AGENDA SOUTH EAST STAFFORDSHIRE and SEISDON PENINSULA CLINICAL COMMISSIONING GROUP GOVERNING BODY to BE HELD in PUBLIC Wednesd

AGENDA SOUTH EAST STAFFORDSHIRE AND SEISDON PENINSULA CLINICAL COMMISSIONING GROUP GOVERNING BODY TO BE HELD IN PUBLIC Wednesday 25th March 2015, 3.00pm Board Room, Merlin House Etchell Road, Tamworth, Staffs B78 3HF

Enc Lead Time 1 Apologies and Declarations of Interest: 3 Verbal JJ .00pm If an executive member has any pecuniary interest in any contract, proposed contract or other matter under consideration at this meeting, he/she shall disclose the fact to the Chair and shall not take part in the consideration or discussion of the matter or vote on any question with respect to it.

2 Minutes from meeting held on 28th January 2015 Enc 01 JJ 3.05pm

3 Actions from Meeting held on 28th January 2015 Enc 02 JJ 3.10pm

4 Questions from members of the public/press Verbal JJ 3.15pm

Strategic Matters 5 Accountable Officer Report Enc 03 RS 3.15pm

6 Update from Locality Directors 3.20pm  South East Staffordshire Locality Board Verbal JW  Seisdon Peninsula Locality Board Enc 04 TD

7 Chairs reports from Committees: 3.25pm

 Patient Council February Enc 05 RC March Enc 06

 Quality Committee February Enc 07 AF March Enc 08

 Finance and Performance Committee Verbal JJ

8 Integrated Quality and Performance Report Enc 09 HJ 3.30pm

9 Board Assurance Framework Encs HJ 3.35pm 10/10a

10 Better Care Fund Enc 11 RS 3.40pm

Finance and Performance 11 Finance Report Enc TT 3.45pm 12/12a

 Financial Plan 2015/16 – TO FOLLOW Enc 13 TT  Programme Delivery Report Enc 14 AH

Assurance 12 Committee Minutes for information: 3.55pm

 Quality Committee Enc 15/15a AF

 Finance & Performance Committee Enc 16/16a SG

 Seisdon Peninsula Locality Meeting Enc 17 TD

 South East Staffs Locality Meeting Enc 18 JW

13 Any Other Business Verbal ALL 4.00pm

14 Date, time and venue of next meeting: Close JJ

Wednesday 27th May 2015, 3.00pm Council Chambers South Staffordshire Council Offices Wolverhampton Road Codsall WV8 1PX

ENC 01 SOUTH EAST STAFFORDSHIRE & SEISDON PENINSULA CLINICAL COMMISSIONING GROUP GOVERNING BODY HELD IN PUBLIC

Wednesday 28th January 2015, 1.00pm, Merlin House, Etchell Road Tamworth, Staffs B78 3HF

Present: Dr James Ward (JW) (Acting Chair) Locality Director Rita Symons (RS) Locality Director Dr Tim Dukes (TD) Chief Finance Officer (Interim) Tim Tebbs (TT) Chief Nurse Heather Johnstone (HJ) Lay Member, PPI Rosemary Crawley (RC) Chief Operating Officer Anna Hammond (AH) Turnaround Director Crispin Atkinson (CA) Lay Member, Governance Stuart Gaskell In Corporate Support Manager attendance: Sara Rogers (SR)

AGENDA MINUTES ACTION ITEM NO. 1 APOLOGIES and Declaration of Interests

Apologies were received from: Tony Goodwin, Dr John James, Alex Fox.

Conflicts of Interest There were no Conflicts of Interests identified.

The meeting was agreed as being quorate.

2 Minutes from meeting held on 3rd December 2014

The Minutes of the meeting held on the 3rd December2014 were agreed as a true and accurate record.

3 Actions from Meeting held on 3rd December 2014

The Actions from the meeting held on the 3rd December2014 were updated as per attached enclosure 2.

SSOTP Workforce Development Tool - HJ provided members with a summary of the workforce tool in use by SSOTP. The approach that SSOTP are taking is that where staff are working in a role which includes elements below their banding then that element will be reallocated. E.g. a Band 7 Nurse whose time is taken up with administrative tasks. 1

It was agreed that there appears to be a dissonance in between what the SSOTP tool is indicating and concerns being highlighted by members in terms of staff and experiences on the ground. JW reported that Frances Sutherland, Head of Transformation, spoke to practice members at the recent SES locality meeting and reported the lack of meaningful data available to feed into the contract negotiations. There were also discussions around the contract, District Nurses and Case Management. There is a sense of the lack of confidence in knowing what the CCG is paying for and what how the service is mapped out.

TT commented that there is a gap in agreeing the baselines. TT has requested a breakdown by service line of what the contract value service provides for the CCG. Work has already been completed by Wendy Kerr, CFO East Staffs CCG, to try to unpick the service lines but this did not prove successful.

RS commented that the CCG needs to be clearer with the host commissioners for the SSOTP contract on what is included particularly with regards to CQUINs. The CCG has worked very hard on collaborative arrangements however it is crucially important in terms of delivery with Case Management and of the future of the possible re-design of services. If required separate contract negotiations can be held. TT reported that all three South Staffordshire Chief Finance Officers are working hard with the Trust to try to resolve all of the concerns with the resource associated with the service provided.

4 Questions from members of the public/press

The Chair invited questions from members of the public/press. There were no questions at this time.

5 Accountable Officer Report

RS presented her report with the key points of note being:

Increase in CCG Allocation As part of the detailed implementation guidance on the national planning framework, revised CCG allocations were released in the New Year. For the CCG this involves an above average allocation. Winter pressures money, normally available on an annual basis, were embedded in the allocation. The increase amounted to £6m which has all been allocated. Members were made aware that while the increase in allocation was welcome it must not distract from the on-going financial challenge.

Planning Guidance As part of the planning guidance a Forward view document was produced on new models of working. Further detailed guidance has been received which details 4 specific models of care that it wants areas to tests in terms of 2

reconfiguring organisational boundaries and incentives. There is a tight deadline in terms of expressions of interests. The CCG had been discussing looking at alternatives around the Good Hope community. This does fit with 2 of the models of care. Conversations are taking place with the Birmingham commissioners and Good Hope hospital to put in an expression of interest.

Financial Recovery The CCG remains in a high risk position with regard to its 14/15 Financial Recovery Plan. The plan has now been signed off by the Regional Office of NHS England. The CCG will continue to work to deliver in year and is currently exploring further mitigating actions.

Dementia Diagnosis Rate The CCG is committed to achieving its target of identifying 67% of people who are suffering from Dementia. The overall rate is increasing and work is underway with individual practices to take appropriate action.

Pilot of Community Matron on Ambulance Working Well The pressures on the urgent care system are well documented. One of the innovative schemes delivered as part of the winter plan is to have a community matron from SSOTP travel with an ambulance paramedic. This appears to be successful with early evidence of awareness raising and a reduction in people being transported to A & E. An evaluation will be undertaken to be sure of the scale of benefits.

HJ updated members on recent staff changes. Karen McGowan has now left the organisation to take up her new post at Southern Derbyshire CCG as Deputy Chief Nurse and Deputy Director of Quality. Steven Forsyth has been appointed as Karen’s replacement.

6 Update from Locality Directors

Seisdon Peninsula Locality Report TD presented the report and highlighted the following:

 Members discussed the pilot of Map of Medicine. It was agreed that the system needs to be localised and kept up to date to be of maximum value. Member practices would also need training to optimise the benefits. One member queried the cost benefit – the pilot did not look at this aspect specifically. With these provisos, it was agreed that Map of Medicine was worth pursuing  Members agreed for one combined Soft Intelligence report across both localities.  Members received an update from Nigel Williams, Clinical Quality Improvement Manager for the CCG. Whilst there are still concerns, members felt assured by the level of involvement, review and challenge by SES&SP CCG with both Dudley Group of Hospitals and Dudley CCG. 3

 Crispin Atkinson, Turnaround Director, updated members with regard to the financial position of the CCG and the Financial Recovery Plan.  The guidance around Co-Commissioning of primary care was discussed by members. It was agreed to stay with Model A – Greater Involvement at present but to keep Model C – Delegated Commissioning in mind for the future.

Members were informed that an approach had been made by the Brewood Medical Practice to join SES&SP CCG. They are currently part of Stafford and Surrounds CCG. Members welcomed the practice returning to join the CCG, having been part of the South Staffordshire Primary Care Group in 1999. RS and TD have a meeting planned with the practice.

South East Staffordshire Locality Report

JW presented the report and highlighted the following:

 Membership – discussions were held on how to instigate a members vote following a request form practices about the use of private companies in providing NHS care.  The 5 Year Forward view was discussed.  Co-Commissioning – Debate was held around managing potential conflicts of interest and the realism of resources that would be available to any CCG prepared to take on the responsibility. Members were not in agreement to take this forward unless further guidance was received with regards to conflicts of interest. It was agreed that this would require a vote of the full membership.  Map of Medicine was discussed with various practices agreeing to be part of the pilot.

7 Chairs Reports from Committees

Patient Council

RC presented the report and highlighted the following:

 Antibiotic Campaign – A presentation was made on the Antibiotic Campaign from a member of the medicines management team. This helped to clarify a lot of member’s queries around prescribing.  TT provided a presentation on Financial Recovery and the steps being taken to make savings.  At the January 2015 meeting a serious and moving story, from a member’s experience of a relatives stay in Good Hope Hospital, was communicated. This has now been escalated to the Quality Committee for investigation and action.  Gravel Hill surgery were commended on carrying on with their service despite a fire on their premises.

Quality Committee

HJ presented two papers from the December 2014 and January 2015 meetings held. There were no issues for escalation to the Governing Body.

The patient story which had been escalated to the Quality Committee from the Patient Council has been picked up by the quality team. The story will be investigated and any actions identified will be fed back to the Patient Council.

Audit Committee

SG presented the report and highlighted the following key points:

 A new risk has been added to the Assurance Framework – Continuing Health Care. The backlog remains significant and is considered to present both clinical and financial risks to the CCG.  Financial policies were approved which include details relating to the legality of the budget and cash and treasury management as well as Petty Cash.  Updates were received from both internal and external Audit.  External Audit also recommended that a list of options for the long- term sustainability of the CCG be presented to the Audit Committee.  Caine Black, Counter Fraud Specialist, informed members of the possibility of provider trusts charging overseas visitors and also charging CCGs. This can potentially be a significant amount. Caine Black will be contacting TT with the intention of working with East Staffs CCG to commission an exercise at Burton Hospital to highlight any incidents of this type.

Finance and Performance Committee

SG presented the report and highlighted the following key points:

 The committee approved the Learning and Development policy.  The year to date deficit of £14.3m was noted and the month 8 improved forecast which incorporates a number of minor improvements and also factors in £1.5m of FRP secured to date.  Performance – there has been one outstanding issue relating to an apparent wait of one year for breast cancer treatment. Information received was that the wait was in fact less than a year but was misrepresented due to an administrative error. There is still an outstanding action as to determining how long the patient did have to wait for treatment.

8 Integrated Quality and Performance Report

HJ presented the newly developed integrated Quality and Performance report. This is following a recent decision to refocus work programmes and recognising the strong links between quality and performance matters.

The dashboard has been updated and now includes the mental health indicators.

HoEFT mortality reporting is now being received. This is following continued challenge at the Clinical Quality Review meetings. The CQC visited HoEFT on the 9th December 2014 and will continue to monitor on-going concerns.

Dudley – In January 2015 for the first time in several months the Joint Quality Committee agreed limited assurance with regards to Dudley Group of Hospitals as improvements had been noted. However there continues to be a lack of data to enable members to be fully assured. Members are also still awaiting the Trusts formal response to the CQC report.

The CQC report highlighted a number of areas for improvement of which a majority are aligned to what is already known about. HJ wrote a letter at the end of November 2014 to the Chief Nurse at Dudley CCG, Rebecca Bartholomew, outlining the CCGs concerns. A response was received which provided some assurance however a number of concerns still remain outstanding. A further letter has been written to Dudley CCG seeking further assurance. Nigel Williams, Clinical Quality Improvement Lead, will continue to work on seeking a higher level of assurance in regards to this trust.

HJ provided an overview of the work that Nigel Williams is undertaking with regards to West Midlands Ambulance Service performance. Nigel has undertaken a detailed review of the CQRM data which identified concerns about the implications, in terms of some of the performance targets, that the Ambulance service are consistently missing in terms of patient safety. The concerns have been shared with the lead commissioners and neighbouring CCGs. Nigel attended a CQRM earlier this week and was concerned that the Ambulance service were querying why the CCG were requesting this type of information on patient safety. HJ has contacted the newly appointed Director of Nursing, Mark Docherty, at the Ambulance Trust to request his support in ensuring receipt of data to provide assurance to the CCG. Nigel will continue to attend the CQRM until such time that there is an increased level of assurance.

RS proposed to write to Sandwell CCG Accountable Officer and Chair airing the CCGs concerns with regards to the lack of performance information and lack of RS assurance being provided from the Ambulance Trust. Members supported the proposal.

9 Board Assurance Framework

HJ presented the CCGs Board Assurance Framework and highlighted the 6

following:

The report includes all clinical risks which score 12 and above and all non- clinical risks which score 15 and above. A brief summary of the current situation for some of the risks was discussed as below:

Continuing Health Care This risk has recently been added to the register to reflect the potentially serious clinical and financial risks to the CCG as a result of the current situation in the Continuing Health Care service. There is currently a significant backlog of case assessment and concerns regarding the management and staffing of the service. To address the clinical concerns the CCGs Chief Nurse is in regular discussions with her counterpart as the lead commissioner, (Stafford and Surrounds CCG).

Service Quality at Burton Hospitals Foundation Trust (BHFT) At the November 2014 meeting of the Joint Quality Committee an improvement in both performance and the quality of data provided by BHFT was noted and the Committee was assured with regards to the Quality of services at the Trust.

Despite the assurance received it is acknowledged that the Trust remains in special measures and for this reason the risk rating remains unchanged.

Service Quality at Dudley Group Hospitals Foundation Trust (DGH) Concerns have been noted regarding the collection and benchmarking of quality data at the Trust, particularly in regards to mortality. At recent meetings the Joint Quality Committee has not been able to gain assurance regarding the quality of services at DGH. The lead commissioner (Dudley CCG) has been made aware of these concerns through a formal letter to the Chief Nurse and further escalation includes discussion with the Area Team who plan to escalate to the relevant Area Team for the locality in which the Trust sits.

The lead commissioner now meets regularly with Trust representatives to address specific Quality concerns; the outcomes of these meetings are reported to the CQRM. Representatives from SES & SP CCG are also intending to begin attending these meetings.

Service Quality at Heart of England Foundation Trust (HEFT) Concerns have been noted regarding the collection and standard of quality data at the Trust, particularly in regards to mortality. It is expected that this will be addressed by a contact variation which will require the Trust to report mortality data on a monthly basis. Concerns have been raised with the lead commissioner(s) (previously Solihull CCG, now Birmingham Cross City CCG).

The CQC have recently visited the Trust and raised concerns, Monitor are also investigating the Trust at present. The CCG awaits the outcome of these interventions. 7

The SES & SP CCG Quality Lead for HEFT has noted that provider engagement in addressing Quality concerns has recently increased and that there is a noted improvement in many targets.

Non-Clinical Risks Members reviewed the non-clinical risks with no further comment.

10 Finance Report

TT reported to members that following the senior management changes at HoEFT he had concerns with the financial arrangements agreed with the former Director of Finance. The CCG has been notified that the £1.5m strategic agreement made will not be honoured. However, following discussions with Birmingham and Cross City and Walsall CCGs, this has been recovered in the forms of offers of brokerage. The regional and area teams have yet to formalise this.

The year to date deficit at month 9 is £15.2m which is in line with the anticipated in-year deficit profile with the financial recovery plan.

The deterioration in the acute position, which principally lies with BHFT, has moved significantly by 0.5m from the forecast at month 8 to the forecast at month 9.

A meeting is due to be held on the 29th January 2015 with BHFT to try to understand the reasons behind the activity movements. The CCG has also tried to secure a year end settlement with BHFT however this has not proved successful. The CCG are now dependent on trying to improve the position as far as it can through reliance on CQUIN underperformance, contract penalties etc. in order to try to get to the position in the negotiations.

The CCG has received a return of the CHC top slice of approximately £530k.

The gross unmitigated deficit is £19.8m compared to the £20.2m forecast at month 8. The improvement in the forecasting is through factoring in slippage on allocated funding for mental health and securing an agreement for a reduction in expenditure on the out of area block contract in line with the financial recovery plan.

The risk to the achievement of the £16.7m deficit remains high. The key risks are to the achievement of FRP schemes relating to the acute and prescribing expenditure and of further deterioration in any or all of the key expenditure areas.

RS and TT will be meeting with the regional and area teams on 3rd February 2015 to continue to discuss the level of risk and the achievability of the £16.7m forecast deficit. 8

RS reported that a conversation had been held with the Chief Executive at BHFT which implied a collaborative approach on finances however this has not transpired. A forensic analysis is taking place on activity at Burton to understand patient flow into the trust. CA reported that this was raised at the SES locality meeting and will be followed up practice by practice when the results are known.

SG commented that in terms of contract challenge and negotiation, the CCGs external auditors have pointed out that each provider trusts include large financial departments to take on tasks e.g. contract negotiation and challenges. There is a need to acknowledge the finite resource in the CCG compared to this. TT welcomed the acknowledgment and reminded members that financial support is also provided by experienced members of staff in the CSU.

11 Committee Minutes to consider:

Joint Quality Committee The minutes from the Joint Quality committee held on the 10th December 2014 were noted with no further comment.

Finance and Performance Committee th The minutes from the meeting held on the 17 December 2014 were noted with no further comment.

Seisdon Peninsula Locality Meeting The minutes from the meeting held on the 12th November 2014 were noted with no further comment.

12 Any Other Business

There was no further business.

13 DATE AND TIME OF NEXT MEETING

Wednesday 25th March 2015, 2pm Board Room Merlin House Etchell Road Tamworth, Staffordshire B78 3HF

SIGNED: ...... DATE: ...... 9

(Chairman)

ACTIONS DUE FOR REVIEW Governing Body Date of Meeting: Wednesday 28th January 2015 Meeting Agenda Action Required By Update/Progress Date Item 28/01/15 8 Integrated Quality and Performance Report RS to write to Sandwell CCG Accountable Officer and RS Chair the CCGs concerns with regards to lack of performance information and lack of assurance being provided from the Ambulance Trust. 03/12/14 3 Minutes from meeting held on 1st October 2014 Update 28/01/15 An action had been omitted from the minutes with TG No further update provided by regards to TG agreeing to meet with Dawn Candy from TG – Carry Forward. Sure Start to discuss the Breast Feeding service in Tamworth. RC has spoken with Dawn Candy and there has not been any progress to date. 01/10/14 7 AF/RS to attend Kinver Patient Group to determine if AF/RS Date originally planned for 2nd there are any Soft Intelligence reports around Dudley December – cancelled by Hospital. Patient Group – waiting new date. Update 06/01/15 Still waiting for dates to be confirmed from Patient Group Update 18/02/15 Date confirmed for 12/03/15 – RS and AF to attend. Update 27/02/15 Date rearranged to 14/04/15 at Patient Groups request.

01/10/14 7 SSOTP Attended presentation on HJ to contact SSOTP to obtain information on their HJ toolkit via CQRM which Workforce Development Tool and data drawn from provided some assurance but audits completed. which currently does not fit with practice experience. Complete

Transformation have collected practice responses but as yet no analysis has been undertaken. Arrangements are being made for this to be done urgently.

Update January 2015 No information yet shared by transformation but this has been requested again and a verbal update will be provided at the Governing Body meeting.

REPORT TO THE SOUTH EAST STAFFORDSHIRE & SEISDON PENINSULA CLINICAL COMMISSIONING GROUP GOVERNING BODY MEETING To be held on: Wednesday 25th March 2015

Enclosure No: 03 Subject: Accountable Officer Report Lead Director: Rita Symons, Accountable Officer Lead Officer: Rita Symons, Accountable Officer Recommendation: For For For √

(Please tick) Approval Assurance Discussion

Purpose of the report:

The purpose of this report is to highlight national policy and developments which are relevant to the work of the CCG and to highlight key local issues for the CCG Governing Body.

Key Points:

The report highlights national developments in diabetes and mental health care.

It also raises the risk posed by the new tariff arrangements.

The report talks about the local developments in mental health (including the Crisis Concordat) and dementia services.

Responsible Committee Name: n/a

Approved at Committee: YES/NO Date of Committee:

Impact: Quality The strategic items on dementia and mental health will improve quality and Implications: coordination for both service users and carers. Financial There is a specific risk identified with regard to the ETO Implications: Equality impact YES/NO assessment If YES please give summary: required:

Delivering the Strategy: How does the This report does not make recommendations, however, it is important in recommendation delivering our strategy we are cognisant of national policy. contribute to delivering the CCG Much of the local information describes actions we are taking to deliver the Strategic Vision? CCG strategy, particularly relevant being the mental health and dementia work.

Contribution to delivering the Health & WellBeing (HWB) Strategy: The Mental Health Strategy is owned by the HWB.

Recommendations/Actions required: The Governing Body are asked:

To note and discuss the contents of this report.

Explanation of acronyms used in this report: Acronym Explanation HWB Health and Wellbeing Board ETO Enhanced Tariff Option

National News

National health initiative launched to prevent diabetes

NHS England, Public Health England and Diabetes UK have announced they will work together on a major national initiative to prevent illness by unveiling the first ever at- scale National NHS Diabetes Prevention Programme. The programme aims to significantly reduce the four million people in England otherwise expected to have Type 2 diabetes by 2025. This links to our General Practice Plus model and we remain committed to supporting prevention and supporting people to look after themselves. We have good working relationships with Diabetes UK locally.

Guidance on new mental health standards published

NHS England has set out guidance for how new access and waiting time standards for mental health services are to be introduced in 2015/16. The guidance explains the case for change in four key areas and sets out the expectations of local commissioners for delivery, working with providers and other partners. As lead commissioner for the mental health trust in South Staffordshire, we will be working to ensure these standards are met as part of our broader strategy implementation.

Tariff for 15/16

Monitor have offered providers the choice of an enhanced alternative (the Enhanced Tariff Option – ETO) for the full year ahead, worth around £500 million more to providers than the tariff proposals consulted on last year. NHS England has written to CCGs to set out how this new option will work from a commissioner point of view.

To give both providers and commissioners certainty, and to reduce administrative complexity, providers who opt for the ETO will do so for the full year 2015/16, with no ability to move from the ETO back to the Default Tariff Rollover (DTR) option and on the basis that it would be continued under any subsequent national tariff for 2015/16. Likewise providers who stick with the DTR or its eventual successor will not be able to switch to the ETO mid-year. This creates a risk for the CCG as although there is mention of national monies, we are unclear how this will be allocated.

Local News

Planning for 15/16

CCG officers have been working hard on developing our plans for 15/16 and drafts have undergone a lot of scrutiny. We are hopeful that plans will be signed off by NHS England shortly. In parallel we have been undertaking work on our medium to long term strategy and financial plan.

Vision for Dementia Services

On the 17th March, the CCG launched its vision for Dementia services at a workshop with professionals, partner organisations and most importantly carers of people with dementia. The aim was to share our proposed model and thinking and gain feedback to allow us to refine our approach. The model was well received and we will work with providers to respond to feedback and begin to plan implementation.

Launch of Mental Health Strategy

This month see the formal launch of the Mental Health Strategy ‘Mental Health is Everybody’s Business’ which has been in development for some time. It was signed off by the HWB in Staffordshire in 2014, but publication was delayed in order to achieve sign up from Stoke HWB. This is the first formal strategy agreed by both HWBs. The development was led by the CCG with support from the Mental Health Commissioning Team. An action plan has been developed and we are continuing to drive delivery. The launch was hosted by the South Staffordshire Service User Network.

Mental Health Crisis Concordat

The action plan related to the Mental Health Crisis Concordat has been submitted to the Department of Health and Staffordshire has been ‘turned green’ on the national map. This is an important part of the delivery of Parity of Esteem and the action plan will be monitored through the Mental Health Commissioning Board, which includes input from the police.

External Review of Governance

NHS England commissioned an external review of governance of this CCG, which is currently underway. We are engaging positively and treating this as an opportunity to gain external guidance on how we can continue to improve.

Staff Changes

There are a number of significant changes to staff in the CCG. We welcome Dr Sekhar Singu as our new Locality Director for the Tamworth area. On a sadder note, the Chief Operating Officer, Anna Hammond will be leaving the CCG to take up a new

post in Telford CCG. This will be a big loss to this CCG and we thank her for her huge contribution and wish her all the best. We have appointed a permanent Chief Financial Officer, obviously a critical appointment for this CCG; Ian Baines who is currently the Director of Finance at Walsall Hospitals NHS Trust. Tim Tebbs has done an excellent job as our interim and I would like to sincerely thank him for helping the organisation move forward.

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FEEDBACK SHEET SOUTH EAST STAFFORDSHIRE AND SEISDON PENINSULA CLINICAL COMMISSIONING GROUP Seisdon Locality Board 11th February 2015 South Staffordshire Council Offices, Codsall

1 Members present:-  Drs Tim Dukes, Peter Maidment, Angus Jones, Aparna Gupta, Eddie Lee, Suki Johal, Peter Jones, Alex Sobainsky & Harinder Grewal.  Rita Symons, Accountable Officer for the CCG was also in attendance  See meeting minutes for others present Quorate:- YES

2 Declarations of Interest:-

Denosumab proposal & Practice Engagement & Development LIS

3 Key Points discussed:-

 Members received and approved a proposal from Mark Seaton, Strategic Lead for Medicines and Decision Support, regarding a service specification and model for the delivery of Denosumab for the treatment of post-menopausal osteoporosis in GP Practices in SES & SP CCG. This service is currently undertaken within secondary care, where there have been problems with the quality of service, cost and capacity. It was agreed that it was within the capabilities of Primary Care to deliver this service which would avoid these issues in the future.  Members received a presentation regarding the proposed Practice Engagement & Development LIS for 2015-16. As in previous years, this will include work around practice engagement with the CCG and prescribing. The third component for the forthcoming year will reflect ‘Clinically Led, Quality Driven’ and embrace the work around implementing Map of Medicine and GP Avoidable Incidents together with an option of a third component around Telemedicine. Members approved the proposal as the direction of travel for this LIS for 2015-16.  Members received a presentation from Rita Symons, Accountable Officer for the CCG, around the long term financial position and plan for the CCG. This included work around the reframing of the CCG strategy, acknowledging that the fundamental priorities previously suggested and agreed by members will not change. Members were informed that the Regional Office of NHS England, whilst being of the opinion that the CCG’s plans were sufficient and ambitious, still had some concerns around delivery.

It was recognised that the CCG needs the support of its member practices to deliver this plan. Members also considered Procedures of Limited Clinical Value and the possibility

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of a leaflet to be given to patients explaining the decision making process.  Members received an update from Rita Symons around Intermediate Care.

4 Issues for escalation:-  None identified from this meeting.

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FEEDBACK SHEET SOUTH EAST STAFFORDSHIRE AND SEISDON PENINSULA CLINICAL COMMISSIONING GROUP Patient Council Wednesday 11th February 2015

1 Members present:- See meeting minutes for attendees. Quorate:- YES 2 Declarations of Interest:- Nil identified

3 Key Points discussed:-

Patient Stories Rachel White from NHS England attended and gave a presentation on the importance of patent stories. She described how their significance was first recognised by the old strategic health authorities and were also acknowledged in the nursing strategy Compassion in Practice by Jane Cummings, Chief Nurse. The programme for developing patient stories was originally set up with a commitment to developing a robust methodology for their use.

The key points of the presentation were that: • The structured use of storytelling results in observable outcomes. • Outcomes for story telling are more likely to be tangible where leadership is evident. • Staff and carer stories are emerging as well as patient stories. • Patient stories are now posted on the 6 Cs website in a dedicated space. • Stories are used for service improvement purposes but they can be used more widely. Example of this includes board development, strategy development and financial planning. • The existence of a story-telling framework is crucial to ensure that those hearing them are prepared to listen and are able to listen constructively.

The presentation gave rise to a lively discussion.

Dementia Services Frances Sutherland gave an update on the work underway to reorganise and improve dementia services. She made the following key points: • A Quality review some two years ago established that services were fragmented and not comprehensive. • The new service provider is SSSFT and the last year has been spent in transferring some 5,000 patents from the previous memory service provider to SSSFT. • That is now complete and work is going ahead on prevalence rates. • At the beginning of the year the CCG was only aware of 39% of likely patients and that has now risen to 57%. The goal is to reach 67%; the Prime Minister’s challenge. • There is a risk of identifying people and then not having a service to offer and the processes in place are designed to ensure that this is not the case. • The new service specification has written into it the national findings of what people with dementia wants from a service.

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• Work is on-going with the County Council to create centres of excellence for people with challenging behaviour and dementia in order to avoid them being detained unnecessarily in hospital. The idea is to provide environments that reduce challenging behaviour by involving patients in a wide range of activities • The problem with trying to progress this work is the lack of capacity to carry out assessments because of the need to respond to historic challenges under the CHC provisions.

The presentation stimulated an excellent discussion on the damaging divide between health and social care and the dilemmas that arose from having to recruit and maintain skilled staff at minimum cost. In the course of this discussion one story told of a man with dementia and challenging behaviour who received the most appropriate treatment in hospital because of the scarcity of other facilities where people had the skills to meet his needs. Another story told of a woman with challenging behaviour who responded well to a variety of activities but who deteriorated when those activities had to be withdrawn.

Any Qualified Provider (AQP) Audiology Services (Consultation) The directive to use AQP is problematic where the level of service cannot be controlled and where the quality of the service cannot be contracted for because of franchised providers. This has happened with the audiology service and a consultation is now underway to consider ending the AQP provision and bringing the service back into the NHS. Members were asked to canvas opinion on this within their various groups and constituencies and bring them back to the Patient Council meeting in April.

Patient story A man using GP services in Kinver attended the surgery to request a repeat prescription for medication that he had been using for some time and that had successfully stabilised his mental health condition. He was told that the medication was no longer available on repeat prescription. The discussion became heated and led to him being accused of making up the story of being on the medication. The man became angry and frustrated and very quickly the panic button was pressed and he found that he could not get out of the surgery and the police had been called. Once the matter had been resolved the repeat prescription was reinstated. This story was told to illustrate how quickly people resort to panic when dealing with people with mental health issues.

Bereavement Two members of the Patient Council had experienced very recent bereavements of close relatives: a husband and mother respectively.

The death of the husband was very sudden. After praising Russell Hall Hospital for the excellent service and care provided there, the member went on to describe the inflexibility of the Coroner’s office. Her encounter with staff there proved to be very difficult and was causing serious delays for the issue of a death certificate. Without the intervention of her son this might well have caused an extremely lengthy delay.

In the case of the member who lost his mother, although it was not a sudden death; she died in hospital on a Saturday; the death certificate was not issued for a further week because of a review being undertaken on causes of death that weekend.

In both of these cases delay around the issue of death certificates caused further distress to grieving families.

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Issues for escalation:- 4  None identified from this meeting.

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FEEDBACK SHEET SOUTH EAST STAFFORDSHIRE AND SEISDON PENINSULA CLINICAL COMMISSIONING GROUP Patient Council Wednesday 11th March 2015

1 Members present:- See meeting minutes for attendees.

Quorate:- YES 2 Declarations of Interest:- Nil identified

3 Key Points discussed:-

Feedback from Patient Story: Good Hope Hospital, Ward 7 The council member who had provided the story of his mother’s experience on Ward 7 at Good Hope Hospital at the Patient Council Meeting of the 6th January 2015 reported on the response that he had received from the hospital.

In summary:  A band 7 senior nurse has been appointed to take charge of the ward.

 Steps have been taken to ensure that an experienced NHS Trust Nurse is on duty for every shift.

 An investigation into the staff responsible for the conditions which led to the complaint is underway.

 A number of other major changes are being undertaken to improve the quality of care provided.

The council member confirmed that he is satisfied with the outcome of this story and it was agreed that the action could be closed.

Patient Research This presentation arose out of the discussion at the December 2014 Joint Quality Committee on low levels of involvement in patient research in GP practices in the CCG. Jessica Graysmark of the West Midland Clinical Research Network spoke about clinical research, highlighting the opportunities for patients to encourage involvement.

She outlined the location and make-up of the Clinical Research Network West Midlands, identifying the constituent CCGs, explaining its primary care role and defining how it aims to improve patient care in the NHS. The presentation included information on how the network interacts with Primary Care Practitioners and also described the types of research that are

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carried out. It led to a wide-ranging discussion around research priorities and the differing levels of GP practice involvement.

It led to a wide-ranging discussion around research priorities and the differing levels of GP practice involvement.

The member representing the SSMHN suggested that a suitable research study might be the impact of discharge from secondary care mental health services on primary care mental health services.

Personal Health Budgets The Patient Council received outline information on the introduction of personal health budgets in CHC some months ago and had requested a more detailed presentation. Tina Groom, the implementation manager for Staffordshire and Shropshire and her colleague attended for this purpose. It was explained how CHC funding is to be used to provide more personalised care for individual patients. The key points were:

Putting the client in charge is a culture shock for the NHS.

There is no new funding so for the system to work existing services will have to be decommissioned where they are not meeting patient’s needs.

At this point in time implementation is focused on people with CHC needs who are living in the community although it will eventually encompass those in residential care.

The presenters emphasised that this funding was purely for health care purposes. It was also emphasised that it had nothing to do with other benefits such as attendance allowance or other social security related benefits.

The concerns aired in the discussion generated by the presentation were primarily related to the ability of the managers (there are only two of them and they are on secondment until the end of this month) to meet people’s needs in a way that is timely and adequate. It was confirmed that the future management of the scheme has yet to be resolved and also that the key problems about implementation relate to the availability of adequate financial resources.

Patient Feedback and Stories Unfortunately there was only a very limited amount of time available for this item because of the discussion time taken around the two presentations.

GP Charging The representative from the Carer’s Association reported her concerns that some GPs are charging carers for letters verifying the need for respite care for their patients. Given the limited funding available in the first place this is not helpful.

Patient Story The following Tamworth patient story is extracted and adapted from a letter written by the patient on the 22 February 2015. It is not clear who the letter is addressed to.

Following surgery for a broken right ankle at Heartlands Hospital on 12 October 2013 the patient attended Solihull Day Procedures Unit on the 20 February 2014 for the removal of

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metalwork from the right ankle.

12 months on the patient is still on crutches, in an air cast boot, only having 4 to 5 hours broken sleep a night. She is able to sit in a car for no longer than 30 minutes and to walk for no longer than 10 minutes. The level of pain is awful. The patient has tried using pain killers, a steroid injection, has had physiotherapy and magnetic resonance therapy all to no avail. It was decided by her surgeon that she should have a MRI scan to establish why she was still suffering such high levels of pain. This was carried out on the 10 February and the patient returned for results on the 18 February.

The MRI report stated that there is metallic artefact seen in the distal fibula. This leaves her to conclude that either the screws were not taken out or some have been left behind. The patient now faces another operation to remove this metal.

The surgeon having not removed all the metal work from her ankle has held back her recovery and affected not only her quality of life but that of her husband as well. She has also spent £5,000.00 on private hospital care to try and relieve the situation quickly.

The letter concludes with a request for compensation.

The council member reporting this story was advised to advise the patient to follow this up through the complaints procedure and to submit it to NHS choices.

Clinical Advice The Patient Council has been of the view for some time that its discussions would benefit from the presence and advice of a clinician. On the occasions when this has been possible the benefit has been very evident. At the end of the meeting the decision was taken to change the day and timing of the meeting in the hope that this will make it more likely that the clinical lead designated for patient engagement will be able to attend.

Issues for escalation:- 4  None identified from this meeting.

Enc 07 FEEDBACK SHEET SOUTH EAST STAFFORDSHIRE AND SEISDON PENINSULA CLINICAL COMMISSIONING GROUP Joint Quality Committee

Wednesday 11th February 2015

1 Members present: Lynne Smith (Chair), Heather Johnstone, Rosemary Crawley, Ann Tunley, Dr Liz Gunn, Mark Seaton, Steve Forsyth, Debbie Vucetic, Sue Wilson, Katie Montgomery, Nigel Williams, Mahesh Mistry, Rob Boland, Judy Bird, Heather Widdowson and Tracey Finney.

Apologies received from: Alex Fox

Quorate: Yes 2 Declarations of Interest:

None

3 Key Points discussed:

 Regular update and feedback report from both Patient Councils highlighted to members’ attention a range of issues that were brought to Joint Quality Committee that needed follow-up and action.

 It was noted that there had been a fall in soft intelligence reports for quarter 3

 Concerns regarding the increasing SSOTP vacancy rate and the Trust’s plan for staff retirement were discussed. It was confirmed that this had been raised at the SSOTP CQRM in December and assurance had been given on the Trust’s retirement management plan.

 Continued concerns regarding the harm from falls at BHFT was raised by members. It was felt that the Trust had put in place yet another initiative; however basics such as completion of falls assessment and one to one nursing were the key to reducing this.

 Concerns raised at continued non-compliance by Derby Hospital with 62 day cancer

waits, although an upward trend was noted.

 The Director of Quality and Chief Nurse has held a telephone meeting with the CQC in February regarding HoEFT, a summary of the issues and concerns were handed over.

 Members approved the IVF Policy.

4 Next steps:

 The Members of the Joint Quality Committee recommended that both ES CCG and SE&SP CCG Governing Bodies are made aware of the additional resource required within the Quality Team to support the investigation of soft intelligence within Primary Care.

 The Joint Quality Committee propose the risk of nurse revalidation is added to the risk register and the impact this may have on commissioning services with a proportion of the organisation requiring to renew their NMC Membership.

5 Issues for escalation:

Governing Body is to be made aware of the lack of dedicated resource for GP soft intelligence investigations.

Enc 08 FEEDBACK SHEET SOUTH EAST STAFFORDSHIRE AND SEISDON PENINSULA CLINICAL COMMISSIONING GROUP Joint Quality Committee Wednesday 11th March 2015

1 Members present: Alex Fox, Heather Johnstone, Dr Liz Gunn, Dr Adrian Parkes, Mark Seaton, Lynne Smith, Katie Montgomery, Sue Wilson, Rob Boland, Nigel Williams, Judy Bird, Fleur Fernando, Debbie Vucetic, Mark Seaton, Steve Forsyth, Paul Winter

Administrator: Tracey Finney

In attendance: The Chair welcomed Mark Docherty and Matt Ward from West Midlands Ambulance Service (WMAS).

Quorate: Yes

2 Declarations of Interest:

None

3 Key Points discussed:

a. The attendance of two senior members from West Midlands Ambulance Service to the Joint Quality Committee (JQC) were welcomed and following a full and frank discussion hope that this will herald a much better relationship between the three organisations. It was agreed that WMAS recognise the need to communicate with CCGs other than the Lead Commissioner. They will attend future JQCs on a quarterly basis or as requested.

b. Following a recent presentation to the Patient Council by Continuing Health Care (CHC) leads, the Chair raised a potential risk. At present the Personal Health Budget scheme within Continuing Healthcare is managed by two seconded staff. Their contracts end on 31st March and the presenter from CHC explained to the Patient Council that the future management of the Personal Health Budget Scheme is yet to be resolved.

c. The provision of good patient intelligence was again discussed. A new soft intelligence report was considered and thought useful. This should be fed back to GPs. The Chair is to meet with Drs Gunn and Parkes to further investigate the value of patient experience in both measuring quality and commissioning outcomes.

d. The Chair reported on a meeting with HealthWatch. The CEO is to be invited to the next meeting and thereafter their local representative will attend on a regular basis.

e. There is continuing concern about SSOTP data. The CQRM has recently been cancelled it was agreed the Chair will meet with the Director of Quality and Chief Nurse to discuss the way

forward and next steps with the Lead Commissioner.

f. Dr Gunn reported that there is an increasing incidence of out of hours doctors refusing to make visits in rural locations. More information is required and further investigation was agreed.

g. Whilst overall satisfaction has been maintained on Burton Hospital Foundation Trust services the committee are now seriously concerned about the rise in Slips, Trips and Falls. Escalated action was recommended.

h. GP Practices have highlighted an increase in unnecessary referrals back to the GP from hospital consultants. Dr Parkes outlined the correct procedure which simply means patients who have related procedures to the original referral do not have to be referred back. New conditions do. The CCG commissioner should note this trend and take action as appropriate.

i. There was agreement that the work undertaken by Southern Derbyshire CCG and the Derby Hospital Foundation Trust regarding Stroke/TIA service is seeking assurances regarding the pathways and is exploring in detail the issues relating to performance and quality. Work is taking place to improve the position and education and communication with GPs in taking place particularly around timeliness of referrals.

j. The JQC were updated relating to HoEFT and MONITORs enacted Enforcement undertaking in December 2015. The Trust have addressed majority of the issues contained within the MONITOR Improvement Programme. Further assurance has been gained and the Trust is sharing the planning and actions from the Improvement Programme. Actions include aspects of Silverman Report (Mortality) - Actions incorporated into the report and include an overarching improvement plan through the Trust Quality & Risk Committee which will be reviewed by the CQRM at the March 2015 and measured against the Plan. The Joint Quality Committee were concerned with the particulars of the enforcement undertaking. Some assurance has been gained through CQRM, but the Joint Quality Committee felt there needed to be further challenge around the trust response to the enforcement letter, and considered escalation. The Quality Improvement Manager will produce a comparison of Trust actions against the MONITOR concerns to give greater oversight.

k. The Committee approved the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards 2007 (Dols) Policy and the ES CCG Equality and Inclusion Report.

4 Next steps:

a. AF to discuss with the Lead Nurse the issues with the Lead Commissioner for SSOTP and if necessary call a meeting to discuss what action can be taken with the CCG Chair and Accountable Officer.

b. GP Out of Hours Lead to investigate incidences of poor service in rural areas and alert the commissioners and raise at next CQRM.

c. WMAS will be presenting an action plan at the May JQC outlining how they will improve the service to ES and SES and Seisdon CCGs. This will include a section on revitalizing the First Responder network.

d. The GP membership will be informed of the position at HEFT relating to MONITOR and directed to MONITOR’s website for review and awareness raising.

5 Issues for escalation:

a. The Committee are seriously concerned about the lack of progress by HEFT on the letter sent to them by MONITOR in December. The SES & SP CCG Accountable Officer write to the Accountable Officers for Solihull CCG & Birmingham Cross City CCG to raise the concerns. The Chief Nurse & Director of Quality will discuss the issues with the CQC.

b. The Governing Body is asked to record that the East CCG Accountable Officer has been asked to take action on the Falls situation at BHFT.

c. Following approval of the East Staffordshire CCG Equality and Diversity Report the East Staffordshire Governing Body are asked to ensure adequate training is planned to ensure compliance with identification of a Lead Director.

SOUTH EAST STAFFORDSHIRE & SEISDON PENINSULA CLINICAL COMMISSIONING GROUP REPORT TO THE GOVERNING BODY To be held on: Wednesday 25th March 2015

Enclosure No: 09 Subject: Integrated Quality and Performance Report Lead Director: Heather Johnstone, Chief Nurse and Director of Quality Authors: Steve Forsyth, Head of Quality & Governance, SES&SP CCG Katie Montgomery, Clinical Quality Improvement Manager, SES&SP CCG Nigel Williams, Clinical Quality Improvement Manager, SES&SP CCG Recommendation: For For √ For

(Please tick) Approval Assurance Discussion

Purpose of the report:

Following the decision to hold Governing Body on a bi-monthly basis, the Integrated Quality and Performance Report will provide the most recent month’s quality assurance data from the two month reporting period.

It is important to note the Joint Quality Committee continues to meet monthly and therefore provides the required level of scrutiny to determine assurance and therefore this report is intended to demonstrate that current systems and processes to provide the required assurance in respect of key quality and performance indicators and where assurance cannot be provided, to demonstrate that action is being taken to address issues and the necessary escalation continues.

Key Points:

The report highlights the key activity following the February and March Joint Quality Committee (JQC) and should be read in conjunction with the Chair’s Report submission to the Governing Body.

The members of the Governing Body are asked to take assurance in respect of the Committees conclusion that all services are safe but members must understand that there are areas requiring further work in the respective providers to ensure consistently high quality services are provided to the local patient population.

Where the CCG are an Associate Commissioner there continues to be gaps in data and this, whilst challenging, continues to be a focus for the Joint Quality Committee and Clinical Quality Improvement Managers responsible for each of the contracts. Influence continues to be placed on the Lead Commissioners during the contract round to ensure submissions meet the required assurance around quality and safety to improve our position and progress is being made.

The Integrated Quality and Performance Dashboard continues to evolve and improve in respect of the gaps in data as discussed above, but also in terms of its format. An additional column has been added to demonstrate small trend graphs, this replaces up and down “arrow” trending symbols previously used.

Responsible Committee Name:

Joint Quality Committee Approved at Committee: YES/NO Date of Committee: 11th February and 11th March 2015

Impact: Quality All aspects of the report have quality implications as this is the key report Implications: highlighting quality and safety concerns and actions to provide assurance. Where specific concerns exist, these are highlighted in each provider summary. Financial There are financial implications in respect to performance. Implications: Equality impact YES/NO assessment If YES please give summary: required:

Delivering the Strategy: How does the Long-term conditions: A number of areas described in the report relate to recommendation patients with long-term conditions. For example, reviews of mortality, EMSA. contribute to Frail Older People: A number of areas described in the report relate to frail delivering the CCG older people such as falls, pressure ulcers. Strategic Vision? Getting the Basics Right: Patient experience, EMSA and pressure ulcers. Partnership Working: The document shows how the CCG works in partnership with provider Trusts to enable quality to be monitored and improved.

Contribution to delivering the Health & WellBeing (HWB) Strategy:

Recommendations/Actions required: The Governing Body are asked:

To note the detail in this report and take assurance from the content and the continuing work to improve quality monitoring in the CCG.

To take assurance in respect of the Committee’s conclusion that all services are safe but understand the further work being undertaken to ensure consistently high quality services are provided to the local patient population.

To be aware of the actions being taken by the Joint Quality Committee and escalations made from the Joint Quality Committee to the Governing Body and to agree any recommended further actions linked to these matters.

If considered necessary to suggest any further actions they would like to see in respect of any of the issues raised.

Explanation of acronyms used in this report: Acronym Explanation BHFT Burton Hospitals Foundation Trust 2WW Two Week Wait CAMHS Child and Adolescent Mental Health Services CBP Cancelled by Patient CCG Clinical Commissioning Group CDIFF Clostridium Difficile CQC Care Quality Commission CQRM Clinical Quality Review Meeting CRHT Crisis Resolution Home Treatment Service CSU Clinical Support Unit DGH Dudley Group of Hospitals DNA Did Not Attend EMSA Eliminating Mixed Single Sex Accommodation FFT Friends and Family Test GP General Practitioner HCAI Healthcare Acquired Infection HEFT Heart of England Foundation Trust HROD Human Resources Organisation Development HSMR Hospital Standardised Mortality Ratios IAPT Improving Access to Psychological Therapies IPC Infection Prevention and Control JQC Joint Quality Committee LIS Local Improvement Scheme MPDS Medical Priority Dispatch System is a unified system used to dispatch appropriate aid to medical emergencies – MPDS codes are the codes assigned to the different priorities MRSA Methicillin Resistant Staphylococcus Aureus NPSA National Patient Safety Agency NSL Non Urgent Patient transport provider OOH Out of Hours PALS Patient Advisory Liaison Service PPCI Primary percutaneous intervention PSI Crisis Patient Safety Incident Crisis PTS Patient Transfer Services RCA Root Cause Analysis Red 1/2 8 minutes to be on site Red 19 19 minutes to be on site RTT Referral to Treatment Times RWT Royal Wolverhampton Trust SDUC Staffordshire Doctor Urgent Care SHMI Summary Hospital-level Mortality Indicator SSOTP Staffordshire and Stoke on Trent Partnership Trust SSSFT South Staffordshire and Shropshire NHS Mental Health Foundation Trust STEMI ST elevation myocardial infarction

T&O Trauma & Orthopaedics TCI To Come In VTE Venous-thrombus Embolism WHO World Health Organisation WMAS West Midlands Ambulance Service YTD Year to Date

Month Selector > December CCG Performance Provider Performance

Staffordshire Heart of Dudley Group The Royal Burton & Stoke-on- Standard/Plan Standard/Plan - NHS South East Staffordshire England NHS Wolverhampton NHS Consultation Period Hospitals NHS Trent Commissioner Provider and Seisdon Peninsula CCG Foundation Foundation Hospitals NHS Trust Partnership Trust Trust Trust Trust RTT admitted December 90% 90% 90% 96% 98% 82% 94% 90% RTT non-admitted December 95% 95% 97% 98% 94% 93% 99% 97% RTT RTT incompletes December 92% 92% 96% 98% 98% No Data 95% 95% RTT 52+ week waiters December 0 0 0 - - No Data 3 0 Diagnostics Diagnostics - 6 weeks+ December 99% 99% 98% 100% 100% 95% 99% 100% - 2 week wait December 93% 93% 95% 97% N/A 89% 98% 94% Cancer - 2 weeks - Breast symptom 2 week wait December 93% 93% 85% No data N/A 81% 99% 84% - 31 day first definative treatment December 96% 96% 99% 99% N/A 98% 100% 96% - 31 day subsequent treatment - surgery December 94% 94% 94% 96% N/A 99% 100% 97% Cancer - 31 day - 31 day subsequent treatment - drug December 98% 98% 100% No data N/A 100% 100% 100% - 31 day subsequent treatment - radiotherapy December 94% 94% 100% No data N/A N/A N/A 100% - 62 day standard (including rare cancers) December 85% 85% 91% 85% N/A 88% 88% 85% Cancer - 62 day - 62 day screening December 90% 90% No data N/A 89% 100% 92% - 62 day upgrade December 88% No data N/A 88% 100% 90% Mixed Sex Mixed sex accomodation breaches December 0 0 1 1 No Data 0 0 0 Mental Health CPA follow up within 7 days (Quarterly Data) December 95% 95% 94% A&E total time 4 hr wait December 95% 93% N/A 82% 95% 90% A&E A&E 12hr trolley waits (ytd) December 0 14 7 0 0 Ambulance Red 1 (8 mins) December 75% 53% - N/A N/A N/A N/A Ambulance Ambulance Red 2 (8 mins) December 75% 62% - N/A N/A N/A N/A Ambulance Cat A (19 mins) December 90% 90% - N/A N/A N/A N/A Cancelled Ops for non clinical reasons rebooked >28 days December 0 - N/A 0 0 0 Cancelled Ops No urgent operation cancelled for the 2nd time December 0 - N/A 4 0 0

- Total elective (YTD) December 20867 4664 7073 1313 2429 - Total elective plan (YTD) December 17022 4876 6364 1132 2491 - Total Non - elective (YTD) December 17879 33552 36328 15910 29209 - Total Non - elective plan (YTD) December 16489 34673 35151 16004 27081 Activity - Outpatients (YTD) December 172824 - Outpatients plan (YTD) December 135660 - GP referrals (YTD) December 66 - GP referrals plan (YTD) December 10 10 4 7 Providers Duty of Candor (Failure to notify) December 0 - No Data 8 No Data No Data VTE December 95% 98.40% N/A 95.02% 94.68% 96.85% Other Mortality SHMI December - - 94 No Data No Data Mortality HSMR December 95 - 88 No Data No Data Key Blue Square No Data On Target Marginal Below Target No Data

Month Selector > January CCG Performance Provider Performance

Staffordshire Heart of Dudley Group Burton & Stoke-on- The Roya l Standard/Plan Standard/Plan - NHS South East Staffordshire England NHS Wolverhampton Health Outcomes Framework/Every one Counts Period Hospitals NHS Trent Commissioner Provider and Seisdon Peninsula CCG Foundation Foundation Hospitals NHS Trust Partnership Trust Trust Trust Trust Safe environment MRSA - Incidence of HCAI January 0 0 0 0 0 1 0 1 and protecting C. difficile - Incidence of HCAI January 5 As Per Provider 4 1 No Data 8 No data 9 from avoidable harm C. difficile - YTD Ceiling January 53 As Per Provider 44 18 - 64 26 38 Friends and family test - In-patient percent who recommend January 97% N/A 90% 97% 94% Friends and family test - Out-Patient percent who recommend January N/A No Data N/A N/A N/A Friends and family test - A&E percent who recommend January 97% N/A 77% 94% 85% Ensuring a positive Friends and family test - Maternity percent who recommend January 88% N/A 94% 99% 94% Experience of care Friends and family test - Staff percent who recommend January No Data No Data No Data No Data No data Friends and family test - Response rate % In-Patient January 33% N/A 37% 31% 23% Friends and family test - Response rate % A&E January 20% N/A 18% 15% 30% Staffordshire Heart of Dudley Group The Royal Burton & Stoke-on- Standard/Plan Standard/Plan - NHS South East Staffordshire England NHS Wolverhampton NHS Consultation Period Hospitals NHS Trent Commissioner Provider and Seisdon Peninsula CCG Foundation Foundation Hospitals NHS Trust Partnership Trust Trust Trust Trust RTT admitted January 90% 90% 91% 93% 99% 79% 94% 90% RTT non-admitted January 95% 95% 95% 98% 94% 86% 98% 97% RTT RTT incompletes January 92% 92% 96% 97% 98% No Data 96% 93% RTT 52+ week waiters January 0 0 0 - - No Data No data 0 Diagnostics Diagnostics - 6 weeks+ January 99% 99% 98% 100% 100% 93% 98% 100% - 2 week wait January 93% 93% 0% No data N/A 91% No Data 92% Cancer - 2 weeks - Breast symptom 2 week wait January 93% 93% 0% No data N/A 77% No Data 59% - 31 day first definative treatment January 96% 96% 0% No data N/A 98% No Data 96% - 31 day subsequent treatment - surgery January 94% 94% 0% No data N/A 97% No Data 88% Cancer - 31 day - 31 day subsequent treatment - drug January 98% 98% 0% No data N/A 100% No Data 98% - 31 day subsequent treatment - radiotherapy January 94% 94% 0% No data N/A N/A N/A 100% - 62 day standard (including rare cancers) January 85% 85% 0% No data N/A 86% No Data 81% Cancer - 62 day - 62 day screening January 90% 90% No data N/A 50% No Data 81% - 62 day upgrade January 0% No data N/A 80% No Data 93% Mixed Sex Mixed sex accomodation breaches January 0 0 0 0 No Data 3 0 0 Mental Health CPA follow up within 7 days (Quarterly Data) January 95% 95% A&E total time 4 hr wait January 95% 95% N/A 86% 94% 90% A&E A&E 12hr trolley waits (ytd) January 0 14 7 0 0 Ambulance Red 1 (8 mins) January 75% 66% - N/A N/A N/A N/A Ambulance Ambulance Red 2 (8 mins) January 75% 63% - N/A N/A N/A N/A Ambulance Cat A (19 mins) January 90% 94% - N/A N/A N/A N/A Cancelled Ops for non clinical reasons rebooked >28 days January 0 - N/A 1 No Data 0 Cancelled Ops No urgent operation cancelled for the 2nd time January 0 - N/A 3 No Data 0

Staffordshire Heart of Dudley Group The Royal Burton & Stoke-on- Standard/Plan Standard/Plan - NHS South East Staffordshire England NHS Wolverhampton Other - Activity & Efficiency Period Hospitals NHS Trent Commissioner Provider and Seisdon Peninsula CCG Foundation Foundation Hospitals NHS Trust Partnership Trust Trust Trust Trust - Total elective (YTD) January 20867 4664 7073 1313 2429 - Total elective plan (YTD) January 17022 4876 6364 1132 2491 - Total Non - elective (YTD) January 17879 33552 36328 15910 29209 - Total Non - elective plan (YTD) January 16489 34673 35151 16004 27081 Activity - Outpatients (YTD) January 172824 - Outpatients plan (YTD) January 135660 - GP referrals (YTD) January 66 - GP referrals plan (YTD) January 10 10 4 7 Providers Duty of Candor (Failure to notify) January 0 - No Data No Data No Data No Data VTE January 95% 98.20% N/A 94.43% No data 96.45% Other Mortality SHMI January - - - No Data No Data Mortality HSMR January 95 - - No Data No Data Key Blue Square No Data On Target Marginal Below Target No Data

Month Selector > December West Midlands Health Outcomes Framework/Every one Counts Period Standard Trendline Ambulance Service MRSA - Incidence of HCAI December 0 0 CB_B15_01 -WMAS - Percentage of Category A Red 1 ambulance calls resulting in an emergency December 75% 73% response arriving within 8 minutes - Operating standard of 75% SES&SP CCG - Percentage of Category A Red 1 ambulance calls resulting in an emergency response December 75% 53% arriving within 8 minutes - Operating standard of 75% Safe environment and CB_B15_02 - WMAS - Percentage of Category A Red 2 ambulance calls resulting in an emergency December 75% 69% protecting from avoidable response arriving within 8 minutes - Operating standard of 75% harm SES&SP CCG - Percentage of Category A Red 2 ambulance calls resulting in an emergency response December 75% 62% arriving within 8 minutes - Operating standard of 75% CB_B16 - WMAS - Percentage of Category A calls resulting in an ambulance arriving at the scene December 95% 96% within 19 minutes - Operating standard of 95% SES&SP CCG - Percentage of Category A calls resulting in an ambulance arriving at the scene within December 95% 90% 19 minutes - Operating standard of 95% West Midlands B National Quality Requirements Period Standard Ambulance Service CB_S8a - Following handover between ambulance and A & E, ambulance crew should be ready to December 0 179 accept new calls within 15 minutes - >0 £20 over 30 mins Handover CB_S8b - Following handover between ambulance and A & E, ambulance crew should be ready to December 0 1 accept new calls within 15 minutes - >0 £100 over 60 mins

Month Selector > January West Midlands Health Outcomes Framework/Every one Counts Period Standard Trendline Ambulance Service MRSA - Incidence of HCAI January 0 No Data CB_B15_01 -WMAS - Percentage of Category A Red 1 ambulance calls resulting in an emergency January 75% 75% response arriving within 8 minutes - Operating standard of 75% SES&SP CCG - Percentage of Category A Red 1 ambulance calls resulting in an emergency response January 75% 66% arriving within 8 minutes - Operating standard of 75% Safe environment and CB_B15_02 - WMAS - Percentage of Category A Red 2 ambulance calls resulting in an emergency January 75% 74% protecting from avoidable response arriving within 8 minutes - Operating standard of 75% harm SES&SP CCG - Percentage of Category A Red 2 ambulance calls resulting in an emergency response January 75% 66% arriving within 8 minutes - Operating standard of 75% CB_B16 - WMAS - Percentage of Category A calls resulting in an ambulance arriving at the scene January 95% 97% within 19 minutes - Operating standard of 95% SES&SP CCG - Percentage of Category A calls resulting in an ambulance arriving at the scene within January 95% 94% 19 minutes - Operating standard of 95% West Midlands B National Quality Requirements Period Standard Ambulance Service CB_S8a - Following handover between ambulance and A & E, ambulance crew should be ready to January 0 No data accept new calls within 15 minutes - >0 £20 over 30 mins Handover CB_S8b - Following handover between ambulance and A & E, ambulance crew should be ready to January 0 No data accept new calls within 15 minutes - >0 £100 over 60 mins

Month Selector > December

South Staffordshire & Health Outcomes Framework/Every one Counts Period Standard Shropshire Healthcare NHS Foundation Trust MRSA - Incidence of HCAI December 0 0 Safe environment and protecting from avoidable C. difficile - Incidence of HCAI December 0 0 harm C. difficile - YTD Ceiling December 15 1

Friends and family test - In-patient response who recommend December 1 81.00%

Friends and family test - Response rate % In-Patient December 0 - Ensuring a positive Experience of care Friends and family test - Community response who recommend December 0 92.00%

Friends and family test - Response rate % Community December 0 -

South Staffordshire & NHS Consultation Period Standard Shropshire Healthcare NHS Foundation Trust

PF1.1 - The total no of service users receiving services December 0 -

PF1.3 - The total no of service users registered for Standard Care December 0 -

Admission & Discharge PF 4.1 - Number of new cases accepted by early intervention services December 71 2 PF 7.1 - Number of Admissions to an Adult inpatient who are under 18 years of age December 0 0 PF 6.1 - Minimising delayed transfers of care (MONITOR Definition) December 0 0 PF 10.1 - Length of wait for first access of CAMHS (8 weeks max) December 8 97 South Staffordshire & NHS Consultation Period Standard Shropshire Healthcare NHS Foundation Trust Diagnostics Diagnostics - 6 weeks+ December 99% - PF 9.1 - 18 Week from referral to commencement of treatment. CAMHS December 95% 98% PF 9.2 - 18 Week from referral to commencement of treatment. Paediatrics December 95% 95% PF 9.3 - 18 Week from referral to commencement of treatment: LD December 95% 100% PF 9.4 - 18 Week from referral to commencement of treatment: Subs. Misuse December 95% No data

18 Week Referral PF 9.5 - 18 Week from referral to commencement of treatment: Eating Disorders December 95% 89% PF 9.6 - 18 Week from referral to commencement of treatment: Mother and Babies December 95% 95% PF 9.7 - 18 Week from referral to commencement of treatment; Adult Mental Health December 95% 97%

PF 9.8 - 18 Week from referral to commencement of treatment: Older Adult Mental Health December 95% 96%

PF 3.2 - All Admissions to be made via Crisis December 95% 100%

PF 3.5 - Total No of services users responded to within 4hrs % December 1 1 CRISIS PF 3.5.1 - Total No of services users responded to within 4hrs December 0 115 PF 1.5 - % of CPA follow up within 7 days December 95% 93% PF 11.1 - Mixed sex accommodation breaches December 0 0 Psychiatric Liaison Never Events December 0 0 Local Avoidable Event - Suicide on an inpatient acute mental health ward of a detained Dementia & CHESS patient for whom there is lack of evidence of adequate risk assessments and neccesary December 0 0 actions undertaken or lack of evidence of agreed observations being carried out. Pressure Ulcers Grade 3 December 0 0 Pressure Ulcers Grade 4 December 0 0 Incidents Harm free care (%) December 95% 99% Duty of Candour (Compliance) December 100% 100%

Month Selector > January

South Staffordshire & Health Outcomes Framework/Every one Counts Period Standard Shropshire Healthcare NHS Foundation Trust

MRSA - Incidence of HCAI January 0 0 Safe environment and protecting from avoidable C. difficile - Incidence of HCAI January 0 1 harm C. difficile - YTD Ceiling January 15 2

Friends and family test - In-patient response who recommend January 1 -

Friends and family test - Response rate % In-Patient January 0 - Ensuring a positive Experience of care Friends and family test - Community response who recommend January 0 -

Friends and family test - Response rate % Community January 0 -

South Staffordshire & NHS Consultation Period Standard Shropshire Healthcare NHS Foundation Trust

PF1.1 - The total no of service users receiving services January 0 0

PF1.3 - The total no of service users registered for Standard Care January 0 -

Admission & Discharge PF 4.1 - Number of new cases accepted by early intervention services January 71 7 PF 7.1 - Number of Admissions to an Adult inpatient who are under 18 years of age January 0 0 PF 6.1 - Minimising delayed transfers of care (MONITOR Definition) January 0 0 PF 10.1 - Length of wait for first access of CAMHS (8 weeks max) January 8 0 South Staffordshire & NHS Consultation Period Standard Shropshire Healthcare NHS Foundation Trust Diagnostics Diagnostics - 6 weeks+ January 99% - PF 9.1 - 18 Week from referral to commencement of treatment. CAMHS January 95% 94% PF 9.2 - 18 Week from referral to commencement of treatment. Paediatrics January 95% 94% PF 9.3 - 18 Week from referral to commencement of treatment: LD January 95% 88% PF 9.4 - 18 Week from referral to commencement of treatment: Subs. Misuse January 95% No data

18 Week Referral PF 9.5 - 18 Week from referral to commencement of treatment: Eating Disorders January 95% 100% PF 9.6 - 18 Week from referral to commencement of treatment: Mother and Babies January 95% 100% PF 9.7 - 18 Week from referral to commencement of treatment; Adult Mental Health January 95% 95%

PF 9.8 - 18 Week from referral to commencement of treatment: Older Adult Mental Health January 95% 98%

PF 3.2 - All Admissions to be made via Crisis January 95% 98%

PF 3.5 - Total No of services users responded to within 4hrs % January 1 1 CRISIS PF 3.5.1 - Total No of services users responded to within 4hrs January 0 155 PF 1.5 - % of CPA follow up within 7 days January 95% 100% PF 11.1 - Mixed sex accommodation breaches January 0 0 Psychiatric Liaison Never Events January 0 0 Local Avoidable Event - Suicide on an inpatient acute mental health ward of a detained Dementia & CHESS patient for whom there is lack of evidence of adequate risk assessments and neccesary January 0 - actions undertaken or lack of evidence of agreed observations being carried out. Pressure Ulcers Grade 3 January 0 - Pressure Ulcers Grade 4 January 0 - Incidents Harm free care (%) January 95% - Duty of Candour (Compliance) January 100% 100%

Integrated Quality and Performance Report – March 2015

Update and exception report from Joint Quality Committee

The Joint Quality Committee met on the 11th February and 11th March 2015 to review formally the submitted data for Month 9 – December 2014 and Month 10 – January 2015 and associated reports in respect of key providers and also to review additional items in line with the Committee business cycle. Key information from the meeting is summarised below:

i) Provider Assurance

A decision is made regarding the level of assurance of each provider in reference to the safety of the service and then pertaining to the quality of care for each provider.

The Joint Quality Committee continue to use the below classification to determine assurance for each of the Providers.

This is the system that has been utilised in both February and March meetings and each is explained briefly below.

1. Assured – certain, complete assurance 2. Partially Assured – only part, not generally, or incomplete information or data 3. Limited Assurance – restricted through lack of data, poor patient experience or refusal to respond to challenges 4. Not Assured – complete lack of confidence or absence of significant information/action following requests from previous quality committees – this level of assurance will require escalation or action from the committee.

HEFT - The Joint Quality Committee determined that they were assured for safety in response to the high level of scrutiny from external agencies (i.e. Monitor) and the changes in personnel at HEFT. The Joint Quality Committee were not assured for quality due to the current issues with MONITOR, RTT, 2 Week Cancer waits, performance breaches and staffing issues.

BHFT – in February members of the Joint Quality Committee agreed they continue to be assured regarding the quality and safety of the care that is provided. In March, the Joint Quality Committee agreed they were assured in respect of safety, subject to the resolution of the management of falls (see main report) and were partially assured for quality.

SSOTPT – At the February meeting members agreed they had partial assurance in respect of quality and care at SSOTP and were assured in respect of safety. No Lead Commissioner SSOTP report was received at the March Joint Quality Committee; this is due to the Lead Commissioner submitting a Quality Report earlier than anticipated in February which the Joint Quality Committee then reviewed in the same month. April’s Joint Quality Committee

will receive the Lead Commissioners Quality Report as per the agreed reporting cycle. This will be following their Quality Committee being held at the end of March (26.3.15). Members of the Governing Body should note that the Lead Commissioner cancelled February’s SSOTP CQRM, however the challenge from the Joint Quality Committee report in February has been robustly applied and clear challenges are with the Lead Commissioner for action at March’s CQRM (25.3.15).

SSSFT - members of the Joint Quality Committee agreed they were assured for both quality and safety in February and March by the data and information that was provided.

DGH - The Joint Quality Committee determined limited assurance for quality in that, recent CQC report (published publicly on the 3rd December 2014) there was evidence that the Trust is responding to the actions outlined in it and have highlighted these to the DGH Board; data quality and narrative has improved, assurance around mortality data reporting and review has Dudley CCG assured. Rationale for not fully assured is continued lack of timely data (to be resolved by April 2015); discharge IT issues, VTE & MRSA screening reports and outpatient cancellations. The monitored saving lives metrics require further investigation and assurance of improvement from the Trust. Good cancer wait times and overall FFT (except A&E) give a good response for patients; therefore the Joint Quality Committee were assured for safety.

WMAS – During February the Committee members were not assured by the quality of services provided but this improved in March to limited assurance – details can be found within the report.

RWT – Members agreed during February JQC to be assured by the Safety and partially assured for quality. To note the Lead Commissioner submits a Quality paper to the Joint Quality Committee bi-monthly.

SDUC – At the February meeting members were informed that the CQRM had not met since 15th December 2014. The Director of Quality and Chief Nurse escalated concerns regarding the lack of commitment from the provider to Accountable Officers to address the issues in data submission and subsequent absence of a CQRM. Subsequent to this escalation the CCG issued a contractual breach notice. The position now following the formal breach notice is that a CQRM is scheduled for 23rd March 2015, three months outstanding data will be presented and reviewed, applying challenge appropriately via performance, quality and contractually if necessary.

NSL – At the February meeting members agreed they were assured based upon the data and information provided. ii) Reports and updates received by the Committee

The Joint Quality Committee has a business cycle which lists when the key reports are to be presented to the Committee. This was agreed at the October meeting. In addition, reports may be received on an ad hoc basis in line with publications, reports and relevant submissions, normally from the CCG Chief Nurse.

At the Joint Quality Committee in February, the following reports and updates were received and discussed:

- Regular update for Patient Engagement - Regular update and feedback report from the CCG Patient Council - Equality and Inclusion Annual Report was received - CCGs’ clinical risks were reviewed and items to be added to the risk register identified - Update on the work of the Quality Surveillance Group - The Primary Care Quality report was received - The Strategic Medicines Management report was received along with a report on community pharmacy quality - Safeguarding reports were received in respect of adults and children - The quarterly update on research was provided - Serious Incident Combined Monthly Report from the Clinical Support Unit

At the Joint Quality Committee in March 2015, the following reports were received and discussed:

- Senior Colleagues from WMAS attended the meeting by invitation and gave an informative presentation on the provision of Ambulance Services in ES and SESP. A number of actions were agreed to ensure closer working going forward - Regular update and feedback report from the CCG Patient Council - Regular update from the CCG Patient Engagement Manager - Regular Medicines Management Update along with the Strategic Medicines Management Report - CCG clinical risks were reviewed and items to be added to the risk register identified - Soft Intelligence Report was received and discussed - Serious Incident Combined Monthly Report from the CSU - An update on the work of the Area Team Quality Surveillance Group - Infection Prevention and Control update Report - The regular report on Transforming Care (Winterbourne View)

iii) Decisions made by the Joint Quality Committee

In February, the following decisions were made:

- The Health Safeguarding Partnership Terms of Reference were received and approved, subject to a small number of changes in respect of quoracy and reference to CCGs. - The process for managing Quality Accounts was approved. - The South Staffordshire Commissioning Policy for In Vitro Fertilisation was approved.

In March, the following decisions were made:

- The Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards 2007 (DOLS) Policy was approved.

Additional Issues for escalation to Governing Body - The Committee are seriously concerned about the lack of progress by HEFT on the letter sent to them by Monitor in December. The Governing Body is asked to take immediate steps to discuss with the Lead CCG and obtain assurance from the CQC that ALL services are safe. - The Governing Body is asked to record that the Accountable Officer has been asked to take action on the deteriorating Falls situation at BHFT. - Following approval of the Equality and Diversity Report the Governing Body is asked to ensure adequate training is planned to ensure compliance. iv) Assurance

Members were in agreement that all provider services reviewed at the Joint Quality Committee are considered to be safe. However, members are asked to note the specific concerns detailed in the provider summaries below. v) Provider Reports

The Committee received and reviewed reports in respect of quality for all key providers on the key quality indicators. A summary of each of these is provided below, highlighting areas by exception.

HEART OF ENGLAND NHS FOUNDATION TRUST (Lead Commissioner – Birmingham Cross City and Solihull CCG)

SUMMARY ASSURANCE LEVEL Current RAG Rating based on information QUALITY SAFETY received and external reviews DECEMBER 2014 Not Assured Assured JANUARY 2015 Not Assured Limited Assurance EXCEPTIONS – December 2014

Silverman Report (Mortality) - Actions incorporated into the report and include an overarching improvement plan through the Trust Quality & Risk Committee. This plan was overviewed and agreed with Monitor. The planning includes aspects of Silverman recommendations, in that, the Trust need to develop policy framework for Mortality & Mobility meetings and standards. Updates to mortality will be reviewed by the CQRM over the next few months and measured against the Silverman Plan.

Staffing update – December 14 - 169 Band 5 vacancies (13% of vacancy rate) - attrition planned to March 15. Nurse Staffing Levels - Heartlands 93%, Good Hope 90% & Solihull 97%. Good Hope struggling with staffing due to supported beds and supported from other sites. Recent recruitment drives in Spain yielded 9 nurses, there is a planned recruitment drive to Portugal and the Trust are exhibiting in national work fairs. The Trust has instigated a flexibility plan across sites/areas to ensure an even consistency of staffing across wards. The recent HCA (Health care Assistant) drive has new starters commencing employment throughout January/February 2015, although it is too early to measure the impact. The lower staffing levels are consistent with soft intelligence and patient experience reports for GHH. The Lead Commissioner is actively involved in workforce meetings and is feeding back on the joint data review meetings.

RTT 18 Week Wait - All overdue cases require Clinical Validation. The Trust has completed its rebasing and data cleansing of the RTT figures and cases. They are utilising Robert Peel and BMI Priory to take patients to reduce this margin. EKIST (National intensive support team) are scrutinising the RTT incompletes and are assisting the Trust to rectify issues. The Trust has a clear plan to improve. Monitor is evaluating the actions against the agreed action plan. The Trust has agreed with Monitor to adjust their end target to May 2015. Continuous monitoring remains an action for the CQRM.

Breast Symptom 2 week wait - HEFT are completing a telephone survey to explain why the patients did not attend in 2 weeks. A full update on the current will be conducted throughout January and February to give assurance of the most up to date position for 2 week cancer waits. This will be reported to the Joint Quality Committee in April 2015. To note NICE are producing new guidance on 2 week cancer waits and this is expected in April 2015.

SI Reporting - The Trust and Lead CCGs are currently updating their SI Policy and reporting. A full update will be prior to the April Commissioning. There has been 1 incident concerning a SES&SP CCG patient, concerning a grade 3 pressure ulcer. SES&SP CCG are awaiting the RCA.

EXCEPTIONS – January 2015

MONITOR –MONITOR have enacted an Enforcement Undertaking. The Trust have addressed majority of the issues contained within the MONITOR Improvement Programme. Further assurance has been gained and the Trust is sharing the planning and actions from the Improvement Programme. Actions include - Silverman Report (Mortality) - Actions incorporated into the report and include an overarching improvement plan through the Trust Quality & Risk Committee which will be reviewed by the CQRM at the March 2015 and measured against Plan. The Joint Quality Committee were concerned with the particulars of the enforcement undertaking. Some assurance had been gained through CQRM, but the Joint Quality Committee felt there needed to be further challenge around the Trust response to the enforcement letter, and considered escalation. The Joint Quality Committee agreed the following escalation plan. The SES & SP CCG Accountable Officer would write to the Accountable Officers for Solihull CCG & Birmingham Cross City CCG to raise the concerns. The Chief Nurse & Director of Quality will discuss the issues with the CQC. The GP membership will be informed that Monitor has raised issues and directed to MONITOR’s website for review. The Quality Improvement Manager will produce a comparison of Trust actions against the MONITOR concerns to give greater oversight.

RTT 18 Week Wait - There has been an improvement in the RTT performance during January 2015, but it is still below target. The Trust commitment to extra resources appears to be having a positive impact on the Trust action plan with this improvement. Further monitoring will continue through the CQRM.

Breast Symptom 2 week wait - Performance for later part of January shows a decline in performance across the majority of the metrics. The Trust is supplying a plethora of data around cancer breaches and this requires analysis by the SES&SP CCG Quality Improvement Manager through March 2015 and will be reported through the Joint Quality Committee for April 2015

Ambulance Handover – The Trust has shown an improvement for handover times in A&E. Times have decreased over February, which impacts on patients being seen quickly, therefore getting treatment quickly.

Breaches – The Trust have reported breaches in MRSA, CDiff, EMSA and 12 hour trolley waits. All RCAs and learning have received analysis by the lead commissioner and the CQRM has been assured by the lead commissioner that there are no trends or patterns of concern from their analysis. The CQRM will continue to monitor for any underlying issues.

Pressure Ulcers and Falls – The Trust is instigating a task and finish steering group for further analysis of reporting, governance and ensuring rigor in its systems. The CQRM will receive updates from these steering groups and the CCG welcomes this positive response from the Trust internal analysis.

BURTON HOSPITALS NHS FOUNDATION TRUST (Lead Commissioner - East Staffordshire CCG)

SUMMARY ASSURANCE LEVEL Current RAG Rating based on information received and SAFETY QUALITY external reviews February 2015 Assured Assured March 2015 Assured Partial Assurance

Exceptions and Actions

December Data

Patient Experience: The Trust overall patient experience score returned to green in December. Being involved in decisions about treatment and care, being welcomed on to the ward and being able to get attention from staff and getting help to the toilet remained in amber. A small improvement in all of those scores would bring the Trust in to the green overall consistently. The domains around kindness and compassion, cleanliness and pain control have maintained excellent high green scores.

52 Week target: Two patients breached the 52 week target, which was raised as a serious incident. Both patients have now been admitted for treatment.

Discharge Survey: Continues to be undertaken, there has been a significant decrease in a score of 80 from 84 for patients being told about the side effects to look for with their medications; and also the score for patients feeling involved in the decisions about leaving hospital dropped to 86. Patient Comments are included in the report.

Treatment Centre: Over the past 12 months the CCG Quality Committees have often discussed the level of patient experience within the Treatment Centre. The patient survey demonstrates a high level of satisfaction.

Ward Assurance: The Trust has sustained a green rating for the 9th consecutive month.

Complaints: The number of formal complaints received in December 2014 reduced to 5. There is no obvious reason for such a drastic reduction, although traditionally complaint numbers do reduce in December. On 1st December the Trust reduced its complaint response timescale to 25 working days from 35 working days, in line with the majority of other Trusts.

PALS: 254 PALS contacts were received during December 2014. Quality of care, appointments and car parking were the three most frequent enquiries via PALS in December 2014. These were slightly higher than last month, but not significantly higher.

Serious Incidents: During December 2014, 6 Serious Incidents were reported.

Patient Safety Incidents: The number of patient safety incidents reported in December 2014 was 479.

C. Difficile: There was 1 reported case of Clostridium difficile during December 2014.The Trust have now exceeded the yearly trajectory of 15, with 17 cases to date but one of these cases was deemed to be avoidable.

MRSA: No cases reported during December 2014.

Elimination of Mixed Sex accommodation: During December eight breaches were reported in the High Dependency Unit.

4 breaches occurred on 21st December: this involved 3 x females (ESCCG) and 1 x male (SESCCG). These breaches occurred due to capacity issues.

4 breaches occurred on 23rd December: this involved 3 x females (2 x ESCCG and 1x SDCCG) and 1 x male (SESCCG). These breaches also occurred due to capacity issues.

Baby Friendly: Work is continuing to prepare for Stage Three and full accreditation.

Soft intelligence: An issue was raised with the Trust and the CSU Commissioning Manager for BHFT as an example of an unnecessary Secondary care follow up. A CQUIN for 2015-2016 is currently being considered aimed at reducing the new to follow up ratio.

Falls: The total number of Slips/Trips/Falls at BHFT resulting in a fracture from 1 st December 2014 – 2nd February 2015 is 7, all of which are subject to a full investigation. The Trust is actively trying to reduce the number of falls resulting in harm: A Falls Summit was held in January 2015 to re-launch the Functional Falls Assessment which was introduced in June 2014 replacing the Stratify assessment. To identify patients at risk, a system of symbols has been introduced for nursing staff to add to the Ward Board allowing staff to easily identify those patients at risk of falls.

January Data

Patient Experience: The Trust overall patient experience score has scored green for two months consecutively for the first time in the past 12 months. Being involved in decisions about treatment and care, being welcomed on to the ward and being able to get attention from staff and getting help to the toilet all remained in amber. A small improvement in all of those scores would bring the Trust in to the green overall consistently. The domains around kindness and compassion, cleanliness and pain control have maintained/increased excellent high green scores.

Discharge Survey: 32% of patients reported a delay in discharge with the 9% of these reporting that they were waiting for medicines and 13% waiting for transport. 12% of patients felt that something else could have been done to improve the discharge process which is 5% higher than the figure reported in December. The Trust are acting on the patients comments and work is on-going with the Pharmacy department to look at making a pharmacist more integrated with the ward Teams

Ward Assurance: The Trust has sustained a green rating for the 10th consecutive month.

Complaints: The number of formal complaints received in January 2015 was 15. The Trust has redesigned the Complaints processes over the last 12 months including a new complaints manager. The

Trust has given increased ownership at ward level to complaints and wards/departments are now involved in the investigating and dealing with complaints. From the reducing number of complaints, dealing with issues at ward level suggests that patients’ concerns are been addressed at ward/departmental level preventing escalation to a formal complaint.

PALS: 247 PALS contacts were received during January 2015.

Serious Incidents: During January 2015, nine Serious Incidents were reported.

Patient Safety Incidents: The number of patient safety incidents reported in January 2015 was 516.

C. Difficile: There was 1 reported case of Clostridium difficile during January 2015. The Trust has now exceeded the yearly trajectory of 15, with 18 cases to date however, only two of these cases were deemed to be avoidable.

MRSA: No cases reported during January 2015

Elimination Mixed Sex Accommodation: During January four breaches were reported. The breaches involved Emergency Department patients who were moved into the GP waiting area during a major internal incident alert. A screen was put in place in-between male and female patients and a standardised operational procedure has been implemented to prevent a mix from occurring again. Assurance was given that an assessment of the area was completed by senior nursing staff to ensure the patients’ privacy and dignity was maintained. These patients would also have failed the 4 hour wait time following their arrival to A&E.

Trolley Breaches: Fourteen 12 Hour trolley breaches occurred in January 2015 (10 on the 5th January; and 4 on the 7th January). At the time BHFT had a large number of patients attending ED however the gap in social care provision blocked the system flow and they were unable to discharge medically fit patients. All patients received the appropriate level of nursing care, diagnostics and treatment including care plans etc. All patients were made comfortable. No complaints were received from patients, carers or family.

Despite the actions being taken by the Trust to reduce the number of falls, the number of falls resulting in a fracture remains a concern to the Joint Quality Committee. Following an in depth discussion members concluded they were partially assured on quality as a result of this (Please see Chairman’s Report for information on the actions being taken).

STAFFORDSHIRE AND STOKE ON TRENT PARTNERSHIP TRUST (Lead Commissioner Cannock Chase CCG)

SUMMARY ASSURANCE LEVEL

Current RAG Rating based on information received and SAFETY QUALITY external reviews February 2015 Assured Partial Assurance

March 2015 No submission No submission

Exceptions and Actions

The East Staffs and South East Staffs & Seisdon Peninsula Joint Quality Committee members in February 2015 agreed that they would consider assurance of quality and safety at key providers separately at this meeting and future meetings. The Committee also agreed that any level less than assured in relation to safety would require immediate escalation to GB with a recommendation of any action to be taken.

The members at the February 2015 meeting agreed they were assured in respect of safety at SSOTP but only partially assured in respect of quality.

The February committee highlighted a number of key concerns in the report from SSOTP:  There had been an increase in the number of pressure ulcers at all grades during December 2014.  The timeliness of social work assessments continues to be an area of concern, around the breaches in relation to the four week threshold for completion of the assessments.  Workforce reporting continues to be an issue for the CCGs particularly high sickness and turnover of staff levels and lack of reporting on bank and agency staff usage.  There were 29 reported deaths in December 2014 of which 17 were end of life palliative care but no reasons were given for the remaining 12 deaths.

Serious Incidents – The number of Serious Incidents reported by the Trust in December was 25, with 7 relating to the South division, one was a Child serious injury and six related to pressure ulcers - Grade 3 pressure ulcers x 4 and Grade 4 pressure ulcers x 2.

The number of Serious Incidents over 45 days for December was 8 (and the missing information for October and November was 14 and 8 respectively). The number of STC SIs for December was 8 (and again the missing information for October and November was 14 and 8 respectively).

Patient Safety Incidents – SSOTP total of Internal incidents in December was 598, with 144 relating to the South division. No breakdown of the level of harm was provided.

Mortality Indicators – The number of deaths in the Trust during December was 29 but there is no breakdown of hospital or community. 17 of the deaths were in end of life palliative care pathways patients. The Mortality Review Group has completed an in-depth analysis of all deaths in December

and reported that no concerns or failures were identified.

Pressure Ulcers – For December, 77 Grade 2 pressure ulcers were reported by SSOTP, 16 Grade 3 pressure ulcers and 4 Grade 4 pressure ulcers were reported, making a total of 12 Grade 4 PUs in the year to date. December was the highest month for reported Grade 4 PUs and represented 33% of the total in the year so far.

Tissue Viability - The Trust tabled a Community Pressure Ulcer Report for the period April to December 2014, of a total of 93 PUs all reported on the SI system as occurring in the Trust’s care. All had been reviewed by the TV Panel and 17 were identified as avoidable, 1 avoidable but not attributable and 49 unavoidable. The cumulative summary of avoidable PUs since April 2013 shows a decrease of 30% of community acquired avoidable PUs in that time period.

Social Care Assessments – Patients are waiting for longer than the four week threshold for their assessments and the members queried who the responsible commissioner was and what the number of patients affected was and the impact on them. This will be forwarded as a query to SSOTP and raised at the next CQRM.

Complaints – The Trust received 15 complaints during December, a decrease from 21 in November.

User and Carer Experience – In December, 259 Randomised User Experience surveys for the South Community Teams achieved a NPS of +82.61 which was an increase of 8.77% compared to November. Only one Carer survey was received achieving a NPS of +100.

Sickness Absence - SSOTP sickness percentage for the South division, East Staffs, in December was 5.98% which is higher than the last previous reported figure of 5.25% for the whole of the South in October. The stretch target is 3.39%. The Trust reports that the North and South Community divisions have had the largest increases in sickness and absence and this will be investigated by the Senior HR Business Partner.

On-going Long Term Sickness cases for December were 56 across the South Division, an increase since October of 8 cases. The number for East Staffs is 9.

In their Internal Incident report the Trust acknowledge that staffing levels within district nursing services are of high risk and this is reflected on the Corporate Risk Register.

Turnover Levels – SSOTP report that their turnover level for December was on course to be below 10% by the end of the financial year; however East Staffs has the highest turnover across the South division of 10.40%. It was also reported that the highest recorded reason for staff leaving the Trust was Retirement. Assurance had been given by the Trust at the December CQRM on their retirement management plan.

Starters & Leavers – SSOTP has not provided the details of the starters and leavers for December.

Bank / Agency – SSOTP consistently have not provided the data on bank and agency staff usage for

over twelve months and the members of the Committee were of the view that it was not acceptable. A Task and Finish group has been established to review workforce issues with the Lead Commissioners, who have reported that additional information will be available in the next workforce report but not bank and agency usage. The lack of information is being addressed in the Information Requirements reporting for 2015/16 with the Trust.

Statutory and Mandatory Training – The Trust reported that training compliance had slightly increased in December to an overall compliance level of 82.37% but no details were provided.

Appraisal Completion – The Trust has not reported the details of compliance in December other than it is below target and being monitored by the Workforce Matters Committee and will be reported in future CQRMs.

The East Staffs and South East Staffs & Seisdon Peninsula Joint Quality Committee in March did not receive a quality report from SSOTP as it had been agreed to accept alternate monthly reports from the Trust. There are a number of actions in progress during March which will be reported back to the committee members at the April meeting:

 The Lead Commissioner had reported that they had received additional information from the Trust regarding workforce but this does not include any details of the bank and agency staff usage across the Trust. The update from the Lead Commissioners identified that the 2015/16 contract will address this shortfall.

 Workforce data in respect of the recruitment and retention of overseas nurses had not been provided.

 Data in respect of the impact on patients of breaches to the four week threshold for social care assessments. It had been established that the Local Authority commission social care assessments and SSOTP provide the service under a Section 75 arrangement. The Lead Commissioner agreed to request this information prior to the next SSOTP CQRM.

 The query raised by the Committee members at the February meeting in respect of the 29 patient deaths reported for December, whereby 17 were in end of life palliative care pathways but the reasons for the remaining 12 deaths were not reported. The update from the Lead Commissioner produced a Mortality report which members accepted.

The East Staffs and South East Staffs & Seisdon Peninsula Joint Quality Committee were not in a position to make a decision on assurance on safety or quality without a full quality report in March.

SOUTH STAFFORDSHIRE AND SHROPSHIRE HEALTHCARE FOUNDATION TRUST (Lead Commissioner - South East Staffs and Seisdon Peninsula CCG)

SUMMARY ASSURANCE LEVEL Current RAG Rating based on information received and SAFETY QUALITY external reviews February 2015 Assured Assured

March 2015 Assured Assured

Exceptions and Actions

December 2014 Data

Monthly Incident Reporting – the total number of incidents reported for the month of December 2014 is 90. The total number of patient safety incidents reported In January is 77 which is a reduction in previous months.

This has been broken down into the following areas;

The number of patient safety incidents for inpatient older adult’s services increased slightly when compared with previous month but figures were within control limits and below the mean line. Assault is the highest reported category in December.

Details as follows: - Assaults – 42% of reported incidents - Falls – 19% of reported incidents - Found on the Floor – No real evidence of Slip/Trip/Fall– 13% of reported incidents

All other incidents reported are no more than 2 incidents across a wide spread of categories.

Duty of Candour – There were 3 incidents to which Duty of Candour was applied.

There were 55 patient safety incidents reported for adult mental health inpatient services in December 2014 which is a 17% decrease from the previous month. The following areas were the highest reported although do not represent a trend or cluster:

- Self-harm – 49% of reported incidents - Assault – 11% of reported incidents - Absconding – 11% of reported incidents - Medication Incidents – 11% of reported incidents

There were no more than 2 incidents reported under any of the other categories.

January 2015

Older Adult Inpatient Mental Health Services – Falls in the highest reported category this month The following areas were the highest reported but have decreased slightly from last month and still demonstrates figures are within control limits and below the mean line. - Falls – 43% of reported incidents - Assaults– 20% of reported incidents - Near Miss – Clinical – 10% of reported incidents

All other incidents were no more than 2 incidents reported under any of the other categories.

Serious Incidents: There were 2 reported Serious Incidents during December 2014 and 4 reported Serious Incidents during December 2014, one of these occurred at the end of December but was not reported until January and another occurred in November but was not reported until December 2014. The delay in reporting of serious incidents will be monitored closely and raised with the Trust directly if a pattern persists. During Q2 Patient Deaths was the highest reported Serious Incident. In addition, Trust have formed a Strategic Group, chaired by the Director of Quality and Clinical Performance was convened to review how the organisation can improve how information is shared and learn lessons from serious incident investigations.

Serious Incidents over 45 days – During January there were a total of 8 Serious Incidents where the RCA had not been closed off within the determined time – the number consists of 4 stop the clocks; 2 agreed extensions; 1 awaited from the Trust and 1 with the CCG to review.

Regulation 28 – The Trust confirmed one Regulation 28 was issued by the Coroner in December (reported February CQRM) – the Trust has now responded and an update will be obtained in April 2015 CQRM.

Suicide Prevention Strategy – As previously reported to the Governing Body concerns remain regarding the lack of a Suicide Prevention Strategy and the impact on the wider health economy. The Chief Nurse and Director of Quality and Nursing have formally expressed concerns on behalf of the CCG in writing, to the Cabinet Member for Health and Wellbeing in Staffordshire.

Delayed Discharges- Total of 18 delayed discharges in December and 17 in January of which 2 related to East Staffordshire CCG and 6 to South East Staffordshire and Seisdon CCG. Since the last report the Trust have undertaken a significant amount of work to ensure discharge/transfers meet three specific criterions before the discharge/transfer is classed as a delay. Following this review there was a slight reduction in the delayed discharge figures.

Crisis Resolution Home Treatment Team Breaches - There were 6 reported breaches in total in December 2014 and no breaches were reported in January 2015. The Trust provided assurance that the breach in December was not due to staffing issues, the exception provided being an increase in activity and the impact of complying with the Lone Worker Policy has on attendance. This is relevant when there are two concurrent assessments.

Friends and Family Test – The Trust reported 81% of inpatient and 92% of community service users during Q3 would be “likely” or “extremely likely” to recommend the service to Friends and Family. Staff Friends and Family Test Q3 data is not yet available on the national website however assurance will be provided as soon as this is published.

Workforce Update for December/January 2014 – The Trust has been requested to submit an exception report for outlying areas which will be reviewed and challenged at CQRM. Current areas that are flagging and being closely monitored are as follows:

Sickness and Absence (4.6% target) – current performance December 4.68% and January 4.77%. Trust-wide Vacancy Rate – (4-8% GREEN) the current performance is 12.20% (RED), the details in this is broken down to Directorate level and those teams which are above >10%. These services are: Forensic and Criminal Justice; Specialist Learning Disability; Specialist Services and Mental Health Division. The Trust has been challenged to provide an exception report detailing the issues and actions being taken to address any identified gaps in provision.

Mandatory Training – Trust wide compliance is 83% for December and 84% for January (target 85%).

Based on GP referrals to teams to commence treatment (based on service user needs and clinical rationale to identify clock stop) within 18 weeks from receipt of referral. Following an information notice the Trust has re-validated their data. The number reported for December was 8 breaches of the 18 weeks (96%) and for January 2015 performance 94.8% (target 95%) as a result this will continue to be closely monitored by both the NHS contract and quality perspectives in the CQRM.

The percentage of active referrals who have waited more than 28 days from referral to treatment (first therapeutic session) - The Trust following an information notice and Contract Query meeting have reviewed every individual patient file to examine those patients who have breached the 28 days to treatment to identify the reason for the breaches. Data presented to CQRM identified 8 genuine breaches in December and 3 in January following the intensive review. The Trust has a remedial action plan in place which is being monitored via the contract. Discussions around the impact on quality for the patient was held at the JQC around the Seisdon Locality and agreement was made to continue to monitor various means of intelligence that the CCG receives to ensure the patient experience in this locality is not affected. The Quality Team will specifically monitor the Trust’s ability to provide a service closest to patient’s homes.

Mother and Baby DNA’s – performance has improved in December and January and is now above the required 95%. The Trust has stated despite utilising text confirmation of appointments the DNA for December was 19.6% which equates to 47 Mothers DNA’d. Work will continue around inappropriate referrals made to the Trust.

CQUIN – The Trust achieved Quarter 3

CQUIN 2015/16 – CQUINS are continuing to be finalised following recently published CQUIN Guidance. There has been a considerable delay nationally of this publication. SSSFT/BHFT Pilot – The Trust are working with BHFT around ECG interpretation in exchange for psychiatrist support – progress report is being presented to April CQRM.

18 Week from Referral to Commencement of Treatment – CAMHS 18 Week from Referral to Commencement of Treatment – Paediatrics 18 Week from Referral to Commencement of Treatment – Learning Disability Performance in the month of January 2015 dipped for all of the above 18 Weeks targets. This was challenged at CQRM and the Trust stated it was for small numbers of patients (1 or 2). The JQC members raised concerns around the DNA rate for CAMHS and highlighted the comparable response by Health Visitors when DNA’s occur and there are concerns regarding safeguarding, the Trust agreed to look at the recommendation made by the CCG and will report back in the April CQRM.

Complaints and PALS update – During Q2 21 Complaints were received and out of those 17 complaints were fully or partially upheld. The top themes were clinical treatment and communication of information to patients. An apology was provided in all instances.

DUDLEY GROUP NHS FOUNDATION TRUST (Lead Commissioner Dudley CCG)

SUMMARY ASSURANCE LEVEL Current RAG Rating based on information Safety Quality received and external reviews February 2015 Assured Limited Assurance March 2015 Assured Limited Assurance Data Quality and Assurance – The Governing Body are asked to note - Dudley Group of Hospitals (DGH) does not submit papers to the CQRM until these have been to their board for ratification. Due to the fragmentation between the timeframes for Boards and Committees between SES&SP CCG, DGH and Dudley CCG, data and reports are on the whole 3 months behind. Where possible the national data is used from national database’s (1 to 2 months behind). DGH board papers are reviewed when published and queries with the lead CCG (Dudley CCG) are raised to remain assured from a Quality perspective. Month 10 exceptions are based on the February CQRM essential issues and feedback from the March Joint Quality Committee. This will not change until the lead CCG will take over reporting in April 2015.

EXCEPTIONS – December 2014

CQC Closure Report – The Trust response was expected at the February 2014 CQRM. Agenda item for the Joint Quality Committee – The Trust stated it had not had a request for a formal action plan from CQC. The trust is willing to provide an update at the March CQRM.

Mortality – The trust remains below 85% target to review deaths and 2 of the 3 specialities still have delay in uploading data. The Lead Commissioner now has a monthly meeting with the trust representatives. – Assurance gained from the Medical Director for Quality (Chair of the CQRM) that there has been progression on this matter and she feels assured the trust are proactive in their approach. The trust response is a multifaceted approach to mortality using SHMI, HMSR, CQC Intelligent Monitoring and their own internal mortality tracking system to identify trends, areas of concern and mortality rates to address mortality issues, this is proactive in addressing issues around mortality and is on schedule to complete by March 2015.

CCG/CSU Unannounced Visit - The Trust provided a verbal update with respect to the action plan. The lead commissioner highlighted that the submission was more of a narrative rather than a formal action plan. The trust will submit a formal action plan at the March CQRM.

Keogh Report - The Trust Board confirmed that it was content to formally close the Keogh Action Plan and remaining actions to be monitored through the Clinical Quality, Safety and Patient Experience Committee - Awaiting Closure from Monitor.

C Diff - The Trust figures reported there has been an increase of 5 cases against a trajectory for the month of 3 cases for December. The Lead commissioner is awaiting a review from the trust. There were no cases for SES&SP CCG

MRSA – The screening data is not available at this time and no HCAI report submitted to SES&SP CCG – however the Trust SPQR shows 100% for December elective screenings but no data for the emergency screening since October 14. This has been raised with the lead commissioner for inclusion into the March CQRM.

Safer Staffing – Mandatory training for Quarter 3 is at 79.01% which is approximately 11% below the quarterly target. The trust has failed to achieve this standard for the last 3 quarters and the lead commissioner has requested an update on the target. The 49 shifts identified as amber or blue (registered & unregistered staff) for December 2014 that had not been covered. This compares to 38 in November, 53 in October and 33 in September. There have been no incidents on any shifts assessed as red and unsafe in December 14. The trust has highlighted active measures, but despite this the optimum numbers of staff for the patients on the identified amber and blue shifts were not reached for December. A further update will be provided in the March CQRM.

RTT Waits over 52 Weeks >60% - There has been an Increase over the last 4 months in 52 week waiters (explanation will be requested for the March CQRM) The Trust is undergoing a full overhaul of their data reporting and it appears that these new figures are a consequence of this overhaul.

Saving Lives - CVC on-going care - Compliance poor for consecutive months as per dashboard (77% November 14 & 88% December 14). Awaiting response from lead commissioner.

Saving Lives – Peripheral Lines - Compliance poor for consecutive months as per dashboard (92%), although this meets the highest level of performance that the trust has achieved all year.

Cancellation of Outpatients Appointments - The CCG is working with the CSU to now review all the data and to gain assurance through clinical oversight. The initial data mine has been completed and the team are now working through the data to identify risks. The Lead commissioner will continue to work with the CSU and to update via the CQRM.

EXCEPTIONS – January 2015

Monthly Themes:

Nurse Care Indicators – this report highlighted a number of areas where there is concern for manual handling particularly on three individual wards: Outcome the manual handling specialist has been made aware of these results, feedback awaited. Secondly Nutrition audits showed that 10 wards reported poor scores with a total of 26 elements contributing to poor performance: Outcome the nutritional lead has been made aware of the results and feedback awaited. The escalation process was also discussed within this monthly theme that highlighted how learning was shared via the matron meeting and escalation was made to Director level following two consecutive months of underperforming.

Safety Thermometer included a review of approximately 650 inpatients and 620 community patients reviewing pressure ulcers, falls, catheterisation and VTE. It appeared there is some trend analysis work to be done as it was clear there are months over the years for example where the

pressure ulcers reported tend to spike.

Infection Prevention and Control Exception Report - C-Diff 33 cases YTD target 48 which is reduced to a target of 2015/16, MRSA 0, Norovirus 0 wards affected. CAS Alerts: Discussions took place regarding the need to close the loop on how the trust have assurance that CAS alerts are being allocated out by the Governance Department correctly and that they have been acknowledged. Auditing of care bundles was also raised, which the Trust plans to respond as to whether they audit these at next CQRM.

Assurance around RCA Processes: The absence of medical staff in the RCA process was reported as a significant concern by the CCG - agreed feedback at May CQRM.

Culture of Learning CQUIN: It was anticipated there would be an evolution from Q1 & Q2 which appeared absent; therefore the challenge was made by the CCG to incorporate the learning journey, what they have taken forward and how they are learning as an organisation. Appropriate channels for quality feedback raised by GP Practices:

A concern had been raised about how should GPs liaise with the hospital regarding individual clinical queries – it was agreed this should be GP directly with consultant with no conduit, ‘handoffs’ will be discussed in the future.

End of Life update- Key author was not present but as part of the transformation programme there has been difficulty setting up a cross economy steering group for which the practicalities of arranging were agreed and the first meeting is to be scheduled ASAP, the Terms of Reference of this meeting is unknown.

West Midlands Ambulance Service (Lead Commissioner Sandwell CCG) SUMMARY ASSURANCE LEVEL Current RAG Rating based on information received and QUALITY SAFETY external reviews

February 2015 Not Assured Assured

March 2015 Limited Assured Assurance December 2014 Thrombolysis & CT response times - issue Journey time to hand over time is a target issue. WMAS prefer to keep timings at these lower figures even though they are scoring red for performance. WMAS have reconfigured the ambulance pathways and prefer to let these embed; using the current position to give a baseline on how the services have improved. Time on scene - Still ongoing issue with elongated times on scene. The Trust is measuring the impact. Electronic Patient Record (EPR) - Progressing with timeframes for implementation. Trust report still on track against plan. Red Targets - Discussions around rural red targets. Suggestions on how to handle the poor performance in rural areas. Model for responses and despatch is in place. Suggestion that we should look at clinical outcomes rather than time targets. WMAS completing further analysis and have added more ambulances to SES&SP Area. Will measure the impact over the coming months. Handover Issues - relay to A&E have longer waits over December. WMAS are working with Out of Hours & Care Homes to attempt to alleviate some of the issues. To continue to monitor. ROSC (Return of Spontaneous Circulation) - should continue upward trend due to community and press initiatives (ie. Vinnie Jones & Pre Ambulance First Responders. WMAS will continue to monitor. PPCI - Data issues of local under reporting/recording of information. Trust investigating issues, reinforcing at local level importance of documentation. STEMI - Pain reporting (Pain Management Issue) – The trust have highlighted recording of pain score information. Trust investigating issues, reinforcing at local level importance of documentation. Change Metrics – Stroke - Heartlands Hospital is for all East Birmingham hyper acute strokes. WMAS will measure its Impact. Assurance that the new pathways are now being adhered to. Stroke Care - Blood Glucose has been missed from the patient report forms- New Guidance sent out to all crews. Single Limb - Poor performance around pain scales and recording. The trust are reinforcing with

clinicians Febrile Convulsion – Has an action plan in place to refocus on individual areas for the febrile convulsion pathway. Trust to monitor and report to the CQRM measured performance. January 2015 – No CQRM - Action from January 2015 Joint Quality Committee – to instigate a South Staffordshire Urgent Care Forum to review factors affecting the Ambulance Service. The South Staffs CCGs (SES&SP, ES, SAS, CC CCGs) quality representatives met on Tuesday 24th February 2015 to discuss the overall position of Urgent Care and Ambulance Service Quality. The main points for discussion were:-  WMAS Performance for Red 1, 2 & 19 being under regional and national targets for all CCGs

 111 referral for A&E and see & treat

 OOH referral for A&E and see & treat

 Ambulance Service Structure

 Rural Ambulance model and Urban Ambulance Response Model

 Use of PTS (i.e. private ambulance services) to pick up Green Calls (non-life threatening)

 Concerns already raised with WMAS

The meeting was a lively meeting with lots of debate. There is agreement to meet up again in late March or early April 2015 to review actions from the meeting. Each member had action to take away from the meeting concerning:

 Any impact from other urgent care providers on WMAS Performance

 WMAS performance for all four CCGs

 OOH impact for 999

 PTS being used for WMAS referrals

The major reason for the meeting was to review impact from Urgent Care. It became apparent that there were many elements where closer working for the South CCGs would benefit both performance and quality. This close collaboration will give the 4 CCGs a single pressure point to raise issues collaboratively and more aligned to the challenges our areas have – i.e. rural vs urban.

March Joint Quality Committee – WMAS Presentation

At the Joint Quality Committee WMAS gave a presentation to the Joint Quality Committee. The Representatives were the Director of Quality and Nursing & a Consultant Paramedic. The purpose of the presentation was to give more assurance to the Joint Quality Committee and explain some of

the issues previously queried with WMAS. This included the following points:-

Modelling – The 2009 independent review on ambulance service modelling set the resource and delivery model for all Ambulance services. Its basis is on a 6 minute response model. WMAS as a region achieve overall good coverage utilising this model. However the Trust accepts that in rural environments the modelling software (which attempts to predict where the next incident will be) does not always initiate a perfect response. Certain factors also impact upon rural ambulance response and conveyance – i.e. use of service by OOH to review patients from telephone triage by Dr – to face to face assessment by Paramedics, Handover issues, Nursing Homes with poor care plans, increased see and treat activity etc. all impact in a major way on rural ambulance services.

The Trust are addressing the issues by a utilisation of different objectives including:-

 Better recruitment and on the job training for workforce growth.

 Reducing length on scene for double manned crews.

 Electronic Patient Record to identify patient care plans and planned care episodes (i.e. End of Life)

 Using robust clinical audits for a variety of emergencies to develop better pathways.

 Patient engagement – educate patients on use of 999

 Reduce 111/OOH referrals by the use of robust models of oversight for these services.

This is an overview of a productive session by the Ambulance Service. The Joint Quality Committee was more assured by this session and response. The discussion highlighted actions and information (from both the JQC and WMAS) for further discussions. The Quality Improvement Manager is to set up a further meeting with the Director of Quality & Nursing for WMAS to review all the information and to gain further clarification and assurance around SES&SP concerns and matters.

The Royal Wolverhampton Trust – Lead Commissioner Wolverhampton CCG

SUMMARY ASSURANCE LEVEL Current RAG Rating based on information received and SAFETY QUALITY external reviews February 2015 Assured Partial Assurance

March 2015 Report Not Due – Report Not Due Bi-Monthly Bi-Monthly It is important to note Stafford and Surround and Cannock Chase CCG act as the Associate Commissioner and therefore act on our behalf by attending Provider CQRM. Concerns raised at the JQC will be directed to the Associate Commissioner to gain the required assurance at the next available CQRM or the CCG will go directly to the Lead Commissioner themselves if required.

Exceptions and Actions

December 2014

Emergency Department: A&E continues to see increasing numbers with attendances in December 8.79% higher than the same period last year this equates to an additional 871 attendances. The Trust did not achieve either Type 1 or all Types for the month – this is to be closely monitored.

Cancer: RWT are currently predicting possible failure of the 2 week wait Breast Symptomatic target for December, validation is on-going. Final cancer data is uploaded nationally 6 weeks after month end – this will be reviewed once validated. It was noted during JQC that Consultant sickness maybe impacting on their performance.

Falls: The number of falls with harm continues to be a concern and the Trust Falls Group is looking into assessment procedures and care pathways to identify areas for improvement.

Staff sickness: Sickness absence for the Trust increased by 1% in December 2014 to 5.32% from 4.32% in November 2014, which is 2.08% above the Trust target of 3.24%.

Respiratory Ward Quality Visit: was undertaken to the Adult Respiratory Ward on the 27th of November 2014; however the committee felt that the feedback from the visit was more concerned with procedures rather than quality. Members were also concerned at the impact on patients of the Interstitial Lung Service moving to Stoke.

NHS England and the Trust Development Authority (TDA) are commencing a national validation in relation to RTT for all Trusts and members felt it would be useful to see the outcome of this.

OTHER PROVIDERS

Staffordshire Doctors Urgent Care (SDUC) Assurance not determined- A formal CQRM has not occurred since 15th December 2014 although meetings have taken place to resolve the current issues around the lack of quality assurance and un-timely submissions with the Provider and CCGs. The discussions between SDUC, North and South East and Seisdon CCG have clarified the CCGs expectations around the quality of reports being submitted for assurance around the quality and safety of services being delivered to the local populations. The next CQRM will be held 23rd March 2015 where Month 8, 9 and 10 quality data will be discussed and subsequent assurance or further contractual action will be determined following the retrospective review of this data. It is important to note all CCGs are working collaboratively to resolve the issues with the current quality assurance submissions being provided by SDUC.

NSL Non Urgent Patient Transport – Assured (February 2015) - Work continues with the provider to ensure all quality requirements are fully reported to CQRM. Two vehicles had been vandalised. Both vehicles were repaired on the same day and no further such incidents have occurred. Incident reports were discussed with provider and future requirements have been outlined. At future CQRMs the provider will supply an incident report in line with contractual requirements. No infection control incidents to be reported.

It was reported that one of the Ward Sisters at Cannock Chase Hospital had difficulties in booking transport. NSL has confirmed that the booking should be taken and then clarification should be sought. Guidelines will be developed for use by NSL to ensure compliance. It was also noted that Orthopaedic work will transfer from Royal Wolverhampton Hospital to Cannock Chase Hospital next month, which will impact on journeys to and from the Wolverhampton area. Commissioners are currently looking at the impact of this on the South Staffordshire service. Eight complaints had been received since 1 July 2014. Five related to delays in being picked up or long journeys, one fall, one crew refused to wait for patient and one around uncomfortable transport.

NSL in South Staffordshire has been piloting a new method of securing meaningful patient feedback on their services, an area that has been lacking in recent reports. The new process involves the provider telephoning 50-60 randomly selected patients to ask them about their experience. Further patient satisfaction surveys have been undertaken in October and November. Recurring incidents/issues/suggestions from patients are used to review and improve service provision. Overall the patients are very happy with the service provided and have commended the drivers for being very friendly, helpful and courteous. The provider will be adding a further column to their reporting to indicate what action they have taken as a result of patient feedback, where appropriate. As patient experience intelligence is built up over time, the provider will be in a position to give an overview of action taken in respect of recurring themes. In addition, the provider is planning to ask the Friends and Family Test question in respect of recommending the service. A further column detailing percentage of patients telephoned against activity levels will also be provided.

It was noted that Hixon staffing levels are satisfactory but the Burton area is struggling with recruitment. This is managed internally but can create difficulties when demand increases from BHFT. The provider is monitoring this carefully and collates any concerns to be raised with

commissioners and BHFT. The provider has been asked to provide a regular workforce report detailing vacancy rates, appraisals, training, etc.

Prime-care –As reported previously the next scheduled CQRM is due to take place on the 31st March 2015. Assurance has been requested from the Lead Commissioner however to date no response has been received.

Conclusion

The JQC discusses and agrees the level of assurance for each provider at each committee meeting based on data and information received and actions taken by the quality team related to each provider and all aspect of patient safety and quality. The discussion at JQC includes a discussion about the quality and safety of all commissioned services. As previously highlighted, the Committee concluded that all provider services are safe and therefore no additional immediate action was required in respect of safety. Where it was agreed that the quality issues highlighted above require further action these are raised with lead commissioners as part of the routine quality and performance monitoring activity.

It is important to highlight the concerns detailed within this report relation to firstly HEFT, the Trust have addressed majority of the issues contained within the MONITOR Improvement Programme. Further assurance has been gained and the Trust is sharing the planning and actions from the Improvement Programme. Actions include aspects of Silverman Report (Mortality) - Actions incorporated into the report and include an overarching improvement plan through the Trust Quality & Risk Committee which will be reviewed by the CQRM at the March 2015 and measured against the Plan. The Joint Quality Committee were concerned with the particulars of the enforcement undertaking. Some assurance has been gained through CQRM, but the Joint Quality Committee felt there needed to be further challenge around the trust response to the enforcement letter, and considered escalation. The Quality Improvement Manager will produce a comparison of Trust actions against the MONITOR concerns to give greater oversight. The SES & SP CCG Accountable Officer write to the Accountable Officers for Solihull CCG & Birmingham Cross City CCG to raise the concerns. The Chief Nurse & Director of Quality will discuss the issues with the CQC.

Secondly that, whilst overall satisfaction has been maintained on Burton Hospital Foundation Trust services the committee continue to be concerned about the number of Slips, Trips and Falls. The Governing Body is asked to record that the East CCG Accountable Officer has been requested to take action on regarding Falls at BHFT.

It has been noted within the report stronger links between quality and performance is continuing to strengthen with the evolution of internal reporting, enabling the CCG Governing Body to remain informed of key developments and areas of concern with all providers.

REPORT END

REPORT TO THE SOUTH EAST STAFFORDSHIRE & SEISDON PENINSULA CLINICAL COMMISSIONING GROUP GOVERNING BODY To be held on: Wednesday 25th March 2015

Agenda Item No: 10 Subject: CCG Assurance Framework Lead Director: Heather Johnstone, CCG Chief Nurse and Lead for Risk Management Lead Officer: Rob Boland, Governance Manager Author: Rob Boland, Governance Manager Recommendation: For For Approval For Assurance √ (Please tick) Discussion

Purpose of the report: This report provides the Governing Body with information about the most significant risks currently facing the organisation.

Key Points: All clinical risks with a current score of 12 or higher and all non-clinical risks with a current score of 15 or higher are included on the CCG Assurance Framework. These risks have been reviewed by both individual Risk Owners and the CCG Risk Group. The narrative for each risk describes:

 Which CCG Corporate Objective the risk is most closely aligned to  A detailed description of controls that are in place to mitigate each risk  A detailed description of how the applied controls provide assurance that each risk is being mitigated  Details of any gaps in either the controls or assurances for each risk.

The attached document shows the risks currently included on the Assurance Framework. A brief summary of the current situation for each of the risks is as follows:

Clinical risks Service Quality at Heart of England Foundation Trust (HEFT) Concerns have been noted regarding the collection and standard of quality data at the Trust, particularly in regards to mortality and cancer waiting times. Concerns have been raised with the lead commissioner(s) (previously Solihull CCG, now Birmingham Cross City CCG).

The CQC visited the Trust in December 2014 and remained on site for 3 days. A CQC risk review is now underway and the CCG has been invited to take part in this.

The Joint Quality Committee has expressed only limited assurance with regards to HEFT for several consecutive months and agreed in March 2015 to formally escalate identified concerns to the Governing Body.

The CCG remains engaged with the lead commissioner and CQRMs in efforts to address the identified concerns. The CCG has also been actively involved in the quality aspects of contract negotiations for 2015/16 and has played a key role in setting KPIs etc.

regarding the quality of services at DGH. The lead commissioner (Dudley CCG) has been made aware of these concerns through a formal letter to the Chief Nurse and further escalation includes discussion with the NHS England Area Team.

The CQC report resulting from a recent visit to the Trust has now been received by the CCG; the report reflects the concerns previously raised by the Joint Quality Committee.

SES & SP CCG is now assured that Dudley CCG (the lead commissioner) is applying appropriate challenge to the provider.

Dudley CCG and CSU will soon take over responsibility for the reporting of Quality Data relating to DGH. It is anticipated that this should result in improved availability and standards of data.

Assurance has been received regarding the imminent departure of the Chief Nurses at both DGH and Dudley CCG. Both organisations have clear plans in place to recruitment replacements in a timely manner.

Continuing Healthcare (CHC) Concerns have been raised with regards to CHC services presenting both a quality and financial risk to the CCG.

The CCG Turnaround Director has been engaged in efforts to address the financial elements of this risk, including regular attendance at a pan-Staffordshire group to address these concerns, this work has revealed that the potential financial impact on the CCG may not be as bad as first feared.

The Quality elements of this risk are being addressed through work with the lead commissioner and the CCGs Chief Nurses have met to discuss this on several occasions. The transformation team is involved in detailed discussion linking Dementia Strategy to CHC management of procurement of care.

Due to the number of patients locally and the length of time it is taking to resolve the issues, particularly the backlog, this matter has previously been escalated to the Governing Body and monitoring continues through the Joint Quality Committee.

Service Quality at West Midlands Ambulance Service (WMAS) This risk has been added to Assurance Framework in recognition of WMAS performance concerns in the SES & SP area. The CCG’s concerns were raised formally with both the provider and the lead commissioner. In response the CCG Chief Nurse met with WMAS Director of Nursing on February 20th. WMAS DoN also attended the CCG Joint Quality Committee on 11th March and there was agreement to work together to address areas of concern and for the DoN to attend future meetings of the JQC, as required.

Monitoring continues through the Joint Quality Committee and engagement with the lead commissioner.

Non-clinical risks Inability of the CCG to remain within its financial control total for 2014/15. This risk recognises the significant financial challenge currently facing the CCG. Mitigating actions include:

 Creation of a formal financial recovery plan, providing details of where savings will be made and how.  Establishment of a Financial Recovery Group to oversee the recovery processes. The Group meets fortnightly and includes all relevant individuals from the CCG and the CSU. It has delegated authority from the Governing Body to make decisions and hold individuals to account.  Recruitment of a Head of Improvement and a Turnaround Director to provide increased monitoring and impetus for financial recovery.  Redesigning Programme Management functions in the CCG to make them more robust. It is anticipated that this will assist in the delivery of projects and the delivery of QIPP targets.

 The Programme Committee has been formed as a formal sub-committee of the Governing Body, it is expected that this will provide further scrutiny and assistance for the delivery of CCG projects.  Working directly with local provider organisations to address issues of over performance.  Renegotiation of the control total to £16.7m  Working with other CCGs to deliver functions more efficiently.  Engaging with member practices more effectively, providing support to manage urgent care and referrals  Improved collaboration in contracting discussions.  A governance review is being undertaken by Price Waterhouse Coopers in March 2014, this will help the CCG further identify areas to focus on.

The current likelihood score for this risk is 4, this recognises the significant challenges involved in remaining within the agreed control total whilst also reflecting the CCG’s ongoing efforts to address these challenges. The consequence score for this risk is 5, this recognises the magnitude of the risk to the organisation.

Limited CCG influence on contracts for which it is not the lead commissioner This risk relates to the difficulties that the CCG has faced when influencing lead commissioners as they set contracts with provider organisations. Efforts are ongoing to improve collaboration in the setting of contracts.

Risks no longer on the Assurance Framework The Governing Body will note that the following risk which was previously reported no longer appears on the CCG Assurance Framework.

Service Quality at Burton Hospitals Foundation Trust (BHFT) An improvement in both performance and the quality of data provided by BHFT has been noted and in recent months the Joint Quality Committee has been assured with regards to the quality of services at the Trust.

In recognition of the recent assurances regarding the quality of services at BHFT the likelihood score for this risk has been reduced to 2, giving an overall risk score of 8. This means the risk is no longer held on the Assurance Framework and thus will not be routinely reported to the Governing Body. Despite the assurances received it is acknowledged that the Trust remains in special measures and thus the risk remains on the CCG risk register and will be monitored through the work of the Quality team and the CCG’s risk management processes.

Responsible committee name: Risk Group Approved at Committee: Yes, meeting held 23rd February 2015.

Impact Quality implications: Any quality implications will be detailed in the narrative of each risk.

Financial Implications: Any financial implications will be detailed in the narrative of each risk.

Equality impact assessment No required?

Delivering the Strategy How does the Awareness of the risks facing the CCG will allow the organisation to take mitigating recommendation contribute actions and thus reduce any impact on the delivery of the strategic vision. to delivering the CCG Strategic vision?

Recommendations/actions required: The Governing Body is asked to review the content of this report, for their assurance.

1 03/07/2014 110 2 25/11/2014 125 04/11/2014 124 2 26/01/2015 127 Risk ID Date

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SERVICE QUALITY AT DUDLEY The Trust has been subject to the Keogh review, mortality rate reviews and visits from the CQC in recent Responsibility for improving quality lies with As the CCG is not the lead The quality data received from the GROUP HOSPITALS TRUST (DGH): months. CCG staff have been involved in some of this work and follow‐up actions are closely monitored the provider organisatons, however commissioner for the Trust its Trust recently has been inadequate Concerns have been highlighted in both informally and through regular CQRM meetings. comissioning organisations have a ability to influence matters is and thus the CCG cannot currently respect of the standard of overall responsibility to ensure standards are limited, although work with both be assured with regards to the quality of services at Dudley Group Concerns have been noted regarding the collection and benchmarking of quality data at the Trust, improved. CQRM meetings are the primary the Lead Commissioner and quality of services. Hopsitals Trust (DGH). This particularly in regards to mortality. At recent meetings the Joint Quality Committee has not been able to mechanism for fulfilling this responsibility directly with the Trust is ongoing. presents a potential risk to patient gain assurance regarding the quality of services at DGH. The lead commissioner (Dudley CCG) has been and the CCG are actively engaged in these experience and reputational risk to made aware of these concerns through a formal letter to the Chief Nurse and further escalation includes with quality team members in regular both the Provider Trust and local discussion with the Area Team who plan to esclate to the relevant Area Team for the locality in which the attendance. CCGs. Trust sits. A recent CQC report on the Trust reflects the The CQC report resulting from a recent visit to the Trust has now been received by the CCG, the report concerns raised by the Joint Quality 2) Ensure we meet our reflects the concerns previously raised by the Joint Quality Committee. Committee. statutory duties, including CCG committee Heather 123 04/11/2014 3412 11/03/2015 3 4 12 Chief Nurse 23/03/2015 but not limited to financial 236 or sub‐ Yes ↔ Johnstone Quality The lead commissioner now meet regularly with Trust representatives to address specific Quality concerns, An escalation process has now been agreed balance and quality committee the outcomes of these meetings are reported to the CQRM. Representatives from SES & SP CCG are also for the Joint Quality Committee, this improvement. intending to begin attending these meetings. SES & SP CCG is now assured that Dudley CCG (the lead provides a clear structure for reporting commissioner) is applying appropriate challenge to the provider. concerns to the relevant bodies (lead commissioners, providers, CQC etc.) Dudley CCG and CSU will soon take over responsibility for the reporting of Quality Data relating to DGH. It is anticipated that this should result in improved availability and standards of data.

SERVICE QUALITY AT WEST CCG Quality Team has written to WMAS raising concerns formally and asking for a response. CCG Chief Responsibility for improving quality lies with As the CCG is not the lead No gaps identified. MIDLANDS AMBULANCE SERVICE Nurse met with WMAS Director of Nursing on February 20th. WMAS DoN attended CCG Joint Quality the provider organisaton, however commissioner for the service its (WMAS): Significant performance Committee on 11th March and there was agreement to work together to address areas of concern and for comissioning organisations have a ability to influence matters is issues have been identified the DoN to attend future meetings of the JQC, as required. responsibility to ensure standards are limited, although work with both 2) Ensure we meet our including failure to meet targets improved. SES & SP CCG are engaging with the Lead Commissioner and statutory duties, including CCG committee Heather 126 26/01/2015 for responding to urgent ('red') 3412 Monitoring continues through the Joint Quality Committee and engagement with the lead commissioner. the lead commissioner and monitoring directly with the service is ongoing. 11/03/2015 3 4 12 Chief Nurse 23/03/2015 but not limited to financial 236 or sub‐ Yes calls and failure to properly quality indicators closely. ↔ Johnstone Quality balance and quality committee investigate serious incidents. CCG Chair has written to the Chair of the lead commissioner (Sandwell and West Birmingham CCG) to raise improvement. concerns.

REPORT TO THE SOUTH EAST STAFFORDSHIRE & SEISDON PENINSULA CLINICAL COMMISSIONING GROUP GOVERNING BODY MEETING To be held on: Wednesday 25th March 2015

Enclosure No: 11 Subject: Sign off of the S75 Agreement to underpin the Better Care Fund (BCF) Lead Director: Rita Symons, Accountable Officer Lead Officer: Rita Symons, Accountable Officer Recommendation: For For For √ (Please tick) Approval Assurance Discussion

Purpose of the report:

The purpose of this report is to seek delegated authority to the Accountable Officer, CFO and Clinical Chair to sign the S75 for the BCF as timescales do not allow the agreement to be made at a public Governing Body meeting.

Key Points: The Better Care Fund totals £105m and is a mix of services commissioned by CCGs, the County Council and, in the case of Disabled Facilities Grants, district and borough councils. It includes some of our core services e.g. General Practice Plus (GPP) and End of Life. For absolute clarity the £105m is money already allocated to existing contracts and therefore is not available for expenditure in any other areas unless we become more efficient.

From the perspective of assurance, this CCG sought confirmation that any delegated arrangements under the S75 did not delegate decision making about models of care or current investment. This confirmation has been received from Andrew Donald and Andrew Burns who are the executive leads for BCF implementation.

There is a draft of the S75 but it is not yet complete. Mills and Reeves (who are our solicitors) are reviewing the S75 documentation currently.

Our share of the £6.9 m cash transfer across Staffordshire is being managed through a separate S256 agreement. In terms of protecting social care and quantifying the benefits realised from this, joint work is going on with the County Council to agree smart KPIs. This is important to the CCG to ensure we can evidence an improvement related to this change and our investment to protect social care.

The timescale requires agreement from CCGs and Staffordshire County Council by the end of April 2015.

Responsible Committee Name: n/a

Approved at Committee: YES/NO Date of Committee:

Impact: Quality The protection of social care should prevent a deterioration of care related to Implications: assessments and care packages. Financial The CCG has planned for transfer of £1.8m to SCC as part of the BCF Plan. Implications: Equality impact YES/NO assessment If YES please give summary: required:

Delivering the Strategy: How does the The Better Care Fund plan is aligned with our CCG strategy . recommendation contribute to delivering the CCG Strategic Vision?

Contribution to delivering the Health & WellBeing (HWB) Strategy: The BCF is signed off by the HWB

Recommendations/Actions required: The Governing Body are asked:

To note this update and agree to delegate authority to the Clinical Chair, Accountable Officer and Chief Finance Officer to sign the final S75 on behalf of the organisation.

Explanation of acronyms used in this report: Acronym Explanation HWB Health and Wellbeing Board.

CFO Chief Finance Officer S75 Section 75 agreement which allows the pooling of funds from health and local government S256 Section 256 agreement which allows the transfer of funds between health and local government BCF Better Care Fund – A national initiative to encourage pooling of resources to deliver transformational change.

REPORT TO THE SOUTH EAST STAFFORDSHIRE & SEISDON PENINSULA CLINICAL COMMISSIONING GROUP GOVERNING BODY To be held on: Wednesday 25th March 2015

Enclosure No: 12 Subject: Finance Report – to month 11 (February) 2014-15 Lead Director: Tim Tebbs, Chief Finance Officer (Interim) Lead Officer: Tim Tebbs, Chief Finance Officer (Interim) Recommendation: For For √ For

(Please tick) Approval Assurance Discussion

Purpose of the report:

 The report provides an analysis of the financial performance of the CCG for the first eleven months of the financial year and the forecast for the year end.  The report is to inform the Committee of the issues and risks with respect to the achievement of a deficit of no more than £16.7m by the year – and the mitigating actions being taken.

Key Points:

 The year to date deficit to month 11 is £15.4m – which is line with the anticipated in-year deficit profile within the financial recovery plan.  The gross unmitigated deficit is £16.7m compared to the £22.3m forecast at month 6. The forecast position reflects an improvement from the unmitigated forecast at month 10 of £1.5m, largely due to confirmation of the brokerage with Birmingham Cross City and Walsall CCG.  Whilst there continues to be a level of risk to the CCG reporting a deficit of no more that £16.7m at the end of the financial year – this risk has now substantially reduced. However, it is important to note the very substantial element of non-recurrent measures taken to secure the position.  An assessment of financial risk continues to suggest a downside deficit of around £17.45m – and therefore a risk value of £0.75m. Mitigating actions to this value have been identified.  The in-year FRP identifies savings and mitigations of £5.6m. The forecast assumes delivery of £4.2m – with £3.9m having been secured to-date. A separate report will provide detail on progress.  The cash position is being managed carefully – and plans are in place to ensure that the CCG remains within its authorised cash limit.

Responsible Committee Name: N/a – informal review undertaken by Chair of F&P with Interim CFO & Interim Turnaround Director

Approved at Committee: YES/NO Date of Committee: N/a

Impact: Equality impact YES/NO assessment If YES please give summary: required: A number of financial recovery actions will require an Equality Impact Assessment – which will be undertaken during the development of project plans.

Delivering the Strategy: How does the There is a critical need for the CCG to identify and deliver savings of £5.6m to recommendation achieve financial targets in the current year and to support financial recovery contribute to at the earliest opportunity. delivering the CCG Strategic Vision?

Recommendations/Actions required:

The Committee are requested to:

 To note that a deficit of £16.7m continues to be forecast for the year end – but that the risk has significantly reduced. An assessment of risk gives a value of around £0.75m – and therefore a potential deficit of £17.45m. Mitigations of £0.75m have been identified.

 To note that achievement of a deficit of £16.7m continues to be dependent on delivery of the in-year FRP and management of areas of risk within the overall position.

Enc 11a South East Staffordshire & Seisdon Peninsula CCG Finance Report – to month 11 (February) 2014-15

1. Introduction

1.1 This report provides an analysis of the financial performance of the CCG to month 11 (February) and of the forecast for the year end – together with an assessment of risk.

1.2 The CCG is currently working to a forecast deficit of £16.7m – which is a variance of £7.8m against an agreed control total of £8.9m. The revised deficit has been approved by the Regional Team as part of the in-year Financial Recovery Plan (FRP) sign off process.

2. Overall Summary

2.1.1 The table below summarises the year to date position at month 11 and the forecast for the year. Further explanation is provided in the paragraphs that follow.

YTD Actual YTD Variance Forecast Financial Forecast Forecast actual before recovery actual after variance after recovery actions to be recovery recovery actions delivered actions actions

£,000 £,000 £,000 £,000 £,000 £,000 Revenue Resource Limit 206,576 0 225,486 0 225,486 0

Mental Health & LD 17,044 -1,542 18,455 0 18,455 -1,856 Acute Services 119,806 2,192 130,939 0 130,939 2,542 Prescribing & Primary Care 32,354 -801 35,341 0 35,341 -895 Continuing Care & Complex 16,184 118 17,588 0 17,588 140 Community Services 30,156 -172 32,895 0 32,895 -190 Other Commissioning 2,334 449 2,468 0 2,468 402 Total Healthcare Expenditure 217,879 245 237,686 0 237,686 142

Corporate/Running Costs 4,088 -162 4,500 0 4,500 -142 Total Expenditure 221,967 82 242,186 0 242,186 0 (Surplus)/Deficit 15,391 82 16,700 0 16,700 0

2.1.2 The year to date position is a deficit of £15.4m - which is a decrease of £0.5m from the position reported at month 10. The year to date deficit is in line with the run-rate profile in the approved in-year FRP – and is the position after factoring in the FRP benefits from schemes now secured and other mitigations.

2.1.3 The unmitigated forecast deficit has now reduced from the £18.2m reported at month 10 to £16.7m. This follows receipt of the £1.5m support from Birmingham Cross City and Walsall CCGs via an increase to the revenue resource limit.

2.1.4 Whilst a number of FRP actions remain outstanding – the forecast financial position is not now reliant on delivery of these – other than to provide cover to the risk of deterioration – Page 1 of 7

Enc 11a notably on acute expenditure and prescribing. A crude assessment of these areas suggests that the CCG is still exposed to risk of circa £0.75m. The position moving into 2015/16 is also critically dependent on the ‘run-rate’ cost reduction being in evidence with respect to the in-

2.1.5 Whilst there continues to be a level of risk to the CCG reporting a deficit of no more that £16.7m at the end of the financial year – this risk has now substantially reduced. However, it is important to note the very substantial element of non-recurrent measures taken to secure the position. Whilst non recurrent measures have been taken of necessity to mitigate the very high level of financial risk - financial recovery remains critically dependent on successful delivery of those FRP schemes currently in process – particularly with respect to evidencing the full monthly run rate expenditure reduction of in-year FRP schemes.

3. Review of financial performance by key area

3.1 Revenue Resource Limit (RRL)

3.1.1 The only change to the Resource Limit is the additional £1.5m brokerage from Birmingham Cross City and Walsall CCGs.

3.2 Mental Health & Learning Disabilities

Previous Plan Actual Variance month £000 £000 £000 £000 Year to date 18,586 17,044 (1,542) (916) Forecast – unmitigated 20,311 18,455 (1,856) (1,976) FRP Actions 0 0 0 0 Forecast - mitigated 20,311 18,455 (1,856) (1,976)

3.2.1 The year to date position has improved again (from a £916k underspend to a £1,542k underspend). A breakdown of expenditure by provider is included at Appendix 3. With the majority of expenditure covered by block contract arrangements – there is limited financial risk of any deterioration in the position in the remaining months of the year.

3.2.2 The main components of the FRP affecting mental health expenditure relate to the contract with SSSHFT - and these have now been achieved. Also, the agreed reduction in the contract value for 2014-15 is now factored into the year to date position which explains the improvement from month 10.

Page 2 of 7

Enc 11a 3.3 Acute Services

Previous Plan Actual Variance month £000 £000 £000 £000 Year to date 117,614 119,806 2,192 3,433 Forecast – unmitigated 128,398 130,939 2,542 4,044 FRP Actions 0 0 0 0 Forecast – mitigated 128,398 130,939 2,542 4,044

3.3.1 The year to date and forecast variances are based on validation and analysis undertaken by the CSU contract management team. For month 11 financial reporting these are based on month 10 activity returns from providers. These report a year to date over-performance of £2.2m and a forecast over-performance of £2.5m. A breakdown of acute expenditure by provider is included at Appendices 4 and 5.

3.3.2 The ytd and forecast variance have reduced due to the non-recurrent addition of £1.5m to the budget in line with the additional brokerage received from CCGs.

3.3.3 An end of year settlement proposal to Burton has been rejected, with no counter proposal from the Trust. Improvement of the forecast position will still be pursued on both acute and community elements of this contract – through full application of KPI penalties and through challenge of activity over performance.

3.3.4 Agreement has now been reached with Royal Wolverhampton Trust and the agreed figure is included within the forecast position. An end of year settlement proposal is also being taken forward on behalf of the CCG by Dudley CCG within set financial parameters.

3.3.5 The position with private providers has stabilised – with the forecast moving from £446k to £438k. Discussions are being held with the Practices where the growth is evident – but is not expected to have any material impact in the current financial year.

3.4 Prescribing and primary care

Previous Plan Actual Variance month £000 £000 £000 £000 Year to date 33,155 32,354 (801) (771) Forecast – unmitigated 36,237 35,341 (895) (774) FRP Actions 0 Forecast - mitigated 36,237 35,463 (895) (774)

3.4.1 The year to date position is an under spend of £895k. This includes underspends of £122k against central drugs costs and £752k against primary care prescribing. The forecast issued by the NHS Business Authority shows a significant deterioration in the position, but it is felt that this is unreliable. The forecast has therefore been held at the level reported in the

Page 3 of 7

Enc 11a previous month. The slight improvement is due to the receipt of additional income received for flu vaccinations

3.4.2 A range of prescribing savings schemes are being taken forward within the FRP and the overall financial position remains dependent on their delivery to mitigate the risk of deterioration.

3.5 Continuing Care (CHC) and complex cases

Previous Plan Actual Variance month £000 £000 £000 £000 Year to date 16,066 16,184 118 237 Forecast – unmitigated 17,448 17,588 140 76 FRP Actions 0 0 0 0 Forecast – mitigated 17,448 17,588 140 76

3.5.1 The year to date overspend has reduced – and demonstrates that delivery of savings plans for CHC is now largely offsetting expenditure pressures. The return of 60% of the top-slice for retrospective CHC claims - £536k is included within the figures. It remains critical to the overall financial position that the CHC savings plans are fully, if not over, delivered. The Turnaround Director remains closely involved with CHC and in developing plans for improving the management of complex cases.

3.6 Community Services

Previous Plan Actual Variance month £000 £000 £000 £000 Year to date 30,328 30,156 (172) (294) Forecast – unmitigated 33,085 32,895 (190) (336) FRP Actions 0 0 0 0 Forecast - mitigated 33,085 32,895 (190) (336)

3.6.1 The under-performance has reduced from £294k to £172k for the ytd. There is still expected to be an under-performance at year end of £190k due to the stance being taken with Burton Community over MIU follow ups and a challenge with respect to drugs costs.

3.7 Other

Previous Plan Actual Variance month £000 £000 £000 £000 Year to date 1,886 2,334 449 463 Forecast – unmitigated 2,066 2,468 402 560 FRP Actions 0 (1500) Forecast – mitigated 2,066 2,468 402 (939) Page 4 of 7

Enc 11a

3.7.1 The FRP completed action, with respect to CCG brokerage of £1.5m, has been covered within the Acute Services section of the report.

3.8 Corporate expenditure

Previous Plan Actual Variance month £000 £000 £000 £000 Year to date 4,250 4,089 (162) (202) Forecast – unmitigated 4,642 4,500 (142) (96) FRP Actions 0 0 0 0 Forecast – mitigated 4,642 4,500 (142) (96)

3.8.1 There has been a slight improvement in the forecast position, due to the recharge of some costs to Staffordshire council and the Area Team.

3.8.2 Given that the CCG is already operating at circa 10% below its running cost limit the additional expenditure commitment to financial recovery will not result in a breach of its running cost allowance – however the additional cost does need to be managed within the revised control total deficit.

3.9 Savings and mitigations

3.9.1 The in-year FRP sets out savings and mitigations of £5.6m. The main areas of savings are set out in the table below – with further detail on progress to be provided in a separate report on financial recovery.

Area for savings & mitigations FRP Value Value Risk Value secured to assumed in (RAG) date Forecast £000 £000 £000 Practice led initiatives – demand related 488 0 50% Practice led initiatives – prescribing 432 85 85 50% Other demand related initiatives 251 0 50% Continuing healthcare 440 0 0% Acute contract challenges 560 322 560 75% Non acute contract challenges 250 325 325 100% Strategic agreements & brokerage 3,000 3,000 3,000 100% Other initiatives 183 200 200 100% Total 5,604 3,932 4,170

3.9.2 The value of savings secured to date has increased from £2,588k at month 10 to £3,932k at month 11 £2,432k– which reflects the confirmation of CCG brokerage now secured. The value assumed within the forecast has increased marginally to £4,170k – which reflects only those areas where the benefit has been secured, or there is a high level of confidence to them being secured. Clearly this suggests an overall underachievement against the plan of Page 5 of 7

Enc 11a £1.4m – with this shortfall now being covered by mitigating actions which were not part of the FRP. This presentation reflects a cautious approach – which is in the context of financial risk management of the year end position. However, it is still anticipated that further benefits will be evidenced against those schemes where no benefit is assumed in the position to mitigate the risk of any deterioration.

4. Assessment of financial risk

4.1 The level of risk to securing a deficit of no more than £16.7m has reduced substantially – largely through brokerage arrangements with CCGs having been confirmed, and a negotiated reduction of £1m on the SSSFT contract. However – there remains a level of risk principally with respect to deterioration on acute contracts and prescribing. The level of risk is estimated at £0.75m – and requires continued pressure on in-year FRP schemes together with additional mitigations.

4.2 Mitigations continue to include pursuit of end of year settlements where possible. The CCG has also been advised of potential funding available to offset the costs of offender healthcare. These mitigating actions are alongside on-going challenge and scrutiny of all areas of expenditure – particularly for areas where services invoiced outside of formal contract arrangements.

5. Operational finance

5.1 Better Payment Practice

5.1.1 The CCG has a requirement to ensure that 95% of its bills are paid within 30 days and Appendix 12 shows the current performance of the CCG.

5.1.2 The CCG is failing on the basis of both total numbers and total value of invoices paid, although we are achieving the indicator for value of NHS invoices paid.

5.2 Cash

5.2.1 A cash flow analysis in Appendix 13 shows the monthly draw down of cash by the CCG. The majority of payments are contractual payments made in the middle of the month to provider Trusts. The CCG needs to be very vigilant in monitoring cash flow given the fact that a deficit is being forecast.

5.2.2 The CCG has now received confirmation that its estimated cash requirements, in the context of a £16.7m deficit, will be met – and cash plans are in place which demonstrate that all cash payments can be met when they fall due.

Page 6 of 7

Enc 11a 5.3 Statement of Financial Position

5.3.1 The Statement of Financial Position (SOFP) in Appendix 14 is a summary of the financial balances of the CCG as of the end of month 10.

6. Recommendations

6.1 The Committee is requested to:

 note the improvement in the unmitigated forecast deficit – which is now £16.7m compared to the £22.3m forecast at month 6 – after factoring in the net impact of additional expenditure pressures and benefits received – and FRP of £4.2m secured to date and further mitigations of £1m.  note that achievement of the control total deficit of £16.7m is still dependent on mitigating the risk of deterioration from the current position – with an estimated risk of £0.75m needing to be managed. This level of risk mitigation is expected to be provided through end of year settlements, improvement in FRP scheme delivery from prescribing and practice visit schemes, and through securing non-recurrent funding relating to offender health.  note that achievement of the deficit target will be predominantly through non- recurrent means. It remains critically important to ensure existing FRP schemes deliver the expected recurrent run-rate reduction in expenditure to ensure the benefit assumed in the 15/16 financial plan is secured.

Tim Tebbs

Interim Chief Finance Officer

10th March 2015

Page 7 of 7

REPORT TO THE SOUTH EAST STAFFORDSHIRE & SEISDON PENINSULA CLINICAL COMMISSIONING GROUP GOVERNING BODY To be held on: Wednesday 25th March 2015

Enclosure No: 14 Subject: PMO Assurance Report: Delivery of Ops Plan Lead Director: Anna Hammond, Chief Operating Officer Lead Officer: Tim Cullinan, Senior Programme Manager Recommendation: For For For  (Please tick) Approval Assurance Discussion

Purpose of the report: To provide assurance of the CCGs delivery of its Operational Plan for 2015/16 and in doing so delivery of in year savings.

Key Points: This report was presented at the CCG Programme Committee on 18/03/2015. A number of actions were approved during the course of the meeting as a result of discussing this report.

Projects updates provided for February 2015 describe the majority of projects as on track, or off- track but recoverable (17 Green, 15 Amber). Only a small number of projects (6), are currently off track with an intervention required, however half of these (OPFU, MIU FUs & UCC) are large projects with significant savings associated. As a result of this the overall level of assurance that the financial and performance benefits described in operational plan will be delivered in 2015/16 is limited.

Programme 1: Ageing Well Overall the projects (Stroke, Continence, Case Management, Care Homes,) are described as on track to deliver the financial and performance benefits with the exception of Dementia Diagnosis Rates (Exception report tabled in this meeting).

Programme 2: Every Interaction Adds Value There are concerns with 2 projects in this programme; OPFU; The reduction isn’t currently in provider contracts, Telemed Cardiology– Small delays to delivery of savings. Actions have been undertaken in the Realising Effective Referral Management project however work is ongoing to provide assurance around delivery of the project outcomes. Effective prescribing projects, Wound healing, Faecal Calprotectin are reported to be on track.

Programme 3: Joined UP Services There is very limited assurance around the delivery of this programme, the majority of projects are either reported as off track or there has been no formal update (meaning there has been no exception reporting). An immediate requirement of the committee is to ensure leads are confirmed and roles and responsibilities clarified in this programme to ensure project delivery. Particular areas of concern are the lack of agreement with BHFT around UCC local pricing and a recent audit which has found that removal of all MIU FU activity may not be appropriate.

This is the first iteration of the monthly report and therefore feedback on both content, level of detail, and presentation would be appreciated.

Responsible Committee Name: Programme Committee

Approved at Committee: 18/03/2015 Date of Committee: 18/03/2015

Impact: Financial Impact The delivery of the financial savings within the Operational Plan is of upmost importance to the CCG. Quality Impact Whilst this summary report has no direct quality impact, each project undergoes Quality Impact Assessment as part of its approval. Equality impact No assessment If YES please give summary: required:

Delivering the Strategy: How does the recommendation The delivery of the Operational Plan enables the delivery of contribute to delivering the CCG the CCGs strategic vision. Strategic Vision?

Contribution to delivering the Health & WellBeing (HWB) Strategy: The goals of the Operational Plan are aligned to the HWB strategy.

Recommendations/Actions required: Governing Body are asked to: 1. Note that this is the first iteration of the PMO Assurance Report, and will be further developed, any feedback on the content, level of detail, and presentation would be appreciated. 2. Provide any feedback on the updates provided.

Explanation of acronyms used in this report: Acronym Explanation OPFA Outpatient First Appointment OPFU Outpatient Follow Up MSK Musculoskeletal MoM Map of Medicine PMO Programme Management Office OP Outpatient COPD Chronic Obstructive Pulmonary Disease FOT Forecast Outturn POLCV Procedures of Limited Clinical Value CHC Continuing Health Care

PMDoc9 PMO Assurance Report: Delivery of Ops Plan

Document Purpose: To provide assurance of the CCGs delivery of its Operational Plan for 2015/16 and in doing so delivery of in year savings.

The following assurance report seeks to describe and provide an update on the CCGs programmes of work and their constituent projects, as illustrated in the CCG plan on a page above. The report is split into 4 sections, one for each programme and a summary section. Each section focuses on the key measures for each programme (as described above), providing an update on the progress against the overarching cumulative measure and the projects that contribute to it (e.g. OPFA

reduction delivered by MSK, Realising Effective Referral Management, Telemed Cardiac Monitoring and Faecal Calprotectin). The report also provides PMO updates that include details of any project exceptions, approved change requests, new or closed projects.

Programme One: Ageing Well Goal: People will maximize their potential in older age, manage the impact of their disease & feel safe / supported in times of crisis.

1.1 KPI 1 – Reduce Non-Elective Admission (639 fewer saving £1,316,380) Projects contributing to the reduction; Case Management, End of Life, Dementia, Care Homes, Urgent Care Centres and POLCV

The graph below details the CCGs previous level of spend, planned spend (as per the Unify submission) as the year progresses actual performance will also be included. NB The planned reduction is inclusive of growth of 2.5% (581 attendances) leading to a net reduction of 58 attendances.

Non-Elective Admissions Narrative to explain performance vs planned, including any factors £4,500,000 that may have led to any increases £4,000,000 or decreases, to be included once £3,500,000 the data is available. £3,000,000 £2,500,000 £2,000,000 £1,500,000 £1,000,000 £500,000

£0

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Jan-15 Jan-16

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Apr-14 Apr-15

Sep-14 Feb-15 Sep-15 Feb-16

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2014/15 Actual 2015/16 Plan 2015/16 Actual (EXAMPLE)

Projects to reduce Activity Activity £ On £ Reduction Activity NEL Admissions Overview Issue Reduction reduction Reduction £ FOT Track Plan FOT (Lead/Sponsor/CD) Plan Actual Actual Case Management Case mange 2% of Pop; 20% of those case Yes None 463 763,685 (JW/FS/VR) managed will have 1 fewer NEL per year End of Life Implement the EoL strategy; 10% reduction Yes None 23 71,045 (JW/SF/SG) in NELs ending in death in hospital Increased Diagnosis and improved support; Dementia 33% reduction in NEL for patients with a Yes None 34 89,240 (JW/SF/SG) primary or secondary diagnosis of dementia Care Homes Implement the Care Home Strategy; 10% Yes None 87 207,758 (JW/HJ/SG) reduction in NELs from care homes Urgent Care Patients currently seen in A&E and admitted Centres (NEL) seen at MIU instead and therefore not Under negotiation NA 100,231 (TBC/CA/JJ) admitted (117 BHFT / 155 GH) Patients on waiting list for POLCV (NEL) Harmonisation of POLCV across South Staffs POLCV will still be seen 32 84,421 (CB /CB/TBC) & RWT reducing savings by approx. £100k (across all PODs) Total 639 1,316,380

700 Narrative to explain performance Non-elective Admissions reductions, by project (actuals to be included in year) vs planned, including any factors 600 that may have led to any increases or decreases, to be included once 500 the data is available. 400

300

200

100

0 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Case Management End of Life Dementia Care Homes POLCV - NEL Impact

1.2 KPI 2 – Implement Case Management (Target 2% of CCG Population)

Cumulative number of Case Managed Pateints No. of pts Case Managed Target No current concerns; the project Target: 2% of CCG Pop = 4200 lead is confident the target of 2% will be achieved.

3042 2816 2939 2524 2678 2235 2001 2087

Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15

1.3 KPI 3 – Increase Dementia Diagnosis Rate (Target 67%)

Dementia Diagnosis Rate Dementia Diagnosis Rate Target Concerns around achieving the Target: 67% nationally mandated target of 67% diagnosis rate. Exception Report 52.81 tabled in this meeting. 49.9 51.85 45.86 45.66 46.94 46.6 45.62 46.85 47.58

Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15

1.4 KPI 4 – Reduce Proportion of Deaths in Hospital (Target maximum rate of deaths in hospital of 45%) [Awaiting Data from JW]

1.5 Other Ageing Well Projects Project Overview On Track Issue Financial Impact (Lead/Sponsor/CD) This is likely to be an additional financial Stroke Clearly defined, quality-led pathway for stroke patients Yes None pressure for the CCG. (CH/FS/VR) (including suspected strokes) for South East Staffordshire. The financial impact of this is still TBC.

1.6 PMO Update: 1.6.1 Project Exceptions; Dementia Diagnosis Rate – Exception report to be discussed in the meeting. POLCV – South Staffordshire harmonised POLCV policy agreed across all providers to be managed via Blutech, to be implemented in year. It has been agreed that patients currently on the waiting list for POLCV will still be treated, this is likely to reduce in year savings by approximately £100,000 across all PODs. Urgent Care Centres – Currently under negotiation (further update required)

1.6.2 Project Developments (e.g. out to procurement / Spec Written) Care Homes; Funding secured from Area Team to support with Care Home Pilot

1.6.3 New projects Scopes Approved / Rejected; None

1.6.4 Project Change Requests Approved; None

1.6.5 Project Closures; None

Programme Two: Every Interaction adds value Goal: Patients and Clinicians will have confidence that their time is used effectively & every pound of NHS funds spent adds value.

2.1 KPI 1 – Reduced OP Firsts (7,695 Fewer saving £1,471,610) Projects contributing to the reduction; MSK, Realising Effective Referral Management, Telemed Cardiac Monitoring and Faecal Calprotectin The graph below details the CCGs previous level of spend, planned spend (as per the Unify submission) as the year progresses actual performance will also be included. NB The planned reduction is inclusive of growth of 6% (8,659) leading to a net reduction of 3,998 attendances. Narrative to explain performance 1st Outpatients £1,000,000 vs planned, including any factors that may have led to any increases £800,000 or decreases, to be included once £600,000 the data is available.

£400,000

£200,000

£0

2014/15 actual 2015/16 plan 2015/16 Actual (EXAMPLE)

Project to Reduce Activity £ Activity £ On Activity £ OPFA Overview Issue Reduction Reduction reduction Reduction Track FOT FOT (Lead/Sponsor/CD) Plan Plan Actual Actual Map of Medicine, Peer review, use of Delays in Map of Realising Effective advice & guidance leading to a reduction of Medicine roll out Referral Management 6,690 1,204,266 1 in 10 GP referrals which relates to 1 in 8 Impact of schemes still (EW/CA/TD) OPFA's (the measure used is GP Ref) in development MSK Improved community provision avoids 50% Yes None 981 116,739 (RE/AH/GK) OPFAs Telemed Cardiac Delays by provider Pilot in Seisdon, transfer from secondary to Monitoring No (Broomwell Health) in 480 122,880 primary, expect roll out 1st July (JW/FS/TD&JW) approving Service Spec. Faecal Cal Protectin 30% transfer pathway from secondary to (456) Yes None 27,725 (AHad/EW/TBC) primary care TBC

Total 7,695 1,471,610

2.2 KPI 2 – Reduced OP Follow Ups (14,652 Fewer saving £942,563) Projects contributing to the reduction; MSK, OPFU The graph below details the CCGs previous level of spend, planned spend (as per the Unify submission) as the year progresses actual performance will also be included. NB The planned reduction is inclusive of growth of 2% (2,626) leading to a net reduction of 12,026 follow ups.

Narrative to explain performance Outpatient Follow Ups £1,000,000 vs planned, including any factors £900,000 that may have led to any increases £800,000 or decreases, to be included once £700,000 the data is available. £600,000

£500,000 £400,000 £300,000 £200,000 £100,000

£0

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Jan-15 Jan-16

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OP FUs 2014/15 actual OP FUs 2015/16 plan OP FUs 2015/16 Actual (EXAMPLE)

Project to Reduce Activity £ Activity On £ Reduction Activity OPFUs Overview Issue Reduction Reduction reduction £ FOT Track Actual FOT (Lead/Sponsor/CD) Plan Plan Actual MSK Extension of OPFA avoided (1,308) & 35% Yes None 1,448 101,378 (RE/AH/GK) C2C's avoided (623) OPFU Reduction in OP Ratios across providers No Not in contracts 13,204 841,185 (TBC/AH/GK) across specialities Total 14,652 942,563

2.3 KPI 3 - Reduced Electives (Saving £718,279) Projects contributing to the reduction; MSK, Faecal Cal Protectin, POLCV Project to Reduce Activity £ Activity £ On Activity Electives Overview Issue Reduction Reduction reduction Reduction £ FOT Track FOT (Lead/Sponsor/CD) Plan Plan Actual Actual MSK 10% reduction in activity, pts managed Yes None 60 318,617 (RE/AH/GK) in primary care Faecal Cal Protectin 30% transfer pathway from secondary Yes None 91 44,979 (AHad/EW/TBC) to primary care POLCV Harmonisation of POLCV across South Patients on waiting list for POLCV will still be seen reducing savings by 96 354,683 (CB/CB/TBC) Staffs & RWT approx. £100k (across all PODs) Total 247 718,279

2.4 KPI 4 - Reduced Day Cases (Saving £468,457) Projects contributing to the reduction; MSK, POLCV Project to Reduce Activity £ Activity On £ Reduction Activity Daycases Overview Issue Reduction Reduction reduction £ FOT Track Actual FOT (Lead/Sponsor/CD) Plan Plan Actual MSK Activity transfer to SSOTP at reduced In discussions with the NA 104,267 (RE/AH/GK) cost current provider (SSOTP) Patients on waiting list for POLCV Harmonisation of POLCV across South POLCV will still be seen 350 364,190 (CB/CB/TBC) Staffs & RWT reducing savings by approx. £100k (across all PODs) Total 350 468,457

2.5 KPI 5 - Reduced OP Procedures (Saving £41,959) Projects contributing to the reduction; MSK, POLCV Project to Reduce Activity £ Activity £ On Activity OP Procedures Overview Issue Reduction Reduction reduction Reduction £ FOT Track FOT (Lead/Sponsor/CD) Plan Plan Actual Actual MSK Carpel Tunnel - Activity transfer to Yes None 0 25,253 (RE/AH/GK) SSOTP @ 65% tariff POLCV Harmonisation of POLCV across Patients on waiting list for POLCV will still be seen 201 16,706 (CB/CB/TBC) South Staffs & RWT reducing savings by approx.

£100k (across all PODs) Total 201 41,959

2.6 KPI 6 – Effective Prescribing (Saving £695,500) Projects contributing to the reduction; Dietician, ScriptSwitch, Prescribing Support Care Homes, Integrated Practice Pharmacists and COPD.

NB - Please note that these savings are in year savings only and the recurrent full year effect is likely to be greater (depending on the time of year the switch has been made).

Project to Reduce £ On Metric £ Reduction Metric Metric Prescribing Spend Overview Issue Reduction £ FOT Track Plan Plan Actual FOT (Lead/Sponsor/CD) Actual Dietician Dietician to review patients in care TBC Yes 36,000 (RE/MM/TBC) homes towards food first Reviews ScriptSwitch Point of prescribing support to reduce Yes TBC 105,000 (NC/MM/CP) spend, increase safety Prescribing Behind target but Support - Care Pharmacist full medication review of 900 forecast to make 120,000 Homes patients in care homes Reviews up shortfall (MM/CA/TBC) Integrated Practice Pharmacists in practice undertaking full 3,200 Pharmacists medication reviews of patients on Yes 309,500 Reviews (MM/CA/CP) polypharmacy COPD Specialist nurses to review patients on TBC (Being scoped) COPD medication towards newer GOLD NA 125,000 Reviews (MM/CA/JW&CP) standards Total 695,500

2.7 Other ‘Every Intervention Adds Value’ Projects

Project On Overview Issue Financial Impact (Lead/Sponsor/CD) Track Improved outcomes for Cost modelling proposes that District and Practice Nurse contacts will be eliminated as a Wound Healing patients: Healing Yes None consequence of the service, as patients will be retained within the service for a shorter (CH/FS/VR) rates/recurrence rates duration. The financial impact of this to the CCG is still TBC. Continence Implementation of a dedicated Yes None The financial impact of this to the CCG is still TBC. (CH/MM/ES) nurse-led continence service Educate patients and carers There is a theoretical saving to this work however this is very difficult to measure as Medicines Waste regarding the costs of wasting there is no baseline for current medicine waste. Quarterly snapshot audits will be Yes None (NC/MM/TBC) medicines and only ordering undertaken to see reduction in medicines ordering. This may support achieving the what is needed prescribing budget for 2015/16.

2.8 PMO Update: 2.8.1 Project Exceptions; Prescribing Support – Care Homes; behind target but forecast to make up shortfall in year (exception report produced –awaiting response) Telemedicine Cardiac monitoring; Issues with IG and Provider have meant a one month delay to project start (exception report reviewed and approved at FRG) Realising Effective Referral Management - Soft launch for map of medicine has been agreed due to the potential risk of non-usage if the system is not configured with enough information in it. Delay in launching may reduce savings initially however this may lead to greater savings in the longer term. The impact of the delay and review of financial assumptions is taking place to ensure accuracy of figures. POLCV – South Staffordshire harmonised POLCV policy agreed across all providers to be managed via Blutech, to be implemented in year. It has been agreed that patients currently on the waiting list for POLCV will still be treated, this is likely to reduce in year savings by approximately £100,000 across all PODs. OPFU – Planned reduction are not yet in provider contracts (Further detail required)

2.8.2 Project Developments (e.g. out to procurement / Spec Written) ScriptSwitch - Delivered £25,940 savings in Feb 15 (£5,107) ahead of the monthly target.

2.8.3 New projects Scopes Approved / Rejected; None

2.8.4 Project Change Requests Approved; None

2.8.5 Project Closures;

None

Programme Three: Joined up services Goal: People feel they are at the centre of joined up care

3.1 KPI 1 – Reduced A&E Attendances (11,375 fewer saving £945,829) Projects contributing to the reduction; Urgent Care Centres, A&E Reduction, MIU FUs

The graph below details the CCGs previous level of spend, planned spend (as per the Unify submission) as the year progresses actual performance will also be included.

Narrative to explain performance vs A&E Attendances planned, including any factors that £700,000 may have led to any increases or decreases, to be included once the £600,000 data is available. £500,000

£400,000

£300,000

£200,000

£100,000

£0

A&E attendances all types 2014/15 actual A&E attendances all types 2015/16 plan A&E attendances all types 2015/16 Actual (EXAMPLE)

Project to Reduce Activity £ Activity £ On Activity OP Procedures Overview Issue Reduction Reduction reduction Reduction £ FOT Track FOT (Lead/Sponsor/CD) Plan Plan Actual Actual Urgent Care Centres: MIU local pricing for 14,000 pts Escalated to Meeting local pricing No NA 317,434 attending with minor illness 17.3.15 (TBC/CA/JJ) Urgent Care Centres: Transfer of 5,988 attendances at Price Differential Queens (1,918) & Good Hope (4,070) to Under negotiation NA 175,751 (TBC/CA/JJ) MIU at lower cost. MIU Follow Ups Transfer of activity from secondary to Audit indicates some No 4,756 285,330 (HB/FS/SZ) community MIU FU is required Urgent Care Centres 2% reduction in people attending A&E – Activity Reduction TBC No Update provided 205 18,018 (at MIU Rate) (TBC/CA/JJ) A&E Reductions – All 2% reduction in people attending A&E Centres (at Combined HRG cost) plus frequent TBC No Update provided 1,316 95,880 (HB/EW/VR) flyers attending 10% less A&E associated with Concern with A&E NEL avoided By-product of NEL schemes 607 53,417 Impact of CM (JW/Various/TBC) Total 11,375 945,829

3.2 KPI 2 –Improved IAPT Access Rate to 15.5% The Wellbeing Matters Service was implemented on 1st October 2014. Based on actual activity (and projected activity for February and March) within both the previous (in-house counsellors) and current service(s), the CCG will achieve 11.25%. Noteworthy, based on an average rate of people entering the SES and SP service over the last 3 months, the CCG would have achieved 15.68%, had the Wellbeing Matters Service been implemented from the 1st April 2014. It should be noted that the actual figures cited above, will not be reflected on the national reporting system, as quarter 1 of 14/15 were not captured due to system restrictions.

3.3 KPI 3 – Improved IAPT Recover Rate to 50% The information required to calculate the recovery rates is a local information requirement of the Wellbeing Matters service. Historically SSSFT submitted reports, which contained the information requirement “The number of people who have completed treatment (minimum 2 treatment contacts) during the reporting quarter” for both the SES and SP locality IAPT compliant services. However, this specific information requirement is no longer submitted via the contracting mechanisms. In light of this the CCG has contacted the contracting team at SSSFT, to ascertain this information, and seek clarification on why this reporting has stopped. SSSFT are not currently able to provide an estimation on how long this information will take to provide, however, it is anticipated that SSSFT will provide an ETA by COP 13.3.15.

3.4 Other ‘Joined up Services’ projects Project On Overview Issue Financial Impact (Lead/Sponsor/CD) Track Children’s Information Handbook and online version of minor Delay caused by other CCGs delayed Savings now counted within the A&E Advice & Guidance No childhood illness guide decision whether to fund or not Reduction figures (RC/AH/SZ) Continuing Health Care Reduction in cost of care placements Yes None £460,000 Saving planned (CA/CA/TBC) Better Care Fund CCG Share of BCF performance fund Analysis of savings being undertaken £250,000 Saving (Risk adjusted) planned (CA/CA/TBC) SSSFT Complex Case Reduction in cost of care placements Yes None £198,000 Saving planned (CB/CB/TBC) Lucentis Harmonisation of drug process at RWHT No Provider rejected initial proposal £108,000 Saving planned (PR/TBC/TBC) Total £1,016,000

3.5 PMO Update:

3.5.1 Project Exceptions; Urgent Care Centres – Currently under negotiation (further update required) MIU Follow-Ups –Initial findings from audit of MIU departments (SRP & SJCH) indicate not all follow up activity can removed - Exception report due A&E Reduction – Update required Children’s Information Advice & Guidance - Project delayed due to waiting on decisions from other CCGs to fund. Lucentis – Provider rejected initial proposal

3.5.2 Project Developments (e.g. out to procurement / Spec Written); None

3.5.3 New projects Scopes Approved / Rejected; None

3.5.4 Project Change Requests Approved; None

3.5.5 Project Closures; None

4. Overall Summary

Activity Projects reported Overall Programme KPI £ reduction Issues Reduction as On / Off Track RAG Urgent Care Centres – Under negotiation Non-Electives 639 £1,349,790 4 2 POLCV - Patients on waiting list for POLCV will still be seen reducing savings Ageing by approx. £100k (across all PODs) Well Case Management (2%) NA NA 1 Dementia Diagnosis (67%) NA NA 1 Not on Track to Achieve 67% Deaths in Hospital (45%) NA NA 1 Death in Hospital Data not available R.E.R.M - Delays in Map of Medicine roll out OP Firsts 8,182 £1,551,483 2 1 1 Impact of schemes still in development Telemed Cardiology - Delays on the provider (Broomwell) side OP Follow Ups 15,959 £976,355 1 1 OPFU – Not in provider contracts POLCV - Patients on waiting list for POLCV will still be seen reducing savings Every Electives 247 £718,279 2 1 by approx. £100k (across all PODs) Interaction POLCV - Patients on waiting list for POLCV will still be seen reducing savings Adds Value Daycases 350 £503,212 2 by approx. £100k (across all PODs) MSK - In discussions with the current provider (SSOTP) POLCV - Patients on waiting list for POLCV will still be seen reducing savings OP Procedures 201 £50,376 1 1 by approx. £100k (across all PODs) Effective Prescribing NA £695,500 3 1 Care Homes - Behind target but forecast to make up shortfall Urgent Care Centres: Price Differential – Under negotiation Urgent Care Centres: Activity Reduction – No update provided Reductions: All A&E Centres – No update provided A&E 12,940 £1,116,228 4 2 A&E associated with NEL avoided – Concern with A&E reduction under delivery vs plan in CM Joined Up UCC: Local Pricing – Escalated to Meeting 17.3.15 Services MIU FUs - Audit indicates some MIU FU is required IAPT Access Rate (15.5%) NA NA 1 IAPT Recovery Rate (50%) NA NA 1 IAPT Recovery – Data TBC BCF – Analysis of savings being undertaken Other NA £1,016,000 2 1 1 Lucentis – Provider Rejected initial proposal Total 38,518 £7,977,223 17 15 6

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EAST STAFFORDSHIRE CCG AND SOUTH EAST STAFFORDSHIRE AND SEISDON PENINSULA CCG JOINT QUALITY COMMITTEE

Wednesday 14th January 2015, 1.00pm, Holiday Inn, Burton on Trent

Present: Alex Fox (AF) Lay Member for Quality Assurance (SES&SP CCG) (Chair) Heather Johnstone (HJ) Chief Nurse (ES CCG/SES&SP CCG) Rosemary Crawley (RC) Lay Member Patient & Public Involvement (SES&SP CCG) Ann Tunley (AT) Lay Member Patient & Public Involvement (ES CCG) Dr Liz Gunn (LG) Clinical Lead (ES CCG) Mike Chester (MC) Secondary Care Consultant (ES CCG) Mark Seaton (MS) Strategic Lead for Medicines & Decision Support (South Staffordshire CCGs) Sue Wilson (SW) Clinical Quality Improvement Manager (ES CCG) Nigel Williams (NW) Clinical Quality Improvement Manager (SES&SP CCG) Arrived at 2.35 pm Steve Forsyth Adult Safeguarding Lead (SES&SP CCG) Sue Bamford (SB) Head of Medicines Optimisation (ES CCG) Arrived at 1.45 pm Jackie Derby (JD) Head of Infection Prevention & Control (Staffordshire Health Economy)

In Tracey Finney (TF) Administrator attendance: Allison Cary (AC) Communications Manager (SES&SP CCG) Caroline Parmenter (CP) Communication & Engagement Assistant (SES&SP CCG) David Brewin (DB) Patient Relations Manager (CSU) Agenda Item 6 Katie Adams (KA) Insight Analyst (CSU) Agenda Item 6

AGENDA MINUTES ACTION ITEM NO 1. Welcome and Apologies

Apologies were received from: Dr Adrian Parkes (AP), Katie Montgomery (KLM), Colette Marshall (CM), Paul Winter (PW), Rob Boland (RB), Debbie Vucetic (DV), Fleur Fernando (FF), Judy Bird (JB), Lynne Smith (LS)

AF joined members in congratulating SF on his appointment as Head of Quality and Nursing. SF will formally take up post on the 2nd of February 2015.

2. Declaration of Conflicts of Interest None were declared.

Quoracy The meeting was agreed as being quorate.

3. Minutes of the Previous Meeting held on the 10th of December 2014

The Minutes of the meeting held on 10th of December 2015 were agreed as a true and accurate record with the following amendments: 1

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AT was recorded as both at the meeting and having given apologies. AT confirmed she did attend the meeting.

Initials RS to be amended to RC throughout the minutes.

4. Actions from the Previous Meeting held on the 10th of December 2014

Action sheet updated as attached.

5. Patient Engagement

SES&SP CCG Patient Engagement – Patient Opinion AC presented a report on Patient Opinion on behalf of FF. The Joint Quality Committee were asked to approve the following recommendations/actions:

 Does not subscribe to Patient Opinion but promotes and utilises the existing mechanisms more effectively. Members APPROVED this recommendation.

 Publish the results of the Friends and Family Test from our GP Practices on our website, and possibly include the results from our providers. HJ informed members that information is already widely available via web-links. Consideration to be given by AC/FF on how these might be accessed.

 Continue to review feedback on Patient Opinion without a subscription. Members APPROVED this recommendation.

 Review contract with CSU with regard to Patient Opinion to ascertain current subscription. CA confirmed that this action was proposed by KLM. HJ asked AC/FF to ensure the Quality Team were involved in any discussions.

 Advise providers who are currently not using Patient Opinion to sign up to the website’s free version, enabling them to respond to feedback submitted via Patient Opinion. HJ advised that the majority of providers already access Patient Opinion, however AC/FF were asked to advice the Quality Team of any providers they believed were not doing so.

SES&SP CCG Patient Council update Members noted the report from the Patient Council in SES&SP CCG produced by RC.

Members’ attention was drawn to the patient story from Good Hope Hospital. This story has now been uploaded on to NHS Choices and referred to HealthWatch. NW NW to raise this at the next HEFT CQRM.

ES CCG Patient Board update Members noted the report from the Patient Board in ES CCG produced by AT.

Members were informed that from April 2015 GP practices are required to host Patient Participation Groups. Six practices in ES CCG were offered support by Patient Board members, however only one took up the offer. The other five 2

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practices will be contacted again in April 2015.

6. Complaints, PALS and Soft intelligence

David Brewin (DB), Patient Relations Manager and Katie Adams (KA) Insight Analyst, attended the meeting to present the Complaints, PALS and Soft Intelligence report.

The report highlights those services which have received more than one complaint in the current quarter. Members were assured that those services will be monitored going forward into the next quarter. The report now includes a lesson’s learnt section. HJ asked members to be aware that it is not necessarily the number of complaints that is important, but the implications of the content of the complaints. DB stated the Complaints Team would be willing to provide additional information on any individual cases.

DB informed the committee that he had recently been appointed to the post of Patients Relations Manager and highlighted some of the priorities planned for the next quarter including quality review of closed cases against Patient Association standards and complainant satisfaction.

Specific social media complaints are not currently included and could be an area for development. HJ reported that providers have their own systems for picking up social media complaints, and Quality Leads need to ensure these are challenged at the CQRMs.

Members were assured by DB that any MP or complaint letters sent directly to CCGs are recorded and passed on to the Complaints Team for investigation and reporting.

The committee discussed whether separate reports for each CCG should be received or whether an amalgamated report would be preferred. Members indicated that they would prefer to see separate information for each CCG however it would be helpful if the information could be presented side by side in one document.

AF suggested that the report be presented to the two Patient Council meetings. KA suggested that the report would need to be revised to remove some of the personal details from the complaints. RC stated that it would be more helpful for Patient Council members to feedback on the quality review of closed cases report when this has been developed.

HJ and DB agreed to meet, with other core members, outside of the meeting to HJ discuss the points raised today and any areas for future development.

KA and DB left the meeting at this point.

7. Quality Surveillance Group

HJ informed members that there had been no meeting held in December 2014. The next meeting is scheduled for the 26th of January 2015 and will be led by the new

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Area Team Director, Wendy Saviour.

8. Medicines Management update

Strategic Medicines Management Report Members were asked to note that the list of meetings on the front cover sheet should have included the Staffordshire and Shropshire Health Economy Infection Prevention and Control meeting.

Members discussed the reduction in reporting from GPs related to Controlled Drug incidents since the dissolution of PCTs, as highlighted in the report. All healthcare professionals are required to report any concerns, however reports from GPs have declined to almost zero since the change in reporting arrangements to the Area Team. This has been raised as an issue previously with the Area Team and they are investigating. Members were concerned about the lack of reporting with LG stating that she felt GPs were not aware of how or where to report issues. MS agreed to MS raise the committee concerns with the Area Team via the Local Intelligence Network. Details of the reporting pathway will be published in the GP newsletters for both ES and SES&SP CCG. Members were assured that pharmacy reporting is still high as their reporting arrangements have not changed; these go to the Local Authority as commissioners of pharmacy services.

ES CCG Medicines Optimisation Report Members noted the report produced by SB.

The report provided the committee with assurance on the three topics set out in the Quality Assurance Framework. The Medicines Optimisation team have put into place a series of actions to address the prescribing issues raised in the report with improvements hopefully being seen in the next set of data.

Members queried whether Public Health England is involved in educating the public with regards to antibiotic prescribing. JD informed members that they do attend the IPC health economy meetings. A work-stream is in place across the whole of Staffordshire led by Shropshire CCGs. A meeting will take place on the 19th of January where patient engagement will be discussed. MS reported that Public Health England had sent out a letter to a random selection of high prescribers of antibiotics with a report due to be published April 2015. MS also queried whether high prescribing is now being raised as part of the GP appraisal and revalidation process. LG replied that it is not currently part of that process. JD confirmed that this had been raised with the Area Team as well as at the recent quality summit held at BHFT. Members agreed that antibiotic prescribing was an area of concern for the committee and agreed to AF’s suggestion of a meeting between MS and HJ MS/HJ to review concerns and options, with a report on recommended actions to be presented to a future Quality Committee.

9. Quality Reports from Key Providers

Staffordshire and Stoke on Trent Partnership Trust (SSOTP) Members noted the Quality Report produced by DV, presented by HJ.

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AF and HJ led members in a debate on the level of assurance for SSOTP, asking that members considered if a decision of ‘Not Assured’ was again taken how could the Quality Committee evidence that it was taking action with the Lead Commissioner or directly with the Trust to address any quality and safety issues. Clear evidence, not only anecdotal concerns, would also be required to support this. HJ assured members that following attendance at the November and December CQRMs, she felt the Trust was taking action to address issues. The Trust is using a workforce toolkit to review staffing and address areas for example where clinical staff could be released from administrative tasks to increase clinical time. Following discussion members concluded that they were satisfied with the clinical delivery of services, however there were significant issues relating to capacity leading to inappropriate delivery of services in both primary care and discharge into the community. HJ and the Quality Team to undertake a review of critical and strategic issues within the HJ/ Trust and present a report and recommended actions as necessary to the SES&SP Quality CCG Management Team and ES CCG Executive Team meetings. This decision to be Team notified to the Governing Bodies of both CCGs.

Members agreed that they were Partially Assured in respect of quality and safety of care at SSOTP.

Burton Hospital (BHFT) Members noted the Quality Report produced by DV, presented by SW.

Members were asked to note that the CQRM had not taken place in January 2015; therefore the report had been produced from papers submitted by the Trust only.

Members highlighted the following points to be raised at the CQRM:

 Slips, trips and falls  Number of incidents relating to transfusions  Increasing use of agency rather than internal bank staff

DV to provide a more detailed analysis of workforce and bank/agency usage in the DV report to the 11th February 2015 committee.

RC highlighted to members that Anna Ward at Samuel Johnson Community Hospital consistently remained as Red or Amber for patient experience. Members agreed that it was important patients were treated equally well at all BHFT sites. DV to raise this at the next CQRM and inform that Trust that the Quality Committee’s DV assurance levels would be downgraded if patient experience on Anna Ward continued to remain a concern.

Members agreed that they were Assured in respect of the quality and safety of care at BHFT

NSL Members noted the Quality Report produced by SW.

NSL have piloted a new system of securing patient feedback on their services, with the data now being reported improving. A Floor Walker is being recruited and will act as liaison between the Wards at BHFT and NSL to ensure that patients are ready 5

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to be discharged and relay any delays in to NSL.

Members agreed that they were Assured in respect of the quality and safety of care at NSL.

South Staffordshire and Shropshire Healthcare NHS Foundation Trust (SSSFT) Members noted the Report produced by KLM and presented by NW.

Members were asked to note that the CQRM had not taken place in January 2015; therefore the report had been produced from papers submitted by the Trust only.

RC queried the Crisis Home Resolution Team breaches. The report stated that 5 breaches had taken place, however only an explanation for three of these was KLM given. KLM to raise with the Trust.

Members agreed that they were Assured in respect of quality and safety of care at SSSFT.

Heart of England Foundation Trust (including Good Hope Hospital) (HEFT) Members noted the Quality Report produced by NW.

Members were asked to note that an abridged CQRM had taken place in December 2014; therefore the report had been produced largely from the papers submitted by the Trust.

Members acknowledged that there had been improvement in the data provided by the Trust including the reporting of mortality data, however there were still areas of concern including:

 A&E performance  Quality of care on the wards at Good Hope Hospital  Communication from the Trust to GP practices  Cancer wait performance  Mixed sex accommodation breaches  Complaints  Falls  MRSA screening

Members agreed that they were Not Assured in respect of quality and safety of care at HEFT.

The Dudley Group of Hospitals (DGH) Members noted the Quality Report produced by NW.

NW assured members that co-operation between DGH and both the lead and associate commissioners had improved. The Trust is now holding monthly mortality meetings and has encouraged associate commissioners to attend. However, there are still issues with the continued lack of timely data and on-going concerns with discharge and IT systems.

NW fed back from the SES&SP CCG Seisdon Locality Board where GP members had 6

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reported no concerns with DGH at the current time and were assured by the information provided by the Quality Team. GP members had been encouraged to raise any issues via soft intelligence.

Members agreed that they had Limited Assurance in respect of quality and safety of care at DGH.

The Dudley Group of Hospitals CQC Report Members received the report produced by NW.

West Midlands Ambulance Service (WMAS) Members noted the Report produced by NW.

Quality concerns have been raised in a letter to the Lead Commissioner, Sandwell CCG, prior to the CQRM to be held on the 27th of January 2015. A full report will be presented to the 11th February 2015 Quality Committee. South East Staffordshire is the worst performing area in the West Midlands for meeting Red 1 and 2 calls. HJ made members aware that Stafford & Surrounds and Cannock Chase CCG act as lead for this provider in Staffordshire; however the Lead Commissioner is Sandwell and West Birmingham CCG. LG raised concerns regarding the number of ambulances sent in response to requests from 111 and the Out of Hours’ service. Members agreed that this needed closer monitoring. NW to contact the Urgent NW Care Team to arrange a meeting to discuss this issue further.

Members agreed that they were Not Assured in respect of quality and safety of care at WMAS.

10. Infection, Prevention and Control Report

This report was presented following Agenda Item 8.

Members were asked to note that the report presented related to the position in October 2014, however based on the current data both ES CCG and SES&SP CCG will exceed their yearly target for C-Difficile. This position has been exacerbated by the reported incidences of Norovirus.

The position for each CCG was given as follows:

ES CCG  No acute cases of MRSA  23 non-acute cases of C-Difficile and 16 acute cases of C-Difficile  Of the RCA’s completed to date 5 cases were avoidable  17 cases of C-Difficile at BHFT against an annual objective of 15, one case was avoidable  1 case of MRSA at BHFT

SES&SP CCG  1 community acquired case of MRSA  No acute cases of MRSA  21 acute cases of C-Difficile and 17 non-acute cases of C-Difficile  No C-Difficile or MRSA cases apportioned from SSSFT year to date 7

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Actions have been put into place for C-Difficile and support and education is ongoing to primary care. A PLT event is scheduled to take place within ES CCG in June 2015, however it is hoped to bring this forward. LG agreed to escalate this to LG the ES CCG Governing Body. A PLT event is also planned in SES&SP CCG. Communication has been sent across the whole of Staffordshire regarding Norovirus and Flu avoidance.

MC, AC and CP left the meeting at this point.

11. Serious Incidents (SI) Combined Report

Members noted the report produced by Janinne Lake (JL), Head of Governance & Compliance (CSU).

LG left the meeting at this point.

12. Joint Quality Committee Sub Group Proposal

HJ asked members to consider the following sub group proposals:

 Quality Working Group. All Quality Leads and SF to meet on a monthly basis to hold detailed discussion and review of provider reports prior to the Quality Committee.  Quality Impact Assessment Review Group. To review and undertake Quality Impact Assessments on behalf of the Commissioning Team prior to presentation at Quality Committee.

Members APPROVED both proposals.

13. Primary Care Quality

No reports presented this month.

Co-Commissioning HJ asked members to be aware of primary care co-commissioning and note the potential risk that this may present with regard to workload and demands associated with the outcomes and impact of co-commissioning.

14. Items To Report To Governing Body

 PLT event Infection Prevention & Control – ES CCG  SSOTP report to be presented to Management Team/Executive Team Meeting – ES CCG and SES&SP CCG  Campaign to reduce antibiotic use – ES CCG

15. Items To Report To Other CCG Committees

 SSOTP report – ES CCG Executive Team/SES&SP CCG Management Team

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16. Items for the Risk Register and Leads Identified

 None

17. Items for escalation to the Area Team

 Reporting of Controlled Drug Incidents by GPS via Local Intelligence Network

18. Any Other Business

None

Date time of next meeting

Wednesday 11th February 2015, Boardroom, Merlin House, Tamworth

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EAST STAFFORDSHIRE CCG AND SOUTH EAST STAFFORDSHIRE AND SEISDON PENINSULA CCG JOINT QUALITY COMMITTEE

Wednesday 11th February 2015, 1.00pm, Merlin House, Tamworth

Present: Lynne Smith (LS) Associate Lay Representative for Quality (ES CCG) (Chair) Heather Johnstone (HJ) Chief Nurse (ES CCG/SES&SP CCG) Rosemary Crawley (RC) Lay Member Patient & Public Involvement (SES&SP CCG) Ann Tunley (AT) Lay Member Patient & Public Involvement (ES CCG) Dr Liz Gunn (LG) Clinical Lead (ES CCG) Mark Seaton (MS) Strategic Lead for Medicines & Decision Support (South Staffordshire CCGs) Steve Forsyth (SF) Head of Quality & Nursing (SES&SP CCG) Debbie Vucetic (DV) Clinical Quality Improvement Manager (ES CCG) Sue Wilson (SW) Clinical Quality Improvement Manager (ES CCG) Katie Montgomery (KLM) Clinical Quality Improvement Manager (SES&SP CCG) Nigel Williams (NW) Clinical Quality Improvement Manager (SES&SP CCG) Mahesh Mistry (MM) Head of Medicines Management (SES&SP CCG) Rob Boland (RB) Governance Manager (SES&SP CCG) Judy Bird (JB) Primary Care Change Manager (ES CCG) Heather Widdowson (HW) Designated Nurse Safeguarding Children (South Staffs CCGs)

In Tracey Finney (TF) Administrator attendance: AGENDA MINUTES ACTION ITEM NO To note

MS arrived at 14:30 pm MM arrived at 15:50 pm and left after Agenda item 10 HW arrived at 15:30 pm and left after Agenda item 11

1. Welcome and Apologies

Apologies were received from: Alex Fox (AF), Dr Adrian Parkes (AP), Lisa Bates (LB), Fleur Fernando (FF), Paul Winter (PW), Eleanor Wood (EW)

2. Declaration of Conflicts of Interest None were declared.

Quoracy The meeting was agreed as being quorate.

3. Minutes of the Previous Meeting held on the 14th January 2015

The Minutes of the meeting held on 14th January 2015 were agreed as a true and accurate record with the following amendment:

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Apologies were received from Lynne Smith (LS)

4. Actions from the Previous Meeting held on the 14th January 2015

Action sheet updated as attached.

5. Patient Engagement

SES&SP CCG Patient Engagement – Equality and Engagement Annual Report RC presented the report in FF’s absence. Members queried whether ES CCG had published a similar report. PW was asked to provide confirmation of this. FF was PW asked to confirm whether all SES&SP CCG staff had received training to enable them FF to embed equality and inclusion within their day to day roles and who this was provided by.

SES&SP CCG Patient Council update Members noted the report from the Patient Council in SES&SP CCG produced by RC.

Members’ attention was drawn to the following:

 It was confirmed that the Joint Quality Committee’s response to a patient’s experience at Good Hope had been fed back to Patient Council members.  The patient story from Kinver Practice highlighted the reaction that mental health service users often experience and a need for training for GP reception staff.  Two patient stories that highlighted unnecessary inflexibility of the Coroner’s Officer in relation to releasing death certificates.

Members’ attention was drawn to the patient story from Good Hope Hospital. This NW story has now been uploaded on to NHS Choices and referred to HealthWatch. NW to raise this at the next HEFT CQRM.

ES CCG Patient Board update Members noted the report from the Patient Board in ES CCG produced by AT.

Members were informed of two patient stories as follows:

 Disabled patient who has been experiencing difficulty with both Social Services and access to equipment from SSOTP. The patient’s Social Worker and Occupational Therapist now have to be contacted via mobile phone at a cost of £10 per month to the service user. There have been problems replacing a bed on loan from SSOTP, now 17 years old and unable to be AT repaired, as the Occupational Therapist is no longer able to order directly. The service user was being assisted to report this by AT. Members agreed AT to log this as soft intelligence, the issues are also to be raised with AT/SW SSOTP.  Patient with an on-going complaint with NSL, AT to find out the details of this complaint and pass to SW to investigate.

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6. Clinical Risk Register

ES CCG Members noted the report produced by PW. The following points were raised:  A17 Primary Care Quality. This risk has been on the register since September 2013. JB reported that information is not being provided by the Area Team; however this may be resolved with the advent of co- commissioning.  A40 Staffing – SDUC. Query why no score assigned to this risk. Members noted that written assurance had been received from SDUC, however as PW there is still concern about shifts not being covered; the possibility of undertaking an unannounced visit was discussed.  C3 Reduce complaints. Members were concerned regarding the wording PW of this risk and felt this needed to be revisited.

SES CCG Members noted the report produced by RB and acknowledged the commonalities between the ES CCG and SES&SP CCG reports eg the reduction of the score for BHFT and the closure of the PEMS risk at SDUC.

7. Primary Care Quality

ES CCG Soft Intelligence Report Members noted the report produced by JB. It was highlighted that there had been a decrease in the number of soft intelligence reports for Quarter 3. However, this was felt to be due to the increased workload in GPs practice during this period of the year.

The following queries were raised from the report:

 Better information/More Choice – 2 issues at BHFT. HJ and DV confirmed that these had both been treated as soft intelligence and investigated within the surgery. o CT exam report containing mixed patient information. There appears to be an emerging theme regarding the outsourcing of diagnostic reporting at BHFT and this was raised at the CQRM on the 6th February 2015. o Discharge letter with diagnosis of leg pain containing details of a head injury. LG informed members that this appeared to be an emerging theme at BHFT.

Members discussed whether it would be useful to share the soft intelligence report with providers. Members agreed that it be recommended to both ES CCG and SE&SP CCG Governing Bodies that an additional resource was required within the Quality Team in order to support the investigation of soft intelligence reports, which would lead to significantly improved outcomes.

ES CCG Primary Care Report Members noted the report produced by JB. Members were asked to note that there are still areas where information is awaited from the Area Team.

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The following points were discussed:

 A new programme of CQC inspections is currently underway with four practices having been visited with all rated as Good.  An audit of the Local Enhanced Services is being undertaken by Internal Audit. Issues had been identified regarding patient identifiable data; however these appear to have been resolved with the development of a data sharing agreement in conjunction with the Local Medical Committee.  QOF attainment. Members were asked to note that these figures were from 2013/14.  Patient Experience. It was noted that ‘patient reported ease of getting through to GP practice on the phone’ percentage was decreasing. JB confirmed that a number of practices are looking at improving access by putting in additional telephone lines for example or employing additional receptionists.

SES&SP CCG Primary Care Report Members noted the report produced by EW. The following points were discussed:

 Discharge CQUIN. There was a query on how discharge letters were being HJ/DV audited. HJ/DV to investigate this.  Attendance at practice member events. HJ to ask EW to investigate reason HJ/EW behind low attendance for particular practices.  Dementia diagnosis rates. Three practices have opted out of sharing data with NHS England and four practices were highlighted as having reducing dementia diagnosis rates. HJ confirmed that those practices are undertaking dementia diagnosis however are not subscribing to the £5 per head scheme.

8. Quality Reports from Key Providers

Assurance The committee were asked to consider separate assurance levels for Safety and Quality for each provider. Members were asked to note that any agreement of a level less than assured in relation to safety would require immediate escalation to the relevant Government Body with a recommendation of any action to be taken.

Staffordshire and Stoke on Trent Partnership Trust (SSOTP) Members noted the Quality Report produced by the Lead Commissioner, Stafford & Surrounds (SAS) CCG/Cannock Chase (CC) CCG. The report was presented by SF.

Members highlighted the following points to be raised with the Lead Commissioner: SF

 Concern regarding the increase in number of pressure ulcers in the community. It was queried whether the RCA into the grade 4 pressure ulcer in Tamworth could be reviewed.

 A task and finish group has been established to undertake a deep dive into workforce issues with SAS and CC CCGs. Members felt that it was not acceptable that bank and agency usage data was still not being published, despite the Trust repeatedly agreeing to provide these details. 4

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 Staff turnover. AT queried whether it was possible to obtain data on the retention of overseas nurses that had been recruited.

 Patients awaiting social care assessment are consistently breaching the four week threshold. Members queried who the responsible commissioner for social care was. It was also queried the number of people affected and the impact of the delay.

 There were 29 deaths reported in December, 17 of which were in end of life palliative care pathways. Members queried the reasons for the remaining 12.

Members also raised the following queries:

 Nurses are now required to undertake revalidation every three years as part of their Nursing and Midwifery Council registration. Members were concerned that this could prove to be a serious issue in relation to vacancy rates if nurses opted not to undergo revalidation. It was also recognised that revalidation was an issue for nurses employed within commissioning organisations. HJ confirmed that providers had been asked to provide assurance on their plans regarding revalidation as part of the contract. Work is being carried out with the Director of Nursing at BHFT on clinical skills updates for ward based nurses

 Concerns regarding increasing vacancy rate and the Trust’s plan for staff retirement. HJ confirmed that this had been raised at the CQRM in December and assurance had been given on the Trust’s retirement management plan.

Members agreed the following assurance levels for SSOTP: SAFETY: ASSURED QUALITY: PARTIAL ASSURANCE

Burton Hospital (BHFT) Members noted the Quality Report produced by DV.

The following key points were highlighted:

 Two patients breached the 52 week target. This has now been resolved and raised as a Serious Incident (SI). The Trust have now undertaken a review of their waiting list records back to April 2013 with a total of 18 queries identified from a total of 1056 records.

 The 62 cancer was 81.6% in November 2014 against a target of 85%. This was due to availability of HDU beds and tertiary delays.

 The Trust has responded to those patients who raised complaints in relation to the Cardiology Service during September, October and November 2014. Full details are included in Enclosure 12a BHFT Exception Report. 5

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 Discharge issues. Assurance was given by the Trust at the CQRM that they are acting on all issues raised by patients and action plans are in place.

 A&E waits. These have been discussed at the Contract Review Board. DV assured members that the Trust are sighted on these issues and have action plans in place to address the issues.

 There were 36 medication incidents in December. LG raised concerns that 17 of these had been designated as insignificant and more information on these was required. MS informed members that there had been a significant effort made by the Trust to ensure that staff are reporting medication incidents. Controlled drug incidents are reported to the Area Team via the Local Intelligence Network (LIN) and although a number of incidents have been raised by the Trust, none of these were significant. RCA’s are carried out and any outstanding actions are reported. MS assured members that any concerns raised at the LIN would be reported back to the Joint Quality Committee. MS and DV to discuss how controlled MS/DV drug incidents could be reported to the committee.

 Members were informed by LG that all ES CCG GPs had received an email stating that BHFT were closed to new Rheumatology referrals due to planned staff sickness. Members were also informed that following the retirement of Mr Bucknall and long term staff sickness, BHFT would only have one breast surgeon available. Members were concerned that no short term plans had been put in place by the Trust to provide cover for planned sickness alongside longer terms plans to recruit to senior medical staff vacancies. DV was asked to escalate the committees concerns immediately. DV

 Concerns regarding the number of falls within the Trust was raised by Members. It was felt that the Trust had put in place yet another initiative however basics such as completion of falls assessment and one to one nursing were not being undertaken. DV/HJ confirmed that negotiations are currently being held with the Trust in relation to a KPI on reduced harm from falls.

 Members noted some positive areas within the Trust for example reduction in SI’s over 45 days, ward assurance green for the previous nine months, above regional average for Friends and Family and no grade 3 or 4 pressure ulcers reported in December 2014.

Members agreed the following assurance levels for BHFT: SAFETY: ASSURED QUALITY: ASSURED

South Staffordshire and Shropshire Healthcare NHS Foundation Trust (SSSFT) Members noted the Report produced by KLM.

Members were asked to note that any anomalies within the report regarding sickness and absence data will be rectified within the Governing Body report. 6

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The following key points were highlighted:

 SSSFT and BHFT have undertaken a piece of collaborative working regarding interpretation of ECG’s in exchange for psychiatric support at BHFT. A three month pilot is currently in place and an evaluation report will be presented to the CQRM.  Quarter 3 CQUIN has been achieved.  18 week from referral to commencement of treatment Older Adult Mental Health has decreased to 75.2 percent. This relates to MAC UK referrals and equates to 32 breaches. An information query has been raised with the Trust via the contract and a report was due on the 9th of February 2015. This has not been received to date. The outcome will be reported in the March 2015 Joint Quality Committee report.  Mother and baby dna rate is 19.6%. The Trust is undertaking some work in the RIO system to ensure duplicate counting has not occurred. The referral process will also be reviewed.  One breach occurred in relation to 7 day follow up where the service user was of no fixed abode. Further assurance on governance arrangements will be requested from the Trust.  An issue in relation to the reporting of the number of patients waiting more than 28 days from referral to first treatment/first therapeutic session within IAPT has been reported by the Trust for November and December 2014. An information query was raised with the Trust and a manual count was undertaken. The issue appears to be with the Trust’s information system RIO.  Delayed discharges and transfers appear to be increasing and members were concerned about the impact to patients. KLM gave assurance that from a quality perspective there was minimal impact as the patients are receiving care. The Trust has reported that the definition of ‘delayed discharges’ is interpreted differently across the network and are currently reviewing this. An update to the position will be provided to the March 2015 CQRM.

Members agreed the following assurance levels for SSSFT: SAFETY: ASSURED QUALITY: ASSURED

NSL Members noted the Quality Report produced by SW.

The following key points were highlighted:  Work is on-going with NSL in relation to complaints data and that a more in- depth report on incidents and workforce will be provided in the next report.  Two soft intelligence reports had been logged from BHFT. This related to two ambulances assigned to the Trust during a weekend where one crew reported in sick and the other vehicle broke down. This was raised with NSL who were not aware of these incidents; however they have agreed to investigate as a matter of urgency.

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Members raised the following queries:  RC reported that the Patient Council had raised concerns regarding the transfer of orthopaedic patients from RWT to Cannock Chase Hospital and asked if feedback could be given from the outcome of the review into the SW impact of this on the South Staffordshire Service.

 RC queried whether further investigation would be carried out in relation to the complaint from a patient’s wife that her husband had fallen and banged his head whilst being transported. NSL had reported that both members of staff were interviewed and deny any fall or injury to the patient. SW agreed SW to raise this again with NSL to ensure the complaint had been resolved.

 Members asked whether it was possible to gain clarity on ‘journey arrival time’ and whether patients had arrived either late or early for their appointments and by how much time. SW reported that NSL had given SW assurance that no patients had arrived late for their appointment. It was agreed that SW would raise this with NSL.

 It was noted that actual activity was below the planned activity target. SW SW to raise this with NSL.

Members agreed the following assurance levels for NSL: SAFETY: ASSURED QUALITY: ASSURED

SDUC Members were informed by KLM that the SDUC CQRM had not met since the 15th of December 2014. Therefore no report was available for the committee today. The next CQRM is planned for the 16th February 2015, however to date no papers have been received and consideration will be given to a possible escalation if those are not received on time.

Heart of England Foundation Trust (including Good Hope Hospital) (HEFT) Members noted the Quality Report produced by NW.

NW gave an update on the patient story raised at February’s Joint Quality Committee. A standard response has now been published on the NHS Choices website and an update received from the Lead Commissioner stating that Good Hope will contact NW directly with a formal response. RC reported that at the Patient Council on the 3rd of February 2015 the patient’s representative had not received any response; NW stated that the response had been uploaded to NHS Choices on the 3rd of February 2015. It was acknowledged that the Trust had taken a long time to respond.

HJ gave an update from a telephone conversation she had held with CQC on the 11th of February 2015. A summary of issues and concerns was given to the CQC who stated that these broadly reflected the concerns raised at their visit to the Trust. As the visit in December was an unannounced visit a rating will not be given and a risk summit is not required, however an informal risk summit will be held 8

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which HJ will be invited to participate in. The Trust has an incoming Chief Executive working two days a week with the interim Medical Director covering the rest of the week as Chief Executive. A new Director of Improvement has also been appointed by the Trust.

Members were concerned regarding the continued lack of data and reporting and it was felt that there were issues on both sides from both the Trust not reporting and Lead Commissioners not requesting data. Examples of issues include RTTs where data had not been captured correctly, mortality, inconsistent reporting of SI’s and no up to date patient experience metrics.

It was noted that a breakdown of complaints had been included in the report which members found useful, however it was felt that it would be useful to understand what complaints are actually about.

Members agreed the following assurance levels for HEFT: SAFETY: ASSURED QUALITY: NOT ASSURED

The Dudley Group of Hospitals (DGH) Members noted the Quality Report produced by NW.

Members were asked to note that the brevity of the report was due to the Dudley CQRM taking place on the day of submission of papers for Joint Quality Committee. A full report has subsequently been submitted and the Chair agreed that this be circulated as the interim report for the March 2015 committee.

Dudley CCG has now appointed Trisha Curran as interim Chief Nurse. DGH are also in the process of recruiting to a new Chief Nurse. Mark Docherty has also been appointed as Director of Nursing at WMAS.

Members agreed the following assurance levels for DGH: SAFETY: ASSURED QUALITY: LIMITED ASSURANCE

The Royal Wolverhampton Hospitals Trust (RWT) Members noted the Quality Report produced by the Lead Commissioner, Stafford & Surrounds (SAS) CCG/Cannock Chase (CC) CCG. The report was presented by SF.

The following points were discussed:

 Increasing number of A&E attendances. 8.79% higher than the same period in the previous year. It was queried what was meant by not achieving either Type 1 or all Types for the month.  The Trust is currently predicting a possible failure of the 2 week wait Breast Symptomatic target for December. KLM advised members that this was due to consultant sickness.  The number of falls with harm continues to be a concern. The Trust’s Falls Group is looking into an assessment procedures and care pathway to 9

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identify areas for improvement.  Staff sickness has increased by 1% in December from 4.32% to 5.32% which is above the Trust’s target of 3.24%.  A quality visit was undertaken to the Adult Respiratory Ward on the 27th of November 2014; however the committee felt that the feedback from the visit was more concerned with procedures rather than quality. Members were also concerned at the impact on patients of the Interstitial Lung Service moving to Stoke.  It was noted that new safety processes are being rolled out at Cannock Hospital and the potential issues this could raise.  The Trust currently had a Locum Colorectal Consultant covering maternity leave until the end of December 2014. However the Consultant does not return from Maternity leave until April 2015. LS recommended that potential for capacity issues needed to be monitored.  NHS England and the Trust Development Authority (TDA) are commencing a national validation in relation to RTT for all Trusts and members felt it would be useful to see the outcome of this.  MS made members aware that there are currently difficult contract negotiations currently taking place within the Trust.

Members agreed the following assurance levels for RWT: SAFETY: ASSURED QUALITY: PARTIAL ASSURANCE

Derby (DHFT) Members noted the Quality Report produced by DV.

DV gave an update on the action surrounding the visit to Stroke Services at DHFT. The report has now been returned from the Trust and will be shared publicly on the 11th of March 2015. Members were concerned that the number of TIA’s treated within 24 hours had decreased to 53.3%. DV gave assurance that the Trust are scrutinising the data. However members felt that immediate sight of the report was required given the commissioning decisions that are currently being made regarding transferring ES CCG and SES&SP CCG patients to DHFT for stroke provision. HJ agreed to contact the Chief Nurse at Southern Derbyshire CCG for urgent sight of the report. DV and PW to undertake a detailed analysis of stroke HJ performance to be completed by the 16th of February 2015 in order that the Joint Quality Committee could make a recommendation on the commissioning of stroke DV/PW services.

Concerns were raised that the Trust are still not compliant on 62 day cancer waits. DV confirmed that the Trust have been asked to provide details of ES CCG patients that have breached. Assurance was given that the Trust is sighted on this issue and has taken a number of actions to improve performance. Work is also being carried out across the East Midlands Strategic Clinical Network. LS queried how much assurance could be given that the Trust will achieve compliance when they have been failing for the whole year to date and also what was meant by the submission of a trajectory for delivery of 62 day compliance. DV to clarify this with the Trust; however members were assured that patient referrals would not be refused. DV

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Never events have increased, however DV confirmed that the Trust have undertaken an external review of never events.

Members agreed the following assurance levels for DHFT: SAFETY: ASSURED. However further investigation and assurance is required regarding Stroke provision. QUALITY: LIMITED ASSURANCE

Primecare Members were informed by KLM that the Primecare CQRM had been cancelled and re-scheduled for the 31st of March 2015. Therefore no report was available for the committee today. The Lead Commissioner has been contacted to provide assurance.

9. Quality Surveillance Group

HJ brought the following points to the Committee’s attention from the QSG held on the 26th January 2015.

 First meeting chaired by Wendy Saviour, new Area Team Director.  SSOTP reported that their mortality process is currently under review.  The SSOTP CQC report is due to be published shortly.  Closer working with Telford and Shropshire, who also commission SSSFT, to merge the QSG report.  Possible missed shared learning opportunity for a retained swab in maternity identified. The new Area Team SI group is likely to be the focus for shared learning opportunities in the future.  Series of issues in Telford and Shropshire regarding injections into the wrong joints. To be considered as a local avoidable event.  Reinforcement of need for a primary care quality report.

10. Medicines Management update

Strategic Medicines Management Report

MS asked members to note the following:

 Immunisation rates for ES CCG appears to be poorer than other CCG areas for childhood immunisations, however assurance was given that this is not an area for concern. Vaccination data for ES CCG has been requested. The data is awaiting validation and should be available within the next few MS weeks. MS to share with JB when received.

 Consideration is being given by the Area Team to vaccinate care home staff utilising any remaining flu vaccine. LS queried the effectiveness of this given the recent reports that the vaccine is ineffective against the current flu strain. MS stated that, although it is recognised that the current vaccine covers a range of strains, the most problematic strain this year is not included, limited protection is better than no protection at all. This is a decision that the Area Team and Public Health are to make. It is however 11

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recognised that care home staff are not universally vaccinated which is a gap in the programme.

Community Pharmacy Report Members noted the report produced by MS.

SES&SP CCG Medicines Optimisation Report Members noted the report produced by MM.

MM reported that the report now includes trend arrows in order to allow members to see a shift in prescribing patterns.

In relation to Non-Steroidal Anti-Inflammatory (NSAID) prescribing, HEFT has now removed Diclofenac from all A&E and restricted usage within the hospitals. This should lead to a reduction in the number of patients discharged on Diclofenac.

11. Safeguarding

Adults Members noted the report produced by LB and presented by SF.

The following key points were highlighted:

 CSU have reported a number of nursing homes within South Staffordshire who are still not signed up to the 2015-2016 standardised contract for Nursing Homes. CSU have been asked to identify any homes within ES CCG and SES&SP CCG who have not signed.

 There are three South Staffordshire nursing homes subject to large scale investigation (LSI). One in South East Staffordshire, one in Cannock and one in East Staffordshire.

 There remains one domestic homicide review (DHR) on-going with a further new DHR review taking place in SES&SP CCG.

 Guidance is being circulated to all GP practices and providers on Prader Willi Syndrome. Further information can be found on the following link: http://www.nhs.uk/conditions/prader-willi-syndrome/Pages/Introduction.aspx

 Safeguarding training is below target at both BHFT and County Hospital. This was been raised by LB and HW at the County Hospital Safeguarding Forum in January 2014. Monitoring will be carried out by LB.

HJ asked members to note that County Hospital is now part of University Hospitals North Midlands (UHNM). Discussions are currently taking place regarding who is responsible for safeguarding at County Hospital. HW was asked to raise this at the HW next SAS CCG/CC CCG Quality Committee.

Enc 15a

Children Members noted the report produced by HW.

The following key points were highlighted:

 One of the safeguarding children’s’ priorities is looking at the transition from childrens to adult services and joint working will be undertaken between the Adult and Childrens’ Safeguarding Boards. A learning review was published in December 2014 regarding the transition from childrens to adult services.

 The independent chair for the Staffordshire and Stoke Adult Safeguarding Board retires March 2015. Interviews are due to take place on the 4th of March 2015.

 A paper has been produced from the Staffordshire Safeguarding Board on emerging themes and patterns for serious childcare incidents. Work will be carried out with the Staffordshire Observatory, which is part of the local authority, to look at some of these themes.

 A full training programme has been put in place for all GPs, Governing Body members and CCG staff.

Health Safeguarding Partnership Terms of Reference (TOR) Members APPROVED the TOR subject to a slight change in wording regarding quoracy and CCG’s. LS agreed to review the wording.

12. Quality Accounts Process

Members were asked to approve the process for quality accounts. Statements from each provider will be presented to the committee for approval prior to final inclusion in the quality accounts. HJ suggested that the newly formed Quality Sub Group allocate a lead to ensure that concerns or comments are communicated to Lead Commissioners for providers such as HEFT and DHFT and for providers such as BHFT and SSSFT responsibility will fall to the relevant Quality Improvement Lead.

13. Research Update

SW reported that a GP from ES CCG, Dr Lucy Ambrose, has expressed an interest in working with practices on research going forward.

LS queried whether there had been any uptake on the stroke training for GP reception staff. SW replied that she did not have any further information about this. It was suggested this be escalated to the ES CCG Practice Managers meeting.

14. Serious Incidents (SI) Combined Report

Members noted the report produced by Janinne Lake (JL), Head of Governance & Compliance (CSU). LS asked if she could have a copy of the full report submitted by TF JL. 13

Enc 15a

15. Draft IVF Policy

Members were asked to approve the proposed South Staffordshire Commissioning Policy for In Vitro Fertilisation (IVF) +/- Intracytoplasmic Sperm Injection (ICS) within Tertiary Fertility Services.

Members were informed by MS that this policy had been recommended for adoption by the Clinical Policies and Priority Group (CPPG) who are approved by the Governing Bodies to review this type of policy. RB confirmed that from a SES&SP CCG point of view the correct route for approval was the Joint Quality Committee. RC queried whether the policy should be open to public consultation. MS confirmed that there had been no significant change to what is offered and there had been no significant service redesign.

Members APPROVED the Policy.

14. Items To Report To Governing Body

 Increasing concern regarding the lack of dedicated resource for soft intelligence investigations

15. Items To Report To Other CCG Committees

 Stroke training for GP reception staff to ES CCG Practice Managers Group  Concerns regarding Stroke performance at DHFT to Finance & Performance Committee

16. Items for the Risk Register and Leads Identified

 Possible impact of nurse revalidation  Score for BHFT to be reviewed

17. Items for escalation to the Area Team

 Reporting of Controlled Drug Incidents by GPS via Local Intelligence Network

18. Any Other Business

Committee Effectiveness Questionnaire HJ informed members that a questionnaire will be circulated to members for completion and return to TF. An analysis of the feedback will be undertaken and reported back to the committee.

Date time of next meeting

Wednesday 11th March, 1.00 pm, Holiday Inn, Burton on Trent

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` SOUTH EAST STAFFORDSHIRE & SEISDON PENINSULA CLINICAL COMMISSIONING GROUP FINANCE & PERFORMANCE COMMITTEE Wednesday 21st January 2015, 10:30 am, Boardroom 2, Merlin House, Tamworth

Present: Dr John James (JJ) CCG Chair (Chair) Rita Symons (RS) Accountable Officer Tim Tebbs (TT) Chief Finance Officer (Interim) Crispin Atkinson (CA) Turnaround Director Tim Cullinan (TC) Senior Programme Manager Nigel Williams (NW) Quality Improvement Manager Mahesh Mistry (MM) Head of Medicines Management In attendance: Tracey Finney Administrator

AGENDA MINUTES ACTION ITEM NO 1 Apologies Anna Hammond (AH), Heather Johnstone (HJ), Stuart Gaskell (SG)

Quoracy The meeting was agreed as Quorate.

Declarations of interest The committee were asked to declare any conflicts of interest that may arise as a result of items on the agenda. No such conflicts were declared.

2 Minutes from meeting held on 17th December 2015

The minutes of the meeting held on 17th December 2015 were approved as a true and accurate record with the following amendments:

 TC was in attendance at the meeting. AH, JJ and MM were noted as present and given apologies. Members confirmed that neither AH, JJ or MM were present at the meeting

3 Action from the meeting held on the 17th of December 2015

Action sheet updated as attached.

4 Performance Report

NW presented the Performance Report and asked members to note that two new dashboards for WMAS and SSSFT had been added to the report.

Key points reported by NW were:

 Red 1 Ambulance response: downward trend is continuing. 1

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 Cancer waits: both HEFT and RWH, although indicated as poor performers, have shown an increase in performance through August to November.  Mixed Sex Breaches: although 4 breaches were allocated to SES&SP CCG

patients in October 2014, there was no trend identified and these breaches

were considered to be an exception.

The following queries were raised by members:

 Rag ratings: NW agreed to add upward and downward arrows to the dashboard to show any trends.  Cancer wait trends: NW confirmed that these are for the treatment waiting time.  CAMHS waiting times: these were reported as 93% and 92% respectively for NW October and November against a target of 95%. NW agreed to raise this with SSSFT.

5 Financial Recovery Plan (FRP)

Key points reported by CA were:

 A revision of the 14/15 Recovery Plan has been submitted to the NHS England Area Team. This confirmed that the control total has been extended to £16.7 million. The plan has been approved by the Regional

Board; however formal notification of this is still awaited.

 A meeting was held with Rachel Hardy, NHS England Regional Director of Finance on the 19th of January 2015 to provide an update on progress towards delivery. A further update to be provided in February 2015 to provide additional detail on the robustness of QIPP plans for 15/16.

 Detailed reviews of the FRP have taken place and a number of projects have

been identified as not expected to deliver the level of savings originally planned. These projects have therefore been removed from the FRP.

 Staffordshire wide saving schemes, including those in the Better Care Fund, are key to long term sustainability. The Commissioning Congress has endorsed proposals for project management of county wide work. RS th confirmed that at the Congress held on the 15 January 2015 it was agreed

that support for the establishment of a Programme Director, Programme

Manager and Administrative support would be delivered by the CSU.

Members went on to discuss the level of detail that the CCG wished to be recorded in the Public and Confidential Governing Body papers, particularly due to the commercially sensitive nature of some of the negotiations being held. It was suggested by TT that a summarised report highlighting risks be provided to the Public Session and a more detailed report to the Confidential Session. Members agreed with JJ stating that Governing Body members needed to be aware of and understand the full details of the FRP and the risks involved and take a share in the 2

Enc 16

degree of risk in delivering the plan. RS suggested that JJ provide an update to Dr Tim Dukes who will be Chairing the Governing Body to be held on the 28th January 2015 and CA provide an update to SG on the current position and the messages being sent from the NHS England Regional Team.

6 Finance Report

Key points reported by TT were:

 The gross unmitigated deficit is has now reduced to £19.8m from the £20.2m reported at month 8.  The CCG has been informed by HEFT that they are unable to defer the non-

recurrent investment commitment of £1.5m; however brokerage of this

value has been agreed by the CCG in principle with Birmingham Cross city and Walsall CCGs.  There has been a partial return of the CHC top slice which offsets a material deterioration in the forecast of acute services of £0.6m.  An agreement has been secured with SSSFT for a reduction in expenditure

on the out of area block contract.

 The achievement of the £16.7m deficit by year end continues to be assessed as high risk and dependent on delivery of further savings and mitigations of £3.1m.  There is a downside risk assessment of £2.3m and potential year end deficit of £19m. The key risks relate to acute and prescribing expenditure.

Negotiations are continuing with BHFT and RWT in order to secure early

settlements.

In summary the CCG is currently in a high risk position with the possibility of the

position moving to £19m plus if the planned mitigations and savings are not

secured.

Members raised the following points:

 RS suggested that the acute position with BHFT and possibly RWT be revisited and challenged.

 CA noted that focus needs to be placed on analysing those practice plans that relate to BHFT.

 TT reported that activity at Spire Little Aston continues to be a concern with

activity increasing from 3 units a month to 10 units for the last three months. The majority of this activity is from the Spires Practice. JJ agreed to JJ speak with Eleanor Wood, Practice Integration Manager with regard to arranging a meeting with the Spires Practice.

 JJ queried whether it would be possible to re-open discussions regarding the transfer of £1m from RWT CCG to SES&SP CCG. Members felt this should be

Enc 16

deferred until 2015/16.

JJ raised the following queries on behalf of SG:

 Is the partial return of the CHC top slice and offsetting of the deterioration in acute position a one off improvement if so does this have implications for the rest of the financial year/future years financial recovery. TT confirmed that this was a one off and if the acute deterioration was recurrent it would impact into 15/16.

 Will the auditors accept agreements with Birmingham Cross City and Walsall CCGs in light of HEFT no longer committing to the deferral of the £1.5 non- recurrent investment commitment? TT confirmed that the auditors would agree to these.

7 Map of Medicine

The committee were asked to approve funding for Map of Medicine as part of the Realising Effective Referral Process project in order to support effective referral processes and reduce out patient referrals where clinically appropriate and improve quality of patient care.

Map of Medicine is a tool that provides evidence based pathways that can be localised to ensure alternatives to secondary care. The solution can be embedded into GP systems and will therefore be easily accessible to GPs. The system also produces ‘live data’ for commissioning reports that can highlight areas where pathways need to be developed or areas for development in primary care.

Members APPROVED funding for Map of Medicine.

8 Any Other Business

None raised.

9 Identified Risks and Review of Non-Clinical Risks

None raised.

10 Date and Time of Next Meeting

Wednesday 21st January 2015, 10:30 a.m, Board Room 1, Merlin House, Tamworth

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SOUTH EAST STAFFORDSHIRE & SEISDON PENINSULA CLINICAL COMMISSIONING GROUP

FINANCE & PERFORMANCE COMMITTEE

Wednesday 18th February 2015, 10am-11am, Boardroom, Merlin House, Tamworth

Present: Dr John James (JJ) CCG Chair (Chair) Rita Symons (RS) Accountable Officer Tim Tebbs (TT) Chief Finance Officer (Interim) Crispin Atkinson (CA) Turnaround Director Nigel Williams (NW) Quality Improvement Manager Mahesh Mistry (MM) Head of Medicines Management Martin Flowers (MF) Interim Deputy Chief Finance Officer Chris Bird (CB) Head of Improvement

In Anna Bogle Administrator attendance: AGENDA MINUTES ACTION ITEM NO 1 Apologies Anna Hammond (AH), Heather Johnstone (HJ), Stuart Gaskell (SG), Tim Cullinan (TC)

Quoracy The meeting was agreed as quorate.

Declarations of interest The committee were asked to declare any conflicts of interest that may arise as a result of items on the agenda. No such conflicts were declared.

2 Minutes from meeting held on 21st January 2015 The minutes of the meeting held on 21st January 2015 were approved as a true and accurate record.

3 Action from the meeting held on the 21st January 2015 Action sheet updated as attached.

4 Performance Report It was noted the Performance and Quality report focuses on the NHS constitution measures. CB highlighted the following key points:

 The NHS constitution measures are primarily focused on access to services.  To ensure a comprehensive review of the performance, additional measures need to be discussed within FRG and other governance forums.

 A meeting has been arranged between CB, NW and Jo Hammond,

th Information Analyst, due to be held on Tuesday 24 February 2015. The meeting is to discuss how we can supplement routine data with more 1

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sophisticated measures in order to bring a more comprehensive report to the committee.

Action: CB, NW and Jo Hammond, Information Analyst, to meet on Tuesday 24th CB/NW/ February 2015 to discuss performance measures. JH

 The report reflects that whilst the CCG are achieving 50% of the measures, there are still 50% causing concern, which could impact with several high

profile indicators not achieving by the end of March 2015.

 In some indicators the performance assessment is accumulated across the year. Although the indicators are measured through the year, the performance is assessed on the 31st March.  A&E, two weeks waits around breast cancer and 18 weeks admitted pathway are all under serious risk of not being delivered. For the CCG to be

assessed as delivering there is a need for all four of the major providers to

also deliver.  Within the report there is an assessment of the overall numbers that are failing by in month and year to date. It was explained targets for January, February and March could be achieved, however, still fail overall. To ensure false assurance is not provided, reporting will be completed reflecting a

simple in month position.

 Depending on whether performance is failing or achieving, it will be shown as either red or green. Amber has been introduced to those that are within a percentage point of 1 or 2 of the threshold. Red and amber performance will be actively pursued with clear action plans developed. The targets which are a cause for concern are the following:

- Healthcare Acquired Infections; this has now been removed and will be

transferred. There will then be the usual post infection review process, which is picked up via CQRM meeting, which NW attends. - Referral to Treatment; for November the two performance measures were failed for admitted pathways and 52 weeks waits. The 52 week wait was in relation to a SES patient who attended Dudley, and has

since been discharged and treated. It was noted there are no on-going

concerns. However, it was documented that the 52 week wait was

breached. The ITT pathways, which are tabled on page 4 of the report, indicate HEFT and Dudley are struggling. HEFT have only just started to report again after a few month of absence and have agreed a recovery trajectory with the host commissioner in conduction with the regulator This will see them get back to achieving 18 weeks as of 31st March,

which means delivery should begin 15/16. Dudley is currently dealing

with their 18 week backlog. There are concerns with Dudley as there is currently no contract manager in the CCG. Assurance is being sought that capacity exists within the host to pursue. - Cancer Waits; three cancer targets have failed, which were 2 week waits, breast symptoms, 31 day waits to first treatment and 62 day 2

Enc 16a

standard. It is expected the latter two will not be sustained throughout the year. Issues have been raised with HEFT around the breast symptoms.

- A&E; the performance reported data is only just catching up with going

into the winter period. Deterioration has been spotted from one month to the next. It is expected that the pressures will remain on the January and February figures. Cause for concern was noted in relation to Burton for the first time, at a Trust level, failing A&E in November and December. The CCG are actively involved in East SRG. Discussions around managing performance have taken place with Birmingham and

Black County. The focus of the discussions has been on how the CCG

might get better leverage on performance. Ambulance; in relation to ambulance hand over times, it was explained there are issues with HEFT experiencing poor A&E performance. Whilst HEFT does not have any poor clinical outcomes for patients, there is a knock on to the wider system if poor handovers continue. The ambulance service has failed and will continue to fail on all three of its response targets. NW has

given this real attention and is actively involved in reviewing the

recovery plans and ensuring the CCG understand any harm to residents.

In consideration to the CCG not being the lead commissioner on all of the contracts,

it was queried whether enough support and encouragement is being provided to

achieve the performance figures. It was noted similar performance is being

experience by the host. Therefore, the host will be under the same pressures as the

CCG to improve their performance. It was explained the challenges are compounded by the fact that for at least two of our main providers, the host commissioners are dealing with the regulator. . Where there is no response from the lead commissioner there needs to be direct formal communication. NW and HJ are arranging a meeting with Mark Docherty, Lead of Quality at WMAS, and Trisha Curran, Interim Chief Quality and Nursing Officer at Dudley CCG.

Action: NW and HJ to arrange a meeting with Mark Docherty, Lead of Quality at NW/HJ WMAS, and Trisha Curran, Interim Chief Quality and Nursing Officer at Dudley

CCG.

It was recommended in future to include the ‘so what’s’ within the report, noting that as an organisation the CCG needs to show the actions being taken and be clear about impact for our patients. In order to support the membership with decision making, it was suggested that communication needs to meaningful and clear. 5 Financial Recovery Plan (FRP) It was noted the report was for discussion not approval as stated on the FRP paper. The key points were explained as the following:

 Whilst the in year position is feeling more secure, there is slippage on specific saving schemes, according to a profile on the dashboard. At the next FRG meeting there will be a discussion on the focus around

delivery and the importance to deliver from the beginning of April

2015, along with identifying additional schemes. These will hopefully ensure mitigation for any slippage in delivery. Proposals for prescribing 3

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will also be discussed.  On a risk adjusted basis the CCG has £6.2m worth of savings, however, more is required. There is on-going work looking at elements of other

CCGs financial recovery plans. It was noted that by 1pm CA would have

more information on the other CCGs plans.

It was noted that since the report was written, latest months prescribing data has

been received. The data suggests that there is a deterioration of the picture.

However, this is due to how the BSA has projected the position, rather than

deterioration in actual prescribing. It was explained the information had only just

come to light and it would need to be investigated in detail. It was noted there could

be a two week delay in reporting the information.

Action: CA to circulate a paper by the end of the week to the group, which will CA provide a more measured view of other CCGs approaches to the FRP and the

situation around prescribing data.

It was noted the report from the Turnaround Director needs to contain more detail,

in order to assure the Governing Body through its subcommittee. It was recognised

the report has identified slippage on plans, however, there needs to be detail on

what is being done about it. CA noted he would add information on further savings

to the report, which will explain what action is being taken.

Action: CA to add clarification on what action is being taken on further savings CA into the Financial Recovery Plan.

It was explained there is still confidence that the CCG will evidence better performance on prescribing savings and measures have been taken to ensure the CCG has more live data to inform our assessment of risk to delivery against the £16.7m.The group were informed that early evidence indicates a positive view in terms of delivery against practice visits.

6 Finance Report The following key points were noted in relation to the financial position for the current financial year:

 The year to date deficit for month 10 is £15.9m, which is close to the £16.7m year-end target. The only outstanding action to get to £16.7m is receipt of the inter CCG transfers from Birmingham Cross City and Walsall

CCGs.

 The gross unmitigated forecast is £18.2m.  The PMD forecast for month 9 suggests £200k underspend against the underlining budget has gone. This is believed to be because of the flaw in the forecasting mechanisms, however, this is to be further investigated.  It was noted that additional mitigations are required in the event that there

is deterioration in any positions. It was explained there has been a growth

in CHC spends, which was noted as alarming as the CHC seem to be over performing. However, the QIPP savings seemed to have absorbed this.  In terms of the forecast within the report, it is expected that £16.7m will be

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reached, however, there remains approximately £1m of risk to manage to ensure delivery.

Within the 2014/15 contract value it was planned that SSSHFT would receive non recurrent during 2014/15 to enable service changes so that the Trust can deliver its long-term cost improvement programme (i.e. funding of non-recurrent restructuring costs). This funding is to be reimbursed back to the CCGs during the current financial year, as a number of the planned work-streams have been deferred into 2015/16 and beyond.

Positive news was noted in respect to the ability to invoice against money the Area Team hold for Offender Health, which will reimburse community expenditure the CCG has incurred for our significant prison population.

It was explained that as an organisation there is a need to understand the extent of non-recurrent measures that has enabled the CCG to get to £16.7m. It was noted the CCG needs to be brutally honest with what is happening, in order to solve the problems. It was explained that next year it will not be possible to rely on non- recurrent measures. It is vital we realise our ambitions around transformational change.

The implication for 15/16 of the increased brokerage was queried. It was noted it had been done in discussion with the Area Team and the implications have been factored in to 15/16 financial plan. When focusing on the movement in the bigger component it was noted the £5.5m of non-recurrence support needs to be managed in the next financial year. £4.5m relates to 13/14, with only £1m additional that relates to 15/16 and £5.5m plays into the expenditure position into 15/16.

TT noted that he is confident in achieving the in year deficit on the condition no unexpected cost occur. 7 Update on 2015-16 Operating and Financial Planning It was explained the CCG have been challenged for not following a robust governance process in what was a draft submission of the financial plan. RS and TT explained that not all the data had been available to make a full judgement, in particular around growth. It was noted that the plan had changed since the last version discussed with Governing Body and there would be further discussion at the board away day next week. The next submission of the plan is on Friday 27th February 2015, subject to further informal reviews by the Area Team and Regional Team CFOs. A planned re-admission will be taken to Governing Body next week to seek their approval of the plan prior to it being submitted. It was suggested that the final plan includes operational, financial and activity plans.

Action: RS to present an updated version of the financial recovery plan to the Extra RS Ordinary Governing Body meeting on Wednesday 25th February 2015, before submitted it to the Area Team on Friday 27th February 2015.

It was noted RS had circulated a copy of the presentation given to the Regional office to Governing Body members and the group has been sighted on the Regional Teams response.

The content of the Board Development meeting was discussed and the following action arose. 5

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Action: RS to liaise with the organisers of the Board Development meeting to RS request a timeslot to discuss business.

8 Any Other Business None raised.

9 Identified Risks and Review of Non-Clinical Risks None raised.

10 Date and Time of Next Meeting Wednesday 18th March, 10:30am, Board Room, Merlin House, Tamworth

Enc 17 SEISDON PENINSULA LOCALITY BOARD

WEDNESDAY 11TH FEBRUARY 2015, 01:00PM – 02:00PM SOUTH STAFFORDSHIRE OFFICES, CODSALL Present: Dr Tim Dukes (TD) Chair – Gravel Hill Surgery Dr Peter Maidment (PM) Bilbrook Medical Centre Dr Angus Jones (AJ) Dale Medical Practice Sue Brookes (SB) Dale Medical Practice (Practice Manager) Dr Peter Jones (PJ) Claverley Medical Practice Steve New (SN) Claverley Medical Practice (Practice Manager) Dr Aparna Gupta (AG) Lakeside Medical Centre Dr Suky Johal (SJ) Russell House Dr Eddie Lee (EL) Featherstone Family Health Centre Dr Harinder Grewal (HG) Tamar Medical Centre Dr Alex Sobainsky (AS) Moss Grove Practice

In attendance: Roger Lees (RL) South Staffordshire District Council Ravinder Kalkat (RK) Seisdon Interface Pharmacist Rita Symons (RS) Accountable Officer Mark Seaton (MS) Strategic Lead for Medicines & Decision Support Andy Hadley (AIH) Practice Support Manager Anna Bogle (AB) Minutes

AGENDA ITEM MINUTES: ACTION NO.

1 APOLOGIES AND INTRODUCTIONS No apologies were received. The meeting was agreed as being quorate. Introductions were undertaken. 2 Declarations of Interests Agenda items 5 and 5A were declared as potential conflict of interests. 3 Minutes from the meeting held on Wednesday 14th January 2015 The previous minutes were agreed as a true and accurate record. Actions from the meeting held on 14th January 2015 Action sheet updated as attached (Enc 02) 4 Matters Arising None were raised. 5 Denosumab Proposal The purpose of the report was to inform members of the proposed service specification and model for the delivery of Denosumab for the treatment of post- menopausal osteoporosis in GP practices in SES&SP CCG. The service is currently undertaken in secondary care, where there have been problems with the quality of service, cost and capacity. It was agreed that it is within the capabilities of Primary Care to deliver the service, in order to avoid these issues in the future.

Members were informed the paper was for approval. Members approved undertaking the work, on the condition that issues with the detail around Dudley and dentists discouraging patients are addressed. Alongside a future piece of work being completed to address the initiation of the service. MS stated he would liaise with the Local Dental Committee (LDC) to discuss how to

1 | P a g e Enc 17 communicate the message to dentists

Action: MS to liaise with the LDC to discuss how to communicate the message MS to dentists about discouraging patients into the service.

5A Discuss Proposal of Engagement and Development LIS AIH provided a presentation on the proposed Practice Engagement and Development LIS 2015/16. The following headlines were explained to members:

 Three Components  Component 1 – Practice Engagement

 Component 2 – Clinically Led, Quality Driven

- Map of Medicine - GP Avoidable Incidents  Telemedicine Project (Optional  Component 3 – Prescribing – Further details are to follow

Members were informed Mahesh Mistry (MM), Head of Medicines Management, met with JW and TD the morning of 11th February. MM has proposed the following elements be focused upon in the prescribing component:

 Medicines waste awareness and action

 Care home medication reviews and waste reduction

 Medication reviews, with a choice of reviewing non care home patients on 15 or more medications, or using a repeat prescription management service, which has been adopted effectively in Walsall  Quick win audits

 ScriptSwitch, concentrating on repeat prescriptions rather than

acute prescribing.

Members were asked for their feedback on whether the suggestions for the new

LIS are the right direction of travel. The following was fedback.

 There is a need for a clear definition around prescribing of what is expected of practices, including how it will be monitored and verified. MM is to continue work around these aspects.  Concerns were raised around the frequency of the proposed practice visits.

Members were assured a structured plan will be circulated in April 2015 and there will be an agreement of dates to ensure practice visits are booked well in

advance. It was enquired whether three or four visits would be sufficient.

Members agreed to three visits. It was suggested several practices meet together with the CCG for the practice visits, in order to use time more effectively. It was noted the practices that link in with Dudley could meet and the practices that refer to Wolverhampton could meet. It was agreed this agreement would be of value.

2 | P a g e Enc 17 Action: AIH to organise joint practice visits as one of the three visits to arrange. AIH

Members agreed they were happy with the suggestions of the LIS as a direct of travel for next year.

6 Long Term Financial Position A presentation was circulated to members, which contained the following headlines:

 Planning: 15/16 and Beyond  Contents  Planning process  Growth  Strategy Reframed  Main Areas of QIPP  CCG QIPP  Analysis of deficit: Recurrent v Non-Recurrent  Analysis of non-recurrent deficit – 2015/16

 Summary bridge to FRPv1 – 2015/16

 Changes post FRP: Impact of allocation and planning guidance

 Changes post FRP: Other (impact on 2015/16 only)

 Outline plan to recover the position

 Governance & Delivery

Members were informed the CCG has received a clear message from NHS England, stating that the control total for this current year, which is the £16.7m deficit, must to be delivered. It was noted that if, there are no surprises in the next seven weeks, the CCG is confident they will deliver.

In terms of the longer term recovery plan, the realistic but challenging aspects are being focused upon, along with Map of Medicine, which will be key to the delivery. The plan will not only focus on recovery but also quality. A piece of work is being completed around reframing the CCG strategy. The fundamental priorities that members have previously suggested will not however change.

Members were informed of the headings that the work will be grouped under. Ageing Well, will include GPP, case management and care homes. It will also bring in locality work and community asset building. The heading Ensuring All Interactions Add Value, will include avoiding hospital care and implementing procedures of limited clinical value. Joined up services, will include the urgent care strategy.

Dr James, RS and Tim Tebbs (Chief Finance Officer) met with the Regional Director, Paul Watson (PW). PW stated the CCG plans are sufficient and ambitious; however there are concerns around the delivery. In light of this, the CCG will be reviewing the plan, which will include the roll out of Map of Medicine.

The consequence of not delivery the plan going forward will mean an intervention regime. It was noted that the CCG is aware their capacity needs to increase, in order to deliver the plan. However, the CCG is also dependent on the support of the membership.

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RL mentioned the South Staffordshire Council is ready to commission most of the £475K local commissioning budget on fourteen schemes that will relate to the prevention agenda. The commissioning will be ready from the 1st April. RL noted he would share details with RS and the CCG once available

Action: RL to share details of the commissioning for the outcome agenda with RL RS once available.

Members were asked if they had any questions. It was queried if the intervention regime would have a negative impact on practices. It was noted it could possible mean general practice could lose the control it currently has. Members noted that they are controlled by the patient and the GMC already.

Concerns were raised around Map of Medicine, noting that it cannot be assumed the system will have the same effects as it does in other areas. Localising the pathways and the launch to practices of Map of Medicine were felt by members to be crucial to its success. Members were informed the CCG will work with members to ensure the pathways required are implemented into the delivery of the system.

When considering procedures of limited clinical value, it was suggested GP should have someone to refer patients to, in order to explain the decision making process. It was noted a leaflet is being designed to explain which services will not be funded and why. The leaflet will be provided to practices to hand out to patients. Members were asked if the leaflet would be helpful. Members noted a professional would be more preferable to refer patients to. It was noted the IFR team are available to refer patients to. It was requested that the procedures are discussed and fedback to GPs before final decisions are made. Members were informed the procedures go via the CPAG group, who agree the prioritisations.

Action:  AIH to liaise with MS to request the list of limited value procedures be AIH/MS circulated to members.  AIH to provide members with contact details of the IFR team. AIH

7 Review of Local Services In Seisdon Due to the time limitation of the meeting, members were instructed to view the content of the paper on the Local Services Review, which describes the process, and to contact RS if there is anything that members think should be included in the review.

Members were informed Crispin Atkinson (CA), Turnaround Director, drafted the paper and would be attending the next locality meeting on 11th March. It was noted any enquires could be discussed with CA in the next meeting.

Action: CA to attend the Locality meeting on Wednesday 11th March 2015 to CA discuss review of local service in Seisdon Peninsula.

8 Item for inclusion on the Risk Register and lead/s identified The financial position was addressed as a risk. 9 AOB

4 | P a g e Enc 17 Update on Intermediate Care A letter has been distributed regarding Intermediate Care.

Members were informed options for the next steps will be discussed within the next few weeks.

Action: RS to circulate options to members in the next few weeks to discuss the RS next steps.

As a result of the MDT meetings, Dale Medical Practice have raised concerns

about the proactiveness of the Community Matron Service. This will be raised by th CA when he meets with Liz Onions from SSOTP on 12 February 2015.

Email from Wolverhampton Federation Members were asked about the email from the Wolverhampton Federation. It was noted the email had not been received by all members. TD noted he would circulate the email to all members. It was suggested Seisdon practices meet in the near future to resume discussions around federated working. TD

Action: TD to forward the Wolverhampton Federation email to members and arrange a meeting for all Seisdon practices to discuss federated working.

Members were provided with packs of 500 Choose Well leaflets for each practices to accompany the banners that have already been circulated to practices.

10 For information only Future Joint Locality Dates

Wednesday 29th April 2015, Roman Way Hotel, Watling Street, Hatherton, Cannock, WS11 1SH.

Tuesday 6th October 2015, Roman Way Hotel, Watling Street, Hatherton, Cannock, WS11 1SH. 11 For information only - Finance and Performance Report Integrated Quality and Performance Report DATE AND TIME OF NEXT MEETING Mental Capacity Act Event, Wednesday 25th February 2015, 1:45pm-5pm, Roman Way Hotel, Watling Street, Hatherton, Cannock, WS11 1SH (Lunch available from 1:30pm)

Seisdon Peninsula Locality Board Meeting, Wednesday 11th March 2015, 1pm - 2pm Council Chambers, South Staffordshire Council Offices, Codsall. (Lunch is available from 12:30pm)

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Enc 18 South East Staffordshire CCG Locality Board Wednesday 27th January 2014 Merlin House, Tamworth Present: Aldergate Medical Dr M. King Longfellow Road, Ahmad Dr Zakai Practice Anchor Medical Dr Julie Thomas Peel Medical Practice Dr C. Jones Practice (Practice Manager) Burntwood Health and Dr D. Saunders Dr Vije Practice Dr Vije Rajput Wellbeing Centre Cloisters Practice Dr Kaul Salters Meadow Health Dr Gregory Centre Crown Medical Dr Joshi Spires Practice Dr Huisman Fulfen Practice (Dr Dr Ward (Chair) Dr Khare’s Practice Dr Khare Wharton & Partners) Heathview Medical Dr Yunas Tri-Links Medical Practice Dr Singu Practice Hollies Medical Practice Dr A. Parkes Westgate Practice Dr Yiu-Chung Cheung

Langton Medical Group Steve Cowley Dr Yannamani’s & John Dr John (Practice Manager) Surgery and Dr Yarra’s

Laurel House Surgery Dr Chapman Dr Yarra’s Practice Dr John

In attendance: Yvonne Wood (YW) – Operations Manager Andy Hadley (AH) – Practice Support Manager Caroline Parmenter (CP) – Communications and Engagement Assistant Pam Bains (PB) – Finance Assistant

Tamworth Practices only ACTION Introductions and Apologies for absence Apologies were received from the following practices: No formal apologies were received.

The meeting was agreed as being quorate. 1. Mini Action Review Actions sheet updated. 2. Practice Engagement & Development LIS – Last year Members were advised that the paper circulated on the Practice Engagement & Development LIS was a draft form, which focuses on the new operational plans for next year. Members were informed that instead of two Locality Directors there will now be three, with two covering the South East Staffs Locality. One will cover Tamworth and the other will cover Lichfield and Burntwood.

Members were asked if the Tamworth Locality meetings should continue on a Tuesday, becoming a shorter meeting. Members agreed to the new arrangements.

It was explained the three localities would take place on three consecutive days, moving to 1 | P a g e

the second week of each month covering Tuesday, Wednesday and Thursday. Instead of ten locality meetings there will now be twelve and two Joint Locality meetings.

It was explained the CCG has co-ordinated diaries in terms of the PLT events to ensure they do not coincide with the Locality meetings. The PLTs will always take place on a Tuesday at the end of the month and the venue agreed is Swinfen Hall.

The language has been abandoned for the practice development plan and the number of components have been reduced as members requested. There will be an increase in

engagement with practices via more locality meeting, as well as practice visits.

In regards to prescribing, Mahesh Mistry, Head of Medicines Management, is working on

reviewing the activities required. It was noted future plans may involve pharmacists starting

to see patients face to face in practice.

It was noted costing’s have changed slightly within the component of Practice Engagement. The main area of the Clinically Led component focuses on Map of Medicine. If practices have an interest in piloting the system they were instructed to liaise with AIH. Once the system is localised it will be an assets to practices. All Action: Members to inform AIH if interested in piloting Map of Medicine. members

The Urgent Care Dashboard is now loading in HEFT data.

In the Quality Driven component it has been agreed to continue with GP Avoidable incidents. Telemedicine will continue into next year, with two or three work streams implemented within this.

Members were asked for their feedback on the proposal. No comments were received. Members were instructed to liaise with AIH or JW after the meeting if any enquires arise.

Action: Members to feedback any enquires around the Engagement LIS proposal for next All year to either AIH or JW. members

3. Soft Intelligence Diabetic Nurses The Crown Medical Practice reported that in regards to Diabetic Nurses, patients had not been followed up regularly for their H-B-A-1-C three monthly check. It was noted that now that the team is fully staffed practices should see improvements.

Action: FS to report the Crown Medical Practice feedback to the Diabetic Nurses Team. FS

There has been no communication in relation to the nurses leaving the care home. VR stated he has emailed Sarah Orm (SO), Team Lead, and was awaiting a reply. VR suggested a meeting be arranged between himself and SO to discuss the team’s progress.

Action:  FS to investigate if Betty Oldford and Rose (Diabetic Nurses) have left the care FS home.  FS to arrange a meeting between Sarah Orm and VR, in order to discuss the FS progress within the Diabetic Team. 2 | P a g e

District Nurses Aldergate has experience problems with flu jabs and blood tests, due to DN’s not accepting patients who are housebound if not on their caseloads. It was advised the matter would be address in the new service specification.

Issues were raised around accessing caseloads and the lists not being on a central I.T system. It was noted DN do have their caseloads recorded electronically. Members were instructed to inform FS if they are told that the DNs caseloads cannot be accessed electronically.

Action: All members to inform FS if it is reported that DN caseloads cannot be accessed All electronically. members

The attendance at MDT meetings was queried. VR reported that from his experience the attendance had improved. Aldergate reported DNs have not be attending the meetings and no care plans have being provided. It was explained there should be at least one professional present from SSOTP, either a District Nurse, Community Matron or Social Worker. Members were instructed to inform FS on whether DNs are attending the MDT meetings or not. 4. Update on the following: District Nurses An Operational meeting had taken place with SSOTP and it was reported that the Tamworth West Team is under staffed. Tamworth East staffing is currently satisfactory. SSOTP are looking to increasing the staffing level in the West Team by utilising nurses from Lichfield. New staff have commenced.

Community Matron One Community Matron from the Tamworth team has gone over to the Lichfield team to fill the gaps. The vacancy in Tamworth still needs to be filled, alongside a team leader position. The Team Lead in Lichfield is due to go off on secondment and the position is currently be advertised.

Ambulatory Clinics Ambulatory Clinics have been set up to undertake MIU dressings and for the nurses to manage their caseloads. However, the clinics are not for Practice Nurses. The service specification will go into the 2015/2016 contract and include case management. There will also be a service specification for Wound Care, Continence and Palliative Care.

Diabetic Nursing The Diabetic Nursing vacancies are now filled. However, there is gap around care homes. There is significant support provided from the team leader who is based in Cannock. The team leaders also offers supervision to all of the Diabetic Nurses in SSOTP.

Increasing Flu Jabs Hayley Bishop, Commissioning Manager, attended the Emergency Responsive training and it was reported flu jabs could be improved. Five practices under the CCG have not sent recordings to Public Health, of which four are Tamworth practices. However, the Hollies Practice in Tamworth was recorded as providing the highest rate of flu vaccinations for over 65s. Practices were instructed to submit their recordings if not already submitted. Practices were encouraged to use up any vaccinations left. A letter from the Department of Health came out on the 16th December 2014 to remind practices to use anti virals.

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Tamworth, Lichfield and Burntwood Localities

5. Declaration of Interest It was explained that the context of declaring a conflict of interest is crucial.

In relation to Alexin attending the meeting it was noted no formal declarations of interest was required, due to no decisions being made within the meeting. It was explained Alexin were invited as a new provider in the locality to discuss their on-going work and services.

It was noted in future members will be asked for a show of hands to self-declare.

Members were asked to declare any conflicts of interest if any arose. None were raised. 6. Minutes of the previous meeting The minutes of the meeting held on 14th January 2015 were approved as a true and accurate record.

Action from the meeting held on 14th January 2015 Action sheet updated as attached.

AOB Stroke Strategy VR presented a paper on the National Stroke Strategy and circulated a copy of the paper to members. Members were provided with an update on Stroke HASU provision for SES, including changes at HEFT, which are due to start 2nd February 2015 and proposed changes and assurance in response to Burton ceasing to be a HASU provider from Summer 2015.

Members were asked if they had an queries. The TIA unit was enquired about. Members were informed the TIA is a separate unit. Members were instructed to view the link to the website, which provides information on the national standards been flowed. It was queried how the numbers of patients attending would be managed. It was explained the process in the Stroke Model means patients will be assessed on a set criteria by a Stroke Co-ordinator and then sign post immediately. TIA Clinics will still be at Good Hope for low risk patients.

Future SES Locality meetings There would be one more SES Locality meeting, due to be held on Tuesday 24th February, from 12pm-3pm and with the same structure of today’s meeting. From May Tamworth and Lichfield/Burntwood will have separate meetings.

Next PLT Event It was noted that the PLT Event due on Wednesday 25th February will be focused on the Mental Capacity Act and will be held at Roman Way, from 1:45pm-5pm. 7. Financial Recovery Plan Crispin Atkinson, the new Turnaround Director, was introduced to members. It was explained CA role is to support the CCG in the recovery of the finances. A presentation followed on the Financial Recovery Plan and focused on the following:

 Financial challenge  Stabilisation  14/15 in year recovery plan and the key elements  Transformational Change – County Wide and SES&SP specific  Medium Term Finance Recovery Plan 15/15 & 16/17, Scheme Categories and Savings.

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Members were asked for their feedback on the finance position. The following was fedback:

 It was felt members should be more involved in the decision making of the Financial Recovery Plan.  More detail to the plan was requested.

Members were informed that anyone who wishes to be more involved is welcome to have their input and it was added that GPs views would be of great value. The plan on a page will be circulated to give members to provide a better view of the on-going work that potentially members could become involved in. It was noted if members are provided with the detail of the schemes it would be helpful to have member’s views on what other opportunities there are.

Action: JW to circulate the plan on a page to members. JW

 Concerns were raised regarding the threat to the quality care being delivered, when considering cost reductions.

It was noted the message is not to lower the quality of care being delivered but to approach how care is provided differently, which means still providing high quality of care but at the same time delivering savings. It was noted transformation change is required to achieve both aspects. It was explained each project has a Clinical Director assigned to it, which should provide members with reassurance that the correct decisions regarding quality are being made.

Action: AB to add Standard Operating Procedures to the next SES Locality agenda for AB February’s meeting.

 It was suggested to make improvements with GPs input there is a need for more investment, along with increased capacity and members meeting every week.

It was noted the CCG would look for ways for members to have more input and present ideas to members in the future to determine views.

 The issue with transparency was raised. It was noted it had been requested the CCG inform the area team of the realistic situation of the financial position and not feedback has been reported on the request.  It was also requested the CCG apply pressure to local MPs in the general election year and no progress has been reported on this either.

CA ensured members he has attended meetings with the Area Team and the Regional Team. It was noted both teams are fully aware of the realistic extent of the financial position and the political aspect of the position have been discussed.

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8. Alexin PJ and SC provided a presentation on Alexin Healthcare and explained what the organisation has been focused on. The following areas were explained in the presentation:

 The Stats  Achievements  Accreditations  Structure of Alexin - Board and Divisional Structure  Project Leads

Member were informed the Prime Minster Challenge Fund has been submitted for the bid and members were instructed to inform PJ if interested in delivering the scheme, if the bid

is accepted.

Action: Members to feedback to PJ if interested in delivering the scheme, if the bid if All accepted. members Members were asked if they had any questions. No questioned were raised.

Lichfield and Burntwood Locality

9. Introductions and Apologies for absence Apologies were received from the following practices: No formal apologies were received.

The meeting was agreed as being quorate. 10. Mini Action Review Action sheet updated. 11. Community Services and Increased Flu Jabs update District Nurses There are vacancies in Lichfield for District Nurses. However, the vacancies may move to Tamworth, due to the issue around the Tamworth West Team being under staffed. Members were informed to liaise with FS if notified by their nurses there is not enough capacity in Lichfield and also if attendance at MDT meetings is low.

Community Matron The Community Matron vacancies have now been filled in Lichfield and Burntwood. Dr Huisman was informed the Community Matrons will be liaising with him to discuss the split with the Spires Practice. The Team Lead in Lichfield is due to go off on secondment and the position is currently be advertised.

Case Management It was queried if SSOTP would have the same contract in regards to Case Management. The Case Management Service Specification is in the contract and KPIs have been added to ensure the service required is delivered. It was queried if SSOTP are not case managing the care co-ordinator for 1% of the population, whether the money could be withdrawn. FS noted she would check the contract.

Action: FS to check the Case Management Service Specification to investigate whether FS money can be withdrawn if SSOTP are not case managing the care coordinator for 1% of the population.

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Case Management will be reviewed and improvements will be implemented to address the issues members have raised. It was suggested to negotiate something locally with the Area Team, whereby General Practice is still supported but the process is done differently with a new management approach. It was noted the KPI approach would not work moving forward in solving the problems and a more radical approach is required. Concerns were raised in regards to what the money is being spent on within the contract. It was requested that members concerns are fedback to the Governing Body.

Action: JW to feedback members concerns regarding where the money is being spent in JW the Case Management contract to the Governing Body.

Ambulatory Clinics Ambulatory Clinics have started to do MIU dressings and in order for the nurses to manage their caseloads. It was noted the clinics are not for Practice Nurses. The service specification will go into the 2015/2016 contract and include case management.

Diabetic Nurses The Diabetic Nursing vacancies are now filled. However, there are gaps in care homes. There is significant support provided from the Team Leader who is based in Cannock but supervises all of the Diabetic Nurses in SSOTP. A document with contact details and pathways was requested as a reminder for practices.

Action: FS to liaise with SSOTP to notify them of members request for contact details and FS an update on the pathway for referring to Diabetic Nurses.

Increased Flu Jabs Five practices under the CCG have not sent their recordings to Public Health, of which four of them are Tamworth Practices. However, the Hollies Practice in Tamworth was recorded as providing the highest rate of flu vaccinations for over 65s. Practices were instructed to submit their recordings if not done already. Practices were encouraged to use up any vaccinations left. A letter from the Department of Health came out on the 16th December 2014 to remind practices to use anti virals. 12. Practice Engagement and Development LIS- Next Year Members were advised that the paper circulated on the Practice Engagement and Development LIS was a draft form and focuses on the new operational plans for next year. Instead of two Locality Directors there will now be three. Two Locality Directors will cover the South East Staffs Localities. One will cover Tamworth and the other will cover Lichfield and Burntwood.

The language has been abandoned for the practice development plan and the number of component have been reduced as members requested. There will be an increase in engagement with practices via more locality meeting, as well as practice visits.

It was explained the three localities would take place on three executive days, moving to the second week of each month covering Tuesday, Wednesday and Thursday. Instead of ten locality meetings there will now be twelve and two Joint Locality meetings. The Lichfield and Burntwood meeting would take place on the Thursday at an alternative venue, somewhere in either Lichfield or Burntwood, and for a shorter period of time.

Members were asked for their feedback on the changes to the locality meeting. Concerns

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were raised around the following:

 Splitting the Tamworth and Lichfield/Burntwood locality meetings.  What the functions of the meetings are used for.  Reluctances that the meeting are used as a micro-management process.

It was noted there will be common agenda items for each locality and everyone will receive the same information. It was explained the change will mean an extra representative will be on the Governing Body. The additional locality director will also make it possible to cover all the practices and having smaller groups will give each members more of a chance to have their say. It was explained the Locality Directors will work closely with one another to ensure all members are kept informed.

It was noted costing have changed slightly within the first component under Practice Engagement. Under the Clinically Led component the main areas which will be focused on is Map of Medicine. Concerns were raised around Map of Medicine. It was explained there is a need to test the system to see if it will make a difference. The tool will be available to support staff too. The CCG is looking to set up forty pathways initially between February and April, which will be built upon. It was noted Stafford and Cannock are also looking to set up the system. The option to pilot the system was offered. It was noted there will be engagement with practices to set up the installation of the system and individual training will be provided. It was suggested the first year be a trail period.

It was noted under the Quality Driven component, there has been an agreement to continue with GP Avoidable incidents. Telemedicine will be continuing into next year with two or three work streams within it.

Regarding prescribing, Mahesh Mistry, Head of Medicines Management, is working on reviewing the activities required. It was noted future plans may involve pharmacists starting to see patients face to face in practices.

13. Soft Intelligence Due to the meeting over running, members were instructed to send any soft intelligences to the Single Point of Access. 14. Items for inclusion on the Risk Register/ Risk Lead Identified No risks were raised.

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Date Detail of Action Person Identified Progress/Completion Update 27/01/2015 Financial Recovery Plan  JW to circulate the plan on a page to James Ward members.  AB to add Standard Operating Procedures to Anna Bogle Completed the next SES Locality agenda for February’s meeting. 27/01/2015 Alexin Members to feedback to PJ if interested in delivering All members the scheme if the bid if accepted. 27/01/2015 Engagement LIS – Last year  Members to inform AIH if interested in All members piloting Map of Medicine.  Members to feedback any enquires around All members the Engagement LIS proposal for next year to either AIH or JW. 27/01/2015 Tamworth Locality Soft Intelligence  FS to report the Crown Medical Practice Frances Sutherland feedback to the Diabetic Nurses Team.  FS to investigate if Betty Oldford and Rose Frances Sutherland (Diabetic Nurses) have left the care home.  FS to arrange a meeting between Sarah Orm and VR, in order to discuss the progress Frances Sutherland within the Diabetic Team.  All members to inform FS if it is reported that DN caseloads cannot be accessed All members electronically. 27/01/2015 Lichfield/Burntwood Locality Case Management Frances Sutherland  FS to check the Case Management Service Specification to investigate whether money 9 | P a g e

can be withdrawn if SSOTP are not case managing the care coordinator with 1% of the population.  JW to feedback members concerns Dr James Ward regarding where the money is being spent in the Case Management contract to the Governing Body. 27/01/2015 Diabetic Nurses FS to liaise with SSOTP to notify them of members Frances Sutherland request for contact details and an update on the pathway for referring to Diabetic Nurses. Actions from 2014 28/10/2014 What do Tamworth Practices want from this meeting HEFT have restructured their AB to add ‘issues around the reconfiguration of Anna Bogle On-going 27.01.2015 timetable to increase public HEFT’ to November’s agenda. consultation. 26/08/2014 SDUC Dr James Ward JW to arrange a subcommittee with RB and KM to On-going 27.01.2015 JW to organise another meeting with discuss the specific recommendations on IG, GK, IG team and CSU. particularly in relation to the OHHs provider. 14/01/2015 Privatisation of local NHS services All members to direct their proposals in relation to All Members Completed 27.01.2015 No feedback was received from privatisation of local NHS services to JW or JJ before members. Members were instructed the next Joint Locality meeting, due to be held on to inform JW or JJ if there are any 29th April 2015. issues.

14/01/2015 Volunteers for invitation to tender panels for NHS Members were asked if they would be 111 re procurement Anna Bogle Completed 27.01.2015 interested in volunteering to be part Volunteers for invitation to tender panels for NHS of the panel for NHS 111 111 re procurement to be added to the next SES procurement. MK expressed an Locality agenda. interest and stated he would liaise with FS. 14/01/2015 Co-Commissioning Guidance JW fedback members views on Co- JW to feedback members views on Co- Dr James Ward Completed 21.01.2015 Commissioning at the Management 10 | P a g e

Commissioning to CCG Senior Management Team. meeting on 21st January. 14/01/2015 Map of Medicine Members were reminded to liaise Members to contact EW if interested in piloting the All Members Completed 27.01.2015 with EW if interested in piloting Map Map of Medicine system. of Medicine come April 2015. 28/10/2014 SSOTP CA met with the Chief Executive and CA to provide a further update to members on Crispin Atkinson Completed 27.01.2015 Chief Operating Manager from SSOTP. concerns raised with SSOTP in the next SES Locality The issues were discussed and the meeting, due to be held on Tuesday 27th January strong message from the meeting was 2015. Team Leaders are to engage more effectively. Member’s feedback around this would be welcomed. CA is to have a further meeting with Liz Onions, Chief Operating Officer, in two weeks. It was noted it will be an opportunity to raise any further issues. 26/08/2014 Soft Intelligence Practice have been written to, JW to liaise with KLM to follow up the issues with James Ward Completed 27.01.2015 requesting feedback on discharge secondary care asking practices to complete letters, in order to challenge Burton unnecessary work and the letter to Burton Hospital. on quality issues of the SQUIN. Members were asked to raise any quality issues via soft intelligence. 28/10/2014 What do Tamworth Practices want from this James Ward Completed 27.01.2015 Alexin was invited to the main meeting structure of the meeting rather than JW to arrange a structure outside of the locality setting up a separate one. Any conflict meetings for Tamworth practices and Alexin to of interest that may arise within the liaise, to avoid any conflict of interest. meeting was advised to be noted. It was noted inviting Alexin would not breach any codes of practice.

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