘contacting GP surgeries is impossible’ and also the limitation of the service that GPs offer, for example, ‘GP does not dress wounds’.

Three comments related to transport in terms of using public transport to travel a distance with ‘such injuries’.

2.10 Unpaid Carer

I neither agree nor I strongly agree I agree with the I disagree with the I disagree strongly disagree with the with the plans % plans % plans % with the plans % plans %

0.0 0.0 0.0 50.0 50.0 One comment received incorporated three themes; the hours of current services at Stafford and Walsall need to be extended otherwise there would be an increased use of A&E and the issue of transport if they had to travel to other services. The respondent felt that ‘not everyone in the area has access to a car or taxi’ and also the cost of this.

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3.0 Meeting Feedback

Feedback was captured from the four meetings that took place attended by 54 people. The responses were grouped into categories in relation to interest group and themed in accordance with the survey responses.

3.1 Event Attendees

131 comments were received from event attendees. The two main themes that were gathered were

Signposting/Information - patients needing to know where to go (41 comments) and Access to GP (26 comments).

Of the 41 comments received on signposting/information - patients needing to know where to go, 16 stated that there wasn’t enough clarity regarding the information that is available, one attendee stating ‘I am 80-years old, I live on my own, where do I go? It isn’t cut and dry. I need a paper in front of me, telling me where to go.’

There were 5 comments regarding improvements to ‘education regarding self-care’ and that there was a need for better ‘external communications and engagement’.

3 comments were made surrounding the Badger GP out of hour’s service, asking if decisions could be reached following the re-tendered Badger GP out of hour’s service.

From the 26 comments received regarding GP access there are a large number of concerns surrounding the ‘shortage with GPs’ and ‘are there enough GPs?’

Two respondents felt that existing services should be made more robust, before further changes are implemented, requesting a ‘review of GP out of hours service’ and stating that ‘111 are providing incorrect information’.

10 attendees raised the issue of access to GP appointments and if there is suitable provision in place?

Finance was a concern for 12 of the event attendees. Among the questions raised were ‘What are you looking to save/spend?’ and ‘How does the cost differ per patient, if they use their GP, MIU or A and E?’ One attendee observed ‘4pm until midnight would be better as there are GP services in place in the day - Why don’t you look at different time slots as you would have better cover for people?’

There were also more generalised observations made by some members of the public, surrounding the budget deficit of the CCG as part of a national comparison.

Following on from these, access to alternatives was revealed to be of interest to 12 people. 3 voiced concerns regarding both Badger GP out of hours service and NHS 111 services. Comments included ‘I go to MIU because it is the only competent

Item: 07 Enc: 05 service. My family have used Badger and have made six complaints about them and have no response’ and ‘Inappropriate referrals from 111’.

There were 5 attendees that had mentioned Patient Engagement had been an issue. Among the comments were ‘The timescale does not provide sufficient time for patients to respond.’ Also ‘What patient engagement has been done?’ One attendee stated that they had been advised by their GP surgery that ‘It should have been given to GPs to publicise’.

3.2 Councillors

From the 17 comments received from Councillors, eight of these comments related to access to GPs. Respondents said that ‘Improved access to and capacity within local GP services’ was needed as ‘it would appear that patients are using the MIU rather than their local GP’. They felt that ‘there is a clear need to improve access to and capacity within local GP services, both primary care and out of hours’ when considering a reduction in services at the MIU. They also thought that there was a particular issue with waiting times to access GPs as ‘local residents struggle to secure appointments within a reasonable timescale’ at many of the GP practices across Cannock Chase.

Six of the comments received related to issues around signposting and patients needing to know where to go for treatment. Councillors stated that there is a ‘need for clear communication and engagement with the public’. They added that ‘in talking with constituents Councillors have picked up expressions of both confusion and mistrust’ and ‘wanted to know how the public would know where to go’. They commented further that ‘directing patients to the appropriate services’ is a necessity with a number of ‘cases presenting to the unit being minor illnesses which could be treated by GPs, a local pharmacist or self-care’.

Respondents summarised that ‘there would appear to be a need to better inform and signpost residents to the most appropriate service’ and ‘communication materials should be widely distributed informing residents of the appropriate service for different conditions and different times of day’. Access to alternatives was a theme captured in a further six comments. The respondents felt ‘that the public were getting a raw deal in Cannock’ as there is ‘no overnight A&E at Stafford and patients are not able to get same-day GP appointments’. They also stated that ‘the out of hour’s service provided by Badger is not adequate’.

Four comments related to an increased pressure on A&E. Respondents felt that ‘extra pressures are put on our already stretched local A&E services’ and that ‘without the MIU, residents who are not able to get a GP appointment will go to their local A&E department’ which ‘will put massive pressure on the local A&E’. Councillors who attended the consultation events raised the same points, however, further comments were made in relation to finance. A respondent stated that the

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proposed reduction in hours at MIU ‘is about saving money’ and ‘you’re only saving £290,000’.

3.3 HealthWatch Staffordshire

HealthWatch Staffordshire were in attendance at all the scheduled events and raised that there was an issue relating to signposting and patients needing to know where to go to be treated, requesting further information about the Urgent Care Centre model and whether this ‘would provide good continuity of care’ for patients.

3.4 MIU Nurse

One comment was received from an MIU nurse regarding the lack of practice nurses in GP surgeries. She stated that that there is a ‘problem with practice nurses. In one shift I saw 6 practice nurse patients.’ The nurse went on to ask ‘Where will these patients go?’ indicating a need to educate both practices and patients on where to go to be treated.

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4.0 Letters, E mails and Formal Reponses to the Consultation

Note there were 8 of the 19 responses to the consultation that arrived after the deadline of 5pm on 28th September. The CCG has decided to include these formally in the consultation in interests of inclusivity despite their arrival after the deadline.

4.1 Councillors, Parish, District and Town Councils

Feedback was received from a number of parish, town and district councils as well as from councillors and prospective parliamentary candidates.

The feedback is summarised below in relation to the proposed reduction in hours at the MIU:-

• 6 comments about - Access to primary care service • 5 comments about - Current out of hours services • 5 comments about - Need for a more holistic approach to view MIU in the context of wider urgent care system • 5 comments about - Pressure on A and E services • 3 comments about - Communications with public and patients about services available • 2 comments about - Overall performance and efficacy of the urgent care system • 2 comments about - Process of the public consultation and approach to engagement • 1 comment about - Development of the urgent care centre • 1 comment about - Engagement with the public outside of Cannock • 1 comment about - Transport service

4.2 Health overview and scrutiny committees

The Healthy Staffordshire Select Committee (HSSC) recommended that the reduction in hours be consulted upon rather than the complete closure of the service and as such their joint workshop with the GPs, staff from the CCG and Health Select Committee members was HSSC response to the consultation

4.3 Cannock Chase District Council

Cannock Chase Health Overview and Scrutiny Committee (HOSC) formally responded to the consultation raising a number of concerns included in the analysis in 41and said that they did not support the reduction in service.

Cannock Chase District Council Cabinet responded to the consultation raising a number of concerns included in the analysis in 4.1 above and said that they did not support the reduction in service

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The CEO of Cannock Chase District Council forwarded the Cannock Chase District Council HOSC response to the consultation to the Secretary of State for Health for information only.

Note this does not constitute a formal referral as only Staffordshire County Council’s Healthy Staffordshire Select Committee can formally refer to the Secretary of State for Health.

4.4 Local Health Economy Partners

There was one formal response from providers and partners in the local health economy who raised concerns about the impact of closures on A and E services.

4.5 Member of Parliament

An MP letter was received that raised a number of issues. Comments were made regarding extension of the current service at the MIU, with the MP stating that there is a ‘lack of diagnostic facilities at the site’ meaning that ‘one in four of the patients who visit MIU are sent to another NHS service’. Issues were also raised regarding access to GPs commenting that ‘if the change to the opening hours at the MIU is to go ahead, it is vital that this is coupled with an increase in GP and other primary care provision’. The MP also stated that it had been identified that the proposal to reduce the hours at the MIU could lead to an ‘increase in attendance to local A&Es’, and that assurances need to be provided about ‘access to an improved GP out of hour’s service to avoid them visiting A&E’. Comments were also made regarding signposting and patients needing to know where to go for treatment. Patients need to be ‘properly informed and educated’ about what local health services are available to them and when. It was suggested that the ‘Choose Well’ leaflet should be ‘widely distributed’ to aid this.

4.6 Members of the Public

From the seven letters received from members of the public, five of these comments related to accessing GPs. Respondents felt that GPs ‘clearly cannot cope with the patient levels they have already’ which ‘will this put added pressure on A&E, GPs and out of hours GPs on weekends?’.

Engagement was also raised by 2 respondents as they would struggle to attend the meetings that had been scheduled due to ‘Cannock and Hednesford meetings are being held during the working day’ and questioned whether ‘when organising any more meetings would it be possible to have more in the evenings’. This being a particular problem for those who work during the day.

Increasing the pressure on A&E provision was stated by a further two respondents who felt that it would be difficult to access alternatives if there is a ‘lack of reasonable opening hours’ which ‘simply leads to people defaulting to local A&E’.

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The need for enhanced communication with the public about services and options was raised by 3 respondents and one respondent wanted more focus on self-care and education. 2 respondents want more enhanced services at the MIU, whilst one wanted ‘more focus on recruiting GPs locally’ and 2 respondents wanted a wider engagement and consultation on the broader urgent care landscape.

4.7 HealthWatch Staffordshire

HealthWatch Staffordshire responded to the public consultation in detail and a summary of the feedback is outlined below

• Patient safety and unmitigated risks versus finance • Limitations on the proposals for consultation and the level of public and staff engagement in the process. • Robustness of the evidence base and the involvement of the public • Level of collaboration with HealthWatch Staffordshire and general communication • Impact of proposal Stafford hospital and tender of GP out of hours service • Future plans for an Urgent Care Centre are not currently defined • Bottlenecks at opening and closing times if the hours are reduced • Impact of planned changes to Telford A and E provision • Ability of GP out of hours provider to cope with increased demand • Adherence to the guidance provided by NHS England in relation to consultation • Access to primary care services via GPs.

HealthWatch Staffordshire felt that the consultation did not comply with NHS guidance and could not support the reduction in hours unless assurances were given in relation to the GP access pilot and the revision of the GP out of hour’s service.

4.8 Petition

The prospective Parliamentary Candidate for Cannock (Lab), Cllr Toth presented the CCG with an 828 named petition that stipulated that: “We, the undersigned demand the decision to close Cannock Hospital’s Minor Injuries Unit is reversed and that its future is guaranteed.”

The petition is not dated so we are unable to ascertain how many people signed the petition before it was announced that the CCG had reviewed its proposal and was no longer planning to shut the unit. As the petition has been submitted in relation to the closure and not the proposed revision to hours the petition has not been submitted formally to the consultation. The decision not to include this in the consultation feedback is formally acknowledged here.

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5.0 Clinical Engagement

The proposal to review MIU was debated by clinical leads at the Quality Improvement Productivity and Prevention (QIPP) Delivery and Accountability workshop on 15th May 2014. GP clinical leads and practice teams have been closely involved in the ongoing development of the proposal and the consultation exercise, having weekly meetings and conference calls.

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6.0 Appendices

6.1Formal consultees

6.2 Press Releases

6.3 Publicity and Posters

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Appendix 6.1 Formal Consultees

1. HealthWatch Staffordshire 2. Staffordshire & Stoke on Trent Partnership NHS Trust 3. NHS England, Shropshire & Staffordshire Area Team 4. Badger Out Of Hours 5. Walsall Healthcare NHS Trust 6. Royal Wolverhampton NHS Trust 7. Mid-Staffordshire NHS Foundation Trust 8. Mid Staffordshire MIND 9. GP Suite - Cannock Chase Hospital 10. NHS Community Mental Health Team 11. All Cannock Chase CCG GP Practices 12. Trust Special Administrators 13. South Staffordshire & Shropshire Healthcare NHS Foundation Trust 14. Cannock Chase Membership Scheme 15. Amanda Milling, Conservative PPC 16. Healthy Staffordshire Select Committee 17. Aidan Burley MP 18. Janos Toth, Labour PCC 19. Cannock Chase District Council 20. Bridgtown Parish Council 21. Whittington and Fisherwick Parish Council 22. Cheslyn Hay Parish Council 23. Blithfield Parish Council 24. Brereton and Ravenhill Parish Council 25. Penkridge Parish Council 26. Hednesford Town Council 27. Great Wyrley Parish Council 28. Colton Parish Council 29. Heath Hayes & Wimblebury Parish Council 30. Cannock Wood Parish Council 31. Rugeley Town Council 32. Longdon Parish Council 33. Cannock Chase District Council - 'Chase Matters Magazine' 34. Hamstall Ridware Parish Council 35. Saredon Parish Council 36. Brindley Heath Parish Council 37. Cllr Brian Edwards - South Staffs District Council 38. Cllr Mike Wilcox - Lichfield District Council 39. Cllr Roger Lawrence - Wolverhampton District Council 40. Cllr Michael Heenan - Stafford Borough Council

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41. Julian Mott - East Staffordshire Borough Council 42. Cllr Sean Coughlan - Walsall Council 43. Chase Day Service 44. VAST Head Office 45. Chase Council for Voluntary Service 46. Citizens Advice Bureau - Cannock 47. Citizens Advice Bureau – Chase 48. Landywood District Voluntary Help Centre 49. Citizens Advice Bureau - Cheslyn Hay 50. Chase Council for Voluntary Service 51. Homestart Lichfield and District 52. Carers Association South Staffordshire 53. Chase Dental Practice 54. Chase Dental Care 55. Christopher Bird Dental Care 56. Cannock Dental Practice 57. Cannock Dental Care 58. Oasis Dental Care Ltd 59. Dentaire Dental Care 60. Valley Centre Dental Practice 61. ADP Dental Care Ltd 62. Heath Hayes Dental Care 63. Avondale House Dental Practice 64. Khiroya Dental Surgery 65. Birchwood Dental Practice 66. Armitage Dental Practice 67. Wrights Dental Practice 68. Hanbury House 69. Barton House Nursing Home 70. 35 Hill Top View 71. Hawksyard Priory Care Home 72. Ashcroft Hollow Nursing Home 73. The Old Vicarage Nursing Home 74. Vicarage Court Nursing Home 75. White Lodge Respite Unit 76. Oak Tree House 77. Marlyn House 78. Grace Moor Court Sheltered Housing 79. Abbey Court Nursing Home 80. Alma Court Care Centre 81. Marquis Court - Tudor House 82. Marquis Court - Windsor House 83. Kingsley Cottage 84. Hathaway House

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85. Needwood House Nursing Home 86. Leafdown 87. The Heathers 88. Marquis Court 89. The Grange 90. Briar Hill House 91. Copperdown Residential Home 92. Talbot House Nursing Homes 93. Hill Top View 94. Lakeview Care Homes 95. Waters Edge 96. The Conifers Nursing Homes 97. Catherine Care 98. Hob Meadow 99. Horse Fair Care Home 100. Four Seasons Nursing Home 101. Nethermoor House 102. Lanrick Cottage 103. Lanrick House 104. Lee Winters 105. Mavesyn Ridware House 106. Cannock & District Multiple Sclerosis Society 107. National Ankylosing Spondylitis Society 108. The Stroke Association 109. Mencap Homes Foundation 110. Mencap 111. Pain Management, Sandy Lane Health Centre 112. Darby & Joan Club (WRVS) - Cannock (Norton Canes) 113. Lively Tiger - Tai Chi 114. Countywide Handyperson Service in Staffordshire 115. Abbots Bromley Community Transport Scheme 116. Dollond & Aitchison 117. Chase Eyecare 118. Boots Opticians 119. Philip Howard Opticians 120. Vision Plus Cannock 121. Boots Opticians 122. Portland Eyecare 123. Vision Plus Rugeley 124. Kelcher Optometrists 125. Co-operative Pharmacy – Hednesford Street Cannock 126. Boots the Chemist - Cannock Orbital Retail Park 127. Co-operative Pharmacy -Market Place 128. Minster Pharmacy- Cannock

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129. Your local Boots Pharmacy - Rugeley 130. Co-operative Pharmacy Bideford Way 131. Cornwells Chemists Limited – Chadsmoor 132. Boots Pharmacy – Church Street Cannock 133. Sainburys Pharmacy 134. Co-operative Pharmacy - Pye Green Road 135. Nucare Pharmacy 136. Lloyds Pharmacy Limited Hednesford 137. Co-operative Pharmacy – Norton Canes 138. Rawnsley Pharmacy 139. Co-operative Pharmacy – Market Hall Street 140. Bains Pharmacy Limited 141. Tesco In-store pharmacy 142. Lloyds Pharmacy Limited Hednesford – Valley Health Centre 143. Colliery Pharmacy 144. Brereton Pharmacy 145. Lloyds Pharmacy Limited- Victoria Shopping Centre Hednesford 146. Boots the Chemist – Rugeley 147. Your local Boots Pharmacy - Armitage 148. Cornwells Chemists Limited 149. Stevenson Pharmacy 150. Lloyds Pharmacy Limited – Sandy Lane Health Centre – Rugeley 151. Fernwood Drive Pharmacy 152. Northwood Dispensing Chemist Limited 153. Morrisons Pharmacy 154. Childrens Centre - Churchfield 155. Children’s Centre - Western Springs 156. Children’s Centre - Cannock 157. Children’s Centre - Norton Canes 158. Children’s Centre - Bridgtown 159. Children’s Centre - Hednesford 160. Children’s Centre - Hungtington 161. Children's Voice Project 162. Cannock Girl Guiding 163. Cannock & District Scout Association 164. St John Ambulance (plus Cannock Badgers) 165. Cannock Youth & Community Centre 166. Chase Village Kids Club 167. New Crazy Saints Youth Club 168. Norton Canes Family Fun Club 169. Tiddlywinks Pre-School 170. Jubilee Playgroup 171. ADHD Lighthouse Support Group 172. Moorhill Pre-School & Fun Club

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173. Heath Hayes Youth Club 174. Friends of Longford Primary 175. Chase Area Pregnancy Centre 176. Redhill Robins Daycare Centre 177. Essington Youth Council 178. Ridgeway PTFA 179. Little Angels Playgroup 180. RACE for Independence (YMCA) 181. Chase Young Farmers 182. BCYS - Our Lady of Lourdes Youth Club 183. Donna Louise Trust 184. Action 4 Children 185. Florence Street Methodist Church Youth Group 186. Acorn's Children Hospice 187. Rascowls B4 & After School Club 188. YMCA Rugeley 189. Rugeley Young People's Partnership 190. Hill Ridware Youth Club 191. Little Springs 192. Parent Champions 193. Prince of Wales Youth Theatre 194. Green Turtles Swimming Club 195. KONCAS Youth Club 196. Heath Hayes Early Learners

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Appendix 62 Press Releases

Press Release Date: 28 April 2014

Public Consultation Announced on Cannock Minor Injuries Unit

Health bosses have announced that they are to carry out a statutory three month consultation into the future of Cannock Minor Injuries Unit.

Representatives of Cannock Chase and Stafford and Surrounds Clinical Commissioning Groups attended the County Council’s Healthy Staffordshire Select Committee today to outline their priorities over the next two years.

The CCGs set out their proposals which have been developed as they both face multi-million pound financial deficits. As part of this, the CCG’s decommissioning and disinvestment proposals were outlined to councillors.

In Cannock, the two main areas for discussion were:

• The potential closure of the Minor Injuries Unit (MIU) in Cannock. This is a small unit within the hospital that provides a nurse practitioner led minor injury service. Current analysis shows that up to 40% of cases at the unit are for minor illnesses, which could be more appropriately managed within Primary Care or through self-management. The unit does not have radiology provision so that patients who need an x-ray are seen and assessed before being sent on to an acute hospital meaning they have to go to two places for treatment. • The permanent closure of Littleton Ward at Cannock Chase Hospital. Littleton Ward is a GP run ward that provides health care services for patients that don’t need to be in an acute hospital or need care before they are sent home. In December 2013 the MSHFT informed the CCG that it would not be able to provide nursing staff for Littleton Ward. As a result the ward was closed, temporarily. Over the past four months, the CCG has been investigating the opportunity to move care from the acute hospital into the community. • Councillors told the CCG that they want them to carry out a three-month public consultation on the potential closure of the MIU. They noted the other

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proposals.

The CCG also outlined the pressures they faced in 2013 with a significant rise in the number of people being referred to hospital, attending Accident and Emergency Departments and increases in emergency admissions to hospital. There have also been further increases in costs of: • Continuing Health Care • Specialised services • Prescribing Costs

The decommissioning and disinvestment proposals form part of a number of actions to bring down excess costs and help deliver savings.

Cannock Chase Chair Dr Johnny Mcmahon CCG said: “We know that the current configuration and healthcare service provision in Cannock is both clinically unsustainable and unaffordable. The CCG is going to have to make some very tough decisions in order to balance the health needs of our patients within the financial resource available to ensure the services we deliver are clinically and cost effective. As a result the CCG’s Governing Body has approved a ‘Decommissioning and Disinvestment of Services Policy,’ and the future of some services including the Minor Injuries Unit will be considered using this policy. This isn’t just about balancing the books – this is about looking at whether existing services are fit for purpose and whether we are using our resources as effectively and efficiently as possible. Our figures show that up to 40% of the activity carried out at the MIU is for patients with minor illnesses which should be managed within primary care or by patients self- managing these ailments themselves. We also now of course have NHS 111 which patients can access 24-7 as well as the Out of Hours Service.

The CCG’s Chief Officer Andrew Donald said: “The Keogh Report in 2013 also set out the vision of emergency and urgent care as having urgent care centres closer to home and if there were to be a change in service in the future, the CCG will consider developing an urgent care centre in the town. We will be carrying out a full consultation exercise with the public to get their views, explain our reasoning and discuss future provision for the town.”

The CCG will now be pulling together the consultation document that will be shared publically and will be issuing details shortly on the consultation process.

To read the Decommissioning and Disinvestment Policy please go to either of the CCG’s websites. www.cannockchaseccg.nhs.uk/ or www.staffordsurroundsccg.nhs.uk/

Ends

For more information contact Richard Caddy Communications and Press Manager Tel: 01782 298 167 Email: [email protected]

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Press Release

Date: 11 August 2014

Consultation launched on plans for Cannock Hospital's Minor Injuries Unit

Leading doctors in Cannock Chase are urging the public to offer their thoughts on plans to operate reduced hours at the Minor Injuries Unit at Cannock Hospital.

Members of Staffordshire County Council’s Healthy Staffordshire Select Committee today (August 11) recommended Cannock Chase Clinical Commissioning Group (CCG) undertake a four-week public consultation on the plans.

The scrutiny committee have been reviewing the proposals in detail since they were submitted as part of the CCG’s operational plans for 2014/15 – 2015/16 on 9 June 2014.

The Healthy Staffordshire Select Committee met with members of the CCG and Cannock-based GPs on 24 July, who presented four options for reconfiguration of the current service – with a description which included the benefits, risks and costs of each – which were discussed in detail.

The preferred option – on the basis of thorough analysis of the data – is for the MIU to operate reduced hours with support from primary care.

Chief Officer of Cannock Chase CCG, Andy Donald, said: "It is important to acknowledge that the need to look at alternative arrangements for Cannock Hospital’s MIU is nothing to do with the current service provided by the staff of that unit.

“The team at the MIU do an exceptional job,” he said. “However, it became clear to us that the service was not being used as it was first envisaged.

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“We are determined to work with staff to deliver a vibrant and efficient service, that offers the people of Cannock Chase the care they are deserve, under any new arrangements.

“In accordance with the recommendations of the Staffordshire County Council’s Healthy Staffordshire Select Committee to conduct a four-week consultation with the public over the proposals, the CCG will now produce a full consultation document, outlining the background and context to the proposal, and the ways in which local people and other stakeholders can feed back their views."

The public consultation is set to take place between September 1 and September 28 and more information about ways in which the public can participate will be made available over the coming weeks.

Ends

For more information contact

Richard Caddy Communications and Press Manager Tel: 01782 298 167 Email: [email protected]

Robin Scott Press and PR Officer Tel: 01782 401048 Email: [email protected]

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Press Release

Date: 26 August 2014

Cannock Minor Injuries Unit Consultation Details Announced

The consultation into the Cannock Minor Injuries Unit will start next month.

Cannock Chase Clinical Commissioning Group (CCG) has announced details of the forthcoming consultation which will run from Monday September 1st to Sunday September 28th.

The CCG want to engage with as many stakeholders, patients and members of the public as possible on their proposal to operate a reduce hours service at the Minor Injuries Unit. The CCG’s preferred option is to retain the unit but reduce its opening hours so that it remains open when patients use it the most. It comes after CCG data shows the number of patients attending the unit drops significantly after 7pm.

A consultation document outlining the background and context to the proposal in more detail and the way in which stakeholders and the public can feed back their views is being produced. It will be publically available from September 1st 2014.

A series of meetings have also been arranged, which the public are invited to attend so they can share their views on the proposal:

• Wednesday September 3rd 2014, 2pm – 4pm, Avon Business and Leisure Centre, Avon Road, Cannock, WS11 1LH • Wednesday September 10th 2014, 10am – 12 noon, The Aquarius Ballroom, Victoria Shopping Park, Hednesford, WS12 1BT • Thursday September 18th 2014, 6pm – 8pm, Rugeley Rose Theatre and Community Hall, Taylors Lane, Rugeley, Staffordshire, WS15 2AA • The CCGs Annual General Meeting (AGM) is taking place on Thursday September 4th 2014 between 6:30pm and 8:30pm. It is an opportunity for the public to attend to hear about the CCG’s achievements and priorities over the last 12 months and its aims for the future. There will also be time to ask any

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questions you may have at the end of the AGM. It’s being held at the Aquarius Ballroom, Victoria Shopping Park, Hednesford, WS12 1BT.

CCG Chairman Dr Johnny Mcmahon said: “I would urge as many people as possible to book a place and attend one of our meetings so they have chance to feed into the consultation process and into the final decision. We are using a range of ways to engage with people as part of the consultation, via face to face meetings, through an on-line survey and people can also fill in a hard copy of the consultation document which they can request a copy of.

He added: “This consultation is about a proposal to reduce the hours at the Minor Injuries Unit from 8am until midnight to 11am until 7pm. This is because our data shows that the majority of patients use the unit during certain time periods.

“We need to ensure that local people are able to access the services they need at the Minor Injuries Unit, at times our data shows they need access to it the most. At the same time we also need to ensure that the service we are providing is cost effective,” Dr Mcmahon said.

To book a place at one of the events, request a hard copy of the document once it is available, or to find out more please email [email protected] or call 0300 404 2999 ext: 6852

You will also be able to find out more detail and fill in an on-line survey at our website www.cannockchaseccg.nhs.uk from September 1st 2014.

Ends Notes to Editor Cannock Minor Injury Unit (MIU) was opened at Cannock Chase Hospital in 2006 and is run by Staffordshire and Stoke on Trent Partnership NHS Trust (SSOTP). It is a Nurse-Led Minor Injury Unit which is open seven days a week, 365 days a year from 8am until midnight. Access to the unit is open and people can walk in, be seen and treated without the need for an appointment. The ‘Out of Hours’ service (OOH) also operates from the same site, in a different part of the hospital, 6:30pm until midnight with further service being supported from the Walsall Healthcare NHS Trust, Manor Hospital site from midnight until 8am.

In the past few years the MIU has seen an influx of patients seeking treatment for minor illness. Patients have arrived to get treatment for illnesses like asthma, toothache, headaches and earaches, which the MIU was not set up to treat. Clinical Commissioning Group (CCG) information shows that up to 40% of cases at the unit are for minor illnesses, which could be treated by a GP, at a community pharmacy or by self-care in the home.

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at another hospital. This means that patients are seen in two different places unnecessarily and, as well as being inconvenient for the patients themselves this also leads to extra costs for the CCG.

For more information contact Richard Caddy Communications and Press Manager Tel: 01782 298 167 Email: [email protected]

Robin Scott Press and PR Officer Tel: 01782 401048 Email: [email protected]

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Press Release

Date: 09 September 2014

Further Cannock Minor Injuries Unit Consultation Meeting Announced

Health bosses have organised a further evening meeting as part of the consultation into the Cannock Minor Injuries Unit - in response to public feedback.

Cannock Chase Clinical Commissioning Group (CCG) held the first consultation meeting last week where the public flagged that they wanted to see a further evening meeting arranged in Cannock.

The CCG listened and announced today that another meeting will be held on Wednesday 24th September at the Civic Ballroom at Cannock Chase District Council, between 6pm and 8pm, which the public are invited to attend.

The CCG want to engage with as many stakeholders, patients and members of the public as possible on their proposal to operate a reduce hours service at the Minor Injuries Unit.

The CCG’s preferred option is to retain the unit but reduce its opening hours so that it remains open when patients use it the most.

It comes after CCG data shows the number of patients attending the unit drops significantly after 7pm.

A consultation document outlining the background and context to the proposal in more detail and the way in which stakeholders and the public can feed back their views has been produced.

The public and stakeholders are invited to attend the public meetings below so they can share their views on the proposal:

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• Wednesday September 10th 2014, 10am – 12 noon, The Aquarius Ballroom, Victoria Shopping Park, Hednesford, WS12 1BT • Thursday September 18th 2014, 6pm – 8pm, Rugeley Rose Theatre and Community Hall, Taylors Lane, Rugeley, Staffordshire, WS15 2AA • Wednesday September 24th, 6pm – 8pm, Civic Ballroom, Cannock Chase Council, Beecroft Road, Cannock, Staffordshire, WS11 1BG

CCG Chairman Dr Johnny McMahon said: “We have listened to public feedback and arranged an evening meeting in Cannock for later this month and I would urge people to attend so they can really have their say.

"The public also told us they wanted to see more information communicated about the range of health services available and as a result we are advertising them this week in a series of newspapers.

"As we head towards the autumn and into winter, as a CCG, we will ensure that we continue to promote the health services available to the public of Cannock and surrounding areas, in a range of ways.

He added: “In terms of the consultation I would urge as many people as possible to book a place and attend one of our meetings so they have chance to feed into the consultation process and into the final decision.

"We are using a range of ways to engage with people as part of the consultation, via face to face meetings, through an on-line survey and people can also fill in a hard copy of the consultation document which they can request a copy of.”

To book a place at one of the events, request a hard copy of the document, or to find out more please email [email protected] or call 0300 404 2999 ext: 6852

You will also be able to find out more detail and fill in an on-line consultation survey at our website www.cannockchaseccg.nhs.uk

Ends

Notes to Editors

Cannock Minor Injury Unit (MIU) was opened at Cannock Chase Hospital in 2006 and is run by Staffordshire and Stoke on Trent Partnership NHS Trust (SSOTP). It is a Nurse-Led Minor Injury Unit which is open seven days a week, 365 days a year from 8am until midnight. Access to the unit is open and people can walk in, be seen and treated without the need for an appointment. The ‘Out of Hours’ service (OOH) also operates from the same site, in a different part of the hospital, 6:30pm until midnight with further service being supported from the Walsall Healthcare NHS Trust, Manor Hospital site from midnight until 8am.

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Commissioning Group (CCG) information shows that up to 40% of cases at the unit are for minor illnesses, which could be treated by a GP, at a community pharmacy or by self-care in the home.

Nearly one in four of all patients who come to the MIU are sent to another NHS service for further treatment because the unit does not have access to X-ray equipment or other tests and as it is nurse led there are no doctors on site. There is also no access to a hospital doctor if further medical advice is needed. For these services, and other services, patients are sent on to Accident and Emergency (A&E) at another hospital. This means that patients are seen in two different places unnecessarily and, as well as being inconvenient for the patients themselves this also leads to extra costs for the CCG.

The MIU’s current opening hours are from 8am until midnight. The CCG’s proposal would be to reduce the hours so that it opens between 11am and 7pm. CCG data shows that the majority of patients use the unit during certain time periods and the numbers attending reduce after 7pm.

For more information contact

Richard Caddy Communications and Press Manager Tel: 01782 298 167 Email: [email protected]

Robin Scott Press and PR Officer Tel: 01782 401048 Email: [email protected]

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Appendix 6.3 Publicity

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REPORT TO THE Clinical Commissioning Group Governing Body Meeting TO BE HELD ON: Thursday 6th November 2014

Subject: Personal Health Budgets Board Lead: Rob Lusuardi Officer Lead: Christine Brown For For For For Recommendation:  Approval Ratification Discussion Information

PURPOSE OF THE REPORT: To seek approval of the attached Policy from the Board

To provide assurance to the Board of the actions taken and being taken to ensure the CCG complies with its legal duties and responsibilities in relation to the implementation of Personal Health budgets.

KEY POINTS:

Personal Health Budgets (PHBs) are part of a model of person-centred care that also includes support for self-management, shared decision making, improving information and understanding, and promoting prevention

All 211 Clinical Commissioning Groups across England have signed up to the NHS England personal health budget support programme

From April 2014 people eligible for NHS Continuing Health Care have had the “right to ask” for a personal health budget. From October 2014 this will be strengthened and this group will have the “right to have” a personal health budget.

From April 2015 people with long term conditions must have a personalised care plan (which could include a PHB if the CCG think they would benefit).

The National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012, the National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) Regulations 2013 and the National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) (No. 3) Regulations 2014 along with the National Health Service (Direct Payments) Regulations 2013 and the National Health Service (Direct Payments) (Amendment) Regulations 201317 set out CCGs’ legal duties relating to NHS Continuing Health Care and Continuing Care rights and personal health budgets. These include duties to Page | 1

Item No: 09 Enc: 07 publicise and promote their availability, to provide information, advice and support, to consider requests for personal health budgets and to ensure they have the systems and processes in place to be able to make this provision.

Staffordshire CCGs had set up a Personal Health Budgets (PHBs) Steering Group in 2013, and have engaged the services of a project manager from within Staffordshire County Council to roll out PHBs out locally across Staffordshire

A part-time interim PHB Lead was also appointed to progress the work in February 2014 to support the PHB Project Manager in the production of the attached PHB Policy for the Staffordshire CCGs in line with the National guidance and in the development of patient information, and guidance for practitioners.

Further partnership work is ongoing with Shropshire CCG in the recruitment of PHB Implementation Manager and Care Manager to take PHBs forward with the CHC team and to work with the CCG Commissioners to support the roll out of personal health budgets to people with long term conditions in April 2015.

RELEVANCE TO KEY GOALS To reduce health inequalities across N/A Cannock Chase through targeted interventions.

To identify and support patients with The implementation of Personal Health Budgets should Long Term Conditions to ensure care increase patient choice and control, and enhance patient delivery closer to home. experience for those in receipt of CHC and those with long term conditions.

To improve and increase overall life N/A expectancy.

To develop integrated services with N/A simple, easy access.

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IMPLICATIONS Legal and/or Risk People who are already receiving NHS Continuing Care will have a “right to ask” for a personal health budget from April 2014 and from October 2014 this group will further be given the “right to have” a Personal Health Budget . Governance frameworks required to mitigate financial and clinical risks to the CCGs

CQC The wellbeing of the individual is paramount. Access to a personal health budget will be dependent on professionals and the individual agreeing a care plan that is safe and will meet agreed health and wellbeing outcomes. There should be transparent arrangements for continued clinical oversight, proportionate to the needs of the individual and the risks associated with the care package.

Patient Safety The implementation of Personal Health Budgets should increase patient choice and control, and enhance patient experience for those in receipt of CHC and those with long term conditions.

Patient Engagement From October 2014 all patients eligible for continuing healthcare funding living in the community have the right to have for a personal health budget

Financial The CCG needs to acknowledge that this is a very different way of working, and it may be a challenge for professionals to balance the need to work alongside a service user to deliver their choices, and a concern over whether a proposed activity or service provision will meet the need and deliver the outcomes. The implementation of PHBs should provide the patient with more autonomy and control of his care Sustainability Equality of access to personal health budgets will be imperative Workforce / Training All staff in contact with patients in receipt of Continuing Healthcare will require various levels of PHB training

RECOMMENDATIONS / ACTION REQUIRED: The CCG Governing Body is asked to: • To approve the attached Personal Health Budgets Policy for the future management of care provision to patients eligible for Continuing Health Care Funding and future patients with long term conditions across Cannock Chase

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Not KEY REQUIREMENTS Yes No Applicable Has a quality impact assessment been undertaken?  Has an equality impact assessment been undertaken?  Has a privacy impact assessment been completed ?  Have partners / public been involved in design?  Are partners / public involved in implementation?  Are partners / public involved in evaluation? 

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Personal Health Budgets Operational Policy: Executive Summary

From April 2014 everyone eligible for Continuing Health Care had the right to ask for their care to be delivered as a Personal Health Budget (PHB) and CCGs needed to be in the position to respond to any requests. From October 1st 2014 those eligible for Continuing Health care NHS funding will have the right to have a PHB. The right has also included children with special educational needs and disabilities who are in receipt of an integrated budget. As of April 2015, CCG Commissioners should be ready to offer a PHB to anyone with a long term condition who could benefit from one.

This summary explains the purpose and contents of each document contained within the Personal Health Budget Operational Policy. The key documents that the CCG need to note, are the Financial Framework and the Delegation of Level 3 tasks policy. Other documents have been produced and will be made available to support the practical implementation of PHBs for service users, carers and practitioners

Risk Management

CCGs are required to commit to the promotion of Personal Health Budgets to service users, as well as supporting them to manage risks positively, proportionately and realistically. Supporting people to make informed decisions with an awareness of risks in their daily lives enables them to achieve their full potential and to do the things that most people take for granted.

Enabling people to exercise choice and control over their lives, and therefore their own management of risk, is central to achieving better outcomes for individuals. A degree of risk can be accommodated within the aim of enhancing the quality of people’s lives.

CCGs are required to acknowledge that service users who have the mental capacity to make a decision, and choose to live with a level of risk, are entitled to do so. CCGs are required to assure that Care Providers document clearly any evidence of decision making and rationale in relation to the management and reduction of risk where appropriate or necessary. This will be considered as part of the PHB approval process that has been put in place clinically and financially for the CCGs across Staffordshire.

Health Professionals will be required to ensure that any clinical and financial risks identified are fully understood and managed in the context of ensuring that the individual’s needs and their best interests are safeguarded and that appropriate governance arrangements are in place.

The CCG needs to acknowledge that this is a very different way of working, and it may be a challenge for professionals to balance the need to work alongside a service user to deliver their choices, and a concern over whether a proposed activity or service provision will meet the need and deliver the outcomes.

The Staffordshire CCGs PHB Steering Group will be required to support the development of a shared forum of clinical and finance staff to discuss complex, unusual or higher risk PHB requests which will include representation from the appropriate CCG. This will support shared learning, and the development of a shared approach to improving quality of care to the service user and identifying possible financial risks.

1. PHB Operational Policy

The Operational Policy outlines the principles for achieving the implementation of personal health budgets by balancing choice, risk, rights and responsibilities. It recognises that, in the right circumstances, a positive approach to risk can promote a culture of choice and independence that encourages responsible support and shared decision making. The Government's aim is that in future, everyone in England who could benefit

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Item: 09 Enc: 07 from one will have the option of a personal health budget. This commitment includes introducing personal budgets for parents of children with special educational needs and disabilities which may include funding from Social Care and Education.

Contents of the PHB Operational Policy

Policy document Appendices and associated documents CCG Responsibility 1. PHB Operational Policy a. PHB Financial Framework (V2) This requires ratification (V3 280714) b. Delegation of Level 3 tasks CCG Policy 2013 by each CCG Governing for Staffordshire PHB clients (V2.1) Body c. Practical guidance for Personal Health Budgets in Continuing Healthcare (V4)

2. PHB Financial a. PHB Agreement for CCGs (Staffordshire) (V3) This is required to be Framework (V2) b. PHB Budget Setting Guidance (V2) agreed by each CCG c. PHB Budget Setting Tool (V1.6) Finance and d. What can a PHB be spent on (V1) Performance Committee 3. Delegation of Level 3 This requires approval by tasks CCG Policy 2013 each CCG Quality for Staffordshire PHB Committee clients (V2.1) 4. Practical guidance for a. CHC and PHB approval process (V3) Incorporated in the Personal Health Budgets b. Support plan summary and checklist (V3) policy for ratification by in Continuing Healthcare c. PHB Risk Enablement Panel Referral Form CCG Governing Body (V4) (V2) Guidance has been d. Risk Enablement Guidance Notes (V3) agreed by the PHB e. PHB Support Plan Template (V4) Steering Group f. Seven criteria for a good health support plan (V1)

2. Financial Framework

The Financial Framework document describes the financial mechanisms to be used by Staffordshire CCGs to deliver Direct Payments for Healthcare in line with the requirements in the National Health Service (Direct Payments) Regulations 2013 as amended by the National Health Service (Direct Payments) (Amendment) Regulations 2013.

Direct payments for healthcare are one way of managing a personal health budget. An agreement is required by the CCGs to approve this new additional way in the future commissioning and finance management of care provision to patients eligible for Continuing Health Care Funding and future patients with long term conditions.

a. PHB Agreement for CCGs This agreement will be signed by personal health budgets holders and CCGs when the individual chooses to take a direct payment. It covers the responsibilities of direct payment holders to spend the money in accordance with the agreed support plan. Regular checks will be undertaken to ensure that the money is being spent in line with the agreed care and records are kept accordingly. This agreement has been shared with the CCG solicitors for approval.

Enc 06-2 CC CCG GB - PHB policy exec summary, Created October 14

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b. Budget Setting Guidance This document explains the process for setting provisional (indicative) budgets for prospective personal health budget holders. When possible, the approach will use existing cost of an individual’s care package. Other methods to support the calculation of the provisional budget are the use of a care specification that is completed by a CHC Nurse and a budget setting tool.

c. PHB Budget Setting Tool The tool will be used for the calculation of provisional (indicative) budgets. This is required to provide an estimate of the budget that will be made available to people and families before they begin support planning. It is based on the scores in the categories covered by the Decision Support Tool. (for CHC patients only)The tool has been adapted from one that was developed during the Manchester PHB pilot programme.

A key principle of personal health budgets is to provide people with an estimate of the funding that will be made available. Best practice in support planning states that providing an early upfront amount can help people to better plan their care and support. The tool will be used when an existing cost is unavailable; instances when this may occur are detailed in the Budget Setting Guidance.

d. What a PHB can be spent on This summarises the principles of how personal health budgets should be used; with a focus on outcomes and what can be achieved rather than what it is being spent on.

There is also a list of what a personal health budget cannot be spent on which is based on national guidance.

3. Delegation of Level 3 tasks CCG Policy 2013 for Staffordshire PHB clients

This guidance provides clarity on the key issues relating to delegation of care from employed registered professionals to third party individuals who are not employed by Staffordshire and Stoke on Trent Clinical Commissioning Groups (CCGs). This will provide assurance that delegation is always undertaken within the clear parameters of safe delegation as stated by the Nursing and Midwifery Council (NMC).

This document needs to be ratified by each Clinical Commissioning Group in order for people that are receiving a personal health budget who wish to employ their own personal assistants to meet their care needs can, if they choose to, delegate clinical care tasks to them.

4. Practical guidance for Personal Health Budgets in Continuing Healthcare

The practical guidance is a resource for staff involved in the delivery of personal health budgets for Continuing Healthcare patients. It breaks down the seven step process that has been adopted in Staffordshire; explains what tasks should be undertaken as part of each step, who will be responsible for ensuring that these tasks are completed and also the likely individuals that will, or could, carry out each tasks.

At present the guidance is a proposed approach for how personal health budgets will operate when a dedicated PHB team is established and the following has been developed to assist practitioners with the process

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a. CHC and PHB approval process This process flow describes the stages of the approval process and specifically the involvement of Continuing Healthcare with the personal health budget process, highlighting additional tasks that need to be carried out when a personal health budget is being set up.

b. Support plan summary and checklist This document will be used as part of the approval process of support plans. It is made up of three parts. The Support Plan summary should be signed by the service user or their representative, the appropriate clinician overseeing the support plan, the PHB Lead and the CHC Lead.

c. PHB Risk Enablement Panel Referral Form Where there is a complex or challenging risk issues in relation to provision of a PHB a clear process has been identified to assist in resolving the issues. The referral form is also included as part of the support plan summary and checklist.

d. Risk Enablement Guidance Notes These notes support the Risk Enablement Panel.

e. PHB Support Plan Template This template is to form part of the information pack that will be given to people who express an interest in having a personal health budget.

Best practice in support planning is to promote self-directed development of support plans and that it can be presented in a way that best suits them. In combination with the Support plan summary and use of the seven criteria for a good health support plan this should allow people

f. Seven criteria for a good health support plan This document explains the criteria that must be covered by a support plan. This is to be used as reference as part of the approval process for evaluation of the quality of support plans to ensure that what is included is lawful, likely to be effective, affordable and appropriate.

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PHB Policy Version 3 July 28th 2014

Personal Health Budgets Operational Policy

Date Approved

Date Ratified

Signature

Reference Number Version 03 Lead Officer Christine Brown Review Date

Table of Contents

1. INTRODUCTION ...... 3

2. THE SCOPE OF THE POLICY ...... 3

3. UNDERPINNING PRINCIPLES ...... 3

4. IMPLEMENTATION OF THE POLICY ...... 4

5. PURPOSES AND PRINCIPLES OF PERSONAL HEALTH BUDGETS ...... 4

6. COMMUNICATION WITH PATIENTS ...... 5

7. THE STAFFORDSHIRE APPROACH ...... 5

8. PATIENT CHOICE ...... 6

9. RESPONSIBLITIES OF KEY STAFF ...... 7

10. THE PROCESS ...... 7

11. TRAINING ...... 8

12. FINANCE ...... 8

13. REVIEWS AND MONITORING ...... 8

14. DISPUTES/DISAGREEMENTS ...... 9

REFERENCES ...... 9

APPENDICES ...... 10

1. INTRODUCTION

1.1 Background

Following the evaluation of the national pilot programme for personal health budgets in November 2012 the government announced that anyone eligible for NHS Continuing healthcare will have “the right to ask” for a personal health budget. From October 2014 for people not in residential or nursing homes placements this will become a “right to have”.

The government also re-confirmed a commitment in the NHS mandate that anyone with a long term condition, who can benefit from a personal health budget will have the “right to ask” by April 2015.

Staffordshire Clinical Commissioning Groups (CCGs) which includes Stoke-on-Trent are to introduce personal health budgets (PHBs) to those eligible for NHS Continuing Healthcare.

This policy outlines the principles for achieving the implementation of personal health budgets by balancing choice, risk, rights and responsibilities. It recognises that, in the right circumstances, a positive approach to risk can promote a culture of choice and independence that encourages responsible support and shared decision making. The Government's aim is that in future, everyone in England who could benefit from one will have the option of a personal health budget. This commitment includes introducing personal budgets for parents of children with special educational needs and disabilities which may include funding from Social Care and Education.

1.2. What is a Personal Health Budget?

A personal health budget is an amount of money to support a person's identified health and wellbeing needs, planned and agreed between the person and their local NHS team.

By April 2014, people eligible for fully funded NHS continuing healthcare will have the right to ask for a personal health budget, including a direct payment for healthcare. This becomes a right to have a personal health budget in October 2014. The NHS will also be able to offer personal health budgets more widely - for example to people with long term health conditions or people with mental health problems that could benefit.

2. THE SCOPE OF THE POLICY

The policy applies to all patients who are eligible for continuing health care funding living in the community (not in nursing or residential care homes) that are or were registered with Staffordshire General Practitioners at the time of decision. This policy builds on the existing collaborations and joint protocols between Multi Agencies and local social care. Personal Health Budget will be discussed with the patient following their first three month review or following their Continuing Care review.

3. UNDERPINNING PRINCIPLES

Notional Budgets and third party budgets could be carried out under existing NHS legislation prior to the pilot programme. Direct payments required new legislation. The 2010 Health Act allowed Primary Care Trusts (as they were then) to legally make direct payments using NHS 3

money. The Act stated that personal health budgets pilot sites with specific permission from the Secretary of State for Health can make direct payments for the pilot period. Following the pilot period, the Act allowed the Secretary of State to extend direct payments to other commissioning organisations. Direct payments powers have been extended to all Clinical Commissioning Groups in England. The principles in this policy are underpinned by the National Health Service (Direct Payments) Regulations 2013 as amended by the National Health Service (Direct Payments) (Amendment) Regulations 2013 and the National Framework for NHS Continuing Healthcare and NHS funded care (DoH 2012)

Procedures relating to the protection of vulnerable adults, use of the Mental Capacity Act (2005) will be followed and wherever appropriate interpreting or advocacy services will be provided.

Local Multi-Disciplinary guidelines will be adhered to in conjunction with Staffordshire Continuing Healthcare Policy.

4. IMPLEMENTATION OF THE POLICY

The successful implementation of this policy is based upon a robust system of Multi- Disciplinary and inter-agency working within local communities. The Clinical Commissioning Groups will work collaboratively with external organizations to ensure that t the policy is a working document, which takes into account current legislation and local policies and procedures.

5. PURPOSES AND PRINCIPLES OF PERSONAL HEALTH BUDGETS

The person with the personal health budget (or their representative) will:

• be able to choose the health and wellbeing outcomes they want to achieve, in agreement with a healthcare professional • know how much money they have for their health care and support • be enabled to create their own care plan, with support if they want it • be able to choose how their budget is held and managed, including the right to ask for a direct payment • be able to spend the money in ways and at times that make sense to them, as agreed in their plan.

The approach to personalisation and personal health budgets in the NHS: • The NHS stands by its promise that it is there for everyone, based on need not ability to pay. • The NHS care and support you get should be safe and effective. It should be a positive experience. • Personal health budgets should help people to get a better service not make things worse. • You will not have to get healthcare in this way if you do not want to. • You should have as much control over decisions as you want

6. COMMUNICATION WITH PATIENTS

The right to ask for a PHB will be communicated to every patient who is screened in for an assessment for NHS Continuing Healthcare from 1st April 2014. The right to have a PHB will be communicated to every patient who is screened in for an assessment for NHS Continuing Healthcare after 1st September 2014

The right to ask and the right to have a PHB will be communicated also to patients in receipt of continuing health care funding in advance of their review date. When the CCG has been asked to communicate with their representative of the patient, this communication will be sent to the representative. Where the patient is under 18 the letter will be sent to any person with parental responsibility. This communication will include an easy read version of “Understanding Personal Health Budgets” produced by the Department of Health (2013)

7. THE STAFFORDSHIRE APPROACH

7.1 Seven Step process

In Staffordshire and Stoke-on-Trent we have adopted a seven-step process support for patients to get a personal health budget.

7.2 Eligibility

From April 2014 people who are eligible for fully-funded Continuing Healthcare will have the right to ask for a personal health budget. In October 2014 this will become a right-to-have.

From September 2014 Children and families who are eligible for Continuing Healthcare will have be able to have a personal health budget as part or whole of an Education, Health and Care Plan.

The approach we will take in Staffordshire is to ensure that everyone who is eligible is offered the opportunity to access a personal health budget as a way to receive their healthcare and support.

If a patient, who is eligible for full Continuing Healthcare, asks for a personal health budget the 5

seven step process will commence at the three month review following eligibility.

In deciding whether to offer a direct payment for healthcare, the CCG must consider: • The indicative budget that the CCG is willing to offer(likely to be based on the cost of a traditional care package) • The CCG’s alternative offer of care • Whether a direct payment is appropriate given the patient’s condition • The impact of that condition on the patient’s life

The CCG will also consider both the complexity and any changing nature of the patients health needs

Where a patient (or their representative indicates to the CCG their wish to exercise their right to ask for/have a PHB, arrangements will be made to discuss this with them, including the form of PHB may be most appropriate to them

A patient who becomes eligible for continuing healthcare on a “fast track” will also be entitled to be considered for a PHB. However, as such the patient will have a terminal condition that will rapidly deteriorate; therefore the CCG will prioritise arranging a suitable care package for them.

7.3 How Personal Health Budgets are used:

Personal health budgets are intended to give people a high level of choice and control in how their care and support is provided and the flexibility to try creative and innovative solutions.

During the national pilot programme people used their personal health budget in a variety of ways; employing their own care staff (personal assistants) to support them in their home, physiotherapy, equipment and training to improve managing their own care more effectively and respite care in alternative settings..

What the patients choose to purchase through their personal health budget will be linked to their health needs and personal outcomes that are described in their support plan

8. PATIENT CHOICE

Patients and their carers are to be actively involved in all decisions regarding their care. In the majority of cases patient choice will be to return to their own home if at all possible. When this cannot be achieved safely a patient may need to transfer to a care home of their choice.

Patients and Carers are to be provided with as much information and support as possible to allow for informed decision making.

Where the CCG has been made aware that the individual may not have capacity to consent to the making of a PHB for them, the CCG will arrange for their capacity to be tested, in line with the Mental Capacity Act (2005). Where that person does not have capacity to consent for a PHB a best interest decision will be taken as to whether they should have a personal health budget.

9. RESPONSIBLITIES OF KEY STAFF

Responsibilities of key staff are laid out in detail in the National Framework for Continuing Healthcare (2012) Medical staff, Ward Nurses, Therapists, Community Nurses, Social Services and Care Co-ordinators.

As a general principle, health and social staff will be responsible for the continuing healthcare assessments of patients, which do require the involvement of multi-agency services and identification of a named Care Co-ordinator.

A Delegation of Level Three tasks to Personal Assistants employed through Personal Health Budgets for Staffordshire CCGs patients Guidance has been developed for health professionals regarding their responsibilities in identifying the key clinical skills and training is required and identifying what of these skills can be delegated to Personal Assistants (PAs) employed by patients(or their representatives) (see Appendix 1) Clinicians involved with the patient will have an important role to play helping to determine and agree the clinical competences that PAs need but decisions about how training to reach these competences needs to be identified with the patient during the support planning stage and agreed and signed up to by the patient.

10. THE PROCESS

Practice Guidance has been developed to allow health and social care professionals to understand the process and where their responsibilities lie in terms of the development of the patients personal support plan. (See appendix 2) The Support Plan will be completed by their Support Planner with the appropriate health care professional. This will include what is important to the person, what they want to see changed, how they want to be supported, how support will be managed, how the person will stay in control of their life, how the person will make the plan happen. From this will emerge a clear set of health and personal outcomes from which to commission the services required as well as a framework in which to review the patient’s care.

To enable the Personal Support Plans to be approved by the CCG the proposals for meeting the patients assessed health needs will be:

• Lawful - the proposals will be legitimately within the scope of the funds and resources that will be used. The proposals will be lawful and regulatory requirements relating to specific measures proposed will be addressed • Effective - the proposals must meet the patient’s assessed eligibility needs and support the patient’s independence, health and well-being. A risk assessment will be carried out and any risks identified that might jeopardise the effectiveness of the plan or threaten the safety or wellbeing of the patient or others must be addressed. The proposals will make effective use of the funds and resources available in accordance with the principle of best value. • Affordable - All costs will be identifies and can realistically be met within the budget. • Appropriate - the patients support plan will have clear and strong links to the patients’ health and social care outcomes.

A strategic overview flowchart can be seen in appendix 3

11. TRAINING

A joint health and social care training programme on PHBs will be arranged across Staffordshire for health and social care professionals

12. FINANCE

The support planning process helps the patient decide how they would like the PHB fund to be managed. Some people will simply not want employer’s responsibilities, and in these cases a third party arrangement may be preferred, where all money, purchases and employment contracts are handled on the patient’s behalf. Though legal responsibilities lie with the third party organisation the patient retains choice and control.

It is vital that the Continuing Healthcare budget setting methods is fully transparent t to the patients (or their representative) from the outset. No Personal Health Budget will be allocated unless the potential Personal Health Budget Holder demonstrates to the Support Planner full appreciation of the implications of PHB uptake. If a direct payment is chosen, the patient is required to sign a service agreement with the CCG, committing them to spend the budget as agreed in their support plan. They take on full employer’s responsibilities, including advertising for staff, decisions on rates of pay and employee requirements The Support Planner may help with some of these tasks. The PHB may also fund extra staff training on certain clinical tasks which has been identified within the Support Plan and also consider a contingency fund to factor in long term sickness and redundancy costs to the patient, this mechanism would allow the CCG to monitor PHB efficiency more closely

Where the PHBs are underspent, the balance will be returned to the CCG. The patient will not be permitted to spend funds on anything not identified in their personal support plan. Guidance of the process is found in Appendix 4 (Personalising Healthcare - Framework for Direct Payments of Personal Health Budgets Guidance)

National guidance provides a list of inappropriate spend: • Alcohol • Tobacco • Gambling • Debt repayment • The purchase of primary care services provided by GPs • Urgent or emergency treatment services • To pay a close family carer living in the same household except in circumstances when “it is necessary to meet satisfactorily the patient’s need for that service; or to promote the welfare the welfare of a patient who is a child” • The employment of people in ways which breach national employment regulations

13. REVIEWS AND MONITORING

The National Framework for Continuing Healthcare and Funded Nursing Care ( Nov. 2012) recommends that patients who have been deemed eligible for continuing healthcare funding should be reviewed initially at 3 months and then annually unless there are any changes in the patients’ needs. There is no national guidance regarding PHB reviews however the frequency of the reviews and monitoring should be guided by the needs of each individual and their circumstances. Some people may have relatively straightforward care arrangements others 8

may have more complex arrangements and particularly vulnerable. At the minimum, new PHB holders will have a review at three months and twelve months and yearly thereafter as the CHC Framework states. Individuals will have access to the Support Planner contact details if at any point healthcare needs change.

14. DISPUTES/DISAGREEMENTS

The Staffordshire and Stoke on Trent CCGs and the Local Authorities have the right to insist on a different support package, or end a Personal health budget if there is serious concern that the care being funded via the personal health budget is not achieving the agreed outcomes identified in the patient’s support plan, involves an inappropriate level of risk, or is proving harmful to the patient.

Complains by patients, families, professionals will be addressed in the first instance through the appropriate organisations Complaint teams

REFERENCES

Department of Health (2012) Personal health budgets guide: implementing effective care planning London

Department of Health (2012) Budget setting for NHS Continuing healthcare London.

Department of Health (2012) National Framework for NHS Continuing Healthcare and NHS funded care. London

Department of Health (2014) Guidance on Direct Payments for Healthcare Understanding the Regulations. London

NHS England (2013) The CCG Assurance Guide 2013/4: Operational Guidance London

APPENDICES

Appendix 3

Delegation of level 3 tasks to Level 3 PAs

Appendix1 Item: 09 Enc: 07

Delegation of Level 3 tasks to Personal Assistants employed through Personal Health Budgets for Staffordshire CCGs clients

Agreed at Cannock Chase Governing Body

Date: …………………………………………………………………..

Signature: …………………………………………………………….

Designation: ………………………………………………………….

Review Date: ………………………………………………………….

Agreed at Stafford & Surrounds Governing Body

Date: …………………………………………………………………..

Signature: …………………………………………………………….

Designation: ………………………………………………………….

Review Date: ………………………………………………………….

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Partners in Care

This is a controlled document. It should not be altered in any way without the express permission of the author or their representative. On receipt of a new version, please destroy all previous versions.

Document Information

Date of Issue: Next Review Date: Version: 1 Last Review Date: Author: Christine Brown Directorate: Quality

Approval Route Approved By: Date Approved:

Links or overlaps with other CCG Documents:

Amendment History

Issue Status Date Reason for Change Authorised

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Contents

1 Introduction ...... 4

2. Statement / Objectives………………………………………………………………...4

3. Definitions and Principles...... 5

4. Roles & Responsibilities ...... 5

5. Deciding on Delegation………………………………………………………………..6

6. Principles of Delegation……………………………………………………………….7

7. Consent ………………………………………………………………………………...9

8. Supervision and Training………………………………………………………………9

9. Governance Framework ...... 11

10. Monitoring, auditing, Reviewing & Evaluation……………………………………..11

11. Bibliography………………………………………………………………………….. 12

Appendix 1 Decision Matrices and Descriptors ……………………………………….13

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1 Introduction This guidance provides clarity on the key issues relating to delegation of care from employed registered professionals to third party individuals who are not employed by Staffordshire and Stoke on Trent Clinical Commissioning Groups (CCGs) This will provide assurance that delegation is always undertaken within the clear parameters of safe delegation as stated by the Nursing and Midwifery Council (NMC),

1.1 Many terms have been used to describe the practitioner who is responsible for delegating a task. This is a professional who is on a register for that particular profession, i.e., the Health Professions Council (HPC) or the Nursing and Midwifery Council (NMC). The code: Standards for Conduct, Performance and Ethics for Nurses and Midwives, states "You must establish that anyone you delegate to is able to carry out your instructions." "You must confirm that the outcome of any delegated task meets the required standards." "You must make sure that everyone you are responsible for is supervised and supported."

1.2 The terminology used to describe this group of support workers and their management, varies within and across professions and so for the purposes of this guidance, the following terms have been used:

Third party Personal Assistant (PA)

There is currently no national policy that determines a single name for this group of workers. Numerous titles exist to reflect the many and varied roles carried out. For the purposes of this guidance the term ‘PA’ describes the third party worker who has a role or task delegated to them. This may include unskilled friends, relatives or other individuals identified by the service user and/or their family. This can be either under a private employment arrangement or through an independent contractor.

Registered Practitioner This is the professional who is on a register for that particular profession, i.e., the HPC or the NMC.

2. Statement/Objective

2.1 The purpose of this guidance is to encourage all groups of staff, employed and not employed, who are engaged in the delivery of health and social care to reflect collaboratively on tasks proposed for delegation to third party PAs, in order to ensure that clients receive safe and effective care from the most appropriate person.

2.2 Health and Social Care in the UK is undergoing rapid change as healthcare organisations restructure the delivery of services in order to provide the most efficient and effective care to service users. A wide range of drivers has led to PA roles growing both in terms of number and in the scope of activities being undertaken. This has prompted an increasing number of enquiries to

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professional bodies and trade unions about their management and support. This guidance has therefore been developed to help clarify the delegation process for registered practitioners and third party PAs and the associated issues of accountability and supervision.

2.3 The issue of delegating tasks to third party PA’s is increasing in significance, as patient choice, the service user making decisions about their own care, the promotion of personalized and inclusive care and care being delivered in the community setting become accepted methods of healthcare delivery.

3. Definitions & Principles of Interpretation

3.1 Delegation is the process by which the delegator allocates clinical or nonclinical treatment or care to a competent person (the delegatee). The delegator will remain responsible for the overall management of the service user, and accountable for the decision to delegate. The delegator will not be accountable for the decisions and actions of the delegatee.

3.1.1 The registered practitioner is accountable for delegating the task and the PA is accountable for accepting the delegated task, as well as being responsible for his/her actions in carrying it out.

3.1.2 The registered practitioner cannot delegate their accountability. The PA holds accountability for their actions and could be taken through a civil court.

3.2 Level 3 Tasks: Tasks using specialised techniques. This may include:

• rectal administration, e.g. suppositories, diazepam (for epileptic seizure) • insulin by injection • administration through a Percutaneous Endoscopic Gastrostomy (PEG)

3.3 If the task is to be delegated to a PA, the healthcare professional must be trained and competent in the skill themselves to ensure adequate training for the PA and be satisfied they are competent to carry out the task. The training provided to the PA is client specific therefore the new skills learnt are not transferable.

4. Roles & Responsibilities

4.1. Registered professionals are regulated within statute and are accountable to their regulatory body- i.e. Nursing and Midwifery Council (NMC) for nurses, midwives and health visitors and, Health Professions Council (HPC) for physiotherapists, dietitians, speech and language therapists and so on.

4.2. Although PAs are not currently regulated by statute they remain aaccountable for their actions in several ways, including:

• to the patient/client - civil law (duty of care). The PA is accountable for their actions and omissions when they can reasonably foresee that they would be likely to injure people, or cause further discomfort

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or harm, e.g. If an PA failed to report that a patient had fallen out of bed;

• to the public – criminal law e.g. If a PA were to physically assault a patient, then they would be held accountable and could be prosecuted under criminal law, as well as being in breach of their contract of employment.

5. Deciding on Delegation

(See Appendix 1 - Decision Matrices and Descriptors)

5.1. Delegation of activity is determined in the context of the relationship that exists between the person who delegates and the person to whom some aspect of practice is delegated. A number of factors have been identified that are significant for those who delegate tasks when deciding on whether to pass a task on to a PA, and the person who is responsible for the decision to delegate should follow the decision making flow-chart contained in Appendix 1 if they are in any doubt as to the appropriate decision making process to be followed.

5.2. A personalised assessment of the service users needs should be carried out and documented by the registered professional(s) involved with the service user and should include:

• mental capacity; • the use of contracts; • costs and funding/ direct payments; • risk assessment; • who will best meet the need of the patient? • is there a need for a third party to carry out the task?

5.3. Where it is identified that the service user lacks mental capacity to decide that a PA can undertake the specific task for them, then the healthcare professional delegating is responsible for ensuring that a discussion has been held with family (and/or those individuals who are deemed to have responsibility for the care of the service user) of the service user and that a decision is made in the service users best interest. A consent form must be completed before the task is delegated and the delegator must ensure this is clearly evident in the service user’s notes. Appropriate individuals who may be deemed to have responsibility for the care of a service user can include: • next of kin; • social worker; or • General Practitioner

5.4. The question of who should carry out which task depends on a number of factors. The central elements involve: • the individual PA’s skills, competence, attitudes and experience; • the requirements of the service user and their own choice; • the nature of the task in the specific circumstance; or

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• if there is a need for a change or introduction of equipment or technology to help in meeting the need.

5.5. Risk assessment is not a substitute for professional judgement and experience and should be informed by the worker’s knowledge, skill and expertise. It is a process involving thinking about the dangers and risks that individual’s face, recording these and considering where the responsibility will appropriately lie. Equally it should not be used as an excuse not to do things unless the likely benefits are outweighed by the likely danger. A risk assessment will need to be a part of and refer to the multi-disciplinary assessment so that the process can be understood.

5.6. When delegating to a PA specified by the service user then the service users personal care plan should be used to highlight any risks and to set up an agreed contingency plan. As part of the care plan consideration needs to be given to how care is provided if PA care breaks down.

5.7. The employer of the PA, whether this is an agency or the service user should be aware of and agree to the training, assessment and task delegated.

6. Principles of Delegation

6.1. The delegation of skilled, specific care interventions must always take place in the best interests of the service user that the professional is caring for and the decision to delegate must always be based on an assessment of their individual needs.

6.2. Every delegation has to be safe; the primary motivation for delegation should be to meet the health and social care needs of the service user.

6.3. The registered practitioner is responsible for the service user’s involvement in the assessment of care and developing a personalised care plan.

6.4. Appropriate assessment, planning, implementation and evaluation of the delegated role must be complete and documented.

6.5. The PA delegated to undertake a task must be in an appropriate role or relationship, with the right level of experience and competence to carry it out.

6.6. Registered practitioners must not delegate tasks and responsibilities to an PA that are beyond their level of skill and experience.

6.7. The task to be delegated must be discussed and both the delegator and the PA should feel confident about the decision, before the delegated task is carried out.

6.8. The PA must feel able to refuse to accept a delegation if they consider it to be inappropriate, unsafe or that they lack the necessary competency.

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6.9. Supervision and feedback must be provided appropriate to the task being delegated. This will be based on the recorded knowledge and competence of the PA the needs of the service user, the service setting and the tasks assigned.

6.10. The delegator must either ensure that PA’s have the competencies required to carry out any tasks required or alternatively provide training to ensure the competencies required are met by the PA. The delegator is also strongly advised to keep their own record of training given and copies of the competency assessment documentation.

6.11. All staff, including agency staff or directly employed individuals have a responsibility to intervene if they consider any delegated task to be unsafe.

6.12. An PAs must be aware of the extent of their expertise at all times and seek support from available sources when appropriate.

6.13. Documentation, including the details of the task and delegation is completed by the appropriate person and within protocols and professional standards and codes of practice.

6.14. The delegation to the PA must always be for the individual named service user only.

6.15. Existing national and local policies as set out by the registered practitioner must be used.

6.16. Where a third party (such as an employer) has the authority to delegate an aspect of care, the employer becomes accountable for that delegation.

6.17. The employer will also be responsible for organising any training with the agreement of the registered practitioner in an appropriate and reasonable manner.

6.18. The decision whether or not to delegate an aspect of care and to transfer and/or to rescind delegation is the sole responsibility of the registered practitioner and is based on their professional judgment.

6.19. The registered practitioner has the right to refuse to delegate if they believe that it would be unsafe to do so or if they are unable to provide or ensure adequate supervision.

6.20. The decision to delegate is either made by the registered practitioner or the employer and it is the decision maker who is accountable for it.

7. Consent

7.1. Service users have the right to know who is treating them and expect that those who provide care are knowledgeable and competent.

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7.2. In many circumstances consent would be inferred by co-operation with the task being performed. Consent would be required in circumstances where the delegation itself might pose a potential risk, albeit that the delegation remains appropriate, or where it could have a material impact on a service user.

8. SUPERVISION AND TRAINING

8.1. Supervision

8.1.1. Where there is no registered practitioner as the delegator, then there must be a supervision system provided by a registered practitioner to the PA.The exception to this is Level 3 Tasks which must only be delegated and not offered through supervision. On-going supervision is used to assess the PA’s ability to perform all other delegated task and capability to take on additional roles and responsibilities. It is normally expected that a named supervisor is identified within the personal care plan.

8.1.2. The following should apply:

• there should be a documented system in place for PA’s to access supervision and clinical advice as required; • regular supervision time is agreed between the registered practitioner and the PA and a record is made of each session; • the PA shares responsibility for raising issues in supervision and may initiate discussion or request additional information/support;

8.1.3. Supervision can vary in terms of what it covers. It may incorporate elements of direction, guidance, observation, joint working, and discussion, exchange of ideas and co-ordination of activities. It may be direct or indirect, according to the nature of the work being delegated. The decision concerning the amount and type of supervision required by a PA is based on the registered practitioner’s judgment and is determined by the recorded knowledge and competence, the needs of the service user, the service setting, and the delegated tasks. Factors to be considered by the registered practitioner therefore include: • the level of experience and understanding of the PA relevant to the task being delegated; • regular assessment of the PA’s competence relevant to the delegated task; • the complexity of the delegated tasks (i.e. whether the delegated task is a routine activity with predictable outcomes); • the stability and predictability of the service user’s health status;

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• the environment or setting in which the delegated task is to be performed and the support infrastructure available (e.g. whether working in a community, or school setting); • availability of and access to support from an appropriate registered practitioner; • periodic review and reassessment of the service user’s outcomes; • an identified process for recording and reporting.

8.2. Training of Third Party Personal Assistants

8.2.1. Support must be given to service user and registered practitioners to make the decision re delegation.

8.2.2. The PA’s competence & level of tolerance must be assessed.

8.2.3. Training needs must be identified and documented

8.2.4. The professional delegating the task is responsible for all training and assessment of competence of any delegate.

8.2.5. If equipment is to be used then the manufacturing company can train in use of equipment if appropriate. This must be overseen by the equipment prescriber.

8.2.6. There must be a documented training and re assessment plan personalised and discussed with the service user.

8.3. Plan for On-going Monitoring

8.3.1. A plan for on-going monitoring must be made and reviewed at least monthly. This must include:

• competence of the PA assessed and monitored at least monthly; • on-going and regular reviews • the on-going frequency of the task; • contingency plans to cover sickness, holiday etc; • an opt-out plan for the PA undertaking the task; • on-going supervision arrangements; • a continuing risk assessment, where necessary.

8.4. Documentation 8.4.1. Competence and assessment documentation must be available to provide audit trail of the PA’s competence and training.

8.5 Outcome Measures

8.5.1. Achieving outcomes should be measured by service user satisfaction, incidents, complaints, capacity, reduction in emergency admissions,

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reduced acute episodes leading to increased support from community services and carer satisfaction.

9. Governance Framework

9.1. Clinical and corporate governance frameworks, strategies and practices should act as an enabler and not a barrier to delegation;

9.2. Healthcare Governance systems will be in place across all areas to support patient safety through personalisation.

9.3. On-going monitoring and review of current clinical practice should support delegation.

9.4. Clear lines of accountability should be in place as part of the wider governance responsibilities.

9.5. To support delegation and clarify accountability it is imperative that all professional codes of conduct are interpreted consistently and understood across the organisation.

10. Monitoring, Auditing, Reviewing & Evaluation

10.1. This guidance will be reviewed in 12 months from ratification, and periodically thereafter.

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11. Bibliography

Department of Health. Regulation of health care staff in England and Wales: a consultation document. London: DOH; 2004. http://www.dh.gov.uk/assetRoot/04/08/51/72/04085172.pdf

Skills for Care (2010) Personalisation and Partnership – A Successful Working Relationship: What Factors Disabled People Feel are Important in their Relationships with their Personal Assistants, Carers and Support Workers. http://www.solnetwork.org.uk/uploads/successful-workingoct2010.pdf

Working for personalised care: A framework for supporting personal assistants working in adult social care. (2011) London: DOH http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyA ndGuidance/DH_128733

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Appendix 1 – Decision Matrices and Descriptors

Decision Matrix One – Assessment of Task (to be read in conjunction with descriptor table for assessment of task)

Start

Yes

Has the task been successfully delegated in the past?

Can this task only be Yes performed by a registered professional?

No Can the task be

delegated?

Yes No Do the benefits outweigh the risks?

Yes

No Do you need to gain service user consent?

Yes

Proceed to Yes Have you No Do not Decision gained service delegate Matrix 2 user consent?

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DESCRIPTOR TABLE FOR ASSESSMENT OF TASK This stage will assist delegators in deciding if the task can or cannot be delegated

Descriptor table for Assessment of Task Question Descriptor

Can the task be delegated? When considering whether the task can be delegated take into account the level of the task, what skills the PA would need to perform the task and if this is a task that needs to be delegated?

Can this task only be performed by Before this task is delegated it a registered practitioner? needs to be considered whether this task must be performed by someone authorised in the profession.

Do the benefits outweigh the risks Having conducted a benefit and to the service user? risk assessment, have the benefits of delegating the task outweigh the risks of delegating the task?

What risks have been identified?

Do you need to gain service user In certain circumstances you may consent? need to gain service user consent to carry out the task.

Have you gained service user Have you consulted with the consent? service user and made them aware that the task that is being undertaken on them will be conducted by an identified PA?

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Decision Matrix Two – Assessment of Individual (to be read in conjunction with descriptor table for assessment of individual)

Start

Identify person

Is the No person able to carry out the task?

Is it feasible for the Yes person to gain Does the person h ave No sufficient knowledge, No sufficient knowledge, skills and training to skills and training to complete the task? complete the task? Yes

Take the appropriate action to ensure that Yes the person has sufficient knowledge, skills and training to complete the task. Identify risks.

Is the person competent Is it feasible for the and confident enough to person to become competent and carry out the task? No No confident enough to carry out the task?

Yes Take appropriate action to Yes ensure that the individual becomes competent and confident enough to carry out the task. Are written procedures available for proper performance of the No Take appropriate task? action to develop the appropriate Yes procedures

Is No supervision required?

Yes

Is No Make sure Delegate Supervision Yes supervision available? is available

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DESCRIPTOR TABLE FOR ASSESSMENT OF INDIVIDUAL This stage will enable you to identify the correct individual to delegate the task

Question Descriptor Identify individual Having decided that the task is delegable it is important to identify whether there is someone available to conduct the task. Is the individual available to conduct Having identified the individual, are the task? they readily available to conduct the task? Does the person have sufficient When determining whether the knowledge, skills and training to individual has sufficient knowledge, undertake the task? skills and training to undertake the task please bear in mind the following;

Has the individual been trained to carry out this task before?

When was this training last given?

Has the task changed since training was given?

Has the PA's training been updated since their last training session? Is the person competent and confident When considering whether the person to carry out the said task? is competent and confident to carry out the task please note the following;

Has the person expressed concerns about the task?

Do you believe the person to be competent to carry out the task?

Is the person confident in themselves to carry out the task?

What risks have been identified?

Are written procedures available for Before the person is given the proper performance of the task? delegated task please check to see if there are written procedure or policy documents available to assist the person when carrying out the task. Is supervision required? The delegator will need to decide whether this task requires supervision. Is supervision available? When carrying out the delegated task will the person have access to support if required?

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Practical guide for Personal Health Budgets in Continuing Healthcare (Version 4) The Staffordshire approach

Page | 0 4. Practical guide for Personal Health Budgets in Continuing Healthcare Version 4, Matthew Oakley, July 2014

Contents

Preface ...... 2 Introduction to personal health budgets ...... 3 Eligibility for a personal health budget ...... 4 Information and advice ...... 5 Budget setting ...... 6 Support planning ...... 7 Approving the plan...... 9 Managing the budget ...... 11 Setting up the support ...... 12 Review the plan...... 13 Appendix ...... 15 Glossary of terms ...... 15 Seven criteria for a good support plan ...... 17 Personal health budget process map ...... 20 Direct payment set up process ...... 23 Decision making for how a PHB could be managed ...... 24 Additional documents that supplement the practical guidance ...... 25

Page | 1 4. Practical guide for Personal Health Budgets in Continuing Healthcare Version 4, Matthew Oakley, July 2014

Preface

The purpose of the practical guidance is to explain the seven step process for delivery of personal health budgets in Staffordshire.

Tasks within the personal health budget work streams have been assigned to individual staff roles that will be in place when Personal Health Budget team is established. This team will be responsible for service delivery of personal health budgets on behalf of the Clinical Commissioning Groups. Should a team not be established then the practical guidance will be reviewed and tasks reassigned to most suitable existing roles.

In addition to listing the person who will carry out a task, other individuals that, in some circumstances, could carry out this task are also included, with the main designated person listed first.

The tables breaking down each step also identifies those that are responsible for the oversight of a particular task; ensuring that it is completed.

A summary of the roles

As part of the proposal to establish a single team to deliver personal health budgets several new roles have been identified. These roles are defined as follows:

PHB Lead: an equivalent to a CHC Lead Nurse designated the clinical lead for personal health budgets on behalf of the CCGs.

PHB Nurse: and equivalent of CHC Nurse Assessor; front-line support to people that are going through the personal health budget process offering clinical input with support planning and the setting up of support.

PHB Admin: administrative support provided to the PHB team.

PHB Finance Lead: to provide financial oversight and support for the delivery of direct payments for personal health budgets.

Head of CHC: the Head of the Continuing Healthcare team with overall responsibility for the delivery of CHC support.

CHC Lead Nurse: the lead practitioner for the particular care category (e.g. Physical Disability, Mental Health, Children, Learning Disability)

CHC Admin: administrative and business support that is in place in the Continuing Healthcare team.

CSU Finance:

CCG Commissioners:

Where tasks could also be carried out by an external organisation or third party (such as support planning) this is listed as ‘External Support’ (in the case that a third party would assist but the role itself in unclear).

Page | 2 4. Practical guide for Personal Health Budgets in Continuing Healthcare Version 4, Matthew Oakley, July 2014 Introduction to personal health budgets

What is a personal health budget?

A personal health budget is an amount of money provided to someone with an identified health need, it enables them to have more choice and control over how their needs are met and how they are supported. This means they can select the treatments and services that meet these needs in a way that is most appropriate to them.

Who can have a personal health budget?

Starting in April 2014 people who are eligible for full NHS Continuing Healthcare (NHS-funded long term health and personal care provided outside hospital) will have the right-to-ask for a personal health budget, including a direct payment. From October 2014 this will become a right-to-have a personal health budget.

The right-to-ask will then be extended to people with long term conditions at the beginning of April 2015.

What are the essential parts of a personal health budget?

At the centre of a personal health budget is the support plan. This plan helps the person choose their health and wellbeing outcomes in agreement with a health care professional. They know how much money is available and will set out how they will use the budget to achieve the outcomes in their plan and the support needed to do this. The plan should also include information on how the budget will be managed and what will be done to stay healthy and safe.

The Staffordshire and Stoke-on-Trent approach

To provide personal health budgets to people who are eligible for Continuing Healthcare. Staffordshire and Stoke have adopted a seven-step process (right), based on best practice guidance.

This guide will go through each of these steps and explain what will be required at each point and the involvement and responsibilities of healthcare professionals. The appendix includes a process map that breaks down each task within the seven steps with the practical guidance going into more detail on what each step means and how each task should be approached.

This guide does not cover the approach for personal health budgets for people who are not eligible for NHS Continuing Healthcare – but the seven-step process could be adapted.

Page | 3 4. Practical guide for Personal Health Budgets in Continuing Healthcare Version 4, Matthew Oakley, July 2014 Eligibility for a personal health budget

To have a personal health budget an individual must be eligible for fully-funded Continuing Healthcare (CHC). Having a personal health budget does not change how eligibility is determined; this will be done in line with existing CHC processes.

For people who already receive full CHC funding, a discussion about a personal health budget should take place when their CHC package and eligibility is reviewed, with the offer to send local information if they want further information.

For people who have recently become eligible, a personal health budget can be discussed at their three- month review. In some circumstances, to ensure continuity of care, (e.g. if when a person is already employing their own care staff or they have a direct payment) people should be supported to keep any existing support as an interim budget to be reviewed after three-months.

A person or family may request a personal health budget at any time, if a review is required then this should be scheduled and be conducted by a CHC Nurse before referring to the PHB Team.

Task When does this happen Who will do this Who is responsible for ensuring this happens Eligibility ratification Following submission for CHC Panel Head of Continuing eligibility. Healthcare PHB Offer / Letter (to inform After 3-month review for new CHC Admin CHC Lead Nurse person of family of the patients. CHC Nurse Head of CHC availability of personal health budgets) After annual review for existing CHC patients (only required once).

When someone who is already eligible for CHC expresses an interest in PHBS. Notify PHB Team When a letter or information CHC Admin CHC Lead Nurse pack has been shared. CHC Nurse Head of CHC Set up ‘interim PHB’ to allow When a person already has a PHB Team CHC Lead Nurse continuity of care direct payment / or employs personal assistants

Employing family members in the same household

Paying family members who live in the same household can only be done when it is an exceptional circumstance, when it is necessary to meet the needs of the person having tried or discussed other options that are available.

These decisions should be made on a case by case basis and in the majority of cases it would be expected that this would decision would be referred for consideration to the Risk Enablement Panel.

Page | 4 4. Practical guide for Personal Health Budgets in Continuing Healthcare Version 4, Matthew Oakley, July 2014 Information and advice

Following the expression of interest and sending of letter to the person or family the PHB Team would begin to work through the rest of the process.

To ensure people and families can make an informed decision about whether or not a personal health budget would be suitable for them a range of information is available. This can be passed on in different ways; the local information pack, online resources and face-to-face conversations with a member of the CHC team, a CCG representative, peer or other professional.

Local Information pack

This pack includes:

 Seven-steps to a personal health budget booklet  Direct payments guidance  A template support plan (electronic versions are available)  An example support plan  Consent form  Employing personal assistants DVD (hard copy packs are available)  Support planning guidance  Preparation for PHB discussion form

Online resources

The current resource for information on personal health budgets in Staffordshire is www.staffordshirecares.info/phb. Each Clinical Commissioning Group website has information about personal health budgets.

Professionals may want to sign-up to the national learning network for additional support and access to the forum if they have any questions or information they wish to share: www.personalhealthbudgets.dh.gov.uk/

Websites that professionals may want to direct people or families that are interested in personal health budgets include: www.peoplehub.org.uk/ and www.nhs.uk/personalhealthbudgets.

Face-to-face engagement

When talking with people and families staff should be familiar with the key aims and messages of a personal health budget:

 It gives more choice and flexibility for how people meet their healthcare needs.  People can have as much control over their healthcare and support as they need.  A support plan that describes how they will be supported and how they want to spend their budget must be completed as part of the process.  Having a personal health budget should be a positive experience and help people get a better service.  People can now choose to manage their budget themselves via a direct payment.  People can employ their own care staff.  Help is available to develop a support plan, set up a direct payment and to recruit and employ your own staff. Page | 5 4. Practical guide for Personal Health Budgets in Continuing Healthcare Version 4, Matthew Oakley, July 2014

 Personal health budgets are intended to be used to meet people’s health and well-being needs with consideration also given to how it can improve their quality of life.  Having a personal health budget will not require people to make a contribution.  People do not have to have a personal health budget it they do not want to.

Information and advice should be readily available at any time and determined by a person or families interest in having a personal health budget

Task When does this happen Who will do this Who is responsible for ensuring this happens Provide PHB Info Pack Following a 3-month review PHB Admin PHB Lead and confirmation the person is PHB Nurse PHB Nurse still eligible for CHC. CHC Nurse CHC Lead Nurse

Following conversation and request for pack from person or family.

When a person or family requests one (following PHB letter) or expresses information in PHB. PHB Conversation At the request of a person or PHB Nurse PHB Lead (to answer any further family who are considering PHB Lead CHC Lead Nurse questions to help an individual pursuing a PHB. CHC Nurse make an informed decision Peer support about whether or not they Often this will be after an want a PHB) information pack has been sent.

Budget setting

When a person or family decides that they would like a personal health budget a ‘provisional budget’ (also known as an indicative budget) should be provided before support planning begins.

What is a provisional budget?

A provisional budget is an estimate of how much money is required to arrange the care and support needed to meet a person’s health needs and outcomes. The provisional budget is not a fixed amount that cannot be exceeded or a target to be reached, but a guide to make the support planning process more effective by providing an indication of how much money will be available for the person’s care and support.

Working out the provisional budget

For people with existing CHC packages the provisional budget will be based on the current cost of their care. If, when a review has taken place, a person’s levels of need (as recorded on the Decision Support

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Tool) have increased or decreased the budget setting tool can be used to assist with the calculation of a provisional budget.

Budget setting tool

The tool can be used when someone is new to Continuing Healthcare or has had a significant change in their needs or circumstances that the existing cost of their package would not be meet their needs effectively. This tool should be used to support the identification of a provisional budget. It is not intended to replace professional judgement on the level of need or care required but can be used to assist professionals in calculating a budget that can allow support planning to begin.

See the appendix for instructions on how the budget setting tool is used.

Final budget

During support planning a ‘final budget’ will be worked out. This is the actual total cost of the care and support that make up the personal health budget. It may be higher or lower than the provisional budget. If there is a significant difference (where the final budget is more that 10% above or below the provisional budget) this should be highlighted during the approval of the support plan and where necessary referred to the Risk Enablement Panel.

Process When does this happen Who will do this Who is responsible for ensuring this happens Identify existing cost When the person or family CHC Admin CHC Lead Nurse / has decided that they want a CHC Nurse PHB Nurse PHB. Use budget tool (if required) PHB Nurse PHB Lead PHB Lead PHB Admin Agree provisional budget When the budget has been CHC Lead Nurse & Head of CHC/ PHB worked out there should be PHB Nurse Lead confirmation that it is an acceptable amount so support planning can begin. Share provisional budget (to This should be sent out in a PHB Admin PHB Nurse the family or person and letter or communicated over PHB Nurse CHC Lead Nurse support broker) the phone.

Support planning

Support planning is central to having a personal health budget, it places the individual or family at the centre of deciding the best way to meet their health and wellbeing needs.

At this point the person should have had a discussion about a personal health budget, been provided with an information pack and have a provisional budget. Although people may start thinking about what is working and what they would like to change, once they receive the provisional budget they can begin to look in more detail at how they can use their budget.

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A support plan can take any form, although there is a template available, however a ‘Support Plan Summary’ should be completed when the plan is submitted for approval.

What is the purpose of support planning?

Support planning should involve conversations with health care professionals, family and friends and other support that people may have. The support plan itself should represent a summary of these conversations and the key decisions that have been made about how they would like to spend their personal health budget. Throughout the process a healthcare professional should be involved to provide input and assistance with the clinical parts of the plan, in particular when this relates to the delegation of clinical tasks that would require training.

What needs to be in a support plan?

There are seven criteria* that need to be met in a support plan. The table below shows these criteria and expands on what information this should relate to:

Criteria Key elements of this criteria 1. What is important to A description of the person, the things and people that are most important to me (and important for them, their strengths and what is essential to their health and wellbeing. me) 2. What is working well The things that people want to keep the same and what people want to and what I want to change or achieve. change SMART outcomes (S – specific, M – measurable, A – achievable, R – realistic, T – time-limited) 3. How I will be supported A description of their health needs and the care and treatments to support them 4. How my personal A breakdown of how the budget will be spent and the care, treatment and health budget will be services that will be purchased spent 5. How my support, Who will be responsible for setting up the support, what training is needed, treatment or care will be what are the risks and a contingency plan. organised and managed A care-coordinator should be identified as part of the plan. 6. How I will stay in What will happen to ensure the person is in control of decision making control of decision making relating to their care What decisions can the person make, what decisions do others make on their behalf and who makes the final decision 7. What I will do to make What are the steps that will be taken to put the plan in place and the this happen (an action outcomes these steps support? plan) *For a detailed breakdown of these criteria and what they mean see the appendix of this guide.

What are outcomes?

Outcomes are the differences made to a person’s life as a result of having a personal health budget. The emphasis of personal health budgets is on an outcomes focused approach. They may relate to quality of life, how support is delivered or changes and improvements that a person would like to accomplish. These could be short-term or long-term to focus on over a 12 month period.

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Some outcomes will be simple and achieved with little difficulty. Others may be more complex or seen as risky, so a healthcare professional should be part of discussions around how they can be achieved.

What help is available for support planning?

Support planning starts with the person or family; however assistance may be required with certain parts of the plan. This could be provided by existing networks of support (e.g. CHC Nurse, a social worker or other healthcare professionals) or they could be directed to peer support (someone who already has a personal health budget). Additional support is available from organisations or individuals (often called brokers or planners) that can help with support planning.

Process When Who will do this Who is responsible for ensuring this happens Refer to planning help When the person requires PHB Nurse PHB Lead support planning assistance PHB Lead CHC Lead Nurse the options that are available PHB Admin should be discussed. Existing / Original plan If the person already has an PHB Nurse CHC Lead Nurse existing support plan or one Person or Family Support broker that has been used in the past it may be easier to update this rather than create a new one. Support planning assistance Provided to the person or External Support Person or family family when they have a (input could also PHB Lead provisional budget and have come from PHB PHB Nurse agreed they would like help to Nurse, CHC Nurse, CHC Lead Nurse develop the plan. Social workers and other healthcare professionals) Share plan for approval When the plan has been PHB Nurse Person or family finished and the person or External Support PHB Nurse family are happy for it to be Person or family CHC Lead Nurse submitted. This includes completion of page 1 of the support plan summary.

Approving the plan

The principles that form the approval a support plan are that what is included will be lawful, likely to be effective and affordable within available resources.

For the support plan to be approved the seven criteria must be met. These criteria cover clinical and financial governance as well the person’s choices and preferences. See appendix for a detailed breakdown of the seven criteria - this includes reasons why a support plan may not be approved.

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To assist with the approving of plans a checklist is part of the support plan summary and should be completed as part of the approval process.

There are some restrictions on what a personal health budget can be spent on: • Emergency or acute services • The vast majority of primary services (including visits and assessments) as GPs provide a comprehensive, registration-based service • Anything illegal • Gambling • Debt repayment • Tobacco • Alcohol • Treatments (such as medicines) that the NHS would not normally fund

Agreeing the plan

The support plan should be agreed and signed off from the following three perspectives: Personal, Clinical and Financial.

 Personal: that the supports plan satisfactorily represents how the person or family wants to use their personal health budget to meet their needs and personal outcomes. This signature should come from the person or their representative.  Clinical: that the care and support and that will put in place will meet the person’s needs safely and effectively and that acceptable considerations for training and clinical governance have been identified. This signature should come from a health professional.  Financial: that the final budget in the support plan will satisfactorily pay for the care that is required, will be managed appropriately and is not below or above the provisional budget (within a 10% range) which may mean there is not enough care to meet their needs and leave them at risk, or more care than is required and could impact upon their independence or would not be a suitable use of NHS resources.

To assist with the agreement and overall approval process the following guidelines should be used when approving a plan:

 The ‘7 criteria for a good health support plan’ document should all be met (see appendix).  The final budget falls within 10% above or below the provisional budget.

When a plan is not agreed

If a support plan is not approved the person or family should be informed of the reasons why and provided with advice on changes that could be made to the plan in order for it to be approved in the future. Information provided should support the person or family to re-submit a plan that will be approved at a second attempt. If a plan is not approved for a second-time this should be referred to the appeals process. The plan could be partially approved; with elements of the budget starting whilst other aspects can be revisited before approval to avoid delays for the person or family.

When a plan is submitted for a third time approval it should be escalated to the Risk Enablement Panel (please see Risk Enablement Panel guidance).

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If the plan is not approved then the person or family should be advised to follow the CCG’s Complaints Procedure

Process When Who will do this Who is responsible for ensuring this happens Approval decision (the final The plan has been submitted CHC Lead Nurse Head of CHC sign off the plan) by the person and PHB Lead CCG Commissioners Referral to REP for advanced If an approval decision cannot PHB Nurse PHB Lead approval be reached after two CHC Lead Nurse Head of CHC attempts. Advanced approval When the CHC Lead Nurse Risk Enablement Head of CHC feels it is necessary for the risk Panel enablement panel to input on the decision. Provide feedback The support plan has been PHB Admin CHC Lead Nurse through the approval process PHB Nurse PHB Lead and part or the entire plan is not agreed. The feedback should be based upon the approval checklist. Advise the person of the CCG When a plan has not been PHB Admin PHB Nurse complaints procedure approved for a third time PHB Lead CCG Directors

Managing the budget

When the support plan has been agreed the chosen option for managing the budget should be put in place. There are three main ways in which a personal health budget can be managed; a notional budget, as a direct payment or by a third party. In some instances people could also have a mixture of these three options.

Notional budget

The person will know the amount of money available but the care and support will be arranged in the traditional way in line with current Continuing Healthcare procedures.

Direct payment

The person (or representative) receives the money to purchase the care and support that has been agreed in the support plan. They will be responsible for arranging the care, although some support may be provided by a third-party (such as managing payroll or recruitment).

They will need to have a separate bank account and keep receipts of how the direct payment is spent.

The direct payment will be made every four weeks and managed by the Staffordshire & Lancashire CSU.

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If the person has previously had a direct payment and the account in still open, this account could be used.

Third party

This option sees the budget paid to a different organisation or trust who holds the money for the person or family.

This organisation will also be responsible for setting up and monitoring the care and support that has been agreed within the support plan.

Process When Who will do this Who is responsible for ensuring this happens Notional budgets When the support plan has PHB Admin PHB Nurse been approved and a notional CHC Admin CHC Lead Nurse budget (managed by CHC) is chosen. Direct payment When the support plan has PHB Admin PHB Nurse This would include setting up a been approved and a direct PHB Nurse PHB Lead direct payment bank account payment will be used to Person and family PHB Finance Lead by the person or their manage the budget. Bank CHC Lead Nurse representative account details should be confirmed. Refer to third parties When the support plan has PHB Nurse PHB Nurse been approved and a third PHB Admin PHB Lead party will manage the budget External Support CHC Lead Nurse (this may be a decision that is Person or family made during the support planning process) Third party budget When the plan is approved External support Person or family and the person or family is Person or family Third party working with the third party. CHC Finance Lead Set up ‘interim PHB’ to allow When a person already has a PHB Admin PHB Lead continuity of care direct payment / or employs PHB Nurse CHC Lead Nurse personal assistants CSU Finance

Setting up the support

When people employ their own staff

If they do not have a copy already, the person or family should be provided with an ‘Employing personal assistants ‘guidebook, and will be provided with information on:

 ‘Personal Assistant Training Programme’ (to be developed)  Payroll providers  Carematch website

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Process When Who will do this Who is responsible for ensuring this happens Notional budget setup When PHB has been approved PHB Nurse PHB Lead and the support will be CHC Nurse CHC Lead Nurse arranged by CHC/PHB team PA Recruitment When PHB has been approved External Support PHB Nurse and the person is recruiting Person or family CHC Lead Nurse their own staff. Other support When PHB has been agreed Person or family PHB Nurse and recruitment has been External support CHC Lead Nurse completed and training needs (based on training are required. This could also plans outlined and be training for agency staff. agreed in plan) Refer to third party support This should be done at regular This will be done Person or family intervals as agreed in the through the CHC Lead Nurse support plan process agreed in the support plan – it may vary from case to case.

Review the plan

There are three key reviews that should be undertaken as part of a personal health budget; review of eligibility, review of the support plan and outcomes and a review of the use of direct payments.

As part of the support planning process the purpose of reviewing the personal health budget should be discussed with the person or family. Reviews should be undertaken together, where possible, but this should be in the agreement of the person or family.

Eligibility and need

Eligibility for Continuing Healthcare will be reviewed in line with current Continuing Healthcare policy and processes. When the level of need of an individual changes, or their circumstances have changed significantly (such as fewer hours of informal support), the provisional budget may need to be reviewed and the support plan amended to reflect this.

Support plan

The review of the support plan and overall effectiveness of the personal health budget should be outcomes focused. The outcomes that were detailed in the original support plan should be reviewed top ensure that the outcomes have been achieved. If outcomes have not been achieved then there should be a conversation to understand why.

Direct payments

Are the direct payments being spent in line with what was agreed in the support plan?

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If there is a surplus amount that has not been spent then this money could be clawed back or payments suspended

Process When Who will do this Who is responsible for ensuring this happens Eligibility review for CHC As part of annual review CHC Nurse Head of CHC funding CHC Lead Nurse Support plan review and As part of annual review PHB Nurse PHB Lead outcomes CHC Lead Nurse Head of CHC A person or family could look to review the outcomes and update this as part of the plan. Direct payments review As agreed in the support plan PHB Nurse CHC Lead Nurse (generally on a yearly basis) External Support CCG PHB Leads Joint funded review In line with annual review PHB Nurse PHB Lead process but incorporating CHC Lead Nurse Head of CHC external funding organisations Competency & Skill Review As agreed in the support plan Person or family PHB Nurse (where someone is employing – but should take place at (external health CHC Lead Nurse their own personal assistants) least once a year support) Person or family (if employer) Third party (if this arrangement is in place)

Reviews should take place after three months and then annually. If the individual has a fluctuating condition or there is a greater risk reviews could be undertaken more frequently.

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Appendix

Glossary of terms

Term What this means Other terms that might be used The agreed amount of money of a personal health budget agreed once Actual budget Final budget a support plan has been written. A service that identifies the care and support a person needs. A Support Broker can also arrange services and may also help with a Brokerage support planning. Brokerage may be done by voluntary organisations, private companies or an individual. A person providing care who is not employed to do so by an agency or Carer organisation. A carer is often a relative or friend looking after someone at home who is frail or ill; the carer can be of any age. NHS continuing healthcare is free care outside of hospital that is CHC, Fully Continuing arranged and funded by the NHS. It is only available for people who funded NHS healthcare need ongoing healthcare and meet the eligibility criteria. Care Direct Where the agreed budget is paid to the person to allow them to payment arrange the care and services that are agreed in their plan. Joint budget, Integrated A budget that is made up of money provided by different organisations Individual budget (e.g. health, social or education funding). budget Where a third-party receives the money on behalf of the person or Managed Holding family, but does not provide support with other aspects of the account account personal health budget . Domiciliary Home care Care and support provided in an individual’s home care The money is held by the NHS and they arrange services and support. Managed Notional The person still has a clear understanding of the budget available and budget, virtual budget has been involved in developing a support plan. budget Outcomes The impacts or end results of services on a person's life. Personalisation The process by which services can be adapted to suit an individual. A personal assistant is a person employed to provide someone with social care and support in a way that is right for them. Personal A personal assistant may help with tasks such washing, using the toilet, assistant shopping and cooking. They can be employed directly by the individual or they can be arranged through an agency. Personal An amount of money your council makes available to help you meet budget your social and support needs A personal health budget is an amount of money to support a person’s Personal identified health and wellbeing needs, planned and agreed between PHB health budget the person and their local NHS team. The amount of money which is identified at an early stage in the process to inform care and support planning. It is a prediction – a best Provisional Indicative guess – of how much money it is likely to cost to arrange the care and budget budget support that would be sufficient to meet the assessed health needs and achieve the outcomes in the care and support plan. Page | 15 4. Practical guide for Personal Health Budgets in Continuing Healthcare Version 4, Matthew Oakley, July 2014

Self-directed A change to the way the health and social care system operates to give support you choice and control over the support you receive. Care plan, A Support Plan describes what a person wants to change about their Personal health Support plan life and how they want to spend their personal health budget to meet plan, their outcomes. Personalised care plan When an organisation independent of the NHS and the person holds Third party some or all of the money on the person’s behalf and supports the budget person to achieve the outcomes agreed in their plan. Includes the full range of non-public, non-private organisations which are non-governmental and ‘value-driven’; that is, motivated by the Third sector desire to further social, environmental or cultural objectives rather than to make a profit.

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Seven criteria for a good support plan

Support plan is the name for the plan that shows how someone’s personal health budget will be spent. In order for the money for the budget to be released, those responsible must be able to see and agree a plan that meets clear criteria.

Support plans can be written in different ways. They may be short or long - with pictures or just text. Crucially this plan must be an integrated co- designed plan between the individual and the clinician. It must contain information about clinical diagnosis and options for treatment or care but be balanced with contextual information from an individual about lifestyle and the impact of their health condition on that lifestyle.

People need to be given time and space to develop their plan and understand what genuine choices they can make. The budget holders and decision makers will need to make sure that the plan answers these seven questions:

1 What’s important to you & what’s important for you If someone reads the plan, they should get a good sense of your lifestyle. They should get an understanding of who you are, and your interests and hopes for the future (e.g. Lifestyle, People, Interests, Dreams), all the things that are ‘important to’ you. They should also be able to read clinical information about diagnosis & treatment/care options for your health condition and the impact it has on your lifestyle and quality of life What this means Plan would not be agreed Providing appropriate information, using all clinical Your plan will not be agreed if the information in information from assessment(s) the plan treats you like a stereotype, and does not express your individuality. Offering choices to enable people to make informed choice about treatment / care options; Listening Your plan will not be agreed if it is written in very well general terms. Managing conflict of interest, Awareness of boundaries, Facilitating, Negotiating, Respecting Your plan will not be agreed if you can’t see a lifestyle choices balance of ‘important to/and important for’ information from both the perspective of the individual and clinician 2 What’s working and what’s not working The plan should describe what is working well about your life and that you want to maintain and what is not working well and you want to change. This could be about: support, paid & unpaid, work, where you live, family, what you do (hobbies/ interests/ how you spend your day)

About your health condition: treatment/ care options, maintaining current lifestyle within the context of worsening health. The plan should describe the outcomes you wish to achieve with these plans. What this means Plan would not be agreed As above The plan will not be agreed if it is not clear what you would like to both maintain about your life and High level of awareness of needs and solutions health condition and what you would like to change.

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The plan will not be agreed if there is no clear outcome from what you are planning.

It will not be agreed if it looks like what is planned would make your life worse 3 How you will be supported

The plan should describe what is needed to support you with the above to live my chosen lifestyle and manage my health condition. It should tell us: what support you need, where you need that support, when you need support, who will give you that support.

It should indicate how to support your health and safety. It should identify any risks that there may be to you and how these risks will be managed. It should describe support to help you stay well and also the support you need when you are unwell or when your health condition is worse. What this means Plan would not be agreed You will need to consider the following questions; The plan will not be agreed if; Is what is planned safe? Does it require a risk assessment There are no detailed plans for support Does it fit with Professional Codes of Conduct? If it looks like the support will make your life Can you defend it? If there are no clear risk management strategies Does it make use of professional expertise where it exists? 4 How your personal health budget will be spent and managed The plan must set out how you are going to use your Personal Health Budget. The money allocated will be for a year and you must show how this annual allocation will be spent to get the support you have outlined in the plan.

It must also indicate how the budget will be received and managed, i.e. Notional budget-. Once an individual’s health outcomes have been agreed, possible options for meeting these outcomes within the amount normally spent on their healthcare can be discussed. As a result the individual understands the amount of funding available to them and is able to contribute to decisions about how the budget is used. The PCT still commissions services, manages contracts etc. Notional budgets could be an option for individuals who want more choice and control over their healthcare but who do not feel able or willing to manage a budget.

Real budget managed by a third party – you will need to indicate who the third party is. This maybe a budget holding lead professional, a GP, a Trust or an organisation like a community interest company. Direct healthcare payment – this option is not currently available but when it is possible the plan would need to indicate who is managing the budget What this means Plan would not be agreed Support with managing the money The plan will not be agreed if the plan does not say Support with reporting expenditure how your money will be used.

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Supporting in identifying which budget The plan will not be agreed if the service costs more management model will work best for the than the amount that has been agreed. individual and their family/carers. The plan will not be agreed if you are going to do anything illegal! 5 How your support will be organised and managed The plan will must describe how your support, treatment or care will be organised and managed. It must describe the following; your role in this, The role others may take, How you will comply with any legal requirements i.e. employment law. Practical arrangements, Managing well/ unwell plans, Risks and review, Training issues, Continued Professional Development What this means Plan would not be agreed Could be a Co-ordination role The plan will not be agreed if; It is not clear how Authorising spending your support treatment and care will be managed. If Communication it looks like you might not be safe. It is not legal. There are no contingencies in place 6 How you will stay in control The plan must describe how you will stay in control of your decision making. It should show; How you make decisions, How information should be presented to you, When your capacity for decision-making maybe affected and how that is supported, Advanced care plans/ directives where appropriate. What this means Plan would not be agreed Capacity assessments > assuming capacity The plan will not be agreed if it looks like others are making decisions for you or there is no evidence Following local guidance that a conversation about decision making has taken place Shared decision-making

Respect for individual’s decision-making 7 What I will do to make this happen? (action plan) The plan should set out real and measurable things that will happen in the future. In that way it is possible to look back and see whether the plan is working or not. The plan should say who will be responsible for each action and when it will be done. The plan should say how you will check your action plan to ensure that problems can be dealt with as they arise. It should be clear how these actions will help you to make the changes that you said you wanted to make. What this means Plan would not be agreed The plan should not be agreed if you just said some general things that need to happen. There need to be clear actions that will make sure your plan will happen.

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Personal health budget process map

Who will do PHB Information Budget Support Approving Managing Setting up Review the this eligibility and advice setting planning the plan the budget the support plan

Governance PHB Policy PHB Policy PHB Policy PHB Policy PHB Policy PHB Policy PHB Policy PHB Policy arrangments DoH CHC/FNC DoH Patient CCG PHB PHB Practice CCG Risk CCG PHB Delegation to CCG PHB Framework Info Booklet Financial Guidance Enablement Financial Level 3 PAs Financial Staffordshire Framework Panel Framework PHB Practice Framework Seven Steps Guidance Delegation to CCG Service Level 3 PAs Agreement PHB Practice Guidance

1. COMPLETE DST 11A. EXISTING / 13C. APPROVAL 18B. JOINT Social care / ORIGINAL DECISION FOR FUNDED REVIEW 2. PANEL Health SUPPORT PLAN JOINT FUNDED APPLICATION professional PACKAGE

3. ELIGIBILTY 6. IDENTIFY 13A. APPROVAL 15A. NOTIONAL 16A. NOTIONAL 18. ELIGIBILTY Continuing RATIFICATION EXISTING COST DECISION BUDGETS BUDGET SET UP REVIEW Healthcare 4. PHB OFFER / 8. AGREE PROV. 14. PROVIDE 15B. REFER TO 18A. SUPPORT LETTER BUDGET FEEDBACK THIRD PARTIES PLAN REVIEW

External 11B. SUPPORT 13D. ADVANCED 15C. DIRECT 16B. PA 19. DP REVIEW PLANNING APPROVAL PAYMENT RECRUITMENT (could include 20. COMPETENCY ASSISTANCE the person or 15D. THIRD PARTY 17. OTHER & SKILL REVIEW family) BUDGET SUPPORT

5A. PROVIDE PHB 7. USE BUDGET 10. REFER TO 13B. APPROVAL 16C. REFER TO Project Team INFO PACK TOOL PLANNING HELP SUPPORT THIRD PARTY (Temporary) 5B. PHB 9. SHARE PROV. 12. SHARE PLAN SUPPORT CONVERSATION BUDGET FOR APPROVAL

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Step Task Description Eligibility 1. Complete DST Decision support tool completed to make a recommendation that an individual is eligible for Continuing Healthcare funding 2. Panel Application DST and other supporting information sent to the CHC Panel 3. Eligibility CHC Panel makes a decision on whether or not the eligibility Ratification should be ratified 4. PHB Offer / Letter When the person is eligible for full CHC funding they receive letter – included in this letter is information on PHBs Information 5. a) PHB Info Pack a) An information pack about personal health budgets is sent & advice to the individual or family that have expressed an interested in personal health budgets.

b) PHB Discussion b) Should they want further information a face-to-face or telephone discussion can be arranged. Budget 6. Identify existing cost To set a provisional budget the existing cost of a person’s CHC setting package will be used (subject to a CHC review) 7. Use budget tool Where someone is new to CHC but would like a PHB or has had a significant change in need or circumstances a budget tool can be used to help set the provisional budget. 8. Agree Provisional Specifically when the budget tool has been used an Budget agreement that this is likely to be enough should be given. 9. Share provisional The provisional budget is passed on to the person or family budget (and support broker) so that they can begin support planning. Support 10. Refer to planning When a person or family requires assistance with support planning help planning they should be provided with options for who could support them to do this. 11. a) Existing / Original a) The person may have an existing support plan that was plan put together previously this should be considered as a way to develop the plan so that the person or family do not have to repeat a process. b) Support planning assistance provided to a person or family b) Support planning so that they can develop their support plan assistance 12. Share plan for When the plan is complete this should be sent to the CHC approval Nurse for a decision on whether this plan and the PHB can be approved. Approving 13. a) Approval decision a) The plan should be approved using the seven criteria and the plan approval checklist as a guide by the CHC Nurse b) Approval support b) Support will be provided by PHB Project Team on behalf of CCG – but only in an advisory role c) Approval decision c) If the package has other funding organisations then there for joint funded approval processes should be considered and where packages possible a joint decision made. d) If a plan cannot be agreed it can be passed on for d) Advanced Advanced approval to a Risk Enablement Panel approval 14. Provide feedback When a decision has been reached this should be communicated to the person or family (or a broker if they are representing them). If the plan is not approved it should be

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explained the reasons behind this (which should be recorded as part of the approval checklist. Managing 15. a) Notional budgets a) When the services that are agreed in the support plan are the budget b) Refer to third arranged and set up in the traditional way. parties b) Provision of the options of third parties that people c) Direct payment c) The person would need to set up a separate bank account d) Third party d) Third party budget would be managed by a separate budgets organisation on behalf of the individual. Setting up 16. a) Notional budget a) This is when support would be arranged in a traditional the support set up way, most likely with support provided by a care agency. It may include respite. b) If a person chooses to employ their own personal b) PA Recruitment assistants then the following should be covered when recruiting: job descriptions, advertising, interviews, setting up of payroll and training c) If the PHB is being managed by a third party this should be c) Refer to third referred to the person or family party support 17. Other support Review the 18. Eligibility review An annual review to determine that the person is still eligible plan a) Support plan for CHC funding should take place. review a) A review of the support plan should be conducted – to b) Joint funded determine if the person is achieving their outcomes and package review that the support in place is meeting their needs effectively b) If the package is jointly funded then the other organisations should be involved. 19. DP Review If the person is using managing their PHB with a direct payment a review should take place to ensure that this is being managed correctly and that the money is being spent in line with the agreed support plan. 20. Competency & Skills If there are specific clinical healthcare tasks that have been Review delegated to a personal assistant (employed by the person or a third party) then the competency and skills should be reviewed.

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Direct payment set up process

To be added.

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Decision making for how a PHB could be managed

Do you make your own Yes decisions about how you are No supported?

Is a Direct Payment the I want a Direct No only way to pay for the Payment support?

No Yes

Managed Budget Are you or your Yes

representative capable of managing a Direct Payment? Are you or your representative No capable of managing a Direct Payment?

Is a Direct Payment

the only way to pay No for the support?

Yes No Yes Yes

Direct payment Managed budget Third-party

4. Practical guide for Personal Health Budgets in Continuing Healthcare Version 4, Matthew Oakley, July 2014 Page | 24

Additional documents that supplement the practical guidance

CHC and PHB approval process v3

Support Plan Summary and Checklist

Risk Enablement Panel Doc v2

4. Practical guide for Personal Health Budgets in Continuing Healthcare Version 4, Matthew Oakley, July 2014 Page | 25

4. Practical guide for Personal Health Budgets in Continuing Healthcare Version 4, Matthew Oakley, July 2014 Page | 26 Staffordshire PHBs Financial Framework Version 2 2.05.14 Item: 09 Enc: 07 Personalising Healthcare-Framework for Direct Payments of Personal Health Budgets

1.0 Purpose of the document

This framework document describes the financial mechanisms to be used by Staffordshire Clinical Commissioning Groups (CCGs) to deliver Direct Payments for Healthcare in line with the requirements in the National Health Service (Direct Payments) Regulations 2013 as amended by the National Health Service (Direct Payments)(Amendment) Regulations 2013 . Direct payments for healthcare are one way of managing a personal health budget.

2.0 Introduction

Direct payments for healthcare are essentially money in lieu of services made by the NHS to individuals (or to a representative or nominee on their behalf) to allow them to purchase the care and support they need. Personal Health budgets, including direct payments have been piloted in Staffordshire and Stoke on Trent since 2010 as part of a national programme. Direct Payments for healthcare are one of the ways of providing all or part of a personal health budget. There are essentially three ways for people to receive and manage their personal health budget

• A direct payment • A notional budget • A third party budget

Notional budgets (where the CCG makes the arrangements for the agreed care and support) and third party budgets( where someone independent of the individual and the NHS holds the budget and makes the arrangements for the agreed care and support) However, while the requirements in the regulations only apply to direct payments for healthcare, most of the steps, such as care planning, budget setting, and the principles around empowering people to make decisions about their own care, will be the same irrespective of the way the personal health budget is provided. Wherever personal health budgets are being provided, the use of direct payments will be considered by the CCG.

3.0 Who can receive a Direct Payment?

The individual will need to live in Staffordshire geographical area and be registered with a GP attached to Staffordshire.

From 1st April 2014, everyone receiving NHS Continuing Healthcare now has the right to ask for a personal health budget, including a direct payment. From October 2014 this “group” will have “a right to have” a personal health budget. Also the Mandate to NHS England sets an objective that from April 2015 anyone with a long term condition who can benefit from a direct payment should have the right to ask for a personal health budget.

Staffordshire PHBs Financial Framework Version 2 2.05.14 Item: 09 Enc: 07

4.0 Calculating a Direct Payment

Within NHS Continuing Healthcare, following the decision by the CCG that the person is or remains eligible for NHS funding and the person seeks a direct payment to fund for their care to meet their health and social care needs an indicative personal health budget will be calculated based on the person’s Continuing Healthcare assessment (Decision Support Tool) utilising Staffordshire PHB Indicative Budget Calculator

The Continuing Health Care team will be required to consult the CCGs “Equity Choice and Resource Allocation” Guidance to consider any options for delivering the assessed support and care of the individual; however, there may be significant cost differences in providing care in different care settings. The CCG will, where possible, accommodate the wishes of the individual and their family/carer when arranging the location of care. However, the CCG is only obliged to provide services that meet the reasonable requirements of a care package that meets those of the individual’s current assessed needs which the CCG has agreed to support.

The indicative personal budget will be internally allocated for the person from the CCG Continuing Healthcare budget and a final personal health budget is calculated once the Personal Health Budget process has been completed and approved by the CCG.

5.0 Services that Direct Payments cannot be used for

A direct payment cannot be used to purchase primary medical services provided by GPs, as part of their primary medical services contractual terms and conditions nor is a direct payment suitable for the following public health services:

• Vaccination or immunisation, including population-wide immunisation programme; • Screening • The national child measurement programme; and • NHS Health Checks

A direct payment cannot be used for urgent or emergency treatment services, such as unplanned in-patient admissions to hospital or accident and emergency

A direct payment cannot be used for surgical procedures.

A direct payment cannot be used to pay for any NHS charges, e.g. prescriptions, dental charges

A direct payment cannot be used

• To purchase alcohol or tobacco • For gambling • To repay a debt

In addition they cannot be used to purchase anything illegal or unlawful

Staffordshire PHBs Financial Framework Version 2 2.05.14 Item: 09 Enc: 07

6.0 What a direct payment can be spent on.

A direct payment can be spent on a broad range of things (except for the services and items mentioned in section 4) that will enable the person to meet their health and wellbeing needs. A direct payment will only be spent on services agreed in the care plan. The care plan must be agreed by both the CCG and the person receiving care, or their representative. Before signing off the care plan the CCG will need to be reasonably satisfied that the health needs of the patient can be met by the services specified in the Care plan. The person receiving the direct payment (whether it is the individual requiring support, their nominee or a representative) is responsible for ensuring that it is only used as specified in the care plan.

Deciding not to offer a Direct Payment

The CCG may decide not to provide a patient with direct payment if for example it considers

• That the person (or their representative) would not be able to manage them; • That it is inappropriate for that person given their condition or the impact on that person of their particular condition; • That the benefit to that individual of having a direct payment for healthcare does not represent value for money; • That the providing services in this way will not provide the same or improved health outcomes; • That the direct payment will not be used for the agreed purposes.

If the CCG decides not to give someone a direct payment, the person will be informed in writing and the CCG reasons.

The person, their nominee or representative may request the CCG reconsiders its decision not to give a direct payment. They may also provide additional evidence or relevant information to inform that decision. The CCG will reconsider their decision in light of any new evidence and then notify and explain the outcome in writing. The CCG will only reconsider the decision not to give direct payment once in any six month period

Even if someone is not suitable to receive a direct payment, they may still benefit from more personalised care. The CCG will, where possible, consider whether other forms of personal health budget, such as a notional budget or a budget held by a third party might be suitable.

7.0 Consent

Direct payments will only be made where appropriate consent has been given by:

• A person aged 16 or over who has the capacity to consent to the making of direct payments to them • The representative of a person aged 16 or over who lacks the relevant capacity to consent • The representative of a child under 16

8.0 Capacity to consent

The CCG will assume that a person aged 16 and over has the capacity to make decisions about the making of direct payments, unless the person has been assessed to lack capacity

Staffordshire PHBs Financial Framework Version 2 2.05.14 Item: 09 Enc: 07

(Mental Capacity Act 2005). As far s possible people will be supported to make decisions which affect them. The Mental Capacity Act requires that a person should not be treated as unable to make a decision unless all practicable steps to support them to do so have been unsuccessful. Therefore before the decision that someone lacks capacity the CCG will satisfy that it has taken all practicable steps to try and help the person make their own decision.

9.0 Nominees for people with capacity

If a person aged 16 or over who is receiving care has capacity, but does not wish to receive direct payments themselves, they may nominate someone else to receive them on their behalf. A representative (for a person aged 16 or over who does not have capacity or for a child) may also choose to nominate someone (a nominee) to hold and manage the direct payment on their behalf.

The CCG will need to be satisfied that a person agreeing to act as a nominee understands what is involved, and had provided their informed consent, before going ahead and providing direct payments. Before the nominee receives the direct payment the CCG will also give its consent and considered whether the person is competent and able to manage the direct payments.

If the proposed nominee is not a close family member of the person, living in the same household as the person, or a friend involved in the person’s care, then the CCG will ask the nominee to apply for an enhanced Disclosure and Barring Service (DBS) Certificate and consider the information before giving their consent.

If the proposed nominee is a close family member of the person, living in the same household as the person or a friend involved in the person’s care, the CCG cannot ask them to apply for a DBS certificate In these circumstances there is no legal power to request these checks

10.0 Representatives

If a person does not have capacity and so may not receive a direct payment personally, the CCG will establish whether someone could act as that person’s representative.

A representative is someone who agrees to act on behalf of someone who is otherwise eligible to receive direct payments but cannot do so because they do not have the capacity to consent to receiving one, or because they are a child. Before someone can become a representative, they must give their consent to managing the direct payment. The CCG will ensure that the representative is fully informed , and provided with sufficient advice and support when making their decision and consider whether the person is competent and able to manage direct payments, on their own or with whatever assistance is available to them.

A representative can be:

• A deputy appointed by the Court of Protection to make decisions relevant to healthcare and direct payments • A donee of a lasting power of attorney with the power to make the relevant decisions; • A person vested with an enduring power of attorney with the power to make the relevant decisions

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• The person with parental responsibility, if the patient is a child • The person with parental responsibility, if the patient is over 16 and lacks capacity; or • Someone appointed by the CCG to receive and manage direct payments on behalf of a person, other than a child, who lacks capacity.

11.0 Personal Care Planning (or Support Planning)

The personal care plan is at the heart of a personal health budget. The CCG will work with NHS Healthcare Providers and local authorities to ensure that the person has a personal care plan covering their health and social care needs (for patients eligible for NHS Continuing Healthcare funding).This plan will include all the services and support traditionally commissioned by the CCG and have had full involvement of the person receiving the care, their nominee or representative and their Care Planner. For children with special educational needs and disabilities, who have a single education, health and social care plan, this will also include their educational needs

The Personal Care Plan used by Staffordshire CCGs is an agreement between the CCG and the person receiving direct payments, and includes responsibilities on both sides. It will clearly set out the health needs that the direct payment to be made by the CCG is to address, it also sets out the outcomes that are intended to be achieved, and specifies the services secured by the direct payment in order to achieve these

12.0 Agreeing the Personal Care Plan

Before a direct payment is made, the personal care plan will need to be agreed by the CCG.

The personal care plan will include;-

• The health needs of the individual and desired outcomes to be achieved through purchase of care provision/services • What the direct payments will be used to purchase • The size of the direct payment and how often it will be paid • The name of the Care Planner and the Health Professional responsible for managing the care plan • Who will be responsible for monitoring the health condition of the person receiving care • The anticipated date of the first review and how it will be carried out • Where necessary procedures and protocols in managing any significant potential risks which could include; risk arising from employing members of staff, risk of the direct payment being misspent, going missing or being subject to fraud, risks to the person’s health • Where the person lacks capacity or is more vulnerable the plan will also consider safeguarding, promoting liberty and where appropriate, set out the restraint procedures: and • The period of notice if the CCG decides to reduce the amount of the direct payment • Joint sign off by the person receiving the care, Health Professional involved and/or nominee/representative

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Before any monies is released the CCG will need to know that the Care Plan is likely to work The CCG needs to assure that the personal care plan is

Lawful- does it take into account any laws or regulations that may apply to what the person wants to do? Is what the person proposed to spend the money on legal?

Safe:-Does it expose the person to potential abuse by others that they may not be able to protect themselves from?

Effective: Will it achieve the agreed outcomes? Will it keep the person healthy, safe and well?

Affordable: - Does it show that the cost of carrying it out can be met from the money that is available?

The personal care plan will be presented to the PHB Lead and CHC Lead for agreement before funding can be released and signed off by the CCG Head of Continuing Healthcare. The costed personal care plan will then be submitted to the CCG approval panel (presently the PHB Steering Group) Approval will only be given if a person has demonstrated that their agreed outcomes will be met and the care and support to be provided is appropriate to meet their identified needs, and the CCG PHB Agreement has been signed by the person (see appendix 1) the plan is then ratified and the personal health budget will be released

13.0 Reviewing and Revising the Personal Care Plan

The Personal Care Plan will be reviewed at clinically appropriate intervals. It will be initially reviewed within the first three months and then at least annually. In case of a change in a person’s condition the personal care plan will be reviewed, adapted to meet their changing needs and agreed as soon as possible

14.0 Managing the money

Direct payments will be set at a level sufficient to cover the full cost of the care identified in the personal care plan. When calculating the budget the CCG will ensure that it recognises all relevant costs eg if a person is employing Personal Assistants it will ensure that there is sufficient funding available to cover the additional necessary costs of employment such as Tax, National Insurance, training and development, pension contribution, any necessary insurance such as public liability.

The Direct Payment will be paid monthly in advance, as NHS services are free at the point of delivery and the person will not have to pay for the services themselves and be reimbursed

The Direct Payments will be paid into a separate bank account used specifically for this purpose and held by the person receiving them. When receiving direct payments the person holding the account will be asked to keep records of both the money going into the account and where it is spent. The person will need to provide evidence that the direct payment was used as agreed in the care plan

The CCG will cease paying direct payments if;-

• A person, with capacity to consent, withdraws their consent to receiving direct payments

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• A person who has recovered the capacity to consent, does not consent to direct payments continuing; or • A representative withdraws their consent to receive direct payments and no other representative has been appointed.

The CCG may also stop payments if they are satisfied that it is appropriate to do so; e.g.

• The person no longer needs care • Direct payments are no longer a suitable way of providing the person with care • The CCG has reason to believe that a representative or nominee is no longer suitable to receive direct payments and no other person has been appointed • A nominee withdraws their consent, and the person receiving care or their representative does not wish to receive the direct payments themselves • The person has withdrawn their consent to the nominee receiving direct payments on their behalf • The direct payment has been used for purposes other than the services agreed in the care plan • Fraud, theft, or an abuse in connection with the direct payment has taken place; or • The person has died

If, for whatever reason, the person receiving care is no longer able or willing to manage the direct payment the CCG remains responsible for fulfilling the contractual obligations the person entered into. After a direct payment is stopped, all rights and liabilities acquired or incurred as a result of a service purchased by direct payments will transfer to the CCG.

In some cases, it may be necessary to stop the direct payment immediately, for example if fraud or theft has occurred, The CCG will protect public money as far as possible, whilst being mindful that the CCG is still under a duty to provide healthcare if the individual requires it. Where possible the CCG will endeavour to continue to provide a personalised service and maintain a continuity of care

15.0 Repayment of a Direct Payment

Direct Payments will be reclaimed by the CCG if;-

• Monies has been spent that was not agreed in the personal care plan • Theft, fraud or other offences have occurred • The person receiving care has died, leaving part of the direct payment unspent • The personal care plan has changed substantially resulting in surplus funds • The persons circumstances have changed substantially such as admission to hospital resulting in the person not using the direct payment to purchase their care • A significant proportion of the direct payment has not been used to purchase the services specified in the care plan resulting in money being accumulated including any interest accrued in year

If the CCG decides to seek repayment, reasonable notice of four weeks in writing or immediate if fraudulent activities have occurred will be given stating

• The reason for their decision.

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• The amount to be repaid. • The time in which the money must be repaid; and • The name of the person responsible for making the repayment.

16.0 Employment of Personal Assistants

If the person receiving care employs a Personal Assistant, the person shall also:

• Maintain employers liability insurance cover with a reputable insurer in a minimum sum of £3 million pounds and provide the CCG on request a copy of their current insurance policy certificate and satisfactory evidence to confirm payment of the current insurance premium; • Comply with the Employers Liability (Compulsory Insurance) Act 1969 and any statutory orders/regulations made under the Act. • Ensure that appropriate arrangements have been made with the Inland Revenue for the proper payment of the income tax and national insurance payable in respect of their Personal Assistants wages; • Use their reasonable endeavour to provide their Personal Assistant with a safe working environment; • Retain a copy of each Personal Assistants contract of employment or service contract for inspection by the CCG

When recruiting, appointing and employing Personal Assistants the person will not discriminate against them on the grounds of their ethnic origin, religion, disability, or sexual orientation.

17.0 Employing Close Relatives residing in the Same Household

Unless the CCG is satisfied that is necessary to meet the person’s needs, it may not allow people to use Direct Payments to secure services from a spouse, from a partner, or from a close relative who live in the same household as the Direct Payment recipient

This restriction is not intended to prevent people from using their direct payments to employ a live-in personal assistant, provided the person is not someone who would primarily be residing in the same household on a personal basis.

18.0 Complaints/Disputes

Where the person is not happy with the amount that the CCG sets the PHB or Direct Payment at, requirements of the Direct Payments processes or any other aspect of the PHB system, all efforts to address the matter will be taken informally. Should informal procedures not prove satisfactory then the individual has the right to use the CCG complaints procedure.

02.05.14

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Service Agreement Appendix 1

Staffordshire Clinical Commissioning Groups (CCGs) [ 2014]

This is an agreement between you and ………………………Clinical Commissioning Group (CCG). If you have any doubts about its contents you should seek your Support Planner assistance. ………………Clinical Commissioning Group (CCG) encourages you to take independent advice before signing this agreement.

Parties This Agreement is between:-

(1) …………………………. Clinical Commissioning Group (CCG) (Address) (“us” or the ”CCG”) and

(2) [Patient’s Name and Address] (“you” or the “patient”)

1. The Agreement

1.1 This is an agreement between you and us which is made pursuant to Section 12A of the National Health Service Act 2006 and the National Health Service (Direct Payments) Regulations 2013.

1.2 Defined terms have the meaning given in Clause 1.6 of this Agreement.

1.3 The CCG has assessed your need for Support and is satisfied that you are capable of managing by yourself or with such assistance as may be available to you to receive your Personal Health Budget as a Direct Payment from the CCG to your Bank Account. The Direct Payment will be made by the CCG itself in accordance with this Agreement and any other agreement and terms and conditions referred to in this Agreement.

1.4 Your Bank Account into which Direct Payments under this Agreement are paid by the CCG will be used by you or your Representative only for the purposes of securing Support as agreed with the CCG in your Personal Health Budget Plan by means of Direct Payments and for no other purpose.

1.5 This Agreement will come to an end with immediate effect upon any change in the law which will make it unlawful for you and the CCG to carry out your and our obligations under this Agreement. Upon termination of this Agreement under this Clause 1.5 all monies held by you or your Representative shall be repaid to us immediately or as directed by us.

1.6 Definitions

Agreement means this agreement between you or your Representative and the CCG to use your Bank Account to receive your Personal Health Budget as a Direct Payment from the CCG and incorporates the terms and conditions referred to in Schedule 1.

Bank Account means the bank account held by you or your Representative with your nominated bank and approved by the CCG into which Direct Payments are paid

Staffordshire PHBs Financial Framework Version 2 2.05.14 Item: 09 Enc: 07

under the terms of this Agreement and which may also include, subject to approval by the CCG, any existing bank account you or your Representative may solely hold for the purpose of receiving direct payments for health and social care needs from your Local Authority.

Care Coordinator means the person nominated by the CCG to monitor and review the making of Direct Payments in accordance with Paragraph 2.2 of Schedule 1.

DBS means Disclosure and Barring Service or any replacement or successor organisation to it.

Direct Payments means the payments made to you in accordance with clause 3 of this Agreement and paid into the Bank Account by the CCG itself .

Employment Costs means costs associated with the employment of staff by you or your Representative for the purpose of this Agreement including (but not limited to) wages, DBS checks, national insurance, training, payroll, insurance and emergency cover, tax and any other costs.

Guidance means the HFMAs Direct Payments for Healthcare – Practical Guide

Personal Health Budget means the budget for provision of health care services to you made by way of Direct Payments in accordance with this Agreement.

Personal Health Budget Plan means the plan you develop with appropriate personalised assistance, which describes the health outcomes you want to achieve and the services to be secured by means of Direct Payments to achieve the health outcomes. This plan is agreed by you or your Representative and the CCG.

Clinical Commissioning Group (CCG) manages the provision of primary care services in a specific area and will work with local authorities and other agencies that provide health and social care locally to make sure that the local community's needs are being met.

Regulations means the National Heath Service (Direct Payments) Regulations 2013 as amended or replaced by subsequent legislation.

Representative means a deputy, attorney, person with parental responsibility and any other person, which the CCG may consider appropriate to receive and manage Direct Payments on your behalf and named at Clause 2.5 of this Agreement.

Support means the arrangements made to meet your health care needs as specified in your Personal Health Budget Plan.

References to “you”, “your” and “yourself” are references to the person first named below as a signatory to this Agreement and references to “we”, “us” and “our” are references to the CCG.

2 Representative

2.1 Any Representative to whom the CCG is to make Direct Payments under the terms of this Agreement will:

a) be considered appropriate by the CCG

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b) agree to act on your behalf in relation to the Direct Payments;

c) act in your best interest when securing the provision of services in respect of which Direct Payments are made;

d) be responsible as a principal for all contractual arrangements entered into for your benefit and secured by means of Direct Payments;

e) use the Direct Payments in accordance with the Personal Health Budget Plan and the terms of this Agreement and the Regulations;

f) cannot be receiving payment through the PHB for any respect, including to help manage or administer the PHB, or to provide services funded by the PHB

g) inform us immediately if you regain mental capacity and can manage the Direct Payments.

h) where required agrees to have a DBS check.

2.2 We will agree to the making of Direct Payments to the representative on your behalf subject to being satisfied that the representative is capable of managing the Direct Payments by themselves or with such assistance as may be available to them. If the Representative is not one of your close family members or a friend involved in your care, then we will require the representative to apply for an enhanced DBS check certificate before giving our consent to making the Direct Payments to the representative.

2.3 You agree to notify the CCG if you wish to change or withdraw your Representative. Following such a notification we may stop the making of Direct Payments, consider paying the Direct Payments to you directly or to a different representative and as soon as reasonably possible review the Personal Health Budget and Personal Health Budget Plan in accordance with the Regulations.

2.4 If Direct Payments to you are stopped under Clause 2.3, it will be you or your Representative’s responsibility to ensure that any surplus monies held by you or your Representative under this Agreement are repaid to us.

2.5 Details of the Representative are:

Name of Representative:

______

Relationship to the Patient:

______

Address:

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3 Payments

3.1 All Direct Payments as agreed by you or your Representative in the Personal Health Budget Plan will be made by the CCG itself to you or your Representative as follows:

3.2 Single payments

You or your Representative will receive in your Bank Account a one-off payment of £ [ ]

3.3 Regular Payments

a) Your first payment may cover more than 4 weeks and may be after the commencement of the service

b) Every 4 weeks, in advance, you or your Representative, will receive in your Bank Account £ ____as your Direct Payment.

c) This is equivalent to £ ______per week.

4. General Provisions

4.1 All amendments and variations of this Agreement must be agreed between you or your Representative and us and confirmed in writing, signed and dated by you or your Representative and us and attached to this Agreement. You or your Representative will receive not less than 4 weeks notice of any proposed review, monitoring or changes to your Personal Health Budget leading to any such amendments and variation to this Agreement.

4.2 Any notice to be given in connection with this Agreement will be in writing and may be delivered by hand, post or facsimile, addressed to the recipient at the address set out below or any other address notified to the other party in writing in accordance with this clause as the address to which notices and other documents may be sent:

CCG Address

……………………………………………………………………

Your Address

…………………………………………………………………….

……………………………………………………………………….

Your Representative’s Address

______

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4.3 The notice, demand or communication will be deemed to have been duly served:

a) if delivered by hand, at the time of delivery;

b) if delivered by post, forty eight (48) hours after being posted (excluding Saturdays, Sundays and public holidays);

c) if delivered by facsimile, at the time of transmission.

4.4 This Agreement will be a legally binding contract made in England and Wales and will be subject to the laws of England and Wales.

4.5 This Agreement together with Schedule 1 constitutes the whole agreement between you or your Representative and the CCG and supersedes any previous arrangement, understanding or agreement between you and the CCG relating to the subject matter of this Agreement.

4.6 If any provision of this Agreement (or part of any provision) is found by any court or other authority of competent jurisdiction to be invalid, illegal or unenforceable, that provision or part-provision will, to the extent required, be deemed not to form part of the Agreement, and the validity and enforceability of the other provisions of the Agreement will not be affected.

4.7 You confirm that you have read and understood this Agreement including the terms and conditions set out in Schedule 1.

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The CCG and you or your Representative agree to be bound by and to comply with the terms and conditions set out in Schedule 1 to this Agreement and any other applicable terms and conditions as referred to in this Agreement or as notified to you or your Representative by the CCG.

Signed by the Patient ……………………………………………………………………..

Name ………………………………………………………………………… Address ……………………………………………………………………… ……………………………………………………………………………….. ……………………………………………………………………………….. ………………………………………………………………………………..

Date ……………………………………………………………………….....

Signed by the Representative (if applicable……………………………………………………

Date ……………………………………………………………………….....

Signed on behalf of………………………….. Clinical Commissioning Group

Signature …………………………………………………………………….

Name ………………………………………………………………………...

Designation ………………………………………………………………….

Address: …………………………………………………………………………………

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SCHEDULE 1

YOU AND STAFFORDSHIRE CLINICAL COMMISSIONING GROUPs (CCGs)- RIGHTS AND RESPONSIBILITIES

This document sets out the rights and responsibilities of the Agreement between you or your Representative and the CCG

1. Your Rights and Responsibilities

1.1 You or your Representative agree that your health needs can be met by provision of the Support as identified in the Personal Health Budget Plan, as updated from time to time in accordance with this Agreement or as required by any relevant law or guidance, and that the amount of the Direct Payments is sufficient to provide for the full cost of the Support identified in your Personal Health Budget Plan. You or your Representative agree to use your Personal Health Budget made available to you as Direct Payments for the purpose of securing services needed to help deliver your agreed health outcomes as agreed by you in your Personal Health Budget Plan from any service provider who meets the conditions set out at paragraph 1.9 of this Schedule and does not fall under paragraph 2.5 of this Schedule.

1.2 You agree that your Direct Payments cannot be used for the purchase of the following:

a) Supply or procurement of alcohol or tobacco; or

b) Provision of gambling services or facilities; or

c) Repay a debt otherwise than in respect of a service specified in your Personal Health Budget Plan; or

d) Primary medical services provided by general practitioners as indicated in the Personal Health Budget Plan; or e) Urgent or emergency treatment services (including any unplanned hospital admissions) as indicated in the Personal Health Budget Plan, or f) Support for social care (in the event direct payments for social care are paid into your Bank Account by your local authority). g) Anything illegal, unlawful or harmful to yourself or others

1.3 You or your Representative must use Direct Payments to cover the cost of your Support and for no other purpose.

1.4 You or your Representative agree to provide us every month a list detailing how you or your Representative intend to spend your Personal Health Budget and upon our request provide information or evidence relating to:

a) your state of health or any health condition and any changes relating to your health in respect of which Direct Payments are made;

b) the health outcomes expected from the provisions of any service;

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c) any other information as we may consider necessary.

1.5 You or your Representative must let us examine, and where appropriate, take copies or make extracts of all information and documentation relating to your Personal Health Budget and the provision of the Support within 30 days of the end of the three and nine months monitoring periods from the date you first receive the Personal Health Budget as set out in paragraphs 1.11 and 1.12, or whenever the CCG requests you or your Representative to do so. This information includes:

a) all financial records (that is of income received and payments made through your Bank Account which show clearly the Direct Payments received from us and details of how you or your Representative have used the Direct Payments as agreed in the Personal Health Budget Plan;

b) Your Bank Account bank statements;

c) Receipts for payment made;

d) Agency invoices and receipts (if applicable); and

e) Any other information as we may consider necessary.

Where you or your Representative are to provide us with information under this Agreement, such information shall be provided in a legible format, accompanied by authorisation for us to take copies or extracts of the information, with an explanation of the information provided to us or a statement to the best of you or your Representative’s knowledge and belief of where any information not provided to us is held.

1.6 You or your Representative must keep all supporting documents relating to your Personal Health Budget and the provision of the care for at least six complete financial years from the date of the payment, even if the payments have stopped. You or your Representative agree to provide us, upon our request, with an explanation of the information you provide to us or a statement to the best of your knowledge and belief of where any information you fail to provide to us is held.

1.7 You must keep a Financial Record which shows clearly:

a) payments you have received to meet your assessed needs; and

b) details of how you have used Direct Payments made into your Bank Account, as agreed with your Support Planner.

1.8 You or your Representative must ensure that provisions are put in place for cover in emergency situations to ensure that you have care when you need it.

1.9 You or your Representative must ensure that the organisation providing the Support:

a) is reputable and can meet the standards of quality expected by us;

b) has complied with all its registration obligations including with the Care Quality Commission if carrying out regulated activities;

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c) has adequate insurance and indemnity cover for the services to be provided to you, if it is ascertained that the provider must operate under insurance or indemnity cover;

d) has the right skills and resources in place to provide the type of services you require under the Personal Health Budget Plan;

e) has adequate complaints procedures in place; and

f) where applicable, is a registered member of a professional body affiliated with the Council of Healthcare Regulatory Excellence.

1.10 You or your Representative, may request us to carry out on your behalf the enquiries under paragraph 1.9(b) and (c) in respect of any particular service provider organisation.

1.11 No later than three months from the date you first receive your Personal Health Budget in your Bank Account there will be an initial review of the management of the Personal Health Budget and a review and re-assessment of your care needs (including a review of the quality of the Support arrangements you have made). Any proposed changes to the Personal Health Budget and / or the support arrangements will be the subject of discussions between you and us.

1.12 There will be subsequent financial monitoring of your Personal Health Budget at months 3 and 9 in year one after the date you first receive the Personal Health Budget and subsequently every 6 months and more frequently if there is a change in circumstances, or where we become aware that the Direct Payment(s) have not been sufficient to secure your Support, there will be a review of the management of the Personal Health Budget and a review and re-assessment of your Support needs (including a review of the quality of the Support you are receiving). Any proposed changes to the Personal Health Budget and / or the Support will be notified to you or your Representative in accordance with Clause 4.1 of the Agreement and will be the subject of discussions between you, your Representative and the CCG.

1.13 If following a review of your Personal Health Budget under paragraphs 1.11 and 1.12 we decide to reduce the amount or stop the making of Direct Payments we will give you or your Representative 4 weeks minimum notice in writing stating the reasons for the decision. Upon receipt of such notice you or your Representative may require us to undertake one further review and provide any relevant evidence or information to consider as part of this further review. We will notify you or your Representative in writing of our decision and the reasons for it.

1.14 You or your Representative, agree to notify us immediately of any substantial change of your health conditions or the Personal Health Budget Plan or other relevant circumstances (including: where you are admitted to hospital, move away from Staffordshire, move to a different address in Staffordshire, leave the country for more than four weeks, no longer wish to receive the Direct Payment, or need help to comply with these terms and conditions).

1.15 Where we are satisfied that the whole or any part of a Personal Health Budget has not been used to secure the Support to which it relates, the CCG on giving reasonable notice reserves the right to:

a) demand repayment of the whole or part of the Direct Payment; or

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b) withdraw your Direct Payment and transfer it onto a notional budget managed directly by us; or

c) arrange for a third party or accountancy service approved by us to take over the management of your Direct Payment.

1.16 Subject to paragraph 2.7 of this Schedule, where we are satisfied that you, your Representative or Nominee have not complied with any term or condition of this Agreement then you or your Representative must repay the whole or part of the Personal Health Budget if we so request.

1.17 You or your Representative (if so directed by you) have the right to bring this Agreement to an end at any time by giving four weeks written notice (or less by agreement) to your Support Planner

1.18 If this Agreement is brought to an end by you or your Representative or by us, we will be responsible for settling any outstanding payments due to a provider organisation whom you or your Representative have made arrangements to provide Support. If there is a surplus Personal Health Budget held by you in a Bank Account under this Agreement it must be repaid to us in accordance with our instructions.

1.19 Any repayment of the Direct Payments, in part or in whole, to the CCG under the terms of this Agreement shall be made in accordance with our other instructions.

1.20 No transfer of Direct Payments monies to any bank account (other than the Bank Account) held by you or your Representatives is permitted under the terms of this Agreement.

1.21 You or your Representative may at any time during the term of this Agreement request us to undertake a review of the Personal Health Budget. Upon receipt of such a request we shall decide whether to undertake such a review and will notify you or your Representative of our decision and the reasons for it.

1.22 When you intend to employ staff directly, you or your Representative must request these staff to undertake DBS checks. When you intend to employ or contract with persons known to you (such as a member of your family or friends) you will have discretion as to whether to request them to undertake an enhanced DBS check to ensure that person has no relevant criminal convictions which would preclude them from being employed in such a role. If you intend to employ a person unknown to you but known to your Representative, you shall require such person to undertake an enhanced DBS check.

1.23 If you directly employ staff you are required to have in force employer's liability insurance which includes public liability insurance. This is to be with reputable insurers or underwriters with a minimum limit for any one claim (the limit to be increased from time to time as reasonably required by us). The relevant insurance policy and the premium receipts must be produced as and when required by us. An allowance for these insurance policies is included within the Personal Health Budget.

1.24 You or your Representative (if so authorised by you) agree to notify in writing your next of kin and/or or personal representative and your bank and/or building society that the Bank Account does not form part of your estate and does not form part of your personal income. A copy of such notification shall be provided to the CCG within […] days of being served on the relevant persons in accordance with this paragraph 1.24. In the event of your death we will assess the outstanding contractual

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responsibilities incurred by you or your Representative in respect of the use of the Direct Payments for the purpose of determining whether any amount shall be repaid to the CCG.

1.25 You must use an accredited/reputable payroll services to pay your personal assistants or employees, if any.

1.26 Anyone employed by you using the Personal Health Budget will not be considered as one of the CCG’s employees or agents.

1.27 All Employment Costs associated with the employment of any staff by you under this Agreement shall be included within the Personal Health Budget as indicated in the Personal Health Budget Plan.

1.28 You or your representative agree that the purchase of equipment with your Personal Health Budget will be discussed with the CCG in regard of any costs of repairs, insurance or replacement and will be clearly outlined in your Personal Health Budget Plan.

2. Our Rights and Responsibilities

2.1 We will agree with you and advise you or your Representative of significant potential risks arising in relation to the making of Direct Payments and the means of mitigating those risks.

2.2 We retain responsibility to review your health care needs and will therefore appoint or identify the Care Coordinator to assess that your needs as agreed in the Personal Health Budget Plan are being met. The Support Planner will be responsible for reviewing the Personal Health Budget Plan and:

a) Monitoring your health needs and the making of Direct Payments to you or your Representative;

b) Arranging for the review of Direct Payments under the terms of this Agreement;

c) Liaising between you or your Representative and us.

2.3 The sum of the Personal Health Budget we have agreed we will pay you for ‘start up’ costs for the regular provision of Support will be paid by us into your Bank Account.

2.4 The Personal Health Budget in the form of Direct Payments will be paid by the CCG itself into your Bank Account for the purpose of you receiving payments for the cost of the Support which we have assessed is needed by you in accordance with clause 3 of this Agreement.

2.5 We reserve the right to require that you or your Representative do not secure Support from a particular service provider as indicated by us in this Agreement or otherwise notified to you or your Representative by us. You or your Representative agree not to use the Direct Payment to purchase the Support from a close family member if they are living in the same household.

2.6 We may suspend or discontinue making payments to you or your Representative if we become aware or are notified that the Personal Health Budget is not needed for a period exceeding 28 days but before doing so we will discuss the matter with you or

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your Representative and take into account any contractual agreements and continuing needs you may have.

2.7 Where we are satisfied that the whole or any part of the Personal Health Budget has not been used to secure the provision of the care to which it relates or your Personal Health Budget Plan has changed substantially then we may suspend, discontinue or reduce the amount of Direct Payments but before doing so we will discuss the matter with you and take into account any contractual agreements and continuing needs you may have. If no contact can be made with you for a period of 4 weeks we reserve the right to suspend or withdraw your Direct Payment.

2.8 Where we are satisfied that you or your Representative have not complied with any term or condition of this Agreement then we may require you or your Representative to repay us the whole or part of the Personal Health Budget we have made to you.

2.9 If we decide that a sum must be reduced or repaid under paragraphs 1.15, 1.16, 2.7, and 2.8 we will notify you or your Representative within 4 weeks of making the decision providing our reasons for making the decision and specifying the amount to be reduced or repaid.

2.10 If we are satisfied that theft, fraud or another offence has occurred in connection with the Direct Payments we may terminate this Agreement with immediate effect and require you or your Representative to repay us the whole or part of the payment. We will notify you or your Representative within 4 weeks of making the decision providing our reasons for making the decision and specifying the amount to be repaid.

2.11 Upon receipt of a notice to repay the whole or part of the Direct Payments served under paragraph 2.10 you or your Representative may require us to re-consider the decision and provide evidence or information for us to consider as part of the deliberation. We will notify you or your Representative in writing of our decision and the reasons for it.

2.12 We have the right to bring this Agreement to an end by giving you or your Representative 4 weeks notice in writing stating the reasons for the decision if it appears to us that you are no longer capable of managing a Personal Health Budget by yourself or with such assistance as may be available to you or you are a person whose ability to arrange your Support is restricted by certain mental health or criminal justice legislation (details of which we will give to you).

2.13 Even if you appear to us no longer to be capable of managing a Personal Health Budget by yourself we may continue to make such payments if we are reasonably satisfied that your inability will be temporary and a Representative is prepared to accept and manage the Direct Payments on your behalf and your Representative allows you to manage Direct Payments by yourself for any period for which we are satisfied that you have capacity to do so.

2.14 We may bring this Agreement to an end by giving you or your Representative 4 weeks notice in writing stating the reasons for the decision if it appears to us that your needs for care can no longer be met by means of a Personal Health Budget or if you are no longer registered with a GP practice covered by Staffordshire CCGs.

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2.15 We may bring this Agreement to an end by giving you or your Representative 4 week notice in writing stating the reasons for the decision if you or your Representative have not complied with any term or condition of this Agreement.

2.16 We may bring this Agreement to an end with immediate effect and arrange appropriate services if:

a) Your Representative refuses to receive Direct Payments; or

b) We consider that your Representative is no longer suitable to receive Direct Payments.

2.17 Upon receipt of a notice served under paragraph 2.16 you may require us to reconsider the decision and provide evidence or information for us to consider as part of the deliberation. We will notify you or your Representative in writing of our decision and the reasons for it.

2.18 Any right or liability of you or your Representative (or personal representatives in case of your death) to a third party acquired or incurred in respect of a Support secured by means of a Direct Payment shall transfer to the CCG when the CCG stops making Direct Payments to you or your Representative pursuant to termination of this Agreement for whatever reason.

2.18 Throughout the duration of this Agreement we will provide information, advice and support to you or your Representative as may be necessary.

2.19 We will ensure, where applicable, that any person involved in the management or delivery of the Support has undertaken an enhanced DBS check. We will inform you or your Representative of the results of any such checks.

2.20 The NHS complaints procedure will apply to any decision by us in relation to a complaint brought by you or your Representative. We will ensure that you or your Representative are aware of the process for accessing that procedure. We will also ensure that you are aware of the procedure for escalating a complaint to the Health Service Ombudsman should you or your Representative feel that it is necessary to do so.

3 Your Bank Account

3.1 Your Bank Account will be held by you or your Representative and, subject to approval by the CCG, be accessible by your Representative for the purpose of using the Direct Payments under the terms of this Agreement and the Regulations.

3.2 In the event that direct payments for social care are paid into your Bank Account by your Local Authority, you or your Representative will ensure that no monies paid under this Agreement as Direct Payments are used for the purchase of social care support.

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Item No: 10 Enc: 08

REPORT TO THE Clinical Commissioning Group Governing Body Meeting TO BE HELD ON: Thursday 6th November 2014

Subject: Medicines Waste Campaign 2014 Board Lead: Lynn Millar Officer Lead: Sharuna Ready For For For For Recommendation:  Approval Ratification Discussion Information PURPOSE OF THE REPORT: Medicines waste is a concern both locally and nationally within the NHS. According to a 2010 report an estimated £300million of medications are wasted annually within primary care in England which is equivalent to over £750,000 within NHS Cannock Chase CCG.

Some wastage of medicines is inevitable however a lot of waste is preventable – around 50% of current waste is thought to be avoidable by changing the processes surrounding medication ordering, supply and use. The aim of the planned medicines waste campaign is to raise awareness of the issue to patients and healthcare professionals to address the problem areas.

KEY POINTS:

Medicines waste can be due to reasons which are difficult to control – patients’ medications do change due to dose changes or discontinuations due to side-effects, changes in the patients’ condition and admission to hospital. However there are many causes of medicines waste which should be avoidable. These include patient’s stock-piling medications at home, inappropriate ordering of repeat medication by patients and community pharmacists and ineffective repeat prescription issuing processing in practices. This medicines waste campaign is aimed at addressing these avoidable causes. The medicines management team have been working with the CSU communications team to produce an awareness campaign of the issue. This will include promotional items such as posters and leaflets, aimed at the public, to be displayed in both practices and community pharmacies together with potential advertising options. This work is still in development at present and further information will be circulated when available. The public medicines waste campaign will focus on the following key messages to patients: 1. Check what supplies you have at home before ordering your repeat prescription and only order the items you require. Do not automatically order everything on your repeat every month. Do not order “just in case”. 2. You do not need to order medication which is only used when required every month. Items will only be removed if they have not been ordered for at least 6 months.

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Item No: 10 Enc: 08 3. Ask your community pharmacist if you have any questions about your medications. 4. Let your GP or pharmacist know if you are not taking any of your medications or are not taking them in exactly the same way which is on your prescription - by changing the quantity on your prescription reduces the risk of unnecessary waste.

In addition to the public awareness campaign we will also be working on the following: • Audits of the repeat prescription process: this will focus on who is requesting repeat prescription items for patients. We will be working with the Local Pharmaceutical Committee and all community pharmacies within the locality to ensure that appropriate SOPs are in place to cover the appropriate ordering of repeat prescriptions on behalf of patients and that these are being used effectively. • Support and training to prescription administration staff within practices: ensuring that the issuing process is as efficient as possible within practices is important to prevent unnecessary waste. The medicines management team will be working with reception/prescription teams to address potential issues and to provide training, where appropriate. • Implementation of Electronic Prescribing Release 2 (EPS2): NHS Cannock Chase and is currently beginning practice implementations of EPS2. When prescriptions are sent electronically there is a full audit trail of the prescription and therefore requests for prescription reprints (from lost or mis-placed prescriptions) will be significantly reduced – this should result in potential reductions in medicines waste where duplicated prescriptions may previously have been dispensed. The public awareness campaign is planned to start in mid-November 2014.

RELEVANCE TO KEY GOALS To reduce health inequalities across N/A Cannock Chase through targeted interventions.

To identify and support patients with N/A Long Term Conditions to ensure care delivery closer to home.

To improve and increase overall life N/A expectancy.

To develop integrated services with N/A simple, easy access.

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Item No: 10 Enc: 08 IMPLICATIONS Legal and/or Risk N/A CQC N/A Patient Safety Improving the ordering systems for medicines and reducing medicines stockpiling will have significant patient safety benefits. Patient Engagement N/A Financial Reducing medicines waste will have significant financial savings on the CCG prescribing budget. Sustainability N/A Workforce / Training N/A

RECOMMENDATIONS / ACTION REQUIRED: The CCG Governing Body is asked to: Approve and support a medicines waste campaign within NHS Cannock Chase CCG.

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Item No: 11 Enc: 09

REPORT TO THE Clinical Commissioning Group Governing Body Meeting TO BE HELD ON: Thursday 6th November 2014

Subject: NHS Health Checks (NHSHC) in Stafford and Surrounds CCG 2013/14 Board Lead: Andrew Donald Officer Lead: Andrew Donald For For For For Recommendation:  Approval Ratification Discussion Information PURPOSE OF THE REPORT: To share the NHS Health Checks in Cannock Chase (CC) CCG, 2013/14 – Executive Summary published by Public Health Staffordshire (June 2014).

A key national programme driver relating to CCG targets is the strategic imperative to reduce health inequalities due to Cardiovascular Disease (CVD) and to increase life expectancy from preventable CVD conditions. Everyone between the ages of 40 and 74, who has not already been diagnosed with one of the identified diseases shall be invited (once every five years) to have a check to assess their risk of heart disease, stroke, kidney disease and diabetes and will be given support and advice to help them reduce or manage their risk.

KEY POINTS: The Executive Summary identifies the following recommendations: • CC CCG encourages practices to participate in NHSHC delivery • CC CCG encourages non-participating practices to share information with Public Health to enable accurate denominators to be calculated • CC CCG encourages non-participating practices to engage with the alternate provider • CC CCG encourages practices that are under performing to avail themselves of the Practice Support Service provided by Quintiles • CC CCG encourages practices to address quality issues within NHSHC delivery in readiness for new round of contracting

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Item No: 11 Enc: 09

Relevance to Key Goals To reduce health inequalities across The provision of Health Checks will support health equality Cannock Chase through targeted across the CCG. interventions.

To identify and support patients with By taking part in the health check programme patients will Long Term Conditions to ensure care be aware of the potential issues sooner. delivery closer to home.

To improve and increase overall life By taking part in the health check programme patients will expectancy. be aware of the potential issues sooner.

To develop integrated services with N/A simple, easy access.

Implications Legal and/or Risk N/A CQC N/A Patient Safety NHS Health checks will help keep patients safe. Patient Engagement This is good service to promote through PPGs. Financial N/A Sustainability N/A Workforce / Training N/A

RECOMMENDATIONS / ACTION REQUIRED: The CCG Governing Body is asked to note the content of the report.

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NHS health checks in Cannock Chase CCG, 2013/14 Executive Summary

CC CCG performance

There has been a significant improvement in performance for both the NHS health checks coverage and uptake of invitations in 2013/14 compared to 2012/13. Cannock Chase CCG is now just above national targets at 22% of the eligible population invited and over half of the 20% annual target population receiving a health check (11%) (Figure 1).

However, the CCG remains below the Staffordshire average (25%) for invitations whilst 13 of the 26 NHSHC participating practices have not achieved the minimum national target (10%) of their eligible population receiving a health check. Uptake of invitations compares to the England average of 50% but could be improved.

Please see figure 1 for comparative activity in all Staffordshire CCGs, Table 3 for outcomes from the NHSHC programme and Table 4 For Cannock CCG practice detail ( which shows the wide variation in performance)

Table 1: Practices signed up to LES in Staffordshire, 2013/14

Number Percentage Number of signed up to signed up to practices LES LES Cannock Chase 27 26 96% East Staffordshire 19 17 89% North Staffordshire 33 33 100% South East Staffordshire and 31 26 84% Seisdon Peninsula Stafford and Surrounds 14 9 64% Staffordshire CCGs 124 111 90% Source: Public Health Staffordshire, Staffordshire County Council

Table 2: Practices who have not engaged with the alternative provider or provided denominator data

Red Lion Surgery (M83130)

Public Health Staffordshire Page 1 Figure 1: Percentage of eligible people that were offered and received a health check, 2013/14

Source: NHS health checks datasets, Public Health Staffordshire and http://www.healthcheck.nhs.uk

Whilst there has been some national controversy over the evidence for NHSHCs, local programmes are already demonstrating benefits in terms of early diagnosis of new CVD disease.

Table 3: Health benefits of NHSHC in Cannock Chase CCG Cases identified National model estimates of due to NHSHC. prevalence based on 10-15% (2013/14) eligible population receiving a NHSHC* Proportion of population receiving an 7% NHSHC identified as having a CVD risk of more than 20% Number of people diagnosed with diabetes 16 42-64 Number of people diagnosed with chronic 1 109-164 kidney disease Number of people diagnosed as 44 132-197 hypertensive/ taking antihypertensive drugs Number of people prescribed statins 11 178-267 Number of people who will given brief 10851/ 25 2 76-1143 intervention1/ referred to physical activity programme2/ increase their physical activity3 Number of people who were referred to1/ 591 296-4432 complete2 a weight loss programme Number of people given smoking 2221 /452 cessation advice1/ referred to stop smoking services2 Number of people with AUDIT score of 143 eight or above and given alcohol brief intervention Source: *Public Health England NHS Health Check ready reckoner (Feb 2014)

Public Health Staffordshire Page 2

Table 4: Summary of NHSHC performance by practice 2013/14 First % of Number Eligible Signed Invites eligible receiving Uptake of population Practice Practice name up to made population a NHS invitations coverage code LES invited health (%) (target (target20%) check 10%) M83001 Horsefair Practice Yes 975 28% 358 37% 10% M83016 High Street Surgery Yes 121 7% 13 11% 1% Dr JS Chandra's M83033 Yes 181 89 Surgery 24% 49% 12% M83048 The Nile Practice Yes 716 43% 295 41% 18% Norton Canes Health M83063 Yes 147 57 Centre 18% 39% 7% Landywood Lane M83080 Yes 144 144 Surgery 22% 100% 22% Bideford Way M83107 Yes 116 22 Surgery 12% 19% 2% Dr VK Singh's M83109 Yes 234 96 Surgery 28% 41% 12% Heath Hayes Health M83129 Yes 337 337 Centre 9% 100% 9% M83130 Red Lion Surgery No 0 0% 0 0% 0% M83139 Moss Street Surgery Yes 363 24% 130 36% 8% Great Wyrley Health M83608 Yes 0 0 Centre 0% 0% 0% Wardles Lane M83613 Yes 108 108 Surgery 15% 100% 15% M83616 GP Suite Surgery Yes 539 19% 318 59% 11% Chadsmoor Medical M83637 Yes 304 34 Practice 34% 11% 4% Hednesford Street M83638 Yes 1,002 677 Surgery 25% 68% 17% M83639 Dr A Yi's Surgery Yes 122 18% 122 100% 18% Newhall Street M83662 Yes 136 37 Surgery 22% 27% 6% Southfield Way M83698 Yes 373 58 Surgery 40% 16% 6% M83703 Brereton Surgery Yes 78 7% 73 94% 7% Chapel Street M83717 Yes 114 95 Surgery 11% 83% 9% M83719 Rawnsley Surgery Yes 420 32% 265 63% 20% Dr M Murugan's M83722 Yes 152 41 Surgery 15% 27% 4% Chapel Street M83727 Yes 379 202 Practice 26% 53% 14% M83738 Aelfgar Surgery Yes 294 22% 146 50% 11% Y02354 Sandy Lane Surgery Yes 1,063 37% 517 49% 18% Essington Medical Y02594 Yes 159 125 Centre 30% 79% 23%

Cannock Chase 8,577 22% 4,359 51% 11% CCG

National targets – 20% of eligible population to be invited annually 10% (min) to 15% (aspirational) of eligible population to have an NHSHC annually

Public Health Staffordshire Page 3 Item No: 12 Enc: 10

REPORT TO THE Clinical Commissioning Group Governing Body Meeting TO BE HELD ON: Thursday 6th November 2014

Subject: HR policies for ratification Board Lead: Andrew Donald Officer Lead: Sally Young For For For For Recommendation:  Approval Ratification Discussion Information PURPOSE OF THE REPORT:

To ratify the Secondment Policy, the Secondment Agreement Template and the Ex-Offenders policies.

KEY POINTS:

The CCG already has a suite of HR policies on the web-site that were ratified in July 2013. The following policies, which cover areas where we have a gaps, were approved at a meeting of the joint staff-side partnership on the 8th September 2014;

Secondment Policy Secondment Agreement Template Ex-Offenders policies

CCGs are asked to ratify the policies and the secondment agreement template

Relevance to Key Goals To reduce health inequalities across The policies have been development to ensure equal Cannock Chase through targeted opportunities for staff and potential employees. interventions.

To identify and support patients with N/A Long Term Conditions to ensure care delivery closer to home.

To improve and increase overall life N/A expectancy.

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Item No: 12 Enc: 10 To develop integrated services with N/A simple, easy access.

Implications Legal and/or Risk The CCG needs to consider the health and safety implications of all appointments. CQC N/A Patient Safety N/A Patient Engagement N/A Financial N/A Sustainability N/A Workforce / Training The secondment policy promotes development opportunities for staff.

RECOMMENDATIONS / ACTION REQUIRED: The CCG Governing Body is asked to: The CCG is asked to ratify the Secondment and Ex-Offenders policies and the secondment agreement template.

Not KEY REQUIREMENTS Yes No Applicable Has a quality impact assessment been undertaken? 

Has an equality impact assessment been undertaken? 

Has a privacy impact assessment been completed ?  Have partners / public been involved in design? 

Are partners / public involved in implementation? 

Are partners / public involved in evaluation? 

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Item: 12 Enc: 10 INSERT CCG LOGO

INSERT CCG NAME (Employing Organisation)

-and-

INSERT ORGANISATION NAME (Secondment Organisation)

-and-

INSERT EMPLOYEE NAME (Name of Employee)

SECONDMENT AGREEMENT

THIS SECONDMENT AGREEMENT IS MADE ON INSERT DATE

Item: 12 Enc: 10

BETWEEN:

(1) INSERT CCG NAME (Employing Organisation)

(2) INSERT ORGANISATION NAME (Secondment Organisation)

(3) INSERT EMPLOYEE NAME (Employee)

1. DEFINITION AND INTERPRETATION

1.1 In this Agreement the following expressions have the following meanings:

1.1.1 "The Agreement" means the Agreement concluded between the Secondment Organisation, the Employing Organisation and the Employee as set out in this document including all or any other documents that are incorporated or referred to herein.

1.1.2 “The Contract of Employment” means the Contract between the Employing Organisation and the Employee.

1.1.3 “The Secondment Period” means a fixed period from INSERT START DATE to INSERT END DATE subject to earlier termination hereinafter provided. 1.1.4 “The Secondment Services” means the duties and services associated with the secondment, which may vary from time to time in accordance with the needs of the secondment organisation.

1.1.5 “The Statutory Payments” means PAYE, Employer National Insurance contributions and such other payments as may be required by law to be made in connection with the employment of the Employee.

Item: 12 Enc: 10

2. PURPOSE

2.1 The purpose of this agreement is to describe the arrangements between The Secondment Organisation and The Employing Organisation for the secondment of INSERT SECONDEE NAME as INSERT JOB TITLE on a full time/part-time basis from INSERT START DATE to INSERT END DATE. This secondment period may be terminated subject to 1 month’s notice before this date by mutual agreement.

The agreement sets out the expectations of all three parties and the arrangements for ensuring that these expectations can be properly met.

3. SECONDMENT

3.1 During the Secondment Period:

3.1.1 The salary during the period of secondment will be £XXXXX (AfC Band X or VSM) per annum, pro rata. Where Agenda for Change terms and conditions apply, this salary will be subject to increments and where Gateways exist satisfactory progression against the knowledge and skills profile or agreed objectives.

3.1.2 The Employee shall provide the Secondment Services to the Secondment Organisation in accordance with the provisions of the Agreement whilst continuing to be employed by the Employer under the Contract of Employment. The Contract of Employment shall remain in force and the Employee shall not be an Employee of the Secondment Organisation.

3.1.3 The Employee shall, subject always to the control of the Secondment Organisation, perform the Secondment Services, whether or not they are within the scope of their normal duties under their Contract of Employment. Notwithstanding their job title contained within their Contract of Employment the Employee shall perform those Secondment Services as if they were specifically required under the Contract of Employment; Item: 12 Enc: 10

3.1.4 The Employee shall faithfully and diligently perform the Secondment Services and exercise such powers as may from time to time be reasonably assigned to them or invested in them by or under the authority of the Secondment Organisation for the performance of those Secondment Services. He/she shall obey all reasonable and lawful directions given to him/her by or under such authority in respect of the Secondment Services, and he will use his reasonable endeavours to promote the interests of the Secondment Organisation.

3.1.5 If the secondment post falls within the criteria for a DBS check outlined by the Department of Health circular HSC 2002/008 and subsequent guidance 2006 and 2013, then a DBS check will be undertaken.

3.1.6 The Employee shall notify both the Employing Organisation and the Secondment Organisation of any absence due to sickness or holiday entitlement.

3.1.7 The Employing Organisation will be responsible for recording any episodes of absence that the Employee notifies them of on the Employing Organisation’s Electronic Staff Record (ESR).

3.2 The Secondment Organisation will ensure that the Employee is provided with an induction programme suitable to their needs and is properly and sufficiently trained and instructed with regard to:

3.2.1 The provisions of the Agreement;

3.2.2 All relevant rules, policies, procedures and standards of the Secondment Organisation as provided by the Secondment Organisation and all relevant statutes and statutory instruments including those relating to fire risks, fire precautions and health and safety.

3.2.3 Assessment and performance review processes

Item: 12 Enc: 10

3.3 It is agreed between the parties that:

3.3.1 The Employee will provide the Secondment Services from a base agreed by the Secondment Organisation and such other reasonable locations as requested by the Secondment Organisation;

3.3.2 The Secondment Organisation will draw up a Learning Agreement, KSF profile or objectives, target dates and measures of performance, with the Employee, so that it can conduct its own assessment of the Employee’s ability and competence in providing the Secondment Services.

3.3.3 The Employer accordingly does not warrant in any way the Employee’s skill, competence or diligence and any condition or warranty express or implied to that effect is hereby excluded.

3.3.4 The resolution of any issues relating to the management of the Employee including disciplinary and grievance procedures, issues relating to pay and conditions, sick leave, pension and other employment issues remain the responsibility of the Employer;

3.3.5 In relation to any of the issues referred to in Clause 3.3.2 the Secondment Organisation agrees to provide any and all reasonable assistance which may be required by the Employer in the resolution of any such issues, including but not limited to any investigatory or documentary assistance, or witnesses and witness evidence as appropriate, and shall afford the Employer access to the Secondment Organisation’s premises and any of the Secondment Organisation’s own Employees as the Employer may reasonably require in the resolution of those issues;

3.3.6 The Employee will assist the Secondment Organisation and the Employer in all regards (including but not limited to providing documentation or access thereto, witnesses and witness evidence) with any and all of the matters referred to in Clause 3.3.4, whenever it is requested by the Secondment Organisation or the Employer to do so. Item: 12 Enc: 10

3.4 The responsibility for the appraisal of the Employee shall remain at all times during the Secondment Period with the Secondment Organisation and will be carried out in accordance with their policies and procedures. The Employer will assist the Secondment Organisation in all regards with the appraisal process.

3.4.1 The Secondment Organisation will provide feedback to the Employer on the outcome of the appraisal, the content of the personal development plan and of any education, training and development activities undertaken by the Employee.

4. PAYMENT FOR THE SECONDMENT SERVICES

4.1 The Employer will continue to pay the Employee through their own payroll during the period of secondment. The Employer will recharge the Secondment Organisation for relevant salary costs and all business expenses claimed by the Employee in respect to expenses necessarily incurred by the Employee fulfilling the role of INSERT JOB TITLE.

5. TERMINATION

5.1 Notwithstanding Clause 1.1.4 and Clause 6 of the Agreement, the Agreement shall automatically terminate if the Contract of Employment is terminated for any reason whatsoever before the expiry of the Secondment Period.

5.2 Upon termination of the Agreement for whatever reason the Employee shall return to the Secondment Organisation all documents, correspondence, information and property made or compiled by the Employee or delivered to the Employee during the Secondment Period concerning the business, finances, or affairs of the Secondment Organisation for the avoidance of doubt, it is hereby declared that all property and rights in all such documents, goods or products shall at all times be vested in the Secondment Organisation.

Item: 12 Enc: 10

5.3 Upon termination of the Agreement for any reason other than under Clause 5.1, the terms and conditions of the Employee’s Contract of Employment shall continue in full force and effect.

6. DEFAULT

6.1 The Secondment Organisation may terminate the Agreement if either the Employer or the Employee is in breach of any of the terms of the Agreement which, if capable of remedy, has not been remedied by the party in breach within 21 days of receipt by the Employer and/or the Employee of a written notice from the Secondment Organisation specifying the breach and requiring its remedy.

6.2.1 The Employer may terminate the Agreement if either the Secondment Organisation or the Employee shall be in breach of any of the terms of the Agreement which in the case of a breach capable of remedy has not been remedied by the party in breach within 21 days of receipt by the Secondment Organisation and/or the Employee of a written notice from the Employer specifying the breach and requiring its remedy.

7. VARIATION OF CONDITIONS

7.1 No changes or additions to the Secondment Services or the provisions of the Agreement must be made without prior agreement in writing between the Employer, the Secondment Organisation and the Employee.

8. HOLIDAY ENTITLEMENT

8.1 The Secondee shall be entitled to XX Days/Hours paid holiday during the Secondment Period (this includes X days Bank and other Public Holidays) to be taken at times approved by the Secondment Organisation, such approval not to be unreasonably withheld.

Item: 12 Enc: 10

8.2 Such holiday entitlement is part of the individual’s holiday entitlement paid by the Employer to the Employee under the Contract of Employment and is not in addition thereto.

9. CONFIDENTIALITY

9.1 In addition to and without prejudice to the confidentiality obligations contained in the Contract of Employment, the Employee shall not, (save in the proper performance of the Secondment Services) either during or after the period of the Agreement divulge or permit to divulge to any person (including the parties to the Agreement) any information acquired by them in connection with the Agreement or in connection with the Secondment Services which concerns:

9.1.1 Any matter of commercial interest contained or referred to in the Agreement;

9.1.2 The Secondment Organisation, its manner of operation, staff, patients or procedures;

9.1.3 The Employer, its manner of operation, staff, patients or procedures;

9.1.4 The identity or address or medical condition or treatment received by any patient of either the Secondment Organisation or Employer; unless previously authorised by the party concerned in writing provided that these obligations will not extend to any information which is or shall become public information available in the United Kingdom otherwise than reason of a breach by the Employee of the provisions of this clause.

10. DATA PROTECTION

10.1 The Secondment Organisation and the Employer shall each comply with the host’s Information Governance policies and the Data Protection Act 1998 and shall protect the personal data, as defined in the Act, of their respective staff, clients and patients.

Item: 12 Enc: 10

10.2 The Secondment Organisation and the Employer will indemnify the other against all claims and proceedings and all liability, loss, costs and expenses incurred in connection therewith made or brought by any person in respect of any loss, damage or distress caused to that person by the disclosure of any personal data by the Employee where the said claims and proceedings, liability, loss, costs and expenses arise or are incurred as a result of the indemnifying party’s breach of its obligations under Clause 10.1.

11. INDEMNITY

11.1 It is agreed between the Employer and the Secondment Organisation that each shall indemnify the other and its staff against all and any liability, loss, costs, expenses, claims or proceedings whatsoever arising under any statute or at common law in respect of any injury to any person, injury resulting in death and any loss of or damage to personal property directly related to such injury where such injury, loss or damage is caused as a direct result of the negligence of the relevant party or any of the relevant party’s staff.

11.2 The Secondment Organisation will indemnify the Employer against any and all liabilities, proceedings, costs, losses, claims and demands whatsoever arising under any statute or at common law and made against the Employer by the Employee where such claims are, in the reasonable opinion of the Employer, brought about directly or indirectly by the actions of the Secondment Organisation.

11.3 The Secondment Organisation will indemnify the Employer against any and all liabilities, proceedings, costs, losses, claims and demands whatsoever arising directly or indirectly out of the activities of the Employee in providing the Secondment Services.

12. DISCRIMINATION

12.1 Neither the Employer nor the Secondment Organisation will unlawfully discriminate against the Employee within the meaning of the Equality Act 2010 Item: 12 Enc: 10

or any enactment relating to discrimination in employment and both the Employer and the Secondment Organisation will take all reasonable steps to secure the observance of this provision by all its staff or agents.

13. SEVERABILITY

13.1 If any provision of the Agreement is or becomes illegal, void or invalid, that shall not affect the legality and validity of the other provisions.

14. WAIVER

14.1 The failure of any party to the Agreement to seek redress for breaches, or insist on strict performance of any provision of the Agreement or the failure of any party to the Agreement to exercise any right or remedy to which it is entitled under the Agreement shall not constitute a waiver thereof and shall not cause a diminution of the obligations under the Agreement.

14.2 No waiver of any provision of the Agreement shall be effective unless the party concerned in writing agrees it.

14.3 No waiver of any default shall constitute a waiver of any subsequent default.

15. INTELLECTUAL PROPERTY

15.1 The parties agree that any intellectual property rights including copyright connected to the provision of the Secondment Services shall belong to the Secondment Organisation.

15.2 It is agreed between the parties that the profits of any exploitation of any intellectual property rights referred to in 15.1 by the Secondment Organisation, will belong exclusively to the Secondment Organisation.

16. FORCE MAJEURE

Item: 12 Enc: 10

16.1 No party to this Agreement shall be liable to the other for any failure to perform its obligations under the Agreement where such performance is rendered impossible by circumstances beyond its control, but nothing in this condition shall limit the obligations of all parties to use their best endeavours to fulfil their obligations under the Agreement.

17. AUDIT

17.1 Both the Employer and the Secondment Organisation must allow the other party’s internal and other nominated auditors access to any and all papers relating to the Agreement for the purposes of each party’s audit.

18. APPLICABLE LAW

18.1 The Agreement shall be governed by English Law and each of the parties agrees to submit to the exclusive jurisdiction of the Courts of England.

Signed by [ ] on behalf of the Employer:

Name:

Address:

Signed by [ ] on behalf of the Secondment Organisation:

Name:

Address:

Signed by the Employee:

Name:

Address: Item: 12 Enc: 10

Recruiting Ex-Offenders Policy

HR Policy: Date Issued: Date to be reviewed: Periodically or if legislation changes

Page 1 of 11

Item: 12 Enc: 10

Policy Title: Recruiting Ex-Offenders Policy

Supersedes: All previous Recruiting Ex-Offenders Policies

Description of Amendment(s): New Policy for CCG employees This policy will impact on: All staff. Financial Implications: No change. Policy Area: HR Version No: 1 Issued By: CSU HR Author: CSU HR Policy Lead Document Reference: Effective Date: 8th September 2014 Review Date: Impact Assessment Date:

APPROVAL RECORD

Committees / Groups / Individual Date Consultation: CCG’s including local partnership forums N/A

Approved by Committees: Management / Staff Side CCG Partnership Forum September 14

Page 2 of 11

Item: 12 Enc: 10

Contents

1.0 POLICY STATEMENT 4

2.0 PRINCIPLES 4

3.0 EQUALITY STATEMENT 6

4.0 MONITORING AND REVIEW 6

Part 2

1.0 Procedure 7

Appendix 1 Dealing With Disclosures in Recruitment 8 & Selection

Appendix 2 Deciding if a DBS check is required 10

Appendix 3 Equality Impact Assessment 11

Page 3 of 11

Item: 12 Enc: 10

HR POLICIES RECRUITING EX-OFFENDERS

1. POLICY STATEMENT

1.1 The Organisation uses the Disclosure service provided by the Disclosure Barring Service (DBS) to assess applicants’ suitability for positions of trust. The Organisation complies fully with the DBS Code of Practice and undertakes to treat all applicants fairly.

1.2 The Organisation undertakes not to discriminate unfairly against any subject of a Disclosure on the basis of conviction or other information received. Guidance on dealing with disclosures is attached at Appendix 1.

1.3 This policy will be made available to all applicants who are required to provide a Disclosure, at the beginning of the recruitment process.

2. PRINCIPLES

2.1 The Organisation actively promotes equality of opportunity for all and welcomes applications from a wide range of candidates, including those with criminal records, as we select all candidates for interview based on their skills, qualifications and experience.

2.2 Disclosures are only requested after a thorough risk assessment has indicated that it is proportionate and relevant to the post concerned. For those posts that require a Disclosure, all adverts, recruitment briefs and application forms will contain a statement indicating what level of Disclosure will be required in the event of an individual being offered a position.

2.3 The Organisation will only ask for details of ‘unspent’ convictions as defined in the Rehabilitation of Offenders Act 1974. However, the Organisation reserves the right, if necessary, to ask details about an applicant’s entire criminal record.

2.4 The Organisation has a number of HR Representatives who are registered with the DBS as the person authorised to handle Disclosures. HR Representatives have been trained to identify and assess the circumstances and relevance of offences and have received appropriate guidance and training in the relevant legislation relating to the employment of ex-offenders.

2.5 HR Representatives will advise and guide recruiting managers where a Disclosure has been made.

2.6 The Organisation undertakes to discuss any matter revealed in a Disclosure with the person seeking employment, before withdrawing a conditional offer of employment.

2.7 The Organisation may conduct an interview to enable an open and measured discussion to take place regarding any offences or other matters that might be relevant to the position. Failure to reveal information that is directly relevant to the position sought, could lead to the withdrawal of an offer of employment.

2.8 The Organisation complies fully with the DBS Code of Practice. Every person who is subject to a Disclosure will be made aware of this Code of Practice and a copy will be provided to all applicants.

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Item: 12 Enc: 10

2.9 Having a criminal record will not necessarily bar a potential employee from working with the Organisation. This will depend on the nature of the position and the circumstance and background of the offence(s).

Security, Storage, Handling, Use, Retention, and Disposal of Disclosures And Disclosure Information

2.10 The Organisation complies fully with the DBS Code of Practice regarding the correct handling, use, storage, retention and disposal of Disclosures and Disclosure information.

2.11 The Organisation complies fully with its obligations under the Data Protection Act and other relevant legislation pertaining to the safe handling, use, storage, retention and disposal of Disclosure information.

Storage, Access & Disposal

2.12 Disclosure information will be securely destroyed as soon as the relevant information has been noted.

2.13 No Disclosure information will be kept on personal files and where a Disclosure needs to be kept due to a dispute or because additional information has been supplied, it will be kept separately and securely in a non-portable, lockable storage unit. 2.14 Where a Disclosure has been kept, it will be securely destroyed once the dispute is resolved or a decision made regarding employment or at the latest after 6 months.

2.15 Access to Disclosure information is strictly controlled and limited to those who are entitled to see it as part of their duties.

2.16 The Organisation will not keep any photocopy or other image of the Disclosure or any copy or representation of the contents of a Disclosure. However, for record purposes only, the Organisation will keep the following information:

• The name of the subject

• The level of Disclosure requested

• The position for which the Disclosure was requested

• The unique reference number of the Disclosure

• Details of the recruitment decision taken

Handling

2.17 In accordance with section 124 of the Police Act 1997, Disclosure information is only passed to those who are authorised to receive it in the course of their duties.

2.18 The Organisation maintains a record of all people to whom Disclosures and Disclosure information has been revealed and the Organisation recognises that is a criminal offence to pass this information on to anyone who is not entitled to receive it.

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Item: 12 Enc: 10

Usage

2.19 Disclosure information is only used for the specific purpose for which it was requested and for which the applicant’s full consent has been given.

2.20 The Organisation will comply with all recommendations from DBS on the proper use and safekeeping of disclosure information.

Acting as an Umbrella Body (an external organisation)

2.21 As an Umbrella Body, the CSU has an independent organisation that will take all reasonable steps to ensure that all CCGs for whom it receives Disclosure information comply fully with the DBS Code of Practice and have a written policy regarding the handling, use, storage, retention and disposure of Disclosure information.

2.22 Before undertaking a DBS check on behalf of a CCG, the Umbrella body will require the CCG to confirm in writing t their intention to comply with the Code of Practice and that they have such a policy or if not practicable, will comply with the code of practice.

3. EQUALITY

In applying this policy, the Organisation will have due regard for the need to eliminate unlawful discrimination, promote equality of opportunity, and provide for good relations between people of diverse groups, in particular on the grounds of the following characteristics protected by the Equality Act (2010); age, disability, gender, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, and sexual orientation, in addition to offending background, trade union membership, or any other protected characteristic.

4. MONITORING & REVIEW

4.1 This policy and procedure will be reviewed periodically by Human Resources in conjunction with operational managers and Trade Union representatives. Where review is necessary due to legislative change, this will happen immediately.

4.2 The implementation and operation of this policy will be audited on an annual basis, including consideration of diversity data, by CSU Leadership Team and reported to the senior management team on a 6 monthly basis

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Item: 12 Enc: 10

Part 2

1. PROCEDURE

This Policy must be read in conjunction with local CCG Recruitment Procedures

1.1 When recruiting for a vacancy the Recruiting Manager needs to answer the questions on the Authority to Recruitment Form. If the answers to those questions result in a DBS check being necessary the Recruiting Manager needs to contact Employment Services team or HR

1.2 The Recruiting Manager will ensure that the advert for the vacancy includes notification that it is essential that the successful applicant obtains a satisfactory DBS check and at what level that check must be, either standard or enhanced.

1.3 Once a provisional offer of employment has been made the applicant will be sent a Disclosure Application Form and Guidance Booklet with the instruction that the completed form must be returned with the supporting documentation.

1.4 The Disclosure Application Form will be verified and countersigned by one of the Human Resources representatives who are registered with the DBS and sent for processing.

1.5 On receipt of the form from the DBS it will be processed by the Human Resources representative who countersigned the form.

1.6 The Human Resources representative will inform the Recruiting Manager if the Disclosure Application was satisfactory or if it contains any information that may affect the appointment decision.

1.7 If the Disclosure Application contains information that may affect the appointment decision, the Human Resources representative will discuss this with the Recruiting Manager (in all instances), and the individual concerned, where appropriate.

1.8 Where the information contained on the Disclosure Application form significantly impacts on a candidate’s ability to undertake the post for which they have been appointed, the offer of employment must be withdrawn.

1.9 If the Disclosure Application contains no information, or information that is not relevant to the post, the offer of employment can be confirmed (subject to all other pre-employment checks having been completed).

1.10 Any decision to withdraw an offer of employment must be reached by the agreement of the Human Resources representative and Recruiting Manager. Where both parties fail to agree the decision will be referred to the Organisation’s Lead Counter signatory which can be determined by the CCG for a final decision.

1.11 The decision to withdraw an offer of employment must be confirmed both verbally and in writing to the candidate concerned.

1.12 All completed Disclosure Application Forms will be recorded and retained by Human Resources. The forms will be recorded, stored and destroyed in line with the Data Protection Act, this policy and DBS guidance.

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Item: 12 Enc: 10

Appendix 1

Dealing With Disclosures in Recruitment & Selection

Guidelines for Managers

The Organisation uses the Disclosure Service provided by the Disclosure Barring Service (DBS) to assess applicants’ suitability for positions of trust.

When advertising/recruiting to a vacant post you must decide whether that position requires a DBS check and if so, at what level. You can use the table outlined overleaf to assist you in making this assessment.

If you decide that a DBS check needs to be undertaken you must inform Human Resources who will ensure that the requirement for a check is made clear in the advertisement.

Departments dealing with their own recruitment will have responsibility for ensuring that the advert contains the requirement for a DBS check.

Types of Check Available

There are three levels of check available:

BASIC LEVEL

Includes details of ‘unspent’ (current) convictions. This may be used for verifying information for applicants for posts that do not fall under the Rehabilitation of Offenders Act (Exceptions) Order but where the individual is being considered for a position of trust. Examples of such posts may include chief executives; finance managers where the person is in charge of public funds or internal budgets; board level directors or senior management. This level of check is permissible where justifiable, whether or not to take this checks at the discretion of the employer. Basic Level Disclosures can only currently be obtained through Disclosure Scotland. Details on how to obtain basic disclosures are available at www.disclosurescotland.co.uk

STANDARD DISCLOSURE

Includes details of both spent (old) and unspent (current) convictions, cautions, reprimands and final warnings held in England and Wales on the Police National Computer (PNC). Most of the relevant convictions in Scotland and Northern Ireland may also be included.

Employers may carry out standard level criminal record checks to assess a person’s suitability for work listed in the Exceptions Order i.e. where the type of work enables the person to have ‘access to persons in receipt of such services in the course of [their] normal duties’. The term ‘access’ only relates to where individuals have direct, physical contact with patients as part of their day to day activities; it does not include positions where there is no contact with patients. Please note that positions that purely involve having access to records are not covered under the terms of the Exceptions Order and therefore employers cannot obtain a standard or enhanced criminal record check for these positions. The changes to the barring arrangements on the 10 September 2012 do no effect eligibility for standard checks. However, it is strongly recommended that employers refer to the Exceptions Order to make an informed decision against positions which may be eligible for a standard level check (paragraph 13, Part 2 of Schedule 1 of the Order specifically refers).

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Item: 12 Enc: 10

ENHANCED DISCLOSURE

An enhanced check contains the same information as a standard check but also includes any non- conviction information held by local police, where they consider it to be relevant to the post. This information is referred to as ‘approved information’ on the enhanced check certificate. From 10 September, there will be two levels of enhanced check – an enhanced disclosure with barred list information (for those that fall under the new definition of regulated activity) and an enhanced disclosure without barring information (for those previously falling within regulated activity but not meeting the terms required under the new definition) – see further detail about eligibility in the sections below.

Eligibility for enhanced with a barred list check

Individuals seeking work in a regulated activity position must be checked against the DBS barred lists (this is known as a barred list check). This check is accessed through the process of applying for an Enhanced Disclosure. Individuals in regulated activity are eligible for an enhanced disclosure with barred list information. It will be possible to check against the children’s and/or adults’ barred list(s), depending on the role under consideration.

Eligibility for enhanced without a barred list check

The number of individuals in regulated activity is being reduced by the changes to the disclosure and barring services and, as a result there will be some positions which will no longer be eligible for an enhanced disclosure with a barred list check from 10 September 2012.

Further information

NHS Employers have produced a helpful document regarding DBS checks which includes scenarios and examples of when checks should be undertaken. The link is http://www.nhsemployers.org/case-studies-and-resources/2014/07/eligibility-for-dbs-checks- scenarios

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Item: 12 Enc: 10

Deciding if a DBS check is required Appendix 2

Will the job holder be Yes No required to work with children? As per the definition above. Will the job holder be Yes No required to work with vulnerable adults? As per the definition above. Is the job holder Yes No required to be a member of the Legal Profession and a recognised member of the Law Society? Will the job holder be Yes No based at a location where they may come in to contact with children or vulnerable adults, such as a hospital or prison? As per the definition above. Will the job holder be Yes No regularly caring for children or vulnerable adults? As per the definition above. Will the job holder be Yes No required to be a “named person” for the Authority in respect of gaming, lottery or entertainment licences?

Equality Analysis Initial Assessment

Page 10 of 11

Item: 12 Enc: 10

Title of the change proposal or policy: Recruiting Ex-offenders Policy

Brief description of the proposal:

To ensure that the policy amends are fit for purpose, that the policy is legally compliant, complies with NHS LA Standards, NHS Employment Check Standards, DSB Code of practice and takes account of best practice.

Name(s) and role(s) of staff completing this assessment:

Date of assessment:

Please answer the following questions in relation to the proposed change:

Will it affect employees, customers, and/or the public? Please state which.

Yes it will affect all employees and members of the public applying for positions within the organisation.

Is it a major change affecting how a service or policy is delivered or accessed?

Will it have an effect on how other organisations operate in terms of equality?

If you conclude that there will not be a detrimental impact on any equality group, caused by the proposed change, please state how you have reached that conclusion: No anticipated detrimental impact on any equality group. The policy adheres to the NHS LA Standards, NHS Employment Check Standards, DBS Code of practice and takes account of best practice. Makes all reasonable provision to ensure equity of access.

The policy will be applied consistently to all applicants regardless of any protected characteristic they may be associated with.

Page 11 of 11

Item: 12 Enc: 10

SECONDMENT POLICY

HR Policy: Date Issued: Date to be reviewed: Periodically or if statutory changes are required

Policy Title: Secondment Policy

Supersedes: All previous Secondment Policies

Description of Amendment(s): New Policy for CCG employees This policy will impact on: All staff

Financial Implications: No change

Policy Area: HR

Version No: 1

Issued By: HR CSU Midlands and Lancashire

Author: CSU HR

Document Reference:

Effective Date: 8th September 2014

Review Date:

Impact Assessment Date:

APPROVAL RECORD

Committees / Groups / Individual Date

Consultation: CCGs’ including local Partnership Forums N/A Approved by Committees: Management / Staff Side Partnership Forum September 2014

Contents

1.0 POLICY STATEMENT 4

2.0 PRINCIPLES 4

3.0 EQUALITY STATEMENT 4

4.0 MONITORING AND REVIEW 4

Part 2

1.0 PROCEDURE 5

Appendix 1 EQUALITY IMPACT ASSESSMENT 7

1. POLICY STATEMENT

1.1 This policy facilitates the secondment of the CCGs staff both internally within the CCG and externally within the wider NHS and exceptionally with other non NHS Bodies. It is also designed to encourage staff from external organisations to take up a secondment where available within the Organisation, for the mutual benefit of both organisations.

1.2 A secondment may be arranged to assist with individual development needs as a result of an appraisal or be specifically requested for project work where specific skills or specialist knowledge are required.

1.3 This Policy will apply to all employees within the Organisation.

2. PRINCIPLES

2.1 Secondment requests will be considered in line with business needs and may be refused on that basis.

2.2 Staff who enter into secondment agreements will be asked to sign a secondment agreement outlining the terms and parameters of the secondment.

2.3 Any individual who agrees to undertake a secondment will be expected to keep any information, which may be made available to them as a direct result of the secondment, (e.g. personnel, salary, business sensitive information) confidential.

2.4 Employees on secondment with an external organisation will retain all of their continuity of service rights with the CCG

2.5 Staff who undertake a secondment will be entitled to return to their substantive post on completion of the secondment. Should the substantive post be subject to organisational change this will be dealt with in line with the relevant CCG procedure.

2.6 The duration of a secondment will vary depending on the circumstances. However the minimum is 3 months and a maximum 24 months with exceptions to be arranged with the relevant line manager and support from Human Resources.

2.7 Training and support will be provided to all Line Managers in the implementation and application of this policy

3. EQUALITY

3.1 In applying this policy, the CCG will have due regard for the need to eliminate unlawful discrimination, promote equality of opportunity, and provide for good relations between people of diverse groups, in particular on the grounds of the following characteristics protected by the Equality Act (2010); age, disability, gender, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, and sexual orientation, in addition to offending background, trade union membership, or any other protected characteristic.

4. MONITORING & REVIEW

4 .1 The policy and procedure will be reviewed periodically by Human Resources in conjunction with operational managers and Trade Union representatives. Where review is necessary due to legislative change, this will happen immediately.

4.2 The implementation of this policy will be audited on an annual basis by CSU Leadership Team and reported to the senior management team on a yearly or 3 yearly basis

4 PART 2

1. PROCEDURE

Requesting and organisation of Internal Secondments within CCG

1.1 Where a Department within the CCG identifies that a secondment opportunity exists, consideration should be given to the length of the secondment, any training required and the skills set or specialist knowledge required of staff undertaking the secondment.

1.2 Depending on the nature of secondment, the vacancy will either be advertised in line with the CCGs Recruitment policy, or, a request will be made directly to the relevant department/organisation if the secondment requires specialist skills or knowledge.

1.3 There is no explicit obligation on the manager to release an individual but proper consideration should be given to such a request. Any refusal to allow an individual to uptake a secondment opportunity should be carefully considered and the potential long term benefits to the CCG should not be overlooked. An explanation should be given to the employee if a request is turned down.

1.4 Once agreed, Human Resources will liaise with the departments to assist with the terms of the secondment and a confirmation letter and agree what parameters will be applied to it.

1.5 If the secondee is from an external organisation, Human Resources will liaise with the organisation sending the secondment agreement template and agree what parameters will be applied to it, detailing very clearly what funding arrangements have been agreed.

Organisation for secondments of CCG Staff to external organisations

1.6 Where an individual manager is approached by an external organisation regarding a secondment opportunity for an employee, contact should be made with Human Resources. The opportunity may be advertised depending on the nature of the request. If the secondment is feasible, Human Resources will facilitate the agreement between all parties involved.

1.7 Where an employee wishes to pursue a secondment opportunity with an external organisation they should approach their manager indicating that they are interested in applying for a position and whether they can be released, if successful.

1.8 Agreement must be reached on how the secondee/placement individual's salary will be paid and which body will be responsible for meeting any additional expenses such as travel and subsistence allowances.

1.9 During the period of the secondment the individual’s Terms and Conditions will remain the same and continue to be subject to CCG policies and procedures. Exceptions to this will be agreed in advance between the host organisation and the secondee/CCG.

1.10 Secondees are responsible for reporting any reasons for absence to the host CCG/organisation in accordance with their own absence management policies. It is advisable for the host organisation to inform the appropriate manager in the other organisation if the employee is absent and in particular if this is long term. 1.11 The CCG is responsible for ensuring that all episodes of absence are recorded on ESR

1.12 Whilst on any secondment employees will continue to accrue annual leave entitlements and be permitted to take annual leave to their entitlement limit with the agreement of the host organisation. Where an employee takes a period of Maternity Leave during the course of the secondment accrual of her annual leave entitlements will continue to apply.

Funding Arrangements

1.13 Prior to the secondment taking place the appropriate manager(s) must liaise with Human 5 Resources and finance to agree who will be funding the secondment and how the payment arrangements are to be facilitated. Depending on the individual agreements it may be appropriate to submit an Organisation change form or arrange for a debtors invoice to be raised

1.14 Where the grade of the secondment post is higher than the grade of the employee’s substantive post, the full salary cost will be paid by the Organisation and recovered from the host organisation. On return to the Organisation the employee will revert to their substantive grade and salary.

1.1.5 The Employer will continue to pay the Employee through their own payroll during the period of secondment. The Employer will recharge the Secondment Organisation for relevant salary costs and all business expenses claimed by the Employee in respect to expenses necessarily incurred by the Employee fulfilling the role of INSERT JOB TITLE.

Working Arrangements

1.14 For the duration of the secondment or work placement the individual will be required to comply with the working/cover arrangements of the department or host employer. Any agreement to exceed/reduce their contractual working hours will be subject to agreement at the initiation of the secondment and the conditions of Working Time Regulations.

Communication

1.15 When the secondment is confirmed it must be agreed by all parties, that three way communication between the secondee, host organisation and the CCG is maintained

1.16 Any secondee from an Organisation should be kept informed of and consulted about any organisational change that takes place during their period of secondment, about their substantive post.

Managers’ responsibilities

1.17 For managers who are accountable for managing the secondee it will be their responsibility to outline at the start what their objectives are for the duration of the secondment. Managers must also conduct performance reviews/appraisals in line with CCG policies

Termination or Extension of Secondment

1.18 A request for an extension of an existing secondment should be considered in accordance with the needs of the service, and be mutually agreed by all parties and confirmed in writing. If an extension is refused, an explanation should be given to the employee. The appropriate notice periods as detailed in the secondment agreement should also be adhered to

1.19 The secondment may be terminated by either party in writing with the appropriate or previously agreed notice period.

Secondment resulting in Permanent Appointment

1.20 Where a full recruitment process was carried out for the secondment, the individual may be offered the post should it become permanent.

1.21 If a full recruitment process was not followed then a recruitment and selection process will need to be carried out.

2. APPEAL

An employee may use the Grievance Procedure if they feel that they have been treated unfairly in relation to application of this policy.

Equality Analysis Initial Assessment

Title of the change proposal or policy:

Secondment

Brief description of the proposal:

To ensure that the policy amends are fit for purpose, that the policy is legally compliant, complies with NHSLA standards and takes account of best practice.

Name(s) and role(s) of staff completing this assessment:

Date of assessment: DATE 2014

Please answer the following questions in relation to the proposed change:

Will it affect employees, customers, and/or the public? Please state which.

Yes, it will affect all employees

Is it a major change affecting how a service or policy is delivered or accessed?

Will it have an effect on how other organisations operate in terms of equality?

If you conclude that there will not be a detrimental impact on any equality group, caused by the proposed change, please state how you have reached that conclusion: No anticipated detrimental impact on any equality group. The policy adheres to the NHS LA Standards and best practice. Makes all reasonable provision to ensure equity of access to all staff. There are no statements, conditions or requirements that disadvantage any particular group of people with a protected characteristic.

Please return a copy of the completed form to the Equality & Diversity Manager

7 Item No: 14 Enc: 11

REPORT TO THE Clinical Commissioning Group Governing Body Meeting TO BE HELD ON: 6th September 2014

Subject: Quality Report Board Lead: Val Jones Officer Lead: Lynn Tolley For For For For Recommendation:  Approval Ratification Discussion Information PURPOSE OF THE REPORT:

To update the Governing Body of the quality issues and matters relating to health care services commissioned by the CCG.

KEY POINTS:

1. The level of concern for MSHFT remains at RED to reflect the Trust’s fragility although this has stabilised to a certain extent with the Trust reporting that the workforce position has improved. The preparations for the transition are progressing with plans for how there will be enhanced monitoring during the immediate to short term transition period. 2. The level of concern for SSPOTPT is changed to AMBER to reflect the concerns which have yet to be validated regarding workforce capacity in particular district nursing. Although there is no evidence so far of safety issues the relationship between chronic capacity issues and quality and safety are well known. Both North and South CCGs are jointly investigation this to establish any issues and actions that may need to be taken. 3. The level of concern for SSSFHT is GREEN although the CCG has not yet received the most up to date quality report from the Lead CCG. There has been an increase in suicides from last month although their overall rates and trends have previously not been found to be outlier. However the CCGs will continue to monitor these and ensure they are fully investigated and to maintain vigilance of any emerging trends. 4. The level of concern for BHT remains AMBER/RED to reflect that the Trust remains in special measures as a result of the second visit from the Keogh Review which has been reported previously. The Trust still has issues with infection control, cancer waits and have recently had 4 falls resulting in serious harms. 5. The level of concern for UHNS is escalated to AMBER/RED due to a number of factors. The chronic problems in A&E and Outpatients which do not seem to be resolving and A&E FFT scores 1

Item No: 14 Enc: 11 are showing a marked downward trend. There will need to be close monitoring following the transfer of MSHFT services to ensure that this does not conflict any capacity issues. They have also reported a second Never Event following the Never Event in July relating to a nasogastric tube. 6. The level of concern for RWT remains at AMBER/RED whilst the Trust has had a reduction in serious incidents and no C Diff cases issues they have had a Never Event and an HSE reportable infection control issue. The CCG have not yet had full assurance around the capacity issues and the ambitious recruitment and will be seeking this through the lead CCG and the RWT CQRM.

The level of concern for WHT remains at AMBER as a result of the ongoing cancer waits problem and the actions being agreed to address this have demonstrated sufficient impact. They are within trajectory for C Diff and inpatient FFT scores show an upward trend whilst there is a reduction in A&E scores reflecting current pressures there.

Relevance to Key Goals To reduce health inequalities across Cannock Chase through targeted interventions.

To identify and support patients with Long Term Conditions to ensure care Commissioning for quality will enable the CCG to put in delivery closer to home. place exemplary systems for commissioning intentions and provider performance management that will deliver To improve and increase overall life its Key Goals expectancy.

To develop integrated services with simple, easy access.

Implications Legal and/or Risk Enable the CCG to meet its statutory responsibilities for commissioning quality; reduce and mitigate risks to the organisation and to patients. CQC Enable the CCG to meet commissioner responsibilities for CQC Essential Standards for Health including that providers have up to date registration with the CQC. Patient Safety Integral element of the Quality Strategy which describes the systems that will be deployed to “keep patients safe.” Patient Engagement Integral element of the Quality Strategy which describes how the CCG will use patient engagement and experience to form the intelligence essential for effective and safe commissioning Financial Following the baseline assessment of the CCG structure, systems and processes there maybe implications for additional funding.

Item No: 14 Enc: 11 Sustainability A three year plan which will be refreshed on an annual basis through the annual Quality Improvement Plan Workforce / Training Organisational Development Plan for the CCG is in place to develop members, staff and leadership.

RECOMMENDATIONS / ACTION REQUIRED: The CCG Governing Body is asked to: Note the key quality and safety issues in the report and actions taken to improve quality and reduce risk

Item: 14 Enc: 11

Cannock Chase Governing Board Quality and Safety Report November 2014 CSU Quality Lead: Mark Doran CCG Director Lead: Val Jones GP Clinical Lead: Dr Tim Berriman Main Issues/Top Themes For Providers

1. Mid Staffordshire Hospital Foundation Trust (MSHFT) a. CQC Inspection July 14 – Final report published b. Transition of Services c. Mortality Review - new back log 2. Staffordshire Stoke On Trent Partnership Trust (SSOTPT) a. District Nursing b. Pressure Ulcers c. Infection control 3. South Staffordshire Shropshire Healthcare Foundation Trust (SSSHFT) a. Quality report not available 4. Burton Hospital Foundation Trust (BHFT) a. Cancer 62 day wait b. Infection control c. Falls 5. University Hospital North Staffordshire (UHNS) a. Failure against the A & E 4hr wait b. Outpatient backlog report c. Never Event 6. Royal Wolverhampton Hospital Trust (RWHT) a. Cancer waiting times and recovery Plan b. WHO Safer Checklist Progress c. Infection control d. Never Event 7. Walsall Hospital Trust (WHT) a. Cancer 62 day Referral to Treatment (RTT) b. Infection Control Level of Concern RAG Rating Index 8. Rowley Hall Hospital RED = High level of concern relating to the main a. CQRM not due until November quality and safety issues reported to CQRM 9. Safe Guarding Reports AMBER = Medium level of concern relating to the a. Quarterly report to Quality Committee main quality and safety issues reported to CQRM 10. Hospices GREEN = Low level of concern relating to the main a. CQRM not due until November quality and safety issues reported to CQRM =Insufficient information available at this time 11. British Pregnancy Association (BPAS) a. CQRM not due until November 12. Nursing Home Quality Assurance (NHQA) Update a. Quarterly report to Quality Committee 13. BADGER (OOH) b. CQRM not due until November

Mid Staffordshire Hospital Foundation Trust (MSHFT)

Regulators involvement and issues CQC Quality report – The CQC report for the inspection visit made on the 1st & 2nd July has now been published. The report confirms the preliminary finding reported to QSG: in a previous 3

Item: 14 Enc: 11

reports:- • That safe care is being delivered in each of the clinical areas except for medical care which requires some improvement due to staffing levels. However the inspectors acknowledged that whilst staffing fragility was being managed through a number of strategies these were not sustainable post November; leaving the Trust vulnerable to any additional pressures as might be experienced during the winter period. • That Ward 11 which was used to flex capacity and found to have had some patient experience and safety incidents relating to capacity to be closed. • The role of the wider economy in stabilising the situation through the Sustaining Services Board was recognised however • The Chief Inspector raised concern at the absence of a clear and timetabled Transition Plan for these services.

An action plan to address the CQC recommendations will be presented to CQRM and a comprehensive Transition Plan developed by the TSA has been shared with the CCG and at the Local Transition Board.

Main Issues for Providers

Transition of Services The CCG is working with the Trust Development Agency (TDA) and other stakeholders to provide assurance on the safe transition of services from MHSHFT to the new providers. Thi sis reported through the Local Transition Board (LTB) which provides economy wide oversight of the processes. .

Mortality Review – new back log

Total number of over due (3 months) mortality reviews 2014 End End End 14 July 05 Aug 20 Aug 03 Sep 23 Sep 06 Oct

April May June Medicine 82 48 36 33 12 4 21 19 33 Surgery 18 15 13 13 9 2 12 12 12 Total 100 63 49 46 21 6 33 31 45

It had been agreed by MSFT that this new backlog would be cleared by 30th September 2014.

The monthly update showed that the position had been deteriorating during the second half of August. MSFT did not meet the number of target reviews by 31 August target and have advised CQRM that the agreed target of zero overdue reviews by 30 September will not now be achieved.

The CCG are now considering approaches to clear the following the transition of services and will be discussed at the final MSHFT CQRM which will be attended by both RWT and UHNS representatives.

Item: 14 Enc: 11

Infection Control

2014

MSHFT Target Trend Apr May Jun July Aug Sep YTD

MRSA Bacteraemia 0 = 0 0 0 0 0 0 0

C Difficile 24  4 1 1 5 1 2 14

MRSA There were no reports of MRSA Bacteraemia to commissioners during September 2014.

Clostridium difficile

MSFT reported 1 case of Clostridium difficile infection during August 2014. The Trust now has 12 cases against a year to date objective of 10 and an annual objective of 24. Of these, 10 cases were deemed unavoidable and 2 avoidable. The lapses in care related to audit scores for environmental cleaning and hand hygiene. These issues have been addressed through the Trust’s Clostridium difficile recovery group and plan.

One case in July diagnosed as pseudomonas colitis upon endoscopy. In line with national reporting requirements, this has been reported as a case of Clostridium difficile. However, the patient has not tested positive for the organism.

Outbreaks and Serious Incidents: There were no reportable incidents or outbreaks of infection at the Trust during August 2014.

Patient Experience Net Promoter MSHFT Apr May Jun July Aug BHFT UHNS RWHT WHT

August F & F Inpatient Score 73 74 70 73 68 73 78 72 70

F & F Inpatient 32.6 26.25 28.52 28.30 28.22 35.65 21.15 27.40 43.11 Response Rate (%) 1

F & F Score - A &E 53 53 45 56 60 62 41 52 46

F & F - A & E Response 30.7 31.5 18.9 30.8 23.7 24.1 17.6 14.0 7.4 Rate (%) F & F Score – maternity 92 91 100 93 92 86 80 97 88 (Birth)

F & F - Maternity 15.8 17.3 27.2 26.6 18.3 47.3 9.5 16.9 7.1 Response Rate (Birth) (%)

Item: 14 Enc: 11

The above comparison table demonstrates that MSHFT Inpatient Net Promoter scores have dropped in August to the lowest rate locally. However the gradual improvement in A&E scores continues.

Complaints The total number of complaints has decreased in the last month after reaching a peak in August 2014. For the last 6 quarters, complaints about poor communication have been the top theme with complaints about medical care second.

The top themes for September are:- • Communication (12) • Medical Care (11) • Attitude (7) • Diagnosis (7) • Discharge (6)

2013 2014 Sept Oct Nov Dec Jan Feb Mar Apr May June July Aug Sept

Stafford 14 26 27 17 21 25 15 21 29 33 20 31 24 Hospital Cannock 2 3 0 0 3 3 0 2 3 2 3 2 2 Hospital Complaints received for Stafford and Cannock Hospital:

Please note – once complaints are received, all complaints within a single communication are extracted

Eliminating Mixed Sex Accommodation There were no breaches in September 2014.

Patient Safety Serious Incident (SIs) The number of SIs reported to Commissioners in September was 3, a reduction from August figure of 7. There were no reported Grade 3 or 4 pressure ulcers.

August 2014 Sept 2014 Pressure Ulcer – Grade 3 x 3 Delayed Diagnosis x 1 Sub-optimal care of the deteriorating patient x 1 Maternity Services - Intrauterine death x 1

Slips/Trips/Falls x 2 Maternity Services - Maternal unplanned admission to ITU x 1 Adverse media coverage or public concern about the organisation or the wider NHS x 1

*Captured by reported date so we can capture any serious incidents which are reported late

Item: 14 Enc: 11

Staffordshire Stoke On Trent Partnership Trust (SSOTP)

Regulators involvement and issues None reported

Main Issues for Providers

District Nurses As a result of soft intelligence and queries relating to District Nursing capacity the CCG has made a formal request through the contract for a workforce analysis and this is due at the end of October 2014. In addition there is a Joint CQRM in October and a South Division CQRM in November which will focus on capacity within district nursing.

Pressure Ulcers (PU) In September the Trust reported a Grade 4 pressure ulcer on a patient in a residential home. Commissioners have requested the Trust bring together all current pressure ulcer and prevention relieving initiatives into a single plan which can be monitored more easily

Infection Control

2014

SSOTP Target Trend Apr May Jun July Aug Sept YTD

MRSA Bacteraemia 0 = 0 0 0 0 0 0 C Difficile 8  0 1 0 3 1 5

Clostridium Difficile There was 1 report of Clostridium difficile during August 2014; the RCA’s have all been completed; 4 cases have been agreed as unavoidable and 1 as avoidable. The Trust’s objective for 2014/15 remains at 8.

MRSA There were no reports of MRSA Bacteraemia during August 2014.

Outbreaks There was an outbreak of viral gastroenteritis on Cottage Ward during August 2014. A total of 5 patients were affected, with no staff or visitors reporting symptoms. Among these was 1 Clostridium difficile toxin positive result which may have been an incidental finding as the symptom profile was not typical of Clostridium difficile. There were no other organisms identified.

Item: 14 Enc: 11

Patient Experience

Trust Overall Feb Mar Apr May June July Aug Sept 72.12 70.61 70.32 69.79 73.57 68.31 68.66 71.31 F & F Score 2915 2419 2092 2189 2417 2977 1768 1969 Number of surveys received Neighbourhood Area FFT Feb Mar Apr May June July Aug Sept Score Stafford (27 users)* 66.66 81.40 59.26 76.47 82.26 78.87 - - Cannock (28) * 88.99 100 75 87.50 70.00 92.86 - - *Data extracted from South Community Teams Dashboard

Complaints The Trust received 37 complaints in September 2014 of which 13 ( 6 Health & 7 ASC) were received for South Community Teams.

2014 Apr May Jun Q1 Jul Aug Total Health & ASC 28 40 29 97 35 37 South 20 22 14 56 23 13

The five top themes are;

• Quality of care (3) • Clinical treatment (2) • Staff attitude behavior (2) • Inaccurate financial information provided (2) • Case management (1)

Eliminating Mixed Sex Accommodation No breaches reported in September 2014

Patient Safety Serious Incident (SIs) North & South Divisions The number of SIs reported to commissioners for September 2014 was 16 this is a significant increase from 5 SIs reported in August 2014. They mainly related to an increase in the number of reported Grade 3 Pressure Ulcers from 2 in August to 11 in September.

Item: 14 Enc: 11

August 2014 September 2014 Pressure Ulcer Grade 3 x 2 Pressure Ulcer Grade 3 x 11 Ward Closure x 1 Ward Closure x 2

Unexpected Death of Community Patient (not in receipt) x Unexpected Death of Community Patient (not in receipt) 1 x 1

Unexpected Death of Inpatient (not in receipt) x 1 Safeguarding Vulnerable Adult x 1

Slips/Trips/Falls x 1

South Staffordshire Shropshire Healthcare Foundation Trust (SSSHFT)

The CCG is awaiting the release of monthly quality report for SSSFHT from the lead CCG for this provider at the end of the month. The information available here is that which can be accessed from national database reports.

Infection Control

2014

SSSFT Target Trend Apr May Jun Jul Aug YTD

MRSA Bacteraemia 0 = 0 0 0 0 0 0 C Difficile 8  0 1 0 3 0 4

SSSFHT have an objective of zero for CDI and zero tolerance to avoidable MRSA Bacteraemia. There were no reports of Clostridium difficile infection or MRSA Bacteraemia in August 2014.

Outbreaks and Serious Incidents There were no outbreaks or serious incidents reported during August 2014.

Eliminating Mixed Sex Accommodation The Trust reported no breaches in September 2014.

Patient Safety Serious Incidents (SIs) The number of SIs reported to commissioners for September 2014 has increased from 2 in August to 6 as a result of the number of reported suicides. A request has been made by CC & SAS CCGS to raise this at the next CQRM.

August 2014 September 2014 Suspected suicide x 2 Admission of under 18s to adult mental health ward x 1

Unexpected Death of Inpatient (in receipt) x 1 Unexpected Death of Community Patient (in receipt) x 3 Unexpected Death of Community Patient (in receipt) x 1 Unexpected Death of Inpatient (in receipt) x 1

Accident Whilst in Hospital x 1 Slips/Trips/Falls x 1

Suspected suicide x 6

*Captured by reported date so we can capture any serious incidents which are reported late 9

Item: 14 Enc: 11

Burton Hospital Foundation Trust (BHFT)

Regulators involvement and issues Nil to report

Main Issues

Cancer 62 day wait Current performance for cancer 62 day wait consultant upgrade is 40% (target of 95%). The CCG continues to monitor this in the CQRM

Eliminating Mixed Sex Accommodation No breaches occurred in September 2014.

Infection Control

2014

BHFT Target Trend Apr May Jun July Aug Sept YTD

MRSA Bacteraemia 0 = 1 0 0 1 0 0 2 C Difficile 15  2 1 6 4 0 0 13

Clostridium difficile There were no reports of Clostridium difficile from Burton Hospitals NHS Foundation Trust during August 2014. Therefore, the Trust currently has 13 cases against an annual trajectory of 15. The RCA’s for all cases have been completed and of these, 12 were deemed unavoidable to the Trust and 1 avoidable.

MRSA There were no reports of Trust apportioned MRSA Bacteraemia during August 2014.

Patient experience Net Promoter

BHFT Apr May June July Aug MSFT UHNS RWHT WHT

August F & F Inpatient Score 72 75 78 77 73 68 78 72 70

F & F Inpatient 32.8 35.20 44.18 38.94 35.65 28.22 21.15 27.40 43.11 Response Rate (%) F & F Score - A & E 69.78 67 63 55 62 60 41 52 46

F & F - A & E 14.8 13.2 23.3 23.1 24.1 23.7 17.6 14.0 7.4 Response Rate (%)

Item: 14 Enc: 11

F & F Score - 86 87 91 88 86 92 80 97 88 maternity

F & F - Maternity 36 50.6 44 49.2 47.3 18.3 9.5 16.9 7.1 Response Rate (%)

Family and Friends Test (FFT) scores and response rates for inpatients has dipped slightly in August.

Complaints – No update available

Eliminating Mixed Sex Accommodation There were 7 mixed sex accommodation breaches reported in August 2014. The breaches were in the critical care unit as capacity impacted upon patients being transferred onto wards.

Patient Safety Serious Incidents (SIs) The number of SIs reported to commissioners for August 2014 was 13, this is a significant increase from 5 SIs reported in July 2014. There have been 4 falls reported as serious incidents and any trends or issues arising from these will be monitored and reported through the BHT CQRM. A falls care bundle will be developed within the Trust and focus on the holistic functional aspects of a patient’s care. The functional falls assessment tool is now in use and has been rolled out across the Trust in June and is part of the health informatics system (HIS). Posters referring to high risk areas for falls have been displayed in bathrooms and toilets. The Host CCG are closely monitoring falls and working with the Trust to identify areas of improvement.

August 2014 September 2014 Unexpected Death of Inpatient (not in receipt) x 1 Pressure Ulcer Grade 3 x 2

Attempted Suicide by Inpatient (not in receipt) x 1 Maternity Services – unexpected neonatal death x 1

Communication issue – 16 urology cancer patients Slips/Trips/Falls x 4 have not received a recall appointment x 1

Other x 1 Unexpected Death (general) x 1

Pressure ulcer Grade 3 x 2

Slips/Trips/Falls x 5

Sub-optimal care of the deteriorating patient x 1

*Captured by reported date so we can capture any serious incidents which are reported late

University Hospital North Staffordshire (UHNS)

Regulators involvement and issues No issues reported

Item: 14 Enc: 11

Main Issues

A & E 4 Hour Wait The performance at UHNS regarding the A&E 4 hour waits and the 12 hour trolley breaches continues to deteriorate. NHS England have requested that CCGs are to have a programme of monthly unannounced visits from October continuing right through the winter months, Area Team to be involved in the visits. In a response to a query from the CCG around the rapid drop in FFT scores the Lead CCG for this provider has reported that the Trust are introducing a new system for collecting FFT responses and that this should improve the scores.

Within A&E the numbers of adverse incidents and complaints, in conjunction with operational performance, are reviewed and monitored on a weekly basis to provide assurance that the safety and quality of the services provided are being maintained and improved. There have not been any serious incidents reported within A&E recently and incidents are reviewed promptly by the directorate teams to ensure that any learning is extracted and shared.

UHNS have reported 18 12 hour trolley waits in August (2 breaches) and September (16 breaches). The RCAs for August were received by the SI Subgroup in October and the main cause for the 12 hour breach was the wait for speciality beds (neuroscience). The remaining final 16 RCA will be received at the November SI Subgroup.

Outpatient backlog report The Trust has accumulated an outpatient backlog which is being scrutinised in the CQRM. The CCG has specifically asked for additional information to be included in the October report; • Monthly Clinical Validation Evidence • Trajectory by Specialty for Outpatient Backlog • National Monitoring of Outpatient Backlog • Benchmarking

The outpatient backlog that has been a persistent problem for UHNS and in addition to the A&E performance raises issues around capacity and will need to be monitored carefully following transition of services from MSHFT.

Infection Control

2014

UHNS Target Trend Apr May Jun Jul Aug YTD MRSA 0  0 1 1 0 0 2 Bacteraemia C Difficile 50  5 4 2 3 9 23

MRSA There were zero reports of MRSA bacteraemia during August 2014.

Clostridium difficile The Trust reported 9 cases of Clostridium difficile. This brings the Trust’s current number of cases to 23 at the end of August, against an annual trajectory of 50. Of the RCA investigations undertaken to date, 13 cases were classified as unavoidable, 1 avoidable and the remainder are 12

Item: 14 Enc: 11 under investigation. .

Patient Experience Family and Friends Test (FFT)

UHNS Apr May June July Aug MSFT BHFT RWHT WHT

August F & F Inpatient Score 79 73 65 73 78 68 73 72 70

F & F Inpatient 20.18 19.21 22.17 23.63 21.15 28.22 35.65 27.40 43.11 Response Rate (%) F & F Score - A & E 76 49 36 39 41 60 62 52 46

F & F - A & E 3.7 1.1 2.5 19.1 17.6 23.7 24.1 14.0 7.4 Response Rate (%) F & F Score – 73 78 77 81 80 92 86 97 88 maternity Birth F & F - Maternity 7.1 5.1 12.5 7.2 9.5 18.3 47.3 16.9 7.1 Response Rate Birth (%)

The F&F scores for the Trust are volatile particularly A&E where the Trust has some chronic issues.

Complaints There were 79 complaints received in July which is an increase from 56 in June 2014. However, the complaints reduced to 58 in August 2014

Eliminating Mixed Sex Accommodation No breaches in September 2014

Patient Safety The number of SIs reported to commissioners for August 2014 was 10.

August 2014 September 2014 Slips/Trips/Falls x 5 C.Diff & Health Care Acquired Infections X 1 Maternity Services - Unexpected admission to Maternity Services - Intrauterine death x 1 NICU (neonatal intensive care unit) x 2 Maternity Services - Intrauterine death x 2 Slips/Trips/Falls x 2

C’ Diff Attempted Suicide by Inpatient (not in receipt) x 1

Pressure Ulcer Grade 3 x 2 Communicable Disease and Infection Issue X 1 Maternity Service x 1

*Captured by reported date so we can capture any serious incidents which are reported late

Item: 14 Enc: 11

A Never Event has been reported in September 2014 in relation to a retained vaginal pack. The investigation is ongoing however as this is the second never event in this category in a short the issues relating to maternity packs is to be escalated to CQRM.

Royal Wolverhampton Hospital Trust (RWT)

Regulators involvement and issues Nil to report

Main Issues for Provider

Cancer Waiting times and Recovery Plan The recovery plan was discussed at the October 2014 CQRM. There has been a slight improvements in the cancer waiting times, however this is not yet sufficient. The provider has stated that one of the reasons is late referrals to them as a tertiary centre from other providers, The CCG has requested evidence of this so that the commissioners can then address this with the appropriate provider.

WHO Safer Checklist Progress – September There are two audits in respect of the assurance for the WHO checklist. One audit measures the rate of compliance with use of the WHO and the other measures of completion of the checklist. There continues to be monitoring of the WHO check list which is reported monthly at the CQRM. The investigation of the latest Never Event has revealed that whilst the dentist fully complied with the checklist behaviour of the child distracted the dentist at the point of extraction. There have been recommendations that there needs to be improvement to the WHO checklist to cover areas other than theatres where minor clinical procedures are carried out.

Infection Control

2014 RWT Target Trend Apr May Jun July Jul YTD

MRSA  1 0 0 1 2 0 Bacteraemia  2 1 2 3 8 C Difficile 39

There has been no cases since April 2014

Clostridium Difficile (C Diff) – Target 39 The Trust has reported 1 case in August and 7 cases in September 2014

Mucor Infection Two patients identified with Mucorcytosis in September 2014. This can be linked to being in contact with building work and it is not clear yet whether this could have occurred on or off the

Item: 14 Enc: 11 hospital site. This is being investigated and the HSE and PH have been informed and are working with the Trust to identify the cause.

Patient Experience

Royal Apr May June July Aug MSFT UHNS BHFT WHT Wolverhampton Trust August F & F Inpatient 74 75 80 78 72 73 78 73 70 Score F & F Inpatient 34.42 34.32 35.18 29.76 27.40 28.30 21.15 35.65 43.11 Response Rate (%) F & F Score - A & E 53 52 52 47 52 56 41 62 46

F & F - A & E 19.5 18.5 16.3 14.8 14.0 30.8 17.6 24.1 7.4 Response Rate (%)

F & F Score - 72 91 98 100 97 93 80 86 88 maternity

F & F - Maternity 25 12.6 13.8 10.9 16.9 26.6 9.5 47.3 7.1 Response Rate (%)

The F&F scores for the Trust show a relatively stable A & E score. However, inpatient score has decreased slightly in August.

Complaints No update reported quarterly.

Eliminating Mixed Sex Accommodation No breaches reported in September 2014

Patient Safety Serious Incidents The number of incidents between Aug and September has reduced considerably. During Aug 2014, 44 new Serious Incidents were reported. 24 were pressure ulcers of which 10 were hospital acquired. In Sept 2014, 30 new Serious Incidents were reported. 13 were pressure ulcers of which 9 were hospital acquired.

It should be noted that as an integrated acute /community Trust these include community services. The incidents include corporate incidents where the detail was not provided.

August 2014 September 2014 Pressure ulcer Grade 3 Hospital acquired x 10 Pressure ulcer Grade 3 Hospital acquired x 9

Wrong site surgery x 1 Unexpected death x 2

Slip, Trip, Fall x 2 Confidentiality Incidents x 3

Confidentiality incident x 2 Intraprtum stillbirths x 2

Item: 14 Enc: 11

Delayed diagnosis x 3 Intra-uterine death x 1

Unexpected admission to ITU x 1 Slip, trip, fall x 3

Unexpected Admission to NNU x 1 Unexpected admission to NNU x1

Interuterine Deaths x 2 Pressure ulcers Grade 3 community acquired x 4

Unexpected deaths x 2 Health Acquired infection x 4 (2 MRSA, 1 C Diff and 1 Mucor Fungal Infection)

Sub Optimal Care x 2

Pressure ulcers Grade 3 community acquired x 13

MRSA x 1

Ward closure x 1

Failure to act on test results x 1

Mortality – 2013/2014 Due to the Provider using a different mortality analytical system to Dr Foster there is to be a meeting with the performance leads of RWT to understand the methodology and how this compare with the Dr Foster used extensively across the country.

Walsall Hospital Trust (WHT)

Regulators involvement and issues Nil to report

Main Issues for Provider

Cancer 62 day Referral to Treatment (RTT) Validated figures for June is 77.61%, which shows a continued low performance over 3 months. Several actions are being taken by the Provider to address this low performance, which is being monitored by the CCG.

Infection Control

2014 Target Trend Apr May Jun Jul YTD

MRSA Bacteraemia 0  0 0 0 0 0 C Difficile 28  1 5 1 1 8

There was no reported MRSA in July 2014 16

Item: 14 Enc: 11

C. Difficile There was 1 reported C Diff in July 2014. The Trust remains within trajectory.

Patient Experience

Walsall Hospital Apr May June July Aug BHFT UHNS RWHT MSFT Trust Aug F & F Inpatient 68 68 72 71 70 73 78 72 73 Score F & F Inpatient 47.67 53.04 45.23 77.01 43.11 35.65 21.15 27.40 28.30 Response Rate (%) F & F Score - A & E 52 58 54 45 46 62 41 52 56

F & F - A & E 12.7 19.8 20.7 22.3 7.4 24.1 17.6 14.0 30.8 Response Rate (%) F & F Score - 79 76 90 85 88 86 80 97 93 maternity

F & F - Maternity 13.4 17 12.7 19.7 7.1 47.3 9.5 16.9 26.6 Response Rate (%)

Family and Friends inpatient scores shows an upward trend. A & E scores are reducing and may reflect current pressures within A & E.

Complaints – no update for August 2014 40 formal complaints were received in July 2014, this is an increase of 8 from the previous month. A breakdown of complaints were attributed to divisions:

• Clinical Support Services – 2 • Women’s Services – 1 • Children’s and Family Services - 3

Eliminating Mixed Sex Accommodation Nil reported in September 2014

Patient Safety Serious incidents During July 2014, there were 8 new Serious Incidents reported, of which 1 was a Community acquired grade 3 pressure Ulcer and 1 grade 3 hospital acquired pressure ulcer.

June 2014 July 2014 Grade 3 Pressure Ulcers - Community Acquired x 2 Lost to follow up – outpatient cancer appointment delay x 1

Grade 3 Pressure Hospital Acquired x 1 Unexpected death x 1

Intra-uterine death x 1 Patient Fall x 4

Item: 14 Enc: 11

Patient Fall x 1 Safeguarding Vulnerable Child x1

Security threat x 1 Maternal Admission to ITU x 1

Missed screening – DOH requested this to be downgraded Unexpected death x 1 Surgical Error x 1 Delayed diagnosis x 1 Pulmonary Embolism x 1

Explanation of acronyms used in this report:

Acronym Explanation BADGER Birmingham And District General Emergency Rooms BHFT Burton Hospitals Foundation Trust CCG Clinical Commissioning Group CHKS Leading provider of healthcare intelligence and quality improvement services CDIFF Clostridium Difficile CQRM Clinical Quality Review Meeting CSU Clinical Support Unit EMSA Eliminating Mixed Single Sex Accommodation EPR Electronic Patient Record FFT Friends and Family Test HEFT Heart of England Foundation Trust IPC Infection Prevention and Control MRSA Methicillin Resistant Staphylococcus Aureus NHQA Nursing Home Quality Assurance NICU Neonatal intensive care unit NSL Non Urgent Patient transport provider OFSTED Office for Standards in Education, Children’s Services and Skills PALS Patient Advisory Liaison Service RCA Root Cause Analysis RTT Referral to Treatment Times RWT Royal Wolverhampton Trust SSOTPT Staffordshire and Stoke on Trent Partnership Trust SSSFT South Staffordshire and Shropshire NHS Mental Health Foundation Trust

Item No: 15 Enc: 12

REPORT TO THE CANNOCK CHASE CLINICAL COMMISSIONING GROUP GOVERNING BODY TO BE HELD ON: Thursday 6th November 2014

Subject: Performance Report – August 2014 Board Lead: Alex Bennett Officer Lead: Sarah Turner For For For Recommendation: For Approval  Ratification Discussion Information

PURPOSE OF THE REPORT:

• To provide a high level summary of the key performance issues for the CCG for August 2014. Performance is shown for NHS Constitution measures. • To provide assurance and details of remedial action being taken to improve performance and mitigate risk and, where applicable, contract queries that have been issued and financial consequences applied.

KEY POINTS:

Performance measures not achieved in August 2014:

• Referral To Treatment - 18 weeks admitted adjusted • Referral To Treatment – Patient on incomplete pathway waiting over 52 weeks. • Diagnostic test waiting times • A&E Waiting Time – Total time in the A&E Dept • Cancer Waits – 31 day standard for first definitive treatment; 31 day standard for first definitive treatment – subsequent surgery; 62 days standard from urgent referral to treatment; • Ambulance - Category A calls resulting in an ambulance arriving at the scene within 8 minutes (Red 2) –(September 2014)

Item No: 15 Enc: 12

RELEVANCE TO KEY GOALS To reduce health inequalities across Cannock Performance metric to be developed to show Chase through targeted interventions. improvement. To identify and support patients with Long Term Performance metric to be developed to show Conditions to ensure care delivery closer to improvement. home.

To improve and increase overall life expectancy. Performance metric to be developed to show improvement. To develop integrated services with simple, easy Performance metric to be developed to show access. improvement.

IMPLICATIONS Legal and/or Risk Note the risks identified relating to delivery of Quality, Improvement, Productivity and Prevention (QIPP), Acute Trust Activity and Continuing Care. Reputation risks if any of the elements of the national operating framework are not delivered. CQC None Patient Safety Patients and their safety are at the centre of everything the CCG commission. Poor performance in services where patients are waiting longer than required to access services may be a patient safety risk. Patient Engagement The inclusion of patient feedback in performance reporting is essential for Board assurance. Work is ongoing with colleagues in the Quality and Governance team to establish lines of reporting. Financial Financial risks associated with delivering key performance targets and delivering contracts in line with contract values. Sustainability None Workforce / Training Work to develop understanding of performance management

RECOMMENDATIONS / ACTION REQUIRED: The CCG Governing Body is asked to: . Note those areas where the current performance rating is below target and the remedial actions being taken to improve performance and mitigate risk.

Not KEY REQUIREMENTS Yes No Applicable Has a quality impact assessment been undertaken?  Has an equality impact assessment been undertaken?  Have partners / public been involved in design?  Are partners / public involved in implementation?  Are partners / public involved in evaluation? 

NHS Cannock Chase CCG - Constitution Report Referral to Treatment pathways RTT 18 weeks admitted adjusted Standard 90%

The percentage of admitted pathways Current 88.4% within 18 weeks for admitted patients YTD 88.6% whose clocks stopped during the period 73% 90% 107% 94 91 91 93 92 92 88 87 87 88 91 89 88 n/a 18 months annualised trend on an adjusted basis. (E.B.1) Month Aug-14 A S O N D J F M A M J J A P to Mar-14 The RTT Admitted Adjusted standard was not achieved for the CCG's patients. Breaches continue at Royal Wolverhampton and Walsall Hospitals in General Surgery and Orthopaedics. The lead CCGs are applying contract penalties and Walsall is to provide a revised plan for achieving RTT To the Trust Development Authority (TDA). RWHT - Although the overall standard was achieved, the Trust did not achieve compliance for 2 specialities (General Surgery and Trauma & Orthopaedics), therefore fines have been applied by the host CCG.

RTT Non-admitted Standard 95% The percentage of non-admitted Current 97.4% pathways within 18 weeks for non- YTD admitted patients whose clocks 97.7% 89% 95% 101% 18 months annualised trend stopped during the period. (E.B.2) Month Aug-14 99 98 97 98 97 98 97 98 98 98 98 97 97 n/a A S O N D J F M A M J J A P to Mar-14 RTT Incomplete Standard 92% The percentage of incomplete pathways Current 92.1% within 18 weeks for patients on YTD incomplete pathways at the end of the 94.6% 76% 92% 108% 18 months annualised trend period. (E.B.3) Month Aug-14 95 94 95 94 95 94 93 95 95 94 95 97 92 n/a A S O N D J F M A M J J A P to Mar-14 Number of 52 week RTT Pathways Standard 0 The number of incomplete Current 1 pathways greater than 52 weeks for Average YTD patients on incomplete pathways at 0 0 7 14 the end of the period. (E.B.S.4) 0 1 0 0 0 0 0 0 0 0 1 0 1 n/a 18 months annualised trend based on current month Month Aug-14 A S O N D J F M A M J J A P to Mar-14 per 100k populatoin

Long waiter reported by Walsall - The provider has a Remedial Action Plan in place and the patient was treated by the target date of 24/10/14 as well as to seek to prevent further 52 week breaches. The TDA are monitoring the providers performance against the Remedial Action Plan (RAP).

Printed: 29/10/2014 Page 1 of 5 Prepared by Midlands and Lancashire Commissioning Support Unit NHS Cannock Chase CCG - Constitution Report Diagnostic test waiting times Diagnostic Wait Standard 99% Current The percentage of patients waiting 6 98.95% weeks or more for a diagnostic test. YTD 98.7% 83% 99% 115% (E.B.4) 18 months annualised trend Month Aug-14 98 94 96 99 99 99 99 99 99 99 99 99 99 n/a A S O N D J F M A M J J A P to Mar-14 12 CCG patients waiting over 6 weeks at the end of August, mostly at Mid Staffs FT (3 CT, 3 Non Obs Ultrasound, 1 Gastro), Walsall (3 cystoscopy), Birmingham Childrens Hospital (1 MRI) and Derby (1 flex sig). Whilst Walsall is taking a number of actions to address diagnostic waiting times, including additional activity throughout September and October for patients who are identified as breaches and re-structuring clinics to provide additional capacity for cystoscopy the host CCG will issue a contract query for August’s breach to ensure a remedial action plan (RAP) is agreed and implemented. Once agreed the RAP will be reviewed at monthly CRMs and the Trust will be requested to provide monthly progress reports. 2 of the CT patients now have dates for 1/11/14 and 1 has chosen not to be treated and has since been removed from the waiting list. Overall Mid Staffs achieved the 99% standard. A&E waiting time - total time in the A&E department Four hour wait Standard 95% Current 90.3% Percentage of patients who spent 4 YTD 91.6% 110% hours or less in A&E. (E.B.5) 80% 95% 97 95 93 91 92 90 95 93 92 90 92 92 90 94 18 months annualised trend Month Sep-14 S O N D J F M A M J J A S P to Mar-14 Walsall - A recovery trajectory for A&E has recently been approved by both the TDA and NHS England Regional Office and this will be used by the host CCG to monitor the Trusts performance over the coming months and any breach will be treated as a contractual breach. The service is currently exceeding the recovery trajectory agreed. Royal Wolverhampton - July proved to be the busiest month the Trust had ever experienced. August and September attendances were also significantly up on last year. Fines have been applied for non-achievement of this standard. Mid Staffs FT are reporting lack of patient flow as a key contributing factor to poor performance and failure to achieve the target. There has been an increased number of delayed transfers of care (DTOC) with capacity issues for Packages of Care (POC) which is being addressed via the CCG and Systems Resilience Group (SRG). The Trusts have established a Recovery Board which had its inaugural meeting week beginning 22nd September and is now meeting weekly, attended by Commissioners. The ambulance divert put in place in July 2014 to reduce the number of admissions at the Trust is achieving on average 12 diverts per day with subsequent reduction in admissions as required.

Printed: 29/10/2014 Page 2 of 5 Prepared by Midlands and Lancashire Commissioning Support Unit NHS Cannock Chase CCG - Constitution Report Cancer Waiting Time Standards - the CCG will be undertaking a comprehensive analysis of cancer pathways to ensure robust timescales for treatment. Cancer waits - 2 week waits Urgent GP Referrals Standard 93% Current 96.1% Percentage of patients seen within two weeks of an urgent GP referral for YTD 95.6% 83% 93% 103% suspected cancer. (E.B.6) 95 97 96 93 95 96 97 96 96 95 95 96 96 n/a 18 months annualised trend Month Aug-14 A S O N D J F M A M J J A P to Mar-14 Breast Symptoms Referrals Standard 93%

Percentage of patients seen within two Current 93.1% weeks of an urgent referral for breast YTD symptoms where cancer was not 96.7% 71% 93% 115% 97 95 89 92 100 100 96 96 98 91 96 100 93 n/a 18 months annualised trend initially suspected. (E.B.7) Month Aug-14 A S O N D J F M A M J J A P to Mar-14 Cancer waits - 31 days First Definitive Treatment Standard 96% Current 92.3% Percentage of patients receiving first definitive treatment within one month YTD 96.7% 92% 96% 100% of a cancer diagnosis. (E.B.8) 98 96 100 98 100 94 98 100 96 98 98 98 92 n/a 18 months annualised trend Month Aug-14 A S O N D J F M A M J J A P to Mar-14 4 breaches out of 52 patients in August: UHB (2 x UGI breached due to transplant priority / capacity issue) 2 x Urology (unable to schedule patients within standard) - UHNS and MSFT.

Subsequent surgery Standard 94% Percentage of patients receiving Current 88.9% subsequent treatment for cancer within YTD 31-days, where that treatment is 95.5% 86% 94% 102% 100 100 100 100 92 100 100 100 93 93 100 100 89 n/a 18 months annualised trend Surgery. (E.B.9) Month Aug-14 A S O N D J F M A M J J A P to Mar-14 1 breach out of 9 patients. UHB - Surgery (breached due to lack of capacity)

Printed: 29/10/2014 Page 3 of 5 Prepared by Midlands and Lancashire Commissioning Support Unit NHS Cannock Chase CCG - Constitution Report

Drug Treatments Standard 98%

Percentage of patients receiving Current 100% subsequent treatment for cancer within YTD 31-days, where that treatment is an 100% 96% 98% 100% 100 100 100 100 100 100 100 100 100 100 100 100 100 n/a 18 months annualised trend Anti-Cancer Drug Regimen. (E.B.10) Month Aug-14 A S O N D J F M A M J J A P to Mar-14 Cancer waits - 31 days Radiotherapy Treatments Standard 94% Percentage of patients receiving Current 96.3% subsequent treatment for cancer within YTD 31-days, where that treatment is a 97.7% 75% 94% 113% Radiotherapy Treatment Course. 95 100 100 92 100 97 100 100 93 100 100 100 96 n/a 18 months annualised trend Month Aug-14 (E.B.11) A S O N D J F M A M J J A P to Mar-14 Cancer waits - 62 days Urgent GP referral Standard 85%

Percentage of patients receiving first Current 79.2% definitive treatment for cancer within YTD 81.2% two months (62 days) of an urgent GP 70% 85% 100% 90 80 88 80 81 80 83 90 76 79 83 86 79 n/a 18 months annualised trend referral for suspected cancer. (E.B.12) Month Aug-14 A S O N D J F M A M J J A P to Mar-14 5 breaches out of 24 patients in August - Mid Staffs FT (Lung - Treatment planning delayed due to clinical reason) Walsall (Other tumour type - Complex pathway with many diagnostic tests) MSFT/UHB (Upper GI - Capacity issue). UHNS (Urology - Many tests required before treatment) MSFT (Lower GI - Patient DNA follow up appointment resulting in delay for anaesthetic review.

Walsall - whilst improvements were recorded in May and June, overall performance declined to 71.4% in July. Whilst the Trust is forecasting a significant improvement in August the host CCG will require assurance this is sustainable by reviewing the new RAP and revised trajectory.

RWHT - A Recovery plan has been submitted to the Host CCG. The Trust has been experiencing problems in compliance against the national cancer waiting Times Targets. The particular areas of concern are the 31 day subsequent surgery target (94%) and the 62 day referral to treatment compliance against the national target (85%). The main reasons for this non-compliance have been identified and action plans have been developed.

Printed: 29/10/2014 Page 4 of 5 Prepared by Midlands and Lancashire Commissioning Support Unit NHS Cannock Chase CCG - Constitution Report

Screening service referral Standard 90%

Percentage of patients receiving first Current 100% definitive treatment for cancer within YTD 100% 62- days of referral from an NHS Cancer 40% 90% 140% 100 100 100 100 67 100 100 100 100 100 100 100 100 n/a 18 months annualised trend Screening Service. (E.B.13) Month Aug-14 A S O N D J F M A M J J A P to Mar-14 Consultant upgrade Standard N.O.S.

Percentage of patients receiving first Current 100% definitive treatment for cancer within YTD 97.6% 62- days of a consultant decision to 0% 50% 100% 100 94 100 100 95 100 100 100 100 93 100 95 100 n/a 18 months annualised trend upgrade their priority status. (E.B.14) Month Aug-14 A S O N D J F M A M J J A P to Mar-14 Ambulance clinical quality Ambulance Red 1 Standard 75% Category A calls resulting in an Current 75.0% emergency response arriving within 8 YTD minutes - Red 1 incidents: immediately 75.9% 47% 75% 103% life threatening and the most time 73 81 62 90 70 64 79 67 100 75 76 63 75 n/a 18 months annualised trend benchmarking based on current Month Sep-14 critical. (E.B.15.i) S O N D J F M A M J J A S P to Mar-14 month Ambulance Red 2 Standard 75% Category A calls resulting in an Current 73.1% emergency response arriving within 8 YTD minutes - Red 2 incidents: life 72.0% 64% 75% 86% threatening but less time critical than 66 72 69 69 69 63 70 74 74 73 67 71 73 n/a 18 months annualised trend benchmarking based on current Month Sep-14 Red 1. (E.B.15.ii) S O N D J F M A M J J A S P to Mar-14 month Ambulance Red 19 Standard 95% Current 95.0% Category A calls resulting in an YTD ambulance arriving at the scene within 93.9% 87% 95% 103% 19 minutes. (E.B.16) 95 96 93 93 94 92 92 94 93 94 93 95 95 n/a 18 months annualised trend benchmarking based on current Month Sep-14 S O N D J F M A M J J A S P to Mar-14 month All 3 standards were not achieved in August, however two standards have been achieved in September 2014. An update has been requested from the Contract Lead in Sandwell and West Birmingham CCG.

Printed: 29/10/2014 Page 5 of 5 Prepared by Midlands and Lancashire Commissioning Support Unit Item: 16 Enc: 13

REPORT TO THE Clinical Commissioning Group Governing Body Meeting TO BE HELD ON: Thursday 6 November 2014

Subject: Finance Report Month 6 (September 2014)

Board Lead: Paul Simpson

Officer Lead: Colin Groom

Recommendation: For Approval  For Discussion  For Information 

PURPOSE OF THE REPORT:

This paper provides the Governing Body with the financial position of Cannock Chase CCG for Month 6 of the financial year 2014/15, covering the period April 2014 to September 2014.

KEY POINTS: 1. This report sets out the in-year financial position at Month 6. This shows a deficit of £1.844m against plan.

2. At this stage in the year, we are reporting that we will not spend more than the planned deficit for 2014/15.

3. The QIPP programme must continue to deliver in order to ensure that the planned deficit level is not exceeded.

Relevance to Key Goals To reduce health inequalities across Cannock Chase through targeted interventions. To identify and support patients with Long Term Conditions to ensure care delivery Finance Plan supports delivery of key goals closer to home. To improve and increase overall life expectancy. To develop integrated services with simple, easy access.

Page | 1

Item: 16 Enc: 13

Implications

Legal and/or Risk See risk section in body of report

CQC None

Patient Safety None

Patient Engagement None Financial Deficit of £1.844m for the year to date

Sustainability None

Workforce/Training None

RECOMMENDATIONS/ACTION REQUIRED:

The Governing Body is asked to: • Note the position to date, the forecast for the year and the risks and mitigating actions.

KEY REQUIREMENTS Yes No Not Applicable Has a quality impact assessment been undertaken? N/A Has an equality impact assessment been undertaken? N/A Has a privacy impact assessment been completed? N/A Have partners/public been involved in design? N/A Are partners/public involved in implementation? N/A Are partners/public involved in evaluation? N/A

Page | 2

Item: 16 Enc: 13

CANNOCK CHASE CLINICAL COMMISSIONING GROUP MONTH 6 FINANCE REPORT

1. Introduction

This is the report to the end of September, based on Month 5 (August 2014) contracting information. The aim is to present clearly the key financial issues for the year to date and highlight any risks to achievement of our planned financial position.

2. Planned Deficit

The planned deficit for 2014/15 for Cannock Chase is £8.574m. At 30th September 2014 the year to date planned deficit was £3.744m. The variance of £1.844m reported below is the variance from this year to date plan.

3. Financial Position to Month 6

The summary Income and Expenditure position is shown in Table 1 below:

Forecast Table 1 - Cannock Chase CCG Annual Year to Date Outturn Summary Financial Statement as at 30th September 201 Budget Budget Actual Variance Variance £000's £000's £000's £000's £000's

Acute Contracts 87,001 44,350 46,392 2,042 2,718 Mental Health 14,913 7,551 7,886 335 (676) Community Services 15,191 7,920 7,963 43 206 Total HCHS 117,104 59,822 62,241 2,419 2,248

Continuing Healthcare 15,155 7,832 8,107 275 73

Primary Care Services 24,856 12,244 12,182 (62) (244)

Other Programme Services 1,179 589 546 (43) 84

Reserves Contingency Reserve 756 186 0 (186) (756) Winter Monies Income Requirement (244) 0 0 0 0 QIPP Reinvestments 1,807 325 0 (325) 0 QIPP to be allocated (11) 0 0 0 0 QIPP Risk Reserve 1,404 298 0 (298) (1,404) CHC Legacy Provision Reserve 0 0 0 0 0 Commissioning Reserve 224 0 0 0 0 Total Reserves 3,937 809 0 (809) (2,160)

Corporate Running Costs 3,282 1,698 1,762 65 0 Corporate Non Running Costs 197 99 99 0 0

CCG Total Expenditure 165,710 83,093 84,937 1,844 0

Revenue Resource Limit prior to repaying previous year deficit (157,136) (79,348) (79,348) 0 0

In Year Position (Surplus)/Deficit 8,574 3,744 5,588 1,844 0

Repayment of previous year deficit 9,599 4,800 4,800 0 0

Cumulative Position (Surplus)/Deficit 18,173 8,544 10,388 1,844 0

Page 1 of 7

Item: 16 Enc: 13

This shows a year to date deficit against plan of £1.84m, compared with £1.61m at Month 5. Most of this is driven by an overspend across the contract portfolio of £2.4m. There are also overspends in Continuing Healthcare (£0.275m) and Corporate Costs (£65k) supported by a year to date release of reserves (£0.81m). More detail is given in Appendix 2.

4. Running Costs

CCG running costs are monitored separately within the Revenue Resource Limit. The position to date is shown in Table 2 below:

Forecast Table 2 - Cannock Chase CCG Annual Year to Date Outturn Summary of Running Costs as at 30th September 2014 Budget Budget Actual Variance Variance £000's £000's £000's £000's £000's

Pay 1,554 776 760 (16) 0

Non Pay 875 495 578 82 0

Commissioning Support Service 1,154 577 609 32 0

Income (301) (150) (184) (33) 0

CCG Total 3,282 1,698 1,763 65 0

There is a £65k overspend to date, but a break-even position is expected by the end of the financial year. The non-pay over spend relates mainly to consultancy support including work to support the dissolution of MSFT.

5. Allocations

Additional allocation adjustments have been made in Month 6 for treatment of overseas visitors. Changes to the initial allocation are shown in Table 3 below:

Table 3

Revenue Resource Limit as at 30th September 2014 £000

Confirmed Healthcare Allocation 151,250 Initial CCG Running Costs Allocation 3,282 Brought Forward Deficit (9,599) GPIT 336 Training Transfer from Shropshire & Staffs AT 24 Secondary Care Funding Returned to CCG's 232 GPIT 67 14/15 RTT Funding 668 CHC Risk Sharing Rebasing 1,510 Adjustments to 13/14 Baseline (109) NHSE Allocation adjustment - European Overseas Visitors (124)

Total Resource Limit - Programme & Admin 147,537

6. Contracting Position at Month 5

We now have contracting information to the end of August (Month 5). The month 5 variances against plan have been extrapolated to give an estimated Month 6 position, which is included in the table above.

Page 2 of 7

Item: 16 Enc: 13

The main contributors to the reported overspend of £2.4m against plan are Burton Hospital (£642k), Royal Wolverhampton Trust (£499k), Rowley Hall (£340k), University Hospitals of North Staffordshire (£135k) and Mid-Staffordshire Hospitals (£132k). The reasons for the variances are as follows:

Burton

• An increase in emergency admissions as a result of the anticipated ambulance diverts • A&E attendances, and • Critical Care.

Rowley Hall

• This is an elective contract which continues to over-perform, but discussions are taking place with the provider about curtailing this increase in activity.

Royal Wolverhampton

• The over-performance is primarily due to emergency admissions as a result of the anticipated ambulance diverts.

7. Reserves Position

Reserves are detailed within Table 1. As at Month 6, £809k of reserves have been used to support the reported position including an element of the contingency. We have just received confirmation of our System Resilience funding (formerly Winter Pressure funding) which is being reviewed and should eliminate the negative reserve currently shown. However, there is a risk that commitments may exceed the level of funding assumed in the plan.

8. QIPP Progress

Delivery of the CCG financial control total is still heavily dependent on achieving the planned QIPP savings. Progress on QIPP implementation is considered in more detail within a separate QIPP Performance Report. In the first six months, it is estimated that savings of just under £1.7m have been delivered, which is £0.59m below plan. The CCG had created a reserve to mitigate against QIPP slippage and within the reserves figure highlighted above, £0.3m has been released from this reserve to support the programme.

The projected savings continue to be validated against contract performance information and will be revised as necessary but due to slippage in some schemes, the projected full year savings are now £5.51m against a plan of £6.99m, a shortfall of £1.48m. The risk reserve highlighted above is £1.4m in total and therefore current projections are that the shortfall will be ostensibly covered by the reserve available. The PMO responsible for the QIPP programme is assessing further schemes and mitigations to address this shortfall.

The detailed programme is shown at Appendix 3.

Page 3 of 7

Item: 16 Enc: 13

9. Balance Sheet, Better Payment Policy Compliance, Cash

The Summary balance sheet (Statement of Financial Position) confirming the position at the end of the previous financial year and the most recent three months of the current financial year is included in Table 4 below

31st 31st 31st 30th Table 4 March July August September Summary Statement of Financial Position 2014 2014 2014 2014 £000s £000s £000s £000s

Current assets: Trade and other receivables 1,931 2,380 1,307 1,880 Cash and cash equivalents 31 39 2 519

Total current assets 1,962 2,419 1,309 2,399

Current liabilities Trade and other payables (9,499) (10,683) (10,010) (7,065)

Total Assets Employed (7,537) (8,264) (8,701) (4,666)

Financed by Taxpayers’ Equity General fund (7,537) (8,264) (8,701) (4,666)

Total Taxpayers Equity (7,537) (8,264) (8,701) (4,666)

Performance against the Better Payment Practice Code (BPPC) for the year to date is shown below:

BPPC Compliance 2014/15 NHS BPPC Compliance 2014/15 Non NHS 100.0 100.0 95.0 95.0 90.0 90.0 85.0 85.0 80.0 80.0 75.0 Number 75.0 Number 70.0 Value 70.0 Value % Compliance 65.0 % Compliance 65.0 60.0 60.0 55.0 55.0 50.0 50.0 APR MAY JUNE JULY AUG SEPT APR MAY JUNE JULY AUG SEPT

The Better Payment Practice Code requires organisations to pay suppliers within 30 days, unless other terms are specified.

Aged debtors and creditors analysis and cashflow information will be included in future months reports.

10. Dissolution Costs

The CCG continues, along with Stafford CCG to be heavily involved in the contractual arrangements linked to the dissolution of the MSFT. We have estimated that around £1m will be needed between the CCGs to fund additional staff to manage the process over the next 3-6 months. In addition, the CCG has had to incur costs associated with the dissolution and overall fragility of the acute system, including the cost of diverting activity from MSFT to other providers such as UHNS and Wolverhampton. The CCG is currently in an arbitration process with MSFT, the outcome of which will determine whether these costs can be recovered.

Page 4 of 7

Item: 16 Enc: 13

11. Risks and Mitigations

Several financial risks have been identified and are contained within the CCG risk register. The more material risks are highlighted below.

There is a risk that elective activity will continue to over-perform in future months due to increased referrals. There is a Commissioning reserve of £224k, which will be used to offset any projected over- performance.

Delivery of projected savings from the QIPP programme remains a risk. Performance is being monitored through the PMO and Finance, Performance and Contracts Committee. As identified above, the risk reserve of £1.4m is broadly sufficient to offset the projected under-delivery in year.

There is a risk that costs associated with fragility at MSFT cannot be recovered and will result in a cost pressure for the CCG. MSFT have been notified that the CCG intends to recharge these costs in line with the terms of the contract.

There are still some 2013/14 contractual issues unresolved and formal dispute resolution with University Hospitals North Staffordshire Trust has commenced.

12. Forecast Outturn

The CCG continues to forecast achievement of its control total for 2014-15 and has commenced regular reviews of the forecast position on a line by line basis through the Executive Management Team. This work has highlighted a range of risks as identified above and a series of compensating mitigations. Key to the delivery of the CCGs control total will be the satisfactory management of the MSFT dissolution and associated risks. Table 1 above and Appendix 1 below show the current forecast assumptions per area and these will continue to be reviewed in light of the risks highlighted above.

13. Recommendations

The Governing Body is asked to note the position to date, the forecast for the year and the risks and mitigating actions.

Paul Simpson Director of Finance 28th October 2014

Page 5 of 7

Appendix 1

Page 6 of 7

QIPP Programme Appendix 2 Sep-14 Year to Date Position Year-end Forecast

ID Scheme Description Start Date Target Predicted Variance Target Predicted Variance Target Predicted Variance

BV01 & Continuing Healthcare - improved management of clients with complex needs 01-Apr-14 £98,403 £43,310 -£55,093 £409,581 £166,704 -£242,877 £1,000,000 £1,000,000 £0 BV02 & SSSFT management of identified patients BV03 MSFT locally agreed tariffs 01-Apr-14 £28,298 £28,298 £0 £169,785 £169,785 £0 £339,570 £339,570 £0

BV04 SSOTP efficiencies above national requirement 01-Apr-14 £24,361 £24,361 £0 £146,169 £146,169 £0 £292,337 £292,337 £0

PIP01 WMAS - A&E Overnight Contract 01-Sep-14 £31,831 £0 -£31,831 £31,831 £0 -£31,831 £222,818 £0 -£222,818

PIP06 SSSFT - Review of the effectiveness of the Out of Areas placement contract 01-Sep-14 £3,571 £3,571 £0 £3,571 £3,571 £0 £25,000 £25,000 £0 SSSFT - Review of Children's Community Support Service (Reduction in PIP07 01-Sep-14 £2,232 £2,232 £0 £2,232 £2,232 £0 £15,625 £15,625 £0 existing 25% management / overheads surcharges) PIP08 SSSFT - Further Contractual Efficiency 01-Sep-14 £14,286 £14,286 £0 £14,286 £14,286 £0 £100,000 £100,000 £0

DD01 Section 256 Staffs County council 01-Apr-14 £2,083 £2,092 £9 £12,500 £12,553 £53 £25,000 £25,106 £106

DD02 Section 256 HIV/AIDS 01-Apr-14 £1,104 £0 -£1,104 £6,625 £0 -£6,625 £13,250 £0 -£13,250

DD02 Voluntary Sector Grants 01-Apr-14 £1,983 £4,376 £2,393 £11,900 £26,255 £14,355 £23,800 £52,510 £28,710

DD03 Voluntary Block Contacts 01-Aug-14 £13,675 £5,091 -£8,584 £27,350 £30,546 £3,196 £109,400 £61,093 -£48,307

DD04 Acute Contracts (MSFT-PAU) 01-Oct-14 £0 £0 £0 £0 £0 £0 £250,000 £0 -£250,000

DD05 Acute Contracts (MSFT-Littleton) 01-Apr-14 £75,000 £75,000 £0 £450,000 £450,000 £0 £900,000 £1,100,000 £200,000

DD06 Community Provider (SSOTP-MIU) 01-Oct-14 £0 £0 £0 £0 £0 £0 £250,000 £250,000 £0

DD07 Community Provider (SSOTP-Diabetes) 01-Oct-14 £0 £0 £0 £0 £0 £0 £70,000 £0 -£70,000

DD08 Community Provider (SSOTP-Healthnet) 01-Jun-14 £10,000 £10,000 £0 £40,000 £40,000 £0 £100,000 £158,356 £58,356

Subtotal £306,828 £212,617 -£94,211 £1,325,830 £1,062,101 -£263,729 £3,736,800 £3,419,597 -£317,203

Transformational Service Redesign amd Pathway Changes

P01 Medicines Optimisation – Care Homes 01-Apr-14 £9,102 £9,102 £0 £54,612 £54,612 £0 £63,714 £63,714 £0

P02 Pharmacy Schemes 01-Apr-14 £45,022 £45,755 £734 £339,334 £327,245 -£12,089 £527,980 £527,980 £0

P03 Medicines Optimisation – Medicines Utilisation review - Domiciliary Care 01-Apr-14 £1,000 £0 -£1,000 £6,000 £0 -£6,000 £12,000 £12,000 £0

P05 Back Pain triage - use of Start Back tool by GPs 01-Aug-14 £2,128 £0 -£2,128 £4,256 £0 -£4,256 £17,024 £12,768 -£4,256

P06 Demand Management 01-Jul-14 £22,002 £22,002 £0 £66,009 £66,009 £0 £198,015 £198,015 £0

CC01 Community Care Team with a focus on Reducing respiratory admissions 01-May-14 £43,182 -£12,483 -£55,665 £215,909 -£13,471 -£229,380 £475,000 £158,318 -£316,682

PC01 MSK one stop shop prime provider model 01-Oct-14 £0 £0 £0 £0 £0 £0 £231,046 £231,046 £0

PC02 Gastro / Calprotectin - direct access to testing to identify IBS 01-Aug-14 £5,972 £799 -£5,173 £11,000 £799 -£10,200 £46,835 £46,835 £0

PC04 BNP (Planned) direct access to testing to diagnosis heart failure 01-Apr-14 £6,954 £4,071 -£2,883 £41,723 £12,213 -£29,510 £83,445 £36,639 -£46,806

PC06 Ophthalmology - redesign of pathways 01-Oct-14 £0 £0 £0 £0 £0 £0 £14,476 £14,476 £0 UP01 & Extend Acute Visiting Services (AVS) (including Care Homes) 01-Jul-14 £60,089 £53,256 -£6,833 £180,266 £155,330 -£24,936 £540,799 £555,649 £14,850 UP02 FE Frail Elderly- To develop pathways and services 01-Oct-14 £0 £0 £0 £0 £0 £0 £386,529 £40,683 -£345,846

LTC Long Term Conditions- Redesign of services 01-Oct-14 £0 £0 £0 £0 £0 £0 £478,326 £70,228 -£408,098 Cardiology - reduction in 1st OPA and FU's - needs a work plan to understand PIP02 01-Sep-14 £3,571 £0 -£3,571 £3,571 £0 -£3,571 £25,000 £0 -£25,000 pathway PIP03 E consultation (Reduction in FU's) - needs a work plan to understand pathway 01-Sep-14 £3,571 £0 -£3,571 £3,571 -£3,571 £25,000 £0 -£25,000

PIP04 PLCV list & audit for 14/15 while Oregon worked up 01-Sep-14 £2,857 £0 -£2,857 £2,857 -£2,857 £20,000 £10,000 -£10,000

PIP05 SSSFT - LD Intensive Support Service Transformation & Milford closure 01-Sep-14 £16,071 £16,071 £0 £16,071 £16,071 £0 £112,500 £112,500 £0

Subtotal £221,521 £138,574 -£82,947 £945,178 £618,808 -£326,370 £3,257,688 £2,090,851 -£1,166,837 Total Cannock £528,349 £351,191 -£177,158 £2,271,008 £1,680,909 -£590,099 £6,994,488 £5,510,448 -£1,484,040

Item: 18 Enc: 14

Cannock Chase and Stafford & Surrounds Clinical Commissioning Groups Audit Committee Meeting 13 August 2014 Boardroom, Greyfriars Therapy Centre, Stafford

Present Names Title Paul Gallagher (PG) (Chair) Lay Member PPI, CC CCG David Pearsall (DP) Lay Member, SAS CCG Paul Woodhead (PW) Lay Member, CC CCG In attendance Sally Young (SY) Head of Governance Tracey Revill (TR) Office Manager, CC & SAS CCGs (Minute Taker) Mike Riley (MR) Internal Audit, Baker Tilly Iain Daire (ID) Internal Audit, Baker Tilly Paul Westwood (PWe) CW Audit Services Jackie Brown (JBr) Interim Finance Director, CC & SAS CCGs Grant Patterson (GPa) Grant Thornton, External Audit

1.0 Apologies Action Neil Chambers (NC) Chair, Cain Black (CB), CW Audit Services, Glenn Palethorpe (GP), Ruth Goodison 2.0 Conflicts of Interest A Declaration of Interest register was circulated with the papers. There were no conflicts declared for any of the items on the Agenda. 3.0 a. Minutes from previous meeting held on 27 May 2014 Subject to the following amendments minutes were approved as a true and accurate record: Page 1 - Initials for Paul Westwood to be amended to PWe Initials for Jackie Brown to read JBr Grant Pattison should be Patterson Page 2 - 7th line of page 2 initials to be amended to JBr Page 5 – 6.0 External Audit action for Grant Patterson, initials to be added to action column Page 10 – Item 16.0 Any Other Business last paragraph to read “NC expressed concern at the lack of Secondary Care Governing Body members” Matters Arising from Minutes dated 27 May 2014 Page 2- Item 4 - PG asked if the review of CSU arrangements had been completed. SY advised that this was ongoing as it was a large piece of work and every aspect of the contracts held with CSU had to be reviewed. A report will be presented at the October Audit Committee meeting.

Action: Sally Young to present report to the Audit Committee on the outcome of the SY CSU Audit on services provided.

Page 4 – Annual Accounts - PG asked JBr if she had appointed to all the posts in the finance team. JBr confirmed the following posts: • Director of Finance – Paul Simpson recruited to post will commence on 15 September 14 – JBr will have a two week hand-over with Paul. • Deputy Director of Finance – Internal interviews will be held middle of week commencing 18 August if not recruited to the post will go out to advert middle of September 14. JBr has asked Martin Flowers, currently in post as Interim Deputy Finance Director, to consider staying until Christmas to have a cross-over with the new post holder • Band 7 post has been recruited to with a start date of 2 September 14.

1 Item: 18 Enc: 14

• JBr also advised that she has formally written to the CSU advising that the CCG intend to bring two senior contracting mangers in-house and requested they expedite a recruitment process if there is no one suitable to TUPE across.

GPa advised that he had previously worked with Paul Simpson in local government and

considered Paul to be a good Finance Director and will be a good member of the CCG

Finance team.

Page 5 – Item 6 - PG noted that the action for GPa had been omitted from the minutes in

May, GPa confirmed that he had not yet produced a summary on lessons learned and will

meet with JBr and Paul Simpson.

Action: GPa to meet with JBr and Paul Simpson to produce a lessons learned GPa summary for the Annual Governance Statement and Annual Accounts.

Page 8 - Item 11.0 - PG asked if the additional information had been added to the Gifts and

Hospitality register regarding Andy Donald’s trip to Austria. SY apologised and will get the

SY/TR Action: SY/TR to update Gifts and Hospitality register with more detail on AD’s trip to

Austria.

Page 10 – Item 16 - SY confirmed that the adverts for the Secondary Care Consultant

Governing Body Members would be in the BMJ this week.

Repeat Prescribing – DP expressed concern about repeat prescribing. Discussion regarding

whether this issue was a was issue or something for Counter-Fraud to investigate took place.

The Audit Committee were not satisfied the update fully dealt with the question and asked

that Lynn Millar be asked to attend the next Audit Committee to provide an update.

Action: TR to invite Lynn Millar to the next Audit Committee Meeting on 22 October TR 2014. b. Action points from previous meeting held on 27 May 2014 Action log updated as attached.

4.0 CSU Assurance JBr has written to the CSU requesting advance notice for a programme of reports as the CCG require advance notice of what they will receive and when. What the CSU have sent back is the same as that which was sent back at year end and does not provide a programme for quarterly Type 1 and Type 2 reports.

JBr will send the letter from CSU to Baker Tilly for an opinion and JBr will write back to the CSU also expressing the concerns from the Audit Committee. JBr will report back to the Audit Committee at the next meeting.

Action: JBr to send letter from CSU to Baker Tilly for them to provide an opinion and JBr/MR write back to CSU raising the Audit Committee’s concerns and asking for a quarterly programme.

Action: TR to include this item on the Agenda for the next meeting. TR 5.0 External Audit Letter a. Cannock Chase GPa noted the key findings: The work carried out in the year comprised: • Auditing the 2013/14 accounts • Assessing the CCG's arrangements for securing economy, efficiency and effectiveness in its use of resources.

2 Item: 18 Enc: 14

The Letter is intended to communicate key messages to the CCG and external stakeholders, including members of the public.

The Letter summarises the outcomes from the first year audit. It also recognises that 2013/14 was the first year of operation of the CCG and it has made progress in a number of areas in challenging circumstances. The key areas, looking forward, for the CCG's attention are: • Delivery to the agreed in-year deficit budget position of £8.57 million - • Delivery of the QIPP programme - for 2014/15 • Development of a five year sustainable repayment plan of the first year deficit • The Staffordshire and Stoke-on-Trent health economy is one of the most challenged in the country - the CCG will need to keep fully engaged with the programme and continue working with its key partners to ensure that health services now and into the future are provided effectively and efficiently to the local population.

GPa noted that the CCG have a five year sustainable plan in place to bring the deficit back into balance in 16/17. GPa also noted that the CCG is one of 11 in the country in deficit as noted in the KPMG Distressed Economy report.

The Audit Committee NOTED the report. b. Stafford & Surrounds GPa confirmed Stafford and Surrounds is similar to Cannock above, with a caveat around where MSFT sits and services moving out.

PW asked what the issues was around pensions disclosure, SY confirmed it was due to the difficulty in obtaining pension information from the Pensions Agency in Blackpool for clinical leaders who were in post later in the year and the due to the late release of national guidance. This should not be an issue for this year.

The Audit Committee NOTED the report. 6.0 Internal Audit Update – Progress Reports a. Cannock Chase MR advised that two internal audit assignment have been completed: • Strategic Commissioning – rated amber/red with 10 recommendations which have been accepted by the CCG. • Follow Up – 12 recommendations have been tracked, and are satisfied with what has been reviewed. Phase 2 will correlate back to the Audit Tracker (Item 9.0 on the agenda).

Work in progress – three reviews with final report to Audit Committee in October: • Collaborative Provider • Provider Contract Management • CIP Quality Impact Assessments

A schedule of further reviews are in the report presented. A review of GP First was to be carried out but this has been put on hold pending the findings from the National Audit Office review.

PG asked if there was an indication of when the work is to be completed by, it was confirmed that this was the Implementation date. Once the work is completed it is moved on the Audit tracker to “Work Implemented”, this document is updated monthly.

PW said that it would be useful to have the date on the audit report’s action plan when the work has been finalised, MR confirmed this can be added to the report.

Action: MR to include the completion date in the action plan. MR

The Audit Committee NOTED the report and reviews carried out.

3 Item: 18 Enc: 14 b. Stafford & Surrounds As above for Cannock Chase.

The Audit Committee NOTED the report and reviews carried out. 7.0 Draft Board Assurance Framework SY circulated a copy of the Board Assurance Framework (BAF) and advised that previously the risk register had been presented to the committee. As part of the assurance for the Governing Body the CCG are required to have a BAF, this was not in place last year, but SY had assurance from Shauna Mallinson that the risk register encapsulated all the fields required in the BAF. SY advised that following a considerable piece of work the BAF has now been developed which details current scores of 15+ which also includes corporate risks.

SY noted two additional risks which need to be added to the risk register which are likely to score 15+ and will be included in the BAF as:

• The risk is the lack of effective collaboration with other CCGs particularly in relation to the host/associate commissioner relationships. • The risk is the implementation of the KPMG Distressed Economy Report recommendations, potential unforeseen consequences of large scale system change and disruption to core business.

SY advised that the KPMG report has been circulated to the Stafford & Surrounds Governing Body members for the confidential section of the meeting next week but the report cannot be shared wider at the moment. PW asked when it is expected to be made public, SY advised she is not sure at the moment.

PG asked if Stafford & Surrounds Governing Body members had received a copy could this be shared with the Cannock Chase members. JBr confirmed that it could go to the Cannock members in confidence.

Action: SY to send Cannock Chase Governing Body members a copy of the KPMG SY Distressed Economy report in confidence.

PW asked if there is someone responsible to do an overall check on the scoring, as there was a difference on similar risks being scored differently.

SY confirmed that this will be a standing item on the EMT agenda where senior management can review the scores.

PG thanked SY, TR and the team for the work done to bring the BAF together, this will be a standing agenda item and the committee may request officers to attend audit if they feel they need more detailed information on a particular risk. PW said they would need to see the BAF more than a week prior to the meeting in order to be able to identify who they would wish to call to the meeting. SY said that TR will get the most up-to-date BAF out when she calls for papers/agenda items.

Action: TR to make sure the BAF is up-to-date and send out when she calls for papers and agenda items. TR

PW asked if over-prescribing was reflected elsewhere as it was not on the BAF. PG said that more work needs to be undertaken before it is on the BAF. SY/T will check to see if over- prescribing is on the risk register.

Action: SY/TR to check the register to see if over-prescribing is on. SY/TR The Audit Committee APPROVED the BAF. 8.0 Anti-Fraud Report - Progress a. Cannock Chase PWe said it was surprising to note that there had not been any referrals from either CCG as other CCGs have been. JBr asked what kind of issues were being referred. PWe said that 4 Item: 18 Enc: 14

concerns about GPs and prescribing but the main high risk problem is regarding personal health budgets. JBr confirmed that neither Cannock Chase CCG or Stafford & Surrounds CCG have yet implemented personal budget schemes. PW advised the CCG of the need to ensure the policies and procedures in contract are fraud-proof, JBr said that Chris Brown from Continuing Health Care was dealing with personal health budgets and would ask her to speak to PWe to go through the paperwork. JBr Action: JBr to ask Chris Brown to meet with PWe to go through the paperwork for personal health budgets.

DP queried if the issues were with patients themselves, PWe confirmed it was about patients receiving money and not using that money for the purpose it is intended, or patients not having the condition they are claiming for.

It was agreed the CCG need to look at lessons learned from other CCGs and make sure the opportunity for fraud is reduced when personal health budgets are implemented.

The Audit Committee NOTED the report. b. Stafford & Surrounds As above.

The Audit Committee NOTED the report. c. Counter Fraud Survey Report PWe confirmed that the survey had been sent to all staff and Governing Body members at Cannock Chase and Stafford & Surrounds CCGs as well as Practice Managers.

There had been 14 responses from Cannock Chase which was disappointing but noted the following:

• 100% of responders stated that they would report fraud if they suspected it. • 84.9% of responders were aware of the CCGs anti-fraud, corruption and bribery policy. • 76.9% of responders were aware of the CCGs whistleblowing policy.

• 61.5% of responders reported that they had received counter fraud materials.

• There was an excellent understanding of the examples given regarding what constitutes fraudulent activity.

PWe noted that it was disappointing that only 38.5% were aware that the CCG had a LCFS provision.

There had been 64 responses from Stafford & Surrounds and noted the following:

• 98.1% of responders stated that they would report fraud if they suspected it • 69.0% of responders were aware of the CCGs anti-fraud, corruption and bribery policy • 75.9% of responders were aware of the CCGs whistleblowing policy • There was an excellent understanding of the examples given regarding what constitutes fraudulent activity

There were disappointing responses concerning the CCG LCFS / NHS Protect: • 32.8% of responders were aware that the CCG had a LCFS provision • 41.4% of responders had seen or received counter fraud awareness materials

It was suggested that the disappointing response for Cannock could be that the majority of staff completed the Stafford survey as staff are working across both CCGs.

PW asked if it was an intention to repeat the exercise. PWe said there is a plan to do more work to increase awareness and can do the survey again. SY asked PWe to avoid March, PWe will send the survey again in February 2015.

5 Item: 18 Enc: 14

Action: PWe to carry out survey in February 2015. PWe

The Audit Committee NOTED the survey results.

d. Bribery & Corruption Policy PWe advised the previous policy was an old PCT version, this policy is now a CCG policy which will go onto the website and SY will send an email to all staff and Governing Body members to make them aware there is a new policy and asking them to confirm they have read it.

Action: SY to email all staff advising of the new policy when it is put on the website. SY

The Audit Committee APPROVED the policy. 9.0 Audit Tracker Cannock Chase All recommendations/actions that have been received from all Baker Tilly’s audit reports have been put into one place on an Audit Tracker. They have been rated red/amber/green depending on priority and due date.

JBr noted that some actions were quite old and should not be on, JBr also noted that there are two officers who do not appear to have done any updates and JBr will speak to them.

Action: JBr to speak to the two Officers concerned to update the audit tracker. JBr

SY will also ask Officers to date when the action has been completed. JBr agreed that there is still further work to be done on the tracker and have it red rated in priority so members can focus on those that are a priority without having to look down to find them.

PW asked for the tracker to be checked with an update at the next meeting to give assurance to the Audit Committee that the actions are being progressed.

PW queried if there are any differences under Stafford & Surrounds, MR said that in the main the recommendations were the same for both CCGs. PW said rather than having two sets could there be one document with an extra column added in to identify which CCG the recommendation referred to. PW also asked for thefront cover to be more informative, where there are overdue actions giving more detail. SY will action this.

SY confirmed that there needs to be separate audit trackers for each CCG but that a joint one with the additional column could be done for Audit Committee.

Action: SY to make the front report cover for the audit tracker more informative. SY

Action: TR to provide one document and include an additional column to identify the TR relevant CCG.

JBr said that this document could also be used to ask Officers to attend Audit Committee to give more detail around the action where it is overdue and a high risk. PW said that again members would need the document more than a week prior to the meeting to give time to ask Officers to attend the meeting. NC and Director of Finance, previously the Chief Finance Officer and the Head of Governance meet to agree the agenda for the Audit Committee.

Action: PG to speak to NC about making sure this happens once new Director of PG Finance starts.

Stafford & Surrounds As above.

The Audit Committee NOTED the process for implementing and managing audit recommendations the Audit Tracker.

6 Item: 18 Enc: 14

10.0 Gifts and Hospitality Register No updates received. 11.0 IG Handbook and Policy SY advised that the IG Handbook and Policy circulated with the papers had been presented and signed off at the IG Meeting on the 8th July 2014 and SY was now asking the Audit Committee to sign them off.

SY advised that the handbook replaces the 16 policies that had been approved and brings them all together with an overarching policy. The handbook will replace the 16 policies on the website.

CF attended to respond to any queries the committee members have. CF said that this document will make things easier and give staff one place to search for IG issues, although it is a large document it is smaller than the 16 individual polices.

PW said that it was a good document and was supplemented by the interactive training Cannock Chase Governing Body members had received.

PG thanked CF for the hard work in pulling the document together and asked her to pass on the committees thanks to her colleagues.

The Audit Committee APPROVED the IG Handbook and Policy. 12.0 National Audit Office Visit re GP First JBr is still awaiting sight of the report from the National Audit Office, which is due around September. This item was deferred to the October meeting.

Action: TR to include on the October Agenda. TR 13.0 Draft Policies for CCG Financial Procedures: MR presented the following policies for approval: a. Expenses Policy b. Petty Cash Policy c. Budgetary Control Policy d. Cash Treasury Management Policy

MR explained they had been asked by other CCGs to put together some financial policies for them to adopt and has shared them with the CCGs should Cannock and Stafford wish to use them.

SY circulated updated copies of the Petty Cash Policy and Procedures which had been changed to reflect the CCG rather than a Trust. PG queried if the documents had version numbers, SY confirmed they would have once approved to adopt.

PWe asked if the policies had been reviewed by Counter-Fraud, as from looking through the expenses policy it states that anyone authorising fraudulent claims would be subject to disciplinary, PWe said this would also need to include any employee submitting a fraudulent claim.

PWe will go through all the policies and send any amendments to JBr, SY and TR. The policies will then be circulated by email to Committee members for approval. The documents will then be put onto the website.

SY also asked PWe to review the HR policies on the websites and make any comments.

Action: PWe to review the CCG Financial Procedures and HR policies and send any PWe amendments to JBr/SY/TR for action.

Action: SY to send policies round to Committee members via email for approval and to SY/TR then put on the website.

7 Item: 18 Enc: 14

14.0 Constitutional Arrangements for Audit Committees SY said that she is waiting to see if there is any more guidance and will take an action to see what the position is.

Action: SY to check if there is any further guidance for constitutional arrangements for SY Audit Committees.

GPa advised that the July consultation document is now published for appointing external auditor arrangements. SY will pick this up for consideration. GPa will send an electronic to SY who will share with the Audit Committee for feedback.

Action: GPa will send an electronic copy of the July consultation document for GPa appointing external auditor arrangements to SY. 15.0 Items for Information Information Governance Minutes • 13 May 2014

The Audit Committee NOTED the Information Governance Minutes. 16.0 Items to report to Governing Body • Inform them IG handbook and Policy has been signed off • BAF will go as an Agenda item • Policies approved at today’s committee meeting 16.0 Any Other Business There was no further business to discuss. 17.0 Date and Time of Next Meeting 22 October 2014, 1pm – 4pm Boardroom, Greyfriars Therapy Centre, Stafford

8 Item: 18 Enc: 15

FINANCE, PERFORMANCE AND CONTRACTS (FPC) COMMITTEE MEETING

Tuesday 9 September 2014 2.00 pm – 5.00 pm Boardroom, Greyfriars Therapy Centre, Unit 12 Greyfriars Business Park, Frank Foley Way, Stafford ST16 2ST

Minutes

Names Role Present: Paul Woodhead (PW) Chair – Lay Member Alex Bennett (AB) Director of Design and Performance Michael Brookes (MB) Commissioning Manager, CSU Martin Flowers (MF) Associate Director of Finance Dr Gary Free (GF) Clinical Lead Dr Paddy Hannigan (PH) Clinical Lead Lynn Millar (LM) Director of Primary Care Tim Rideout (TR) Director of Transition

In attendance: Alex Birch (ABi) Primary Care Development Manager Mark Jones (MJ) Strategic Locality Director – CSU Claire McHugh (CLM) Minute Taker – Executive Assistant Laura Mitchell (LCM) Financial Planning Manager Sharuna Reddy (SR) Medicines Management – CC Mel Savage Senior Commissioning Manager Bev Thomas Head of Procurement, Midlands & Lancashire CSU

Action

1. Welcome by the Chairman

Chair thanked those present for attending and welcomed Laura Mitchell, Financial Planning Manager attending as part of her induction. PW confirmed that the meeting is quorate unless stated otherwise within the minutes.

2. Apologies

Dr Mohammed Huda David Pearsall

3. Minutes of Previous Meeting – 21 August 2014

The minutes were approved as an accurate record.

The item ‘QIPP PMO Report’ should be a standing item, this had been omitted

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Action from the Agenda because of the short timescale from the last meeting. It would be placed as item 5.

Action: Ensure QIPP PMO Report is a standing agenda item CLM

3.1 Actions

Actions were reviewed and updated on the Action List. Discussion recorded as below:

3.1.1 Item 46: Winter Monies/Referral to Treatment Time (RTT) AB updated the meeting and confirmed that the full amount of monies has been awarded to the CCGs. NHS England have informed that any monies not appropriately used for RTT has the potential to be clawed back and there may be a requirement to demonstrate how the money has been spent. Providers have been asked to report on spend.

LM added that Primary Care Resilience Monies could be used for AVS and confirmation is awaited that this is an option. AB is communicating with the appropriate colleagues to progress this.

There is an additional £1.6m that may be awarded for non-elective system resilience monies.

3.1.2 Item 45: Walsall Healthcare Trust The position is still not confirmed because data is not currently available. MF expressed concern that there is currently no data to confirm the over performance however, this is currently the assumption. MJ informed the meeting that requests for further information have not been well received.

3.1.3 Item 44: Risk Register MB has obtained access to the Risk Register and this will now be updated for the meeting in October 2014.

3.1.4 Items 41, 42, 43: Reporting Outcomes This will be provided within the October Report.

3.1.5 Item 40: CCG Performance Report This action will be addressed for October 2014.

3.1.6 Item 36: Quarterly Report This will need to be addressed for December 2014.

3.1.7 Item 35: October Meeting Date It is thought that the next Membership Board/PLT was on 16/10/2014 and the FPC could not attend on the same date, but this may have moved to 14/10/2014.

Action: CLM to check whether MB is moving to 14/10/2014 and plan 16/10/2014 as appropriate.

3.1.8 Item 33: Repeat Prescriptions LM confirmed that this matter is ongoing and can be completed.

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Action 3.1.9 Item 32: ‘Stemming the Flow’ Business Case TR confirmed that this item has been completed.

3.1.10 Item 30: Provider Meetings AB confirmed that meetings are taking place with RWHT and although UHNS have not met, she has had opportunity to discuss issues with them at other key meetings. This is now complete.

3.1.11 Item 27: UHNS KPI AB confirmed that as there is no contract lever for this, the action is now complete.

4. Conflicts of Interest

Michael Brookes’ declared a conflict of interest as his spouse works at South Staffordshire and Shropshire Healthcare NHS Foundation Trust (SSSFT).

All GPs declare a conflict of interest for any issues relating to GP First.

5. QIPP PMO Report

AB presented her report and provided copies for all attendees.

Action: AB provide electronic copy of the QIPP PMO Report to CLM AB

LM expressed concern because QIPP monies has already been taken from her budgets. AB/LCM are considering how future communications will take place regarding QIPP with budget holders.

MF informed the meeting that there is allowance for slippage, however, there is a high dependence on schemes achieving their QIPP targets and consideration should also be given for additional savings.

TR recommended that careful consideration be given to both Continuing Care and Community Respiratory and asked that a more detailed report be submitted at October FPC.

Action: MB/MJ to produce detailed report regarding Continuing Care MB/MJ and Community Respiratory

6. Finance Reports Month 4 (July 2014)

MF presented the report to the meeting. Month 5 has not yet been reported, both Stafford & Surrounds and Cannock Chase have not performed well but MF did not have final figures to share with the meeting.

NHS England have revised guidance on how to report forecast outturn, it is no longer possible to operate outside control total without prior approval.

GF suggested that it would be useful to be aware of where the over performance is for Cannock. MB reported that the main over performance is in a number of Approved 16.10.14 Page 3 of 7

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Action areas with the largest being elective and day case.

LM reported that there is a reduction in referrals for practices as part of an exercise to improve performance. TR asked what should be done to address these issues.

LM explained that there are other issues that need to be considered, although GP referrals are reducing, they are still higher than other areas of the country. There may be issues regarding activity and GF suggested that some referrals are inter-department eg, fracture clinic to physiotherapy.

The meeting agreed that it is important for performance and primary care to meet to discuss demand management.

Action: LM arrange meeting with appropriate colleagues to address LM demand management and report back to October FPC

Discussion took place around the soft intelligence available to CCG and mechanisms to report back.

LCM explained that at other CCG there are also Consultant to Consultant benchmarks but AB explained that this is not a particular issue for these CCGs.

MF informed the meeting that he will share a report by the end of the week.

7. CCG Performance Report – June 2014

AB presented both reports. i) Cannock Chase TR raised the 62 day cancer waits at Cannock. AB will meet with the tertiary centre to discuss but informed the meeting that the centre is experiencing difficulties with getting prompt referrals from providers. MB reiterated that the transfer of patients between providers does not appear to work to the patients advantage.

PW asked AB to consider what resources would be needed to address these issues.

Action: AB/TR consider what resources are needed to address the AB/TR referral issues. ii) Stafford & Surrounds Discussion took place regarding Red2 breaches which AB had brought to the previous meeting. PH explained that any concerns had been raised and discussed at the Q1 Assurance meeting with NHS England.

8. Report on Month 5 Position and Ability to Deliver Control Total

MF presented the report and explained that progress on improvement is good and he will provide an up to date report in November 2014 when further steps will have been agreed.

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Action

Action: MF to provide report at the November meeting. MF

9. Finance and Contracting Improvement Plan

MF led discussion around finance and contract improvement plans and it was agreed that he would update at the meeting in November.

Committee moved to Item 13 EMIS Web Conversion

13. EMIS Web Proposed Conversion

LM presented the report and provided more information. PH had attended an IM&T meeting earlier and explained that North Staffs are also trying to align systems between practices.

LM explained that the original plan had been to identify capital funding from ‘Stemming the Flow’ Business Case, however, there is a timing issue eg, a system change in the winter period could create a risk so it should be done now, or wait until Spring 2015.

Stemming the Flow has currently been put on hold and LM is asking if the £110k funding can be approved.

15:29 Sharuna Reddy joined the meeting Melanie Savage and Bev Thomas joined the meeting

LM explained that a system would only normally be replaced when they were no longer functioning, however, changing the system will reduce the need to fund changing systems at differing times.

TR expressed concern that if the funding, without confirmation of the ‘Stemming the Flow’, is approved then this is an additional risk that the CCG does not have the source of funds for. MF confirmed that this is not factored into any costings.

TR confirmed that if the ‘Stemming the Flow’ funding is accessed then this is potentially a priority for funding.

GF reminded the meeting that there are potential savings eg, for out of hours and SR confirmed that medicines management would benefit from shared systems. It was proposed that if savings can be identified that this could be represented.

The request for £110k funding was denied.

Committee moved to Item 11 QIPP – Medicines Utilisation Review Exception Report

11. QIPP – Medicines Utilisation Review Exception Report

SR presented the report and assured Chair that there is a commitment to the

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Action activity, however, the savings cannot be confirmed.

LM explained that there are other benefits and SR confirmed that this about adverse events. This is a defining pilot in Rugeley and when it is established, it will be rolled out to other areas.

Following confirmation from Clair Fleet that IG is complete, then the programme can start.

Committee noted the elements identified within the report and agreed that the project should be reviewed in November 2014.

Committee moved to Item 12 Non-NHS Contracts Procurement

12. Non-NHS Contracts Procurement

15:43 Sharuna Reddy left the meeting Lynn Millar left the meeting Alex Birch joined the meeting

MS presented the report.

15:46 Lynn Millar returned to the meeting

MS confirmed to TR that if any of the services, except Out of Hours, were removed, then patients would still be able to access treatment. TR asked MS to consider which services can be decommissioned and which need to continue.

TR explained to GF that if MS’s report finds that it will cost more money for patients to be referred elsewhere then this will support any decision making process.

Action: MS to present findings around decommissioning to MS September Performance meeting

MB reminded the meeting that the plan from April 2015 is for mental health to be payment by results.

15:51 Mel Savage/Bev Thomas left the meeting

Committee moved to Item 10 QIPP Scheme Update – P05 Back Pain Triage Update

9. QIPP Scheme Update – P05 Back Pain Triage Update

ABi presented the report. This has also been discussed at Stafford & Surrounds Membership Board and there is discussion about whether to enforce decisions made at Membership Board, ie, make processes mandatory. It will be discussed with Cannock Members on 10/09/2014.

ABi informed the meeting that Physiotherapy Service will also use the tool. Some GPs have reported that patients appear to appreciate the screening tool

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Action and are less inclined to book further appointments.

Discussion followed regarding the practicalities of the tool and GF expressed concern regarding the resource issues in the Cannock Chase area. PH has been using the tool for some time and finds that it gives greater structure to appointments and it has found it to be valuable.

ABi explained that consideration has been given to what GPs are telling the CCG but this is an evidence based tool, used internationally. LM explained that it is hoped that Cannock GPs agree to make use of the tool.

ABi explained that Keele University are doing further work in attempts to make it even easier/more practical to use. It was agreed that it may be valuable to introduce the tool in Cannock, following Membership Board approval, and establish good practice.

Committee noted the areas where the current performance rating is below target and the remedial actions being taken to improve performance and mitigate risk.

16:06 Alex Birch left the meeting

Committee moved to Item 13 Risk Register Review

13. Risk Register Review

AB asked to identify an additional risk regarding performance.

Action: AB to update Risk Register AB

16. Any Other Business

There were no matters for any other business.

17. Next Meeting

Date: Thursday 16 October 2014 Time: 2.00 pm – 5.00 pm Venue: Boardroom, Greyfriars Therapy Centre, Unit 12 Greyfriars Business Park, Frank Foley Way, Stafford

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Item No: 02 Enc:01

Communications & Engagement Committee Wednesday 16th July 2014 Springfields Health & Well Being Centre

Present Paul Gallagher (Chair)( PG) Lay Member, Patient and Public Involvement CC CCG Ruth Goodison (Vice Chair) Lay Member, Patient and Public Involvement SAS CCG (RG) Adele Edmondson (AE) Communications & Engagement CSU Lead Cannock/Stafford Clive Cropper (CC) Practice Manager, Moss Street Surgery, Cannock Katie Woods (KW) Communications & Engagement Officer Hester Parsons (HP) Healthwatch Carole Howard (CH) Patient Champion

In attendance Paul Woodhead Lay Member, CC CCG Sally Young Head of Governance 1. Apologies Dr Johnny McMahon, Tamsin Carr, Lynn Millar

2. Declaration of Interest Nil declared

3. Minutes of the last meeting The minutes of the meeting were agreed as a true and accurate record subject to the following amendments:  Item 6. Engagement Activity CSU/CCG to read antenatal  Item 9. Report on Lay Member Committees to read Action List The action list was updated and distributed to members.

4. Chairman/Terms of Reference

Chairman PG advised members that following a discussion and with the agreement of the committee that RG to take over as Chair at the next meeting.

The committee agreed the change of Chair.

Action: PG to email AMH and JM to confirm their support for the change of Chair. PG

Action: TOR to be changed to reflect this. SY

5. Communications & Engagement Strategy – Work shop feedback

AE reported that there was mixed feedback regarding the outcome of the workshop. Members were disappointed that the session did not implement the strategy and the lack of clinical representation and focus on engagement.

Action: Meeting between PG/RG/TC to take forward. PG/RG/TC

Further to the Management of Change process taking place at the CCG HQ, the committee agreed that job descriptions and person specifications include communications and engagement within the responsibilities.

Action: All JDs and PS to include communications and engagement SY

Members agreed to create a standing agenda item for inclusion in the annual report.

Action: standing agenda item for inclusion in the annual report (engagement and SY annual report articles)

The committee received and noted the feedback.

6. Engagement Activity CSU/CCG

CCG  MIU survey - purpose to find out why people are going to the unit and shape any options that will go forward for the consultation

PG thanked all officers for conducting the survey.

CSU  Events at school? TC Action: CSU report to be circulated to members.

The committee received and noted the update.

7. Healthwatch Update

 AGM recently held, 70 people attended votes were taken next 3 priorities

 Finalising information gathering for young carers.

 SS and Shropshire dignity and respect work

 Healthwatch England looking at inappropriate discharges for Staffordshire footprint

 Enter and View GP practices and appointments, mystery shoppers PG/RG Action: SB RG PG and HP to meet

The committee received and noted the update. 8. 360° Stakeholder Survey 2014

Strong relationships with a range of health and care partners in order to be successful commissioners within the local system. The stakeholder survey is a key part of ensuring strong relationships are on place. The survey, conducted by NHS

England allows stakeholders to provide feedback on working relationships with CCGs. Members discussed the survey, reservations were had specifically regarding engagement work and ‘survey response rates’ AE commented that engagement needs to be measured over the last 12 months.

The committee received and noted the report.

9. Patients in Control AE discussed the programme which takes a community development approach, working in partnership with patients, carers and the voluntary sector to understand what high quality outcomes and experience look like from a patients’ perspective. The programme will focus on the role that commissioners can play to put patients in control and aim to:

 Identify and work with organisations which are already leading the way.  Review the commissioning cycle to ensure that opportunities to put patients in control are taken at each stage.  Work with the leadership of commissioning organisations to help them understand how they can put the patients in control  Develop practical tools and interventions through which commissioners can encourage patients to exercise control through the system.  Support commissioning organisations to create their own development programme to take the work forward.

The committee received and noted the report.

10. Engagement – What do we mean?

The committee discussed what patient’s and public expectation of engagement is.

Action: AE & RG to take discussion forward and feedback to the committee.

Action: AE to distribute ‘ladder of engagement to members’

The committee received and noted the update.

11. Website Action Plan

AE updated members on outstanding actions.

The committee received and noted the update.

12. Equality & Inclusion Report

AE reported that the CCG has a statutory duty to publish the report which details the progress made over the last year on equality and inclusion issues in regard to its staff, patients and service users and other stakeholders.

AE asked the committee to review the report and submit any comments.

Action: review the report and forward comments to AE. AE

The committee discussed EDS grading process which provides the Governing Body with an assurance mechanism for compliance with the Equality Act 2010 and enables local people to co design the CCG equality objectives to ensure improvements.

Action: review EDS2 grading process and report comments back by August 16th ALL

The committee received and noted the report.

13. PPG Training

The committee discussed feedback from the recent training event, and felt that the members at the last PPG District Group meeting have a more proactive understanding as to their role. Priorities were summarised as GP access and access to patients.

The committee received and noted the update.

14. Any Other Business SY advised the committee that interviews will be taking place on 15th August for SAS Lay Members.

The next meeting date is confirmed as: 17th September 14:00 – 16:00 Meeting Room 1, Springfields Health & Well Being Centre