Agenda South East Staffordshire and Seisdon

AGENDA SOUTH EAST STAFFORDSHIRE AND SEISDON PENINSULA CLINICAL COMMISSIONING GROUP GOVERNING BODY TO BE HELD IN PUBLIC Wednesday 29th July 2015, 3.00pm Board Room Merlin House, Tamworth, Staffs B78 3HF

Enc Lead Time 1 Apologies and Declarations of Interest: Verbal JJ 3.00pm 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 27th May 2015 Enc 01 JJ 3.05pm

3 Actions from Meeting held on 27th May 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  Lichfield/Burntwood Locality Board Enc 04 JJ  Seisdon Peninsula Locality Board Enc 05 TD  Tamworth Locality Board Enc 06 SS

7 Chairs reports from Committees: 3.30pm

 Patient Council Enc 07 AH  Quality Committee – June & July Enc 08/08a AF  Finance and Performance Committee Enc 09 AH  Audit Committee Enc 10 JJb 8 Integrated Quality and Performance Report Enc 11 HJ 3.40pm

9 Board Assurance Framework Encs HJ 3.50pm 12/12a

10 Secondment of Accountable Officer Enc 13 JJ 3.55pm

11 Appointment of Interim Accountable Officer Enc 14 JJ 4.00pm

12 Real Accountability Report Enc 15/15a RS 4.05pm

Finance and Performance 13 Finance Report Enc IB 4.10pm 16/16a

Assurance 14 Committee Minutes for information: 4.20pm

 Quality Committee Enc 17 AF

 Finance & Performance Committee Enc 18 JJ

 Seisdon Peninsula Locality Meeting Enc 19 TD

 Burntwood & Lichfield Locality Meeting Enc 20 JJ

 Tamworth Locality Meeting Enc 21 SS

15 Any Other Business Verbal ALL 4.25pm

16 Items to be included on the Risk Register Verbal JJ 4.30pm

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

Wednesday 30th September 2015 Board Room Merlin House, Etchell Road Tamworth, Staffs B78 3HF

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

Wednesday 27th May 2015, 3.00pm, Merlin House, Etchell Road Tamworth, Staffs B78 3HF

Present: Dr John James (JJ) Chair Rita Symons (RS) Accountable Officer Dr Tim Dukes (TD) Locality Director Dr Sekhar Singu (SS) Locality Director Ian Baines (IB) Chief Finance Officer Richard Alsop (RA) Director of Transformation Rosemary Crawley (RC) Lay Member, PPI Crispin Atkinson (CA) Turnaround Director Alex Fox (AF) Lay Member, Quality Colette Marshall (CM) Secondary Care Consultant Anne Heckels (AH) Lay Member, PPI and Finance Jeni Jobson (JJb) Lay Member, Governance Tony Goodwin (TG) Chief Executive, Tamworth Borough Council In attendance: Sara Rogers (SR) Corporate Support Manager Martin Flowers (MF) Interim Deputy Chief Finance Officer Nigel Williams (NW) Clinical Quality Improvement Lead

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

Apologies were received from: Mark Seaton and Dr James Ward

Conflicts of Interest There were no Conflicts of Interests identified.

The meeting was agreed as being quorate.

2 Minutes from meeting held on 25th March 2015

The Minutes of the meeting held on the 25th March 2015 were agreed as a true and accurate record.

AF was pleased to report to members that the relationship with the West Midlands Ambulance Service has improved with key members of WMAS having attended the CCGs Joint Quality Committee. 1

3 Actions from Meeting held on 25th March 2015

The Actions from the meeting held on the 25th March 2015 were updated as per attached enclosure 2.

Breast Feeding Service TG reported that Rob Barnes from Tamworth Borough Council has contacted Dawn Candy with regards to the local authority providing match funding to support a local solution. However it was acknowledged that there is still a need to look for a long term solutions. RC responded that there is currently no further funding or service being worked up however there is an interim service which is being supported by health visitors. TG responded that there may be potential for the borough council to provide funding to sustain a new service in the future.

Kinver Patient Group AF and RS attended a recent meeting of the Kinver Patient Group and found it to be an extremely positive meeting and well attended. Conversations were held specifically on issues around Dudley group of hospitals.

SSOTP Workforce Development Toolkit Audit work that the transformation team have completed on the SSOTP Workforce Development Tool has now been analysed. The outcome of this work is not yet known. RS reported that the original purpose of looking at the workforce development tool was around issues with capacity of teams within SSOTP and that the tool would map the journey of the team to deliver GP Plus. HJ reported that, in terms of the use of the tool, meetings have been set up with senior colleagues in both the north and south to review data.

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 following key points highlighted:

NHS E referral The new NHS E-Referral service, which replaces Choose and Book, will go live on 15th June 2015. CCGs have been working to ensure that the relevant people within the organisation are aware and, more importantly, engaged.

Heatwave Plan published The 2015 Heatwave Plan for England was published on 20th May 2015. This plan remains a central part of the Department of Health’s support to the NHS, social care and local authorities, providing guidance on how to prepare for and 2

respond to a heatwave.

Dementia Awareness week As part of the CCGs work to mark Dementia Awareness Week 2015, fifteen members of staff took part in a Dementia Friends Awareness raising session run by Carers Association Southern Staffordshire (CASS). This work is particularly important in light of the CCGs new Dementia Strategy and vision for creating Dementia Friendly communities.

Achieving the Dementia targets will remain a significant challenge for the coming year for the CCG. The denominator for the prevalence targets have altered for the new year with the target being set at 67%. There is an active plan in place to engage with practices and engage to ensure achievement.

2015/16 plans The CCG is now at the point of final agreement around plans for 2015/16. This has been a difficult planning round with enhanced scrutiny from NHS England and delays in final agreements. The CCG will continue to have a Financial Recovery Group in addition to the committee structure and must focus on delivery.

Management of change with staff. The consultation with staff around structural changes to the CCG has now finished. Staff have engaged positively and there was extensive feedback which has helped to support a final structure. This will strengthen senior capacity and move to a locality structure to better support the locality directors to work with member practices and drive deliver on the ground.

Local CCG support TG queried whether the CCG has a plan on how it will engage with the Troubled Families’ programme as it moves into phase 2. RS responded that the CCG was engaged with phase 1 however in terms of the detail for the future this is currently not clear. The organisation is very clear on its commitment to be actively involved with Building Resilient Families and meetings are planned with Denise Tolson and Charlotte Bailey of Staffordshire County Council. TG chairs the leadership group and informed members that there is currently a vacancy on the group and queried whether it should be a clinician or Accountable Officer who would be best placed to represent GPs and practices. RS is currently a member of the board. It was proposed to use the emerging structures around the CCGs to identify a delegate to consider for recruitment to the vacancy. SES & SP CCG are currently the lead for Safeguarding and as such have a great deal of involvement in the troubled family’s agenda. As part of the management of change proposals HJ will be managing the lead commissioners for children and has already met with them to take the work forward.

6 Update from Locality Directors

Lichfield/Burntwood Locality Board Members noted the report and the issue identified for escalation on the risks of delivering urgent government led priorities on 7 day working. It was noted that the CCG has a work stream around urgent care and around community hospitals. This will also be picked up in the work around new models of care with the three localities.

AF queried whether finer detail had been released on how the 7 day working will be rolled out. It was noted that the policy is due to be mentioned in the Queens speech taking place today. TD commented that while there is a view that 7 day working may prove problematic to deliver it is viewed by GPs in the Seisdon locality as a driver for the opportunity to work together to be able to manage effectively. CA reported that it will be part of the requirement for the BCF that there is regular reporting for national work, of which 7 day working is one element, and will be a specific channel of scrutiny to NHSE and the Department of Health.

Seisdon Peninsula Locality Report March and May 2015 TD presented the reports. There were no further comments.

Tamworth Locality Report SS presented the reports.

Consultant Prescriptions - CM queried whether there was a sense that hospital consultants prescribe on an ad hoc basis or whether there are sometimes valid reasons for doing so. SS responded that there appears to be mixed reasons for this happening and it would be useful to have a standardised process. The main concern is around high cost drugs.

Joint Locality Board April 2015 It was noted that there was good representation from all practices and items of discussion included:

 Co Commissioning  Integrated Musculoskeletal Service  Dementia Service  Map of Medicine

Map of Medicine (MoM) Map of Medicine is being rolled out into practices over the next few weeks. Real value will be having the pathways localised and encouraging the GPs to incorporate it into their thinking and consultations. MoM is being discussed at all practice visits and featured on the agenda at a recent Protected Learning Time event.

7 Chairs Reports from Committees

Patient Council 4

RC presented the report and highlighted the following:

April 2015 Report South Staffordshire Network for Mental Health feedback Seisdon was perceived to be an area where mental health services are not as accessible as they should be for young people. RC offered to circulate a copy of the report to members. RS reported that a great deal of work is underway in Seisdon to improve services and this will continue to be monitored by both the CCG and the contract management team within the CSU.

Quality Committee AF presented the reports and highlighted the following:  Attendance and representation from key members was noted as a concern.  AF has met with Nigel Radcliffe, Chair at SSOTP, with regards to interaction with the organisation and included a discussion around recruitment difficulties that the trust is experiencing.

May 2015 During the May meeting the key concern was the lack of attendance of a senior Medical Consultant at the joint quality meetings. In turn an issue for escalation that has been identified is to revisit the terms of reference with regards to this post on the JQC. RS responded that in rescoping CM’s responsibilities it was identified that due to work commitments she would not able to commit to attending the JQC. It was also noted that the current secondary care consultant for East Staffs CCG at present has health problems so is not always able to attend meetings either. Members agreed that there would be value in appointing to a joint post with East Staffs CCG if the JQC decided to pursue this course of action.

School Nursing JJb requested clarification on the process the CCG is following to ensure the local health economy will deliver its statutory duty to safeguard children. HJ reported that the school nursing service is currently out to tender. The specification for the service was challenged by the Safeguarding Board and those challenges are being worked through and the CCG has been working very closely to this. The majority of the school nursing service has been transferred to Public Health who have led on the procurement. CCGs have therefore been involved in both a joint specification and procurement with Public Health.

Serious incidents (SI) – CM queried whether, as part of the new SI framework, there had been an increase in the reporting of SIs from provider organisations. HJ responded that the quality team are closely watching the responses to the new framework and that conversations are being held with NHSE to enhance the framework locally and outcomes monitored.

Finance and Performance Committee 5

RS provided a verbal update and highlighted the following key points:

 Discussions were held on the 2015/16 plans, scenarios and activity changes  Data used to measure success and the non-reliance on SUS data which can be 2 months out of date. There is now an initiative where practices provide more live referral data. However this needs refining and additional resource is required in terms of business analysis in terms of data collection to support primary care to measure success.

Performance  Discussions were held around Dementia and the associated challenge in delivering the target  HoEFT’s on-going performance issues were discussed at length and subsequently, following an Informal Assurance meeting with the Area Team, they have agreed to support the CCG in addressing these concerns. Monitor are currently in HoEFT and effectively running the trust and agreeing to targets which are below constitutional markers. NHSE have contacted Birmingham and Black Country Area Teams to escalate and a proposed tripartite meeting may take place in the near future. CM expressed her disappointment at Monitor agreeing targets below national standards and their poor decision making.

AF queried what the financial penalties are if performance drops from 95% to 92%. IB confirmed that there are implications which will need to be reviewed when the contracts are signed.

8 Integrated Quality and Performance Report

Members noted the Integrated Quality and Performance Report which highlighted the key activity following the 2015 JQC.

Suicide Strategy Progress has been made with the production of a Suicide Strategy by Staffordshire Public Health which has been outstanding for a number of years. The strategy will be available from September onwards across the local health economy.

Quality Accounts The Joint Quality Committee are requested to comment on the quality accounts for providers where they are lead commissioners which are Burton Hospital and Shropshire and South Staffordshire Healthcare Foundation Trust. An exact replication of the comments made by the JQC are incorporated into the documents of those providers.

Infection and prevention control summary A summary of a very detailed report was included and provided assurance on the significant work undertaken on infection and prevention control. 6

Quality impact assessment meetings All projects and programme work going forward will have an early and strong quality impact assessment.

60 Second GP Report This is now a standing agenda item at the JQC which allows the GP members to brief the committee attendees of the top current priorities and issues.

Staffing issues at SSOTP Key concerns remain with staffing issues at SSOTP which includes sickness, absence and high levels of turnover. A new Director of Nursing has been appointed and is working hard to address the JQC’s on-going concerns.

TD reported that there has been an improvement at Dudley Group of Hospitals which was welcomed.

RS queried how confident are the JQC that the targets for the infection rates, particularly CDif, will improve in the next year. HJ responded that in terms of the avoidable vs. the unavoidable debate the majority of cases highlighted have been unavoidable so there are no issues with those cases. There is also a great deal of work being undertaken by Jackie Derby, Infection Control Lead, and a team across the health economy including monitoring of reports and monthly conference calls across all CCGs.

JJb commented that her observation of the report is the challenge in getting real data at a local level and challenging those providers with that data. Does the quality team go back on a local level and request a response to specific data e.g. a Practice Nurse with a high level caseload. Furthermore what is the responsibility, where the CCG can push and change what is within our control, and is there a reporting mechanism which shows our performance in clarity, as well as in a group and how are we effecting the data.

HJ responded that the decision was taken to move to an integrated Quality and Performance to ensure a consistent set of data. Nigel Williams, Clinical Quality Improvement Lead, is currently undertaking a lot of work on the integration of the reports which means there is an evolving process to get to a middle ground. HJ welcomed all feedback which will ensure that the report reaches a position where the CCG local performance data and analysis is included. HJ has also met with Val Jones, Chief Nurse at SaS and CC CCGs who confirmed that there is a push for locality level data with the providers, in this case SSOTP. Val Jones has assured HJ that a conversation has taken place to request more local data and will be picked up again at CQRM.

CM commented that there appeared to be a number of gaps in the figures in terms of performance. HJ requested that CM provides her with a list of queries to which she will investigate and respond immediately.

HJ requested member’s approval to revert to bimonthly CQRMs and reporting for SSSFT. Data will continue to be provided on a monthly basis. Members approved the change.

9 Board Assurance Framework (BAF)

Members noted the report which provides the Governing Body with information about the most significant risks currently facing the organisation.

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.

Members were informed that while there is no risk noted on the BaF for Finance this is due to the previous year’s finance target being achieved. The financial risk to the CCG is currently in the process of being assessed and an entry for the new year will be included once agreed at the next Risk Group Committee.

AF commented that it worth investigating further potential risks already identified during the course of the meeting including the lack of capacity with GPs, staffing levels with SSOTP and undertaking tasks to achieve the financial plan.

Members agreed that an additional agenda item titled “Items to be included to the Risk Register”.

JJb commented that she will be taking the lead for the Audit Committee with immediate effect and will be reviewing the Risk Register and BaF to ensure that the lists are both aligned. HJ is the lead Director for Risk.

10 Annual Report

RS presented the Annual Report which has been produced with the support of External Audit in line with national requirements. Due to on-going changes the final report was not received from Grant Thornton until late last night which has not allowed the opportunity for a final review by the CCG senior officers.

The report covers the work of the CCG and reflects the new direction of the organisation and revised programmes of work.

RS reported that last year a large number of copies of the report were printed which were wasted. This year there will be a limited print run aligned with a public facing summary.

JJb welcomed the report however queried that on pages 25 and 26 the report discussed transformation savings and that the narrative is different from what IB 8

was indicated. IB agreed to pick this up.

Thanks go to all members of staff who have supported the organisation in meeting the deadline.

Members approved the content of the CCGs Annual Report 2014/15.

11 Finance Report

IB presented the report and informed members that the deficit for the year is £16.68m. The position was achieved with non-recurrent measures and came in on line with the revised control total. IB reiterated the need to ensure that the organisation continues to deliver savings in order to return to an underlying surplus position.

Financial Plan 2015/16 IB presented the report which summarises the CCGs Financial Plan for 2015/16. The CCG is proposing to set a deficit plan of £18m for 2015/16. This is an increase of the in-year deficit of £12.2m reported for 2014/15 and is dependent on the delivery of £6.5m QIPP savings in year.

RS reported that going beyond 2015/16 the CCGs Medium Term Financial MF Recovery Plan was sent into NHSE however no feedback has been received to date. MF to chase a response.

JJb acknowledged the detail behind reaching the figure of £18m, and the creation of that start point, however requested clarification that the deficit carried forward for 2013/14 has been covered off and the figures have just not been adjusted for this year. MF confirmed that the accumulated deficit based on this plan for 2015/16 will be approximately £35m. There were issues in the past in that the CCG was not clear about the underlying position however, as a result of a lot of scrutiny over the past 6 months, there is now a clear picture of the recurrent position and non-recurrent factors and how they plan to change over the coming year. JJb requested a meeting to go through the finer JJb/IB detail of the figures with IB which will includes all brokerage deals.

RS provided further assurance that a great deal of scrutiny and work has gone into the drafting of the plan by members of the finance team. A good part of the PWC review was to examine the organisations figures and the underlying deficit and have agreed with our numbers and underlying position.

CM queried what the activity growth is based on and the level of confidence in the figure being a true forecast. MF responded that the plans been through a number of reiterations after discussions with the Area Team and that the figure is what the CCG have been directed to include. The CCG did have lower figures based on forecast outturn and trends in growth however what is included is a higher growth figure. RS reported that a great deal of detailed modelling has been undertaken including activity trends. CM requested that 9

activity reports are included in future reporting to the Governing Body. RA reported that if the CCG wait for the normal run of reports then it will not have an up to date position. It is therefore important to get a measure of trend as soon as possible.

JJ reported that the CCG are also aiming to obtain soft intelligence from practices on the number of referrals being made in month. This should be able to assist with identifying trends.

JJb commented that it would also be helpful to include a sensitive analysis on the numbers. PWC reported that they believe the CCG are being too optimistic about the activity levels the organisation have based on past trends.

RS reported that the numbers included in the PWC report are different from those agreed following the review undertaken by them in March 2015.

Annual Accounts and External Audit Opinion The auditors have issued an unqualified opinion on the preparation of the accounts and a Qualified opinion on the regulatory of the accounts and on the Value for Money opinion.

Members were also asked to note a letter of representation provided by the external auditors which stated that the Governing Body have been honest and open with the auditors and there was nothing further known to the CCG that materially might affect the accounts of the organisation as a going concern. Grant Thornton were satisfied that they had received all of the information that they required.

HJ queried the value of including bullet point 3 of the letter of representation which focusses on non-compliance with requirements of the Care Quality Commission or other regulatory authorities that could have a material effect on the financial statements. Members agreed that this bullet point is not applicable to the CCG and requested that it is removed.

Members approved the letter of representation, Annual Accounts for the financial year ending 31st March 2015 and the report of the External Auditors on the Accounts and Annual Report.

11 Committee Minutes to consider:

Joint Quality Committee The minutes from the Joint Quality committee held on the 14th January 2015 and 11th February were noted with no further comment.

Joint Quality Committee th th The minutes from the meeting held on the 14 January and 11 February 2015 were noted with no further comment.

Finance and Performance Committee The minutes from the meeting held on the 21st January and 18th February 2015 were noted with no further comment.

Seisdon Peninsula Locality Meeting The minutes from the meeting held on the 11th February 2015 were noted with no further comment.

South East Staffordshire Locality Meeting The minutes from the meeting held on the 27th January 2015 were noted with no further comment.

13 Any Other Business

Lay Member for PPI JJ informed members that this was the last meeting for Rosemary Crawley as she stands down from her position as Lay Member for PPI. Members thanked RC for her valuable contribution in raising the profile of the Patient Council.

Turnaround Director JJ informed members that this was the last meeting for Crispin Atkinson, Turnaround Director. CA was thanked for his contribution to the organisation during the 6 months he had worked in the CCG in an interim post.

Local Authority TG reported that following the elections a manifesto is being drafted which provides detail on centralisation of local authority services and could be of interest in the future to the Governing Body.

14 DATE AND TIME OF NEXT MEETING

Wednesday 29th July, 3.00pm Board Room Merlin House Etchell Road, Tamworth Staffs B78 3HF

SIGNED: ...... DATE: ...... (Chairman)

ACTIONS DUE FOR REVIEW Governing Body Date of Meeting: Wednesday 27th May 2015 Meeting Agenda Action Required By Update/Progress Date Item 27/05/15 11 Financial Plan 2015/16 Update 24/07/15 JJb and IB to meet to discuss the Financial Plan JJb/IB Updates on finance have been 2015/16. provided at two F&P Committees since the last GB meeting. JJb and IB to also arrange a meeting to discuss in further detail. 27/05/15 10 Annual Report Update 24/07/15 IB to check figures on Pages 25-26 and compare with IB The difference noted is in narrative to ensure they are aligned. respect of the external QIPP plan reported on page 25 (£6.5m) whereas the Ageing Well programme is in respect of the internal plan (£7.3m).

27/05/15 11 Financial Plan 2015/16 Update 24/07/15 MF to chase a response from NHSE on the Medium MF Response received from NHSE Term Financial Recovery Plan submitted. that the plan has been approved. Action complete. 28/01/15 8 Integrated Quality and Performance Report Update 25/03/15 RS to write to Sandwell CCG Accountable Officer and RS RS has written to Sandwell CCG Chair the CCGs concerns with regards to lack of re the ambulance trust. Since performance information and lack of assurance being then the strategy has been to provided from the Ambulance Trust. work with WMAS direct with

monthly meetings now in place. Action complete.

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 Update 27/05/15 Tamworth. RC has spoken with Dawn Candy and there TG reported that there may be has not been any progress to date. potential for the local authority to provide match funding to support the service in the short term however there is acknowledgement that the longer term future will also need to be considered. RC informed members that the service has now ended and a new one has been put in place by the Health Visitors. Action complete. 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. Update 27/05/15 AF and RS attended a meeting on the 14/04/15. The meeting was well attended and highlighted the concern to ensure that practices across the patch are actively engaged. Action complete. 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. Update 27/05/15 HJ reported that the first part of the action is complete and the

information is presented to the CQRM. The original purpose of reviewing the workforce development toolkit was to address staffing concerns in the teams in SSOTP. In terms of the use of the tool HJ has a meeting set up with Tina Cookson and senior nurse colleagues across the health economy to discuss this further. Action complete

The transformation team has also completed an analysis of audit work undertaken. The outcome of that audit will be made available to the HR/OD Group. Action complete.

REPORT TO THE SOUTH EAST STAFFORDSHIRE & SEISDON PENINSULA CLINICAL COMMISSIONING GROUP GOVERNING BODY MEETING To be held on: Wednesday 29th July 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 aim of this report is to make the Governing Body aware of relevant national policy initiatives and changes and to identify key local actions.

Key Points:

The report highlights changes to NHS provider regulators, the new vision for the NHS and initiatives in key areas such as cancer care.

Locally, we talk about our public engagement events and the new MSK service available to our residents.

Responsible Committee Name: n/a

Approved at Committee: YES/NO Date of Committee:

Impact: Quality The new vision and cancer recommendations will directly enhance quality of Implications: provision if commissioned appropriately Financial The Governance Checklist will help us to improve our financial performance Implications: Equality impact YES/NO assessment If YES please give summary: required:

Delivering the Strategy: How does the Strategy needs to be informed by national policy changes. recommendation

contribute to delivering the CCG Strategic Vision?

Contribution to delivering the Health & WellBeing (HWB) Strategy: Cancer outcomes work needs close working with public health to deliver improvements.

Recommendations/Actions required: The Governing Body are asked:

 Note and discuss the contents of this report

Explanation of acronyms used in this report: Acronym Explanation SRG System Resilience Group CSU Commissioning Support Unit AGM Annual General Meeting MSK Musculo-skeletal

National News

NHS Review of Urgent Care

One of the major challenges for the NHS is creating a sustainable urgent care system. NHS England Chief Executive Simon Stevens and the NHS Five Year Forward View partners) announced on the 24th July eight new vanguards that will launch the transformation of urgent and emergency care for more than nine million people.

Locally, there will be a network jointly chaired by the Accountable Officers of Shropshire and Stoke CCGs. Locally we are committed to work through the three relevant System Resilience Groups (SRGs) to address operational issues around urgent care.

NHS England Publishes Second Annual Report

On 22nd July, NHS England published its second annual report, highlighting achievements in 14/15, including the publication of the Five Year Forward View. NHS England Chairman, Sir Malcolm Grant states “The status quo cannot hold. We need to carry through transformation rather than throwing yet more money at outdated models. Nobody should believe this will be an easy process”.

Financial Control Assessment Process Launched

On 17th July, Paul Baumann, Chief Financial Officer for NHS England wrote to CCGs outlining a new initiative that they are launching across the commissioning system to help us in delivering one of our key priorities for the NHS in 2015/16 – to achieve financial resilience and sustainability. We will need to complete a checklist with Audit Committee and Governing Body.

Secretary of State Launches Vision for the NHS

On 16th July, the Secretary of State, Jeremy Hunt launched a vision for the Future of the NHS, titled ‘Making healthcare more human-centered and not system-centered’.

This focusses on patient empowerment and how we change services, including the delivery of seven day working.

On 17th July, the Secretary of State wrote a message to NHS staff highlighting the key points of the vision.

Primary Care Co-Commissioning

In June, NHS England launched further details on the Approval processes for fully delegated primary care commissioning, with a deadline of 2nd August for applications. We intend to move to level 3 in 16/17 and will therefore be working up an application to meet this deadline.

Taskforce established to Improve Cancer Outcomes

On 18th July, the Independent Cancer Taskforce published their report outlining six strategic priorities.

. A radical upgrade in prevention and public health. A national ambition to achieve earlier diagnosis.

. Patient experience on a par with clinical effectiveness and safety.

. Transformation in support for people living with and beyond cancer.

. Investment to deliver a modern high-quality service, including:

 A replacement plan for radiotherapy machines (linacs) as they reach 10- years and upgrading of existing linacs by the time they have been operational for six years;

 A permanent and sustainable model for the Cancer Drugs Fund to help patients get access to innovative cancer treatments;

 A nationally-commissioned, regionally-delivered, molecular diagnostics service, to guide more personalised prevention, screening and treatment;

 Plans to address critical deficits in the cancer workforce.

. Overhauled processes for commissioning, accountability and provision.

Partnership Agreement between Monitor and TDA

On 16th July, the Secretary of State announced a partnership Agreement between the two key regulators of NHs providers; the Secretary of State has appointed NHS England’s deputy chair Ed Smith as new chair of the body. Lord Darzi will be a non- executive director, but a chief executive is yet to be appointed. The combined regulator will focus on supporting providers to become more efficient and will be called’ NHS Improvement’.

Local News

Let’s Talk About Health Events

The CCG has started to run its series of public engagement events, which are aimed at engaging our local communities and sharing our strategy. The events have been well attended and I would like to thank those who have attended and the staff who have supported the events.

The events have been in partnership with NHS Citizen who are using this CCG as a demonstrator site. We will take the feedback from all the events in the run up to the AGM.

Staffordshire Transformation Programme

The Pan Staffordshire Transformation Programme is progressing and a successful event was held on 21st July which brought together 270 health and social care staff to share the work leaders have been doing on the work streams.

New Musculo-Skeletal Service

The new MSK Service (IPOPS – Integrated Physiotherapy Orthopaedic and Pain Service) was launched on 1st July 2015 in SES and Seisdon. This new innovative service brings together specialist musculoskeletal clinicians to assess, diagnose and manage conditions at health centres and GP practices within the local community. The team provides a comprehensive assessment and range of treatments/management plans in a community setting, enabling the service to become the default referral route for all musculoskeletal conditions. All patents in the service have their own Personalised Care Plan and named Link Physiotherapist, who will manage the patient in the community where possible, ensuring, only those patients who truly need/want surgical intervention go to secondary care. The service is able to deliver Carpal Tunnel release and joint injections in the community which was previously not available, and seeks to empower patients to self-manage their conditions, working towards specific goals tailored to individual patients.

Enc 04 FEEDBACK REPORT SOUTH EAST STAFFORDSHIRE AND SEISDON PENINSULA CLINICAL COMMISSIONING GROUP Burntwood and Lichfield District Locality Chairs Report June and July 2015

1 Members present: One absentee for June meeting – Langton practice Quorate: Yes 2 Declarations of Interest: None

3 Key Points discussed:

Two meetings have been held during June and July with the main aim of progressing the 5YFV agenda.

First an informal 2 hour workshop facilitated by KPMG in support of the 5YFV Secondly, July 9th more usual formal meeting.

Main outcomes:

4 main areas of focus to be supported by sub groups to report back to the locality in October.  Primary care sustainability – including “bigger footprint” general practice…  MIU - possible PACS development  Case Management and MDT working – community provider integration.  Common IT platform and shared access to patient records

KPMG yet to complete a full survey of all the locality’s practices, absent and key players who had missed the meetings to be consulted.

Discussion on Peer review and practice visits- agreement to review practitioner level data and have more meaningful discussion on the variability in referrals and the causes of this.

Decision to send all referrals through the new IPOPS in support of the CCGs financial objectives and new service redesign.

Concerns raised about the quality of data and how that is also likely to be driving costs up with the Acute trusts – over-reporting / up-coding episodes.

4 Next steps:

Bring in support for the subgroups and develop terms of reference to support this. Revisit the incomplete KPMG work.

Improve the data reporting within the locality – identify reporting mechanisms through the use of Choose and Book as a data source to focus in greater detail on referral behaviours.

5 Issues for escalation:

Continued concern regarding the risks of ongoing poor contracting and analysis of costs in the acute trust’s contracts. As a specific example of this concerns were raised that the CCG is paying for Advice and Guidance referrals when this is actually a contractual requirement within Choose and Book.

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FEEDBACK REPORT SOUTH EAST STAFFORDSHIRE AND SEISDON PENINSULA CLINICAL COMMISSIONING GROUP Seisdon Locality Board 1st July 2015

1 Members present:-  Drs Tim Dukes, Steven Maung, Angus Jones, Aparna Gupta, Eddie Lee, Suki Johal, Peter Jones, Mark Hopkin & Harinder Grewal.  See meeting minutes for others present. Dr Asif Ahmed and Gill Bowers from Brewood Medical Practice attended in an observer role. Quorate: YES

2 Declarations of Interest:-

A potential conflict was identified around the follow-up and next steps from the meeting held in the locality with KPMG.

3 Key Points discussed:-

 Members received a report from Ian Baines, Chief Finance Officer, on the current financial position for the CCG. He discussed the closure of the finances for the 2014/15 year and the achievement of the deficit position agreed with NHS England of just under £17million, albeit with borrowing which would need to be repaid back. He explained that the total deficit will climb to around £35million this financial year before it will start to improve. At present, there is a QIPP which has NHSE approval and includes a figure of £6.5 million per year savings for 3 years. It was recognised that this was a huge challenge which would require new ways of working to be achievable.

 Members received an update on IPOPS (Integrated Physiotherapy, Orthopaedic and Pain Service), which is the redesign of the musculoskeletal service for the CCG, which went live on 1/7/15. After discussion, in view of the financial position for the CCG, members decided by a majority (8/9 GP leads) that all orthopaedic referrals from Seisdon practices, except red flags, are to be made in future through IPOPS.

 Members discussed the meeting held in the locality on 23/6/15 with KPMG on the subject of Seisdon practices working in a more integrated way and expressed disappointment with the outcome from KPMG to date. The final report from

KPMG is awaited and this remains work in progress until received. It is however expected that the view of the Seisdon locality will be fed back to KPMG and this will be reflected in their final report. Three areas have however been identified as having potential for transformational change: - 7-day service provision, GP provision of secondary care services (with possibly dermatology as a pilot) and integrated community services. A paper on General Practice Plus and Integrated Community Services was also presented under this agenda item updating members on the work being carried out in the locality with SSTOP around intermediate care and community nursing. It was recognised that a shared IT platform and data analysis are common threads which run through the integration agenda. A number of next steps were identified for the three areas and these will be developed further to bring back to the next locality meeting.

 Francis Sutherland was thanked for her work in the CCG and wished well for the future.

4 Issues for escalation:-

 The departure of Senior Team Members from the CCG was recognised as a risk to the organisation  The decision regarding all orthopaedic referrals, except red flags, to be made through IPOPS will be forwarded to the Locality Clinical Directors in Lichfield and Tamworth for consideration in their localities.  The final report from KPMG is awaited and remains as work in progress until received. It is however expected that the view of the Seisdon locality will be fed back to KPMG and this will be reflected in their final report.

Enc 06 FEEDBACK REPORT SOUTH EAST STAFFORDSHIRE AND SEISDON PENINSULA CLINICAL COMMISSIONING GROUP Tamworth Locality Committee 9th and 30th June 2015

1 Members present: All practices present Quorate: Yes 2 Declarations of Interest: None

3 Key Points discussed:

9th June 2015  MF financial update on CCG position  Discussion on KPMG transformation role

30th June 2015  KPMG Transformation changes in Tamworth locality.  Meeting was very well attended.  Underfunding issues of Tamworth and Staffordshire.  The value of the CCGs true deficit in the current financial year.  Issues about community services (already known issues) solution may be to redesign the service  Discussions on MIU - there were positive feedback about starting discussions on integrating MIU with community services. There was a willingness to further explore this.

4 Next steps:

9th June 2015 MF will provide 3 monthly updates. This will be welcomed by the member practices in Tamworth.

30th June 2015 It is important that as a CCG we engage with the members in Tamworth and follow the positive thread regarding MIU and local GP input.

5 Issues for escalation:

 Need improved communication from the CCG regarding status in terms of financial to help members make informed decisions.  Awaiting KPMG feedback following the meeting.

Enc 07

FEEDBACK REPORT SOUTH EAST STAFFORDSHIRE AND SEISDON PENINSULA CLINICAL COMMISSIONING GROUP Patient Council 7th July 2015

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

3 Feedback from Patient District Groups and organisations, including patient stories/experiences of primary care

SP representing Support Staffordshire A lady who has Macular Degeneration had surgery booked to remove a cataract. When she arrived at Queen’s Hospital they did not have her notes and she was asked to wait until 3pm, to see if notes would arrive. Once the notes had arrived she happened to mention that she would be going on holiday in four weeks and was told that she could not have the surgery because her holiday was too close. A new date has come through for the surgery but it is two days before her holiday, even though she had already given them the dates. In the pre-op she should have been asked about whether she was going on holiday.

LS representing South East Staffordshire Citizen Advice Bureau (CAB) The withdrawing of the Supporting People fund is impacting the CAB. A lot of distressed people are asking for help with their benefits and the meeting room is very full. LS is worried that there is going to be a lack of advice. SP: The 10 organisations that are being directly affected by the withdrawal of the Supporting People fund are being supported individually but no one is considering the impact on other voluntary sector organisations. FF: It was raised at the Tamworth Strategic Partnership meeting because of the worry that there will be a reduction in housing support. If someone was to lose their house there will be the cost of rehousing. The cost in the system will just move on.

NB representing Staffordshire Neurological Alliance (SNA) NB would like clarification of which hospitals the CCG covers – these are attached. The SNA have heard about problems at New Cross Hospital. People who are being diagnosed with Parkinson’s Disease are not automatically being seen by a Neurological Occupational Therapist. Additionally, an individual with MS was not offered appropriate rehab following discharge. NB to follow up. SNA have been working on their Advocacy Programme with St Giles Hospice. Emma Hodges, the new Chief Executive has been keen to work with them. St Giles will be hosting a volunteer recruiting evening for SNA’s Advocacy Programme. They currently have six volunteers.

LS been hearing good information about Burton Hospitals. LS described the story of an individual who was terminally ill had a positive journey due to the excellent links to the community nursing service. AH added that Burton Hospital is hoping to be out of special measures soon and at Good

Enc 07

Hope Hospital they have put up posters asking people to tell them the good news stories on their website as well as the bad.

JL representing Liberty Staffordshire When JL was at Portland College he had a bad experience with the nursing service. He was given the medication with the longest shelf life first, this meant that the older medication went out of date, and they were unable to give him them the medication they had in stock. However, as a whole his positive experiences of healthcare outweigh the bad.

RS representing ProHealth UK ProHealth UK is looking to support people with post birth trauma. On a personal level RS has a lot of contact with health services locally and there have been many positive experiences.

KW representing Healthwatch Staffordshire At Healthwatch events there has been mainly positive feedback, particularly about GP services, Sir Robert Peele and Samuel Johnson.

Healthwatch are holding Mental Health Engagement events on behalf of SCC and the CCGs. The consultation will inform how Staffordshire County Council will implement their Mental Health Strategy. There will also be focus groups, development groups and an online survey for people to give more feedback.

MC representing Carer’s Association Southern Staffordshire (CASS) CASS put in a tender for the new redesign of carer support services, which will now be county and Stoke-on-Trent wide. CASS was unsuccessful and A4E will be the new provider. MC suggests that the Patient Council invites someone from A4E to talk about the new service. The new service will begin in the Autumn but CASS will still be providing their usual service until January 2016. MC asks that people are still signposted to CASS as there is still some funding available.

The impact of not receiving the tender will mean that CASS will be unable to distribute their newsletter as widely because it is one of their most expensive costs. MC asks that the members of the Patient Council share leaflets which list the groups that will still be running.

CASS has been delivering workshops about Personal Health Budgets and there was good take up and positive feedback. Not sure whether these will be running in the future. LS added that the roll out of Personal Health Budgets seems quite fragmented. The main problem is a lack of funding. The most progress is in North Staffordshire with most momentum in Stoke. MC discussed the Health and Wellbeing Board and the influence the voluntary sector has. At the meeting the public has to ask questions at the beginning and there is no opportunity to join in the discussions. MC would encourage people to attend a public meeting.

JA representing Seisdon Peninsula PPGs JA recently went to an eye infirmary and received a text afterwards inviting her to complete a survey.

Complaints Advocacy Service – Jo Darrant, Healthwatch Staffordshire JD is an advocate at Healthwatch. The Complaints Advocacy service is free, independent and confidential service that helps people make complaints about the NHS. The service is funded by Staffordshire Council, and Healthwatch started delivering it on 1 February 2015. The service can be contacted via their Freephone number, text, email and their website.

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Equality Delivery System 2 FF: There has been some national legislation regarding equality and inclusion, which we needs to implement as a CCG to make sure that all of our services are fully inclusive and meeting the needs of the whole health population. FF invited people to the CCG’s Public Grading event for the Equality Delivery System 2 (EDS2), which will be held on 15 September, 9am-2.40pm at Merlin House, Tamworth. The CCG needs a mixed stakeholder group to grade their level of inclusion.

Urgent Care Reference Group FF explained how the CCG is looking at the whole Urgent Care package; include A&E, Minor Injury Units and some ambulance services. Over the next 12-18 months the CCG will be putting together some options. They would like to have a representative patient reference group to help the CCG make decisions about the future of Urgent Care and identify patient needs.

FF suggested that the Patient Council meeting on 5 August, 12.30pm-2.30pm at Merlin House, Tamworth becomes the first Urgent Care Reference Group meeting. All in agreement.

Clinical representation FF: Dr John James, Chair of the CCG will be the new clinical representative at the Patient Council. He is unable to attend the September meeting but he will be able to attend the August meeting, which is now the Urgent Care Reference Group. We will also look into having a deputy for meetings that John is unable to attend.

Items to be escalated to the Governing Body 4 Feedback from Enter & View of Ward 7, Good Hope Hospital

KW: The report from the Enter & View of Ward 7 at Good Hope Hospital, which was a result of the feedback from TJ, is to be shared shortly on the Healthwatch website. There is now a matron in post and there are no safeguarding issues but the main problem at the ward is the high number of temporary staff. The original feedback was reported to Governing Body.

Action: AH to ‘close the loop’ at the Governing Body regarding Ward 7 at Good Hope Hospital

Enc 08 FEEDBACK SHEET SOUTH EAST STAFFORDSHIRE AND SEISDON PENINSULA CLINICAL COMMISSIONING GROUP Joint Quality Committee Committee 10th June 2015

1 Members present: Alex Fox (Chairing), Ann Tunley, Dr Adrian Parkes, Steve Forsyth, Sue Wilson, Debbie Vucetic, Katie Montgomery, Nigel Williams, Paul Winter, Tracey Finney, Rob Boland, Fleur Fernando, Ann Heckels, Mahesh Mistry, Jan Sensier & Lynn Smith. Quorate: Yes 2 Declarations of Interest: None declared

3 Key Points discussed:

 The Joint Quality Committee welcomed Ann Heckels as the newly appointed Lay Member for Finance, Performance and Public & Patient Involvement.  A discussion took place regarding Health Watch becoming a member of the Joint Quality Committee.  An update on the Suicide Prevention Strategy was given. Local Public Health has taken the Joint Quality Committee’s recommendation on board and will host a stakeholder event in July 2015.  A key presentation from Burton Hospital Foundation Trust was received at the Joint Quality Committee on Falls and the work the provider has and continues to progress in this area.  Quality Accounts Commissioner Statement for SSOTP was approved. These have now been forwarded to the Lead Commissioner.  Items received for Information included: o SI Report o Mental Capacity Act Project Implementation Report o SSOTP action sheet o IFR Annual Report  The Managing Safeguarding Allegations Against Staff Policy was approved, subject to a minor request that it should include Safeguarding training in the policy for staff.  The first GP 60 Seconds Report was given by Dr Parkes; this was welcomed by the Committee and shaped a healthy discussion about taking this forward in both CCGs.  Updates and feedback was given regarding: Transforming Care, Quality Surveillance Group, Patient Engagement and Medicine Management.  In line with routine reporting, all provider reports were received and reviewed in terms of both safety and quality. The key highlights are included in the Integrated Quality and Performance report.  Joint Quality Committee noted that Quality Surveillance Group is calling a risk

summit for SSOTP.  The Committee noted WMAS have not yet responded to the request to forward their action plan regarding The Saville Inquiry.  HEFT was discussed issues remain regarding Mortality figures and the CQC report remains outstanding.  Royal Wolverhampton Trust concerns were raised regarding pressure ulcers, falls and cancer waits.  Joint Quality Committee asked Medicine Management Lead to triangulate antibiotic prescribing to incidents of infection prevention. 4 Next steps:  WMAS to provide Saville Inquiry Update at CQRM.  CCG Quality team to feed in the issues highlighted regarding SSOTP to the Risk Review meeting. 5 Issues for escalation: None

Enc 08a FEEDBACK SHEET SOUTH EAST STAFFORDSHIRE AND SEISDON PENINSULA CLINICAL COMMISSIONING GROUP Joint Quality Committee Committee 8th July 2015

1 Members present: Alex Fox (Chairing), Dr Adrian Parkes, Dr Elizabeth Gunn, Heather Johnstone, Sue Wilson, Debbie Vucetic, Katie Montgomery, Nigel Williams, Anne Heckels, Tracey Finney, Fleur Fernando, Sue Bamford, Lynn Smith, Tony Bruce. Quorate: Yes 2 Declarations of Interest: None declared

3 Key Points discussed:  Members welcomed Tony Bruce; Chief Accountable Officer for ESCCG to the Committee who explained that he had always planned to attend a JQC meeting after it was established. His attendance was intended to assure him that the JQC is functioning to his satisfaction. Subsequent feedback confirmed he is recommending to ESCCG Governing Body that the JQC is effectively fulfilling its brief.  The two GP Quality Leads gave their “60 Second update” in line with the recent launch of this as a standing agenda item. A number of emerging issues were briefly discussed particularly devising a matrix to capture trends and themes. One issue of particular concern related to an on-going but increasing issue in respect of discharge letters from Burton Hospitals. SDUCs performance in rural areas was also highlighted (see issues for escalation below).  West Midlands Ambulance Service has not yet produced, as requested, their response to the Saville Inquiry. The Clinical Quality Improvement lead for the WMAS contract was advised by the Committee that if this is not received by the date of the next committee meeting this will be escalated.  The Committee was informed that SSSFT had recently been subject to an unannounced inspection by the CQC following receipt of a whistleblowing letter. Coincidentally the CCG quality team had also undertaken an unannounced visit which had resulted in a vulnerable adult referral being made. As a result SSSFT’s assurance levels were reviewed resulting in partial assurance for quality.  Members were pleased to note the continued progress in respect of the Staffordshire Suicide Prevention Strategy and look forward to receiving an update after the stakeholder event which is due to take place on Friday 17th July.  Members received either verbal or written reports in respect of involvement and engagement work. It was agreed that neither report fully met the requirements of the JQC. It is important that these reports are confined to patient centred actions and intelligence that materially will triangulate quality evidence and drive improvements in patient care.  The Governing Body need to be aware that over the last few months concern has grown about the lack of primary care surveillance by the area team. Evidence

presented by medicines optimisation staff on antibiotic prescribing raised legitimate concerns about patient safety, specifically their risk of contracting Cdiff infections.  Members agreed that the reports submitted in respect of SSOTP and RWH were inadequate and did not enable members to make an informed judgement in respect of the level of quality and safety. Members felt that there were commissioning issues that both CCGS need to address.  The report in respect of Royal Derby Hospitals reinforced an on-going concern regarding 62 day cancer waits therefore clarification from the lead commissioner and the hospital is sought to provide more detail around the reasons for under- performance and outcomes for individual patients. The CCG Quality lead was asked to take appropriate action and if necessary escalate any serious issues to a higher authority. 4 Next steps:  Updated Saville response report and action plan from WMAS expected by the next JQC.  Issues regarding discharge letters from Burton hospitals to be discussed at the contract review board.  Communication to be sent to GPs alerting them to the issue identified re attendance by SDUC GPs where required in rural areas and to seek feedback.  It was agreed that a primary care surveillance working group should be established to explore next steps with regard to primary care quality management and the role of the area team. 5 Issues for escalation:  The JQC has reported on and taken action with regard to SSOTP. Members are still raising concerns particularly around clinical staffing levels, sickness and absence, training and appraisal rates, poor attendance at CQRMs and a belief that the strategic objectives of the CCGs are not being fully delivered. Members would ask the two Governing Bodies to consider the on-going concerns and give guidance on how future discussions should proceed.  The Governing Body should be aware of the situation at Derby regarding 62 day cancer waits. If this situation is not improved the Governing Bodies will be kept informed.  The Governing Bodies should note that there will be no formal JQC in August but the Chair, Vice Chair and Chief Nurse will meet to review the update actions.

Enc 09 FEEDBACK REPORT SOUTH EAST STAFFORDSHIRE AND SEISDON PENINSULA CLINICAL COMMISSIONING GROUP Finance & Performance Committee 17th July 2015

1 Members present: Quorate: 2 Declarations of Interest: Dr John James – Declared his interest as a GP.

3 Key Points discussed:

The Committee reviewed a number of papers and had considered debate across a range of areas. The key points to note included:

1. Activity remained slightly below plan across a number of key areas at month 2 but it was recognised that the data set may change as more information is forthcoming. The primary area of over performance was outpatient follow ups which was 1.3% above planned levels; 2. The CCG was not meeting the statutory/constitutional targets for A&E 4 hour waits; RTT admitted care and a number of cancer targets including 2 week breast symptomatic and 62 day treatment standard. Whilst not exclusive the Committee noted that the CCG’s performance was predominantly related to under delivery at HEFT. 3. The Committee requested that the Senior Management Team develop an overarching ‘Management Plan’ for how the issues will be addressed with HEFT. This will be considered at the September Committee. 4. The Committee noted the CCGs overspend against plan of £248k at month 3 (RWH and prescribing costs being the drivers) and the forecast slippage on QIPP of £1.5m. The seriousness of the situation was discussed and the Committee requested that the Executive develop further efficiency savings to ensure that the financial plan was met. It was agreed that this would be escalated to the Governing Body for discussion and action. 5. Whilst issues of data quality and poor CSU performance were noted, the committee requested that future reports on performance (be it statutory, activity or financial) consider the wider implications and potential actions for the CCG to take. 6. The Committee agreed that despite annual leave commitments of members it would meet informally to review the month 4 position. This meeting has been set for the 2nd September and the financial position and forecast will be scrutinised. 4 Next steps:

1. The next steps are contained in the narrative above – the CCG needs to consider further efficiency savings.

5 Issues for escalation:

1. As described above, the financial position and associated QIPP forecast under delivery should be escalated to Governing Body.

Enc 10 FEEDBACK SHEET SOUTH EAST STAFFORDSHIRE AND SEISDON PENINSULA CLINICAL COMMISSIONING GROUP Audit Committee 23rd June 2015

1 Members present: Chair J. Jobson. Lay members A. Fox, A. Heckels. Quorate: Yes. 2 Declarations of Interest: None Declared.

3 Key Points discussed: - Private discussion with Auditors prior to the full meeting. - Improving the year end process and Audit committee proceedings. - Annual report. - Action plan in response to PWC report and RS governance assurance. - Remuneration for VSM and Losses and Special Payments. - Internal Audit y/e report and 2015/16 plan. - External Audit y/e report and opinions. - Counter Fraud y/e report and 2015/16 plan and whistleblowing. - Inclusions on the risk register. - CCG governance surrounding QIPP and ability to achieve. - CSU contract management and delivery of service. - Contract management where the CCG is not the host commissioner.

4 Next steps:

A comprehensive list of actions (over 20) were taken and will be tracked via the Audit Committee to ensure improvements are made in the areas indicated above. Please refer to the Audit committee action tracker for specific detail.

It was also agreed that the Audit committee would follow up the action tracker from the Improvement plan in response to the PWC report.

5 Issues for escalation:

- Although some areas of the External Audit opinion were positive there were many comments regarding process that need to improve next year and we had qualified opinions for both “regularity” and “value for money” as we missed our financial targets. Risks were noted regarding the I.T. provision to the CSU. - Feedback and assurance should be obtained at the July Governing Body (GB) that activity levels in contracts and any contract variations added are not exposing the CCG to any new high level risks.

- That any new high level risks with mitigating actions are highlighted to the GB including the informal meetings to ensure that lay members are informed in a more timely manner. Any key issues re Finance, Audit and QIPP should also be included and added to the Agenda at informal meetings where necessary. - The CSU performance needs to improve as does some of the value we obtain from our contracts. The Exec has been tasked with completing a paper for the September GB on how we might change this arrangement and what the alternatives are. - Internal Audits will focus on QIPP and contract management in the early part of the year as these are seen as high risk areas to the CCG. - Assurance on QIPP delivery and achievement of financial balance are not convincing enough at quarter 1 and the CCG should decide the next course of action to bring back the CCG to a deliverable target.

REPORT TO THE SOUTH EAST STAFFORDSHIRE AND SEISDON PENINSULA CLINICAL COMMISSIONING GROUP GOVERNING BODY To be held on: Wednesday 29th July 2015

Enclosure No: 11 Subject: Integrated Quality and Performance Report Lead Director: Heather Johnstone, Chief Nurse and Director of Quality Authors: 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:

The Integrated Quality and Performance Report provides two month’s quality assurance data and supporting information where required in line with the current reporting cycle.

The Joint Quality Committee continues to provide the required level of scrutiny to determine assurance for our Provider servicers, this report demonstrates the current systems and processes that provide the required assurance and challenge in respect of key quality, safety 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 June and July Joint Quality Committee (JQC) and should be read in conjunction with the Chair’s Report which is submitted 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.

Responsible Committee Name: Joint Quality Committee Approved at Committee: YES/NO Date of Committee: 10th June and 8th July 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. 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 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 recent CQC un-announced responsive visit and CCG un-announced visit to SSSFT (George Bryan Centre).

To be aware of the basic details relating to the recent risk review meeting held regarding SSOTPT which is included within the report.

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

To acknowledge that “Healthwatch” will be a core member of the Joint Quality Committee going forwards and recognise the value of this in terms of increased assurance.

To support the actions being taken by the Joint Quality Committee and escalations made from the Joint Quality Committee to the Governing Body (if any) and to agree any recommended further actions linked to these matters.

In addition and if considered necessary, members of the Governing Body are invited 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 2WW Two Week Wait ACDP Advisory Committee on Dangerous Pathogens BHFT Burton Hospitals Foundation Trust CAS Central Alerting System

CCG Clinical Commissioning Group CDIFF Clostridium Difficile CHC Continuing Healthcare CPA Carer Programme Approach CPD Continuing Professional Development CQC Care Quality Commission CQRM Clinical Quality Review Meeting CQUIN Commissioning for Quality and Innovation CSU Clinical Support Unit DGFT CCIO Dudley Group Foundation Trust Chief Clinical Information Officer DGH Dudley Group of Hospitals DN District Nurse DNA Did Not Attend ED Emergency Department EMSA Eliminating Mixed Single Sex Accommodation FFT Friends and Family Test FTE Full Time Equivalent GP General Practitioner HCAI Healthcare Acquired Infection HEFT Heart of England Foundation Trust HSMR Hospital Standardised Mortality Ratios IAPT Improving Access to Psychological Therapies IPC Infection Prevention and Control ITU Intensive Therapy Unit JQC Joint Quality Committee MRSA Methicillin Resistant Staphylococcus Aureus NSL Non Urgent Patient transport provider OOH Out of Hours PALS Patient Advisory Liaison Service PROMS Patient Reported Outcome Measures 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 SI Serious Incidents SSOTP Staffordshire and Stoke on Trent Partnership Trust SSSFT South Staffordshire and Shropshire NHS Mental Health Foundation Trust SVA Safeguarding Vulnerable Adults TDA Trust Development Authority TV Tissue Viability VTE Venous-thrombus Embolism WMAS West Midlands Ambulance Service YTD Year to Date

CCG Month Selector > Provider Performance Apr-15 Performance National

Staffordshire NHS South East Heart of Dudley Group Data Burton & Stoke-on- The Roya l Standard/Plan Standard/Plan - Staffordshire and England NHS Wolverhampton Health Outcomes Framework/Every one Counts Period Hospitals NHS Trent Commissioner Provider Seisdon Peninsula Foundation Foundation Hospitals NHS Published Trust Partnership Trust CCG Trust Trust Trust Safe environment MRSA - Incidence of HCAI Apr-15 0 0 1 1 0 0 0 0 Monthly and protecting C. difficile - Incidence of HCAI Apr-15 5 As Per Provider 6 2 2 4 3 5 Monthly from avoidable harm C. difficile - YTD Ceiling Apr-15 53 As Per Provider 6 2 0 4 3 5 Monthly Friends and family test - In-patient percent who recommend Apr-15 98% 98% 92% 96% 91% Monthly Friends and family test - A&E percent who recommend Apr-15 98% 79% 90% 84% Monthly

Ensuring a positive Friends and family test - Maternity percent who recommend Apr-15 98% 98% 99% 91% Monthly Experience of care Friends and family test - Staff percent who recommend (Quarterly) Apr-15 Quarterly Quarterly Quarterly Quarterly Quarterly Quarterly Friends and family test - Response rate % In-Patient Apr-15 26% 25% 16% 36% Monthly Friends and family test - Response rate % A&E Apr-15 11% 17% 8% 23% Monthly

Staffordshire NHS South East Heart of Dudley Group The Royal Burton & Stoke-on- Standard/Plan Standard/Plan - Staffordshire and England NHS Wolverhampton NHS Consultation Period Hospitals NHS Trent Commissioner Provider Seisdon Peninsula Foundation Foundation Hospitals NHS Trust Partnership CCG Trust Trust Trust Trust RTT admitted Apr-15 90% 90% 90% 91% 98% 82% 95% 90% Monthly RTT non-admitted Apr-15 95% 95% 97% 98% 100% 93% 98% 97% Monthly RTT RTT incompletes Apr-15 92% 92% 94% 95% 99% 90% 95% 96% Monthly RTT 52+ week waiters Apr-15 0 0 1 No data No data 8 1 0 Not National Diagnostics Diagnostics - 6 weeks+ Apr-15 99% 99% 97% 100% 100% 91% 99% 100% Monthly - 2 week wait Apr-15 93% 93% 94% 97% 89% 98% 95% Quarterly Cancer - 2 weeks - Breast symptom 2 week wait Apr-15 93% 93% 89% No data 84% 100% 93% Quarterly - 31 day first definative treatment Apr-15 96% 96% 96% No data 98% 100% 96% Quarterly Cancer - 31 day - 31 day subsequent treatment - surgery Apr-15 94% 94% 88% 100% 95% 100% 95% Quarterly - 31 day subsequent treatment - drug Apr-15 98% 98% 100% No data 100% 100% 100% Quarterly - 62 day standard (including rare cancers) Apr-15 85% 85% 92% 99% 84% 84% 75% Quarterly Cancer - 62 day - 62 day screening Apr-15 90% 90% 100% No data 67% 82% 97% Quarterly - 62 day upgrade Apr-15 73% No data 61% 96% 93% Quarterly Mixed Sex Mixed sex accomodation breaches Apr-15 0 0 0 11 0 0 0 0 Monthly A&E total time 4 hr wait Apr-15 95% 94% 86% 99% 96% Published by Provider A&E A&E 12hr trolley waits (ytd) Apr-15 0 1 1 0 0 Published by Provider Cancelled Ops for non clinical reasons rebooked >28 days Apr-15 0 0 0 0 0 Quarterly Cancelled Ops No urgent operation cancelled for the 2nd time Apr-15 0 0 0 0 0 Quarterly

Staffordshire NHS South East Heart of Dudley Group The Royal Burton & Stoke-on- Standard/Plan Standard/Plan - Staffordshire and England NHS Wolverhampton Other - Activity & Efficiency Period Hospitals NHS Trent Commissioner Provider Seisdon Peninsula Foundation Foundation Hospitals NHS Trust Partnership CCG Trust Trust Trust Trust

Providers Duty of Candor (Failure to notify) Apr-15 0 0 0 No data 0 No Data Not National VTE Apr-15 95% 97.90% 95.10% 95.45% No Data Quarterly Other Mortality SHMI Apr-15 4 0 109 Jun 14 103 98 6 months behind Mortality HSMR Apr-15 98 38 deaths 91.3 Nov 14 100 103 6 months behind Key Blue Square No Data On Target Below Target No Data N/A Not applicable to the service

CCG Month Selector > Provider Performance May-15 Performance National

Staffordshire NHS South East Heart of Dudley Group Data Burton & Stoke-on- The Roya l Standard/Plan Standard/Plan - Staffordshire and England NHS Wolverhampton Health Outcomes Framework/Every one Counts Period Hospitals NHS Trent Commissioner Provider Seisdon Peninsula Foundation Foundation Hospitals NHS Published Trust Partnership Trust CCG Trust Trust Trust Safe environment MRSA - Incidence of HCAI May-15 0 0 1 1 0 0 0 0 Monthly and protecting C. difficile - Incidence of HCAI May-15 5 As Per Provider 4 1 0 3 3 1 Monthly from avoidable harm C. difficile - YTD Ceiling May-15 53 As Per Provider 10 3 0 7 6 6 Monthly Friends and family test - In-patient percent who recommend May-15 97% N/A 94% 97% 91% Monthly Friends and family test - A&E percent who recommend May-15 96% 81% 90% 83% Monthly

Ensuring a positive Friends and family test - Maternity percent who recommend May-15 98% 98% 99% 97% Monthly Experience of care Friends and family test - Staff percent who recommend (Quarterly) May-15 Quarterly Quarterly Quarterly Quarterly Quarterly Quarterly Friends and family test - Response rate % In-Patient May-15 21% 36% 16% 33% Monthly Friends and family test - Response rate % A&E May-15 3% 16% 15% 26% Monthly

Staffordshire NHS South East Heart of Dudley Group The Royal Burton & Stoke-on- Standard/Plan Standard/Plan - Staffordshire and England NHS Wolverhampton NHS Consultation Period Hospitals NHS Trent Commissioner Provider Seisdon Peninsula Foundation Foundation Hospitals NHS Trust Partnership CCG Trust Trust Trust Trust RTT admitted May-15 90% 90% 89% 91% 99% 83% 95% 90% Monthly RTT non-admitted May-15 95% 95% 97% 98% 100% 93% 97% 97% Monthly RTT RTT incompletes May-15 92% 92% 95% 97% 100% 91% 95% 95% Monthly RTT 52+ week waiters May-15 0 0 0 No data No data 6 0 No Data Not National Diagnostics Diagnostics - 6 weeks+ May-15 99% 99% 96% 100% 100% 90% 99% 100% Monthly - 2 week wait May-15 93% 93% 93% Due July 15 No Data No data No Data Quarterly Cancer - 2 weeks - Breast symptom 2 week wait May-15 93% 93% 89% No data No Data No data No Data Quarterly - 31 day first definative treatment May-15 96% 96% 98% No data No Data No data No Data Quarterly Cancer - 31 day - 31 day subsequent treatment - surgery May-15 94% 94% 95% Due July 15 No Data No data No Data Quarterly - 31 day subsequent treatment - drug May-15 98% 98% 100% No data No Data No data No Data Quarterly - 62 day standard (including rare cancers) May-15 85% 85% 77% Due July 15 No Data No data No Data Quarterly Cancer - 62 day - 62 day screening May-15 90% 90% 100% No data No Data No data No Data Quarterly - 62 day upgrade May-15 100% No data No Data No data No Data Quarterly Mixed Sex Mixed sex accomodation breaches May-15 0 0 0 5 0 0 0 0 Monthly A&E total time 4 hr wait May-15 95% 93% 89% 99% 94% Published by Provider A&E A&E 12hr trolley waits (ytd) May-15 0 2 2 0 0 Published by Provider Cancelled Ops for non clinical reasons rebooked >28 days May-15 0 0 0 0 No Data Quarterly Cancelled Ops No urgent operation cancelled for the 2nd time May-15 0 0 0 0 No Data Quarterly

Providers Duty of Candor (Failure to notify) May-15 0 0 0 No data No Data No Data Not National VTE May-15 95% 98.10% 93.24% No Data No Data Quarterly Other Mortality SHMI May-15 0 109 Jun 14 103 98 6 months behind Mortality HSMR May-15 5 99 N/A 91.3 Nov 14 100 103 6 months behind Key Blue Square No Data On Target Below Target No Data N/A Not applicable to the service

South Staffordshire & Shropshire Healthcare NHS Foundation Trust 2015-2016 Standard/Plan - Health Outcomes Framework/Every one Counts Apr-15 May-15

Provider Trend

Safe environment and MRSA 0 0 0 protecting from avoidable C. difficile 0 0 0 harm C. difficile - YTD Ceiling 15 0 0 Friends and Family Test - In-patient response who recommend 72% No data No data Ensuring a positive Experience Friends and Family Test - Community response who recommend 44% No data No data of care Percentage Recommended Care No data No data Percentage NOT Recommended Care No data No data Standard/Plan - NHS Consultation Apr-15 May-15

Provider Trend LQR-6 - Total number of new cases accepted by early intervention services (Omnibus) 71 5 6 Admission & Discharge LQR-11 Children & Young People - Number of admissions to adult inpatient facilities of patients 0 3 0 who are aged under 18 LQR-17 CAMHS % of patients seen within 18 weeks for non- admitted pathway 95% 100.0% 98% LQR-18 Paedriatrics % of patients seen within 18 weeks for non-admitted pathway 95% 95.3% 95.7%

LQR-19 LD % of patients seen within 18 weeks for non-admitted pathway 95% 100.0% 100.0% 18 Week Referral LQR-20 Eating Disorders % of patients seen within 18 weeks for non-admitted pathway 95% 100.0% 100.0% LQR -21 Mother and Baby % of patients seen within 18 Weeks for non-admitted pathway 95% 100.0% 100.0% LQR-22 - Adult Mental Health % of patients seen within 18 weeks for non-admitted pathway 95% 95.7% 95.9% data being LQR-23 Dementia Services % of patients seen within 18 weeks for non-admitted pathway 95% 96.05% validated LQR-4 All admissions to be made via crisis 95% 100.0% 100.0% CRISIS LQR-5 CRHT - Total Referred and Total No. of service users responded to within 4hrs 95% 96.0% 94.7% LQR - 2 All service users to have a care plan or statement of care as appropriate that is reviewed 95% 97.0% 96.5% CPA and updated every 12 months (split by CPA and Non-CPA) LQR-3 - % of patients discharged on a CPA and followed up within 7 days of discharge 95% 93.1% 89.6%

Delayed Transfers of Care LQR-10 Minimising delayed transfers of care 7.50% 1.7% 1.9%

LQR 24- EMSA Breaches 0 0 0 Never Events 0 0 0 Serious Incidents 0 11 2 Serious Incidents >45 Days 0 0 3 Safeguarding Issues (Serious Incidents reported) 0 0 0 LQR-31 Local Avoidable Event - Suicide on an inpatient acute mental health ward of a detained patient for whom there is lack of evidence of adequate risk assessments and neccesary actions 0 0 0 undertaken or lack of evidence of agreed observations being carried out. Incidents Total No. of Patient Safety Incidents 0 65 71 Incidents of violence and aggression patient to patient 0 38 48 Incidents of violence and aggression patient to staff 0 91 135 Pressure Ulcers Grade 3 0 0 0 Pressure Ulcers Grade 4 0 0 0 Falls resulting in harm 0 9 9 Harm free care (%) 95% 99.0% 99.0% No. of unexpected deaths (community) 12 5 No. of unexpected deaths (inpatient) 0 1 Number Complaint Quarterly reporting No target PALS 6 No target Patient Experience Compliments No target Duty of Candour (Compliance) 100% 100% 100%

West Midlands Ambulance Service

Standard/Plan - Health Outcomes Framework/Every one Counts Apr-15 May-15 Jun-15 YTD Provider

MRSA - Incidence of HCAI 0 0 0 0 0 CB_B15_01 -WMAS - Percentage of Category A Red 1 ambulance calls resulting in an emergency response arriving within 8 minutes - 75% 80.60% 78.10% 79.70% 79.47% Operating standard of 75% SES&SP CCG - Percentage of Category A Red 1 ambulance calls resulting in an emergency response arriving within 8 minutes - 75% 70.00% 63.00% 61.00% 64.67% Operating standard of 75% CB_B15_02 - WMAS - Percentage of Category A Red 2 ambulance Safe environment and calls resulting in an emergency response arriving within 8 minutes - 75% 78.00% 76.80% 75.30% 76.70% protecting from avoidable Operating standard of 75% harm SES&SP CCG - Percentage of Category A Red 2 ambulance calls resulting in an emergency response arriving within 8 minutes - 75% 68.50% 69.30% 65.70% 67.83% Operating standard of 75% CB_B16 - WMAS - Percentage of Category A calls resulting in an ambulance arriving at the scene within 19 minutes - Operating 95% 97.20% 97.60% 97.10% 97.30% standard of 95% SES&SP CCG - Percentage of Category A calls resulting in an ambulance arriving at the scene within 19 minutes - Operating 95% 95.90% 95.10% 94.80% 95.27% standard of 95%

Integrated Quality and Performance Report – July 2015

Update and exception report from Joint Quality Committee

The Joint Quality Committee met on the 10th June and 8th July 2015 to review formally the submitted data for Month 1, April 2015 and Month 2, May 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

The Committee received reports in respect of the following key providers and decisions were made regarding the level of assurance regarding the safety and quality of each provider as follows:

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 June and July 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 – In June the members agreed limited assurance for quality of services due to ongoing issues with cancer performance targets, mortality reporting and the current improvement plan around gastroenterology prior to the planned Joint Advisory Group (JAG) accreditation visit which is expected in October 2015 and full assurance for safety. In July, 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 were limited assurance for quality due the number of outstanding incomplete actions plans that are in operation.

BHFT – In June and July the Joint Quality Committee agreed they were assured in respect of quality and safety by the data and information that was provided.

SSOTPT – At the June meeting members agreed they were assured in respect of safety and had limited assurance due to incomplete data, in respect of quality and care at SSOTPT in July the Joint Quality Committee concluded limited assurance for Quality and Assured for Safety due to the concerns around staffing.

SSSFT - Members of the Joint Quality Committee agreed they were assured in June by the quality and safety of services by the data and information that was provided, however in July the level of assurance for Quality changed to partial assurance following an unannounced CQC visit to the adult mental health wards at the St Georges Hospital and safeguarding concerns that were raised by the CCG following an un-

announced responsive visit to the West Wing, George Bryan Centre. This was as result of soft intelligence being received from a service user’s representative to the CCG. The visit concluded with an Adult Protection Referral being made. There were no immediate high risk concerns raised by the CQC. The Trust are taking the findings seriously and are in process of undertaking an internal investigation. The draft formal CQC report is awaited and the Trust is reviewing the factual accuracy of the CCG Quality Report which is due to be returned by the 17th July 2015.

NSL – At the June meeting members agreed they were assured for quality and safety for quality based upon the data and information provided.

SDUC – In June and July the Joint Quality Committee agreed that they were assured on safety and partial assurance on quality and these assurance levels has not changed since May 2015. Actions are being taken the address the concerns via the CQRM process, collaborative working with North CCGs and utilising contractual levers.

RWT – The members determined full assurance for safety and for partial assurance for quality due to the issues around cancer waits and pressure ulcers in June and the number of cancelled operations in July. The member concerns were clarified with the Lead Commissioner and assurance was secured by the Quality Lead apart from the action around the number of cancelled operations, this is still awaited. The Lead Commissioner continues to be well cited on the current issues and is currently assured by the action RWT and external agencies were taking to resolve the issues.

DGH – In June the Joint Quality Committee were assured with safety and determined partial assurance for quality for the cancer breaches and VTE risk assessments. The members in July determined full assurance for safety and partial for quality, this level of assurance improved due to the issues around lack of data and assurance being available for the Committee, reassuring the members.

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 June, the following reports and updates were received and discussed:

- Falls Prevention was presented to members by BHFT - Regular update for Patient Engagement - Regular update and feedback report from the CCG Patient Council was received - CCGs’ clinical risks were reviewed and items to be added to the risk register, identified - Verbal update from Quality Surveillance Group was received - Verbal update on Transforming Care was received. - The Primary Care Quality report was received - The CCG Medicines Optimisation report was received from CCG Head of Medicines Management - Serious Incident Combined Monthly Report from the Clinical Support Unit. - New quality initiative was launched named “GP 60 Second Reporting” – this is another means of receiving soft intelligence from GP member practices via the Clinical Directors for Quality.

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

- Regular update and feedback report from the CCG Patient Council - Regular update from the CCG Patient Engagement Manager - CCG clinical risks were reviewed and items to be added to the risk register identified - Serious Incident Combined Monthly Report from the CSU - Verbal update received Francis Action Plan

Health-watch – Discussion took place on Healthwatch becoming a permanent core member of the Joint Quality Committee – this was agreed as a positive step forward in terms of working collaboratively around the patient engagement and experience agenda.

The following items were received for information/assurance:

In June, the following were received:

 Mental Capacity Act Project Implementation Report  Outstanding Actions SSOTP  SSOTP Quality Accounts  IFR Annual Activity Report

In July, the following were received:

 MBRRACE-UK Perinatal Mortality Surveillance Report  SI Network Report

Decisions made by the Committee Please also refer to the JQC Chairs report. In June, the following decisions were made:

- Managing Safeguarding Allegations Against Staff Policy - approved.

In July, the following decisions were made:

 Members agreed that there will be no formal Joint Quality Committee in August due to annual leave. However, the Chair, Deputy Chair and Chief Nurse will meet to ensure continued momentum on quality improvement activities. (This is in line with the Committee terms of reference which require the JQC to meet at least ten times per year.)  Members agreed that due to noted improvements in data in respect of Dudley Hospitals, the frequency of reporting would be reviewed as part of the wider review of the JQC business cycle.

Additional Issues for escalation to Governing Body

- Please refer to Chair’s Report

Assurance

Members were in agreement that all provider services reviewed at the Joint Quality Committee in June and July 2015 are considered to be safe. However, members are asked to note the specific concerns detailed in the provider summaries below.

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 June 2015 Limited Assurance Assured

July 2015 Limited Assurance Assured

Exceptions and Actions – April and May 2015

The main change this month is the reporting of data and schedule of submission to the lead commissioner. This has had an impact on the reporting, moving the CQCRM to the 2nd week of the month. The main rationale for this is to ensure that the reporting is as up to date as possible and alleviate the issue of data being a month in arrears in the submitted data. Whilst some of the metrics being monitored to ensure quality of service are still below target the main trend is moving towards compliance.

The key points from the June and July reports

MONITOR – Action plans for Governance and an update for Mortality remain outstanding and have been requested from the Lead CCG. The Integrated Improvement Plan has been requested from the Trust. A presentation made to the Lead CCGs Governing Body has been passed from SES&SP CCG Accountable Officer and this will be reviewed and reported to the next Joint Quality Committee.

Complaints – Improvements have been noted in the amount of open complaints. There will be a draft improvement plan shared. The Trust is undergoing radical change in the Governance of Complaints and Serious Incidents. The Trust is fully engaged with the Lead CCG (Birmingham Cross City). It is anticipated improvements will continue.

RTT – Trust continues to rebase the RTT and the expectation that this will be completed within Quarter 1 (15/16). Current progression indicates that the Trust is above the projections within their recovery plan.

Cancer waits – 2 week wait remains an issue. The numbers of referrals have increased since March 2014 and have remained above the average. The trend for the Trust is increasing although it remains below standard. However, Cancer Waits have shown a downward trajectory for April 2015. Cancer wait recovery remains high on the quality agenda.

Diagnostic Waits –Issues in Gastroenterology and Endoscopy continue. The Trust has a resilience action plan in place; however issues with this metric are having a direct impact on the patient experience. Diagnostic waits have suffered due to the flood in Solihull Hospital. The recovery is taking longer than expected due to the damage caused. HEFT has reported recent figures indicate that recovery is improving and this will be reviewed as the data and clinical review becomes available. Potential risk to patients will be raised at the July Clinical Quality Review Meeting for assurance.

Breaches – The Trust have reported breaches in Diagnostic Tests over 6 weeks, Cancelled Non-urgent Operations 4 hour A & E waits and 12 hour trolley breaches. All RCAs and learning have been received and analysed and the Clinical Quality Review Meeting has been assured that there are no trends or 12

patterns of concern from their analysis. SES&SP CCG patients RCAs and breach analysis are being shared with the Quality Team at SES&SP CCG for an assessment of the quality impact to be made.

Gastroenterology – The Lead CCG report failings in the service that require further escalation and review. The lead CCG (Solihull) is engaged with the Trust on measuring the impact for patients on the issues around the service.

Endoscopy and JAG Accreditation – The Trust has reported that the mobile units go live in July. Assurance has been requested around the Infection, Prevention & Control arrangements. The Lead CCG is reviewing the request and proposes to visit the units alongside the Trust. The JQC has requested assurance on Eliminating Single Mixed Sex (EMSA) compliance in the mobile units. JAG Accreditation has remained on the CQRM agenda and the Trust report the action plan has been submitted for their consideration. This will continue to be monitored until resolution.

Changes in Service and reporting – HEFT have reported changes in the Children’s services at Good Hope Hospital this has been reviewed externally and reporting will be available at the July CQCRM. The revision of recording for Maternity, further changes to the monitoring system and criteria for the reporting. Presentations have been sent to the Local Maternity Group and SES&SP CCG has been asked to provide a representative to this meeting from the Quality Team. Date to be confirmed.

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 June 2015 Assured Assured July 2015 Assured Assured

Exceptions and Actions – April and May 2015 CQC Visit Members of the Governing Body need to be aware that the CQC completed a planned, follow up inspection of Burton Hospital’s in early July. The draft report is awaited and a summit is likely to take place in September. The CCG Chief Nurse will be invited to the summit and will feedback to the Governing Body once this has taken place. The initial findings will be discussed at the next CQRM (7th August) and will be included in the next report.

Comparative Health Knowledge System (CHKS) Award - Burton NHS Foundation Trust made it into the top 40 list compiled by CHKS, which champions excellence among NHS trusts. The ratings are based on the evaluation of 20 key performance indicators covering safety, clinical effectiveness, health outcomes, efficiency, patient experience and quality of care. Burton had slipped out of the list in 2014 having been in the Top 40 for the previous six years.

Patient Experience - in April Darwin Ward (Samuel Johnson Community Hospital) was the only ward scored red with a score of 89, but in May the Trust had no overall scores in red with Darwin ward making a great improvement and moving back into green. However a shortage of volunteers and many patients not being capable of being surveyed on Anna and Darwin Ward meant that less than 75% of the required surveys were completed. The Patient and Public Engagement team continue to work with the Volunteer Coordinator to recruit new survey volunteers however illness, holidays and other commitments mean that the Patient Experience Volunteer team is rarely at full capacity and they are being required to undertake many more tasks leaving the team very stretched. The Trust overall has scored well in all questions other than Doctor’s explaining things in an understandable way.

Friend and Family Scores - now that the token system has stopped in Accident & Emergency Department and the Trust has returned to a card and email system the number of responses has dropped dramatically as people have less time to complete a card and tend not to want to stop and complete feedback. A process is underway to procure an SMS solution for A&E this is aimed to be in place for August. April Results: % Recommend- inpatient and day case = 97.55%; A&E =84.09% based on 44 responses May Results: % Recommend –inpatient and day case = 97.26%; A%E = 63.64% based on 11 responses

Ward Assurance- the Trust has sustained a green rating in April and May which equates to 15 consecutive months.

Complaints - the number of formal complaints received in April was 10 increasing to 23 in May 2015. This is the first time since November 2014 that the number has exceeded 20. The common themes are consistently Communication and Information; medical care and treatment; Nursing care and Treatment Attitude of Staff and Medication issues. On completion of each formal complaint where there are issues upheld, an action plan is requested as per the Complaints Toolkit. Learning from Complaints is shared across directorates within the Trust to address the issues/themes raised. 14

PALS - 263 PALS contacts received in April increasing to 305 PALS received during May 2015. (both these figures include high numbers of Compliments) The top themes are compliments; enquiries; request for information, and to provide information. The Trust do respond to issues raised through the PALS service and take actions as a result.

Compliments - in April the Trust received 87 Compliments which was the highest number for over 12 months but in May this was exceeded with a total of 93 compliments.

Serious Incidents - During April 5 Serious Incidents, CDiff & Health Care Acquired Infections - Clostridium Difficile an unexpected admission to Neonatal Intensive Care Unit, Slips/Trips/Falls- Fractured Femur, Grade 3 Pressure Ulcer and Maternity Services - Unexpected Neonatal Death admitted via Emergency Department which is a Coroners Case. During May 2015, 2 Serious Incidents were reported, one Grade 4 Pressure Ulcer on Ward 4 and one Grade 4 Pressure Ulcer on Ward 5. As a result of these two Grade 4 Pressure Ulcers the Commissioners undertook an unannounced visit on the 22nd June 2015. This was a very positive visit with no concerns identified.

Patient Safety Incidents: The number of patient safety Incidents reported in April was 587 increasing to 662 in May. There is been a substantial increase in the number of Grade 3 pressure ulcers in April which saw 8 reported against 10 for the whole of 2014-2015. New staff have commenced at the Trust for Tissue Viability from April 2015 which may have influenced the validation of grading. As a result the Trust is validating each pressure ulcer to ensure correct grading of the incidents. RCAs are being undertaken by the Ward Managers and with support from the new Tissue Viability Lead Nurse to ensure that lessons are learned. The number of Grade 3 pressure ulcers reported in May was 9.

Clostridium Difficile: There were two cases reported in April and one reported case of Clostridium Difficile during May 2015.

MRSA: One case was reported during April 2015 and one in May 2015. The April case was an MRSA contaminant which was scrutinised; the patient had a skin condition which had resulted in a bacteraemia, the reviewers agreed that if they could have deemed it unavoidable they would have. In May one case of an MRSA reported, an RCA has been undertaken which showed there were no lapses in care along the patients care pathway and the case was deemed unavoidable.

Eliminating Mixed Sex accommodation: During April 11 breaches occurred in Critical Care due to capacity issues in the Trust preventing patients being transferred to ward environments. During May 5 breaches occurred in the Medical Day Case Unit which was also due to capacity issues in the Trust. The Clinical Quality Improvement Manager for East Staffordshire CCG has undertaken a review of 2014-2015 breaches including the level of escalation the Trust was declaring at the time and it was evident from the dates the breaches occurred the Trust was on operational Level 3 or 4. The CCG Chief Nurse will be discussing this further with NHS England in a drive to ensure all possible action is being taken to address the breaches and that this aligns with similar trusts across the country.

Mock CQC Visit 5th June: Prior to the CQC visit in July, a Mock CQC visit took place. The visit was positive with the visitors recognising the overwhelming sense of pride from staff who were keen to share their work which had been undertaken to improve the patient safety and experience. Great leadership was demonstrated on wards and patient feedback was good, with high praise for staff and the organisation. A full report of the outcome has not yet been shared with the reviewers at the time of writing.

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 June 2015 Assured Partial Assurance July 2015 Assured Partial Assurance Exceptions and Actions for April and May 2015

QSG Risk Review Meeting - a risk review meeting took place on July 2nd, this was led by NHS England and involved representatives from all key stakeholders and SSOTP. A number of issues were highlighted by commissioners and other representatives present and SSOTP Chief Executive responded to these concerns and gave a presentation on work taking place at the Trust. A number of actions were agreed including improved transparency, and improved communication and reporting at CQRM. It was agreed that a Risk Summit was not required but that any continuation of issues would be escalated back to QSG.

Review of CQRM/Reporting requirements - a meeting also took place in early July to review the Trust’s submissions to CQRM and a number of actions have been agreed between all parties to ensure improved reporting to CQRM.

CCG Joint Quality Committee meeting - in addition to the discussions which took place at the risk review above, at the Joint Quality Committee in July members expressed a number of concerns as follows:-

 The quality of the report from the main commissioner was not of the standard expected to enable Joint Quality Committee to reach a judgement in respect of safety and quality.  The incident numbers reported within the report were inconsistent.  The number of responses for Friends and Family Test were not broken down by locality and had previously been reported as very low in Lichfield and Cannock.  No analysis of complaints and PALS data was provided, leading members to question whether there were missed opportunities to learn from patient feedback and recognise early warning signs.  The numbers of pressure ulcers reported are of such a level that a separate and specific report was requested.

The Joint Quality Committee concluded that the shortfalls within the report would be raised with the main commissioner with explicit expectations outlined to enable JQC to make informed decisions on the quality and safety of the services. In addition, the concerns highlighted would be escalated to the Governing Bodies to enable members to be fully appraised of the current situation and the actions taken by Joint Quality Committee.

CQC Visit November 2014 – Report Published 13 March 2015 - as previously reported, the Care Quality Commission (CQC) report on the responsive visit made to the Trust in November 2014 was published on Friday 13th March 2015. CQC visited two community hospitals and 4 district nursing teams, in response to whistle blowing incidents. Three of the district nursing teams visited were in the North and one was in the South (Stone). CQC recommended that the Trust needed to review the capacity of their district nursing service and to consider how they utilised the post of Ambassador for Cultural Change in the context of their management of change processes, in order to engage staff understanding of the change. The Trust

has developed and implemented an action plan relating to the 4 key recommendations identified following the CQC inspection.

Media Interest - a news article was published in The Sentinel (Stoke on Trent local newspaper) on April 2nd 2015, which raised concerns regarding staffing levels and capacity to deliver care in relation to pressure ulcers and medication administration. The Trust has published a response to this article. In addition the commissioning CCG has requested a response to a number of queries to provide further assurances. The Trust was investigating to see if there was any correlation between any incidents reported and workforce issues. SSOTPT reported to April CQRM, that there were no themes or trends identified within the data they had reviewed relating to incidents and staffing issues. SSOTPT confirmed that staff could differentiate on the reporting system if the incident relates to staffing issues; however there were only a small number of incidents that detailed staffing issues on the incident reporting system. The data and analysis provided from SSOTP does not reflect whether this is a contributory or causal factor.

Serious Incidents - 35 serious incidents were reported in March (trust-wide), which is an increase compared to 28 reported in February, 6 related to South Staffordshire and 3 were unknown location. In April, 28 serious incidents were reported, 5 of which were in the south and 12 were unknown location. All serious incidents in the south were pressure ulcers.

Pressure Ulcers - as previously reported, there has been an increase in grade 2 and 3 pressure ulcers in recent months, and the Tissue Viability Team are undertaking a review to identify any themes and trends related to these. April 2014 – March 2015, 34 pressure ulcers have been identified as avoidable and attributable to Trust care in the Community following the Tissue Viability panel. The Tissue Viability Panel continues to meet monthly to review and challenge Root Cause Analysis reports relating to pressure ulcers, this includes making a decision on whether the pressure ulcer is avoidable or not, whether to close the incident and to identify lessons learnt. The trust has developed and implemented a pressure ulcer zero tolerance action plan.

Patient Safety Incidents - 196 incidents were reported for the South Division in March. This is in keeping with the numbers of incidents reported throughout 2014/15. Lowest reported number was in August 2014 (176) and highest in February 2015 (208). The areas of highest reporting remain as incidents within the patient’s home, with pressure ulcers and clinical incidents being the highest two categories. During April, a slight increase is noted from previous months and represents an overall increasing trend in reporting for the South Division. 13 medication incidents were reported, only 3 of which related to East Staffordshire (none in South East and Seisdon Peninsula).

Workforce – the Workforce Dashboard reports are now provided to commissioners on a monthly basis and contain details about the number of vacancies by Division. A task to finish group has been established to look at SSOTPT Bank and Agency arrangements and part of this group’s remit is to look at improving the reporting on supplementary staffing. The vacancy rate is 11.29%, the backfill of agency, bank and overtime reduces this to 1.52%. A Service Development Improvement Plan (SDIP) has now been agreed within the 15/16 Contract and the first workforce dashboard report is due to be submitted no later than September 2015 which will include details relating to bank and agency usage. The Director of Human Resources is expected to attend the July CQRM to provide further assurance in respect of workforce.

Corporate Services Workforce -the corporate services workforce report in January indicated that the nursing and quality directorate had a 21% vacancy rate. SSOTP has confirmed that the nursing and quality directorate had been subject to a management of change process and identified new structures. Some vacancies were not fully recruited to and then SSOTP had a corporate freeze on recruitment in January 2015. Most vacancies have been covered with agency and interim posts and it has been confirmed that not 17

all vacancies are at senior management level as there are a number of specialist teams within the directorate. SSOTP were due to provide an update on Nursing & Quality Directorate structure and recruitment to the May CQRM which will be reported on in July. It should be noted that this directorate does not include the operational teams.

Statutory and Mandatory Training Compliance - the SSOTP Workforce reports indicate that the uptake of training for programs relating to Basic Life Support, Information Governance, and Fire Safety have not reached the Trust internal target levels across all services since April 2014. SSOTP has reported that there have been internal discussions regarding the uptake of Basic Life Support training across all areas and managers have been requested to update the data system relating to which staff in each department should be attending this training. SSOTP have a firm internal policy that people cannot complete their CPD unless they have completed basic life support.

Appraisal Completion - workforce reports indicate low compliance of Appraisal Rates. SSOTP have confirmed that this is a corporate priority monitored on a weekly basis by the Executive Team and actions have been taken to address this. In March and April the mandatory compliance rate remained red with no division currently meeting the 90% compliance rate. The Trust figure is consistently around the 81% based on the last 6 months data. The Trust has indicated they will achieve a 5% increase in compliance per month, across the Trust, which will result in 95% compliance rate by December 2015.

Clostridium difficile - 2 cases of Clostridium difficile were reported in April, which is above the month trajectory of 1.

Mortality Indicators - the Trust has confirmed they will continue to review all inpatient deaths but only unexpected community deaths will be reviewed. These deaths are already reported as serious incidents and the trust will contribute to any investigation and will review the care provided by their staff (as part of the RCA).

Complaints - the Trust received a total of 32 complaints during March (trust-wide). Of these, 13 were received by South Community teams (3 health related and 10 social care). The highest reported category was quality of care. In April, 24 complaints were received 12 of which related to South Community teams. The categories were appointments and patient care.

User and Carer Experience -the Friends and Family score for March was 97% and 98% for April (trust wide). Concerns regarding the response rates in two south Staffordshire areas have been raised directly with the Trust given that it is possible that the excellent performance highlighted above may mask issues.

NHS Safety Thermometer - since data collection for the NHS Safety Thermometer began across the Partnership Trust as a whole, “Harm Free Care” has risen from 89.27% (March 2012) to 90.92% (April 2015) and the percentage of people experiencing “No New Harms” has risen slightly from 96.39% (March 2012) to 96.42% (April 2015). The reason the changes in these figures have been relatively modest relates to the nature of prevalence data; those individuals accessing community hospital and community nursing services by the fact that they are utilising these services have complex health needs and may have experienced one of the four harms during their care journey (often across a number of providers) and these harms will continue to be captured (both new and old harm) until discharged or the harm has resolved only to be replaced by another patient/service user with similar health issues and harms.

Quality Visit to Inner Burton District Nursing Team - Inner Burton District Nursing Quality Visit took place on 1 April 2015. This was a Trust-led visit that the CCG Clinical Quality Improvement Lead was invited to participate in. The Inner Burton District Nursing service was assessed against nine standards and was rated 18

Amber for two standards which were: communication and Record Keeping and Green for seven standards, which were Respect and Dignity, Safe Environment, Care Environment, Infection Control, Safeguarding, Pressure Ulcer Management, The Team (staff feedback).

Reviewers noted 2 areas of moderate concern that were outside of the team’s control:

 A reviewer noted that a staff member was using their personal phone for work purposes. The team leader was requested to purchase a Trust phone for this staff member. On further review, the phone has been on order for six months.  The Inner Burton (Branston) District Nursing team supports five GP practices. It is noted that GPs may expect more than the service can offer which does have an impact on relationships. Commissioners were present at the time of the quality visit and agree that relationships can be strengthened with GPs and the development and introduction of a service specification will greatly help to achieve this to clarify the nature of the service provided.

Outstanding Actions from SSOTP Reports - the Joint Quality Committee had been expressing concern in respect of the information received from the trust and the lack of response in respect of specific queries and concerns raised by JQC. Although it is noted that the standard of report received by JQC had been much improved since Cannock Chase CCG has been submitting their report (although acknowledging the deterioration for one month noted above), a number of actions from our JQC remained outstanding. The Quality Improvement Lead has worked with colleagues in CC CCG to respond to all of the outstanding actions. This report was received in JQC and members agreed that the majority of the actions can now be closed. Those that are still ongoing will be incorporated into the main JQC action plan.

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 June 2015 Assured Assured

July 2015 Assured Partial Assurance

Exceptions and Actions April and May 2015

CQC Unannounced Visit:- The CCG has been informed by the Trust that they received an un-announced responsive visit from the Care Quality Commission (CQC) on Wednesday 24th June 2015 to Chebsey, Brocton (Adult Mental Health) and Milford Wards ) at St Georges Hospital, Stafford following receipt of a whistleblowing letter from a member of staff. It is noted that Milford is currently being used to accommodate patients from others wards during a period of estates improvement work) The draft formal report into this visit is awaited.

CCG Unannounced Visit:- The CCG Quality Team undertook an un-announced visit on the 30th June 2015 to the George Bryan Centre West Wing (Adult Mental Health) following receipt of soft intelligence (this soft intelligence will be reported in next month report). The draft formal report is currently being written and will be forwarded to the Trust for accuracy and then shared with JQC members. During the visit there were concerns raised around safeguarding which correlated with the soft intelligence received which has unfortunately led to an Adult Protection Referral being raised by the CCG Quality Team. Other themes noted during the visit were around serious incidents particularly around learning from them, staffing, infection control and staff attitude and behaviour. This visit did not relate to or result from the CQC visit, the timing was purely coincidental.

Serious Incidents – There were 11 reported serious incidents reported in April. During May this fell to 2 reported Serious Incidents. All are subject to full root cause analysis and the reports will be reviewed by the CCG Quality Team prior to closure.

Patient Safety Incidents – The total number of reported patient safety incidents in April was 65, this was a reduction from March which was 86. In May, 71 Patient Safety incidents were reported. These were all reviewed for patterns and trends and discussions in relation to this took place at the CQRMs.

Workforce Data- There continues to be several indicators that are causing concern which are detailed in the report. The Trust has been asked to send a representative from Workforce to discuss the measures the Trust is taking to improve their current position this will take place at the September CQRM.

Crisis Resolution Home Treatment - – there were 7 breaches in April and 8 in May. The quality impact it had on services users has been discussed at CQRM and further assurance provided by the Trust. The Clinical Quality Improvement Manager has met with the Associate Director of Quality and Risk to review all breaches to ascertain if there were any themes. There were no overriding concerns noted during this review. Going forwards the Trust is changing way it reports to CQRM, to ensure more robust quality

assurance reporting is evident.

7 Day Follow Up – there were 5 breaches in May. The Clinical Quality Improvement Manager has met with the Associate Director of Quality and Risk to review all breaches to ascertain if there are any themes. There were no overriding concerns noted during this review. Going forwards the Trust is changing way it reports to CQRM, to ensure more robust quality assurance reporting is evident.

Delayed Discharges – There were 3 delayed discharges in April – 1 Perton; 1 Tamworth and 1 Stafford patient. Reasons for the delay were Next of Kin delaying discharge; waiting public funding and issues with CHC funding and 4 in May – 1 Tamworth, 2 Stafford and 1 Cannock resulting in similar reasons for delay. The Clinical Quality Improvement Manager is working with Stafford and Surround CCG to review the current CHC and Trust funding and discharge arrangements to identify the potential blocks. There is currently one service user on several months of a delay causing concern. This is being reviewed.

Violence and Aggression from Patient to Staff – CQRM members are currently monitoring the number of incidents relating to this indicator. In April 91 was reported which increased to 135 in May. The Trust has assured the members this falls within the expected range, however it was agreed continuous monitoring of this alongside further analysis was required.

IAPT – Seisdon: - As previously reported an action plan is in place and discussions for 2015/16 are being held in terms of the arrangement for the services. Patient Experience will be monitored alongside performance which is dealt with by the Contract Management Team

Staffing – In April Registered Staff at Night was reported as below the required level for the acuity of patients in some areas. The Trust responded by back-filling with non-registered staff. There is a recruitment drive and the Trust will be undertaking bi-annual staffing establishment review and undertaking further analysis to understand the cause and effect of this. During May it was reported staffing was consistent across both registered and unregistered staff apart from one occasion where Brockington Ward (St Georges Adult Mental Illness) was 71.1% and Bromley (Old Age Psychiatry) was 81.8% for registered staff on day shifts. This will be closely monitored as no other patterns have emerged and overall the fill rates look good.

Suicide Prevention Stakeholder Event – An event was held on the 17th July by Public Health England (PHE) to further progress the development of the Suicide Prevention Plan. This was a well-attended event that yielded some really good feedback for PHE to take forward. The next steps are to await the draft plan. This will continue to be monitored at JQC and progress communicated to Governing Body members.

Royal Wolverhampton Trust – Lead CCG Wolverhampton CCG

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

July 2015 Assured Partial Assurance

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 if required.

The Joint Quality Committee concluded there were shortfalls within the report which would be raised with the main commissioner with explicit expectations outlined to enable JQC to make informed decisions on the quality and safety of the services.

As previously reported, there was a planned Care Quality Commission full inspection which took place on the 2nd June 2015 to the 5th June 2015 – the draft formal report is awaited. The Lead Commissioner has been contacted to ascertain if any immediate concerns were found as a result of the visit. This information was not available at the time of the JQC. The CCG Chief Nurse will be notified prior to next JQC.

Cancer Standards - the Trust has struggled to meet the 62 day target for April 2015, due to late tertiary referrals. RWT have raised these issues with the TDA who have approached Monitor and they have agreed to liaise with the relevant Trust. The Cancer recovery plan has started to indicate positive impact on performance and provides assurance that the new equipment and recruitment is helping to reduce pressures. The Trust is predicting that May will show an improved and sustained performance.

62 Day to First Treatment - there were 22 patient breaches during the month of April - 8 x Tertiary referrals received between day 34 - 80 of the patients pathway (operating guidelines state referrals should be made within 42 days), 6 x Capacity Issues, 6 Complex Pathways and 2 x Patient Initiated. Of the tertiary referrals received in month 75% were received after day 42 of the pathway and 25% of the total tertiary referrals were received after day 62 of the Pathway.

Clostridium Difficile - 13 cases were positive by toxin test; 5 of these were attributable to RWT, (using the external definition of attribution) against a target of 3 for the month. This means RWT are 2 cases over target at the end of month one.

Falls - per 1000 bed days in April was 6% which is above the target of 5.6%. Care of the Elderly speciality had a high number of repeat fallers due to a particular group of delirious/confused patients that required supervision to reduce risk. The Trust continues to focus on falls prevention.

Pressure Ulcers – The Joint Quality Committee were concerned around the number of Grade 3 and Grade 4 pressure ulcers – additional assurance has been sought from the Lead CCG which was presented to the members in July. This will continue to be scrutinised and challenged.

Serious Incidents - there were 29 incidents reported to STEIS in April which is a decrease in comparison to 41 in March. 16 out of the 29 incidents reported in April related to pressure ulcers. There are 32 ongoing 22

incidents across both Divisions, of which 9 relate to pressure ulcers. A total of 33 incidents have been closed and there were no initial reporting breaches during April.

Number of Cancelled Operations – It was noted at the July JQC that the number of cancelled operations were increasing – additional assurance has been requested from the Lead CCG. This will continue to be closely monitored.

DUDLEY GROUP NHS FOUNDATION TRUST (Lead Commissioner Dudley CCG)

SUMMARY ASSURANCE LEVEL Current RAG Rating based on information Safety Quality received and external reviews June 2015 Assured Limited Assurance July 2015 Assured Assured Exception and Actions – April and May 2015

Cancer 62 Day Screening - The trust has been requested to provide an update. The trust is awaiting validated year end data for all metrics an update to be provided at July 15 CQRM.

VTE Assessment - The CQRM raised concerns around a recent variation with the Trust in June 2015, the CQRM awaiting outcome from the Trust investigations.

Diagnostic Waits over 6 weeks - Cardiology, Cystoscopy and MRI as the key areas identified with an issue in respect of waiting times. The Trust submitted a report looking into the contributory causes of the increased number of echo-cardiograph breaches in the last quarter of fiscal year 2014/2015 and outlines the short-term recovery plan put in place to bring the waiting lists back below 6 weeks. .

Complaints and SIs - the quarterly reporting on the learning from complaints and SIs at DGHFT and the action the Trust is undertaking to improve in the areas identified from their analysis was received and reviewed at CQRM. Further presentation and update will be made to the CQRM.

Pressure Ulcers - All categories of Pressure Ulcers (Grade 1 to 4) have shown an increase in reporting since the previous quarter and continue to be an area of high reporting. In response the trust has integrated the weekly Acute and Community to improve continuity and quality. This seems to have had a positive effect reported by the Trust. This will be monitored via CQRM.

Cardiology Outpatient Letter Backlog - The CQRM has requested that the Trust is to advise a timescale to clear the backlog and reach sustainable and timely discharge letter production. Further update will be included in next month’s quality report but it is noted that the trust has shown significant reductions from 1400 in January15 to 87 in June 15.

National Regulator – Update - The CQC intelligent monitoring report (from information that is presented to the Trust Board) was deferred until April 2015. The Trust are challenging the composite mortality indicator with CQC, the CQRM has requested that the report is moved to July 2015. The Trust has replied to the cardiology Dr Foster Alert and is waiting internal reporting to complete the Sepsis alert.

CQC Action Plan – The trust has produced the CQC Action Plan which identifies the key areas from the December 2014 and March 2015 inspections. Only 2 Actions remain open and SES&SP CCG have requested an update on these at the July 2015 CQRM.

CQC Patient Satisfaction – The CQC has produced patient satisfaction report from May 15. The Trust remain the same from the last report with only one area worse and no areas better. This has been raised with the Lead CCG who assures they are sighted on it and have raised it with DGH.

Clinical Audit Annual Report – The Trust has published the National Clinical Audit report. The main key actions will need to be addressed and the report will be discussed at CQRM in July.

New Senior Management Appointments – The trust has appointed and new Chief Nurse and Chief Operating Officer.

Rescheduling outpatient appointments - Dudley CCGs intention to promote and increase the use of electronic referrals via Choose and Book gave an opportunity to reduce the number of referral routes and booking processes being employed. This initiative was communicated and implemented across Dudley CCG and the Trust mid-April 2015. The Quality requirement has recently been reviewed for 2015/16 and agreed at no more than 6% of Choose and Book clinics to be cancelled, a target to be phased in quarterly and achieved by the end of quarter 4. A result of 9.62% was recorded for April 15. This will continue to be monitored via the CQRM.

SDUC - GP Out of Hours– Lead Commissioner South East Staffordshire and Seisdon CCG

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

July 2015 Assured Partial Assurance

Health Education West Midlands – Concerns have been raised from medical trainees over the level of supervision of Registrars. This was received by North Staffs CCG and shared with South CCGs. The outcome of this is awaited however North CCG has agreed to share the findings and learning. Commissioners have been concerned around the level of staffing and have requested further data from SDUC. Both North and South Commissioners have agreed to use contractual levers.

Soft Intelligence – It was raised at JQC that there were concerns around home visits particularly to rural areas. Soft intelligence suggested that ambulances were called rather than GPs attending. Commissioners have requested a breakdown of home visit data from SDUC to review this. To date no data has been forwarded. Both North and South Commissioners have agreed to use contractual levers should this not be forthcoming. This request was also made to ensure commissioners are sighted on the current level of staffing across the county, particularly at weekends and on night shifts – as described above.

Patient Safety Incidents – The highest reported incidents for both months were delays in care; this is consistent with previous reports and is being closely monitored through CQRM in terms of understanding the impact on patients.

Speak to Dispositions – There continues to be a pattern of poor performance around DX11 - Speak 2 Dispositions within 1 and 2 hours. Challenges continue at both CQRM and contract meetings.

Comfort Calling Standard Operating Procedure – SDUC have developed and have implemented this procedure to improve the consistency of practice following the challenge from commissioner where it was noted not all patients were receiving telephone checks when there was a delay in service. Performance will continue to be monitored.

Call review meetings - SDUC now meet regularly with commissioner clinical representatives to undertake reviews of recorded calls received by the service in an attempt to drive further improvement and provide additional assurance. It is expected that this will continue and that commissioner clinical representatives will attend.

Friend and Family Test – SDUC have now implemented the national Friends and Family Test question following challenge by the CCG at CQRM. The first data is expected in August 2015.

NSL Non Urgent Patient Transport – Lead Commissioner Stafford and Surround CCG

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

July 2015 Assured Assured

The Clinical Quality Review meeting with NSL takes place bimonthly, and is due to take place on 27th July where May and June data will be discussed.

CQC NSL Care Services is registered with the CQC to provide ambulance services. The registered manager is identified on the CQC website but they have not yet been inspected. The provider is expecting a visit in the near future and reports they are ready to demonstrate their compliance with CQC standards.

Patient Safety Incidents: It was reported that there was nothing of note to be reported by NSL during April 2015.

Serious Incidents: It was reported that there no serious incidents were reported by NSL during April 2015.

Complaints: One received in March in relation to timeliness of the service. NSL have been requested to provide a narrative report which identifies the issues /themes and actions taken/lessons learned as a result of any complaint which.

Patient Satisfaction Report: NSL in South Staffordshire has been piloting a new method of securing meaningful patient feedback on their services, an area that has previously been lacking. The new process involves the provider telephoning 50-60 randomly selected patients to ask them about their experience. In March attempts to contact 66 patients were made, of which 47 contacts were made which equates to 71% of users contacted, of these 100% would recommend the service to family and friends.

West Midlands Ambulance Service – Lead Commissioner Sandwell

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

July 2015 Assured Assured

Red Performance - There had been improvements in the Red Performance for Ambulance Response in 2014/2015 Quarter 4. However since then there has been a further deterioration in performance in respect of the Red metrics. This is expected to be discussed at the divisional meeting in August 2015. WMAS has produced a recovery plan that projects the meeting of Red 1 requirements by November 2015.

Meetings – The Chief Nurse/ Director of Quality continues to meet with WMAS Director of Nursing and Quality & Safety on a regular basis to ensure regular dialogue in respect of key local quality concerns.

CQRM – The last CQRM which should have taken place in June was cancelled at the request of the provider.

Summary – WMAS performance has been raised through CCG Performance Monitoring and Contracting, with relevant notices being raised. Although performance is identified as an issue the Quality Team and representatives from the core membership of the Joint Quality Committee met with WMAS Director of Nursing/ Quality & Safety at the Air Ambulance to discuss patient quality issues and resolution to the local area needs. This was a positive meeting and through this quality was assured and improvements identified. Further discussions on WMAS will be in August where representatives from Performance and Quality will attend the Divisional meeting to discuss and gain further assurance on the local issues.

Conclusion

The Joint Quality Committee concluded that all provider services covering South East Staffordshire and Seisdon patients 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 have been raised with Lead Commissioners as part of the routine quality monitoring activity.

The Governing Body is asked to note, whilst overall quality and safety does not pose escalation, the committee continues to be concerned about the level of staffing and staffing issues at SSOTPT and SDUC, the number of cancelled operations and number and harm of pressure ulcers at RWT and the degree of external scrutiny and number of on-going and outstanding actions plans at HEFT.

The Governing Body are asked to note the recent un-announced responsive quality assurance visits undertaken to SSSFT from both the CQC and CCG following whistle-blowing letters and receipt of soft intelligence. Whilst the JQC await the formal draft CQC report and outcomes from the safeguarding investigation the members have determined a partial assurance level which is the first time in many months. The Trust has responded well to the CCG visit and is working collaboratively with the CCG and CQC to make the required improvements. 28

The Governing Body are asked to note the progress made in terms of the long awaited Suicide Prevention Plan.

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 CCG GOVERNING BODY To be held on: Wednesday 29th July 2015

Agenda Item No: 12 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 orgnaisation.

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:

Non clinical risks Failure to deliver agreed financial recovery plan  It is understood that the CCG’s financial position is the most significant risk facing the organisation at present.

 Restructure of the CCG has significantly increased capacity and capability of the organisation, particularly with regards to senior management positions.

 A comprehensive review of the mechanisms for reporting delivery is being undertaken, this will ensure that these are fit for purpose and provide accurate and consistent information.

 Detailed reports providing updates on financial and QIPP performance are presented to the Finance and Performance Committee on a monthly basis. There reports include progress updates on both year to date and forecast outturn positions and describe remedial actions where required. Work has been undertaken to ensure that there is consistency of reporting with the Programme Committee.  NHS England is closely monitoring delivery of the recovery plan through the CCG assurance framework.  A 'CCG improvement plan' that has been developed as a result of feedback received from Pricewaterhouse Coopers' review of the organisation, the implementation of this plan is being monitored by the Audit and

Senior Management Committees. It is anticipated that the CCG improvement plan will have been fully implemented by the end of August 2015.

Clinical risks Service Quality at Heart of England Foundation Trust (HEFT)  The CCG is now in receipt of the recent CQC report which was published on 1st June 2015. The Trust has issued a formal response agreeing the findings and recommendations of the report. An action plan to address these recommendations is being developed and monitoring of this will be undertaken through CQRMs and other established quality monitoring mechanisms.  Specific concerns have recently been noted with regards to the Gastroenterology service and the Trust has highlighted this on their risk register. An action plan has been developed to address these issues and this has been shared with the CCG. The plan includes the provision of additional resources for the Gastroenterology department.

 The CCG remains engaged with the Lead Commissioners and the Trust through CQRMs and other less formal mechanisms.

Continuing Healthcare  Agreement has been obtained at a county-wide level, via the Commissioning Congress, to provide additional funding for increased capacity in the CHC team. CHC team have committed to clearing the backlog by September 2015. Subsequently concerns have been raised regarding the team's ability to meet this commitment; CCG continues to monitor the situation closely.

 CCG working with lead commissioner both via Chief Nurse to Chief Nurse regular meetings and discussions and also through a regional CHC Individual Patient Activity (IPA) Board.

 CHC internal risk register now regularly shared with CCG to provide assurance regarding awareness of risks and mitigating actions.

Service Quality at Dudley Group Hospitals Foundation Trust (DGH)  Joint Quality Committee has recently noted an improvement in the provision of data, particularly with regards to mortality rates.  Significant engagement with Dudley CCG (the lead commissioner) has been undertaken and SES & SP CCG now have some assurance that the provider is being appropriately challenged.  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 further improvements to the availability and standards of data.

 Following the departure of Chief Nurses at both DGH and Dudley CCG these positions have now been recruited to.

Responsible committee name: Risk Group Approved at Committee: Yes, meeting held 29th June 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.

125 130 124 Risk ID Date Added Date 25/11/2014 29/06/2015 04/11/2014

Quality Quality Financial Risk Category

Yes Yes No Clinical Risk CCG. the for risks financial and clinical service. Thiscould lead both to staffing and management of the andassessed difficulties with the there is a backlog of cases to be in services Staffordshire. (CHC) provision of Continuing Healthcare the with issues significant are There HEALTHCARE: CONTINUING Provider and Trust local CCGs. reputational risk the both to patient experience and aThis presents potential risk to England Foundation (HEFT). Trust quality at services Heart of of of therespect standard of overall Concerns have been highlighted in ENGLAND FOUNDATION TRUST: SERVICE QUALITY AT HEART OF organisation. for the consequences serious in result will plan this deliver to Failure working. of change and developing new ways transformational significant delivery of this is dependent on term financial recovery plan. The CCG has developed a medium- The PLAN: RECOVERY FINANCIAL FAILURE TO DELIVER AGREED Description Of Risk Of Description

3 3 3 Initial Likelihood

4 4 5 Initial Consequence 12 12 15 Initial Risk Score CCG Chief Nurse consider to attending Board IPA in future CCGthis commitment, continues monitor to the situation closely. backlog by September 2015. Subsequently have concerns been raised regarding the team's ability meet to additional funding for increased capacity in the CHC team. CHC team have clearing to committed the Agreement has been obtained at a county-wide level, via the Commissioning Congress, provide to through the Joint Quality Committee. the backlog, this matter has previously been escalated the to Governing Body and monitoring continues theDue to number of patients locally and the length of time it is taking resolve to particularly the issues, actions. mitigating and CHC internal risk register now regularly shared with CCG provide to assurance regarding awareness of risks on the CCG may be not as bad as first feared. including regular attendance at Board. the IPA Thiswork has revealed that the potential financial impact CCGThe Turnaround Director has been engaged in efforts address to the financial elements of this risk, Turnaround Director. and also through a regional CHC Individual Patient Activity Board (IPA) which is attended by the CCG CCG working with lead commissioner via both Chief Nurse Chief to Nurse regular meetings and discussions negotiations for 2015/16 and has played a role in etc. setting KPIs formal CCG mechanisms. The has also been actively involved in the quality of contract aspects CCGThe remains engaged with the lead commissioner and through the Trust CQRMs and other less May 2015. in CEO HEFT with met Officer Accountable CCG concerns. raise formally to CCG) City Cross Birmingham to transferring currently CCG, Solihull (previously Body. In addition the JQC requested that the CCG Accountable officer write the to Lead Commissioners andconsecutive agreed months in March 2015 formally to escalate identified the to Governing concerns several for only Joint regards with limited HEFT Quality expressed to The has assurance Committee monitoring mechanisms. being developed and monitoring of this will be undertaken through CQRMs and other established quality the findings and recommendations of the report. action An plan address to recommendations these is on 1st June 2015 and the CCG is now in receipt of this. has issued Trust a The formal response agreeing CQCThe visited on 9th the Trust December and remained on site for 3 days. CQC report A was published provision of additional resources for the department. measures' an process, action plan has been developed and shared with the CCG, this includes the Gastroenterology department and is the now Trust managing this department through an internal 'special in regards mortality to and cancer waiting have times. Issues been particularly noted in the Concerns have been noted regarding the collection and standard of quality data at particularly the Trust, expected have to been completed by 2015. the end of August Coopers' review of the organisation and implementation of this began in June 2015, all actions are 'CCG receivedA plan' Pricewaterhouse improvement developed from been feedback a has as of result EnglandNHS is closely monitoring delivery of the recovery plan through the CCG assurance framework. that there is consistency of reporting with the Programme Committee. outturn positions and describe remedial actions where required. Committee on a monthly basis. There reports include progress updates on year both date to and forecast providing updates on financial performance and QIPP are presented the to Finance and Performance this will enable remedial action be to taken quickly when problems are identified. Detailed reports Mechanisms for reporting delivery are being reviewed and enhanced ensure to accuracy and consistency, in accelerate place also put to deliveryhas been recovery the of plan. organisation in all areas, particularly with regards senior to management. Short term additional capacity organisaiton undertaken in June and July 2015 has strengthened the capacity and capability of the CCG has been reviewed and ensure to re-focussed delivery in the CCG's localities. restructure A of the In order facilitate to the delivery of the required large scale transformational change the structure of the Controls To Mitigate Risk Mitigate To Controls

Work has been undertaken ensure to Committees. monitored by Audit and Senior Management plan improvement CCG of Delivery action. remedial andconcern take prompt and effective allow more clearly CCG focus to areas on of assurance. These improvements will also provide more consistency and more thus will delivery of reporting in Improvements required changes. deliver to ability improve should capability Strengthening of organisational capacity and monitor financial elements of this risk. this of elements financial monitor CCG Turnaround Director continues to Committee. reports are being provided Joint to Quality regular communication and where available ChiefThe at Nurses organisations both are in feedback. provides and discussion forum for focussed Newly established pan-Staffordshire group commissioners, providers, CQC etc.) the to relevantconcerns bodies (lead reporting for structure a clear provides for the Joint Quality Committee, this escalationAn has now process been agreed interventions. CQC recent CCG The of awaitsconcerns. outcome the address to help will meetings CQRM Ongoing work during both and outside of Assurance On Controls On Assurance data included in CCG reports. the of accuracy and availability Intelligence and consequently the provided by Business CSU regarding level the service of Concerns have been noted No gapsNo identified. provide can be limited. the influence to ability CCG's As an associate commissioner the Gaps in Control in Gaps will be closely monitored. closely be will agreed, these of implementation recovery have actions been with BI the CSU and a series of assurance. Thisis being addressed currently represent a gap in Concerns regarding data quality do significant. significant. controls the backlog remains identified of implementation Despite consistent Gastroenterology. particular in services, regarding the quality of some areas significant concerns remain in some improvements Despite Gaps In Assurance In Gaps Last Review Review Last 29/06/2015 29/06/2015 22/07/2015 Date

3 4 3 Current Likelihood

4 4 5 Current Consequence 12 16 15 Current Risk Score New New Change risk ↔ ↔ Risk Owner Risk Johnstone Johnstone Ian Baines Ian Heather Heather Chief Finance Chief Nurse Chief Nurse Exec Lead Exec Officer Date of Next of Next Date 27/07/2015 27/07/2015 27/07/2015 Review improvement. balance and quality financial to limited not but statutory duties, including 2) we Ensure our meet improvement. balance and quality financial to limited not but statutory duties, including 2) we Ensure our meet improvement. balance and quality financial to limited not but statutory duties, including 2) we Ensure our meet Corporate Objectives

2 2 2 Acceptable Likelihood

3 3 5 Acceptable Consequence 10 6 6 Level Of Acceptable Risk CCG committee CCG committee Source Of Risk Of Source Assessment Assessment committee or sub- Risk Risk Risk 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 an associate commissioner the 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 CCG's ability to influence the Trust recently has been Concerns have been highlighted in both informally and through regular CQRM meetings. CQC conclusions align with what the CCG has comissioning organisations have a provide can be limited. inadequate and thus the CCG respect of the standard of overall previously reported. responsibility to ensure standards are cannot currently be assured with quality of services at Dudley Group improved. CQRM meetings are the primary regards to the quality of services. Hopsitals Trust (DGH). This The CQC report resulting from a recent visit to the Trust has now been received by the CCG, the report mechanism for fulfilling this responsibility presents a potential risk to patient reflects the concerns previously raised by the Joint Quality Committee. and the CCG are actively engaged in these experience and reputational risk to with quality team members in regular both the Provider Trust and local The lead commissioner now meet regularly with Trust representatives to address specific Quality attendance. 2) Ensure we meet our CCGs. concerns, the outcomes of these meetings are reported to the CQRM. SES & SP CCG is now assured that statutory duties, including CCG committee Dudley CCG (the lead commissioner) is applying appropriate challenge to the provider. A recent CQC report on the Trust reflects Heather 123 04/11/2014 3 4 12 29/06/2015 3 4 12 Chief Nurse 27/07/2015 but not limited to financial 2 3 6 or sub- Yes the concerns raised by the Joint Quality ↔ Johnstone Quality balance and quality committee Improvements in the availability and standards of data have recently been noted, particularly with regards Committee. improvement. to mortality. In addition, 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 further improvements. An escalation process has now been agreed for the Joint Quality Committee, this Following the departure of Chief Nurses at both DGH and Dudley CCG these positions have now been provides a clear structure for reporting recruited to. concerns to the relevant bodies (lead commissioners, providers, CQC etc.)

REPORT TO THE SOUTH EAST STAFFORDSHIRE & SEISDON PENINSULA CLINICAL COMMISSIONING GROUP GOVERNING BODY MEETING To be held on: Wednesday 29th July 2015

Enclosure No: 13 Subject: Secondment of Accountable Officer Lead Director: Dr John James, Chair Lead Officer: Dr John James, Chair Author: Dr John James, Chair Recommendation: For For For √ (Please tick) Approval Assurance Discussion

Purpose of the report:

To discuss the NHS England’s request that Rita Symons, Accountable Officer, is seconded to the Staffordshire Commissioning Congress in the position of Staffordshire Transformation Director.

Key Points:

The need to consider risks and benefits to both SES & SP CCG and the wider Staffordshire health economy.

Responsible Committee Name: Governing Body

Approved at Committee: YES/NO Date of Committee:

Impact: Quality N/A Implications: Financial N/A Implications: Equality impact YES/NO assessment If YES please give summary: required:

Delivering the Strategy: How does the The strategic vision is delivered both internally and externally. recommendation contribute to delivering the CCG Strategic Vision?

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

Recommendations/Actions required: The Governing Body are asked: to agree to the secondment for the Accountable Officer.

Explanation of acronyms used in this report: Acronym Explanation

Terms of Secondment for Accountable Officer

The Accountable Officer will be seconded through a secondment agreement to Staffordshire County Council as the receiving organisation. She will have a county council email and be based in Staffordshire Place. She will remain on the payroll of the CCG and her salary will be cross charged to the Transformation Budget. She will, however, be removed from the systems of the CCG in terms of authority to act and authorise activity. Her substantive role will remain with the CCG at its current status. As this is a two year secondment it is possible that there will effectively be no role for her to return to. As part of the governance arrangements for the Pan Staffordshire work, an agreement will be sought to ensure any potential redundancy costs are shared across the six CCGs.

In the event that the Transformation Programme fails and the Transformation Director post is no longer required, the substantive AO will return to her substantive post and the interim AO will return to managing his two CCGs. In the event there is a problem with the interim AO, the Governing Body and Remuneration Committee would need to take a view on required action.

REPORT TO THE SOUTH EAST STAFFORDSHIRE & SEISDON PENINSULA CLINICAL COMMISSIONING GROUP GOVERNING BODY MEETING To be held on: Wednesday 29th July 2015

Enclosure No: 14 Subject: Appointment of Interim Accountable Officer Lead Director: Dr John James, Chair Lead Officer: Dr John James, Chair Author: Dr John James, Chair Recommendation: For For For √ (Please tick) Approval Assurance Discussion

Purpose of the report:

To consider the appointment of Andrew Donald, Accountable Officer for Stafford & Surrounds and Cannock Chase CCGs, as the Interim Accountable Officer for SES & SP CCG.

Key Points:

The need to consider risks and benefits for SES & SP CCG.

Responsible Committee Name: Governing Body

Approved at Committee: YES/NO Date of Committee:

Impact: Quality N/A Implications: Financial N/A Implications: Equality impact YES/NO assessment If YES please give summary: required:

Delivering the Strategy: How does the recommendation contribute to delivering the CCG Strategic Vision?

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

Recommendations/Actions required: The Governing Body are asked: to agree to the appointment of the Interim Accountable Officer.

Explanation of acronyms used in this report: Acronym Explanation

Proposal to South East Staffordshire & Seisdon Peninsula CCG

Arrangements for the cover of South East Staffordshire and Seisdon Clinical Commissioning Group

1.0 Purpose

 To detail the proposals for interim Accountable Officer cover to be provided to South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group  To set out the proposed plan to ensure effective on-going Governance, Financial Management and Delivery

2.0 Introduction and Background

Clinical Commissioning Groups (CCGs) are at the heart of commissioning reforms in the National Health Service. With responsibility for 60% of the commissioning budget they need to be at the forefront of transforming their health and care systems. CCGs in Staffordshire are no different in this regard to any other CCGs in England except that the system in which they work has been deemed neither clinically or financially sustainable in the long term.

The six CCGs have developed a plan for transformation which ensures that by the 31st March 2018 the system can provide the level of services required within the financial resources available. This will only be achieved through a dedicated team led by a Transformation Director who can with and on behalf of CCGs drive this agenda forward.

The Accountable Officer for South East Staffordshire and Seisdon has been identified as the preferred candidate for this role. Therefore arrangements will need to be developed role to cover the Accountable Officer role within the CCG.

It has been proposed that the Accountable Officer for Stafford and Surrounds and Cannock Chase CCGs takes on the Accountable Officer responsibilities for South East Staffordshire and Seisdon and this is supported by the Chair of the Governing Body. NHS England have asked for a proposal on how this arrangement will be enacted to ensure that South East Staffordshire and Seisdon CCG has the requisite level of leadership and focus given to it by an Accountable Officer covering three CCGs.

The following describes the joint proposals of the Accountable Officer and Chair on how this arrangement will work giving confidence to NHS England that the organisation is robustly governed, has effective systems and processes for financial management and delivery of an increasingly complex agenda.

3.0 Proposition

In setting out arrangements on how the Accountable Officer for Stafford and Surrounds and Cannock Chase CCG would be able to take on the responsibilities of Accountable Officer South East Staffs and Seisdon Peninsula. The Chair and prospective AO have worked up a set of criteria which will have been used to test whether the proposals being put forward make sense and are deliverable. This will ensure focus is retained on the key in year tasks whilst working alongside the transformation programme.

The criteria are:-

 Do things once where possible  Does the proposal enhance delivery of the key 15/16 objectives (delivery of NHS Constitutional Commitments)?  Do the proposals support development of the system / transformation?  Do the proposals create economies of scale across the work of officers?  Clinical Leadership is embedded in the proposals  Do the proposals create the environment for shared learning?  Do the proposals enhance stakeholder involvement and engagement?

The principles which underpin the criteria are that all changes proposed should be easy to implement and avoid unnecessary upheaval which removes the focus from core tasks. Alongside this changes will not be made unless demonstrable improvement can be achieved

There are eleven areas for action:-

 Accountable Officer working pattern  Communication  Corporate Governance / Systems and Processes

 Quality and Safety  Financial Management  Commissioning / Contracting  Operations  Primary Care  Stakeholder Engagement  Organisational Development  Assurance

All areas for action have been tested against the underpinning principles and the criteria above.

The proposal takes cognisance of the six key domains setting out what a successful CCG should be delivering.

The follow table details the proposed changes alongside work to be completed and the timescales for delivery. Bearing in mind the challenges faced by SES and Seisdon many of the proposals (subject to agreement) will need to be implemented quickly.

Area Proposed Immediate Actions Work Plan Timescales Accountable Officer working 1.Two days per week on-site 1. Meetings with Senior Team From 4th August 2015 Pattern SES(Tuesdays/ Fridays/ Alternate Members, Clinical Leaders etc. Wednesdays) 2.Weekly Meeting three Chairs 2.Identify suitable deputies at (Wednesday am), SAS /CC and SES & Seisdon 3.Weekly Executive Management 3. Identify Lead Officers from Team across three CCGs each CCG to take forward key (Wednesday following Chairs programmes meeting) 4.Review with other AOs and 4. Initial meetings key Transformation Director Pan stakeholders Staffordshire work and decide if 5. Review current arrangements / responsibilities should change Progress on Management of 5.Ensure focus where possible is Change SES&S agree any

do once and share changes to process with the Chair 6.Briefings to all Governing 6.Governing Body dates in diary Bodies through Clinical Chairs 7.Membership / Locality meetings 7. Agree actions with CSU to 8. Paper to three CCGs streamline co-ordinate support Governing Bodies setting out proposed plans for alignment of work for sign-off Communications 1.Initial communication plan 1.Sign-off Transformation Director 16th July 2015 produced Appointment Commissioning Congress 2.Communication to stakeholders, 20th July 2015 staff on appointment of Transformation Director and cover arrangements for SES&S (SAS,CC and SES&S) 3.Communication with three 20th July 2015 CCGs Governing Bodies to formalise arrangements Corporate Governance / Systems 1.Review where joint meetings / 1. Identify and agree where joint 11th September 2015 and Processes committees can be developed Committees can be formed 2. Review systems and processes (Quality, Audit, REM, Finance and for management of Governance Performance) matters 2. Identify where systems and 25th September 2015 processes can be improved or streamlined 3.Report to Governing Bodies October 2015

Quality and Safety 1.Discuss with Heads of Quality 1. Report to Chief Officer on roles 4th August 2015 workload distribution move to one and responsibilities / Joint Quality approach / maximise coverage Committee, how CQRMs will be across Providers covered etc. 2. Governing Body sign-off September 2015

Financial Management 1.Review Financial Position with 1. Meeting with CFO and Chair By 7th August 2015 CFO / Chair 2. Forensic review of 2.DOF and CFO agree process 10th August 2015 opportunities for ensuring delivery and action forensic review with of the control total AO 3. Review of QIPP Plan and 3.Director of Strategy and 31st Augusts 2015 monitoring / undertake confidence Collaborative Projects SAS/CC assessment with CFO work with CFO on confidence 4.Buddy CFO with DOF in SAS assessment of QIPP and further and CC mitigation 5. CSU Director of Contracting to 4.CFO/DOF urgent meeting / 31st August 2015 identify opportunities for outcome report to AO minimising costs 5. CSU Director of Contracting 25th September 2015 undertake work and advise AO on opportunities over and above efficiencies already identified Commissioning and Contracting 1.Align Commissioning portfolios 1.Workshop to align 18th September 2015 between organisations Commissioning intentions where 2.Align Contracting to achieve appropriate Officers and Clinical economies of scale for example Leads CC Lead Wolverhampton to allow 2.Director of Strategy SAS / CC 31st August 2015 SES to focus on Heft and COO / Turnaround Director 3. Identify Transformation meet to agree arrangements for programmes to become effective use of Commissioning / responsibility of Transformation Contracting resource Director within Staffordshire 3.As 2 above to identify with 31st August 2015 Transformation Programme Transformation Director 4. Align programmes to clinical programmes which become the leads / sharing clinical leads lead of the TD across the three CCGs

Operations 1.Understand current 1. Interim COO SES&S to advise 10th August 2015

performance and delivery issues on key operational matters and 2. Ensure robust mitigation / risks and mitigations 25th September 2015 recovery plans 2. Director of Operations SAS 3. Confirm coverage and focus / /CC review Urgent care Team to set up systems to ensure forensic ensure coverage to SES&S into process of follow through GHH and Heft 4. Realign Urgent Care Resource to ensure effective coverage Primary Care 1.Enhance Primary Care support 1. Agree with Chair / Locality 18th September 2015 to General Practice across all Clinical Leads extra support three CCGs, remove duplication needs to assist Primary Care where possible 2.Identify key opportunities for 18th September 2015 2.Develop Plan for delivery enhanced delivery in Primary across SES&S, provide support Care which supports CCG and experience from SAS and delivery CC, assist Chair and Locality Clinical Leads 3. Ensure consistent schemes across all three where appropriate Stakeholder Engagement 1.Understand current work 1. Agree with Chair focus of 30th September 2015 programme and how that can engagement which links in to continue to be developed, share wider Transformation consultation learning from SES&S with SAS and Cannock 2. Define key meetings / groups and agree attendance Organisational Development 1.Support Chairs in building OD 1.Ensure OD programmes are in 30th September 2015 Plans for GB, Members and Staff place and underway for GBs, consider where possible joint sessions By 30th September 2015 2. Set out plans for how OD for staff can be streamlined across

the three CCGs Assurance 1.Gain sign-off of proposal 1.Sign-off of cover proposal By 15th July 2015 2.Work with NHS England to 2.Discussion with NHS England By 31st August 2015 agree streamlined approach to -Finance Meetings assurance if possible -Assurance Checkpoints -Other key meetings

This initial plan sets out a programme of work which will develop further over the coming months. However there are a number of actions that must be completed early to give confidence to all three organisations that there are significant benefits of these proposed arrangements for the local population and the clinicians within each are of the three CCGs, as well as providing assurance to NHS England that the arrangements being developed and implemented will enhance the CCGs ability to deliver in 2015/16.

4.0 Recommendation

That the Governing Body supports the proposition that the Accountable Officer for Stafford and Surrounds and Cannock Chase CCG takes responsibility as the Accountable Officer for South East Staffordshire and Seisdon Peninsula.

REPORT TO THE SOUTH EAST STAFFORDSHIRE & SEISDON PENINSULA CLINICAL COMMISSIONING GROUP GOVERNING BODY MEETING To be held on: Wednesday 29th July 2015

Enclosure No: 15 Subject: Finance Report – to month 3 (June) 2015-16 Lead Director: Ian Baines, Chief Finance Officer Lead Officer: Ian Baines, Chief Finance Officer 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 three months of the financial year and the forecast for the year end.  The report is to inform the Governing Body of the issues and risks with respect to the achievement of an in year deficit of no more than £18m (£34.7m cumulative) in 2015/16

Key Points:

 The year to date deficit is £8.259m compared with a planned position of £8.011m an adverse variance of £248k.  This is largely due to overspends currently within Prescribing and Acute Commissioning  Further savings schemes are being worked up and other outline schemes are being brought forward to ensure that we can cover the risk of continued overspend  At this stage we still anticipate delivering the full £6.5m net QIPP savings in 2015/16 and hitting the control total for the year There is still little reliable contract information available as yet on which to judge contract performance

Responsible Committee Name: Finance & Performance Committee

Approved at Committee: YES/NO Date of Committee: 17th July 2015

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 deliver net savings of £6.5m to achieve recommendation financial targets in the current year and to support financial recovery at the contribute to earliest opportunity. delivering the CCG Strategic Vision?

Recommendations/Actions required:

The Governing Body is requested to:

 To note the adverse variance from plan as at Month 3

 To note that further savings schemes are being developed to meet a potential shortfall in QIPP delivery

 To note that we are forecasting achievement of the control total at year end

REPORT TO THE SOUTH EAST STAFFORDSHIRE & SEISDON PENINSULA CLINICAL COMMISSIONING GROUP GOVERNING BODY To be held on: Wednesday 29th July 2015

Enclosure No: 15 Subject: Real Accountability – Engagement Annual report Lead Director: John James, Chair Lead Officer: Fleur Fernando, Engagement and Partnership Manager Recommendation: For For Approval √ For Assurance (Please tick) Discussion

Purpose of the report: There are several duties around participation that we follow as a CCG including the Health and Social Care Act 2012 Participation Duties outlined below:

Individual Participation NHS Commissioners must promote the involvement of patients and carers in decisions which relate to their care or treatment, including diagnosis, care planning, treatment and care management. This duty requires CCGs and commissioners to ensure that the services commissioned promote involvement of patients in their own care including: personalised care planning, shared decision making, self-care and self-management support information with targeted support.

Collective Participation NHS commissioners to ensure public involvement and consultation in commissioning processes and decisions which includes involvement of the public, patients and carers in: commissioning activities, planning of proposed changes to services monitoring, insight and evaluation.

The CCG is required to report on consultations that are carried out by any person who influences the commissioning decisions or any other decisions the CCG makes. There is no one definition of consultation, but in essence it means the act of asking a person for their views on a proposal or issue before a decision is taken. As a CCG we believe involving patients, public and partners individually and collectively is vital to our success and have endeavored to include them in every stage of the cycle as outlined in this report.

The report, attached, outlines how people’s views should be taken into account at every point of the commissioning cycle, and how this has now been embedded in project planning processes and through new staff structures.

Key Points: The CCG puts patients and staff at the heart of decision making, we focus on individuals, public, staff and partner views. We continue to work with providers to increase the amount of independent assessment of patient experience in key areas, such as the frail elderly. This will reflect a more open and learning culture helping us to focus our strategic priorities in the areas of greatest need. We have improved staff communication and support mechanisms through a period of rapid change, and we are implementing various techniques to ensure that staff voice is integral to our planning.

During the last year, the CCG has considered local implementation and new joined up thinking, we have taken bold steps with partners to join up funding across districts through locality commissioning. We have ensured participation is a reality and engagement is a key element of quality improvement.

Over the next two years, we are committed as a CCG to tackling major transformational change to address inherent issues with current services and improve efficiency, engagement with public, individual staff and partners will be vital to the successful implementation of this transformation. It is imperative that patients, staff, partners and the public are involved and are able to explore these problems. Patients can help define solutions, and develop the framework, to assist with difficult decisions making.

Responsible committee name: Governing Body

Approved at committee YES/NO Date of Committee:

Impact Quality Implications: Yes the report will need to go to Joint Qulaity committee Financial Implications: No Equality impact No assessment required? If yes, please give summary:-

Delivering the Strategy How does the The CCG puts patients and staff at the heart of decision making, we focus on recommendation individuals, public, staff and partner views. We continue to work with contribute to delivering providers to increase the amount of independent assessment of patient the CCG Strategic vision? experience in key areas, such as the frail elderly. This will reflect a more open and learning culture helping us to focus our strategic priorities in the areas of greatest need.

Recommendations/actions required: To note and approve the report.

Explanation of acronyms used in this report: Acronym Explanation

Real Accountability

NHS duty to report on consultation

April 2014 - March 2015

Real Accountability

NHS duty to report on consultation

April 20 14 - March 2015

Introduction

The CCG puts patients and staff at the heart of decision making, with a focus on individuals, public, staff and partner views. We continue to work with providers to increase the amount of independent assessment of patient experience in key areas, such as the frail elderly. This will reflect a more open learning culture, helping us to focus our strategic priorities in the areas of greatest need. We have improved staff communication and support mechanisms through a period of rapid change, and we are implementing various techniques to ensure staff voice is integral to our planning.

During the last year, the CCG has considered local implementation and new joined up thinking; we have taken bold steps with partners to join up funding across districts through locality commissioning. We have ensured participation is a reality and engagement is a key element of quality improvement.

Over the next two years, we are committed as a CCG to tackling major transformational change to address inherent issues with current services and improve efficiency. Engagement with public, individuals, staff and partners will be vital to the successful implementation of this transformation. It is imperative that patients, staff, partners and the public are involved and are able to explore these problems. Patients can help define solutions, and develop the framework, to assist with difficult decision making.

Our Communications and Engagement team, along with our patient representatives, have revitalised patient engagement, and we have an in-house team. Governance has been strengthened so information about engagement activity is reported to both the Joint Quality Committee and the Governing Body. We are currently redeveloping our engagement model to ensure it is fully inclusive of all groups and to take into account the large role partnership organisations such as Heathwatch and the Voluntary and Community sector have to play.

Consultation and Engagement

There are several duties around participation that we follow as a CCG including the Health and Social Care Act 2012 Participation Duties outlined below:

As a CCG we believe involving patients, public and partners individually and collectively is vital to our success and have endeavored to include them in every stage of the cycle as outlined in this report.

We have outlined how people’s views should be taken into account at every point of the commissioning cycle, this has now been embedded in project planning processes and through new staff structures.

Fig 1 – the engagement cycle

Engagement is the next step from consultation and is now embedded in all that we do as a CCG, patient participation greatly increased within our teams.

Throughout the year, as we plan a new project or piece of work, we consider patient and public involvement and identify opportunities for patients and public participation in every stage of the project implementation, through a communications and engagement plan. These range from large- scale strategies, to very local community issues and specific patient pathways.

As part of our CCG model of engagement we work very closely with our providers, NHS England, Staffordshire County Council, the three district councils, the Voluntary Sector and Healthwatch Staffordshire to ensure all patients have the opportunity to have their voices heard.

Developing the Infrastructure for Engagement and Participation

Processes The processes for engagement that we utilise as a CCG are very wide and varied and examples can be seen in the summary of key achievements section. We include the local population through focussed work, surveys, participation and engagement events, the patient council, patient district groups, Patient Participation Groups, Healthwatch champions, Healthwatch champion organisations, locality commissioning, partnership meetings, local data, soft intelligence analysis and use of social media.

Networks & Structures There are a number of networks that we are responsible for as a CCG outlined below:

The Patient Council The Patient Council provides the means for a two-way communication flow between South East Staffordshire and Seisdon Peninsula CCG (SES&SP CCG) and patients, carers, patient participation groups, voluntary and community groups and Staffordshire Health Watch in the local area, it is a varied and very representative group. The Patient Council is one of the mechanisms through which information is fed into the CCG Governing Body and Joint Quality Committee including patient experience and patient feedback to help inform commissioning decisions and prioritisation. The Patient Council also provides the means for the CCG Governing Body to cascade information relating to any proposed service changes at the beginning of the planning process. This ensures that patient representatives of South East Staffordshire and Seisdon Peninsula have the opportunity to influence commissioning plans and decisions in a timely and effective manner and members often engage in more in depth pieces of work.

Remit  To work in partnership with the Clinical Commissioning Group (CCG) as a critical friend to provide strategic oversight and assure patient involvement in all aspects of the commissioning cycle.  To work with patient participation and district groups to actively seek out patient and public feedback in order to improve services.  To network with other groups and stakeholders to actively seek out the opinions and feedback of patients and the public, including the views of seldom heard groups.  To provide assurance that all commissioning work has patient input at the heart of the process.  To use the intelligence from the Insight database to ensure that decisions about commissioning and services are informed by the evidence provided by Insight.  To report to the CCG Governing Body and Joint Quality Committee via the PPI Lay Member who will chair the Patient Council.

Membership Voting membership  Chair – CCG Lay Member for Patient and PubIic Involvement  Vice Chair (to be elected by Council members from list below)  2 representatives from South East Staffordshire District Patient Group (preferably 1 from Tamworth Borough Council area and 1 from Lichfield District Council area)

 1 representative from the Seisdon District Patient Group (with a nominated deputy representative to provide cover when required)  1 representative from Staffordshire Healthwatch  1 member representing Tamworth, Lichfield and South Staffs District Councils for Voluntary Service  5 or 7 members from the voluntary sector, community or condition support groups in South East Staffordshire and Seisdon Peninsula  Non- voting membership  2 representatives of SES and SP CCG Total Membership: 10-12 (voting)  Frequency of meetings  The patient council meets monthly and sometimes has additional/extended meetings for particular key pieces of work.

District Engagement Groups There are two district patient groups one in Seisdon Peninsula and one in South East Staffordshire (combining Tamworth, Lichfield and Burntwood). The district patient groups provide the means for a two-way communication flow to be established and maintained between South East Staffordshire and Seisdon Peninsula CCG (SES&SP CCG) and patients, carers, patient participation groups, voluntary and community groups, and Staffordshire Healthwatch in the local area. The district group is one of the mechanisms through which information will be fed into the CCG Governing Body, Joint Quality Committee and the Patient Council on patient experience and patient feedback to help inform commissioning decisions and prioritisation. The district group will also provide the means for the CCG Governing Body to cascade information relating to any proposed service changes at the beginning of the planning process. This will ensure that residents of South East Staffordshire and Seisdon Peninsula have the opportunity to influence commissioning plans and decisions in an effective manner.

Fig 2 – the SES & SP engagement model

Partnerships Engagement with Marginalised and Seldom Heard Groups As a follow on from the highly successful Call to Action events in 2014, engagement with the nine protected characteristic categories and vulnerable groups was undertaken in a more proactive way. Support Staffordshire’ (in Tamworth, Lichfield and South Staffordshire) engaged with groups through specific targeted work in the local communities. The feedback has been fed into the 5 year CCG strategic plan, ensuring all groups have had the opportunity to be heard and that their local needs and circumstances can form part of the forward planning.

Equality and Diversity System (EDS2) The CCG has a strong commitment to ensure commissioned services are fair and accessible to all. This is reflected in the engagement model described in Section 4.1. Moving forward the CCG has embraced the opportunity to utilise the EDS2 tool. The CCG welcomes the refocus of EDS2 on engagement and patient experience within the goals and outcomes. It recognises that the application of EDS2 to disadvantaged groups will support the CCGs commitment to deliver on the health inequalities agenda. The CCG will be grading performance across the EDS2 outcome 4, Inclusive Leadership in partnership with patients, voluntary and community sector via the patient council, to ensure the process is robust and the CCG receives appropriate challenge. The CCG is ensuring EDS2 is not separate or isolated from mainstream business.

Stronger partnerships with Voluntary and Community Organisations We have further developed our work with the Voluntary and Community Sector (VCS) in 2014/15. VCS organisations are represented on the Patient Council and commissioning workshops have included relevant community groups to help to redesign services. We are continuing to build on the work with Support Staffordshire the local Infrastructure organisation following the pilot ‘Building Health Partnerships’, and are developing the concept of social capital and Asset Based Development approaches in two areas. We are part of an exciting pilot project in Tamworth and 6

Seisdon that focusses on Risk stratification and joined up services to help the most vulnerable groups within our communities.

Locality Commissioning During 2014/15 Staffordshire took some bold steps to join up our funding streams with the Police and Crime Commissioner, Staffordshire County Council, Fire Service and the three District Councils, we took a locality outcomes based approach. Through this innovative and ground breaking work we have funded a wide variety of projects that aim to:

• Reduce reliance on public services • Reduce in social isolation and loneliness • Improve lifestyle choices • Improve health and wellbeing • Improve self-care and management of long term conditions • Increase community resilience and an improve focus on prevention.

Enabling self-control and self-care through partnerships The CCG is dedicated to enabling patients and communities to have the tools they need to manage their own health, stay healthy and make informed choices about treatment options. The points below highlight a couple of very innovative projects that are encouraging communities to take control.

 There is a Citizens Advice Bureau floating advisor service in rural parts of Seisdon, where those who are housebound or vulnerable can receive support and advice. They can link into valuable services to enable patients to take control of their conditions and their lives.  Age UK are running a Care navigator programme in Seisdon. The aim of this service is to target early intervention and prevention services to build resilience and wrap around support to improve health and well-being using volunteers. By focusing the delivery of the service through volunteers the community will be able to understand the engagement, sustain involvement and support individuals in tangible improvements in wellbeing. The second phase of the project is now up and running and is utilising social prescribing and looking at risk stratification for our most vulnerable in Tamworth and Seisdon, if successful this model could be replicated across the whole of Staffordshire.  A Volunteering 4 All programme in Tamworth supports those who may not have the confidence or skills to partake in supported volunteering. This valuable project is an excellent example of how social isolation can be overcome with some time and compassion and enabled individuals to take control of their own lives  The Pro-Health postnatal buddies project in Lichfield and Burntwood works with families to support them post birth, and continues to support them through their journey and ensure they have the right information and support to feel in control and care well for their baby.  The production of the minor childhood illness guide, this guide gives families and new parents the right information about common childhood illness nesses early on, ensuring they know where to go for support and what they can do at home. This has been distributed through all health visitors as well as being distributed to GP practices and voluntary and community groups.

Healthwatch Champion Organisations Healthwatch Staffordshire is a close partner of the CCG, we meet regularly and look for opportunities to join up our engagement and ensure we are hearing voices form every section of the community.

Healthwatch actively pursues feedback from users of health and social care services, this information helps to improve service delivery. Healthwatch Staffordshire supports local groups and organisations in becoming Healthwatch Champion Organisations.

There are a wide variety of 30 healthwatch champion organisations in SES & Seisdon who have become Healthwatch champions and are representative of our local population. We have actively encouraged all of the organisations funded through locality Commissioning in the three districts to become Healthwatch Champion organisations. The aim of Healthwatch champion organisations is to develop close working relationships and support Healthwatch engagement work, as a CCG we have direct links to Healthwatch via our patient council and also Joint Quality Committee. Healthwatch Champion Organisations seek, channel and represent the views of their users and/or members and publicise the role of Healthwatch and it activities. Our CCG messages and feedback mechanisms are publicised to all Healthwatch champion organisations and we will work with them on key pieces of work such as Urgent Care and the Equality and Delivery System 2.

Summary of key achievements around Engagement and Participation 2014/15 Our CCG approach to engagement is focussed on three areas, two of which were outlined in NHS England’s ‘Transforming Participation in Health and Care’ (2013). Transforming Participation in health and Care can be found here: http://bit.ly/1b4JVOo. Insight and feedback - which was the third area outlined are embedded in all of the three areas of engagement and insight is integral particularly in terms of ensuring quality of services and service redesign.

 To ensure individual participation  To ensure public participation  To ensure staff and partner participation.

Individual Participation

 Joined up patient case management, which will be further developed by implementing the House of Care model, this will improve patient care.  In depth care pathway work around chronic obstructive pulmonary disease (COPD) and Stroke, with partners, staff and patients and carers to ensure patients have the safest, easiest and most appropriate access to services.  The South Staffs Network for Mental Health (SSNMH - patient group) have been involved in the commissioning of ‘Improving Access to Psychological Therapies’ service. They will continue to input around the development of mental health services and the ambition to improve ‘parity of esteem’. SSNMH are now active partners in helping us performance manage these services by providing us with regular soft intelligence around mental health services.  We have worked with patients to implement the dementia strategy, dementia friendly communities have been developed and patients have been actively involved in the commissioning of key services. An couple of examples include: 1) St Giles Hospice offering ‘Dementia Friends’ training. This training has ensured communities can support those with dementia in a holistic way and has supported carers. 2) The Alziemers Society is now offering a dementia support service in Tamworth for those woith dementia and their families and friends.  We have received information about individual concerns from Healthwatch and PALs, and have acted on these effectively and efficiently, this feedback also forms part of our soft intelligence, we are linking closely to the new complaints advocacy project and they have attended our engagement events.  The CCG has been encouraging the sharing of soft intelligence as part of our wider quality and participation work and looking at how we can utilise other soft intelligence such as that 8

generated through Experience Exchange including joining up more closely with neighbouring CCG’s.  Soft intelligence is collected via GP’s, individual feedback, patient council stories, reports, and our single point of contact. It is used to drive quality and service improvements, changes in pathway design and assists in informing contract requirements.  As a result of the Francis Report (2012) a pilot project (spotter practices) has been developed enabling four practices to collate intelligence around quality concerns on particular patient care such as discharge processes and patient experience, this is then fed into the CCG and utilised to enhance service delivery and quality improvement.  A new feedback mechanism called ‘60 seconds’ has been developed for GP’s to feedback burning issues to Joint Quality Committee.  We partnered with NHS England to deliver a pilot ‘Patient Leaders’ programme, bringing expert patients and aspiring patient leaders together to share experiences and equip some of our patient groups to lead at a local level.

Public Participation

 The Patient Council and District Patient Groups have now been refocused and are going from strength to strength, we have two new members and are now more representative.  The Patient Council has helped to incorporate the patient voice throughout the governance structure of the CCG. The Patient Council reports directly to the Governing Body and Joint Quality Committee via the Patient Participation and Involvement (PPI) lay member. A sense of trust has been developed where members know that issues raised will be acted upon.  Both the Patient Council and District Patient Groups have received training in the concept of ‘prioritisation’, understanding the current health agenda and the challenges faced. They have supported the Clinical Prioritisation Advisory Group (CPAG) process.  We designed and commissioned a survey around Minor Injuries Unit (MIU) services at Sir Robert Peele and Samuel Johnson which have helped inform the local urgent care work.  The MIU survey was widely distributed through partner panels and the Staffordshire County Council portal and had a high response rate.  We have commissioned a piece of work from Engaging Community Staffordshire (ECS) to carry out in depth face-to-face interviews at Sir Robert Peele and Samuel Johnson. ECS compared the findings with similar work from other providers to triangulate and further inform the urgent care strategy and the way forward.  The Wolverhampton Urgent Care Strategy Group includes members of the Patient Council and District Patient Groups, ensuring patients from our local area can have their voices heard.  We are feeding into the Dudley Urgent Care Strategy and taking feedback to inform the strategy about local issues.  We worked together with the Burton Hospital Trust to look at the Community hospitals and have supported the engagement programme organised by Engaging Communities Staffordshire  We have has supported ‘listening events’ following the Keogh review into Burton Hospitals NHS Trust. As part of ‘Call to Action’ we held three large events in each of the localities, which were well attended. We also had targeted work to ensure the seldom heard voices were part of our consultation, and had an online feedback form for those unable to attend the events but who wanted to feed into our future direction.  We supported the consultation process for the Staffordshire Joint Health and Wellbeing Strategy, and analysis has fed into our strategic and operational plans.  We have a programme of clinical visits which involve staff talking to patients and feeding back to inform our commissioning intentions.

 We make use of quality data reports including patient opinion, NHS choices, friends and family tests, Experience Exchange in house surveys, CCG quality visits and monitoring arrangements to inform the planning process.  We have worked closely with the County Council and partners to develop a mental health strategy entitled – ‘everyone’s business’ and are currently engaging about the shape of the implementation of the strategy  The CCG is now a pilot site for NHS citizen and we have worked in partnership to ensure we can feed the public voice fed in to NHS England directly.

Partner and Staff Participation

 Internal communications and staff feedback channels have improved with the introduction of more structured, themed team meetings and use of various survey tools. This means staff can feed into the CCG’s future plans.  External communications are also improving with the development work on the website; the introduction of an intranet in 2014 and the production of various reports and newsletters.  We are currently working on a social media strategy covering the next two years, to enable staff to effectively engage internally and externally.  There has been a recent management of change agenda which has seen staff engaged and consulted on the future structure of the organisation.  The new organisation structure will incorporate matrix working across the organisation.  The introduction of spotter practices helps gain information on strengths and weaknesses in the system to inform future commissioning plans.  There is a Human Resources and Organisational Development Group made up of a cross section of staff who oversee policies such as training, equalities and flexible working.  The CCG considers the results from the staff opinion survey for CCG and providers and acts on these.  Internal staff development means the wider team now fully understand how participation fits within their own priorities; have the best tools to enable participation and know how to feed findings in to the strategy and planning mechanisms.  The CCG continuing to support a partnership approach to consultation and engagement, for example, by sharing citizen’s panels with the local authorities and joined up consultation on the county portal. This means less duplication and better use of resources.

For further information about SES&SP CCG patient and public engagement activity, please contact the Engagement and Partnership Manager, Fleur Fernando on 01827 306148 or email [email protected]

Project index

Below in the chart are some practical examples of how engagement and involvement has been embedded into the work of the CCG and the ‘So what’ factor? What difference has this actually made to the services we commission?

Example Page Development of the Patient Council 12 A Call to Action 13 Pediatrics Care 15 Dementia Strategy 16 Urgent Care Strategy 17 Improving Access to Psychological Therapies 18 Quality Assurance Visits 19 Chronic Obstructive Pulmonary Disease 20 Clinical Prioritisation Advisory Group 21 Healthwatch Champion organisations 22 Locality Commissioning 23 Patient Leadership Programme 24

Project E-cycle Who has What specific issues What was the So What? Status been were stakeholders asked feedback from the consulted about and what engagement activity? What decision has been and information was taken & how has the engaged? provided to them? feedback influenced any decision?

Development of Analyse and We now have a The patient council has The patient council provides The patient council has Ongoing & the patient Plan, Design very well been a key sounding board verbal feedback during taken decisions on several forward plans council Pathways, balanced, varied, for all large pieces of work. meetings which is formally issues and also feeds back to develop Specify and passionate and Examples include clinical recorded and helps inform soft intelligence and patient further Procure, & representative prioritization, urgent care, decision making. The stories to the Governing Deliver and patient council, surgical reconfiguration, patient council is also Body and Quality including Improve strategic direction, invited to take part in the Committee. These issues are representation personal health budgets, online surveys and investigated and where from seldom required services are heard groups. locality commissioning and questionnaires. The

Where we find wider patient engagement. representatives on the improved and patients

gaps in patient council often receive feedback on the representation become involved in areas of improvements. we actively commissioning that are of Key patient stories have led promote and particular interest to their to changes in services – for support representative groups. For example a story was applications for example, the SS network for brought about a Ward in a these areas. We mental health is actively local hospital that was ensure the involved in feedback investigated and also Patient Council regarding mental health undertook an enter and have any barriers services. view via Healthwatch – as a for engagement result the Ward involved removed. now has a new Matron and more permanent staff in place to prevent future issues for patient care

Project E-cycle Who has What specific issues What was the So What? Status been were stakeholders feedback from the consulted? asked about and engagement What decision has what information was activity? been taken & how the provided to feedback influenced stakeholders? any decision?

A Call to Analyse and All stakeholders The engagement focused There were numerous key The feedback and themes Ongoing – Action Plan, Design including: the around four key themes that emerged that emerged have been this is now Pathways, public, patients, questions/issues facing the throughout the Call to utilized in all of our CCG an annual Specify and VCS, partners, NHS: Action work including planning. They focus in our conversation Procure, & staff. communication, operational plan, our 5 year with our • What must we do to build stakeholders Deliver and consistency, integration, strategic plan, GP plus, the Plus targeted an excellent NHS now and community, prevention, end of life strategy, quality including Improve work with the 9 in future generations? personal responsibility, strategies, and patients and

protected • How can we maintain technology, avoiding commissioning intentions. public. The characteristics financial sustainability? waste, staffing, patient current groups. • How can we meet focus, access, equalities, Every document or strategy theme being everyone’s healthcare whole person approach, that the CCG develops and Let’s talk needs? customer care, and adopts must have about • How can we improve the efficiency. considered the findings form health, quality of the NHS? A Call to Action as decided focusing on It was interesting that at our Governing Body. mental Stakeholders were provided these themes were health, with up to date information echoed throughout the Our current 3 programmes parity of about the NHS national and events, the online surveys of work 1) Ageing Well 2) esteem, local picture and the major and the targeted work. Every interaction adds Value reducing issues we are facing going and 3) Joined up services reliance of forward. For more information see were all influenced by the urgent care our summary document patient feedback. and quality here. within our three See one of the graphic programmes representations overleaf. of work. 13

Project E-cycle Who has What specific issues What was the feedback So What? Status been were stakeholders from the engagement consulted? asked about and what activity? What decision information was has been taken & provided to them? how the feedback influenced any decision?

Pediatrics Analyse and Patients, families 1)Focussed work has taken There was lots of feedback To take a whole system In the forward Care Plan, Design and carers, GP’s, place with families in form stakeholders including: approach planning stages Pathways, communities & mother and toddler settings  Difficult to get same day GP – there is an 1) Acute VCS. action plan to Specify and in partnership with appointments when worried “To support and illness Procure, & Homestart in Tamworth, start this whole about children empower children, system approach in CYP Deliver and asking them what are the young people and and districts are Improve main issues in health for  Lack of confidence in GP’s 2) Minor families (CYPF) to stay now being acute illness in children. knowledge of children’s healthy, manage childhood engaged to take work in children illnesses illness and recover this forward. illness (attached doc).  Minor injuries unit in quickly.” It reflects guide Tamworth provides excellent many strands of service, great staff, common commissioning, all of Acute illness in CYP which impact on the scope v1.docx sense advice health and well-being  Need an after school drop-in of CYPF. The system is 2) Stakeholders were asked  Happy to use internet but not broken down into 3 about the guide, what sure which sites are most components: information would be useful, helpful  Staying healthy what would make the guide  Need better support for  Identifying risk more accessible, where should parents to manage illnesses at of illness the guide be distributed by home (HV, SN, Pharmacists,  Empowerment Sense CDS. The whole after school walk-in sessions). and support to guide was written with Information and reassurance. deal with the crisis and parents, carers and families prevent re- occurence

Project E-cycle Who has What specific issues What was the So What? Status been were stakeholders feedback from the consulted? asked about and engagement What decision has been information was activity? taken & how the provided to feedback influenced stakeholders? any decision?

Dementia Analyse and The public, Public engagement events Early diagnosis and Dementia was one of the CCG Ongoing & strategy Plan, Design patients, and education sessions community support are vital priorities as a result of the continuing in Pathways, community around dementia have for those with dementia and feedback and is part of the the forward Specify and groups, and sought opinion and raised their families. Ageing Well programme. Two plans Procure, & health and social awareness of dementia. projects supporting people Deliver and care Understanding and support diagnosed with dementia and professionals. There was a focus on their families were funded Improve early on can make a whole support from diagnosis through locality world of difference in the through to end of life. Commissioning. long run. Dementia friendly Dedicated staff is vital to communities are now being those diagnosed with initiated in South dementia and their families. Staffordshire.

Supportive communities We have developed dementia provide a safe and centre’s of excellence with supportive space for people the county council. with dementia. These centres will meet all of the needs identified by patients and their families.

Project E-cycle Who has What specific issues were What was the feedback So What? Status been stakeholders asked about from the engagement consulted and information was activity? What decision has ? provided to stakeholders? been taken & how the feedback influenced any decision?

Urgent Care Analyse and The public, There have been A&E studies in Our CCG commissioned the Good The feedback is now being In the strategy Plan, Design patient Good Hope hospital, Queens Hope A&E work and the key will fed directly into our future Pathways, representatives, hospital and University Hospital findings were: urgent care strategy going planning as Specify and GPs, NHS North Staffordshire looking at  A strong majority reported forward. a large scale consultation Procure, & stakeholders. A&E usage and how this fits in to relatively short waiting Deliver and Urgent care in the area. Findings times, with 55% of Good Hope, responded to Improve were coordinated by Staffs surveyed patients waiting all points raised and where appropriate made Healthwatch and triangulated. 1 hour or less and 88% two improvements. There has also been a survey of hours or less. Samuel Johnson and Sir the two Minor Injuries Units, Sir  The general experience at Robert Peele are part of a Robert Peele and Samuel A&E was positive, with wider strategic review Johnson, asking patients about 89% of patients reporting looking at the future of their experiences and reasons for that they were ‘very community hospitals and attending. ECS has run a satisfied’ or ‘fairly need in the area and the consultation on behalf of Burton satisfied’ with their findings have contributed looking at Community Hospitals experience. to these plans, which will  Some patients left positive also form part of the qualitative comments urgent care strategy A&E response from HEFT.doc explaining their past experience at Good Hope, commenting upon short waiting times and praising MIU Survey the attitude of staff. Research Project.pdf 

 There were several issues raised by patients that the hospital has 17 responded to as can be seen in the response.

Project E-cycle Who has What specific issues What was the So what? Status been were stakeholders feedback from the consulted? asked about and engagement activity? What decision has been information was taken & how the provided to feedback influenced stakeholders? any decision?

Improving Access Analyse Service users, Stakeholders were asked The key feedback was that A new service has been Ongoing & to Psychological and Plan, GP’s, providers what was important to them patients wanted: commissioned through cyclical therapy Design and communities. when accessing South Staffordshire & Pathways, A mental health psychological therapies and Recovery - People want to Shropshire Foundation Trust. Specify and improvement how they would like the become well based upon the The new service has a more Procure, & network also service to look. treatment provided. community based approach Deliver and worked with their Stakeholders are now being Resilience - People do not and includes social value. Improve service users to asked about how the service want to become unwell The service has been well help develop the is running and if it is meeting again once the treatment received by patients on the service whole. their needs. has stopped. specification. Impact - People want to see South Staffs network for that the treatment has mental health feed in soft unlocked other potential for themselves. intelligence to the patient

SSNMH Response to council and Joint Quality IAPT.pdf Committee.

Project E-cycle Who has been What specific issues were What was the feedback from So what? Status consulted? stakeholders asked about and the engagement activity? information was provided to What decision has stakeholders? been taken and how the feedback influenced any decision.

Chronic Analyse Patients, Stakeholders were asked: The feedback identified that: There has been a Ongoing & Obstructive and Plan, carers, new service cyclical Pulmonary Design partners, the  What does social inclusion  We need to ensure that commissioned in Disease Pathways, respiratory mean to someone with outcomes for patients and line with the (COPD) Specify network, COPD? their carers with COPD are feedback form and providers and  How can we improve patient-centered, with a patients and carers. Procure, communities. health and wellbeing for holistic and wellbeing It is being delivered & Deliver people with COPD and approach. by the British and their carers?  Programmes supporting Oxygen Improve  How can we work patients and their carers Company.(BOC) collaboratively and avoid need to be community The service looks at duplication? based and easy to access. the patient as a  What would help in the  Services need to be whole person and self-management of C delivered in partnership works with the local  OPD? with other relevant communities. There services. is also a focus on mental health progression and sustainability. Services and support are in place for patients at the end of the pulmonary rehabilitation programme.

Quality Analyse and Patients and The Quality Team are undertaking Feedback has been mixed from Patient’s feedback has Ongoing & Assurance visits Plan, Design hospital staff a series of visits to ‘test’ the patients dependent on the visit formed improvement part of Pathways, patient experience at various sites ands which ward has been visited, plans for wards which forward Specify and an example of a visit to Ward 30 are followed up in a planning across Heart of England Procure, & Heartlands can be seen here. joined up way by the Deliver and Foundation Trust. We are asking Commissioners to Improve patients about their experience of ensure they have been care that includes such elements made. as, but not exhaustive; ward 30 BHH 19th May assurance visit FINAL.docx  Quality and suitability of

food We can target Quality Assurance  Informed about plan of visits in line with, quality reports, care and discharge serious incidents, high rates of falls  Response call to buzzers and soft intelligence gathered  Feeling cared for through Datix and patient stories.

 Information relating to

self-care i.e. pressure are

care, falls

Clinical Analyse and There has Stakeholders were asked if The patient council was widely in The patient council Ongoing & Plan, Design part of Prioritisation been lots of CPAG was clear, concise and a favour of CPAG. They looked at the CPAG Pathways, national future Advisory Group fair mechanism for scoring understood and liked the model and agreed to it (CPAG) Specify and consultation. health provision. before it had been to planning Procure, & approach and they were also in Deliver and agreement of utilising the the Governing Body. If The patient They were asked about the they had not agreed it Improve Oregan scores. council has Oregan model and whether or more work would have been involved not as a CCG we should adopt been needed to look at locally. They their scores. a scoring model. There have been are lay members and trained in the CPAG Prioritisation.pdf patients on the Clinical usage of CPAG and Prioritisation Advisory Oregon Group making the attended Presentation.ppt workshops decisions about what about its does and does not get delivery. funded.

Healthwatch Analyse and Patients, public, Healthwatch carry out a wide Healthwatch compile a wide range The Healthwatch Ongoing & Champion Plan, Design communities range of varied consultations and of feedback which is essential to Champion part of future Organisation Pathways, and engagements on behalf of the ensuring we are commissioning the organisations are planning project Specify and representative Staffs County council, CCG’s, right services in the right way. encouraged to gather Procure, & groups. providers and the voluntary sector. We recognize as a CCG that we feedback from their Deliver and They closely link in to our cannot engage with every single representative groups Improve engagement and are a key partner. individual, however, we wish to and feed it directly have as wide a patient into any consultation representation as possible. or engagement that is Through the Healthwatch happening. This allows Champion organisations project we patient voice to be at can achieve this ambition. The the heart of all healthwatch champion decision making that organisations in our geographical we take as a CCG. area now total 30 organisations, Staffs Healthwatch are we have encouraged all of the a key and vital partner projects funded through locality and we work very commissioning to become closely together. healthwatch champion organisations.

Project E-cycle Who has been What specific issues were What was the feedback So what? Status consulted? stakeholders asked about and from the engagement information was provided to activity? What decision has been stakeholders? taken and how the feedback influenced any decision.

Locality Analyse The Stakeholders were consulted on County wide there was a The new locality Completed Commissioning and Plan, Voluntary the COMPACT principles and also drive led by Tony Goodwin Commissioning first round of Design and asked about what would make Chief Executive of Tamworht model was locality Pathways, bidding for funds easier for them. implemented in all commissioni Community Borough Council to join up three distircts Specify and Sector, Commissioners and partners were all of the funds that were ng & covered by SES& SP improvemen Procure, & patients, also asked the same questions being funded separately, CCG. Deliver and ts for the align our priorities to district partners and next round in Improve All projects funded providers. level need and have a the forward simplified and joined up have a preventative aspect to them and planning application process across all scored highly in stages organisations. The process terms of social value. led to outcomes based An example of the commissioning type of project funded can be found here.

Tamworth Referrals.docx

Patient Analyse and Patients, public, Patients were provided with three The feedback was good. Although Patients have told us Ongoing and Leadership Plan, Design and full day training sessions to help the course was a pilot, it built upon they feel better in future Programme Pathways, representative them to learn new skills, and best practice from previous equipped to make planning. Specify and groups. become patient leaders. programmes. their voice heard at Procure, & our patient groups We will be Deliver and Stakeholders were asked about Some of our patient through the training involved in Improve leadership locally and how we can representatives felt that a range of provided. future enable effective local leaders, different speakers were required to development Expert patients delivered the inspire change and give an On the back of the work and are programme and speakers came indication of the qualities a patient pilot a decision was linking this and shared their experiences. leader should have. This feedback made to further work into NHS Attendees took away a wide range was taken on board by NHS develop patient citizen as we of information, and a focus on England who will develop the leadership are a pilot site applying what they had learned at programme regionally. opportunities their Patient Participation Group, regionally. and any other groups to which they belong.

REPORT TO THE SOUTH EAST STAFFORDSHIRE & SEISDON PENINSULA CLINICAL COMMISSIONING GROUP GOVERNING BODY MEETING To be held on: Wednesday 29th July 2015

Enclosure No: 16 Subject: Finance Report – to month 3 (June) 2015-16 Lead Director: Ian Baines, Chief Finance Officer Lead Officer: Ian Baines, Chief Finance Officer Recommendation: For For √ For

(Please tick) Approval Assurance Discussion

Purpose of the report:

Key Points:

Responsible Committee Name: Finance & Performance Committee

Approved at Committee: YES/NO Date of Committee: 17th July 2015

Recommendations/Actions required:

The Governing Body is requested to:

 To note the adverse variance from plan as at Month 3

 To note that further savings schemes are being developed to meet a potential shortfall in QIPP delivery

 To note that we are forecasting achievement of the control total at year end

Finance Report – Month 3 – Year to Date June 2015

Date of Meeting Wednesday 29th July 2015

Contents

Finance Report Month 2 Page

• Key Messages 3

• Revenue Resource Limit 4

• Overall Financial Position 5

• Acute/Mental Health Commissioning 6

• Activity Analysis 7

• QIPP 8

• Operational Finance 9

• Forecast Analysis 10

• Use of Reserves 11

• Risks and mitigations 12

2 Key Messages

Plan Year to Date – Key Message • The CCG is showing an overspend at month 3 of £8,259k . This is a variance of £248k against plan. • The variance is driven predominantly by over-performance against Acute Contracts, particularly at Royal Wolverhampton Hospital and Prescribing costs This has to be set against the context of little reliable contracting data to support analysis and only one months Prescribing data.

Commissioning – Key message • Mental Health contracts are now showing a small underspend of £23k at month 3. • Acute Contracts are over performing at month 3 by £481k. This has to be treated with caution at this stage as there is limited supporting contract/activity data to facilitate analysis at the time of writing this report. Month 2 and needs scrutiny

QIPP – Key message • As at month 3, estimated QIPP savings YTD are £1.229m against a plan of £1.228m. However, some schemes are phased in Months 4 -12 and some delivery risk is emerging relating to those schemes. Consequently we are looking to bring forward other schemes to mitigate against any reduction in savings in year.

Operational Finance – Key • There is currently an underspend of £75k against the running cost allowance. Message • Performance against the Better Payment Practice Code continues to be below target for non-NHS suppliers

• Despite our deficit, we are able to draw down additional cash to cover payments to our suppliers

Plan Forecast / Financial Risk • At this early stage of the financial year, we are forecasting that the planned deficit of £18m will be delivered.

3 Revenue Resource Limit

South East Staffordshire and Seisdon CCG Non- Total Commentary Recurrent Recurrent Resource Month • The Revenue Resource Limit at Revenue Resource Limit as at Month 02 (1 April - 31st May 2015) Confirmed £000 £000 £000 Month 3 is £223,100k. Confirmed Healthcare Allocation M02 238,571 -16,019 222,552 • The non recurrent deduction (£16,019k) from the opening GP IT M03 549 549 allocation includes the return of Medway PAS and Stroke M03 -1 -1 the previous years cumulative 0 deficit £16,687 off set by a non 0 recurrent allocation £668k to reflect the additional costs of the 0 Enhanced Tariff Option (ETO) 0 over the initial published tariff. 0 • The GP IT allocation (£549k) has 0 been confirmed in Month 3. 0 0 0 0 0 0 0 0 Subtotal Month 3 238,570 -15,470 223,100

New Allocations New allocations in Month 3 M03 0 0 0 GP IT 0 549 549 Medway PAS and Stroke -1 0 -1 Total Month 3 -1 549 548

4 Overall Financial Position

South East Staffordshire and Seisdon CCG - Finance Report Annual YTD YTD YTD Forecast Forecast Budget Budget Expenditure Variance Expenditure Variance Commentary Month 03 (1 April - 30th June 2015) £,000 £,000 £,000 £,000 £,000 £,000 Revenue Resource Allocation -223,100 -57,410 -57,410 0 -223,100 0 • The CCG has an agreed Expenditure cumulative deficit plan of £34,681k. Mental Health 22,045 5,658 5,682 23 22,045 0 This equates to a £17,994k deficit Acute 128,474 32,556 33,038 481 129,716 1,243 in year. Primary Care 36,269 8,887 9,167 279 36,292 23 • The CCG has a year to date Cont Care & FNC 20,117 5,970 5,970 -1 20,117 0 overspend against its revenue Community 38,998 9,980 10,002 23 39,839 841 resource limit of £8,259k. Other 7,237 1,212 729 -483 5,169 -2,069 Total HCHS 253,140 64,264 64,587 323 253,178 38 • This has resulted in a year to date deficit against plan of £248k. Corporate/Running Costs 4,641 1,156 1,082 -75 4,603 -38 • Presently this variance is driven by over performance on Acute Total Expenditure 257,781 65,421 65,669 248 257,781 0 Contracts and Prescribing costs, offset largely through the use of Total Surplus / Deficit reported at Month 03 34,681 8,011 8,259 248 34,681 0 reserves. • There is also a small underspend South East Staffordshire and Seisdon CCG - Annual YTD YTD YTD Forecast Forecast on corporate running costs. This is Finance Report In Year Performance Budget Budget Expenditure Variance Expenditure Variance expected to come back into line Revenue Resource Allocation -239,787 -61,582 -61,582 0 -239,787 0 once the new CCG structure is Total Expenditure 257,781 65,421 65,669 248 257,781 0 recruited to. In Year Deficit 17,994 3,839 4,087 248 17,994 0 • The forecast assumes that the position on Acute Commissioning will improve, as QIPP schemes start to make an impact and that Prescribing will come back into line. • The position on Community services, (which includes the Community Hospitals managed by Burton FT) may deteriorate, if QIPP cannot be delivered. • The overall Forecast at Month 3 is that the planned deficit will be achieved

5 Commissioning

Annual YTD YTD YTD Forecast Forecast Commentary SES&S CCG Mental Health Budget Budget Expenditure Variance Expenditure Variance £,000 £,000 £,000 £,000 £,000 £,000 Staffs and Shropshire Healthcare Trust 19,698 5,072 5,072 0 19,698 0 • The Mental Health Contracts are Mental Health Resilience Funding 0 0 0 0 0 0 now overspent by £23k, following realignment of the budgets with Bham & Solihull MH 230 57 57 0 230 0 the agreed contract values. Midlands Psychology 423 106 109 4 423 0 • The Acute providers are North Staffs Combined Hcare 53 13 13 -0 53 0 overspent by £481k presently. Other Providers 1,641 410 430 20 1,641 0 • The exercise to reconcile budgets Total Mental Health 22,045 5,658 5,682 23 22,045 0 to acute contracts has been undertaken to ensure that they aligned correctly. Annual YTD YTD YTD Forecast Forecast SES&S CCG Acute Providers Budget Budget Expenditure Variance Expenditure Variance • HEFT and Wolverhampton are significantly overspent, but £,000 £,000 £,000 £,000 £,000 £,000 underspends on other contracts, Burton 28,197 7,195 7,192 -4 28,114 -84 notably non NHS providers, HEFT 36,128 9,220 9,628 408 38,007 1,879 reduce the net over-performance Wolverhampton 22,810 5,764 6,071 307 24,818 2,008 • There is still limited supporting Dudley 9,274 2,353 2,327 -26 8,797 -477 activity, performance and trend data to support the financial UHB 2,927 732 732 0 2,927 0 positions reported. Work is Derby 2,452 621 795 174 2,504 52 continuing with the CSU Contract Walsall 2,881 720 724 4 2,817 -64 Management Team to strengthen this over forthcoming weeks. Sandwell & W B'ham 1,593 398 381 -17 1,407 -186 • It should be noted that the Acute Royal Orthopaedic 1,512 378 331 -47 1,232 -280 Overspend is largely balanced in Shrewsbury & Telford 860 215 218 3 876 16 the CCG through the use of B'ham Childrens 984 246 209 -37 983 -0 reserves, which cannot be relied upon as the year progresses. Cov & Warks 620 155 110 -45 591 -29 George Eliot 561 140 135 -5 561 0 Ambulance 6,630 1,657 1,671 14 6,630 0 Total Main Acute Providers 117,427 29,795 30,522 728 120,263 2,837

Other acute - NHS 5,487 1,372 1,338 -33 4,744 -743 Other acute - Non-NHS 5,560 1,390 1,177 -213 4,709 -851 Total Acute 128,474 32,556 33,038 481 129,716 1,243 6 Activity Analysis

Commentary

A summary of the main ytd and forecast activity variances will be included here in future months

7 QIPP

15/16 15/16 M3 YTD M3 YTD M3 YTD Variance Commentary 15/16 FOT QIPP Plan Plan Actual Variance from Target (£m) (£m) (£m) (£m) (£m) (£m) • The CCG has QIPP plan that is expected to deliver £7.3m over Acute Services* 6.012 0.979 0.978 (0.001) 3.913 (2.099) the course of the year. Mental Health Services 0.198 0.050 0.040 (0.010) 0.160 (0.038) • The financial plan requires that Community Health Services 0.000 0.000 0.000 0.000 0.000 0.000 £6.5m of the £7.3m is delivered in 2015/16. Continuing Care Services* 0.460 0.115 0.115 0.000 0.460 0.000 • £6.5m is 2.7% of our Revenue Primary Care Services 0.386 0.084 0.096 0.012 0.386 0.000 Resource Limit. 0.250 0.000 0.000 0.000 0.000 (0.250) • As at month 2 the CCG has Other Programme Services* delivered £1.229m of QIPP Grand Total 7.306 1.228 1.229 0.001 4.919 (2.387) against a target of £1.228m. • It should be noted that the delivery of QIPP is profiled to the latter months of the year. • A separate QIPP report is being developed to provide more detail on the programme for all committees and stakeholders, and to align to financial reporting. • Work is on going to: 1. Strengthen governance and reporting of QIPP; 2. Align resources to delivery and allocate accountability; 3. Develop a continual pipeline of QIPP.

8 Operational Finance

Commentary

• Running costs are showing a Annual YTD YTD YTD Forecast Forecast slight underspend of £75k as Corporate Running Costs Budget Budget Expenditure Variance Expenditure Variance at month 3. Month 03 (1 April - 30th June 2015) £,000 £,000 £,000 £,000 £,000 £,000 • There is an expectation that Pay 2,221 555 487 -69 2,170 -51 these will come back to budget Non-Pay 2,458 611 605 -6 2,471 13 once the new structure is Income -38 -10 -10 -0 -38 0 recruited to. Total Corporate Running Costs 4,641 1,156 1,082 -75 4,603 -38

• The CCG has a responsibility Public Sector Payment Policy to pay both NHS and Non April May June July August September October NovemberDecember January February March Cumulative NHS creditors within 30 days, % % % % % % % % % % % % % the target being 95%. NHS Value 98.79 99.27 99.95 99.38 • There has been some Number 96.30 86.94 90.18 91.51 improvement in the performance this month, Non NHS although the % of non NHS Value 93.24 83.49 95.14 90.85 invoices paid within the target Number 85.17 90.16 83.46 86.17 is still low.

South East Staffordshire CCG Financial Year 2015/16 • Cash is drawn down to meet CASH DRAWINGS contract mandate payments, Actual prescribing costs charged by Planned BSA BSA Total Actual % Cumulative % Variance The Business Services Monthly Prescribing Cumulative Prescribing Actual Cash Monthly Cumulative Drawings Variance from Plan Authority, salaries and any Month Plan Drawdown Plan Drawdown Drawdown Drawdown Drawdown to Date from Plan (cumulative) other costs. £000 £001 £000 £000 £000 £000 £000 % £000 % April 17,500 2,328 19,828 2,480 17,500 19,980 19,980 7.80% 152 0.77% May 17,500 2,553 39,881 2,675 17,500 20,175 40,155 15.68% 274 0.69% June 21,000 2,459 63,340 2,709 21,000 23,709 63,864 24.94% 524 0.83% 9 Forecast Analysis

Commentary

A more detailed breakdown of the forecast position by major contract and programme spend will be included here in future months

10 Use of Reserves

Commentary

• The CCG has a number of reserves that now total £5,157k. • Over 50% of this is already committed in terms of the repayments to Birmingham Cross City, Walsall and the anticipated IAT for Overseas Visitors charges • The FRP Delivery reserve has firm commitments up to £543k with further outline plans to use another £320k. This still leaves at least £600k to contribute towards the bottom line. • The contingency reserve has been reduced by £394k and now stands at £754k. This is due to a centrally mandated increased contribution to the risk pool for legacy CHC claims. It is possible that this will not all be used in year and the CCG could receive a refund. • It has been agreed to continue with the acute roving service as part of the Systems Resilience planning for 2015. Although no further firm or expected commitments are shown, it is likely that further investment will need to be made.

Annual YTD Firm Expected Balance Reserves Budget YTD Budget YTD Actual Variance Commitment Commitment remaining Notes £000's £000's £000's £000's £000's £000's £000's Contingency 754 0 0 0 0 0 754 £394K Reserves used to fund CHC Top Slice System Resilience 1,196 320 0 -320 411 0 785 Roving Service Commitment Non recurrent costs of FRP delivery 1,500 375 109 -266 543 320 637 This has been transferred to a separate budget to be managed within Programme costs B'ham X City and Walsall CCG's IATS 1,500 0 0 0 1,500 0 0 CCG IAT's Commitment CEOV anticipated IAT 207 0 0 0 207 0 0 CEOV Commitment

TOTAL 5,157 695 109 -586 2,661 320 2,176

* The Commissioning Reserve £3.9m has been allocated to individual contract lines in M03 to fund the Acute & Mental Health signed contracts

CEOV - Charge Exempt Overseas Visitors IAT - Inter Authority Transfer 11 Risks and mitigations

Commentary Estimated Probability Full Risk of risk Value at being Potential Commentary • An initial risk assessment has Month 3 realised Risk Value been undertaken below , in Risks £m % £m order to understand and quantify Risk not related to QIPP under delivery, but due to unplanned growth or other factors within the potential risks to the financial Acute Commissioning portfolio. Only 2 months SLAM data available for most Providers. position , which are not reflected Acute SLAs 3.00 50.00% 1.50 Particular risk around HEFT contract moving to PbR basis. in the forecast. Mitigations are QIPP Under-Delivery 2.80 50.00% 1.40 QIPP plan already risk adjusted then considered to offset the Month 1 data shows higher than expected spend, but forecast assumes future months return risk. Prescribing 1.12 50.00% 0.56 to planned levels. Also unknown impact of generic price increases in year. • The extract below is taken Other Risks 0.00 directly from the return to NHS England, which requires an TOTAL RISKS 6.92 3.46 estimate of the financial value of Please enter the probability of success of mitigating action the likely risks. The assessed Probability risk on the Acute portfolio is at a Full of success Expected high level and is informed by the Mitigation of Mitigation Commentary limited activity information that is Value mitigating Value currently available. A more £m action £m detailed assessment of the Mitigations % contracts will be undertaken in Uncommitted Funds (Excl 2% Headroom) conjunction with a review of forecasting methodologies for Contingency Held 1.15 65.00% 0.75 Contingency partially used to fund increase in CHC risk share contributions Month 4 and will be presented to Investments Uncommitted 0.60 100.00% 0.60 Uncommitted from £1.5m Transformation reserve the next Committee. Uncommitted Funds Sub-Total 1.75 1.35 • At this stage, the main Actions to Implement mitigations are use of uncommitted reserves and the Further QIPP Extensions 2.00 50.00% 1.00 Pipeline schemes under development for 2016/17 to be brought forward acceleration of QIPP schemes Non-Recurrent Measures 0.80 100.00% 0.80 Includes further running costs savings to compensate for slippage in Delay/ Reduce Investment Plans 0.70 50.00% 0.35 Systems resilience reserve currently undercommitted the original programme. Other Mitigations 0.00 • While Detailed risk assessments Mitigations relying on potential funding 0.00 0.00 on individual contracts are have Actions to Implement Sub-Total 3.50 2.15 not yet been fully developed, it should be noted that there is a significant level of risk, which is TOTAL MITIGATION 5.25 3.50 not reflected in the reported outturn position. NET RISK / HEADROOM 0.04 12 Enc 17

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

Wednesday 10th June 2015, 1.00pm, Boardroom, Merlin House, Tamworth

Present: Alex Fox (AF) Lay Member Quality Assurance (SES&SP CCG) (Chair) Anne Heckels (AH) Lay Member Patient & Public Involvement and Finance & Performance (SES&SP CCG) Lynne Smith (LS) Associate Lay Representative for Quality (ES CCG) Ann Tunley (AT) Lay Member Patient & Public Involvement (ES CCG) Dr Adrian Parkes (AP) Clinical Director Quality (SES&SP CCG) 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) Paul Winter (PW) Head of Performance & Governance (ES CCG) Rob Boland (RB) Governance Manager (SES&SP CCG) Mahesh Mistry (MM) Head of Medicines Optimisation ( SES&SP CCG) Fleur Fernando (FF) Engagement & Partnership Manager (SES&SP CCG) Judy Bird (JB) Primary Care Change Manager (ES CCG)

In Jan Sensier (JS) Chief Executive (Healthwatch Staffordshire) attendance: Paula Gardiner (PG) Deputy Chief Nurse (BHFT) Agenda item 5 Fay Bayliss (FB) Assistant Director of Nursing & Quality (BHFT) Agenda item 5 Julie Thompson (JT) Senior Nurse for Older People (BHFT) Agenda item 5 Tracey Finney (TF) Administrator

AGENDA MINUTES ACTION ITEM NO To be noted: JS arrived at 13:30 and left at 15:20 JB arrived at 13:50 and left at 14:45 FF left at 14:30 PW left at 15:15 MM arrived at 16:10

AF informed members that concerns had been raised with regard to the naming of a GP in the ES CCG Primary Care report in relation to training and fitting of a Mirena Coil. PW confirmed that, following consultation with the Information Governance Team at the CSU, there was no information breach due to the GP being named in a professional capacity. Members were assured by this and that the Joint Quality Committee papers are not in the public domain. PW gave further assurance that if a Freedom of Information (FOI) request was made the GPs name would be removed under Section 40. It was confirmed by JB, under Agenda Item 10 ES CCG Primary Care Report, that the GP in question had now agreed to complete a significant event report. 1

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Further discussion was held regarding the potential for information that may come to the committee from NHS England on behalf of the Co-Commissioning Committee, which may include named doctors. It was suggested that a separate confidential section of the meeting be held for core members only. PW/RB to PW/RB discuss outside of the meeting and provide a recommendation to the committee on the way forward.

1. Welcome and Apologies

Apologies were received from: Heather Johnstone (HJ), Dr Liz Gunn (LG), Mark Seaton (MS), Mike Chester (MC).

Anne Heckels was welcomed to the Committee in her role as Lay Member for Patient and Public Involvement/Finance and Performance for SES&SP CCG.

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 13th May 2015

The Minutes of the meeting held on 13th May 2015 were agreed as a true and accurate record with the following amendments:

SSOTP Members were concerned to learn that the Trust has reported executive teams are not aware of bank and agency usage as teams are empowered to use bank and agency staff as required. To be amended to: Members were informed that team managers have been empowered to use bank and agency staff as required with the levels of spend being reported to the Trust’s executive team via their finance meetings.

Quality Accounts Members thanked SW & KLM for producing the Quality Accounts for SSSFT and BHFT. To be amended to: producing the Commissioner Statement for the SSSFT and BHFT Quality Accounts.

4. Actions from the Previous Meeting held on the 13th May 2015

Action sheet updated as attached.

5. Presentation on Falls – BHFT

Paula Gardiner (PG), Deputy Chief Nurse; Fay Bayliss (FB), Assistant Director of Nursing & Quality and Julie Thompson (JT), Senior Nurse for Older People attended the meeting to give a presentation on Falls at BHFT. 2

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NHS Safety Thermometer (FB) A hand out was circulated to members which included the following information:  Falls with or without harm since July 2012. BHFT are below the national line on this chart, although there had been a spike in falls during April 2015.  Falls with harm since July 2012. BHFT are below the national line on this chart.  Funnel chart for falls with harm. The Trust is almost better than expected. The chart shows the position for all acute Trusts against whom BHFT benchmark favourably. The chart looks at per 1000 bed days and is measured against the number of patients seen rather than on a specific timescale. It was queried whether benchmarking could be undertaken against specific or similar sized Trusts. It was reported that BHFT are looked to for best practice by other Trusts.  Ward Assurance data December 2014 – May 2015. All wards are currently scoring at 80% or above with 95% being the benchmark the Trust would like to achieve. Any ward failing to achieve 95% compliance has an action plan put into place and report in to the Trust’s Chief Nurse.

Innovative Ideas and Actions (PG)  Following NICE guidance the Trust has moved from using the Modified Stratify Falls Risk Assessment Tool which is a numerical tool, to using a functional falls assessment. Any patient identified as at risk of falling has an in-depth Tinetti assessment carried out by a therapist.  A number of red flag indicators have been introduced.  Falls sensors have been removed from the Trust as these have been shown to increase the risk of falling for those patients with cognitive impairment.  Sleep hygiene tool has been introduced which emulates the patients routine prior to going to bed. This was introduced on Phillip Ward and has led to a huge reduction in falls. The tool has now been rolled out to Anna, Darwin and Ward 44.  Medication review tool which looks at any medication that patients take which are indicative of a risk of falling. This has been introduced in every drugs trolley in order that doctors are aware.  Enhanced Care Team has been put into place and an activities coordinator has also been employed.  The Trust participates in national falls conferences and is looked to for best practice.  One of the areas where falls occur is when patients are in the toilet. Posters were introduced in August/September 2014. These have now been revamped due to patient confusion and the Trust is ensuring these are being placed in the right position.

Enhanced Care Team (JT) A team of 10 Health Care Assistants (HCA) were recruited in December 2014 and underwent a specific training programme looking at nursing patients with dementia, person centred care, nursing patients in distress and prevention of falls. The team is managed by the Dementia team and visit each patient on a daily basis where a one to one nurse request has been made. The allocated HCA supports the patient throughout their journey. The Safeguarding Team are also involved with 3

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any patients that require a Deprivation of Liberty (DoLs). The quality of care for patients has been significantly improved.

AF thanked the Trust for attending and opened the discussion to questions. LS highlighted members’ concerns which included the increase in fractures resulting in harm from 20 in 2013 to 33 in 2014, with 5 in January 2015. However it was acknowledged that there had been an improvement with only 1 reported in February 2015. It was hoped this was a result of the initiatives put in place; however assurance will be required in the future that this continues.

6. GP 60 Second Reporting

AP gave a verbal update on the current themes and concerns from within GP Practices in SES&SP CCG:  Lack of follow up, particularly from secondary care.  Delayed communication, particularly for patients under multiple specialities.  Cancelled appointments, particularly cancellations by SSSFT and short notice cancellations.  Patients classed DNA’s and discharged when the appointment has been cancelled by the provider.  Lateness of advice and guidance from HEFT.  Confusion regarding the incontinence service.  999 ambulance attendance at GP surgeries with downgrading of urgency of GP requests.  Delays in being able to access counselling from the Wellbeing Service.  None availability of commonly prescribed drugs.  None availability of GP appointments.  Concerns about nurse revalidation.  Nursing home allocations.

Members welcomed the report from AP and discussed how this information could be used going forward within the CCG. It was suggested that the themes and concerns be listed with the Quality Team picking up those that need immediate action. The following month any new concerns would then be listed. It was also agreed that these should be logged on Datix as soft intelligence.

7. Patient Engagement

SES&SP CCG FF drew the following to members’ attention:  Let’s Talk About Health events. A series of nine events will be held across South East Staffordshire and Seisdon Peninsula. These will focus on the three programmes of work. Each discussion table will be asked a question on quality of care.  There is currently very little or no CCG Clinical Director representation at Patient Councils meetings. It was felt this was important to reinforce the CCG’s message that ‘patients are at the heart of everything we do’ and to answer any queries relating to clinical issues. AP agreed to raise this at the AP/FF next Clinical Director meeting.

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 Training is being arranged for all managers on the Equality Delivery System 2 (EDS2). This system focuses on leadership within the organisation.  The next Real Accountability report will be brought to the August 2015 committee.  Choose well messages are being sent out to try to reduce urgent care usage. A patient reference group is being set up as part of the work on urgent care.

SES&SP CCG Patient Council update No formal report this month.

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

The following points were highlighted:  Visits have taken place to a range of support groups across the patch.  SW and Dr Ambrose attended a meeting to discuss research projects. Members of the Patient Board agreed to support SW and Dr Ambrose and promote research activities.  Members’ attention was drawn to a patient story regarding the Orthopaedic Ward at BHFT. A patient on the ward observed lack of care from an agency nurse for a distressed patient with dementia. There were AT/DV no complaints regarding the patient’s own care. AT to pass details to DV who will investigate.

8. Discussion on Healthwatch as a permanent member of the Joint Quality Committee

Following on from a meeting between AF and JS, it was proposed that Healthwatch become a permanent member of the Joint Quality Committee in order to improve the liaison between both CCGs’s quality requirements and Healthwatch. JS highlighted some of the work that Healthwatch do including:

 Representation at SES&SP CCG Patient Council.  Member of the Health and Wellbeing Board.  Statutory member of the Quality Surveillance Group.  Patient experience feedback tool ‘experience exchange’ on Healthwatch website which also provides information, advice and signposting to members of the public. Now receiving approximately 50 reviews a month across all services in Staffordshire. Any identified concerns are acted on.  Hold engagement events across Staffordshire where feedback and intelligence is gathered.  Dashboard in development to pull together intelligence and look at trends in a meaningful way.

JS stated that she would welcome the opportunity for Healthwatch to become a member of the committee and would nominate a representative to attend. Terms RB of Reference to be updated to reflect this. LS suggested that a one page report either monthly or bi-monthly be brought to the committee highlighting trends and activity.

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9. SES&SP CCG Clinical Risk Register

Members noted the report produced by RB.

There are currently three risks on the assurance framework, HEFT, Continuing Healthcare and Service Quality at Dudley Group Hospitals Found Trust (DGH).

10. Primary Care Quality

ES CCG Members noted the report produced by Judy Bird.

The following points were discussed:  AP highlighted the Atrial Fibrillation project and queried how many practices use the GRASP tool. JB reported that practices are being encouraged to use it, but would find out more information from Dr Pidsley.  Data by practice level was requested, eg on non-elective admissions and vaccinations. It was queried whether not achieving flu vaccination targets had any adverse outcomes for patients. AH/AT were asked to raise this with members of the Patient Council/Board.

SES&SP CCG Members noted the report produced by Eleanor Wood.

11. Quality Reports from Key Providers

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

A meeting is to be arranged to discuss what would constitute an unsafe service and what tools are available that could be utilised by the committee.

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 SW.

The following points were highlighted:  Workforce – a Service Development Improvement Plan (SDIP) has been agreed as part of the 15/16 contract and the first report will be due in September 2015. Julie Tanner, Director of Workforce and Development, will attend the CQRM in July 2015. Members were concerned regarding the lack of bank and agency usage data which needs to be triangulated with sickness/absence rates.  Pressure ulcers – the Trust are aware of the concerns and are undertaking a deep dive to look at the numbers in more depth.

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JS informed members that at the May 2015 QSG the Trust were put on ‘enhanced surveillance’ and it was agreed to hold a risk review meeting with regard to SSOTP. This will take place on the 2nd of July 2015.

The following queries were raised:  Workforce Toolkit – it was queried how and when the Trust will be implementing the recommendations from this work.  Statutory training and mandatory compliance – the Trust have an action plan in place however it was queried what the timeline is for this. SW  Significant increase in internal incidents.  Appraisal compliance.  Serious Incidents – queried why 3 x unknown grade 3 pressure ulcers were reported in March 2015.

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 points were highlighted:  Elimination of mixed sex accommodation – there were only 3 breaches on the 6th of April. This data will be re-submitted in the July 2015 Quality Report.  CQRM – the meeting was not held in June 2015 due to the mock CQC visit. A list of questions have been submitted to the Trust and the responses will be included in the July 2015 Quality Report.  Discharge question – the Trust are currently not asking this question due to the same themes occurring each month. The Trust is acting on the concerns raised during 2014/15. The question will be reintroduced in six months’ time. Members were concerned about this and DV agreed to DV raise at the July 2015 CQRM.

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.

The following updates to the report were given following the CQRM held on the 4th of June 2015:  Concerns continue regarding some of the workforce data. The Trust’s Head of Workforce will attend the July 2015 CQRM in order to provide assurance on the Trust’s actions.

 Crisis Resolution Team – 7 breaches have been reported and the Trust has

been asked to provide assurance on these.

 Delayed discharges – Stafford & Surrounds CCG, Lead Commissioner for 7

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Continuing Health Care (CHC) are developing an escalation process.  Railway deaths – the Trust have reported being higher than the national average. The Trust has stated that it is their belief that this is due to increased media publicity. The Trust is working with the Samaritans to put together an action plan.  Suicide Strategy Stakeholder event to be held on the 17th of July 2015, 9.00 am – 12.00 pm at the Stafford Gatehouse Theatre.  CQRM frequency – meetings will take place bi-monthly with effect from July 2015.

The following queries were raised:  Friends and Family data – appears that no data has been published since December. KLM confirmed this is reported quarterly, however will raise KLM with the Trust.  Increase in the number of Serious Incidents (SI’s). This has been raised at the CQRM and will be monitored going forward.

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

NSL Members noted the Quality Report produced by DV.

The following queries were raised:  180 minutes plus exceptions – DV to ask the provider for the outcomes for those patients. This information should be available from their incident reporting process. DV  Customer feedback survey – DV to ask provider to re-look at the scoring categories.  NSL Fleet – provider to be asked to provide data on the number of vehicles they are contracted to provide.

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

SDUC Members noted the Quality Report produced by KLM.

The following points were highlighted:  The CQRM is currently focussing on Speak 2 Dispositions, delays in care and staffing levels. The next CQRM will take place on the 15th June 2015. The pre-meet has been held and concerns were raised about the data being reported through performance and contracting.

 SDUC have now been appointed as provider of the NHS 111 contract and

discussions are being held at a regional level regarding an amalgamated

CQRM.

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Members agreed the following assurance levels for SDUC: SAFETY: Assured QUALITY: Partial Assurance

WMAS Members noted the Quality Report produced by NW.

The following points were highlighted:

 Performance figures are improving for both ES and SES&SP CCGs, particularly for Red 1 and 2; however it was reported by NW that this could be due to a seasonable reduction in service pressures.  NW to attend a meeting on the 11th of June 2015 with regard to the Paramedic Pathfinder initiative within the West Midlands Local Health Economies (LHE). This initiative will have an impact on the Red 19 performance.

The following queries were raised:  Response timescales – NW to obtain details of how far outside the timescales the Trust were for each indicator.  Saville report –lack of reporting from the Trust. NW confirmed that this information has been requested from the Lead Commissioner (Sandwell NW CCG) on a number of occasions. To be raised directly with WMAS if this information is not provided at the next CQRM. It was suggested that the Trust be asked for a copy of their volunteer and disclosure and barring service (DBS) policies.

Members agreed the following assurance levels for WMAS: SAFETY: Assured QUALITY: Limited Assurance

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

The following points were highlighted:  Work is on-going in obtaining the level of data required to provide assurance to the committee. Additional data is now being obtained via the Trust’s performance team and the CSU.  Announced Visit to Urology Services – DV took part in this visit and gave assurance to members on these services.

Following discussion members acknowledged that, although there were some gaps in the data, the level of assurance and data provided had significantly improved and DV was thanked for her work with the Trust.

The following assurance levels were agreed for DHFT: SAFETY: Assured QUALITY: Assured

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

The following points were highlighted:  Gastroscopy and RTT – the Trust’s six month recovery plan does not appear to show any sustainability and both SES&SP CCG and Solihull CCG are challenging this with the Trust.  CQC report – actions plans are awaited from the report published on the 1st June 2015. An update will be given in the July 2015 quality report.  Two week wait booking process – alert sent to GPs as problems with capacity of the email system.  Cancer waits – visit planned to Oncology outpatient department. Patients will be asked two non-threatening questions around ‘did your GP tell you why you were coming’ and ‘is this your first appointment’.  HSMR – is increasing, however this has been attributed to the flu spike. As part of the mortality action plan all deaths are clinically reviewed and any queries subject to internal review. NW agreed to include details from the NW CQC report in the July 2015 quality report.  Joint Advisory Group (JAG) accreditation – if accreditation is not granted then the national bowel screening programme will be withdrawn from HEFT and an alternative service sought for patients. However the Trust is putting actions in place to achieve the standards required. The situation is being monitored closely by Birmingham Cross City, Solihull and SES&SP CCGs.

The following assurance levels were agreed for HEFT: SAFETY: Assured QUALITY: Limited Assurance

Royal Wolverhampton 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 KLM.

Position in relation to cancer waits and pressure ulcers remains the same as the previous month. There are elements of assurance from the Trust in their improvement actions. Serious incidents related to delayed diagnosis and failure to act on test results were highlighted as areas for monitoring by the committee.

Members discussed assurance levels and due to concerns including symptomatic breast cancer, pressure ulcers and rates of C-Diff the following assurance levels for RWT were agreed:

SAFETY: Assured QUALITY: Partial Assurance

KLM to raise the committee’s concerns directly with the Wolverhampton CCG. KLM

The Dudley Group of Hospitals (DGH) Members noted the Quality Report produced by NW. 10

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The following points were highlighted:  62 week wait breaches – report still waited for the breaches reported in February 2015.  VTE assessments – this has been raised with the Trust who will investigate.  Diagnostic six week waits – the Trust have been asked to further investigate issues regarding Cystology and MRI.  Pressure Ulcers – the Trust is now holding an integrated committee between community and acute to discuss all pressure ulcer incidents.  Saving Lives Audit – a report is to be presented to the Trust Board.  Outpatient appointments/Choose and Book – it is reported that 88% of GP practices are now booking appointments via Choose and Book. Anecdotal evidence has been received from SES&SP CCG Primary Care team that referrals are being rejected to practices inappropriately. NW to investigate this further.  WMQRS – a visit will take place in September and will focus on the Trust’s Dementia Service.  CQC Closure Report – will be included in the July 2015 quality report.  Falls – NW agreed to include assurance on Falls in the July 2015 quality NW report.

Members agreed the following assurance levels for DGH: SAFETY: Assured QUALITY: Partial Assurance

12. Quality Surveillance Group (QSG) Members noted the report produced by SF.

The following points were highlighted:  SSOTP are now subject to enhanced surveillance and a risk review meeting is to be held on the 2nd of July 2015.  NSL discussed for the first time and placed on enhanced surveillance due to issues with the contract in the North.

Members welcomed the report and noted the action taken by the QSG with regard to SSOTP.

13. Transforming Care Members noted and acknowledged the concerns raised in report produced by Christine Adams.

14. Medicines Management

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

The following points were discussed:  There has been a decrease in the ranking for antibiotic prescribing; however this is due to a national decrease. The number of items prescribed within the CCG has however decreased.

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 Practice level data has now been included in the report, this highlights which practices are outliers.  The red, amber and green indicators were queried and highlighted as potentially misleading. MM confirmed these indicators are the PrescQIPP national indicators. These have been revised for the new financial year. MM agreed to carry out more in-depth practice audits to find out the reasons practices are outliers both positive and negative and also to overlay the data with C-Diff rates to see whether there are any trends associated with prescribing.

SES&SP CCG Feedback on Care Homes Pharmacist Reviews Members thanked MM for producing a really good report and an excellent initiative. It was agreed that better triangulation between the work of the Medicines Management Team and other areas eg safeguarding teams was required.

15. Serious Incident (SI) Combined Report

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

The number of SI’s reported in relation to attempted suicides at the George Bryan Centre was queried. KLM agreed to look at all SI’s for the centre over the last six KLM months in order to gain an overall picture.

16. Items for Approval

Managing Safeguarding Allegations Against Staff Policy The policy was APPROVED subject to the following suggested amendment:  Inclusion of safeguarding training under Section 3.1 Prevention.

17. Items for Assurance

Members noted the following reports: Mental Capacity Act Project Implementation Report SSOTP Quality Accounts IFR Annual Activity Report

Outstanding Actions SSOTP SW was thanked for the work undertaken in gaining updates for the outstanding SSOTP actions. It was agreed to close all actions with the exception of:

 Appraisals – the Trust to be asked who undertakes appraisals for locums on long term contracts.  Agency staff data – agreed to be kept open until the first SDIP report in September 2015.  Incidents.  District Nurse staffing issues.

All open actions to be amalgamated with the current Joint Quality Committee action list. 12

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18. Items To Report To Governing Body None identified

Items To Report To Other CCG Committees  None identified

Items for escalation to the Area Team  None identified.

19. Items for the Risk Register and Leads Identified

None identified.

20. Any Other Business

None

Date time of next meeting

Wednesday 8th July 2015, 1.00 pm, Holiday Inn, Burton on Trent

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SOUTH EAST STAFFORDSHIRE & SEISDON PENINSULA CLINICAL COMMISSIONING GROUP FINANCE & PERFORMANCE COMMITTEE Friday 19th June 2015, 10:30am -12:30pm, Boardroom, Merlin House, Tamworth

Present: Anne Heckels Chair Rita Symons (RS) Accountable Officer Martin Flowers (MF) Interim Deputy Chief Finance Officer Chris Bird (CB) Head of Improvement Ian Baines Chief Finance Officer Heather Johnstone Chief Nurse Mark Seaton Interim Chief Operating Officer Jeni Jobson Lay Member Richard Alsop Transformation Director

In attendance: Sherry Samaan Administrator

AGENDA ITEM MINUTES ACTION NO 1 Apologies Mahesh Mistry and Tim Cullinan.

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. JJ declared ‘Acute visiting service and its impact on practices’ as a conflict of interest.

2 Minutes from meeting held on 15th May 2015 The minutes of the meeting held on 15th May 2015 were approved as a true and accurate record with one amendment in page 3, item 4 Diagnostic. ‘HJ noted that EMSA in endoscopy is a known problem’.

3 Action from the meeting held on the 15th May 2015 Action sheet updated as attached.

4 Performance Report AH raised her concern regarding the delay of data for the report of which CB explained that it has been a national issue. It was noted that national issues with the sus data uploads; change in the national tariff and CSU analysis which revealed significant amount of duplicate records in the system have been part of the problem. It is established that data to be received at week six following the end of the period which we are reporting.

Further data will be received by end of next week, data might be robust enough to verify whether CCG hit the A&E 4hrs and RTT targets but not for monitoring 1

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finances which might put us in a significant risk.

It was highlighted that as a CCG we are currently facing the challenge of achieving 12 month worth of work in 6 month from receipt of data. RS queried whether we are applying contract penalties on data being delayed and suggested to raise our concern to the Director of Finance at the regional team. IB pointed the importance of defining data requirement received from CSU and its impact on the CCG. CB to discuss with Staffordshire Service Director and feedback to the next meeting. CB

Key points: o There are 10/22 areas of performance below the national standard for April 2015. o This includes two instances of breaches against measures with a zero

tolerance; MRSA & 52+ waiters, these targets will not be achieved in

2015/16. o Ambulance, it was noted that the tabled figures represents the ambulance performance for our CCG. . AH queried if the ambulance service is working towards one set of measures of which CB explained that ambulance service have focused on delivery on contract level and tolerated that not every CCG will

achieve across that.

. CB and HJ updated that Mark Docherty, new ambulance chief nurse has been more open to engagement with CCGs where performance has traditionally struggled. He is currently looking at few pilots which will have an impact on the existing figures. . There is an expectation of extension pilot throughout the year. . MF queried if there is any penalties in relation to the under- CB performance locally and ensure that CSU are acting on that. CB to

investigate and feedback.

Impact of HEFT on CCG performance

o HEFT performance in 2014/15 has had significant ‘drag’ effect on CCG

performance o Third of CCG population goes to GHH/HEFT. o For key measures, CCG performance improves considerably when HEFT data is excluded. o HEFT performance is biggest risk to CCG delivering NHS Constitution

Standards in 2015/16. Analysis demonstrates that without HEFT

achieving standards probability of CCG delivering standards is remote o HEFT has agreed recovery trajectories with Monitor in some key areas as A&E, RTT and diagnostic which will not see national standards achieve until deep into 2015/16. Some of them are already at risk particularly diagnostic. This will have a disproportionate impact on

overall CCG performance.

Victoria Hilpert the incoming deputy CFO will be leading on the HEFT contract. RS reiterated that in terms of capacity and focus we prioritised attendance at the SRG and currently meeting with the clinicians to try and 2

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drive some of the change clinically. RS added that Mathew Cooke, deputy Medical Director at HEFT will be presenting their strategy at the next management team meeting. It was agreed that CB will bring further update to July meeting. CB

52 week wait, Urology patient at HEFT breached 4th April 2015. o Breach was expected following data cleansing activity by HEFT subsequent to implementation of new PAS system in year. CB explained that the breach was a result of technical update issues

on the system i.e. 3 patients did not wait 52 weeks for their

treatment. o It was noted that no more 52 week wait breach affected by data cleansing is expected.

MRSA, reported at Burton but brought in from Community Post Infection Review completed in May 2015 found to be non-avoidable.

Diagnostics, the CCG failed the 99% target. This is a direct consequence of under delivery at HEFT. o HEFT performance for April 2015 recorded 1,103 patients not receiving their diagnostic outcome within 6 weeks; this is a worsening of the position from the latter part of 2014/15. o The mobile endoscopy suite that was due on in May has recently arrived and puts at risk the agreed recovery trajectory to achieve

the standard by September 2015

RS queried about the clinical appropriateness around those diagnostics

and gastroscopy tests at HEFT and suggested to raise the matter with MS Mathew Cooke. It was suggested to relook at other ways of providing this

service that would give elements of direct access if that works to avoid a

referral and save money across the pathway.

Cancer, The CCG has failed to achieve 2/8 cancer targets in April 2015.

Cancer 2 ww (Breast symptoms), CCG performance in April 2015 has

increased from the latter end of 2014/15 but remains well below national

target of 93%. With the exception of Dudley, all other Trust failed to

deliver the 2 week pathway in accordance with the required standard. For

SES&SP CCG, this equated to Burton 3/25 patients, HEFT3/29 patients and

RWH 4/26 patients.

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5 Finance Report

Key points

o The year to date deficit is £5.947m compared with a planned position of £5.780m an adverse variance of £167k. o The variance is driven predominantly by over-performance against Acute

Contracts. This has to be set against the context of lack of reliable

contracting data to support analysis presently and that budgets need to be aligned to contracts. o The over-spend on Community services is in respect of Burton Contract. o It was noted that some of the CCG commissioning budget is sitting in the central reserve, pending allocation to the relevant contract line. MF is currently working on an exercise to finalise the budgets.

o The CCG has QIPP plan that is expected to deliver £7.3m over the course of

the year. o The financial plan agreed by NHS England requires that £6.5m of the £7.3m is delivered in 2015/16 o At this stage we still anticipate delivering the full £6.5m net QIPP savings in 2015/16 and hitting the control total for the year o There is very little reliable contract information available as yet on which

to judge contract performance.

o Management running costs are showing a slight underspend of £73K as at month2. There is an expectation that these will come back to budget once the new structure is recruited to. o Performance against the Better Payment Practice code continues to be below target for non-NHS suppliers

o Despite our deficit, we are able to draw down additional cash to cover

payments to our suppliers o At this early stage of the financial year, we are forecasting that the planned deficit of £18m will be delivered.

It was noted the presented report is very good report in terms of format and content.

Members were concerned regarding the lack of data for activity trends and the t forecast position. RS and IB will raise this with the NHS England regional team director of finance and also with CSU colleagues.

JJB queried the reasons behind having two set of targets within the report, a £7.3m internal target and a £6.5m financial target. RS explained, as a CCG we set ourselves an ambitious plan with the expectation of some slippage.

It was agreed that by end of July (month 4 position), and depending on the trends RS/IB outcomes, a discussion will take place to review our internal target.

Use of reserves, it was noted that the listed items are being held centrally with expectation of commitments against. Both, ‘B’ham X City & Walsall CCGs IATs’ and

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‘CEOV anticipated IAT’ are previous year’s commitments/IATs. Our areas of flexibility are the ‘Non-rec costs of FRP delivery’ currently our only commitment is to KPMG work, Contingency 0.5% a national mandate phased into our position in terms of balancing out some of the QIPP delivery plans and ‘System resilience funding’ which usually spent over winter.

The commissioning reserve will be reviewed towards end of August and allocated IB according to the final contracts agreed with providers. Any flexibility or cost pressure will be advised at that stage.

RS informed members that Vicki Hilbert, currently managing the Mental Health contract in CSU has been appointed as a Deputy CFO. RS raised her concerns around the risk of not being able to manage the QIPP in around complex cases and the over performance. CB to discuss into with Jayne Deaville, Director of Finance and Performance at the Mental health trust. CB to cover through the next QIPP CB report. It was agreed to conclude in future reports a forecast slide to outline key risks. IB

6 Month 2 QIPP report

The purpose of the report is to provide the committee with an update on the progress of CCG QIPP schemes at month 22015/16. CB updated that the report was developed by Tim Cullinan, Senior Programme Manager. TC will be leaving the CCG early July 2015; interim interviews will be taking place next week.

Key points and overview Month 2 data with the exception of Medicine Management was not available at the time of writing therefore the QIPP savings forecast is based on project delivery updates from project leads.

Members were assured that a refined degree of analysis around impact of QIPPs on activity across various contracts at HRG level is in place. This should enable the CCG to monitor delivery more effectively than in previous years. Also, that staff are aware that we are working toward achieving the ‘Internal Target’.

Practice Plan/Realising Effective Referral Management ‘RERM’, it was noted that the variance between the internal plan (-£497, 378) and the finance plan (-£250,364) is about design risk.

Outpatient follow-ups (OPFU), a mixture of design and delivery risk. o Only £250K of the planned QIPP reduction £841K in provider contracts. A potential impact of QIPP plan under deliver by approximately £641K. o It was noted that an original estimation £841K was going to be driven

by bringing CCG 3 major providers more in line with the west midlands

average for their follow-up ratios based on data published by CSU. Looking at more contemporaneous data, it was evident that some of those providers have already moved on in 14/15 and the extent to which they were a drift from regional levels was less than originally anticipated. Also there was some delivery risk around working with

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host commissioners towards redesigning some of those pathways.

Procedures of Non Clinical Value (POLCV), all around design risk. o Monitoring systems not yet adopted by providers. Under deliver of QIPP plan by £820K (-£12,895K gap between estimate and actual plan). In process of agreeing contract compliance measures with CSU. This would flag up any instances where a provider has carried out an

excluded procedure.

o On- going work with three providers to support the implementation of Blutec (a decision making software). Burton by end of Q1, Wolverhampton by end of Q3 and HEFT not agreed as yet. MS updated that Good Hope is looking to use Blutec in isolation to HEFT.

Urgent Care Centres ‘UCC’, under deliver risk of QIPP plan by up to £593K. o Current plans for an SDIP with BHFT are not sufficiently developed/agreed to deliver the in-year QIPP plan. o It was noted that approximately forty four thousands of our patients

go to SRP and SJ minor injury units. Fourteen thousands of which go

with primary care issues, yet still CCG is charged type 3 A&E rates.

o Discussions are currently taking place with Burton to predominately agree a local tariff with us and putting our GPs on the front of MIU effectively. CB & RS had a meeting with Dr Magnus Harrison, Executive Medical Director (BHFT) on 18th June to pursue SDIP further. It was agreed to

have a short term task and finish group to meet after BHFT CQC

inspection and report back with three in-year cashable savings to be released from MIU by end of July. It was noted that significant finance decisions may take place depending on the tactics agreed.

MIU Follow-ups, under deliver of QIPP plan £285,330. o Review of the assumptions and contractual position suggest that this saving was not realistic and no further reduction from MIU follow-ups will be possible. o CB explained that the original QIPP was designed in 13/14 to take 50%

of follow-ups out in 14/15 and the remaining 50% in 15/16. Still there

are some follow-ups that need to happen in MIU or elsewhere. A

report has been submitted to FRG around the issue.

A&E reduction, under deliver of QIPP plan by up to £173K. o Lack of assurance that current plans will deliver the planned savings. o An issue around high number of frequent flyers which is currently managed by practices (part of practice pack information provided by CCG). o CB updated that through the new locality model a dedicated locality manager will be working through with practices toward the matter.

SSSFT Complex Cases, under deliver of QIPP plan by up to £198K. o Working with SSFT contract lead to seek other opportunities to reduce 6

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the contract value in year. o CB and MF had an earlier meeting with VH, Mental Health Contract Manager on 19th June and there is confidence in securing £160K this

year plus a risk share arrangement on the reduction of cost of care

packages. Forecast will be amended accordingly.

Better Care Fund ‘BCF’, under deliver of QIPP plan by approximately £250K.

Lack of clarity/concerns re realisation of any saving.

o RS explained that as part of the ‘BCF’, the CCG invested money

towards the locality authority. In terms of the size of gap and protecting social care, there was set of projects that were agreed to deliver additional savings to our individual FRP, and a share agreement agreed around 50/50 between us and local authority. Those projects have never been driven so there is still some opportunity but at this point and time there is nothing happening. Andy Donald and Andy

Burns are the two senior responsible officers.

JJB queried if there is any services that we might consider decommissioning

particularly in the community service area of which RS updated that it was agreed

at the congress yesterday to decommission hearing aids for people with minor

hearing loss was agreed following North Staffs decision. MS also, noted that there

is currently a review of AQP contracts and continuing work on Staffordshire

prioritization program, looking at expenditures areas.

JJB was assured that the CCG carries out a quality impact assessment on schemes

and a dedicated quality lead is working with individual members of commissioning

transformation team. In addition to a quality impact assessment subgroup to the

quality committee.

AH pointed out the importance of setting target dates for the organisation to

monitor projects/action plan and act on them accordingly. Also, ensuring clarity

and focus on areas where we are most confident in.

7 Acute Visiting Service - Business Case

CB explained that the AVS, is a service that the GP Practices can refer into, where the patient requires a fast track response within 2 hours. The services can be utilised where practices are unable to fulfil this fast response, due to surgery commitments. It was highlighted that patients often phone 999 if their condition cannot be dealt with promptly. This service fast track response.

The AVS scheme was operated during the winter period of 14/15 and contributed towards the creation of capacity in primary care, reduction in A&E attendances and a subsequent reduction in non-elective admissions.

In light of the above, it is proposed to invest £400K into the existing AVS service is to operate all-year-round.

HJ noted that the reduction of A&E attendances may already be identified as a CQUIN for SSOTP and this should be cross – referenced to ensure that there is no duplication of service. 7

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Members approved the Business Case subject to financial review.

8 Any Other Business Non raised

9 Identified Risks and Review of Non-Clinical Risks

o CCG financial position o Availability and standard of performance data o HEFT performance is biggest risk to CCG delivering NHS Constitution Standards in 2015/16 o CCG performance against national measures (for example A&E 4 hour waits) and increased scrutiny of this by NHS England as part of the CCG Assurance Framework process

10 Items to be escalated to the Governing Body CCG financial position and reviewing CCG internal target by end July.

11 Date and Time of Next Meeting Friday 17th July, 10:30am, Board Room, Merlin House, Tamworth

ENC 19 SOUTH EAST STAFFS & SEISDON PENINSULA CLINICAL COMMISSIONING GROUP SEISDON PENINSULA LOCALITY BOARD WEDNESDAY 13TH MAY 2015, 01:00PM – 03:00PM SOUTH STAFFORDSHIRE OFFICES, CODSALL BILL BROWNHILL ROOM

Present: Dr Tim Dukes (TD) Chair – Gravel Hill Surgery Dr Peter Maidment (PM) Bilbrook Medical Centre Dr Angus Jones (AJ) Dale Medical Practice Dr Peter Jones (PJ) Claverley Medical Practice 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 Mark Hopkin (MH) Moss Grove Practice

In attendance: Steve New (SN) Claverley Medical Practice (Practice Manager) Roger Lees (RL) South Staffordshire District Council Ravinder Kalkat (RK) Seisdon Interface Pharmacist Eleanor Wood (EW) Practice Integration Manager Nikki Chapman (NC) Medicine Management Clinical Audit Specialist

AGENDA MINUTES ACTION ITEM NO

1 APOLOGIES Apologies were received from Sue Brookes, Practice Manager from Dale Medical Practice, and Anna Bogle, Minute Taker.

Introductions were undertaken. 2 DECLARATIONS OF INTEREST Agenda item 8, Federation Working in Seisdon Care was declared as a conflict of interest. 3 MINUTES FROM THE MEETING HELD ON 11TH MARCH 2015 The previous minutes were agreed as a true and accurate record.

ACTIONS FROM THE MEETING HELD ON 11TH MARCH 2015 Action sheet updated as attached (Enc 02) 4 PRESCRIPTION ORDERING AUDIT NC explained that one of the actions from the meeting in October 2014 was to carry out an audit to try and identify the most common cause of over ordering of medication in the Seisdon Locality. The audit targeted at all areas of ordering, covering community pharmacies, patients and other parties.

Three approaches were undertaken to carry out the audit. Practice 1 – 5 individual days of repeat prescription ordering slips randomly selected from the previous 28 days. Practice 2 – All prescription ordering slips from the previous 5 days Practice 3 – Repeat prescription slips previously filed identifying the source of ordering i.e. chemist, patient and internet. This did not represent a full 5 days

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of prescription requests.

The initial criteria was to review patient’s notes from repeat slips showing they had ordered everything. If the patient had regularly ordered all items on the prescription; that would trigger a call to the patient to ask them how they order their medication and whether they had excess stocks of any medicines

in their home. After reviewing a number of prescription request slips it was

evident that not many patients had ordered ALL medication at one time and if they had it was for tablets, which would need to be ordered regularly. Most prescriptions were not synchronised and so items were being ordered at different times of the month.

NC started to look at prescription requests for inhalers, creams, sip feeds or other ‘when required’ medication and reviewing them to establish whether the patient was ordering them every month and if quantities looked excessive. This then triggered a call to the patient. This approach was more targeted and productive in finding patients who were likely to have excess

stock at home. The telephone conversation with the patient was impartial

and non-accusatory in establishing how they order their prescriptions, who orders them and if they had any excess stock in their home.

In Practice 1 NC attempted to contact all patients identified as potentially over ordering by phone, unfortunately there was not a massive amount of success and only three patients were reached.

Within the second practice NC liaised with the prescription clerks and patients regarding information on issues raised and what to look out for. The clerks suggested it would be useful to have information on how long prescriptions should last for. From liaising with a couple of pharmacies; process issues were identified and these are being addressed.

In practice three some issues had already been identified with prescriptions and in effect NC investigated the existing issues. NC spoke with mainly with the practice staff regarding the issues and what to look out for.

From the practice visits, thirteen issues with prescriptions in total were easily identified. Seven out of the thirteen patients reported that they received medication without being asked what they needed by the pharmacy. Two patients called the chemist to order their prescription, two patients ordered directly from the GP practice and two patients said the chemist called them to ask what items they required that month.

The issues that were identified from the audits were the following:

 Over prescribing. The quantities of drugs being prescribed on one prescription could be reduced with certain patients, which would reduce waste.  The pharmacy should not be ordering medication for patients without

checking what the patient needs prior to ordering the prescription for

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them. The LPC has been informed and have visited all the pharmacies in the Seisdon area.  A waste campaign is starting this year as part of the LIS, which will be a big

public campaign about patients over ordering. As part of the LIS there will

be a training session with the Medicines Optimisation Team for prescription clerks in practices to highlight some of the issues relating to waste medicines. Local pharmacy technicians will also be invited to attend to promote dialogue between the professions.

Members were informed awareness of the issues have been raised within the locality. It was noted the audit was useful as it move towards resolving the issue and has also promoted the purpose of the waste campaign.

Members were informed NC will be liaising with the LPC this afternoon, who are on board with the waste campaign. The LPC will be displaying posters in their pharmacies.

Concerns were raised with the percentage of pharmacies ordering medication for patients. Members were informed for EPS there is a contractual obligation for each pharmacy to check with patients that the item is needed.

RL asked if he was able to feedback the figures from the audit to the local MP. NC said she was happy for the data to be shared.

Action: RL to share the figures from the prescription ordering audit with the local RL MP.

It was explained that as part of the waste campaign all Heads of Medicines Optimisation in the South Staffordshire area will be writing a letter to all MPs in the localities too.

It was noted that the report was a useful piece of work and if further issue arise they will be fedback directly to NC. NC was thanked for attending the meeting. 5 MATTERS ARISING

SOFT INTELLIGENCE EW presented the Soft Intelligence report on behalf of Katie Montgomery, Clinical Quality Improvement Manager. Members were informed there had been an increase in the number of reports and members were encouraged to

continue reporting. It was explained feedback is being received from both

patients and GPs. Responses have been similar, raising issues around waiting times, access and discharge. Within the South East Staffs Locality there have been issues around discharge summaries not being received on time and the information provided being vague. Members were asked for their opinion on the situation is in the Seisdon area, in terms of discharge summaries and if support is required via CQRMs.

Members fedback the following:

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 Information is poor on A&E discharge summaries from New Cross Hospital. - Unclear on the tests and treatment provided. - If a follow up is planned, the information should state what has been

arranged.

- No confirmation in writing is provided.  Positive feedback was received in terms of ward discharges from New Cross Hospital.  Ward discharge summaries from Dudley are ad hoc and nothing is received from their A&E. Batches of summaries are being received from paediatric

A&E months later.

It was noted that there have been many compliments from patients and

members were encouraged to feedback positive outcomes too.

Action: EW to raise the issue regarding lack of discharge summaries from EW adult A&E at Russell Hall to KM.

OPEN ACCESS TO EPAU The issue raised regarding open access to EPAU (Early Pregnancy Assessment Unit) at New Cross Hospital had been incorporated into the soft intelligence report under ‘We said, you did’. With Mid Staffs Hospital being downgraded, numerous patients from Cannock are now attending New Cross Hospital as a result. EL raised concerns regarding the capacity with EPAU at New Cross

Hospital. There are also issues around the delay in being able to speak to a

Registrar about suspected ectopic pregnancy and the patient being seen. It was noted that if a GP is reporting an ectopic pregnancy the patient should not be waiting and should be seen straight away as it is a matter of life or death.

It was also reported that a referral to EPAU had not been accepted by a qualified Midwife. The GP instead had to make the appointment with the Registrar with the information passed on from the Midwife.

It was noted that the delay with the Registrar taking the call would be

reported to KM, along with asking the question what is the benefit of adding

speaking to a Registrar to the process. In regards to the wider issue with capacity at New Cross Hospital, members were encouraged to continue to monitor the situation and to raise further issues via SPA, in order to gather the evidence. TD Action: TD to inform KM of the concerns around delays in Registrars taking calls regarding ectopic pregnancies and to question what is the benefit of having a registrar is in the process. 6 FINANCE UPDATE An overview of the financial position was explained to members, noting that although the control total of £16.7m deficit has been achieved, there is still a need for on-going work to accomplish further savings for 2015/16. The focus is to get back into a recurrent balance position by 2017/18. Members were informed that when 4 | P a g e

the CCG was first set up it was done so with a deficit straight from the start. This was combined with the CCG being underfunded for its geographical area. The debt is mirrored around most CCGs in South Staffordshire. Although the situation in North Staffordshire is not as bad, they too are not entirely in a comfortable position and Staffordshire wide there is a huge problem. It was explained that the CCGs as a group are in discussions with Dr Paul Watson, Regional Director for NHS England. Joint working across CCGs has been suggested for a Staffordshire wide solution. The danger for the Seisdon Peninsula area is that a Staffordshire wide solution may not be relevant due to Seisdon’s traditional commissioning geography. It was noted that as a locality members need to protect their patient’s interests.

The 2015/16 plan has not been signed off yet and neither has the medium term financial strategy, however, this is due to be completed shortly. The financial position is expected to deteriorate in 2015/16 before it starts to improve.

It was explained the next Governing Body meeting will take place on 27th May 2015 and a detailed financial report will be populated to be then circulated for the next Seisdon Locality meeting in June.

7 LOCALITY STRUCTURE CCG The CCG is planning to restructure the internal Management Team and bring in external support for the development of the new models of care.

The management of change means restructuring the organisation, which is mainly around increasing capacity. The main area being focused upon is Primary Care and the support being provided to the localities and practices. From the practice visits it has been identified that the CCG was not responding quick enough to ideas and the implementation of actions due to capacity. Due to the financial position, transformation transition is required and to do this more capacity is necessary.

The locality model was explained, noting that there will be a Locality Manager for each of the three localities. Underneath this will be a support structure and will include prescribing pharmacist and medicines management support. Two Support Managers will be part of this model, meaning there will be a team working with the Clinical Directors, alongside working directly with practices.

The senior positions within the organisation have differed with Anna Hammond, Chief Operating Officer, leaving. This role has now been split into two separate positions.

Three elements to the organisation were explained as the following:

 Strategic element  Primary Care element - The posts within this element need to be thought through carefully.  Information and performance element

It was noted the changes will mean having a Seisdon Locality Team again, which TD stated was a positive approach for the locality.

Members were informed the restructure is out to consultation until the 18th May

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2015. 8 SEISDON CARE – FEDERATION WORKING – UPDATE AND NEXT STEPS Three weeks ago six out of the nine practices met at the Dale Medical Practice and practices agreed that there was a need to move forward with federated working around three strands, which included seven day working, integrated nursing teams into the practice teams and around the delivery of services within Primary Care that are currently provided in Secondary Care. The three approaches taken together aim towards transformational change rather than transactional change. Within the meeting TD noted it would be an appropriate time to work with the CCG to develop the ideas that members signed up to but that support was needed for this. The CCG has taken this on board. There has been a tendering process for external support to develop new models of care. KPMG will be the new external support and will be in place for the next eight weeks. TD is due to meet with KPMG next week and will request a workshop for all GPs and Practice Managers to liaise with a member from KPMG.

Action: TD to organise a workshop with all GPs, Practice Managers and KPMG. TD

The CCG recognised that with the size of the financial problem it will not be resolved by transactional changes and there is a need for transformational change. It has been agreed support is required to launch ideas.

Members were asked how they would like to take the following work forward:

 Transformation change  Getting practices working together  Changes to I.T processes  Data sharing

The following was fedback:

 Quick wins - seven day working – flesh out what seven day working will look like  Focus on practical approach to move forward with  Concerns were raised that seven days working is not a quick fix, due to lack of resources  Key part will be data sharing and making sure systems are compatible  Members to tell the KPMG what needs to be focused on  KPMG to provide ideas too  Develop pathways specific to Seisdon to better utilise MoM

9 ITEMS FOR INCLUSION ON THE RISK REGISTER No risks were identified. 10 ANY OTHER BUSINESS

RENAL SERVICE AT NEW CROSS HOSPITAL The Renal Service at New Cross Hospital will be transferred into a Clinical Assessment Service. A Choose and Book referral will be reviewed by a Consultant. An outpatient appointment will then be offered or tests will be organised before the 6 | P a g e

patient is seen. The process, which has been agreed between Wolverhampton CCG and New Cross Hospital, is the same as currently offered for GI referrals and is due to start in the next few weeks.

AGENDA - PLT EVENT DATE Members were informed that the next date of the PLT event is 20th May not the 29th May as stated on the agenda.

SITE ALLOCATIONS Members were informed site allocations are being offered and members were asked if they knew of any areas in their patch that might need new medical facilities. Feedback was requested asap from Practices who had not already replied.

DEVELOPMENTS Members were informed large developments are occurring in Gospel End with nearly 200 houses being built and it was explained the area is within the Wombourne catchment area. 11 CONFIDENTIAL – INTERMEDIATE CARE COMMUNITY NURSING RL left the meeting once the confidential item began.

MINUTES FROM THE MEETING HELD ON 11TH MARCH 2015 The previous minutes were agreed as a true and accurate record.

CONFIDENTIAL ACTIONS FROM THE MEETING HELD ON 11TH MARCH 2015 Action sheet updated as attached (Enc 03) DATE, TIME AND VENUE OF NEXT MEETING:

The next Seisdon Peninsula Locality meeting has been changed to Wednesday 1st July, 1pm-2pm, South Staffordshire County Council, Codsall. (Lunch available from 12:30pm)

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Enc 20 SOUTH EAST STAFFORDSHIRE & SEISDON PENINSULA CLINICAL COMMISSIONING GROUP LICHFIELD/ BURNTWOOD LOCALITY MEETING THURSDAY 11TH JUNE 2015, 1:00-3:00PM BURNTWOOD AND WELLBEING HEALTH CENTRE

Present: Dr Ward (Chair) Fulfen Practice (Dr Wharton & Partners) Dr Zakai Ahmad Claire Hutchins Burntwood and Health Wellbeing Centre Dr Huisman Spires Practice Julie Wigley, Deputy Manager Salters meadow Craig Dorrington, Practice Manager Cloisters Dr Yiu-Chung Cheung Westgate

In attendance: Andy Hadley Practice Support Manager Eleanor Wood Practice Integration Manager Yvonne Wood Operations Manager Phil Livingstone Management Consulting - KPMG Dr Steve Laitner GP – KPMG Frances Gallagher KPMG Verena Stocker KPMG Richard Alsop Director of Transformation at CCG AGENDA MINUTES ACTION ITEM NO

1 APOLOGIES & INTRODUCTIONS Apologies were received from Dr Kaul, Cloisters Practice and Peter Gregory, Salters Meadow Practice.

Introductions were undertaken. 2 CONFLICTS OF INTEREST No conflicts of interest were noted in the meeting.

The meeting was agreed as quorate. 3 SUMMARY OF PREVIOUS MEETING A discussion paper on integration was circulated and summarised to members. It was reiterated that KPMG have been employed to support Lichfield/Burntwood practices with identifying practices priorities and helping to implement them. The locality can use KPMGs expertise and experience from supporting different regions around the country.

The following priorities previously identified for Primary Care were:

 Recruitment and retention  Use of and development of better skill mix – Physician Assistant/pharmacy support etc

 Patient flow and demand – understanding high users of primary care

services.

A number of potential projects were summarised from the priorities

discussed. Further areas identified on the CCGs agenda and in other localities were listed as the following:

 AQP anti coag service  Microsuction AQP with pathway  Telecardiology with ABPM machines and ECG monitoring devices  Enhanced Gynaecology diagnostics

4 DEVELOPMENT OF INTEGRATED CARE OPTIONS

Members were asked what the main issues to solve are within the locality.

The following issues were noted:

Recruitment and retention

 More GPs, clinical staff and nurses practitioners are required  Problems being caused by recruitment – unable to deal with patient demand and long waiting times to see a GP  Retiring GPs and the implications  The need to make general practice more attractive and more financially viable  Difficulties getting responses to applications when advertising roles - New staff desire salaried roles, the ability to move and a better work/life balance  Pressure on GPs due to capacity  Skill mix - recruiting to other roles, i.e. physician assistants and difficulties recruiting nurse practitioners  Knowing what the role of the pharmacists would involve

Demand

 Consider how to control the workload – possibly increase in resource or a shift in resource  Plan for seven day working  Capacity sharing across practices  Managerial demands  Sharing back office functions/managerial functions to reduce costs  Manage demand in Primary Care by looking at frequent flyers  Consider how GPs can be involved in providing care that has historically been undertaken by community trust organisations – this is an opportunity to make additional income

Redesigning the Minor Illness Unit (MIU)

Weaknesses  Distorts the urgent care system

 Costs the CCG a large amount of money  GP involvement is not that effective

Strengths  Favoured by patients  Confidence in the staff  Good resource in different ways

GPs involvement in the MIU was queried. The following was fedback:

 GPs review patients because nurses are not trained to review  Dealing with patients with general medical illnesses, which could be addressed in general practice  The work is similar to cases seen in A&E

It was noted that the MIU seems to drain money out the system and the work flow could possibly be dealt via primary care. It was queried what members would envision if MIU did not exist. The following was fedback:

 A Primary Care alternative, maybe something like the Corby model. However, the localities requirements would need to be identified first.  The localities requirements may entail a better case mix and access to better diagnostic, alongside promptly supporting patients.  There is value having GPs in MIU but it needs to be more effective.  MIU deals with potential overflow that could go to A&E/primary care – where there are issues with capacity

The following questions were asked to members:

 Can Primary Care offer something to the delivery of MIU service that is as good quality and cost effective?  Could the MIU be used to support the delivery of seven day working, case management and acute visiting service?  Could MIU be integrated into general practice?

The following was fedback from members:

 Follow ups could be seen in general practice, which would be more cost effective.  There would be a need to invest within general practices to cope with the demand of minor illness cases.  Minor injuries nurses would still need to be employed to undertake minor injury cases.  Practices could work more collaboratively, in order to support extended hours.  Potential to create a centralised hub with skeleton staff, which might be

more cost effective.  The location of the MIU was agreed as in a good location  MIU offers X rays, which is a benefit.

Primary Acute Care System (PAC) It was queried how the Primary Acute Care System (PAC) could fit into the model? It was explained that PAC would not be separate and that normally a Foundation Trust would leads the delivery of integrated care. Partners from Primary Care and Community Care would be brought in. The Hospital Trust would then lead on it. The PAC system on the Isle of Wight was explained to members. It was noted that the Trust is fully integrated with community providers, Mental Health and Ambulance services, within a federated Primary Care model. The head of the federated model sits on the board with the Chief Executive of the Trust and the Accountable Officer of the CCG. The Primary Care System is split into three localities.

It was noted the geography of the South East Staffs and Seisdon Peninsula CCG would struggle to commit to a similar model.

It was suggested not to consider working as a PAC but to consider working in a way that resembles a PAC for Primary Care in regards to being more collaborative. This would be in terms of having a group of practices with one person that represents all members’ views when considering discussions within the wider system. It was explained practices do not need to be legally federated to move forward with such an approach. It was suggested using a virtual approach across the localities to improved communication and strengthen the support within the organisation.

It was queried if federated working could be brought under Co Commissioning. It was explained it could potentially be possible as practices will technically be responsible for their primary care contracts, which means there would be the influence to describe what practices want in the primary care contract.

Case Management

Members were asked what the strengths, weaknesses, opportunities and threats are in terms of case management when considering care homes, high intense users and frail elderly people that require a MDT approach. The following was fedback:

Strengths

 Case management approach allows professionals to work together using different resources to provide the correct support  Delivering integrated case management to frail elderly people means patients will receive better care, which prevent admissions and reduces

costs  When all professional are present a robust care plan is completed, with set actions

Weaknesses  A ten minute consultation with a GP is not enough time to support the patient’s entire needs and requirements.  Capacity issues with supporting large numbers of patients that probably require case management support  Resources being consumed by patients spending weeks in hospital  Difficult to deliver sufficient care with the population size of the locality with the income the CCG receives  Shortage of Community Matrons and District Nurses

Opportunity

 Find alternative ways to spend the money and deliver the appropriate care  Reduce admissions by prevention and avoid spends in A&E  GPs require head room in order to be proactive. Time and money may be required to support this  GPs can be involved but Primary Care does not need to lead as other multi skilled teams can provide this support, or individual GPs with a certain interest could lead  Social workers could ideally lead – although their capacity also needs to be considered  Working with the volunteer sector – joint sector could support practices with case management on the practices behalf  An alternative provider could lead on proactive case management care and pull in general practice if required, meaning others would manage more of the complexity for high users and in a proactive way to reduce demand on Primary Care  Have an overarching case management service  Potential of Lichfield gaining from having a Care Coordinator – positive feedback in Tamworth has been received from having a care coordinator  Potentially arrange a meeting with all practice who are investing money, in order to learn from one another  To deliver the work required it was noted the technology has yet to be benefited from, however this is due to be implemented soon

Threat  Time is stretched in trying to complete additional tasks within a day i.e. liaise with other professionals, completed care plans (threatening the current sustainability of the current structure and the future of the structure)

5 SYSTEM ENGAGEMENT Members were asked what they thought was meant by Primary Care sustainability. The following was fedback:

 The existence of practices in three years’ time

 Practice having sufficient staffing

 The way services are accessed by patients  Education of patients  The criteria for how home visits are requested need to be articulated  Expectations patients have of their GP

 Burn out – is the job getting too difficult for GP to want to do it any more

 The need to make general practice more attractive

It was queried how Primary Care may be delivered differently to tackle the issues above. The following was fedback:

 Back office functions and sharing staff across practices, consider the difficulties in practically implementing sharing staff  Share the same job roles to improve efficiency and provide security

 Tick box exercises need to change

 Stop constant changes and destabilising what is currently in place  If Co Commissioning brings general practice together and supports it then more GPs might be interested in being involved.

Primary Care organisations bringing practices together was enquired about. PL said he would investigate the success of these organisations.

Actions:

 PL to feedback to JW information on how the following organisations PL

work: New Zealand Primary Care, Vitality and the Hurley Group.

 JW to present the information to members in a future JW Lichfield/Burntwood Locality meeting.

It was queried in relation to back office functions what other staff would be beneficial. The following positions were noted:

 Health and Safety advisor to provide risk assessments  Someone who could organise policies, training and managerial training

It was questioned how core primary care could be delivered differently to assist with demand and capacity. The following was noted:

 Use a call centre to support demand  Use phone triage  Pull resources from each other’s practices

 Skill mixing

It was noted the CCG needs to provide support to practices with the delivery of alternative models. The outcomes should aim to include same day access, good continuity and an improved integrated model, which is cost effective for the MIU. Alongside an effective multi-disciplinary proactive case management model that allows reduced unscheduled admissions and A&E attendances.

Members were informed the Hurley Group website educates patients before they make an appointment. It was noted not all patients would benefit from this approach. It was explained triage could be an alternative to educating patients. It was noted that triage has caused burn out for the GPs when attempted in the past, however, was popular with the patients. It was suggested that in order to support a new model there will be a need to increase capacity to manage change. 6 FOLLOW UP 1-1 SUPPORT The next steps were discussed, noting that KPMG are available until the first week in July to provide 1-1 meetings with individual GPs or practices as a whole, alongside members not present at today’s meeting. These meetings would be to gain more insight into the detail of what GPs want and build on ideas.

Action: PL to arrange further meetings with practices and Langton Practice in PL particular as not present in todays meeting.

It was queried if a document could be produced to capture what had been discussed. PL noted that he would produce a piece of work that collates member’s feedback from the meeting.

Action: PL to produce a document that captures member’s feedback from within PL the meeting to be distributed to practices within the Lichfield/Burntwood locality.

It was suggested to investigate three main areas to focus on and identify key people to take the lead on brainstorming, in order to build upon for future discussions within another meeting. It was agreed a straw man structure needs to be built upon. Once this has been drawn up, the next step is to arrange a member engagement meeting with all GPs across the localities. It was suggested sharing the work out between the Clinical Directors. It was noted Dr Kaul could lead on MIU and Dr Geeranavar could lead on Frail Elderly.

Actions:

 PL to liaise with Dr Kaul and Dr Geeranavar to discuss their involvement in PL leading on MIU and Frail Elderly elements.  JW to arrange for Dr Kaul and Dr Geeranavar to meet before the next PL

meeting.

The different elements involved in the system and the cost behind them was

queried. It was noted there needs to be clarity on what costs there are and where

they are spent. It was agreed knowing the budget for each element would be

beneficial.

RA Action: RA to investigate the breakdown of the budgets for the elements

discussed.

When considering the impact of admissions, it was queried if there is data within the 7

CCG to bench mark areas. It was noted that members need to consider the data that they want.

Action: Members to feedback on what data is required to reduce admissions. All members It was queried if the volunteer sector is to be utilised, which agencies would be useful and how can contact be made. It was advised a further brainstorming session would be required to answer these questions.

Action: JW to arrange a future meeting with members to discuss which volunteer JW sectors would be useful in the delivery of integrated services.

Members were asked to consider over the next couple of weeks what they think is needed from a clinical and practice managers point of view.

It was requested that the outcomes from other localities KPMG meetings be fedback to the Lichfield/Burntwood locality. It was noted that members would be kept informed.

Action: JW to update members on outcomes from Seisdon and Tamworth Locality JW KPMG meetings. 7 WIDER CCG SUPPORT Members were asked if wider CCG support was required. Members were informed there are no doors closed to anything in terms of initiative ways of doing things differently, reorganise services and reducing costs. It was noted that the CCG need to be clear to the membership what the meetings are in

relation to and why, in order to move forward in organising a boarder

engagement piece of work. The engagement work needs dedicate time to it, in order for everyone to communicate effectively with a solid understanding of what is being discussed. It was suggested that a PLT event could support the approach. 9 ANY OTHER BUSINESS No other business was raised. DATE AND TIME OF NEXT MEETINGS:

Lichfield/Burntwood Locality Meeting Thursday 13th August 2015, Burntwood and Wellbeing Health Centre, 1:00pm- 3:00pm, Lunch available from 12:30pm.

PLT Event – Prescribing Tuesday 21st July, Swinfen Hall, 1:30pm – 5:15pm

Enc 21 SOUTH EAST STAFFORDSHIRE & SEISDON PENINSULA CLINICAL COMMISSIONING GROUP TAMWORTH LOCALITY MEETING 9TH JUNE 2015, 12:30– 14:00 MERLIN HOUSE, ETCHELL ROAD, BITTERSCOTE,TAMWORTH, B78 3HF

Present: Dr Khare STONYDELPH HEALTH CENTRE Dr Jones PEEL PRACTICE Dr Singu TRI LINKS Dr King ALDERGATE Dr Joshi CROWN MEDICAL Dr Parkes HOLLIES Dr Mahanta ANCHOR MEDICAL Dr Yunas HEATHVIEW Dr Ijaola RIVERSIDE SURGERY MEDICAL Dr John WILNECOTE & STONYDELPH SURGERY Dr Rajput STONYDELPH HEALTH CENTRE

In Andy Hadley (AH) Practice Support Manager attendance: Eleanor Wood (EW) Practice Integration Manager Yvonne Wood (YW) Operations Manager Martin Flowers (MF) Deputy Chief Finance Officer, Interim Anna Bogle (AB) Minute Taker Liz Anderson (LA) Administrator (Interim) AGENDA MINUTES ACTION ITEM NO

1 APOLOGIES Apologies were received from Laurel House Surgery.

2 INTRODUCTIONS MF, Interim Deputy Chief Finance Officer, introduced himself to members.

3 CONFLICTS OF INTEREST No conflicts of interests were noted within the meeting.

4 MINUTES & ACTIONS OF MEETING HELD ON 12TH MAY 2015 The previous minutes were agreed as a true and accurate record subject to the following amendment on page 3: Under agenda item 7, Soft Intelligence, it was requested that the name of the practice be removed from the previous minutes.

Action: AB to remove the name of the practice from the previous minutes. AB

ACTIONS Action sheet updated as attached (Enc 02) 5 FINANCE UPDATE A paper was circulated within the meeting, titled 2015/16 financial plan v 2014/15 forecast.

MF explained that the paper portrayed the financial position, noting that the information is extracted from the financial plans, which have been submitted to the Governing Body and NHS England.

It was explained that at the end of 2014/15 there was a deficit of £16.7m. The target had been agreed part way through the financial year and was successfully achieved at £16.687m. It was noted that the in year position was £12.2m, with a deficit of £4.4m relating to 2013/14.

The financial plan for 2015/16 is an in year deficit of £18m, which means that the accumulated deficit will be almost £35m by the end of 2015/16.

The £4m deficit reported in 2013/14 was not a realistic perspective of the financial position and in effect money was borrowed from non-recurrent means to achieve the £4m. The underlying position was more like £11m. It was noted this should have been taken into account for planning into 2014/15 but unfortunately in the last nine months it is evident this was not included in the plan.

There is now a plan that is split between what is recurrent and non-recurrent, which will be rolled into 2015/16. In 2015/16 there will be an in year deficit of £18m. The underlying improvement will go from £13m down to £11m. The current position has been improved by £2m. However, there is a large non recurrent deficit, which needs to be repaid from previous years. The CCGs main aim is to get into recurrent balance.

It was queried where the money had been borrowed from in 2013/14. It was noted that money had been borrowed from the Heart of England Trust, South Staffordshire & Shropshire Health Care Trust (SSSFT) and from other CCGs too.

It was asked how much was still owed to HEFT and SSSFT. It was noted currently nothing is owned to HEFT and £2m is outstanding to SSSFT.

It was enquired if the CCG will be under special measures in 2016. It was explained that with the current plans to get the recurring position down special measures should not be necessary.

It was queried why SES&SP CCG is in debt. It was noted there are numerous contributing factors. It was explained that there was debt inherited from the PCT and the CCG is under target for the allocation. There are issues for what is being spent on the population, however, this is being reviewed. It was noted a more detailed investigation needs to be undertaken to fully understand all the reasons behind the debt. One issue that has been identified is the management of contracts. The CCG will be addressing all the issues in the forthcoming months.

It was queried how far the CCG is from their target allocation. MF noted he 2

would have to feedback on the exact figure.

Action: MF to feedback to members the exact figure for the distance from MF target.

Concerns were raised with the contracting process not supporting transformational change and around the fair shares capitation basis being addressed. The turnaround of staff in SSOTP was also addressed as an issue. It was noted that introducing contractual levers could address the issues raised and that there are processes for challenging, which have recently been implemented.

Concerns were raised with the overall system being unable to deliver what is required. It was noted queries around coding and contracts have been questioned on several occasions, with no progress being made. It was agreed that contract management needs improving and this is being addressed.

It was noted the lead commissioning role has destroyed the culture of commissioning.

It was queried whether the £16.7m deficit had been achieved via further borrowing. It was noted that half way through the year it was realised that the target was not going to be met for 2014/15 and the CCG did have to borrow again to ensure the target was hit. It was queried how much was borrowed. It was explained that £5.5m was borrowed.

It was noted that a financial update will be arranged within the locality meeting every three to four months. MF stated he would be happy to provide further updates.

Action: MF to attend a future Tamworth Locality meeting to provide a MF financial update.

6 KPMG Members were informed KPMG will be attending the next Tamworth Locality meeting, due to be held on Tuesday 30th June 2015, from 1pm– 3pm. The discussion will focus on practices needs in Tamworth. It was explained KPMG are external support that will assist practices with transformational change. It was noted two out of the three members of KPMG are practicing GPs and the third member is part of the management. Members were advised that senior colleagues are also welcome to join the meeting and were advised to inform AH if additional people will be attending.

Action: Members to inform AH if senior members of staff are intending to All attend the Tamworth Locality meeting, due to be held on Tuesday 30th June members 2015.

Members were asked how their practices could benefit from 3

transformational change and what they would like to discuss with KPMG in the next meeting. Feedback from practices visits so far has focused on the following areas:

 Patient access needs improving possibly via seven day working  Looking at how seven day working will work

 Recruitment of GPs and backroom staff

 Having a local GP campaigns  Finding ways to share the work/practices working together  Local issues with SSOTP

A discussion was undertaken around the KPMG agenda. It was explained that KPMG have been employed as external support to assist practices with implementing improvements within general practice. The support is also looking to respond to the five year plan and how as a membership organisation practices can move forward to remain sustainable. It was explained that outside money has been given to the CCG to employ KPMG for the sole reason of supporting practices with transformational change.

It was suggested that if seven day working is due to commence there should be a CCG pot that will pay for seven day working and be managed by the CCG. It was explained this could support practices in the future. It was suggested this could be an item to discuss with KPMG.

It was stated that KPMG could be of value when considering where the gaps are and in using their knowledge from their experiences of working around the country.

Members were advised to email Dr Singu or AH with any items for the agenda to be including in the KPMG meeting.

Action: Members to email Dr Singu or AH with items to be added to the All th agenda for the meeting with KPMG, due to be held on Tuesday 30 June members 2015.

Members were informed there is no Tamworth Locality meeting in July, however, if members wish, arrangements can be made for individuals practices to meet with KPMG in July. All Action: Members to feedback to Dr Singu if they would like to arrange members individual meetings with KPMG in July. 7 AOB Financial update Members asked for clarification on whether either NHS England or the CCG incurred a charge for employing the Turnaround Director.

It was queried where the £5.5m was borrowed from to reach the deficit of 4

£16.7m, who made the decision to borrow the money and if the Area Team was aware of this.

Action: Dr Singu to feedback more in the future once a further financial Dr Singu update is provided.

DATE AND TIME OF NEXT MEETING: Tuesday 30th June, Merlin House, Tamworth, 1:00pm -3:00pm

PLT Event Tuesday 21st July, Swinfen Hall, 1:30pm – 5:15pm