DUDLEY CLINICAL COMMISSIONING GROUP BOARD AGENDA
Thursday 13 November 2014 1.00pm – 4.00pm Boardroom, Brierley Hill Health & Social Care Centre, Venture Way, DY5 1RU
QUORACY Meetings will be quorate when four elected GP clinical members and one other Board member are present, (one of whom shall be the CCG Chair, Chief Officer or Chief Finance Officer)
Time Agenda Item Attachment Presented By 1pm 1. Apologies
1pm 2. Declarations of Interest To request members to disclose any interest they have, direct or indirect, in any items to be considered during the course of the meeting and to note that those members declaring an interest would not be allowed to take part in the consideration for discussion or vote on any questions relating to that item.
1pm 3. Minutes from 11 September 2014 meeting Enclosed Dr D Hegarty
1pm 4. Matters Outstanding Enclosed Dr D Hegarty 5. Public Voice
1.05pm 5.1 Questions from the Public; To respond to questions from members of the public present at the meeting on the provision of health care to the population served by the CCG. Verbal Dr D Hegarty 1.15pm 5.2 Feet on the Street: Discharges Presentation Dr D Hegarty 1.25pm 5.3 Public Update Enclosed Mrs L Broster
1.35pm 6. Chairman’s & Chief Executive Officer Report Verbal Mr P Maubach 7. Strategy
1.45pm 7.1 Health & Wellbeing Board Report Enclosed Mr N Bucktin
8. Quality & Safety
1.55pm 8.1 Report from Quality and Safety Committee Enclosed Dr R Edwards
9. Commissioning
2.05pm 9.1 Report from Clinical Development Committee Enclosed Dr S Mann 2.15pm 9.2 NHS 111 West Midlands Procurement Enclosed Dr S Mann
2.25pm ** BREAK **
10. Communications & Engagement
2.40pm 10.1 Report from Communications & Engagement Committee Enclosed Mrs L Broster
11. Governance
2.50pm 11.1 Report from Audit Committee Enclosed Mrs J Jasper 3.00pm 11.2 Combined Board Assurance Framework and Risk Register Enclosed Mrs J Jasper 3.10pm 11.3 CCG Constitution Enclosed Mr S Wellings 3.20pm 11.4 CCG Structures Enclosed Mr P Maubach
12. Finance and Performance
3.30pm 12.1 Report from Finance & Performance Committee Enclosed Dr J Rathore
13. Primary Care
3.40pm 13.1 Report from Primary Care Development Committee Enclosed Dr J Rathore
Close 14. For Information
14.1 Glossary Enclosed
Time and Date of Next Meeting
Thursday 8 January 2015 1pm – 4pm, Boardroom, BHHSCC
DUDLEY CLINICAL COMMISSIONING GROUP BOARD PUBLIC MINUTES
MINUTES OF THE MEETING HELD IN PUBLIC ON THURSDAY 11 SEPTEMBER 2014 AT 1.00 PM, BOARDROOM BRIERLEY HILL HEALTH AND SOCIAL CARE CENTRE
ATTENDEES:
Mr S Wellings Lay Member for Governance (Chair) Miss R Bartholomew Chief Quality & Nursing Officer Dr J Darby GP Board Member (Halesowen & Quarry Bank) Dr K Dawes GP Board Member (Sedgley, Coseley & Gornal) Dr R Edwards GP Board Member (Kingswinford, Amblecote and Brierley Hill) Ms J Emery Chief Officer - Health Watch Dr C Handy Lay Member for Quality & Safety Mr M Hartland Chief Finance Officer Dr D Hegarty Chair Ms V Little Director of Public Health Dr M Mahfouz GP Board Member (Dudley & Netherton) Dr S Mann Clinical Executive – Acute & Community Commissioning Mr P Maubach Chief Accountable Officer Mr J Polychronakis Chief Executive Officer - Dudley MBC Dr J Rathore Clinical Executive – Finance & Performance Dr R Tapparo GP Board Member (Kingswinford, Amblecote & Brierley Hill)
IN ATTENDANCE:
Mrs L Broster Head of Communication and Engagement Mr N Bucktin Head of Commissioning Mrs S Cartwright OD Practitioner Dr R Gee GP Engagement Lead Ms S Johnson Deputy Chief Finance Officer Mrs E Smith Minute taker
CCG97/2014 APOLOGIES
Apologies were received from Dr Gupta, Dr Johnson, Dr Heber, Mrs Jasper, Dr Horsburgh & Mr King
CCG98/2014 DECLARATIONS OF INTEREST
Members were asked to disclose any interest they may have, direct or indirect, in any of the items to be considered during the course of the meeting and to note that those Members declaring an interest would not be allowed to take part in the consideration or discussion or vote on any questions relating to that item.
Agenda Item 11 – Election of Board Member All GPs declared an interest in this item
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CCG99/2014 MINUTES FROM 10 JULY 2014
Mr Maubach asked that on page 8 the reference to Assisted Conception needed to be re-worded to confirm that the specification “will be subject to consultation and the CCG will be contacting the Overview & Scrutiny Committee to discuss how this will take place.”
The minutes of the meeting held on 10 July 2014 were accepted as a true and accurate record pending the above amendment.
Resolved: 1) The Board accepted the minutes from the 10 July 2014 as an accurate record pending amendment.
CCG100/2014 MATTERS OUTSTANDING
CCG040/2014 Communications & Engagement Report Les Williams to attend a Patient Opportunity Panel (POPs) meeting.
CCG087/2014 Commissioning for Outcomes Mr Maubach reported that the group was not meeting until mid October so feedback would be coming to the November Board, possibly the January Board.
CCG095/2014 Finance & Performance Mr Bucktin provided the Board with a verbal update with regards prescribing wastage. He reported that the prescribing team have a number of initiatives in place to deal with wastage and they were currently carrying out a “waste audit” which is being done as part of the contractual arrangement with the Community Pharmacists. Mr Bucktin confirmed that he would report back once it was completed.
He reported that there is also a “Waste Campaign” taking place which will be targeted at GP Practices and Community Pharmacists to encourage them not to over order. There is still some debate regarding the supply of repeat prescriptions and the length of time that they should be made out for, the standard currently sits at about 56 days but evidence shows that it is more than 84 days in some cases. Therefore there is a piece of work to be done around this and it will be reported back to the Clinical Development Committee.
Resolved: 1) The Board noted the matters outstanding 2) The Board noted that Mr Maubach would feedback on Commissioning for Outcomes.
PUBLIC VOICE
CCG101/2014 QUESTIONS FROM THE PUBLIC
Mr Alan Ward – Carer
“When will you start thinking differently about Dementia?”
Mr Maubach reported to the Board that the development of the CCG’s services for dementia is a key part of the strategy and that there were a number of innovations and developments in place. The CCG are aware that the service is not perfect and that there are areas that still require work. He confirmed that the level of people with dementia was rising and one of the things the CCG needs to do, and it a key objective this year and was last year, is to improve the diagnosis of dementia and it has quite challenging targets to be able to develop this. Dr Mahfouz explained to Mr Ward that developing a dementia service would be a long process as there are such varying levels of dementia. She suggested that the CCG would really benefit from Mr Ward outlining the situation he is experiencing to
2 | Page her directly as the information and insight he could provide would be extremely useful in developing services. Mr Ward agreed he would be contact Dr Mahfouz and take the offer forward.
Mr John Payne – Halesowen
“In regard to item 8.1 on your July meeting agenda, Co-commissioning Expression of Interest, please explain the meaning and significance of co-commissioning: who are the co-commissioners; when will co-commissioning begin; will that coincide with the date when advertising contracts begins or has that already begun?”
Mr Wellings felt he needed to apologise for any confusion about what the term co-commissioning actually meant. Co-Commissioning for the CCG means working with the NHS England Local Area Team to support commissioning services within GP Practices, not the more general term that is being used in the press.
Previously the PCT was responsible for commissioning services within GP practices in Dudley, however this is now out of the CCGs control and the responsibility lies with NHS England (NHSE). NHSE has since realised that the input of the CCG is vital and that is what is being referred to as Co- Commissioning. Mr Payne asked if there will be a Commissioning Committee that a member of the public could be present on or be able to see minutes. Mr Wellings confirmed that reports from all the Committees come to Board and highlighted that there is a recommendation later on in the agenda which reference to developing a Committee specifically relating to Co-Commissioning and therefore will be subject to the same reporting process as the other committees. This will be available in the public domain.
Resolved: 1) The Board thanked the members of the public for their questions.
CCG102/2014 FEET ON THE STREET - NAVIGATING HEALTHCARE SYSTEMS
Mrs Broster introduced “Feet on the Street” and confirmed that the video was a collection of patient opinions based on their experiences in acute and secondary care.
At the end of the video three questions were asked to the Board to prompt discussion.
• How do we help people manage multiple appointments? • How do we help people access the most suitable place for their care? • How do we help people access the right advice?
Mr Polychronakis felt the comments were positive and noted that he was surprised that the patient was quite happy to wait 3 hours in A&E.
Dr Rathore felt it highlighted that patients were satisfied when they get care, either through primary care or secondary care, but the environment now was very challenging. Dr Rathore felt it was vital for us to communicate more with patients about where the most appropriate place for their individual care is and this is clearly an area we need to improve on.
Mr Wellings expressed concern about how the patient felt that they were wasting a consultant’s time and that this was inexcusable. There were some important messages in the presentation which the Board need to take into account.
Dr Hegarty reported to the Board that at an assurance visit held yesterday with the Local Area Team, he was informed that Dudley are the only CCG across Birmingham, Black Country & Solihull that carries out this type of engagement and they felt that the CCG engaged well with the patients of Dudley. Dr Hegarty reiterated that there was always room for improvement.
Resolved: 1) The Board noted the presentation for information
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CCG103/2014 PUBLIC UPDATE
Mrs Broster spoke to this item and presented to the Board a new report from the Communications & Engagment team, with the aim of keeping Board members up to date with important communications and engagement issues and ‘hot topics’ that may be outside or beyond the assurance required from the Communications and Engagement Committee Report.
Mrs Emery highlighted three key areas that Healthwatch were currenlty involved in. One was a piece of work being carried out with the Dudley Youth Service which involved asking for young people’s view on health & wellbeing: the group are meeting in September and the results will be analysed. The second was a special inquiry into hospital discharges and a recent survey had been carried out as part of Healthwatch England to gather peoples experience of discharge from hospital. The final item was around an Excluded Patient Scheme and she reported that this was being adressed with NHS England and findings will be shared.
Mrs Broster brought to the Boards attention that, in response to a story dated 21st August titled “Eight areas axed from BCF fast-track scheme”, concerns were raised that the article did not accurately reflect the true position with regards to the Better Care Fund. Netiher the CCG or Dudley Council were offered an opportunity to comment on the story before it was published and therefore a jointly agreed statement was issued. She confirmed that the correction will be carried by the publication.
Resolved: 1) The Board noted the report for assurance.
CHAIRMANS & CHIEF OFFICER REPORT
CCG104/2014 REPORT
Mr Maubach updated the Board on the following:
Election of GP Board Members Mr Maubach informed the Board that the three-year term of office, for several of the GP Board members reaches its end by the 30 September 2014. The wider GP membership have been invited to stand for election; all seven existing Board members have been re-elected unopposed. The seven GPs are: Dr Jaswant Rathore, Dr Steve Mann, Dr David Hegarty, Dr Ruth Edwards, Dr Mona Mahfouz, Dr Richard Johnson, Dr PD Gupta.
Election of Chair He also highlighted that the process was now open for voting members of the Board to nominate a GP Board member to stand for the role of Board Chair.
Interim Head of Systems Development Mr Maubach reported that the CCGs has brought in Andrew Coote from Alscient to lead the development and implementation of local systems and technology – including the roll-out of mobile IT and maximising the use of EMIS. Both of these areas offer the CCG a fantastic opportunity to support significant improvements in the effectiveness and efficiency of its primary and community services.
Head of Communications and Engagement The Board thanked Richard Haynes and Rockhouse Communications Ltd for their work with the CCG over the last year and the Board welcomed Laura Broster back into her role after her maternity leave.
Director of Public Health Mr Maubach formally informed the Board of Valerie Little’s last attendance at a Dudley CCG Board meeting before her retirement. The Board extended its sincere gratitude and thanks for her tireless commitment to the CCG and the health and wellbeing of the people of Dudley.
System Resilience – Long-term sustainability Mr Maubach confirmed that a letter was recently sent to the Chairs and Chief Executives of the three
4 | Page main NHS providers locally (DGFT, DWMHT and BCPT) highlighting that collectively their five-year financial plans do not give the CCG confidence that there is a sustainable position, long-term, across the Dudley Health economy. A full report will be presented to the November Board.
NHS England planning requirements Over the course of the last few months there had been a requirement to submit and/or update the details of the CCG plans to NHS England on the Better Care Fund; the Strategic Plan; and the System Resilience Plan. Further iterations of all three would be resubmitted during this month.
National pilot for 7-day working The CCG had recently presented the work on 7-day service deliver at a national conference organised by NHS Improving Quality (NHSIQ). Mr Maubach confirmed that the CCG’s work on developing community standards was being picked up by NHSIQ with a view to using them as the basis for establishing a set of national standards.
Integration Mr Maubach reported that five early implementer practices are now piloting the new integrated model for primary and community services. These will be used as the basis for rolling-out the model across the whole system. Mrs Cartwright will be leading the OD programme for this key initiative.
Urgent Care Centre He confirmed that the bids for the Urgent Care Centre had been submitted and were currently being evaluated. The CCG should be able to confirm the preferred bidder within a few weeks time after the moderation process had been completed. DGFT are managing the premises redesign for the new UCC and a deadline has been set for the end of September to finalise the plans.
Child Health Summit The CCG is planning a Child Health Summit for 20 November. This was being organised in conjunction with Dudley Health and Wellbeing Board and will provide the opportunity to build on the CCGs plans for sport and wellbeing with children and engagement with education and other council services to improve child health. Mrs Helen Codd is coordinating the organisation of this event.
NHS England Area Team Assurance Meetings The CCG had a Quarter 1 (Q1) assurance meeting with NHS England on the 10 September 2014. The CCG continues to require support due to the Q1 A&E performance being below target. However it was expected to change at the next assurance meeting should the A&E performance improvement in Q2 continue.
Mr Maubach also recommended the establishment of a time-limited Task and Finish Group to steer the introduction of its co-commissioning arrangements for primary care services.
Ms Little mentioned the Health & Wellbeing Board (H&WB) Peer Review Challenge meetings that were taking place the next week. Mr Maubach explained that this was a developmental process for the H&WB to look at effectiveness and how the organisations work well together. A suggestion was made for the outcomes of the review to be reported back to the next Board.
Mr Wellings stressed that the proposed restructuring of the Area Team highlighted the importance of getting the co-commissioning process and integrated working in place.
Resolved: 1) That the Board noted the report for assurance 2) That the Board receive an update with regards the H&WB Peer Review Challenge Meetings.
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STRATEGY
CCG105/2014 STRATEGIC ISSUES
Mr Bucktin spoke to this item and confirmed that the report was to note progress in relation to; the Strategic Plan; the Operational Capacity and Resilience Plan; service integration; the Better Care Fund and the Urgent Care Centre.
STRATEGIC PLAN Following approval by the CCG Board and the Health and Wellbeing Board, the Strategic Plan was submitted to NHS England in June 2014. Initial feedback had been received from NHS England on the outcome of their assurance process and a further meeting with NHS England is scheduled to take place on 8 September, prior to a final submission being made in late September.
An update on the outcome of the meeting to be held on 8 September would be given to the Board in November.
OPERATIONAL CAPACITY AND RESILIENCE PLAN The Board was reminded that in June 2014 NHS England issued guidance on the preparation of Operational Capacity and Resilience Plans, designed to deal with two key issues – elective care and the 18 week referral to treatment target, as well as urgent care and the 4 hour ED waiting target.
These plans were to be overseen by “System Resilience Groups” (SRGs) consisting of all key partners in the health and social care economy and chaired by the CCG’s Chief Accountable Officer. The System Resilience Group would also deal with the allocation of resources made available non- recurrently by NHS England to be set out in the plan. Plans would also identify what further local resources were being committed as part of this process.
The original submission was in July and following initial feedback, there was a resubmission at the end of August. There had been further feedback the day before and as there were still a number of areas where NHS England felt the CCG’s plans only partially assured them, another submission would be made to NHS England in the following week.
SERVICE INTEGRATION Mr Bucktin reported that the Community Rapid Response team was now operational and recruitment was underway for its associated services. Further discussions had taken place in relation to clarifying the clinical governance arrangements for the team and its ability to take responsibility directly for responding to calls which would ordinarily be managed by the West Midlands Ambulance Service NHS Foundation Trust. Miss Bartholomew confirmed that a meeting had been arranged with herself and Mrs D McMahon, Director of Nursing the following week to confirm all the governance issues.
Dr Gee felt the wording that Dudley CCG are “stopping people going in to hospital” needed to include the word “unnecessarily”. The Board agreed that the statement needed to reflect that the CCG wants to treat people closer to home and prevent un-necessary admissions.
BETTER CARE FUND Mr Bucktin confirmed that revised guidance on the Better Care Fund (BCF) had now been published. This had amended the original arrangements, such that the performance related element of the BCF (£ 5.787m out of a total base fund of £ 23.841m in Dudley) was now solely dependent upon performance in reducing emergency admissions. Further work would also need to take place so that all parties were clear about the financial implications of the revised guidance and reach agreement on a risk sharing arrangement to underpin this. The BCF submission needed to be made to NHS England by Friday, 19 September 2014.
URGENT CARE CENTRE Mr Bucktin confirmed that the procurement process for the Urgent Care Centre was nearing its conclusion. Presentations from short listed bidders were scheduled to take place on 3rd September, following which a contractor would be selected. In addition, arrangements were being made to appoint a Quantity Surveyor to assess the capital infrastructure proposal.
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CO-COMMISSIONING OF PRIMARY CARE Mr Bucktin asked the Board that approval be given to establish a Task and Finish Group as previously mentioned in the Chair & Accountable Officers’ update. This would be chaired by Steve Wellings, Governance Lay Member and would develop the CCG’s plans for co-commissioning.
Dr Gee felt the wording that Dudley CCG are “stopping people going into hospital” needed to include the word “unnecessarily”. The Board agreed that the statement needed to reflect that the CCG wants to treat people closer to home and prevent unnecessary admissions.
Resolved: 1) The Board noted the report for assurance 2) The Board agreed the establishment of a Task & Finish Group
QUALITY & SAFETY
CCG106/2014 QUALITY & SAFETY COMMITTEE REPORT
Dr Edwards spoke to this item and confirmed that the report summarised the key issues discussed at the Quality & Safety (Q&S) Committees in July and August 2014.
She highlighted to the Board the key areas of the paper:
SECRETARY OF STATE ANNOUNCEMENTS The Quality & Safety Committee would discuss these announcements at its next meeting, but felt it was important that the Board are sighted on these developments.
DUDLEY GROUP FOUNDATION TRUST Dudley CCG received information on an anonymous whistle-blowing allegation from the Care Quality Commission in August 2014 regarding Dudley Group Foundation Trust (DGFT). The allegation specifically mentioned three wards at Russells Hall Hospital, and made reference to the care and treatment provided to patients.
In response to the information received, an unannounced visit to DGFT was planned and undertaken by members of the Quality team on Friday 15 August 2014. Interim plans to gain assurance of patient safety will be discussed at the next DGFT Clinical Quality Review Meeting (CQRM).
A draft report had been completed and forwarded to DGFT on 29 August 2014. DGFT’s initial comments were expected by 12 September 2014, and a copy of the report would be made available to the Quality & Safety Committee, for comments, at the next meeting on 16 September 2014.
SERIOUS INCIDENTS The Committee had been made aware of a significant Serious Incident relating to electronic discharge letters with up to 30% of letters not being received within the practices and also apparent discrepancies with the dates. The CCG was working closely with DGFT to support their recovery plan which is essentially due to an IT problem. An interim process had been put in place which were paper letters, and the Trust had also introduced a sign and stamp campaign. The CCG was requesting a retrospective review/audit to highlight any further issues. This had been added to the CCG risk register.
Mr Maubach asked Dr Edwards if there was more the CCG should be doing with regards the discharge letters situation and whether it should be escalated further. Mr Hartland informed the Board that he met with the Director of IT at DGFT on Monday and understood that DGFT had stalled in purchasing software that enabled communication with the GP Practice Docman systems. This would potentially solve a lot of the problems being experienced. DGFT had now purchased the software and are running tests. This would be rolled out by the end of the year.
Mr Maubach highlighted that the Board need to be made aware if there had been any cases of harm caused by this breakdown in communication and the Board agreed that a member of the CCG be involved in the audit that would take place.
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Dr Hegarty reiterated to the Board that this was completely unacceptable and a major risk to the patients of Dudley, the systems in practices are not set up to deal with discharges on paper, they are set up electronically. There was also concern that there would be a delay and inevitably practices will receive a back log of 3 weeks’ worth of discharges. He stressed the importance of this situation being rectified urgently and the need to understand what potential risks there might be.
Discussion took place about whether a retrospective audit should also be carried out. Dr Mahfouz and Dr Darby felt it would be more efficient to carry out a prospective audit. Dr Hegarty confirmed that whilst this would demonstrate if the process had been fixed, it was also a necessity to be confident that there were no patients waiting for treatment or at risk of potential harm.
Mr Maubach asked the Board to agree that the CCG identifies the resources to make sure this was sorted as soon as possible. The Board agreed.
Mrs Emery raised a concern around the transparency when a serious incident had taken place, for example recently Healthwatch only found out after being copied in by NHS England that there was a serious incident being investigated. The CCG was also not aware.
Item 4.6 stated that a total of 46 SIs had been reported by DGFT year to date. This implied that there had been a 200% increase in SIs in one month. Miss Bartholomew confirmed that this increase was due to the recently corrected reporting of community pressure ulcers after this had been repeatedly challenged through CQRM. Mr Maubach felt the Board needed to see the split and felt the report was not clear and did not explain the true reflection of what the numbers are. Such a large increase in pressure ulcers was staggering so it needed an explanation within the paper. He suggested an addendum to the report to clarify the figures.
Section 4.11 in relation to Falls resulting in Harm suggest that DGFT could have had two out of the three falls which could have been avoided might result in injury/death. He did not feel that this was clear. Miss Bartholomew suggested that clarity is sought on what is avoidable and unavoidable and include that in future reports. Mr Maubach felt that as this was a public document an addendum explaining this needed to be added.
INSPECTION AT DGFT The CQC undertook a visit to DGFT in March 2014 as part of a national review of the 14 Trusts reviewed by NHS England following identification of concerns regarding mortality rates. The CQC inspection included two days on site and focused on eight services. A summit meeting took place on Monday 23 June 2014, and the CCG is awaiting the final report (progress monitored via monthly CQRM).
DUDLEY & WALSALL MENTAL HEALTH TRUST (D&WMHT) Receipt of Serious Incident notification and Route Cause Analysis (RCA) reports continues via Walsall CCG. Investigation reports are reviewed by the Quality Team, and feedback has been provided to Walsall CCG that there is room for improvement in relation to some RCAs. Issues are addressed via monthly CQRMs. A trend of serious harming behaviour has been identified, and further detail and assurance is being sought via the CQRM.
BLACK COUNTRY PARTNERSHIP FOUNDATION TRUST (BCPFT) Receipt of Serious Incident notification and Route Cause Analysis (RCA) reports continues via Wolverhampton CCG. No Serious Incidents were reported during June and July 2014. Issues would be addressed via monthly CQRMs.
RISK REGISTER The Committee reviewed the CCG risk register, added new items during the meetings in July and August, and changes had been submitted to the Audit Committee.
Mr Wellings queried the Friends and Family test where there are considerable downward spikes at certain times of the year. He asked if the CCG understands why the responses are low despite this not being replicated nationally. In future he asked for an explanation of why this may have happened.
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A trend of serious harming behaviour had been identified at DGFT however this did not seem to be reflected in the safety thermometer. Miss Bartholomew confirmed that the thermometer does not reflect harms and is a snap shot. The trend is around self-harming. It was agreed that this would also be amended to “serious self-harming....”
Dr Handy suggested some kind of sign off before the paper is circulated to the public board.
Resolved: 1. The Board noted the report for assurance. 2. The Board agreed that an urgent addendum be added to the papers providing clarity on the figures in the paper.
COMMISSIONING
CCG107/2014 CLINICAL DEVELOPMENT COMMITTEE REPORT
Dr Mann spoke to this item and confirmed that the report summarised the key issues discussed at the Clinical Development Committee on the 23 July and 20 August 2014.
Dr Mann highlighted that there have been three service developments that had been approved under the delegated powers of the Committee which are:
• a therapeutic programme for people with autistic spectrum disorder that will enable 48 people to access a programme for a 12 week period;
• an out of hours telephone support line to be provided to enable a suitable response for people with mental health problems experiencing a crisis.
• a minor ailments scheme to be provided by community pharmacists, on the basis of advice from the Primary Care Development Committee.
He then reported to the Board that approval is required to progress with the Expansion of the NHS Continuing Healthcare/Intermediate Care Team. The Committee had approved a proposal to expand this team in order to provide the necessary capacity to deal with an increasing level of referrals and the provision of services 7 days per week. The cost of expanding the team to deal with existing service pressures would be £168,394 per annum. The cost associated with 7 day working which is subject to out of hours payments would be £122,976. Further work was required however to define the operating practices of the team.
Dr Mann also confirmed that the Committee required approval from the Board with regards a service development of Re-provision of Existing Capacity Commissioned for People with Dementia. The CCG currently commissions a service for people with dementia and NHS Continuing Healthcare needs at Woodview Nursing Home. In order to respond to this demand, it is proposed to re-model the provision at Woodview in order to reverse the current level of provision and move from 8 challenging behaviour and 16 general dementia beds to 16 challenging behaviour and 8 general dementia beds.
Resolved: 1) The Board noted the report for assurance 2) The Board approved the service development recommendation for the Expansion of the NHS Continuing Healthcare/Intermediate Care Team and the Re-provision of Existing Capacity Commissioned for People with Dementia.
COMMUNICATIONS & ENGAGEMENT
CCG108/2014 COMMUNICATIONS & ENGAGEMENT COMMITTEE REPORT
Mrs Broster spoke to this item and confirmed that the report summarised the key issues discussed at the Communications & Engagement Committee on the 12 August 2014.
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Mrs Broster highlighted to the Board that the Communication Team is currently in the process of appointing a Patient Experience Information Analyst. This post will add more depth and insight in to the initial report presented to the Board, but will also help the links with Healthwatch and Dudley Group to get more transparency in relation to patient experience and establish one picture.
Mr Wellings reiterated the importance of this post and the significant contribution it will make.
Resolved: 1) The Board noted the report for assurance
GOVERNANCE
CCG109/2014 AUDIT COMMITTEE REPORT
Mr Hartland spoke to this item and confirmed that the report summarised the key issues discussed at the Audit Committee on 31 July 2014
Mr Hartland highlighted that in the Key Indicator Summary the one item that is rag rated amber is the Business Continuity Policy and he gave assurance to the Board that there was a plan to have this completed by the end of November and it would be presented to a future Board.
Committee Reporting/Effectiveness The Audit Committee considered and approved a proposal for the review of its effectiveness based on the completion of two checklists. It was agreed that the first relating to “Committee Processes” would be completed by the Chair working with the governance lead and committee secretary. The second on “Committee Effectiveness” would be sent as a questionnaire for completion by the Audit Committee members and auditors. The results would be presented to the next Audit Committee. This model would be used to assess the effectiveness of all CCG committees and will be reported back to Board.
Board Assurance Framework and Risk Register The Committee received the Combined Board Assurance Framework (BAF) and Risk Register as at 7th July 2014. The Audit Committee felt that it still needed further development and it was confirmed that the management lead for the relevant committees should be updating the BAF and Risk Register whilst the responsible Committee should be providing challenge.
Reports had been received from both internal and external audit. Internal Audit were reviewing the impact of services being brought in house from the CSU. A slightly re-profiled audit plan to incorporate this would be going back to Audit Committee for sign off.
Resolved: 1) The Board noted the report for assurance
CCG110/2014 COMBINED BOARD ASSURANCE FRAMEWORK & RISK REGISTER
Mr Hartland spoke to this item and reported that in accordance with the CCG’s Risk Management Strategy, the combined BAF and Risk Register for those risks scored 16 and over (which comprise the Board Assurance Framework) was presented to the Board. This report was based on the position as at 7th August 2014.
An annual review of the BAF and Risk Register was undertaken on 24th July with representatives of the Audit and other CCG Committees. Although the BAF and Risk Register is regularly reviewed and updated through the Committees and reported to the Board, he reported that this was an opportunity for a fresh look at the document as a whole. This noted the addition of a new corporate objective of system effectiveness with certain existing risks being aligned to this and a number of changes to the risks being proposed including some closures.
On behalf of the Committee, Mr Hartland asked for Board approval that the following risks be closed:
Risk 1 – “Failure to resolve potential mortality issues at Dudley Group results in avoidable deaths.” The Quality & Safety Committee recommended that this risk be closed on the basis that
10 | Page assurance has been received that this is no longer a risk and that they would be alerted if anything changed. The Board received a report at its July meeting on mortality which provided this assurance.
Risk 9 – “Risk of poor relationship management with the Area Team through the transition/bedding down resulting in breakdown of relationship with GPs and/or disconnected primary care/medical service priorities”. The Primary Care Development Committee recommended that this risk be closed as the relationship with the Area Team is managed through the Interface Group.
Risk 20 – “Failure of providers due to quality failures will result in inadequate care for the local population”. The Quality & Safety Committee recommended this risk for closure on the basis that there are robust controls and assurance processes in place and these are working well. If specific quality issues were identified through these processes, they would be reported by the committee to the Board and potentially a new risk would be raised.
Risk 32 – “Current reorganisation of Health Visiting Service could result in breakdown in continuity of care to patients and consequent risks to safeguarding children”. The Quality & Safety Committee proposed that this specific risk be closed as it was time-limited and has now been resolved.
The Committee also asked for the merger of:
Risks 36 & 44 – The review group considered that Risks 36 and 44 were duplicates. It is proposed that Risk 44 “Overall achievement of the Quality Premium is impacted by performance issues with the delivery of Local and National Targets by the local provider and reduces the Quality Payment the CCG receives with the consequent financial and reputational impact” (under the Finance & Performance Committee) be merged with Risk 36 “Failure to achieve whole of Quality Premium resulting in lost income and reputational damage” (under the Clinical Development Committee). Risk 44 would then be closed.
Dr Edwards confirmed that the issue around discharge letters had been added to the risk register but was not shown due to the register being as at the 7 August 2014.
Mr Wellings and Mr Maubach suggested that the Quality & Safety Committee also investigate if there is a risk with relation to the earlier discussion around falls and Dr Edwards agreed that they would take this forward and if appropriate add it to the risk register.
Ms Little highlighted that after a certain amount of time the wording around risks on the registers can sometimes lose their meaning and stressed the importance of not keeping a risk open because it may relate to a new concern. It is vital to close risks and add new ones.
Resolved: 1) The Board noted the report for assurance 2) The Board agreed approval the closure of risk 1, 9, 20 and 31 3) The Board approved the merger of risk 44 with risk 36 and the closure of risk 44
CCG111/2014 GOVERNING BODY ELECTION PROCESS
Mr Wellings spoke to this item and reported that the Governing Body of Dudley Commissioning Group consists of 10 GP members elected from localities within the Dudley Borough and in line with the CCG Constitution all elected members are in office for a period of 3 years. The tenure for seven elected members would be expiring on 30 September 2014.
Mr Wellings highlighted the key elements of the process and reported that all nominations received were from existing elected Board members and that there were no nominations from elsewhere within the GP membership, therefore all current members were unopposed.
A competency assessment was completed for all nominees when initially appointed and re-tested. In addition, Dr Hegarty, CCG Chair, was requested to provide a statement of assurance that there were no issues in relation to the performance of relevant elected Board members that should prevent them
11 | Page from being re-elected. This assurance was provided. A similar statement was provided by Mr S Wellings, Lay Member for Governance and CCG Vice-Chair, in relation to Dr Hegarty.
Therefore, as existing members were nominated were unopposed, and met the competency criteria, there was not a requirement for a full election of the GP membership. The appointment was for a period of 3 years and the posts will be subject to re-election on 1 October 2017.
Mr Wellings also reported that the tenure of Dr Hegarty as Chair of Dudley CCG ends on 9 November 2014 and the process for the recruitment of the Chair is underway with an appointment expected by 30 September 2014 with an effective date of 10 November 2014.
As Dr Rathore and Dr Mann had been re-elected, they would continue in their posts as Clinical Executives. A separate paper to Board proposed a revision to the Constitution in relation to the appointment process for Clinical Executives.
Resolved: 1) The Board noted the re-election of seven GP Members: Dr Hegarty: Dr Mann: Dr Rathore: Dr Mahfouz: Dr Gupta: Dr Johnson and Dr Edwards 2) The Board noted the process for the election of the Chair 3) The Board noted that Dr Rathore and Dr Mann would continue with their roles as Clinical Executives and a revision to the Constitution was proposed in relation to the appointment process of the Clinical Executives.
CCG112/2014 DUDLEY CCG CONSTITUTION
Mr Wellings spoke to this item and reported that guidance states that CCG’s have two opportunities per year to amend their constitution, in June and November. Any application for variation which will change a CCG’s boundary or its list of members, and therefore have a potential impact on its financial allocation, can only be made at the 1st June deadline so that the change can be reflected in the allocations for the following financial year.
Mr Wellings confirmed that following a review of the Constitution, only one item is proposed to change with effect from 1st November 2014 and that is in relation to the Clinical Executive appointments process and that in reference to Eligibility for reappointment the detail is changed to
“there is no limit to the number of terms of office served by an individual providing that they continue to meet the eligibility criteria. The Chair and Chief Accountable Officer can jointly agree for a reappointment to be renewed automatically; otherwise the post will be subject to a competitive appointment process (as outlined above) after each term”
Mr Wellings confirmed that there were no other proposed changes to the Constitution at this point in time with regards to Member Practices and that the number of practices within the CCG remains at 47. However the CCG is in discussion with the Area Team, regarding the process and timeframe for a potential change in CCG membership. The CCG was not in a position to finalise any amendments at this point in the Constitution, however appropriate flexibility is being sought form NHS England to allow any future change to happen in a timely manner.
Mr Hartland reported that since drafting the report, he would also like to ask the Board for approval to establish a Co-Commissioning Committee and that this be added in to the constitution.
Dr Hegarty asked for it to be also noted that whilst the Clinical Executives took part in the debate around the changes in the Constitution, they had declared a conflict of interest.
Resolved: 1) The Board agreed the suggested changes to the Constitution 2) The Board agreed the potential change in respect of an additional GP practice for submission to NHS England for approval, subject to confirmation they have taken place
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CCG113/2014 REPORT FROM REMUNERATION COMMITTEE
Mr Wellings spoke to this item and reported that the paper provided assurance to the Board with regards key issues discussed and approved by the Extraordinary Remuneration Committee on the 26 June 2014 and no further meeting had taken place since.
Mr Wellings highlighted one particular issue that had been discussed at the Committee and reported that there were a number of contradicting issues and concerns regarding the office holder contracts held by Lay Members and Clinical Leads. Therefore an independent review was being commissioned and the Committee would report back to the Board in due course.
Resolved: 1) The Board noted the report for assurance
FINANCE & PERFORMANCE
CCG114/2014 FINANCE & PERFORMANCE COMMITTEE REPORT
Dr Rathore spoke to this item and confirmed that the report summarised the key issues discussed at the Finance and Performance Committee at its meetings on 31 July 2014 and 28 August 2014. He highlighted the following areas:
QIPP 2014/15 The QIPP target for 2014/15 is £7.166m. A shortfall of £0.980m had been identified against schemes in the plan. It was imperative that new schemes be identified to retrieve this shortfall, although a non- recurrent QIPP reserve is held to mitigate this risk. If this were used it would increase next year’s QIPP target to £10.241m.
18 WEEKS REFERRAL TO TREATMENT (RTT) PERFORMANCE (DGFT) The 2014/15 Provider RTT figures show that DGFT achieved the aggregate RTT targets in April and May, but at specialty level failed the 90% target in ENT, Ophthalmology, Trauma and Orthopaedics and Urology for admitted patients.
Detailed recovery plans had been introduced with a range of initiatives such as extra sessions and outsourcing. These recovery plans had continued to deliver reductions in the waiting lists and progress was monitored by the CCG on a weekly basis.
All GPs declared an interest in the following item and were not involved in any discussion.
PRACTICE BUDGET SETTING In previous years the PCT/CCG used a local approach to set practice level budgets as there was no definitive formula for doing so. However, NHS England announced that the formula used to set 2014/15 CCG allocations could be used for setting practice budgets. Options in relation to setting practice commissioning budgets were considered. This formula had been compared to that currently used by the CCG to set practice budgets. The impact was that nine practices would receive budget reductions.
The GP Engagement Lead was consulted on the budget and agreed with the principle of using the NHS England formula to derive practice budgets. The Committee agreed to adopt the NHS England model to calculate GP practice budgets in 2014/15 and to amend practice list sizes in the model to actual list sizes as at 1st April 2014. The finance team would work with the nine practices to carry out an in-depth study of their spending profile.
A separate comparison was being undertaken between the NHS England model and the local model proposed by the Medicines Management Team for prescribing. A recommendation would be made to the next Clinical Development Committee.
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CCG IT STRATEGY GROUP All practices had migrated to EMIS Web. A Development Group, which would meet monthly, had been established to explore the benefits of having all practices on one system. It was intended that an EMIS employee would be seconded into the CCG a couple of days a week.
Patient self-check in screens and SMS text messaging had been identified as priorities within the IT Strategy. At its meeting on 6 August the IT Strategy Group agreed to fund touch screen technology for practices and linked into this the introduction of digital signage, and to fund SMS text messaging for all practices.
ESTATES STRATEGY GROUP The development of the Health Infrastructure Strategy was progressing and the deadline for its completion was 31 March 2015. A significant element is an audit of all primary care facilities, both NHS and privately owned, which had recently been commissioned. The Chief Finance Officer and Mr Richard Darch, who had been engaged to lead on the development of the Strategy, would be attending each of the September/October locality meetings to discuss estates developments within primary care.
Resolved: 1) The Board noted the report for assurance.
PRIMARY CARE
CCG115/2014 PRIMARY CARE DEVELOPMENT COMMITTEE REPORT
This report summarised the key issues discussed at the Primary Care Development Committee on 17th July 2014 and 14th August 2014.
Primary Care Incentive Scheme 2013-14 The Committee received a report summarising performance against the incentive scheme developed and implemented in 2013-14. The key points from the report were noted in that 45 (91%) of practices had completed and shared and action plan with the CCG in response to the Primary Care Foundation Audit, identifying ways in which practices could improve access. 38 practices (78%) demonstrated to their patient panels that access had been improved as a result of the actions taken in response to the audit.
Primary Care Transition Fund The Committee discussed use of the transition fund and noted that a paper would be developed for consideration by the Finance and Performance Committee. The Committee noted that ideas would be canvassed from the wider membership, through locality meetings, and the membership event taking place in August and that a process of prioritisation would have to be agreed.
Care Quality Commission Inspection The Committee received an update following feedback from member practice experiences and the actions were highlighted in the paper. Dr Rathore stressed the importance to take learning from these inspections and implement change.
GP Patient Survey The Committee received a summary of “the GP Patient Survey” an independent survey run by Ipsos MORI on behalf of NHS England. The Committee considered the results focussed on access. The Committee noted that the CCG responses were broadly similar to the national median, and one question (from nine) revealed a national outlier.
E-Learning Package The Committee received a presentation on behalf of the Dudley Practice Management Alliance whose members had been piloting an e-learning training package. The Committee supported the package being funded and rolled out to all practices in response to fulfilling CQC recommendations. The Committee agreed that the roll out and implementation of the package will be co-ordinated and managed by the Dudley Practice Management Alliance.
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Risk Register The Committee on the 14th August agreed a new risk regarding “failure to work in partnership with NHS England Area Team to successfully co commission primary care medical services resulting in an inability to deliver the outcomes set out in the Primary Care Development Strategy and expression of interest for co-commissioning”.
Mrs Broster gave an update around the videos from CQC. These had now been edited and the CCG was trying to establish a platform to share these videos.
Resolved: 1) The Board noted the report for assurance
The Board also agreed the meeting dates for 2015 however agreed it might want to move the AGM to the end of June.
DATE OF NEXT MEETING Thursday 13 November 2014 1pm – 5pm Boardroom, Brierley Hill Health & Social Care Centre
MINUTES ACCEPTED AS A TRUE AND CORRECT RECORD Name Title Signed Date
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DUDLEY CLINICAL COMMISSIONING GROUP BOARD
MATTERS OUTSTANDING
UP TO THURSDAY, 13 NOVEMBER 2014 – PUBLIC BOARD MEETING
ITEM NO AGENDA ITEM ACTION TO BE TAKEN ACTION FOR DEADLINE
Update CCG040/2014 COMMUNICATIONS & The Board noted that Mr Williams would establish if LAT Mr Williams 13 November ENGAGEMENT REPORT representation would attend a POPs. 2014
The Board agreed to receive a report on the work done by the COMMISSIONING FOR 13 November CCG87/2014 task and finish group on commissioning for outcomes in Mr P Maubach OUTCOMES 2014 September 2014.
CHAIRMANS & CHIEF OFFICER The Board agreed to receive an update on the Health & 13 November CCG104/2014 Mr P Maubach REPORT Wellbeing Board - Peer Reviews that have taken place. 2014
QUALITY & SAFETY COMMITTEE The Board agreed that an urgent addendum be added to the Miss R 13 November CCG106/2014 REPORT papers providing clarity on the figures in the paper Bartholomew 2014
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DUDLEY CLINICAL COMMISSIONING GROUP BOARD
Date of Report: 13 November 2014 Report: Public Update Agenda item No: 5.3
TITLE OF REPORT: Public Update • To update the Board on items of interest including recent media activity and issues raised by patients and public. • This new report is positioned at the start of Board to add to the other PURPOSE OF REPORT: public voice items • This report is intended to add value by giving the Board insight into what the patients & publics views on the NHS locally are.
AUTHOR OF REPORT: Laura Broster – Head of Communications and Public Insight
MANAGEMENT LEAD: Laura Broster – Head of Communications and Public Insight
CLINICAL LEAD: Dr David Hegarty – Chair
• Message from Healthwatch • Public views on primary care access for young people, phlebotomy KEY POINTS: & urgent care • Media coverage
• Note the contents of the report • That the Board is assured that the CCG has mechanisms in place to RECOMMENDATION: hear the voice of the patient & public and that issues raised are being reflected on internally with appropriate actions taken
• The CCG has a statutory duty to involve. Failure to do so could result in costly judicial proceedings FINANCIAL IMPLICATIONS: • All activity reported is covered by the existing communications & engagement budget unless stated otherwise
WHAT ENGAGEMENT HAS This report has been designed to highlight more public views to the TAKEN PLACE: CCG Governing Body
Assurance ACTION REQUIRED: Decision Approval
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Public Update
Introduction
This new report is presented with the aim of keeping Board members up to date with important communications and engagement issues and ‘hot topics’ that may be outside or beyond the assurance required from the Communications and Engagement Committee Report.
It is also produced with the specific aim of further strenghtening the patient voice at our board meetings by including sections dedicated to feedback from our Patient Participation Groups, Patient Opportunities Panel and Healthwatch – a response to a series of requests from some of our more active patient representatives.
The Feet on the Street video screened at today’s Board meeting features a collection of patient stories around hospital discharges. This production has been created with the support of DGFT and Healthwatch colleagues to ensure a more rounded view of the experiences of patients in Dudley.
It highlights some of the issues for patients and organisations around the safe discharge of patients and the impact on the patients experience of the services we commission.
This work will also be presented to Dudley Group Foundation Trust Patient Experience Group via Healthwatch in November and we hope to work with DGFT and partners to explore any issues further before the publication of a national report by Healthwatch England later this year.
This section includes specific updates from, and issues raised by, Public and Patients in our forums plus snapshots of what our patients are saying on social media and other relevant arenas.
Under plans to expand the remit of the CCG’s Communications and Engagement Team to take on patient experience, future versions of this report will also include updates on issues identified from our analysis of a comprehensive suite of patient experience data and feedback. To support this area we are currently out to advert for a Patient Insight Specialist.
• Patient Participation Groups (PPGs) We have 44 PPGs across the borough and we are working with the GP Engagement Lead to support the remaining 3 practices to develop this resource for their patients. The focus this month 1 | Page
has been on preparations for self-care week. This initiative has been led by our Patient Opportunity Panel who have created, with our support, a self-care campaign. This has now been produced and cascaded to each PPG, along with other supporting information from partners. We hope that by our PPGs leading this work at practice level it will have more reach and impact.
• Patient Opportunities Panel (POPs) At the most recent meeting Paul Maubach attended and gave members an opportunity to ask him questions. These were predominantly focussed around CCG Integration.
• Healthcare Forum (HCF) Our next Healthcare Forum is on December 11th 12-2.30pm at Brierley Hill Civic Hall.
The event will give participants the opportunity to live a ‘day in the life’ of CCG decision makers. The attendees will be looking at commissioning decisions in a key area to understand and role play different perspectives and contribute views on how decisions should be made. We are keen for different CCG personnel to facilitate the event and raise awareness within the CCG of the importance of these public meetings.
This also addresses feedback from the last event where there was a clear view that clinical representation should be stronger.
• Other areas of Public opinion / insight include: o Phlebotomy- we have received views from services users on the current service and how future services should be delivered. This work shows strong patient opinion on the following: - A mixture of bookable and non-bookable appointments - The importance of retaining a geographical presence - Ability for fasting patients to have earlier appointments - That on the whole, people are happy with the current service
These views have been fed into the commissioning team and responses given to members of the public to assure them that they will be considered before any decision is made.
o Young people’s views on access to primary care have been presented by the Dudley Youth Council to Health & Wellbeing Board. The CCG Communications & Engagement Team have cascaded these findings to the CCG Head of Membership, CCG Children’s Commissioner and they were discussed at the Communications & Engagement Committee. The findings are interesting and there could be some areas for development in Primary Care which would undoubtedly break down some big barriers for young people in accessing these services. The CCG will consider this report and how we can influence and drive improvements in primary care for young people. This report will feed into the
o The Communications & Engagement team are receiving requests from public & patient groups for updates on the Urgent Care Centre Developments. We will soon be in a position to announce the provider and work with them to develop key messages about the new centre and how things will work. We are also keen to ensure that the CCG work to improve access to primary care is built into this feedback.
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Update from Jayne Emery, Chief Officer, Healthwatch Dudley
- Healthwatch England Special Inquiry into unsafe discharge Healthwatch England tasked local Healthwatch to find out people’s experiences of discharge from hospital. While it is important note that the majority of people who responded to our Healthwatch Dudley survey of Russells Hall Hospital patients had positive experiences, the focus of the Special Enquiry was of unsafe discharge. As such, initial findings of key issues were shared with the Dudley Group NHS Foundation Trust and Dudley CCG to be included in ‘Feet on the Street’. A final report of local findings and the Healthwatch England Special Inquiry will be available by the end of 2014.
- Patient experience transition funding action plan The aim of the transition funding joint action plan is to ‘produce a richer and more comprehensive picture of the quality of the patient experience.’ This is the main business of Healthwatch Dudley and as such, it is reassuring to see how much importance partners are placing on this area of work. We value the opportunity to work together and feel that we can contribution to the process in an independent and meaningful way that will make a difference to the lives of local people.
- CCG patient journeys on a medical and surgical ward We have been commissioned by Dudley CCG to collect patients’ views and experiences of their journeys through a hospital medical, or surgical ward with possible discharge options. There will be a focus on gaining an understanding of procedures and experiences by examining relationships and conversations between patients, families, carers, hospital staff and any other relevant people on their journey through a ward. Volunteers will support the project and it is due to take place over the next three months.
- Pharmacy research The Office of Public Health at Dudley MBC asked us to conduct a piece of research into public views and experiences of pharmacy services in Dudley borough. Over 800 people completed our survey and our findings will contribute to the development of a Pharmaceutical Needs Assessment outlining what pharmacy services could look and feel like in the future.
Some of our findings included:
• Pharmacy opening times may need to be reviewed along with other primary care services if improved access is to be achieved that better meets the needs of both casual and regular users of services. • It is relevant to focus on promoting pharmacy services such as health checks and support for long- term conditions and consider how different pharmacy services might be enhanced and developed to meet people’s changing needs in a modern living and working context. • More people could be encouraged to use particular services such as immunisation and vaccination jabs, stop smoking and alcohol advice and interventions and opportunities could be explored to further enhance and develop pharmacy links and relations with other primary and secondary care health sector partners. • It is important to ensure there are adequate private areas for pharmacist and pharmacy staff consultations with members of the public. • Rolling out a minor ailments scheme would be useful for the public.
3 | Page Our final report will be published at: http://healthwatchdudley.co.uk/research-reports/ by November 10th.
- Young people’s views on visiting a doctor’s surgery Healthwatch Dudley has a priority to champion the voice of children and young people and our partnership with Dudley Youth Council has continued to grow.
Following on from our joint piece of work where the views of more than 300 people from many different backgrounds were gathered, a group of Youth Council members presented their findings to Dudley’s Health and Wellbeing Board in September. Our research highlighted that on average young people think that they cannot visit a doctor without a parent or carer under the age of 16. It further highlighted that 1 in 10 young people would not visit their doctor about general health concerns. This leads us to question who would these young people talk to? Our findings will inform questions that will be asked at Dudley Youth Summit / Me Festival in November. We are working with Dudley Youth Council to produce a final report which will be circulated to key stakeholders before the end of 2014.
- Community Information Point Network Launch Our new information giving network was launched on Friday 26 September 2014 with an event at Brierley Hill Civic Hall attended by over 150 people. Community information points will be located in places where people already visit, such as libraries, pharmacies, churches and community groups. The points, staffed by trained information champions, will give local residents easy, face to face access to current local information about health, wellbeing and social care services and support, as well as information about benefits debt and money management. The main aim is to prevent local people from getting into crisis. Over 100 Information Champions are in the process of being trained and our network has received positive feedback locally and has been commended nationally with a Healthwatch England award for partnership working.
- West Midlands Care Association Healthwatch Dudley has a statutory function and power to ‘enter and view’ any health or social care communal setting that has an element of public funding. We are working with Dudley members of the West Midlands Care Association, to ensure that our approach with care homes in Dudley borough is meaningful and is carried out in a way that really makes a difference to local people.
This section of the report includes updates on proactive and reactive media activity and any other current issues.
Proactive and Reactive Media Activity
Communications and Engagement – Media Monitoring – September 2014
Title/weblink Summary Release Coverage (with links Comments Date where available) New fertility clinic Media Story 2 Sep 2014 Express and Star (Web) laboratories are handed A specialist design and over construction company http://www.expressandstar. has handed over new com/business/business- laboratories and a picks/2014/09/02/new- clinical suite to fertility-clinic-laboratories- independent fertility are-handed-over/
4 | Page clinics, Midland Fertility
Dudley CCG Invites Press Release 5 Sep 2014 Dudley, Halesowen Also circulated Public to attend Board Informing public of &Stourbridge News via CCG Meeting… board meeting and http://www.dudleynews.co. Facebook and papers uk/news/11468460.GPs_to Twitter Feeds _host_public_healthcare_fo rum/?ref=rss Jobs Pledge on New Media Story Dudley Chronicle Urgent Care Centre Health chiefs have http://www.dudleyccg.nhs.u pledged to create new k/wp- jobs under plans for a content/uploads/2014/09/Jo new urgent care bs-Pledge-on-New-Urgent- centre… Care-Centre.pdf Hospice Launches new Media Story 10.09.2014 Stourbridge News, scheme to improve end of Macmillan Specialist Dudley News, Halesowen life care Care at Home model, News with Dudley CCG, http://www.dudleyccg.nhs.u MacMillan, Mary k/wp- Stevens Hospice and content/uploads/2014/09/H DGFT – Charity Event ospice-launches-new- scheme-to-improve-end-of- life-care.pdf Hospice Leading Way in Media Story 11.09.2014 Stourbridge News Care Plan A Stourbridge hospice is trialling an innovative http://www.dudleyccg.nhs.u new scheme which k/wp- aims to improve patient content/uploads/2014/09/H choice for people ospice-launches-new- across the borough scheme-to-improve-end-of- nearing the end of their life-care1.pdf lives. Open Health Forum Coverage of HCF 17.09.2014 Dudley News following PR: http://www.dudleyccg.nhs.u Members of the public k/wp- are invited to discuss content/uploads/2014/09/O their health need with pen-Health-Forum.pdf borough GPs A Chance to discuss Coverage of HCF 18.09.2014 Halesowen News Health Needs following PR: http://www.dudleyccg.nhs.u Members of the public k/wp- are invited to discuss content/uploads/2014/09/A- their health need with Chance-to-Discuss-Health- borough GPs Needs.pdf Voice Concerns at Public Coverage of HCF 19.09.2014 Halesowen News Healthcare forum following PR: Members of the public http://www.dudleyccg.nhs.u are invited to discuss k/wp- their health need with content/uploads/2014/09/V borough GPs oice-Concerns-at-Public- HCF.pdf New ambulance liaison Media Story 22.09.2014 Express & Star Dudley staff for the West A dozen new specialist Midlands to combat health workers are to be http://www.expressandstar. waiting times drafted in at hospitals com/news/2014/09/19/new- this winter in an attempt ambulance-liaison-staff-for- to reduce the number of the-west-midlands-to- patients left waiting in combat-waiting-times/ corridors with ambulance staff. New Staff to Free up Media Story 19.09.2014 Express & Star – All Ambulance Workers A dozen new specialist Local 5 | Page health workers are to be drafted in at hospitals http://www.dudleyccg.nhs.u this winter in an attempt k/wp- to reduce the number of content/uploads/2014/09/N patients left waiting in ew-Staff-to-Free-Up- corridors with Ambulance-Workers.pdf ambulance staff Media Enquiry Response on behalf of 23.09.2014 Response to Telegraph Dudley CCG Allegations of Restraint at http://www.dudleyccg.nhs.u DGFT Shared with Dudley k/wp- Safeguarding Board content/uploads/2014/10/M and DGFT edia-Response-Sunday- Telegraph-Restraint- Allegations-Review.docx Media Enquiry Response on behalf of Response to Daily Mail Dudley CCG http://www.dudleyccg.nhs.u Letter from University Shared with CSU k/wp- Hospital Bham to Paul Comms content/uploads/2014/10/M Maubach Dudley CCG edia-Response-Daily-Mail- UHB-Letter.docx Health Groups Spend Response to Media Express & Star Thousands on Award Enquiry Ceremony Story on: NHS http://www.expressandstar. organisations in the com/news/2014/09/29/healt Black Country and h-groups-spend-thousands- Staffordshire have on-awards-ceremony/ spent thousands of pounds sending staff http://www.dudleyccg.nhs.u and guests to awards k/wp- ceremonies. content/uploads/2014/09/H ealth-Groups-Spen- Thousands-on-Award- Ceremonies.pdf Media Enquiry Response on behalf of Response to Express & Dudley CCG Star http://www.dudleyccg. Update on Urgent Care nhs.uk/wp- from Express & Star content/uploads/2014/10/M edia-Response-Express- Star-UCC-Update-30-Sep- 2014.docx
Communications and Engagement with our Member Practices
In a bid to further improve the effective cascade of information to our member practices, we held a series of discussions with GPs through locality meetings, Clinical Forum and Clinical Executive about what they wanted from our corporate communications. As a result of feedback from GPs, we introduced a the end of August a new weekly email brief designed to redcue the number of emails sent out, summarise key issues and raise awareness of who the clinical and managerial leads are for key areas of work.
This is supported by a protocol to prioritise messages to GPs and further reduce the amount of email ‘noise’ – a subject many of them were keen to see the CCG tackle.
6 | Page We have received feedback since the launch of this new communication protocol which suggests that not all practices or CCG staff are fully embracing it. The CCG Head of Communications believes that if we continue to promote a single source of information this will become embedded and accepted so long as the information contained within it remains timely, relevant and consistent.
Views from Members on GP Workforce
The Communications & Engagement team are producing a short video on views from GP Members and VTS GPs to highlight what makes Dudley a good place to be a GP. The aim is for this insight to inform a future campaign to promote Dudley and hopefully help our GP workforce.
Practice Pefect
Practice perfect is a new scheme developed with Dr Jas Rathore to create useful videos for practices on topics such as CQC registration visits. The first 2 films have been produced and promoted through members news and give highlights from 2 practices who have undergone recent visits from the CQC. They include useful tips on what the inspectors are looking for and how to improve practice procedures ahead of the visits.
Laura Broster
Head of Communications
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DUDLEY CLINICAL COMMISSIONING GROUP BOARD
Date of Report: 13 November 2014 Report: Dudley Health and Wellbeing Board Report Agenda item No: 7.1
TITLE OF REPORT: Report of the Dudley Health and Wellbeing Board
To advise the Board of matters considered by the Dudley Health and PURPOSE OF REPORT: Wellbeing Board
AUTHOR OF REPORT: Neill Bucktin, Head of Commissioning
MANAGEMENT LEAD: Neill Bucktin, Head of Commissioning
CLINICAL LEAD: Dr David Hegarty, Chair of the Governing Body
1. The Health and Wellbeing Board has been the subject of a peer challenge by the Local Government Association 2. Approval has been given to the Better Care Fund (BCF) Plan and the outcome of the national assurance process is now awaited 3. The updated Joint Strategic Needs Assessment (JSNA) has been KEY POINTS: approved 4. A presentation on the implications of the Care Act has been received 5. An alcohol strategic framework has been approved 6. A presentation has been received from young people on their experiences of accessing primary care
That matters considered by the Health and Wellbeing Board be RECOMMENDATION: noted None arising directly from this report. The financial implication of the BCF FINANCIAL IMPLICATIONS: are dealt with in the finance report
WHAT ENGAGEMENT HAS None TAKEN PLACE: Decision ACTION REQUIRED: Approval Assurance
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DUDLEY CLINICAL COMMISSIONING GROUP – 13 NOVEMBER 2014 REPORT OF THE HEALTH AND WELLBEING BOARD
1.0 INTRODUCTION
1.1 The Health and Wellbeing Board, a statutory committee of Dudley MBC, met on 30th September 2014.
1.2 This report sets out those issues considered by the Board.
2.0 HEALTH AND WELLBEING BOARD PEER CHALLENGE
2.1 Dudley was the subject of a “peer challenge” process, led by the Local Government Association in September.
2.2 The process focused on five particular questions:-
• How is the Board ensuring high levels of engagement from key stakeholders including clinicians and providers? • How does the Board ensure it adds value/makes a real impact? • How does the Board build capacity of individual members and collective capability to drive change and integration and champion health and wellbeing issues? • How far have health and wellbeing objectives been embedded across the Council?
2.3 Initial verbal feedback was given to senior managers and Board members at the end of the process and a formal outcome is now awaited. This will be reported to the Clinical Development Committee.
3.0 BETTER CARE FUND
3.1 The Board has approved the BCF Plan, originally submitted in line with the national deadline of 19th September. In addition, the Finance and Performance Committee has received a separate report on this.
3.2 At the time of writing this report, the outcome of the national assurance process for the plan is expected and this will be reported to the Board verbally.
4.0 JOINT STRATEGIC NEEDS ASSESSMENT (JSNA)
4.1 The Board has considered the updated JSNA.
4.2 This has been used to inform the BCF Plan referred to above and will be used to refresh the CCG’s Operational Plan, in the light of new planning guidance from NHS England expected to be received in December 2014.
5.0 THE CARE ACT
5.1 The Board has received a presentation on the implications of the Care Act which legislates, inter alia, for:-
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• the findings of the Dilnot report on the funding of adult social care; • the recommendations of the Mid-Staffordshire report; • the BCF.
6.0 ALCOHOL STRATEGIC FRAMEWORK
6.1 The Board has approved a strategic framework based around both downstream interventions and the tackling of wider social determinants. This includes:-
• local regulation; • advocating national policy change; • control of local licensing and retailing; • addressing risk taking behavior • promotional work with schools and colleges; • public mental health.
7.0 THE EXPERIENCES OF YOUNG PEOPLE ACESSING PRIMARY CARE
7.1 The Board received a presentation form young people on their experiences of accessing primary care.
7.2 This will be considered by the Primary Care Development Committee at their November meeting.
8.0 RECOMMENDATION
8.1 That the report of the Health and Wellbeing Board be noted.
Neill Bucktin Head of Commissioning October 2014
3 | Page
DUDLEY CLINICAL COMMISSIONING GROUP BOARD
Date of Report: 13 November 2014 Report: Quality & Safety Committee Report Agenda item No: 8.1
TITLE OF REPORT: Report from the Quality & Safety Committee
To provide on-going assurance to the Governing Body regarding quality PURPOSE OF REPORT: and safety in accordance with the CCG’s statutory duties.
Ruth Edwards, Clinical Executive Lead for Quality AUTHOR(s) OF REPORT: Rebecca Bartholomew, Chief Quality & Nursing Officer MANAGEMENT LEAD: Rebecca Bartholomew, Chief Quality & Nursing Officer
CLINICAL LEAD: Ruth Edwards, Clinical Executive Lead for Quality
Report of the Quality and Safety Committee Meetings held on 16 September 2014 and 21 October 2014. KEY POINTS: • Patient Safety • Updated Mortality Data
The Board is asked to accept this report as a source of on-going assurance that the CCG Quality & Safety Committee continues to RECOMMENDATION: maintain forensic oversight of all clinical quality standards in line with the CCG’s statutory duties.
FINANCIAL IMPLICATIONS: None to report
User experience is an essential component of quality assurance and WHAT ENGAGEMENT HAS surveillance and as such public views and feedback form part of the TAKEN PLACE: triangulation of hard and soft intelligence.
Assurance ACTION REQUIRED: Approval Decision
1 | Page DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 13 NOVEMBER 2014
QUALITY & SAFETY COMMITTEE REPORT TO GOVERNING BODY
1. INTRODUCTION
1.1 The CCG Quality & Safety Committee meets monthly and is chaired by Dr Ruth Edwards, Clinical Executive Lead for Quality. This report is a material summation of the Committee’s meetings in September and October 2014.
1.2 The Governing Body will be briefed on any contemporaneous matters of consequence arising after submission of this report at its meeting.
2. NATIONAL ISSUES
Patient Safety Collaboratives
2.1 This is a new national programme aimed at improving safety of patients and ensuring continual learning. Headlines from the programme are:
• Patient Safety Collaboratives (PSCs) will be co-ordinated by NHS England and NHS Improving Quality to ensure that the most effective and successful solutions are rapidly spread and adopted across England; • A network of 15 PSCs will be established; • Each network will be led by an Academic Health Science Network (to provide a unique combination of NHS, academia, third sector and industry partners and work across defined geographical areas); • The focus will be on improving safety and empowering patients, carers and staff to highlight, challenge and implement local improvements in patient care; • PSCs will bring together patients, healthcare staff and other partners from across the health and care economy to determine their local patient safety priorities and to develop and implement solutions to these problems; • Examples of some of the issues that PSCs may tackle on a 'whole patient pathway' basis include reducing infections, pressure ulcers, medication safety ,falls and problems with patient transfers and discharge; • The programme is borne out of Professor Don Berwick's report last year into the safety of patients in England and builds on learning from the Francis and Winterbourne View recommendations.
The implications for the CCG will be discussed at a future Quality and Safety Committee.
3. ITEMS DISCUSSED
3.1 The following sections provide a brief update on issues discussed by the Committee, or matters arising of which the Governing Body need to be aware.
4. DUDLEY GROUP FOUNDATION TRUST (DGFT)
Unannounced Visit
4.1 A summary of the findings of the visit team, along with DGFT’s action plan, is provided in a separate report to the private session of the Board.
2 | Page Discharge information
4.2 Attendance at a table-top review meeting in August 2014 in relation to a Serious Incident investigation revealed a problem with electronic discharge letters whereby information was not reliably reaching GP practices. Further discussions took place at the Clinical Executive team meeting on 13 August 2014, and DGFT’s Chief Clinical Information Officer presented a report to the Clinical Executive on 8 October 2014. This highlighted the complexities of the electronic system and the interface with primary care.
4.3 DGFT is ensuring that discharge letters are posted to GP practices and that every patient is given a paper copy of their discharge letter to confirm changes in treatment plan and medication updates. Plans are in place for DGFT and the CCG to carry out joint reviews on the electronic letter process. The initial audit suggests there may be problems with receipt and processing of letters in practices as well as the sending of information from DGFT. EMIS is undertaking an investigation within practices to understand and resolve the issue. An action plan has been developed and is being monitored by the Task & Finish Group. It is difficult to predict when all actions in the action plan will be fully implemented as a number are dependent on our Providers and third party private companies. The Board should be assured however that all actions are being proactively managed to reduce risk to patients.
4.4 A response has been made by DGFT to a National Patient Safety Agency (NPSA) alert which has been sent out from NHS England regarding communication between secondary and primary care highlighting the local issues and our joint response to these concerns. The CCG has requested GPs to inform us of any clinical incidents that have come about due to non- receipt of a discharge letter.
Mortality
4.5 Hospital Standardised Mortality Ratios (HSMR) compares the expected rate of death in a hospital with the actual rate of death.
4.6 Summary Hospital-level Mortality Index (SHMI) covers deaths after hospital treatment and up to 30 days after discharge.
4.7 New HSMR and SHMI mortality data has been released (end October 2014) and this will be presented in full at the November 2014 Quality & Safety Committee. The source of this data is the Healthcare Evaluation Data tool (HED Tool).
4.8 In the meantime, the graphs shown below (Figures 1 & 2) reflect that DGFT is not an outlier.
Figure 1: DGFT – HED HSMR (July 2013 to June 2014) Funnel Plot
Source: HED Tool (extract on 16/10/14)
3 | Page 4.9 In this instance DGFT is not an outlier with a HED HSMR of 101 (confidence intervals of 95 and 106). Figure 2: DGFT – HED SHMI (July 2013 to June 2014) Funnel Plot
Source: HED Tool (extract on 16/10/14)
4.10 In this instance DGFT is not an outlier with a HED SHMI of 102 (confidence intervals of 97 and 106).
4.11 There are no Care Quality Commission / Dr Foster Intelligence mortality outlier alerts in relation to DGFT.
Serious Incident reporting and management
4.12 Provider organisations reporting Serious Incidents (SIs) are required to submit a completed Root Cause Analysis (RCA) investigation tool to complete the investigation process and provide appropriate assurance to the CCG. There is a timeline of 45 working days for submission of RCAs related to SIs. The RCA should demonstrate learning which has taken place and improvements which have been introduced as a result of the SI.
4.13 Figure 3 (below) provides an update of SIs reported by DGFT on the national Strategic Executive Information System (STEIS) for 2014/15 to date, 2013/14 (by quarter) and 2012/13.
Figure 3: Serious Incidents reported by DGFT
2014/15 Subject Jul 2014 Jul 2012/13 2013/14 Jun 2014 Jun Apr 2014 Apr 2014 Sep Aug 2014 Aug May 2014 Q1 2013/14 Q1 2013/14 Q2 2013/14 Q3 2013/14 Q4 Q1 2014/15 Q2
Total SIs 207 28 28 42 45 143 13 15 11 39 37 24 34 95 reported Source: STEIS – by date reported
4.14 The Board will note the increase in the reporting of SIs from Q1 to Q2. This is largely due to an increase in the reporting of community pressure ulcers by DGFT. These pressure ulcers were not previously recorded on STEIS. Considerable work has been done with DGFT and the Area Team over the last year to establish and address this reporting issue.
4 | Page 4.15 It should also be noted that Figure 3 shows the number of SIs which were reported each month by DGFT, and that this is unvalidated data. The data is subject to change once DGFT and Dudley CCG have validated the outcome of individual RCAs. We encourage a high reporting culture, and this sometimes means that DGFT may report an incident as an SI which, after full investigation has taken place, does not meet the national criteria set out by the Department of Health. In such an instance, the SI would be removed from the national STEIS records.
4.16 A report detailing Q2 SIs will be presented to the November 2014 Quality & Safety Committee and subsequently to the next Board meeting. Any identifiable themes will be followed up via CQRM.
4.17 On-going liaison is taking place with DGFT to gain assurance that the medical equipment manufacturer involved in an SI (reported in April 2014) has agreed that equipment failure was the cause of the incident before a request for closure is submitted to the Area Team.
Never Events
4.18 Never Events are defined by NHS England as “serious, largely preventable patient safety incidents that should not occur if the available preventative measures have been implemented”. They include incidents such as wrong site surgery, retained instrument post operation, or wrong route administration of chemotherapy.
4.19 Figure 4 (below) shows the number of Never Events reported by DGFT on the national Strategic Executive Information System (STEIS) for 2014/15 to date, 2013/14 (by quarter) and 2012/13.
Figure 4: Never Events reported by DGFT
2013/14 Subject Jul 2014 Jul 2012/13 2013/14 Jun 2014 Jun Apr 2014 Apr 2014 Sep Aug 2014 Aug May 2014 Q1 2013/14 Q1 Q2 2013/14 Q3 2013/14 Q4 2014/15 Q1 2014/15 Q2
Never Events 1 0 0 1 0 1 0 0 0 0 0 0 1 1 reported Source: STEIS – by date reported
4.20 DGFT reported a Never Event in September 2014. At the time of reporting, the incident is under investigation and the outcome of DGFT’s findings is awaited. At this early stage, the Quality team has no immediate concerns about this incident.
Falls resulting in Harm
4.21 Figure 5 (below) shows: • a month-by-month breakdown of Slips / Trips / Falls (resulting in harm) reported onto STEIS by DGFT to date during 2014/15 • a quarterly breakdown of Slips / Trips / Falls (resulting in harm) reported onto STEIS by DGFT during 2013/14.
4.22 “Severe injury” is consistently classified by the Quality team as a debilitating fracture, i.e. fractured neck of femur, fractured pelvis. This is a local indicator agreed by the Quality & Safety Committee.
5 | Page Figure 5: Falls resulting in harm recorded by date of entry onto STEIS
Subject Jul 2014 Jul 2013/14 Jun 2014 Jun Apr 2014 Apr 2014 Sep Aug 2014 Aug May 2014 Q1 2013/14 Q1 2013/14 Q2 2013/14 Q3 2013/14 Q4 2014/15 Q1 2014/15 Q2
Falls resulting in harm 1 1 3 7 12 0 0 0 0 2 2 3 7 Falls resulting in severe injury 3 4 4 5 16 1 1 1 3 1 3 1 5 Total Falls 4 5 7 12 28 1 1 1 3 3 5 4 12 Source: STEIS – by date reported
4.23 Five falls occurring in Q2 2014/15 resulted in severe injury, the details of which are: • Four hip fractures; • A dislocation of an earlier hip replacement.
4.24 None of these patients died as a result of their falls.
4.25 Figure 6 (below) shows information about falls resulting in harm, sourced from the NHS Safety Thermometer between March 2012 and September 2014, and reflects DGFT’s position against national results and the median level based on the proportion of patients. The overall trend between March 2012 and September 2014 appears below national results.
Figure 6: Falls resulting in harm
4.26 Slips / trips / falls which do not result in harm are recorded by DGFT on their own internal incident reporting database. There is no requirement for Provider organisations to record details of all falls on STEIS.
4.27 Falls have been a key feature of discussions with DGFT at CQRMs, particularly around risk assessments and roll out of the falls care bundle. Falls featured as one of the main themes of discussions at the August 2014 DGFT CQRM and the Quality team will continue to monitor and maintain oversight of falls data.
6 | Page Grade 3 and Grade 4 pressure ulcers
4.28 DGFT continues to do a significant amount of work to eliminate avoidable pressure ulcers. From July 2014, acute and community services at DGFT have been consistently reporting pressure ulcers. This has resulted in the increase in SIs attributable to pressure ulcers, primarily reported from community settings. Work is underway to further understand this trend and identify areas for improvement.
4.29 Figures 7a and 7b (below) shows a month-by-month breakdown of pressure ulcers reported onto STEIS by DGFT to date during 2014/15, a quarterly breakdown of pressure ulcers reported onto STEIS by DGFT during 2013/14, and the number of pressure ulcers reported onto STEIS by DGFT during 2012/13. The tables also reflect the split between hospital- acquired and community-acquired pressure ulcers from July 2014 for reference purposes.
4.30 Information from 2013/14 and Q1 2014/15 is being audited at present to determine additional historical detail about hospital-acquired and community-acquired pressure ulcers.
Figure 7a: Incidence of Grade 3 pressure ulcers
Grade 3 YTD Jul 2014 Jul 2012/13 2013/14 2014/15 Jun 2014 Jun Apr 2014 Apr 2014 Sep Aug 2014 Aug May 2014 Q1 2013/14 Q1 2013/14 Q2 2013/14 Q3 2013/14 Q4 2014/15 Q1 2014/15 Q2
Community 13 7 13 33 Hospital 10 9 7 26 Total 45 1 2 13 18 34 5 5 3 13 23 16 20 59 72 Source: STEIS – by date reported
Figure 7b: Incidence of Grade 4 pressure ulcers
Grade 4 YTD 2013/14 Jul 2014 Jul 2012/13 2013/14 2014/15 Jun 2014 Jun Apr 2014 Apr 2014 Sep Aug 2014 Aug May 2014 Q1 2013/14 Q1 2013/14 Q2 2013/14 Q3 Q4 2014/15 Q1 2014/15 Q2
Community 0 0 1 1 Hospital 1 0 0 1 Total 50 1 0 0 0 1 0 0 0 0 1 0 1 2 2 Source: STEIS – by date reported
4.31 The numbers of pressure ulcers for Q2 2014/15 shown in the tables above are submitted but not yet validated, and may be subject to change depending on the findings and outcomes of DGFT’s RCA investigations and whether the CCG Quality team agree with any request for reclassification or downgrading.
4.32 A total of 74 pressure ulcers have been reported by DGFT year-to-date (April to September) during 2014/15, with 72 reported as Grade 3 and two reported as Grade 4.
4.33 Figure 8 (below) shows information about pressure ulcers of new origin (grades 2-4), sourced from the NHS Safety Thermometer between March 2012 and September 2014, and reflects DGFT’s position against national results and the median level based on the proportion of patients.
4.34 The proportion of patients with a pressure ulcer of new origin at DGFT has an overall downward trend between March 2012 and September 2014 despite some spikes, most noticeably in April 2012 (when it was at its peak) and July 2012. The proportion has dropped from being in line with or above the national rate to below it from January 2013, though the
7 | Page gap does appear to be closing in more recent months, which may reflect the increased reporting.
Figure 8: Pressure ulcers
Safety Thermometer
4.35 The NHS Safety Thermometer provides a quick and simple method for surveying patient harm free care and analysing results so that this can be measured and monitored over time. For acute providers this focuses on reducing the incidence of four harms; pressure ulcers, venous thromboembolism, catheter acquired urinary tract infections, and falls. This provides organisational context for the services we commission.
4.36 Analysis regarding falls and pressure ulcers is shown in sections 4.22 to 4.28 and 4.29 to 4.35 of this report.
4.37 The incidence of venous thromboembolism demonstrates a low number of occurrences. The risk assessment and prophylaxis are areas to be addressed via a CQRM themed review.
4.38 Catheter acquired urinary tract infections show both a low occurrence of catheter insertion and also associated urinary tract infections.
4.39 The methodology is to audit a sample of patients from across the Trust each month. Figure 9 (below) shows the percentage of sampled patients reported by DGFT as having no harm identified, and reflects the consistently high levels of harm free care reported by DGFT. The results reported by DGFT are in line with peer Trusts.
8 | Page Figure 9: Harm Free Care reported by DGFT September 2013 – September 2014
Friends and Family Test (FFT)
4.40 FFT scores can range from -100 to +100. The higher the score, the better reported patient experience.
4.41 There are three indicators in 2014/15 – Inpatients, A&E and Maternity.
Inpatient
4.42 2014/15 CQUIN guidance confirms funding will be based on increasing and/or maintaining response rates in inpatient services (30% by Q4 2014/15), and for reducing (or maintaining at zero) negative responses from inpatient services.
4.43 Figure 10 (below) shows that DGFT’s Inpatient FFT scores are generally higher than the national score, and have been equal to or above the national score since May 2013.
4.44 However, the Inpatient response rate has been below 30% for the last five months, whilst the national response rate is currently at 36.9% (September 2014).
Figure 10: FFT scores and response rate for inpatient services at DGFT
Source: NHS England Source: NHS England
9 | Page A&E
4.45 2014/15 CQUIN guidance confirms funding will be based on increasing and/or maintaining response rates in A&E (to 20% by Q4 2014/15), and for reducing (or maintaining at zero) negative responses from A&E.
4.46 Figure 11 (below) shows that DGFT’s A&E FFT scores have generally been higher than the national score since September 2013, with one exception in May 2014 (DGFT achieved a score of 53, the national score was 54). DGFT’s score for August 2014 improved for the third consecutive month (to 71) which is approaching DGFT’s highest score since reporting began (73).
Figure 11: FFT scores and response rate for A&E at DGFT
Source: NHS England Source: NHS England
Maternity
4.47 FFT is operational in maternity services across four touch-points (antenatal, birth, postnatal ward and postnatal community). DGFT continues to do better than the national average at all these stages based on the information shown below in Figure 12 (below).
Figure 12: FFT scores for maternity service at DGFT
Source: NHS England Source: NHS England
10 | Page
Source: NHS England Source: NHS England
4.48 DGFT has consistently scored above the national score in all Maternity FFT results since May 2014, although it should be noted that DGFT’s Antenatal score (Question 1) for August 2014 matched the England score (66).
Clinical Quality Review Meeting (CQRM)
4.49 CQRMs are held monthly with DGFT together with other associate commissioners and colleagues from the Office of Public Health as appropriate. All stakeholder commissioners receive copies of reports and minutes. Meetings are focused on reviewing the quality of care given supported by surveillance data and reports and data / analysis. Meetings are attended by senior management from DGFT and CCG(s) and operate on the basis of scrutiny and challenge. All providers are now subject to monthly meetings and have a schedule of dates going forward.
4.50 Any issues of concern are referred to Quality & Safety Committee and have been included in this report.
5. DUDLEY & WALSALL MENTAL HEALTH TRUST (D&WMHT)
Serious Incident reporting and management
5.1 Serious Incident (SI) notification and Root Cause Analysis (RCA) reports relating to Dudley patients are received directly from D&WMHT. Investigation reports are reviewed by the Quality Team. Issues are addressed via monthly CQRMs.
Never Events
5.2 There have been no Never Events reported by D&WMHT.
Safety Thermometer
5.3 The safety thermometer is a national initiative focused on reducing harm at the point of care – in mental health providers this focuses predominantly on reducing harm related pressure ulcers and falls, other work looks at reducing the risk of harm from violence and aggression and at the point of handover. This provides organisational context for the services we commission.
11 | Page Figure 13: Harm Free Care reported by D&WMHT September 2013 – September 2014
5.4 There are no concerns relating to safety thermometer data.
Friends and Family Test
5.5 As previously reported, updated guidance from DoH confirms that reporting on Friends and Family Test (FFT) has been deferred to January 2015 for mental health trusts. The Quality team will continue to monitor this and present information to the Quality & Safety Committee when data has been published.
Clinical Quality Review Meetings
5.6 A themed approach to future CQRMs is being devised. Items discussed at CQRM are reported to the Quality & Safety Committee. Workforce issues / Mutually Agreed Resignation Scheme
5.7 D&WMHT is undergoing a staff realignment process, involving a Mutually Agreed Resignation Scheme (MARS). D&WMHT has provided updated information regarding workforce plans to provide assurance that the quality of care provided to patients would not be compromised. The Quality team will continue to monitor this issue via CQRM using Quality Impact Assessments.
6. BLACK COUNTRY PARTNERSHIP FOUNDATION TRUST (BCPFT)
Whistle-blowing
6.1 The CCG received recent contact from the Area Team regarding a whistle-blowing allegation. BCPFT has provided assurance that this was a historical issue (from October 2013) which the Trust was aware of and had dealt with appropriately. Assurance has been received that any future whistle blowing allegations will be escalated to the CCG in a timely manner.
12 | Page CQC Unannounced Visit
6.2 CQC undertook an unannounced visit to Penn Hospital on 21 August 2014, in response to a whistle-blowing allegation. BCPFT has reported that CQC indicated verbally after the visit that they were satisfied with compliance and no concerns were identified. Publication of the report is awaited. There are currently no Dudley patients at Penn Hospital.
Serious incident reporting and management
6.3 Receipt of Serious Incident (SI) notification and Root Cause Analysis (RCA) reports continues via Wolverhampton CCG. No SIs were reported during August and September 2014, and the Quality team is in the process of ascertaining the total number of SIs during 2014/15. Issues would be addressed via monthly CQRMs.
Never Events
6.4 There have been no Never Events reported by BCPFT.
Safety Thermometer
6.5 The safety thermometer is a national initiative focused on reducing harm at the point of care – in mental health providers this focuses predominantly on reducing harm related pressure ulcers and falls, other work looks at reducing the risk of harm from violence and aggression and at the point of hand over. Figure 14 (below) shows the high reporting percentage of harm free care at BCPFT, this is one of the highest figures across the country, and provides organisational context for the services we commission.
Figure 14: Harm Free Care reported by BCPFT September 2013 – September 2014
Patient Experience / Friends and Family Test
6.6 As previously reported, updated guidance from DoH confirms that reporting on Friends and Family Test (FFT) has been deferred to January 2015. The Quality team will continue to monitor this and present information to the Quality & Safety Committee when data has been published.
13 | Page Clinical Quality Review Meetings
6.7 Monthly CQRMs continue to be held. BCPFT is now compliant with reporting data at strategic and service level. Greater scrutiny is now in place to ensure that services delivered are effective and responsive to new legislation with regard to children’s services.
6.8 A presentation on Speech and Language therapy (SALT) was received at the October 2014 CQRM. There is currently an 18 week waiting list for SALT which is being addressed with a recovery plan.
7. INDEPENDENT PROVIDERS UPDATE
7.1 Dudley CCG commissions services from Ramsay Healthcare at its West Midlands Hospital. There are no quality concerns to report.
8. HEALTHCARE ASSOCIATED INFECTION
8.1 The Office of Public Health (OPH) provide support and advice to the CCG on Infection, Prevention and Control matters, and provide epidemiology reports to the CCG which are discussed by the Quality & Safety Committee.
C difficile
8.2 For 2014/15, C difficile thresholds have been set at 48 cases for DGFT and 108 cases for the CCG. At the time of reporting, OPH had published their latest weekly report (dated 30 October 2014) and there have been 15 confirmed cases at DGFT and 39 confirmed cases within the community (CCG attributed), which are both below trajectory.
MRSA
8.3 In 2014/15 the MRSA threshold set is zero for DGFT and the CCG.
8.4 There has been one case of MRSA reported to date (in September 2014). This has been assigned to Dudley CCG.
9. SAFEGUARDING CHILDREN
9.1 The CCG continues to ensure that it meets its statutory functions regarding the safeguarding of children. The Designated Senior Nurse post meets NHS England accountability framework and Working Together 2013 requirements and the post-holder works closely with other members of the team including the Designated Doctor. A Named GP has been appointed by the CCG. The post will equate to two sessions per week and the post holder will work closely with the Designated Senior Nurse to engage GP practices in safeguarding children training and the wider safeguarding remit.
9.2 The safeguarding review commissioned by Dudley CCG has been completed and a draft report will be discussed week commencing 3 November 2014. Once the final report is received, it will be presented to the Quality and Safety Committee and the CCG board.
Looked After Children
9.3 There are currently 750 Looked After Children (LAC) in Dudley. The Designated Senior Nurse is working with other Designated colleagues in neighbouring areas to develop an equitable system to ensure that LAC assessments are undertaken in a timely fashion within the Black Country. This will also enable the CCG to ensure health assessments are appropriately quality assured. The DoH LAC checklist tool should now be completed by the
14 | Page health assessor for all LAC (both in and out of borough) and will be reviewed by the responsible commissioner / designated professional to support payment against the agreed quality.
9.4 In response to the issue of abuse of LAC in light of the Rotherham enquiry, the Designated Nurse for Safeguarding Children will be speaking to staff in local children’s homes to determine their experiences of potential sexual exploitation of LAC within Dudley and any perceived risks to the young people who are currently in residential care. Dudley has an established multi agency operational panel that discusses individual cases of disclosed or potential sexual exploitation and a Vulnerable Children and Young Persons Group who take a strategic lead on the Child Sexual Exploitation agenda.
9.5 The Quality & Safety Committee was assured that NHS England was aware of this issue. Statutory guidance for LAC is currently being updated.
10. SAFEGUARDING ADULTS
Individual Care Home Provision
10.1 The CCG is working with Social Care to establish a Risk Register for all care homes, and ongoing work is continuing within the CCG for additional resource for an enhancement to the continuing and intermediate care teams.
Dudley Safeguarding Adults Board and Dudley Safeguarding Children Board – Review of Safeguarding at DGFT
10.2 A number of concerns were raised about care and treatment at DGFT (including allegations of unlawful restraint via whistle-blowers, media coverage and CQC in January 2014, a peer challenge exercise into adult safeguarding, and further media coverage in May 2014).
10.3 The executive summary of the Safeguarding Review has been published on the Dudley Safeguarding Board website, and includes: • Reasons for the review • Timeline of events • Findings • Conclusions and recommendations
10.4 There are no causes for concern and no further action required.
11. CONTINUING HEALTH CARE
11.1 Work is being undertaken to establish the number of outstanding assessments. Scheduled reviews have started and there is a plan in place to recruit additional staff to the Continuing Health Care team to reduce the number of outstanding assessments. Commitment remains to ensure all patients receive an annual review. Further detail and update will be provided to the next Board meeting.
12. NATIONAL REGULATORS
Care Quality Commission (CQC)
Inspection at DGFT
12.1 CQC undertook a visit to DGFT in March 2014 as part of a national review of the 14 Trusts reviewed by NHS England following identification of concerns regarding mortality rates. The CQC inspection included two days on site and focused on eight services. A summit meeting
15 | Page took place on Monday 23 June 2014. At the time of reporting, CQC has not published its report. It is understood that the CQC report will be available by 17 November 2014 at the earliest. Progress is being monitored via monthly CQRM.
Inspection at D&WMHT
12.2 CQC undertook a visit to D&WMHT in February 2014. D&WMHT presented an action plan complying with identified actions at the September 2014 CQRM, which has provided appropriate assurance. There are a number of actions which are due to be completed in December 2014 and one action which is due to be completed in March 2015. Progress will be monitored via CQRM.
13. MEDICINES MANAGEMENT
13.1 The Specialist in Pharmaceutical Public Health from the Office of Public Health attended the October Quality & Safety Committee meeting to discuss Hospital Admissions Relating to Medicine (HARMS) and Medicines Safety.
Hospital Admissions Relating to Medicine (HARMS)
13.2 The HARMS project continues a theme of medicines management review that has been undertaken by practices in previous years. Some analysis of work reports from the Practice Based Pharmacist (PBP) team enabled them to prioritise interventions relating to HARMS which the PBPs were involved in at practice level.
Medicines Safety
13.3 In order to meet the requirements of the March 2014 MRHA and NHS England Stage 3 (Directive) Patient Safety Alert Improving medication error incident reporting and learning, the Specialist in Pharmaceutical Public Health has been identified as the Medication Safety Officer (MSO), and the CCG’s Quality & Safety Committee will regularly review medication error incident reports, improve learning, and take local action to improve medicines safety.
14. QUALITY VISITS
14.1 A timetable of announced and unannounced visits is being formulated.
15. COMPLAINTS TO CCG
15.1 There are currently 13 active complaints at the time of this report which are reviewed each week at the CCG’s Clinical Executive meeting. There are no common emergent themes.
Complaints Policy
15.2 The Communications & Engagement team brought the new CCG complaints policy to the October 2014 Quality & Safety Committee meeting.
16. RISK REGISTER
16.1 The Quality and Safety Committee reviewed the CCG risk register, added new items during the meetings in September and October, and changes have been submitted to the Audit Committee.
Risk 1 – Effective monitoring of mortality rates This risk would be closed and a new risk opened on mortality rates in general across the system.
16 | Page
Risk 20 – Failure of providers due to quality failures will result in inadequate care for the local population To be closed but create a new risk on specific concerns around providers to also note that the risk score on Risk 20 and Risk 21 should be 20.
Risk 23 – The failure of the CCG to fully understand, effect and deliver its statutory duties for safe guarding to include LAC, DOLs, capacity and finance risks to patient safety Provision is now in place agreed to close and open a new risk to have systems in place with Black Country Partnership for LAC to reflect the risk
17. CONCLUSION
17.1 The Quality & Safety Committee continues to provide forensic oversight of the quality agenda supported by the CCG Quality Team. Any matters of relevance are contained in this report to the Board. If there are material issues that arise after submission of this report, the Chair of the Quality & Safety Committee will provide an oral briefing to the Board.
18. RECOMMENDATIONS
18.1 The Board is asked to accept this report as a source of ongoing assurance that the CCG Quality & Safety Committee continues to maintain forensic oversight of all clinical quality standards in line with the CCG’s statutory duties.
Ruth Edwards, Clinical Executive Lead for Quality Rebecca Bartholomew, Chief Quality & Nursing Officer
November 2014
17 | Page
DUDLEY CLINICAL COMMISSIONING GROUP BOARD
Date of Report: 13 November 2014 Report: Clinical Development Committee Report Agenda item No: 9.1
TITLE OF REPORT: Clinical Development Committee Report
To advise the Board of matters considered by the Clinical Development PURPOSE OF REPORT: st nd Committee on 1 and 22 October 2014
AUTHOR OF REPORT: Mr N Bucktin, Head of Commissioning MANAGEMENT LEAD: Mr N Bucktin, Head of Commissioning CLINICAL LEAD: Dr S Mann, Clinical Executive 1. QIPP progress noted
2. Service developments in relation to the What? Centre, the “Big White Wall” and continence services approved
3. GP Lead for Palliative Care/End of Life approved
4. Pilot community based back pain clinic approved in principle KEY POINTS: 5. Integrated heart failure pathway approved
6. GP prescribing budget setting methodology; policy for engagement with the pharmaceutical industry; assurance framework for clinical policies and guidelines and practice based pharmacists annual report approved
7. Individual Funding Requests (IFRs) half year report received
That matters considered by the Clinical Development Committee be RECOMMENDATION: noted
Financial risks are associated with the non-delivery of QIPP targets. FINANCIAL IMPLICATIONS: These are reported separately to the Finance and Performance Committee
Engagement has taken place in relation to individual proposals WHAT ENGAGEMENT HAS considered by the Committee as necessary through CCG locality TAKEN PLACE: meetings and with relevant patient groups Decision ACTION REQUIRED: Approval Assurance
1 | Page DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 13 NOVEMBER 2014 REPORT OF THE CLINICAL DEVELOPMENT COMMITTEE
1.0 BACKGROUND
1.1 The Clinical Development Committee met on 1st and 22nd October 2014.
2.0 KEY INDICATOR SUMMARY
QIPP
2.1 The Committee has noted current progress in relation to QIPP. A shortfall of £1.925m has been identified against the current QIPP target. This is attributable, in part, to delays with the implementation of some schemes including the community rapid response service and savings in relation to prescribing not being achieved.
2.2 Under achievement in the current year will result in a QIPP target for 2015/16 of £11.186m. Further work will be required in order to identify schemes to achieve this, and this will be the focus of the Committee.
3.0 OTHER MATTERS CONSIDERED BY THE COMMITTEE
The What? Centre – Increased Funding
3.1 The What? Centre delivers a range of therapeutic services to young people between the ages of 13 and 18 years. The service has seen a significant increase in referrals from local GPs in recent times. The Committee has agreed to increase the grant it makes available to the service, alongside a further contribution from Dudley MBC.
The Big White Wall
3.2 This on line therapy service has been commissioned by the CCG historically on a non-recurrent basis.
3.3 Take up of the service, both in terms of online live therapy and the support network service had been good. Feedback from service users and local GPs had been positive.
3.4 The Committee agreed to commission the service until 31st March 2016, to align with the likely timetable for the re-procurement of primary care mental health services.
Specialist Continence Service – 7 Day Working
3.5 The Committee has approved a proposal to invest additional resources in the continence service to support 7 day working and more effective input into care homes. It was anticipated that this would enhance the quality of care available to patients, enhance patient dignity and prevent unnecessary admissions.
GP Clinical Lead – End of Life and Palliative Care
3.6 Given the significance of end of life and palliative care to the CCG’s priorities, the Committee has agreed to pick up the funding of this post, previously funded by Macmillan Cancer Support, on a recurrent basis from January 2015.
Pilot Community Based Back Pain Clinic
3.7 The Committee has approved, in principle, proposals for a community based back pain clinic to operate on a 6 month interim basis, subject to the clarification of a number of technical issues.
2 | Page 3.8 This involves operating an existing out-patient clinic in the community. It is anticipated that efficiencies may be generated through the more efficient management of chronic pain in primary care and a reduction in traditional out-patient attendances.
Integrated Heart Failure Pathway
3.9 The Committee have approved a proposed pathway for heart failure patients designed to integrate acute and community services.
3.10 The proposed pathway will:-
• facilitate admission avoidance and early supported discharge; • provide IV diuretic therapy in the community; • support the community rapid response team; • provide a 7 day service – 8a.m.- 8p.m.
Medicines Management
3.11 The Committee has approved:-
• a methodology for setting GP prescribing budgets; • a policy on engagement with the pharmaceutical industry to be considered by the Audit Committee; • a framework for assuring clinical policies and guidelines; • an annual report from the practice based pharmacists.
Individual Funding Requests (IFRs) – Half Year Report
3.12 The Committee has received a half year report on IFRs.
3.13 To date, £163,420 has been spent on IFRs. It was noted that total IFR requests had fallen by 31.7%.
4.0 RECOMMENDATION
4.1 That matters considered by the Clinical Development Committee be noted.
Dr S Mann, Clinical Executive Mr N Bucktin, Head of Commissioning October 2014
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DUDLEY CLINICAL COMMISSIONING GROUP BOARD
Date of Report: 13 November 2014 Report: NHS 111 West Midlands Procurement Agenda item No: 9.2
TITLE OF REPORT: NHS 111 West Midlands Procurement
This paper forms the introduction to a report on the status and PURPOSE OF REPORT: progress of the NHS 111 West Midlands Procurement.
AUTHOR OF REPORT: Jason Evans – Commissioning Manager for Urgent Care
MANAGEMENT LEAD: Neill Bucktin – Head of Commissioning
CLINICAL LEAD: Dr Steve Mann – Clinical Executive
Upon the collapse of NHS Direct as national provider for NHS111, step-in arrangements were made nationally to ensure the safe continuation of the service prior to commissioning of a market tested provider. In November 2013 West Midlands Ambulance Service (WMAS) provided step-in arrangements and took over the service for 22 CCGs within the West Midlands. Due to the nature and legalities of this step-in arrangement, all CCGs are now required to go to open tender to procure their NHS111 service. WMAS can only continue delivery of the service until September 2015. All CCGs are now charged with procuring a provider for NHS111 and mobilising the KEY POINTS: service by September 2015.
The infrastructure, liabilities and costs associated with providing the NHS111 service significantly challenge a CCG considering the commissioning of the service on an individual basis. A collaborative agreement offers the best option in regards to cost, stability and infrastructure costs.
NHS111 West Midlands Procurement is shortly to begin and Dudley CCG Board must now confirm its intentions with regard to the process.
The Board are asked to:
1. Note for assurance the comprehensive and robust procurement process which is planned for appointing a qualified provider for RECOMMENDATIONS: NHS111 West Midlands.
2. Note for assurance the work being undertaken at a local level to influence the service specification to ensure it is innovative and responsive to the needs of Dudley patients.
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3. Agree to join in a planned procurement to be delivered through one combined process for all West Midlands CCGs.
4. Agreed to a restrictive procurement process to be undertaken and led by Sandwell & West Birmingham CCG (S&WB CCG) with representation throughout from Dudley CCG.
5. The Board to note the procurement process deadlines and timeframe.
6. The Board to agree to sign the enclosed Memorandum of Understanding with Sandwell & West Birmingham CCG.
7. The Board to note the supply market briefing event to be held on 12th – 13th November 2014 and a CCG Board member to be nominated to attend these events.
8. The Board to note that the NHS111 West Midlands Service specification must be signed off by all CCGs before 9th January 2015 and where possible earlier.
9. The Board to agree that Jason Evans, Urgent Care Commissioning Manager be the nominated evaluator for Dudley CCG throughout the procurement process
£992,040 for Dudley CCG if single lot is chosen by the 22 CCGs within the current commissioning collaborative. Dudley CCGs current FINANCIAL IMPLICATIONS: forecast outturn for 2014/15 (Month 6 data) for NHS111 delivered by WMAS is £1,001,000.
National engagement and media campaign underway. Various WHAT ENGAGEMENT HAS correspondents and check-point reports issued by S&WB CCG to the TAKEN PLACE: commissioning collaborative. Dudley specific patient/ public engagement planned throughout Q4 2014/ 15 and 2015/ 16.
Assurance ACTION REQUIRED: Decision Approval
2 | Page DUDLEY CLINICAL COMMISSIONING GROUP BOARD - 13 NOVEMBER 2014 NHS 111 WEST MIDLANDS PROCUREMENT
1.0 Introduction
1.1 Due to the nature and legalities of the step in arrangements, CCGs are now required to go to open tender to procure their NHS111 service. WMAS can only continue delivery the service until September 2015. The CCGs are now charged with procuring their NHS111 service and mobilising the service by September 2015.
1.2 The current NHS111 service is led by S&WB CCG under a collaborative lead commissioner model. Following review of an options appraisal exercise with all 22 CCGs, it was agreed S&WB CCG, led by the Accountable Officer, Andy Williams would continue to be Lead Commissioner for the service and mobilise an expert team to lead the regional procurement and mobilisation.
2.0 Purpose
2.1 The purpose of this paper is to set out the proposed high level approach and plan for the procurement exercise for approval and sign off by Dudley CCG Board and to provide an interim update on progress to date.
The specific elements to be signed off comprise the following:
a. Procurement Scope and Lot Strategy b. Procurement Route c. Procurement Plan d. Supplier Briefing Event e. Core 111 contract specification f. Procurement Team
3.0 Procurement Scope and Lot Strategy
3.1 The planned collaborative procurement will cover the NHS111 requirements of all West Midlands CCGs. In order to achieve a level of regional consistency, to take advantage of potential economies of scale and to allow for local elements to be incorporated, the services need to be procured in one combined process as a collaborative. Each CCG has the opportunity to contribute to the development of the specification and evaluation of bidders.
3.2 Legal and procurement advice has been taken, on how to structure the procurement of lots if CCGs choose a model separate to the collaborative approach. Legal advice indicates that if a CCG considered a separate lot they may be liable for TUPE and/ or redundancy costs of current WMAS NHS111 staff. In regards to value for money Appendix 1 illustrates that should a CCG choose to move away from the collaborative approach the financial envelope required to purchase the service increases significantly.
Decision Requiring Sign-Off: Dudley CCG agrees to be incorporated into a single lot and combined procurement process with other West Midlands CCGs.
4.0 Procurement Route
4.1 The services included within scope of the competitive procurement process for NHS111 in the West Midlands have been identified as predominantly pertaining to the category of services known as “Part B” under the Public Contracts Regulations 2006. This means that the
3 | Page procurement is not subject to the full implications of minimum timeframes applicable to “Part A” services under the regulations.
4.2 Notwithstanding this principle, the selected procurement route will follow key elements of the Restricted Procedure as these are seen as familiar to commissioners and suppliers and represent a well-recognised good practice approach.
4.3 The procurement will therefore take the form of a two-stage process with a Pre-Qualification Stage occurring initially in which suppliers will be asked to provide evidence of their financial and economic standing and of their existing capabilities as relevant to this process. The second stage will invite a qualifying subset of suppliers to tender for the service by submitting a full response to the service requirements.
4.4 The process will be advertised both in Contracts Finder and through the Official Journal of the European Union in order to notify a broad supply base in an open and transparent manner. Following a competitive tendering process S&WB CCG has recently appointed Deloittes to provide commissioning and procurement support to the process
Decision Requiring Sign-Off: The procurement of 111 services for West Midlands will follow a two-stage process advertised through open channels and following good practice elements of the Restricted Procedure; the full implications of the Public Contracts Regulations do not apply to this procurement process as the services are predominantly Part B in nature.
5.0 Procurement Plan
5.1 The current timelines for the Procurement Plan have been developed based on the key milestones associated with the procurement process itself, and taking into consideration the need to decommission current arrangements and transition to a new provider(s) by September 2015.
5.2 A further consideration has been the General Elections scheduled for May 7th 2015 and the pre-election Purdah period commencing on 30th March. The current procurement plan will seek to award the contract prior to the commencement of Purdah in order to allow for sufficient transition time for the new service.
5.3 Contingency options will be considered where necessary to mitigate against risks of potential delay. Indicative planned milestones are highlighted in the table below (a diagram presenting the current plan is included in the Appendix 2 to this paper).
5.4 Dudley CCG has recently begun raising awareness of the NHS111 procurement process with local Patient Participation Groups and Dudley Patient Opportunity Panel. Regular patient and media communications on the process and outcome of the procurement will be issued by S&WB CCG and these will signed-off by the CCG Communications Team prior to distribution. On the 11th December 2014 Dudley Health Forum will be also be used to distribute information and updates on the process.
Milestone Anticipated Indicative Timing1 Prior Information Notice 8 October 2014 Supplier Briefing Event 12 – 13 November 2014 Contract Notice and Pre-qualification Questionnaire Late November 2014 issued
1 Timings are indicative only and may be subject to change
4 | Page Invitation to Tender January 2015 Contract Award March 2015 Contract Transition Period commences April 2015 “Go Live” of service under new contracts September 2015
Decision requiring Sign-off: The current plan for Procurement will seek to award a contract before 30th March 2015 allowing for transition and go-live of a new service by September 2015. Contingency plans in place will seek to mitigate potential delays to the process and will be tracked on an ongoing basis.
6.0 Supplier Briefing Event
6.1 At this stage of early planning, prior to the commencement of a formal procurement process, S&WB CCG are looking to engage informally with the supply market to share initial assumptions and test current thinking on the specification that will form the subject of the eventual procurement process.
6.2 A Supplier Briefing Event to be held on 12th and the 13th November 2014 will present some current working assumptions on the scope of the service, give an overview of the planned procurement process, and provide an opportunity for Q&A. Suppliers will also have the opportunity to attend a one to one discussion for further Q&A with the procurement team.
6.3 The event will not form part of the proposed procurement process and is intended exclusively to allow for preliminary research and market sounding of the proposed draft service specification. Non-attendance at the Briefing Event will not preclude suppliers from responding to an eventual procurement advert and all information provided as part of this event will be available to all suppliers who express an interest.
6.4 A Prior Information Notice was issued to the market in OJEU and via Contracts Finder on 8th October 2014, providing an early indication of the proposed procurement process and making them aware that the Supplier Briefing Event will be held. 6.5 All CCGs will need to consider themes and feedback from the Supplier Briefing Event when refining the developing the final service specification.
Decision requiring Sign-off: Dudley CCG executive representation is recommended at the Briefing Events on the 12th and the 13th November 2014, giving suppliers the opportunity to ask questions and enabling CCGs to conduct high level marketing testing of the proposed service specification.
7.0 Core 111 Service Specification
7.1 The specification for 111 Services has been developed over the past several months, building on lessons learned from the Step-In arrangements and from the recent pilots. A Design and Delivery Working Group with representatives of each CCG has been meeting on a bi-weekly basis to review and refine the detail of the draft specification.
7.2 The final specification must be issued to suppliers as part of the Invitation to Tender documents, planned for 9th January 2015. In order to facilitate this process, early sign-off by individual CCGs where possible is requested.
7.3 Dudley CCG has identified a number of potential weaknesses within the current draft specification. Of particular concern is the current specification is the lack of consideration of the potential for new technology to drive innovation within the service. Further challenge and assurance is now being sought from S&WB CCG on these points. Furthermore Dudley CCG
5 | Page will recommend that potential bidders should be tested on their approach to technological innovation in all stages of the procurement.
7.4 Further meetings of the Accountable Officers in December and early January 2015 will seek full and final sign-off of the specification.
Decision requiring Sign-Off: Service specification for 111 Services to be signed off by Dudley CCG at the latest 9th January 2015.
8.0 Next Steps
8.1 The immediate high level next steps in this process are to:
1. Confirm agreement to the principles included within this paper 2. Prepare and deliver Supplier Briefing Event 3. Continue to review and develop Service Specification 4. Prepare for issuing a Contract Notice to advertise the procurement on 28th November 2014.
9.0 Conclusion
9.1 Due to the national failure of NHS Direct as a service provider and the nature and legalities of the step in arrangements by WMAS in November 2013, Dudley CCG is now required to go to open tender to procure their NHS111 service and mobilise the service by September 2015.
9.2 The NHS111 national delivery framework and infrastructure costs associated with delivering the service, make the provision of the service by individual CCG’s financially unviable. It is the recommendation of this paper that the Board agree to joining a collaborative commissioning arrangement. This approach will ensure the best value for money, ensure service resilience and mitigate against local variations in clinical governance and patient safety.
Jason Evans Commissioning Manager for Urgent Care October 2014
6 | Page Appendix 1 NHS111 Re-procurement
Report prepared by James Green, Chief Finance Officer,
Sandwell & West Birmingham CCG
21st October 2014
Estimated financial impact of multiple lots
Forecast modelling has been undertaken in an attempt to generate the estimated impact of introducing multiple lots into the re-procurement of NHS111 for the West Midlands.
The starting point for the scenarios has been the financial calculations underpinning the existing service delivered by WMAS for 14 out of the 22 CCGs. Whilst this contract does not cover all CCGs, the records held are very detailed and have enabled scenarios to be developed.
Basis for senarios
The behavior of each type of cost has been assessed and categorised into variable, semi-fixed, or fixed. Clearly some costs (such as physical buildings) will be replicated each time the number of separate contracts/call centres are increased.
Other costs such as Call Handler & Clinician staff become fully variable after a certain point.
The costs were then modelled against the varying levels of activity likely under each of the scenarios. Some recognition of the call volumes have been assumed depending on the number of contracts/call centres (i.e. smaller building footprints required for multiple call centres).
Three scenarios have been calculated
• 1 single Lot (& call centre) for all 22 CCGs in the West Midlands • 3 separate Lots (& call centres) – representing the 3 Area Team groupings • 8 separate Lots (& call centres) – representing smaller geographical groupings
The attached table shows the modelled impact of each of the scenarios.
Please note that this is purely a desktop exercise and the calculations are designed simply to demonstrate the potential impact of diseconomies of scale.
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8 | Page Appendix 2: Current Proposed Procurement Plan
Activity / October 2014 November 2014 December 2014 January 2015 February 2015 March 2015 Workstreams Week commencing: 29/9 6/10 13/10 20/10 27/10 3/11 10/11 17/11 24/11 1/12 8/12 15/12 22/12 29/12 5/1 12/1 19/1 26/1 2/2 9/2 16/2 23/2 2/3 9/3 16/3 23/3 30/3
Project Project Initiation Key:
Set up Procurement Steering Board Sign- Activity Route off – Procurement Procurement Legal review/ Develop Route (27/11) advice (TBC) Procurement Milestone Plan Key Meeting Dependency Governance Review
Draft Issue PIN (08/10) Market PIN
Consultation Prepare for Market Day Market Day (12/11-13/11) Bidders register to attend and submit written comments Refine Specification based upon Market Day output Christmas Break Christmas
Steering Board PQQ Phase Develop Lotting Strategy Sign-off – Lotting Strategy, Contract Notice & PQQ (27/11)
Draft Contract Notice Publish Contract Notice & PQQ (28/11) Train PQQ evaluators PQQ Deadline (19/12) Bidders respond to Evaluate PQQ Steering Board Sign-off – Draft PQQ & selection methodology PQQ 22/23 Dec PQQ Results (08/01) Purdahcommences
ITT Steering Board Sign- Develop ITT Documentation & Evaluation off – Specification & Issue ITT (09/01) ITT (wc15/12)
Develop service specification Bidders to respond to ITT Final amendments to ITT (35 days) ITT Deadline (13/2)
Develop T&Cs Steering Board Train ITT evaluators Evaluate ITT Responses Sign-off Develop Contract Schedules (incl. Pricing and Performance Evaluation (17/3) Management) Clarification Announce Meetings Preferred Bidder Develop Instructions for Tenderers (17/3) Alcatel Award Develop ITT Evaluation Methodology (10 days) Contract (27/3)
Project Accountable Officers Steering Board meetings: 27/11 15/12 08/01 17/03
Management PMO – Project Plan, Risk, Issue Log Updates
Stakeholder Engagement and Communications
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Memorandum of Understanding
West Midlands NHS 111 Re- procurement 2014-15
Between
Sandwell and West Birmingham CCG
And
NHS Birmingham South Central CCG, Birmingham Cross City CCG, NHS Cannock Chase CCG, NHS Coventry and Rugby CCG, NHS Dudley CCG, NHS East Staffordshire CCG, NHS Herefordshire CCG, NHS North Staffordshire CCG, NHS Warwickshire North CCG, NHS Redditch and Bromsgrove CCG, NHS Shropshire CCG, NHS Solihull CCG, NHS South East Staffordshire and Seisdon Peninsular CCG, NHS South Warwickshire CCG, NHS South Worcestershire CCG, NHS Stafford and Surrounds CCG, NHS Stoke on Trent CCG, NHS Telford and Wrekin CCG, NHS Walsall CCG, NHS Wolverhampton CCG, NHS Wyre Forest CCG
Document control
Audience West Midlands Clinical Commissioning Groups and stakeholders
Document Status Draft
Document Version V 3.0
Issue date 07.10.2014
Contact details Gail Fortes Mayer
Version Date Name/Initials Comment
V 1.0 07.10.2014 GFM Creation of document V 2.0 12.10.14 GFM Amended document V 3.0 30.10.14 HM Amended to include feedback and redistributed to distribution list
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1. What is a Memorandum of Understanding
A memorandum of understanding (MoU) is a document describing a bilateral or multilateral agreement between parties. It expresses a convergence of will between the parties, indicating an intended common line of action. It is often used in cases where parties either, do not imply a legal commitment or in situations where the parties cannot create a legally enforceable agreement.
2. Parties to this Agreement
The parties to this agreement are:
Sandwell and West Birmingham CCG as the Lead Commissioner for NHS 111 located in West Bromwich and the local CCG’s within the West Midlands Region.
3. Purpose of the Memorandum of Understanding
This memorandum of understanding is intended to define arrangements for re- procurement of the NHS 111 service executed by Sandwell & West Birmingham CCG (S&WB CCG). This will be for and on behalf of the 22 West Midlands CCGs; summarising the roles, responsibilities and obligations which will flow from these arrangements.
The arrangements are necessary to support the effective procurement, implementation and leadership of the NHS 111 service on behalf of the patients of the 22 CCG’s within the West Midlands region.
Each of the parties (each of the 22 CCGs) is committed to the delivery of high quality patient care to the population it serves, taking account of:
- Patient safety and wellbeing as the ultimate priority; - Working together, in the interest of successful delivery of patient care within CCG designed services, for the patients in the West Midlands region; - The monitoring of activity and performance of this service to the public.
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4. Introduction
4.1. NHS 111 Service The NHS 111 service is a nationally specified, locally commissioned service. This allows for consistent identity and quality of service is maintained across the country, whilst allowing local sensitivity and specifications to meet local population needs and commissioning strategic objectives.
Local CCG commissioners have contracted NHS 111 services locally and developed new pathways to local care services to support direct access from triage - to appointment bookings and referrals direct into local services.
The aim of NHS111 is to drive the culture change away from the default position of 999 and Emergency Departments to enabling patients access the most appropriate place of care first time
The telephony and border infrastructure across England requires that areas chose an NHS111 provider that has the ability to take calls from outside their local boundaries. This is typically due to close border issues and sharing National Number Groups (NNG) codes. Thus providing resilience across the West Midlands footprint, but also offering national contingency.
4.2. Current service provision across the 22 West Midlands CCGs
Following the demise of NHS Direct the original contracted provider; step in providers need to be secured. The current providers of the West Midlands 111 Service are 1) West Midlands Ambulance Service (WMAS) 2) Staffordshire Doctors Urgent Care (SDUC)
Due to the nature and legalities of the step in arrangement the 22 West Midlands CCG’s are required to go to open tender to procure their NHS111 service. Both WMAS and SDUC have the option to continue delivery until September 2015. The CCG’s are now charged with procuring a NHS111 service and mobilising the service by September 2015
5. Scope : Re-procurement of the NHS 111 service across West Midlands CCGs
Following an options appraisal regarding procurement approaches; agreement was reached in June 2014 that a West Midlands wide re-procurement of NHS 111 services would be undertaken.
Following the review of options available, CCG’s agreed their preferred option being that Sandwell and West Birmingham CCG(S&WB CCG) to continue to be lead Commissioner
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and lead the procurement exercise for the West Midlands. Sandwell & West Birmingham CCG were authorized to mobilise an expert team to lead the regional procurement, led by Andy Williams Senior Responsible Officer for the programme of work and Accountable Officer (S&WB CCG).
The scope of the design of service and specification which potentially may include lots is to be agreed locally with guidance and support from the Regional Team.
This MOU covers the period up to and including securing the preferred providers across the West Midlands.
The MOU will be reviewed and refreshed accordingly to accommodate contract awards; mobilization of services; decommissioning; NHS England assurance etc.
6. Individual CCG Responsibilities
The table below outlines: • the key areas of delivery and support to be given to CCGs by the Programme Team hosted by S&WB CCG; • the local requirement from CCGs to Sandwell and West Birmingham CCG;
PLEASE NOTE: individual CCGs are responsible for ensuring they are represented and informed with respect to decisions. Where CCGs are: not present represented or submitted decision prior to AO board sign off; absence will be considered as consent.
Key Delivery Areas S&WB CCG Local CCG Re-procurement of NHS 111 services Each CCG to provide names of Accountable Officer and Commissioning contact lead for the re-procurement.
Where CCGs delegate authority this is to be agreed locally by party CCGs. Information pertaining to the delegation arrangements are to be formalised locally and information to be provided to the PMO and updated as necessary Mobilisation of core delivery leadership team with expertise on: • NHS 111subject matter; • NHS111 design and delivery • Procurement; • Contracting and commissioning;
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• Finance and • Legal advice associated to the collective procurement.
Introduce PMO office to deliver project to robust project plans including risk and issues management Secure a procurement partner to support the re-procurement of the NHS111 service Co-ordinate and service accountable officer leadership board.
Servicing of the 111 procurement, design and delivery board this board will enable the accountable officers to make informed decisions and choices Develop key decisions time table, outlining key dates for decisions; when decisions need to be made in line with the procurement timeline.
CCGs sign off key deliverables within the timelines. CCGs to ensure appropriate Boards and Bodies are convened to accommodate key deadlines. Notification of dates to PMO Identification of board members with local expertise Define Local delivery teams and reporting structure to be defined Local design of specification and timeline local involvement of key stakeholders in mobilisation and delivery Host the Regional Clinical Governance lead and ensure robust clinical governance procedures and processes are at the centre of all decisions Ensure CCG is represented on the Regional Clinical Governance board Support local CCG’s to define local specifications enabling the shared knowledge of best practice and learning
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Oversight of procurement panel selection and training Develop procurement documentation: • PIN • OJEU notice • PQQ • ITT Organise supplier engagement event
Oversight and development of procurement selection criteria and framework Liaison with NHSE to ensure assurance processes and gateways adhered to Quality assurance of NHS111 provider and service build Development of technical and clinical governance gateway submissions Host Communications and Marketing support function.
Create Communications plans and messages throughout the process. This will include media and stakeholder management DOS development and delivery
Sourcing of key panel members to participate as evaluators Support quality assurance of chosen provider
Provide appropriate clinical input into the clinical design of the 111 service and the assessment process of bidders.
Ensure that Sandwell and West Birmingham CCG are aware of relevant CCG plans for urgent and out of hours care.
To ensure joint working regardless of the number of lots and variances in schedules within the specification
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Risk share in the event of a formal challenge to the procurement process that may result in a subsequent financial penalty
7. Review
This MOU covers the period up to and including securing the preferred providers across the West Midlands.
The MOU will be reviewed and refreshed accordingly to accommodate contract awards; mobilization of services; decommissioning; NHS England assurance etc. to reflect the development of the NHS 111 programme through the NHS 111 Procurement Working Group
If a review is requested at any time by one of the co-signatories or those mentioned above; all parties must agree to a review at this point and to act on any recommendations as a result thereof.
All reviews will be reported back to the NHS111 Procurement Working Group.
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8. Appointed Officers
Appointed Officers to this contract are:
Andy Williams, Senior Responsible Officer, Sandwell and West Birmingham Clinical Commissioning Group
9. Signatures:
Name: Andy Williams
Designation: SRO NHS 111 Re-procurement
Signature: ………………………………………………..
NHS CCG Designation Signature Date Birmingham Cross City Birmingham South Central Solihull Walsall Wolverhampton Dudley
Sandwell & West Birmingham Stafford & Surrounds Cannock Chase East Staffordshire South East Staffordshire and Seisdon Peninsular North Staffordshire Stoke on Trent Coventry & Rugby North Warwickshire South Warwickshire Herefordshire Redditch & Bromsgrove South
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Worcestershire Wyre Forest Telford & Wrekin Shropshire
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DUDLEY CLINICAL COMMISSIONING GROUP BOARD
Date of Report: 13 November 2014 Report: Communications & Engagement Committee Report Agenda item No: 10.1
TITLE OF REPORT: Communications & Engagement Committee Report • To update the Board on the activity of the Communications & Engagement Committee PURPOSE OF REPORT: • To provide the Board with assurance that the committee is responding to its delegated duties as set out in the Scheme of Delegation
AUTHOR OF REPORT: Laura Broster- Head of Communications & Public Insight
MANAGEMENT LEAD: Laura Broster- Head of Communications & Public Insight
CLINICAL LEAD: Dr David Hegarty - Chair • The committee held its most recent bi monthly meeting on Tuesday 14th October 2014. KEY POINTS: • This report includes details of key discussions at the meeting • The summary table details progress in key areas around the CCG Communication & Engagement Strategy • That the Board is assured that the committee is fully functioning and that statutory duties are being met with regard to engagement RECOMMENDATION: with the public & patients. • That the Board is assured that the Communications & Engagement Strategy is being progressed well. • The CCG has a statutory duty to involve. Failure to do so could result in costly judicial proceedings. • All activity reported is covered by the existing communications & FINANCIAL IMPLICATIONS: engagement budget unless stated otherwise. • AVE is a method of estimating the value of editorial media coverage, which is widely used throughout the PR industry. • The committee is responsible for ensuring that appropriate WHAT ENGAGEMENT HAS mechanisms are in place for Engagement to take place. Progress TAKEN PLACE: on this is included in the report. Assurance ACTION REQUIRED: Decision Approval
1 | Page DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 13 NOVEMBER 2014 COMMUNICATIONS & ENGAGEMENT COMMITTEE REPORT
1.0 INTRODUCTION
This is a report to the CCG Governing Body (Board) from the Communications & Engagement Committee. The Committee had its latest meeting on Tuesday 14 October 2014. Also included is the Key Performance Indicator Summary (section 2.0)
2.0 KEY INDICATOR SUMMARY (Produced October 2014)
Communications and Engagement Strategy Summary Report
Number of Patient 44 groups established. Work under way to establish three more. The Participation Groups (PPGs) practices still to set up PPGs are all being offered support.
Date of next Patient th 27 Nov- 4.30-6.30 pm at Lion Health Opportunity Panel (POPs)
Date of next th Healthcare Forum (HCF) 11 Dec- 12-2.30pm at Brierley Hill Civic Hall- ‘walk a day in our shoes’ (simulation excersise on commissioning decision making)
Twitter Followers 2,188 (up by 171 since last Board)
Facebook Likes 147
Media Coverage - Advertising Sept 2014: Total £9,557 Value Equivalent (AVE) • On message £8,360 • Off message £1,197 (Health groups spend thousands on awards ceremony)
Media Coverage • New staff to free up ambulance workers Topics • GPs Host Healthcare Forum • Hospice launches new End of Life Care
Collaborative Work • Young peoples views on Primary Care Access • Community Engagement network with Dudley MBC • Development of the Dudley Community Information Directory
Key Projects • PPG Development • Youth Summit #mefestival • PPI Internal audit and work on action plan th Next Membership Meeting • Wednesday 10 December 2014
3.0 ITEMS DISCUSSED
3.1 Planned Internal Audit Review
The Committee were updated on the findings from a recent Internal Audit into the CCG Engagement function. The audit did not highlight any weaknesses that would materially impact on the achievement of the system's key objectives.
The audit did find some low impact control weaknesses which, if addressed, would improve the overall performance of the system. The Committee agreed that these weaknesses do not affect key controls and are unlikely to impair the achievement of the system's objectives.
2 | Page The committee were pleased with the overall significant assurance given and will monitor the teams progress around delivery on key actions to improve this area further.
3.2 Risk
The Committee reviewed the corporate risks on the Board Assurance Framework (BAF), these are:
- Failure to ensure meaningful public engagement - Failure to fully engage with HOSC
It was noted that there has been some confusion in previous months about whether these risks had been removed from the BAF. The committee agreed to keep both risks on the register and discuss possibly reducing the rating at a future committee.
The importance of updating the BAF was noted and actions set to ensure that this happens.
3.3 Freedom of Information (FOI) Update
The Freedom of Information (FOI) Update was presented to the committee. The purpose of this report is to provide the Communication and Engagement Committee with an overview of the CCG activity in relation to Freedom of Information requests received and to provide assurance that this key function is being managed well by the team.
The committee were also assured that the handover from CSU was being managed with only a handful of requests still being processed by CSU. We are awaiting final disclosure logs from CSU for Sept 2014 along with reports on FOI activity for that period. Any issues on this will be escalated to the CCG Chief Operating Officer.
• Dudley CCG received a total of 24 Freedom of Information requests between 1- 31st August. • No trend in terms of request topics • Proportionally more requests from the public than other sources • The average time taken to complete a Freedom of Information during this period was 11.58 days, well within the statutory 20 working day limit.
This process is now being managed in house by the CCG FOI and complaints officer, Vivian Vasey. A new policy will go to Audit committee in December to be ratified.
3.4 Patient Opportunity Panel (POPs) Update
Members were updated on continuing progress towards the evolution of a locality structure for PPGs, PPG/POPs development sessions and the implementation of the scheme to award grants of up to £1,000 in direct funding for each of our PPGs.
The last POPs meeting in July was well attended and Paul Maubach was available to answer any questions which arose. There is still development opportunities for this panel which the CCG Organisational Development Lead is supporting. The meeting is facilitated to ensure that everyone gets a voice and feels able to be heard.
The committee discussed a knock on effect of the successful POPs being a reduction in HCF attendances. The team will look to expand representation at this group.
One locality has now established their own PPG locality group which we are calling a Pod. This is great news and sees our PPGs starting to mirror the CCG operating model and aligning to the new integrated model of care.
3 | Page 3.5 Youth Summit
An update was received by the Committee on the Youth Summit which is being organised for 20th November 2014 on behalf of the Health and Wellbeing Board.
The Youth Summit will be called #MeFestival and have a festival theme. All 27 schools in Dudley Borough have been invited and 14 schools have responded positively so far. The event will be aimed at Year 8 students (12-13 year olds) however, some schools have chosen to send a selection of students from different year groups.
There will a number of different workshops, including:
• Fastaid Black Country delivering 2 hour heart start session for max 50 participants at a time (so 2 groups will go through) • Loudmouth delivering one session of Bully4u and one session of One Too Many for 90 mins with a maximum of 40 participants • Kick Ash Dudley and Mega Lungs – 1 hour session with max of 25/30 participants • Communic8 – looking at information needs and preferences of young people with max of 15 participants for 1hour • Headmaster Office – facilitated session for school staff (and school health advisors if they join us) including a graphic facilitator for 60/90 mins maximum of 15 participants • VIP tent to include: cooking, cyber dance, rowing machines, videoke booth, what’s up doc, switch substance misuse involving beer goggles and possibly a football goal, connexions stand, LED sofa and roving reporters • Outside will include fire engine, possibly fire dog too, riot police and gear and ambulance
The committee agreed that the event created an ideal environment in which to engage young people. Further work is now being progressed by the team to ensure that we get the right outputs from the event. Work with the commissioning team is underway to ensure this happens.
3.6 Commissioning Developments/Intentions
The Committee received the latest Commissioning Intentions and discussed that this was year two of a 2 year plan. Future engagement activities should focus around ensuring that public views already gathered on these top level themes influence any future service changes.
It was also recognised that we need to move away from a reactive response to service change business cases and be in a position where we can better plan how the public can add real influence to decision making processes.
3.7 Media Report
The Committee received the media activity report and had an opportunity to ask the team any questions on recent coverage or releases.
At the time of committee the CCG had received coverage on two of their press releases in September, one for Board and the other for September Healthcare Forum. The team have received two media enquiries, one regarding restraint at Dudley Group and the other regarding the letter from UHB to Paul Maubach regarding referrals.
Now that the team have a full time FOI and complaints officer in post there is the intention to increase the proactive relationship with the media.
4 | Page 3.8 Duty to Report
The committee received information on engagement activities that were undertaken in the period 1st April 2013 to 31st March 2014. This report fulfils one of the CCG statutory duties, Duty to consult about commissioning plan and to publish a summary of the expressed views of the individuals consulted and how the CCG has taken account of those views, as set out in Section 14Z13, NHS Act 2006.
Dudley CCG has undertaken a significant amount of engagement and has been praised for some of this activity – notably the Urgent Care Consultation and Feet on the Street.
The committee accepted the report and approved it for upload to the website.
3.9 Patient Experience Transition Funding Update
The Committee were pleased with the progress towards the Transition Funding Criteria. Whilst the committee recognised that it did not fall directly under the remit of them, they thought it was useful to be aware of the on- going work with DGFT on improving transparency around patient experience data.
3.10 Patient Experience Role Update
The committee were made aware of the decision to replace the planned Analyst in the team with an Insights Specialist. This new post would have more focus on the way that patient stories were captured and presented, leaving the analysis to the existing highly skilled people within the CCG.
4.0 DECISIONS TAKEN BY COMMITTEE UNDER DELEGATED POWERS FROM BOARD
1. To accept the Duty to Report and upload to web 2. To agree actions to mitigate risks and keep these active on the BAF 3. Accept findings of Internal audit and agree actions
5.0 DECISIONS REFERRED TO THE BOARD
No decisions were referred to the Board.
6.0 RECOMMENDATION
• That the Board is assured that the committee is fully functioning and that statutory duties are being met with regard to engagement with the public & patients. • That the Board is assured that the Communications & Engagement Strategy is being progressed well.
Laura Broster Head of Communications and Public Insight October 2014
5 | Page
DUDLEY CLINICAL COMMISSIONING GROUP BOARD
Date of Report: 13 November 2014 Report: Audit Committee Report Agenda item No: 11.1
TITLE OF REPORT: Audit Committee Report
To advise the Board of the key issues discussed and agreed at the Audit PURPOSE OF REPORT: th Committee on 26 September 2014
AUTHOR OF REPORT: Mr M Hartland, Chief Finance Officer Mr M Hartland, Chief Finance Officer MANAGEMENT LEAD: Mrs J Jasper, Chair of Audit Committee CLINICAL LEAD: Dr J Rathore, Clinical Lead for Finance and Performance
• Results of committee self-assessment survey received and next steps in review of Committee Effectiveness agreed. • Information Governance (IG) Policy approved and IG Improvement Plan and Handbook received. • Combined BAF & Risk Register as at 5th September reviewed; risks KEY POINTS: 27 and 35 approved for closure. • Updates from Internal Audit and LCFS received. Updated Internal Audit Operational Plan 2014/15 approved. • Prime Financial Policies-Assurance received. • Other matters considered–Evaluation of Consultants received; Updated draft Terms of Reference for Audit Committee received.
• The Board is asked to receive this report on the issues discussed and RECOMMENDATION: the decisions taken under delegated powers at the Audit Committee on 26th September 2014 for assurance.
FINANCIAL IMPLICATIONS: None
WHAT ENGAGEMENT HAS None TAKEN PLACE: Decision ACTION REQUIRED: Approval Assurance
1 | Page DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 13 NOVEMBER 2014 AUDIT COMMITTEE REPORT
1.0 INTRODUCTION The report summarises the key issues discussed at the Audit Committee on 26th September 2014.
2.0 KEY INDICATOR SUMMARY The following items are indicators of the current position in relation to the main responsibilities and obligations of the Committee as defined in the CCG Constitution and Terms of Reference.
Indicator Position RAG 1. Regulation and Control Good progress CCG Governance Arrangements – Constitution Changes agreed by Board 13/03/14 approved by NHS England. Update to Board 11th September Scheme of Delegation No issues Compliance with Prime Financial Policies No issues 2. Annual Report and Accounts – CCG 2014/15 Plan for Annual Report to be considered December Audit Committee. Committee meetings scheduled to meet timetable. 3. Operational & Risk Management Good Progress Counter Fraud and Security Committee updated Risk Management Arrangements – Combined BAF & Risk Register in Good Progress place; Chairs/Management Leads of committees attending & updating Audit Committee; Annual Review July 2014 Report newly commissioned services Revised Procurement Strategy approved by CCG Board 13/03/14 External Audit No issues Internal Audit Updated 2014/15 Plan approved; 2014/15 audits progressing. - Other Policies – 6 of total of 7 received and approved Good progress - Other Policies – Business Continuity Policy Work progressing 4. Information Governance Good progress Information Governance Group established Established, not met regularly. Awaiting revised IG support arrangements Information Governance Breaches – Provider Regular updates Compliance with Information Governance toolkit Improvement Plan agreed Information Asset Management structure to be established with IAOs IAOs identified, IAAs and IAAs identified from CCG staff identified by IAOs. CCG staff briefed IG Policies – 18 policies replaced by overarching IG policy supported Good progress by handbook. FOI policy to be updated separately.
3.0 ITEMS DISCUSSED – 26th SEPTEMBER 2014
3.1 Committee Reporting/Effectiveness The Audit Committee received a report on the results of the committee self-assessment survey (based on contributions from committee lay members and auditors) and a verbal update on the checklist of processes from the Committee Chair. It was agreed that the Chair and governance lead would prepare an action plan for the next meeting drawn from the self-assessment survey and the checklist of processes. The latter would be circulated to members for feedback in advance of this being prepared.
2 | Page The Committee received the draft Audit Committee Terms of Reference amended for the changes agreed at the previous meeting. It was agreed that the draft revised Terms of Reference for all the Committees would be presented to a future Board meeting for approval once they had been assured for consistency and completeness.
3.1 Information Governance The Audit Committee received an update on the future arrangements for Information Governance support and was assured that the CCG would have continuity in provision. The Committee also received and approved a new overarching Information Governance Policy which replaced 18 individual information governance policies listed below: • Confidentiality Audit Policy • Corporate Records Policy • Courier Policy • Data Protection Policy • Email Policy and Code of Conduct • Information Asset Risk Assessment Procedure • Information Governance Framework • Information Governance Policy • Information Governance Toolkit Policy • Information Risk Management Policy • Information Security Policy • Internet Use Policy and Code of Conduct • Malicious Code Policy • Mobile and Remote Working Policy • Password Management Policy • Safe Haven Policy • Serious Information Governance Incident Policy • Staff Code of Conduct on Confidentiality
The policy was supported by an Improvement Plan and Information Governance Handbook which included the detail previously included in the policies. A separate policy is still required for Freedom of Information Act and this is currently being reviewed in conjunction with Communications & Engagement Team. 3.2 Board Assurance Framework and Risk Register The Committee received the Combined Board Assurance Framework (BAF) and Risk Register as at 5th September 2014. The Audit Committee noted that although the processes for managing and escalating risks within certain committees had improved, further development was required. It was agreed that a monthly report would be prepared in a similar format to those that were already taken to the Board and Audit Committee that highlighted the changes made since the previous month. An extract for each Committee could then be presented to them allowing time to focus on challenging the risks rather than identifying what has changed.
The Committee approved the closure of risks 27 and 35 and noted the approval by the Board of the recommendation to close risks 1; 9; 20; 32; and 44 with 44 being merged with 36.
3.3 Internal Audit The Committee received a number of documents from Internal Audit for information, assurance and approval: • Customer Satisfaction Survey Results 2013/14. On the whole the results were positive with the intention of the survey being to inform enhancements in the internal audit service. One outcome was the revised format of the progress report on the agenda. • Performance Outcome Measures and Key Performance Indicators 2013/14. This summarised internal audit’s performance in achieving the ethics and standards contained in the Public Sector Internal Audit Standards and their performance against key performance indicators. A peer review of internal audit is conducted every five years with the next one due to take place in the next 12-18 months.
3 | Page • Updated Operational Plan 2014/15 which reflected 10 days required to audit financial systems that had been brought in-house from 1st October 2014, with 5 funded from contingency days within the plan and 5 additional days. This was approved by the Audit Committee under its delegated responsibilities. • Progress Report September 2014. This now included the current cumulative position on the Head of Internal Audit Opinion (significant assurance) and a section on key developments relevant to the Audit Committee. • Audit Report-Complaints Handling. This report had been given significant assurance. • Audit Report-Public & Patient Involvement. This report had been given significant assurance.
3.4 Local Counter Fraud Specialist The Committee received a Counter Fraud Progress Report 2014/15 for assurance. The LCFS advised that he would provide an update at the next committee meeting on future arrangements in respect of the National Fraud Initiative following the cessation of the Audit Commission. 3.5 External Audit The Committee noted apologies from External Audit. There was nothing to report at this point in the year.
3.6 Evaluation of Consultants The Committee received an evaluation report in respect of work done by a consultancy appointment and requested more detail in respect of the costs incurred and the value of the outcomes that were described in the report. Concern was expressed regarding a lack of demonstrable outcomes.
The Committee noted that an evaluation framework was being developed to ensure all consultants are evaluated objectively. This will be conducted for all consultancy appointments retrospectively and for all future commissions.
3.7 Other Issues The Audit Committee considered and received assurance in respect of: • Waivers and No Orders authorised, subject to concern raised at 3.6 • Scheme of Delegation • Aged Receivables and Payables • Compliance with laws and regulations governing the NHS. • Progress in the development of the Business Continuity Plan.
The Committee noted that the Healthcare Forum held the previous evening had been very well attended with all key stakeholders represented but were disappointed to note that CCG clinical representation was limited.
4. DECISIONS TAKEN BY COMMITTEE UNDER DELEGATED POWERS FROM BOARD • Approval of the Information Governance Policy • Approval of the closure of risks 27 and 35 in the Combined BAF and Risk Register • Approval of changes to the Audit Plan 2014/15 including the use of 5 Contingency days and 5 additional days
5. DECISIONS REFERRED TO THE BOARD • None
6. RECOMMENDATION • The Board is asked to receive this report on the issues discussed and the decisions taken under delegated powers at the Audit Committee on 26th September 2014 for assurance.
M Hartland Chief Finance Officer November 2014
4 | Page
DUDLEY CLINICAL COMMISSIONING GROUP BOARD
Date of Report: 13 November 2014 Report: Combined Board Assurance Framework and Risk Register Agenda item No: 11.2
TITLE OF REPORT: Combined Board Assurance Framework and Risk Register
To update the Board on the combined Board Assurance Framework PURPOSE OF REPORT: th (BAF) and Risk Register and present it as at 7 October 2014.
AUTHOR OF REPORT: Mr M Hartland, Chief Finance Officer
MANAGEMENT LEAD: Mr M Hartland, Chief Finance Officer
CLINICAL LEAD: Dr D Hegarty, Chair
• Update on combined BAF & Risk Register KEY POINTS: • Summary of risks as at 7th October 2014 presented • Details provided of changes made since 7th August 2014
RECOMMENDATION: • The Board is asked to receive the report for assurance
FINANCIAL IMPLICATIONS: None direct. Potential consequence if risks materialise.
WHAT ENGAGEMENT HAS None TAKEN PLACE: Decision ACTION REQUIRED: Approval Assurance
1 | Page DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 13 NOVEMBER 2014 COMBINED BOARD ASSURANCE FRAMEWORK (BAF) AND RISK REGISTER
1.0 INTRODUCTION In accordance with the CCG’s Risk Management Strategy, the combined BAF and Risk Register for those risks scored 16 and over (which comprise the Board Assurance Framework) is presented to the CCG Board. This is based on the position as at 7th October 2014.
The Audit Committee received the overall combined BAF and Risk Register as at 5th September 2014 at its meeting on 26th September. It approved the changes within its delegated powers and these are included in the version now presented to the Board.
2.0 COMBINED BOARD ASSURANCE FRAMEWORK (BAF) & RISK REGISTER Those risks with an initial or residual score (after actions having been taken and controls implemented) of 16 or higher are presented to the Board in detail at Appendix 1. These risks, as at 7th October 2014, are also summarised in the table below.
Initial Residual Accountable Risks 16 or higher as at 7th October 2014 Risk Risk Committee 6. Failure of a main provider (Dudley Group NHS FT) due 20 20 Finance & to financial pressures will result in inadequate care for the Performance local population (note: this accounts for legacy risk brought forward from Cluster regarding failure to manage demand, creating financial pressures within the local health system). 10. Failure of the health economy to work together to 16 12 Clinical implement service changes which will adversely impact Development commissioning and delivery of health services. Committee 14. Failure to engage with Public Health, Health and Well 16 6 Clinical Being Board and the Local Authority will limit the Development effectiveness of health care commissioning. Committee 16. Providers may be reluctant to develop and implement 16 12 Clinical alternative approaches to service delivery Development Committee 17. Tensions between innovation, quality and financial 16 12 Clinical pressures could limit the innovation shown by the CCG Development Committee 19. Failure to ensure meaningful public engagement will 16 8 Communications prevent effective commissioning and patient centred & Engagement services 21. Challenges to resources within the CSU to deliver a 20 12 Quality & Safety service offering that delivers the CCG's requirements (particularly quality framework) which underpin the CCG strategy 22. The delivery of efficiency savings could impact the 20 20 Quality & Safety drive for quality in health care 26. Risks to women and neonates as a result of increased 16 4 Clinical volume of patients which has led to inadequate staffing Development levels at certain times with particular issues around Committee specialist medical staffing and capacity issues in triage area. 34. Being unsighted on significant performance issues 16 6 Primary Care identified by the Area Team in relation to primary medical Development services that could result in removal of GP member from the Performers' List. 36. Failure to achieve whole of Quality Premium resulting in 16 16 Clinical lost income and reputational damage. Development Committee 39. Lack of a systematic approach to ascertaining the 16 12 Quality & Safety quality of the care in our commissioned nursing homes, potentially resulting in harm to vulnerable adults.
2 | Page Initial Residual Accountable Risks 16 or higher as at 7th October 2014 Risk Risk Committee 41. Lack of capacity in the right place for patient access to 16 6 Clinical phlebotomy services. Development Committee 43. Failure to deliver significant QIPP targets in 14/15 and 25 20 Finance & 15/16 puts the future financial stability of the CCG at risk. Performance 45. NHS England terminating primary medical service 16 9 Primary Care contracts of member practices leading to a gap in primary Development care service provision or pressure on other primary care providers. 48. Failure of Black Country Partnership FT due to financial 20 15 Finance & pressures will result in inadequate care for the local Performance population. 58. The JAC electronic system is not operating efficiently 16 16 Quality & Safety which has resulted in an unspecified number of Discharge Letters not being received by GPs. This risk affects patients returning to primary care following changes in treatment medication. Detail to medication changes following review, in some cases could be inaccurate. NEW RISK
3.0 RECENT AMENDMENTS TO THE BAF AND RISK REGISTER The following amendments to risks 16 and over have been made since the Board received the BAF and Risk Register as at 7th August at its meeting on the 11th September. These reflect the decisions made at the last Board plus the addition of new risks and changes to existing risks approved by the CCG’s Committees: New Risks – One new risk was approved for inclusion in the BAF & Risk Register by the Quality & Safety Committee: • Risk 58 – This risk reflects the concerns that have been raised about Primary Care not receiving discharge letters for all patients. Changes to the Risks – Following the annual review of the BAF & Risk Register in July, no changes to the scores or description of the risk have been made. Closed Risks/Risks Proposed for Closure – The following risks have been closed following Board approval in September: • Risk 1 – Failure to resolve potential mortality issues at Dudley Group results in avoidable deaths. • Risk 9 – Risk of poor relationship management with the Area Team through the transition/bedding down resulting in breakdown of relationship with GPs and/or disconnected primary care/medical service priorities. • Risk 20 – Failure of providers due to quality failures will result in inadequate care for the local population. • Risk 32 – Current reorganisation of Health Visiting Service could result in breakdown in continuity of care to patients and consequent risks to safeguarding children. • Risks 36 & 44 – Risk 44 “Overall achievement of the Quality Premium is impacted by performance issues with the delivery of Local and National Targets by the local provider and reduces the Quality Payment the CCG receives with the consequent financial and reputational impact” has been closed and merged with risk 36 following approval at the last Board meeting.
4.0 RECOMMENDATIONS • The Board is asked to receive the report for assurance
5.0 APPENDICES Appendix 1 – Combined BAF & Risk Register as at 7th October 2014 (risks 16 and over)
M Hartland Chief Finance Officer November 2014
3 | Page Dudley CCG Combined Board Assurance Framework and Corporate Risk Register 2014/15 07-Oct-14 CORPORATE OBJECTIVES 1. Reducing health inequalities 2. Delivering best possible outcomes
3. Improving quality and safety NOTE: TREND IN RESIDUAL RISK AGAINST PREVIOUS MONTH IS SHOWN //= 4. System effectiveness
ID Original Last Risk Description Accountable Accountability Management P I Initial Risk Key Controls Gaps in Control Gaps in Assurance P I Residual Risk Trend Internal Assurances External Assurances Actions Timescales COMMENTS Date Update Committee Sponsor & Lead Score (PxI) What controls/systems are in Where are we failing to put Where are we failing to gain Risk Score Board Reports, Minutes Internal and External To improve control, Date action will Owner Score place to assist in securing controls/ systems in place. / evidence that our controls/ (PxI) of meetings Audit Reports, CQC ensure delivery of be completed before any delivery of our Where are we failing in systems, on which we place Score Reports principal objectives, controls objective. Such as strategies, making them effective. For reliance, are effective. Such following gain assurance are in policies and procedures example lack of training or no as no assurance a strategy or controls put ABOVE) place. regular review of policy is effective in place performance OBJECTIVE (SEE KEY LINK TO CORPORATE
6 01/05/2013 29/08/2014 2 Failure of a main provider (Dudley Group F&P Jas Rathore Matt Hartland 4 5 20 Robust contract management via Review of methods to mitigate 5 4 20 Reports to F&P & Q&S, AT review, Monitor Implement new Ongoing NHS FT) due to financial pressures will contract review meetings, financial risk to provider and = Board reports - minutes of financial rating-under methods to mitigate result in inadequate care for the local performance management, joint CCG. CRM and QRM meetings. formal review due to deficit financial risk (e.g. population (note: this accounts for legacy strategic planning. Financial Plan Performance report across position in financial plans, reinvesting penalties) - risk brought forward from Cluster regarding and contracts agreed with a range of KPIs. Monthly Internal Audit review. awaiting response failure to manage demand, creating providers. Financial Assurance meetings between CCG from DGH to CCG financial pressures within the local health KPIs reported to Board. Joint and DG FT Senior Manager proposal. system) monthly payment reconciliation Teams now being held. CCG is expecting process including validation of Board to Board (including formal letter from activity. lay member only) meetings Monitor to which it being held. must respond. CCG & DGH FT Senior Teams meet regularly as do other staff members to share understanding and agree mitigating actions. CCG CFO to lead on health economy plans taking long term view.
10 01/05/2013 24/09/2014 2 Failure of the health economy to work CDC Steve Mann/ Steve Neill Bucktin 4 4 16 QIPP plan and implementation. 4 3 12 QIPP reporting to CDC and Internal and external audit 1.Develop and BCF Plan in together to implement service changes Cartwright Joint approach to QIPP = governing body reviews implement service place September which will adversely impact commissioning development with Dudley Group. improvement 2014. System and delivery of health services. Service Improvement Delivery development plans Resilience Plan Plans in place with providers. with JHWS External in place August Collaborative Leadership Teams - peer plans with all 2014. DGFT and DWMHPT Health and providers.. Social Care Leadership Group. 2. Health and Social BCF Section 75 Agreement. Care Leadership Group to be responsible for major system change: - Urgent Care - Service Integration
14 01/05/2013 24/09/2014 2 Failure to engage with Public Health, Health CDC Steve Cartwright Neill Bucktin 4 4 16 Memorandum of Understanding None 2 3 6 Report to Board on CCG Nov-14 Appropriate mechanisms in place. and Well Being Board and the Local with Public Health, membership of = contribution to HWB CCG has contributed to JSNA Authority will limit the effectiveness of H&W Board, contribution to JSNA activity. CCG compliance JHWS and agreed Operational health care commissioning. with JHWS. Extend peer Plan for 14/15 and 15/16 takes review process for 14/15. account of JHWS External peer review to take place in September 2014..
16 01/05/2013 01/04/2014 2 Providers may be reluctant to develop and CDC Richard Johnson Neill Bucktin 4 4 16 Commissioning intentions, Change Reporting process not yet in Reporting to CDC 3 4 12 None Internal audit review Commissioning Sep-14 Significant alternative approaches implement alternative approaches to Meetings with providers place for all providers = intentions lay out in Operational Plan. service delivery case for change. Contracting round for 14-15 will require providers to sign up to explicit change programme 17 01/05/2013 01/04/2014 2 Tensions between innovation, quality and CDC Richard Johnson / Neill Bucktin 4 4 16 £200k to be invested in innovation 4 3 12 reports to CDC Significant innovation Sep-14 financial pressures could limit the Jas Rathore pilots for 2013-14. Innovation bid = programme in innovation shown by the CCG process to be handled through Operational Plan. localities 19 01/05/2013 01/04/2014 2 Failure to ensure meaningful public C&E David Hegarty Neill Bucktin/Laura 4 4 16 Communications & Engagement Business cases / service Reporting on proper engagement 2 4 8 Report to Commissioning Health Watch, Overview & Establish revised Jun-13 engagement will prevent effective Broster Strategy change proposals need to through the business case = Development Committee Scrutiny Committee business case commissioning and patient centred services Health Care Forum identify that appropriate process through business cases, process. Ensure clear Individual Service User Groups, engagement has taken place assurance that exposition of Business case process, Compact engagement is taking place engagement process 21 01/05/2013 03/10/2014 3 Challenges to resources within the CSU to Q&S Ruth Edwards Rebecca 4 5 20 Regularith l meetings l with it R CSU. l ti hi There is inconsistent reporting Systems being tested. 3 4 12 Thet C Committee & E will be t Clinical Surveillance 1.Finalisei f ll d quality b f Issues remain with regard to deliver a service offering that delivers the Bartholomew Reporting to Q&S and other of information between = reviewing all the RAG rates Meeting at Area Team, assurance framework MiCS and dashboard CSU offer CCG's requirements (particularly quality committees established . committees (validation on a quarterly basis within Internal Audit review. and reporting agreed. CSU Quality team staff framework) which underpin the CCG Performance resolution process in processes need to be Q&S Committee meetings. arrangements. TUPE'd over to Dudley CCG from strategy place. PLANS IN PLACE TO improved, teething problems A clear criteria is being 2. Define CCG/CSU 1/10/14. To be dsicussed at Q&S. BRING QUALITY SERVICES IN prevail). Staffing resource developed and brought roles and Query risk removed. HOUSE TO CCG, DISCUSSIONS reduced currently due to back to Q&S Committee. responsibilities and TAKING PLACE WITH CSU vacancies. implement. MANAGEMENT TEAM Access to MiCS needs to be 3. Improve validation consistently available to of reporting to various appropriate staff. sources to ensure consistency. 4. Ensure MiCS access.
22 01/05/2013 03/09/2014 3 The delivery of efficiency savings could Q&S Ruth Edwards Rebecca 5 4 20 QIPP programme monitoring Quality Impact Assessments not 5 4 20 Reports to F&P, Q&S, Quality Surveillance 1. Set up regular Q&S assured that DGFT involving impact the drive for quality in health care Bartholomew through F&P. Involvement of yet completed and provided by = CDC, and Board reports. Meetings with Area Team, Board 2 Board their quality leads. BCPFT and quality leads in QIPP projects DGOH for 2014/15. Meet with Medical and Internal Audit review meetings. DWMHP aware of ongoing through Quality Impact Nursing Director at 2. Review QIA by challenge. Assessments. DGFTand this will be DGOH once replicated for BCPFT. produced. D&WMH and Ramsay require meetings with Directors. ID Original Last Risk Description Accountable Accountability Management P I Initial Risk Key Controls Gaps in Control Gaps in Assurance P I Residual Risk Trend Internal Assurances External Assurances Actions Timescales COMMENTS Date Update Committee Sponsor & Lead Score (PxI) What controls/systems are in Where are we failing to put Where are we failing to gain Risk Score Board Reports, Minutes Internal and External To improve control, Date action will Owner Score place to assist in securing controls/ systems in place. / evidence that our controls/ (PxI) of meetings Audit Reports, CQC ensure delivery of be completed before any delivery of our Where are we failing in systems, on which we place Score Reports principal objectives, controls objective. Such as strategies, making them effective. For reliance, are effective. Such following gain assurance are in policies and procedures example lack of training or no as no assurance a strategy or controls put ABOVE) place. regular review of policy is effective in place performance OBJECTIVE (SEE KEY LINK TO CORPORATE
26 26/09/2011 24/09/2014 2 Risks to women and neonates as a result of CDC TBC Neill Bucktin/ Mark 4 4 16 Any GP practice located within a Outcome of maternity services None 1 4 4 Monitoring via Clinical None Specific request Apr-14 Cap in place however concerns increased volume of patients which has led Curran 16 minute travel time from City review across the Black = Quality Review Meetings made to DGFT to raised re quality of triage service to inadequate staffing levels at certain Hospital is not able to book Country by Sandwell & West (DPCT/DGFT). Monitoring assure that sufficient which are currently being times with particular issues around patients at Russell Hall Hospital. Birmingham CCG. of SIs (DPCT/DGFT). staff are in place to investigated. Therefore risk is specialist medical staffing and capacity New cap agreed for 13/14 through Maternity ratios within undertake triage being kept on until response issues in triage area. contracting round which allows for acceptable range received. sufficient staffing for demand. Update requested from Quality and Safety Committee - Feb 2014. Further update requested - March 14. Furthjer request made August 2014.
34 22/04/2013 17/02/2014 2 Being unsighted on significant performance PCD Jas Rathore Dan King 4 4 16 CCG and Area Team Interface 2 3 6 CCG and NHSE Interface CCG and NHSE Interface issues identified by the Area Team in Group developing joint processes = Group established. Reports Group established. relation to primary medical services that including support mechanisms for to CCG PCD on quality and Reports to NHSE Area could result in removal of GP member from under-performing GPs/practices. safety and contractual Team on quality and safety the Performers' List performance. and contractual performance
36 16/05/2013 24/09/2014 3 Failure to achieve whole of Quality CDC Neill Bucktin Neill Bucktin 4 4 16 Plans for local targets mostly in Successful plans for domain 1 None 4 4 16 Quality Premia None Regular report on Sep-14 Review recommended merger of (merged with Premium resulting in lost income and place and on track, but still and 5 need to be put in place = achievement reporting to actions and risks 36 (under CDC) and 44 44) reputational damage. significant risk of not achieving CDC and governing body performance to CDC (under F&P). Responsibility to be national domains 1 and 5 (PYLL linked to Outcome determined and recommendation and HCAI) Ambitions and Better for closure of one of these risks to Care Fund. be put to next Board on 11th September. CCG BOARD APPROVED RECOMMENDATION TO CLOSE RISK 44 AND MERGE IT WITH RISK 36 AT 11-SEP-14 MEETING.
39 16/07/2013 03/10/2014 3 Lack of a systematic approach to Q&S Ruth Edwards Rebecca 4 4 16 (some) nursing home provision is No systematic approach to Reporting on quality, how to 3 4 12 MATRIX DEVISED FOR Rolling CQC inspection 1. Systematic on-site Work in nursing homes has ascertaining the quality of the care in our Bartholomew provided under suitable monitor and act upon poor assure appropriateness and = ASSURANCE OF CARE programme reviews introduced. commenced. Safeguarding reps commissioned nursing homes, potentially commissioning contracts. Self- quality. No consistent on-site quality of placements HOME EFFECTIVENESS 2. Ensure NHS from CCG provide support. resulting in harm to vulnerable adults assessment reporting by nursing review process. Some providers IN PLACE contracts in place with homes don't have suitable contracts in all nursing homes. place Report to Q&S delivered in presentation, however 41 03/10/2013 24/09/2014 2 Lack of capacity in the right place for CDC Steve Mann Neill Bucktin 4 4 16 Performance management of Service specification does not Phlebotomy service not on 3 2 6 CDC sighted on complaints Service being Oct-14 Report on AQP. patient access to phlebotomy services. phlebotomy service through have sufficient performance priority list for CCG. = and concerns raised by reviewed. Potential contracts. standards. practices. for AQP Procurement.
43 05/12/2013 29/08/2014 2 Failure to deliver significant QIPP targets in F&P Jas Rathore Matt Hartland 5 5 25 The QIPP challenge process is None identified. None identified 4 5 20 QIPP challenge process; Reports to NHS England. Final sign off of PIDs Sep-14 14/15 and 15/16 puts the future financial robust and the CCG has a history = F&P Committee oversight; Identification of new stability of the CCG at risk. of delivery. The process has been internal audit reviews. schemes/schemes to enhanced in 14/15 with project bring forward to meet plans required for schemes; gap 45 07/01/2014 17/02/2014 2 NHS England terminating primary medical PCD Jas Rathore Dan King 4 4 16 CCG and Area Team interface None identified. 3 3 9 CCG and Area team The interface group will Actions will be As required See also Risk 34 (similar). service contracts of member practices for group have agreed process should = interface group in place to report into the NHS identified by the non-clinical performance issues leading to a termination for non-clinical agree process and England Area Team interface group if and gap in primary care service provision or performance reasons be required. respective responsibilities Primary Care Committee. when NHS England pressure on other primary care providers. in the event of termination. Area team issues termination notices.
48 05/06/2014 29/08/2014 2 Failure of Black Country Partnership FT due F&P Jas Rathore Matt Hartland 4 5 20 Performance management. CQRM Not determined at this stage. Not determined at this stage. 3 5 15 CCG CAO has met the FT Monitor action plan and Meetings to be held Initial meetings to financial pressures will result in to monitor quality. = CE and agreed a number oversight. initially between CCG held inadequate care for the local population. of actions to ensure the and FT managers CCG receives regular followed by Board to Board updates and assurance. Management Teams Sept/Oct 2014. then Board to Board. Range and level of risk to be determined 58 07/10/2014 07/10/2014 3 The JAQ electronic system is not operating Q&S Ruth Edwards Rebecca 4 4 16 Patients are being provided with Patients with inaccurate detail 4 4 16 NEW Escalated to trust risk Medicines management Meeting with Provider Oct-14 Exercise to take place imminently efficiently which has resulted in an Bartholomew paper copies of discharge details realting to prescribing not yet register team continues to monitor to outline extent of unspecified number of Discharge Letters and mediciation to share with GPs identified. Provider to carry out high risk medicines risk and request not being received by GPs. This risk affects to support treatment. Letters are retrospective review immediate review of patients returning to primary care following additionally being sent to GPs by information via changes in treatment medication. Detail to post electronic system. medication changes following review, in Retrospective some cases, inaccurate patients review needs to talke place to identify further risk to patient safety.
DUDLEY CLINICAL COMMISSIONING GROUP BOARD
Date of Report: 13 November 2014 Report: Dudley CCG Constitutional Changes Agenda item No: 11.3
Dudley CCG Constitutional Changes including the impact of the TITLE OF REPORT: Legislative Reform (CCGs) Order 2014
To seek Board approval for changes to the CCG Constitution prior to PURPOSE OF REPORT: st their formal submission to NHSE by 1 December 2014
AUTHOR OF REPORT: Mr M Hartland, Chief Finance Officer
MANAGEMENT LEAD: Mr M Hartland, Chief Finance Officer
CLINICAL LEAD: Dr D Hegarty, Chair
• Letter from NHSE outlines purpose of Legislative Reform Order • Changes to the CCG Constitution are to be submitted to the NHSE by 1st December 2014, being shared with the Local Area Team by KEY POINTS: 3rd November 2014 • Changes agreed at September Board are restated; noted that guidance is still awaited for co-commissioning governance • Changes proposed for new Clinical Executive
• The Board confirms the changes to the Constitution in respect of eligibility for reappointment for Clinical Executives and the addition of a Co-Commissioning Committee. • The Board approves the delegation of authority to the Lay Member for Governance, Chief Accountable Officer and Chief Finance RECOMMENDATION: Officer/Chief Operating Officer to amend the Constitution as appropriate for the appointment of an additional Clinical Executive and the nationally prescribed governance arrangements for Co- Commissioning (Primary Care and Specialised Commissioning) and submit this to NHS England.
FINANCIAL IMPLICATIONS: None
WHAT ENGAGEMENT HAS None TAKEN PLACE: Decision ACTION REQUIRED: Approval Assurance
1 | Page DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 13 NOVEMBER 2014 DUDLEY CCG CONSTITUTIONAL CHANGE
1.0 INTRODUCTION Guidance issued in May 2013 (procedures for clinical commissioning group constitution change, merger and dissolution) allowed CCGs two opportunities each year to request amendments to their Constitution, specifically 1st June and 1st November. Any application for a variation which would change a CCG’s boundary or its list of members, and therefore potentially impact on its financial allocation, can only be made at the 1st June deadline so that the change can be reflected in the allocations for the following financial year.
The NHS England Local Area Team (LAT) is required to review new proposals for change at a local level to ensure that they fit with the national guidance on CCG Constitutions as well as taking an overview to make sure that suggested changes in CCG membership do not adjust CCG boundaries. They also have a requirement to ensure that the appropriate consultation with both patient and CCG members has been undertaken in relation to proposed changes that may involve more than one CCG in practice transfers.
Exceptionally NHS England has extended the 1st November 2014 deadline to 1st December 2014 to allow for the impact of the Legislative Reform (Clinical Commissioning Groups) Order 2014 (LRO) to be reflected in the Constitution although the Area Team has asked for sight of any applications for review by the 3rd November.
Appendix 1 is a copy of the letter from Dame Barbara Hakin, National Director of Commissioning Operations, outlining the purpose of the LRO i.e. to enable (a) two or more CCGs to form joint committees to exercise their functions jointly; and (b) one or more CCGs and NHS England to form joint committees so that the CCG(s) and NHS England can exercise functions jointly.
The CCG Governing Body (the Board) has delegated authority from the group to adopt any changes proposed and approve the application to the NHS Commissioning Board.
2.0 AGREED CHANGES TO DUDLEY CCG CONSTITUTION 2014/15 At its meeting on the 11th September 2014 the Board agreed the following changes to the CCG’s Constitution:
Appendix C, Standing Orders, 2.2.7 Clinical Executive roles, section e) Eligibility for reappointment Amended from: “there is no limit to the number of terms of office served by an individual providing that they continue to meet the eligibility criteria and are subject to a competitive appointment process (as outlined above) after each term” to: “there is no limit to the number of terms of office served by an individual providing that they continue to meet the eligibility criteria. The Chair and Chief Accountable Officer can jointly agree for a reappointment to be renewed automatically; otherwise the post will be subject to a competitive appointment process (as outlined above) after each term”
Section 6.4/6.4.1, Committees of the Group Verbally the board agreed the addition of a new Committee to lead on Co-Commissioning. However at that point the governance arrangements were unclear and therefore it was not possible to develop the detail required for other sections of the Constitution.
GP Practice Changes The Board also noted that whilst there were no proposed changes to the Constitution at this point in time with regards to Member Practices, the CCG was in discussions with the Area Team regarding the process and timeframe for a potential change in CCG membership. We are not in a position to finalise any amendments at this point in the Constitution, however appropriate flexibility is being sought form NHS England to allow any change to happen in a timely manner.
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3.0 PROPOSED ADDITIONAL CHANGES TO DUDLEY CCG CONSTITUTION
3.1 Addition of Details in respect of Co-Commissioning
Although the Board agreed to setting up a Co-Commissioning Committee at its September meeting, further detail needs to be added to the Constitution, in particular the following: • 5.2 General Duties; • 6.4 Committees of the Group; • 6.6.2 Composition of the Governing Body • Appendix D Scheme of Reservation & Delegation
As Dame Barbara Hakin’s letter states: “NHS England will be publishing a draft governance framework for primary care joint commissioning arrangements as part of its forthcoming publication: the next steps towards primary care co-commissioning, which will be published in the autumn of 2014”. Also “Once the LRO comes into force, NHS England will share a suggested form of words for constitutions, which can be tailored to individual circumstances.”
This has not yet been received although it may be available by the time the Board meets on the 13th November. It is proposed that any action required to meet the national deadline of 1st December is discussed and agreed at the Board meeting if appropriate guidance has been published.
It is also proposed to include the requirements of a joint Committee for Specialised Commissioning if appropriate detail is received from NHSE.
3.2 Appointment of an additional Clinical Executive The CCG has redefined its internal structures from the 1 October 2014 following the withdrawal of services from the CSU. To complement the new structure it is proposed to appoint a new Clinical Executive for Systems Redesign. Appropriate adjustments to the Constitution will be made to reflect this.
3.3 Member Practice The CCG is in advanced talks with an out-of-borough practice to join the CCG. The process prescribed by NHS England, including consultation with patient, local authorities, current CCG and other stakeholders is in progress. We will also be bringing a due diligence paper to the CCG membership and Governing Body for approval. The intention is, if possible, to enact the transfer from 1 April 2015 and we will request in the constitution authority to make a variation on member practices. Board will be kept informed of the progress.
4.0 APPENDIX Update on the Legislative Reform Order (LRO)
4.0 RECOMMENDATIONS 1. The Board confirms the changes to the Constitution in respect of eligibility for reappointment for Clinical Executives and the addition of a Co-Commissioning Committee. 2. The Board approves the delegation of authority to the Lay Member for Governance, Chief Accountable Officer and Chief Finance Officer/Chief Operating Officer to amend the Constitution as appropriate for: • the appointment of an additional Clinical Executive • governance arrangements for Co-Commissioning • additional practice to join CCG and submit this to NHS England
M Hartland Chief Finance Officer November 2014
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Publications Gateway Ref. Number 02281 Commissioning Operations NHS England Quarry House Quarry Hill Leeds LS2 7UE
E-mail: england.co- [email protected]
29 September 2014
To CCG Clinical Leaders cc. Area Team Directors
Update on the legislative reform order (LRO)
We are writing to advise of changes that will come into effect from 1 October 2014 as a result of the passing of a legislative reform order (LRO) through Parliament to enable:
(a) two or more CCGs to form joint committees to exercise their functions jointly; and (b) one or more CCGs and NHS England to form joint committees so that the CCG(s) and NHS England can exercise functions jointly.
The changes amend section 14Z3 and 14Z9 of the NHS Act 2006 (as amended by the Health and Social Care Act 2012). The reforms mean that CCGs will no longer find it necessary to operate work-around arrangements such as “committees in common” when they wish to make joint and binding decisions. However, joint committees are only one potential governance model for collaborative commissioning which CCGs may wish to adopt.
The formation of a joint committee will require CCGs to amend their constitutions. A suggested form of words for constitutions, which can be tailored to individual circumstances, will be made available once the LRO is in force.
The LRO affects all CCGs and NHS England. The LRO does not allow CCGs to form joint committees with Local Authorities.
High quality care for all, now and for future generations A. Background and context
In order to commission improvements in health and healthcare for their local populations and to drive the integration of services around the needs of individuals, CCGs need to develop robust collaborative arrangements with other CCGs, NHS England and other partners.
While the NHS Act 2006 (as amended by the Health and Social Care Act 2012) allowed two or more CCGs to exercise their commissioning functions jointly, it made no provision for them to do so via a joint committee. Furthermore, there was no provision in the Act to allow CCGs to exercise their commissioning functions jointly with NHS England and to form a joint committee when doing so.
CCGs reported that the inability to form joint committees presented a number of challenges particularly when working together on issues that cut across boundaries, such as the commissioning of continuing healthcare. It also had an effect on the ability to make effective decisions in relation to service design or provision.
In the interim, some CCGs formed “committees in common” in order to exercise their functions jointly. In practice, this can be an administrative inconvenience, create additional bureaucracy and be an obstacle to efficiency, productivity and value for money.
It was these challenges which prompted CCGs and NHS England to request an amendment to the Act. The Department of Health consulted with a wide range of partners on the proposed amendments to the Act including CCGs, NHS England, NHS Clinical Commissioners and the Local Government Authority. The LRO has now been approved by Parliament and will come into effect on 1 October 2014.
B. Impact upon CCGs and NHS England
From 1 October 2014 onwards, CCGs will have the ability to form a joint committee with:
one or more other CCGs to jointly exercise their functions; NHS England so that the CCG(s) and NHS England can exercise functions jointly.
Joint committees are a statutory mechanism, which give CCGs an additional option for undertaking strategic decision making. CCGs can still form “committees in common” or establish another governance arrangement providing this is compliant with the legislation. NHS England is not able to participate in “committees in common”.
Individual CCGs always remain accountable for meeting their statutory duties, for instance in relation to quality, financial resources and public participation (s.14Z2), and CCGs need to ensure that any collaborative commissioning relationships and governance arrangements enable them to do so effectively.
High quality care for all, now and for future generations NHS England will confirm in due course the internal arrangements by which NHS England will enter into a joint committee with CCGs.
Regardless of the governance arrangement CCGs adopt for strategic decision making, a significant determinant of their effectiveness will be the development of strong collaborative relationships between partners.
C. Examples of where it might be appropriate for CCGs to form a joint committee
CCGs are not compelled to form joint committees. The LRO brings forward new options that CCGs may choose to use. Circumstances where CCGs may wish to consider forming a joint committee with one or more CCG(s) include:
Delivering large scale transformation of NHS services across multiple providers and populations; Developing a unified strategic approach for the local population; Pursuing shared priorities and strategies with a single large provider that serves their populations and a wider geographical area, such as the commissioning of ambulance services or the commissioning of community and acute mental health services. Agreeing consistent approaches to clinical or administrative approaches where the development and management of shared protocols might enable more efficiency, challenge and transparency, such as those for Individual Funding Requests (IFRs), joint audit or remuneration committee arrangements.
It may also be appropriate for CCGs to consider forming a joint committee with NHS England to exercise functions of either party when:
Developing and agreeing aligned strategic planning and delivery processes that take into account the effects of services across a whole pathway, facilitating design and continuity of services across primary, secondary and community care. Reviewing service delivery across specialised services (commissioned by NHS England) and any impact re-design may have on non-specialised acute services (commissioned by CCGs) in order for services to be designed and delivered to achieve the best possible outcome for the population served. Improving the integration of the respective health services that CCGs and NHS England commission, and the integration of health with social care services more widely.
However, joint committees are only one potential governance model for collaborative commissioning and the LRO does not allow CCGs to form joint committees with local authorities. Furthermore, it is not the intention that joint committees will replace other important strategic decision making fora such as Health and Wellbeing Boards.
High quality care for all, now and for future generations D. Impact on co-commissioning
Many CCGs have submitted expressions of interest to undertake primary care co-commissioning, with a large majority proposing to assume joint commissioning responsibilities. The passing of the LRO gives CCGs and NHS England the ability to form joint committees for the commissioning of primary care services at a geographical level which they feel is most appropriate. NHS England will be publishing a draft governance framework for primary care joint commissioning arrangements as part of its forthcoming publication: the next steps towards primary care co-commissioning, which will be published in the autumn of 2014.
The passing of the LRO also opens up the possibility in law in the future for NHS England and CCGs to form joint committees for other healthcare services.
E. Forming a joint committee
Changing a CCG constitution CCGs will need to consider the implications of the LRO on existing or proposed collaborative arrangements with other CCGs and/or with NHS England. It would be good practice for CCGs to review their constitutions and if necessary make an application for a constitutional amendment to NHS England using the procedure set out in the following guidance: Procedures for clinical commissioning group constitution change, merger and dissolution. Once the LRO comes into force, NHS England will share a suggested form of words for constitutions, which can be tailored to individual circumstances.
The forthcoming deadlines for submitting an amendment request are: 1 December 2014 (postponed from 1 November 2014 to account for the impact of the LRO) 1 June 2015 1 November 2015 If constitutional amendments relate solely to primary care co-commissioning arrangements then these will be accepted later in 2014-15 (the deadline for co- commissioning amendments will be confirmed in the next steps publication but it is expected to be January 2015).
CCGs are reminded of their duty1 to take into account the views of their local authority when making amendments to their constitutions.
Involvement duties Clinical Commissioning Groups (CCGs) and commissioners in NHS England have a legal duty to enable:
Patients and carers to participate in planning, managing and making decisions about their care and treatment; through the services they
1 National Health Service (Clinical Commissioning Groups) Regulations 2012, SI 2012/1631 High quality care for all, now and for future generations commission;2 and
The effective participation of the public in the commissioning process itself, so that services provided reflect the needs of local people.3
CCGs and NHS England remain accountable for meeting their statutory duties and should ensure any governance arrangement does not compromise this, and ensures that CCGs are able to meaningfully engage patients and the public in decision making.
Membership of joint committees It is for the CCGs involved to determine the membership arrangements of their joint committees. CCGs are encouraged to consult the Transforming Participation in Health and Care guidance when considering the membership of their committees.
Good governance when collaborating with other organisations When collaborating with other organisations, it is considered good practice to:
Secure shared objectives; Ensure explicit alignment of the vision and values for the area of collaboration; Agree the scope of collaboration; Clarify the extent to which decisions can be taken by the collaborative arrangement; Clarify the process for taking decisions; and Confirm reporting arrangements.
F. Further information
For further information about the LRO and is impact please contact england.co- [email protected]
Dame Barbara Hakin National Director: Commissioning Operations
2 s.14U 3 s.14Z2 High quality care for all, now and for future generations
DUDLEY CLINICAL COMMISSIONING GROUP BOARD
Date of Report: 13 November 2014 Report: CCG Structures Agenda item No: 11.4
TITLE OF REPORT: CCG Structures
As a result of the decision to withdraw services from the CSU with effect from 1 October 2014, the internal structure of the CCG has been enhanced.
PURPOSE OF REPORT: The attached paper presented to Remuneration Committee on 5 November paper outlined the new structures, including additional support functions, and proposed alterations to titles of management posts within the structure.
AUTHOR OF REPORT: Mr M Hartland, Chief Operating and Finance Officer
MANAGEMENT LEAD: Mr P Maubach, Chief Accountable Officer
CLINICAL LEAD: Dr D Hegarty, Chair
• New structure established from 1 October 2014 • Change in responsibility of posts with structure KEY POINTS: • Change in titles of posts • The Remuneration Committee noted the amendments to the CCG structure and post titles with effect from 1 October 2014.
The Board is asked to note the amendments to the CCG structure and RECOMMENDATION: post titles with effect from 1 October 2014.
FINANCIAL IMPLICATIONS: Affordable with running costs allowance
WHAT ENGAGEMENT HAS Extensive with staff. Formal consultation with management leads in TAKEN PLACE: Finance, Performance and Governance Team Decision ACTION REQUIRED: Approval Assurance
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DUDLEY CLINICAL COMMISSIONING GROUP REMUNERATION COMMITTEE – 5 NOVEMBER 2014 CCG STRUCTURES
1.0 INTRODUCTION
1.1 As a result of the decision to withdraw services from the CSU with effect from 1 October 2014, the internal structure of the CCG has been enhanced. This paper presents to Committee the new structures, including additional support functions, and proposed alterations to titles of management posts within the structure.
2.0 STRUCTURE
2.1 In 2012 the CCG was required to undertake a process whereby it assessed the functions it wished to provide in-house within the CCG, and those it wished to purchase from commissioning support organisations.
2.2 The functions procured from the CSU from 1 April 2013 were:
• Quality & Safety, Complaints & Patient Experience • Workforce assurance • IFR’s • HR • Technical accounts • Corporate governance • Information governance • Business intelligence • Contracting and procurement • Strategic IT • Strategy Unit
2.3 The contract with the CSU ended on 30 September 2014. We have taken the opportunity to re-visit how we provide our functions and have informed the CSU we will not be re-commissioning the following services:
• Quality & Safety, Complaints & Patient Experience • Technical accounts • Corporate governance • Contracting • Strategic IT
2.4 These services have therefore been brought in-house, and result in an amendment to the structure of the CCG with effect from 1 October 2014.
2.5 The key changes to the structure, by Department, are as follows:
1. Finance, Performance & Governance 1.1. Establishment of Technical Accounts team within the internal structure 1.2. Establishment of a Corporate Governance post 1.3. Establishment of a Performance/Analytics team 1.4. Establishment of a Contracting team 1.5. Change in the responsibility of the Deputy Chief Finance Officer 1.6. Change in responsibility of the Head of Business and Performance 1.7. Change in responsibilities of Finance Managers
2 | Page 2. Communications and Public Insight 2.1. Change in responsibility of Head of Communications & Engagement 2.2. Establishment of a new post for Complaints & FOI 2.3. Establishment of a new post for Patient Experience
3. Commissioning 3.1. Formalise Head of Commissioning post in structure 3.2. Establishment of a new post in anticipation of Co-commissioning
4. Quality & Safety 4.1. Establishment of a new Quality and Patient Safety team
5. Organisational Development & HR 5.1. Redefinition of PA roles to support the Chair & Chief Accountable Officer 5.2. Increased admin support for new teams 5.3. Redefinition of Office Manager role to support HR and OD.
6. Membership Development 6.1. No change
Other Changes
2.6 NHS General Management Trainee A new post of NHS General Management Trainee has been included with the aim of recruiting from the NHS Leadership Academy programme.
2.7 IT & System Redesign The new post of Head of IT & System Redesign will now report directly to the Chief Accountable Officer and be part of the Senior Management Team of the organisation.
2.8 Chief Operating Officer The job description for the Chief Finance Officer (CFO) includes the requirement to deputise for the Chief Accountable Officer. The restructure, and redefinition of roles, within the Finance, Performance and Governance department will allow the post-holder to take on a greater role in ensuring that business processes for the whole organisation are robust and adhered to, thus ensuring CCG meets its statutory financial and non-financial duties and delivers the improvements in patient care described in our Strategic and Operational Plans. From the 1 October, therefore, the CFO will now also take the role of ‘Chief Operations Officer’ in addition to Chief Finance Officer.
2.9 Continuing Care/Intermediate Care Clinical Development Committee (CDC) agreed to an increase in the Continuing and Intermediate Care teams to support a move to 7 day working in addition to an increase in the number of referrals to the teams. Following Committee the working practices of the team are being reviewed and the appropriate rota and on-call arrangements are being agreed. When this has been concluded consultation will start with the team and when finalised the structure diagram will be updated.
2.10 Financial Impact The changes described above are to be funded from the value for money benefit of moving services in- house from CSU and supplementary use of running-cost reserves. The structure is affordable in 2015/16 when running cost budgets reduce by 10%, and contains resource for non-recurrent expenditure as required. This resource is limited, however, as the aim is to deliver the majority of services from within in-house teams.
Post titles
2.11 The Health and Social Care Act, and CCG Constitution, describes formal titles for posts within the CCG as defined by statute, however as time has progressed since 2013 such titles do not reflect roles
3 | Page undertaken or are not comparable with titles in neighbouring organisations. This is particularly apparent in the restructure of Dudley MBC.
2.12 It is therefore proposed to change the ‘day-to-day’ titles of certain posts within the structure as defined below:
Current: Proposed Chief Accountable Officer Chief Executive Officer Lay Members Non Executives Head of Communications Head of Communications & Public Insight Chief Finance Officer Chief Operating & Finance Officer Organisational Practitioner Head of Organisational Development and Human Resources Finance Manager (Corporate) Head of Financial Management (Corporate) Finance Manager (Commissioning Head of Financial Management (Commissioning) Business & Performance Manager Head of Intelligence & Analytics
2.13 There will be a requirement for new job descriptions for some of the posts above that will be updated over the next 3 months.
2.14 It is proposed for the new titles to be applicable immediately. It is not proposed to amend the titles in the Constitution, therefore all legal documents will be signed as per the Constitution.
3.0 RECOMMENDATION
The Committee is asked to note the amendments to the CCG structure and post titles with effect from 1 October 2014.
Matthew Hartland Chief Operating & Finance Officer October 2014
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Dudley CCG Management Structure (including support functions) October 2014
Chief Accountable Officer P Maubach
Chief Operating & Finance Organisational Officer Development M Hartland S Cartwright
NHS General Communications & Finance, Performance & Membership Organisational Quality & Safety Commissioning IT & System Redesign Management Trainee Public Insight Governance Development Development & HR Vacant
L Broster M Hartland R Bartholomew D King Vacant S Cartwright N Bucktin Head of Communications Chief Operating & Finance Chief Quality & Nursing Head of Membership Head of IT & System Head of OD & HR Head of Commissioning & Public Insight Officer Officer Development Redesign
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DUDLEY CLINICAL COMMISSIONING GROUP BOARD
Date of Report: 13 November 2014 Report: Finance and Performance Committee Report Agenda item No: 12.1
TITLE OF REPORT: Finance and Performance Committee Report
To advise the Board of key issues discussed at the Finance and PURPOSE OF REPORT: Performance Committee on 25 September 2014 and 30 October 2014.
AUTHOR OF REPORT: Mr M Hartland, Chief Finance Officer
MANAGEMENT LEAD: Mr M Hartland, Chief Finance Officer
CLINICAL LEAD: Dr J Rathore, Clinical Executive for Finance and Performance • CCG expects to meet all its statutory financial duties by 31 March 2015. • The CCG expects to achieve its control total of £5.4m as agreed with the Area Team, which reflects the carry forward of the surplus achieved in 2013/14. • CCG is achieving all its Area Team assurance indicators. • Shortfall identified against the QIPP target in 2014/15 which will increase the value of the target in 2015/16. • The principle and proposed approach to the development of KEY POINTS: comprehensive and robust community contracts designed to support the integration model agreed. • The revised methodology for practice prescribing budgets for 2014/15 and 2015/16 with a review towards the end of the financial year agreed. • Performance exceptions noted and discussed • Scorecard report presented and the position of practices against key indicators noted. • Reports from IT Strategy Group and Estates Strategy Group received. RECOMMENDATION: The Board is asked to approve the report.
FINANCIAL IMPLICATIONS: As described in the report.
WHAT ENGAGEMENT HAS None TAKEN PLACE: Decision ACTION REQUIRED: Approval Assurance
1 | Page DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 13 NOVEMBER 2014 FINANCE AND PERFORMANCE COMMITTEE REPORT
1.0 INTRODUCTION The report summarises the key issues discussed by the Finance and Performance Committee at its meetings on 25 September 2014 and 30 October 2014.
The following items are indicators of the current position in relation to the main responsibilities and obligations of the Committee as defined by the CCG Constitution and Terms of Reference. The finance indicators summarise the CCG’s key financial indicators and performance against its statutory financial duties to 30 September 2014 as reported to Committee on 30 October 2014.
2.0 KEY INDICATOR SUMMARY The table below identifies key financial indicators as at 30 September 2014.
DUDLEY CLINICAL COMMISSIONING GROUP FINANCIAL PERFORMANCE DASHBOARD SEPTEMBER 2014 Year To Forecast Plan Performance Item Date Variance RAG £000's £000's £000's Statutory Financial Duties Achieve Revenue Resource Limit Control Total (5,400) (617) (5,400) Capital Resource Limit 0 0 0 Running Costs 7,647 (341) (0) Cash Limit 0 67 0 Better Payment Practice Code - NHS 95% 99.49% 97% Better Payment Practice Code - Non NHS 95% 98.74% 97% LAT Assurance Indicators Underlying Recurrent Surplus (11,937) (5,580) (11,160) Programme Surplus - Year to date performance (273) (276) Running Cost Surplus - Year to date performance (336) (341) Programme Surplus - Full year forecast (5,400) (5,400) Running Cost Surplus - Full year forecast 0 (0) Management of 2% Non Recurrent funds within agreed Yes YES YES processes QIPP - Year to date delivery (2,489) (2,489) QIPP - Full year forecast (7,166) (7,166) Activity trends - Year to date (IP/ OP / A&E) 285 282 Activity trends - Full year forecast (IP/ OP/ A&E) 569 564 Clear identification of risks against financial delivery and Met in full Met Met mitigations
Internal & External Audit Opinions and an assessment of the There were no exceptions to report this month timeliness and quality of returns
Balance Sheet indicators including cash management and BPCC Local Indicators Revenue Resource Limit Planned Care 168,015 1,059 2,177 Urgent Care 78,931 1,991 3,959 Preventative Care 37,795 486 680 Reablement 22,137 (5) 29 Corporate 7,647 (341) (0) Non Recurrent 9,273 (2) 0 Reserves including Surplus 16,348 (1,286) (8,346) Other 44,873 (2,520) (3,898) Total 385,018 (617) (5,400)
2 | Page Year To Forecast Plan Performance Item Date Variance RAG £000's £000's £000's Localities Dudley & Netherton 26,023 81 162 Sedgley,Coseley & Gornal 25,875 329 657 Halesowen & Quarry Bank 24,372 263 525 Stourbridge, Wollescote & Lye 30,867 (333) (666) Kingswinford, Amblecote & Brierley Hill 41,366 1,170 2,340 Total 148,503 2,254 4,248 Activity Emergency Activity 34 1 1 Elective Activity 38 (0) (0) A&E Activity 73 3 7 Outpatient Activity 424 (6) (12) Total Activity 569 (2) (5) Memorandum Items Total Revenue Resource Limit 385,018
Movement in Revenue Resource Limit since last month (441)
3.0 EXCEPTION REPORTING
3.1 Statutory Financial Duties The CCG is on target to achieve all statutory duties by 31 March 2015 and is expected to achieve its control total of £5.4m at the year-end as agreed with the Area Team.
The CCG achieved its financial performance target of ensuring the month end cash balance was within 5% of the cash drawn down from NHS England (NHSE).
3.2 Area Team Assurance Indicators The CCG is currently achieving all its Area Team Assurance indicators.
3.3 Local Indicators Urgent care was reported as red mainly due to over-performance in emergency activity. This is predominantly an increase in same day emergency care provided at Dudley Group Foundation Trust (DGFT).
Stourbridge, Wollescote and Lye (SWL) was the only locality not overspending. Please refer to 4.10 for further detail.
4.0 ITEMS DISCUSSED – FINANCE
4.1 Revenue Resource Limit At the end of September the CCG’s commissioning budget was £385,018,481.
4.2 Capital Resource Limit The CCG has submitted a nil return for capital plans and therefore is not planning to receive a capital allocation for 2014/15.
4.3 Running Costs The CCG has a running cost allowance of £7,647,000 for 2014/15 and is reporting a year to date underspend of £341,000. It is expected that the full running cost allowance will be utilised by the end of the year.
4.4 Cash Limit The CCG is required to meet two targets in relation to cash management - to remain within the allocated cash limit and to ensure that monthly cash balances are within 5% of the cash requested from NHSE. The CCG achieved its cash target.
3 | Page Recent guidance has been received from NHSE notifying the CCG of a reduction in the target from 5% to either 1.25% or 1.75% with effect from January 2015. As a consequence cash forecasting within the CCG will need to be enhanced with much stricter controls being applied to the timing of payments.
4.5 Better Payment Practice Code Compliance with the prompt payment code requires the CCG to pay all NHS and non-NHS trade payables within 30 days of receipt of goods or a valid invoice (whichever is later) unless other payment terms have been agreed. The CCG has a target of 95% for these transactions, which are both being achieved as described below:
4.5.1 Better Payment Practice Code – NHS At the end of September the CCG’s cumulative performance was 99.49%.
4.5.2 Better Payment Practice Code – non-NHS At the end of September the CCG’s cumulative performance was 98.7%.
4.6 QIPP 2014/15 The QIPP target for 2014/15 is £7.166m. A shortfall of £1.925m has been identified against schemes in the plan, which is being covered non-recurrently by releasing funding from the QIPP reserve. This has resulted in a QIPP target of £11.186m in 2015/16. This position cannot be sustained as we approach 2015/16. The CCG must identify additional savings initiatives or it will be in a position where all reserves are utilised to achieve its statutory duties, thus removing the ability to invest in new services on either a recurrent or non-recurrent nature. The Clinical Development Committee has been asked to dedicate the majority of their November meeting to the QIPP agenda in 2015/16.
4.7 Statement of Financial Position The Committee noted the statement of the financial position of the CCG at the end of September 2014. No areas of concern were reported.
4.8 Workforce An establishment register has been constructed with employees and contracted staff reported against the funded established posts. Workforce issues pertinent to provider organisations are managed by the Quality and Safety Committee.
4.9 Localities Of the five localities, only Stourbridge, Wollescote and Lye (SWL) is forecasting an underspend to the end of September. Kingswinford, Amblecote and Brierley Hill (KAB) locality is forecasting an over-performance of 5.66% and therefore rated red in the indicator summary. The main reason is an increase in urgent care costs. It is important that the financial position of localities takes a greater emphasis at locality meetings as the financial position is deteriorating. The financial position of the CCG is being upheld by the use of contingency reserves, but this position cannot be sustained.
4.10 Area Team Assurance The CCG has achieved green ratings for all Area Team financial indicators for the first and second quarters of 2014/15.
4.11 Risks The main risks facing the CCG financial position relate to further slippage in the QIPP programme; cost pressure relating to NHS 111; increased prescribing costs; potential cost pressure following the transfer of buildings and services to NHS Property Services and Community Health Partnerships, and over-performance on acute service level agreements. As the year progresses, these risks reduce.
4 | Page 4.12 Non-Recurrent Spend/Balance of Reserves The CCG is undertaking a non-recurrent spending programme focussed on the delivery of failing performance issues in providers; investment in the CCG’s strategic priorities and pump priming of further initiatives. The delivery of the plans is key to the achievement of the CCG’s statutory duties. Contingency reserves are being utilised to fund slippage in key QIPP initiatives and prescribing overspends, however such reserves are in the financial plan for the year.
5.0 COMBINED BOARD ASSURANCE FRAMEWORK AND RISK REGISTER The risks assigned to the Committee were reviewed and accepted. No new risks were added to the register.
6.0 OUT OF AREA PLACEMENTS The Committee had expressed concern about the costs associated with an out of borough placement. It received a report on the relocation of the individual to a placement closer to home; however it is understood that this is an area of spend volatility.
7.0 SERVICE INTEGRATION UPDATE The Committee received a report on progress with the implementation of the service integration model. This was important to the Committee due to the shortfall in the savings programme from delays in the implementation of the Rapid Response Team. The Committee has requested enhanced monitoring of the programme to ensure the financial position of the CCG is not put at risk.
8.0 DUDLEY GROUP OF HOSPITALS CONTRACTUAL PENALTIES/FINES The Committee considered and agreed the CCG’s response to DGFT on the reinvestment of fines in 2013/14 and 2014/15 and transition support. At the time of reporting to the Board DGFT have not implemented all of the actions stipulated as conditions of the re-investment and transition funding and claw-back is, therefore, expected.
9.0 CONTRACTUAL DEVELOPMENT OF THE INTEGRATION MODEL The Committee considered a proposed approach to the development of comprehensive and robust community contracts designed to support the integration model. The Committee supported the principle and proposal.
10.0 PRESCRIBING BUDGET REPORT The Committee received a report on the methodology for setting 2014/15 prescribing budgets. This allowed consideration of a range of parameters, placed practices into one of eight budget levels and supported the setting of bespoke practice goals. The Committee approved the new methodology for practice budgets for 2014/15 and 2015/16 with a review towards the end of the financial year.
11.0 BETTER CARE FUND The Committee received a report on the current position in relation to the Better Care Fund.
Dudley’s plans have been approved with three conditions, two of which were of a technical and presentation nature. The third related to the CCG’s ambitions for reducing emergency admissions. Dudley is expected to produce an action plan to address the three conditions by 14 November 2014.
12.0 BLACK COUNTRY RISK POOL CCGs are required to establish risk pools with neighbouring CCGs. Dudley CCG is part of the Black Country risk pool as approved by Board. A request was received from a member of the pool for
5 | Page non-recurrent utilisation of the pool in 2014/15, which was agreed by the Committee, subject to pay- back in 2015/16.
13.0 PATHWAYS EFFICIENCY In order to achieve the NHSE requirement on the CCG to achieve a 20% improvement in the productivity of elective care, Deloitte were commissioned to develop a model to assess the variation in the provision of such care initially in eight troubled specialities. The output from phase 1 of the review was presented to the Committee and has identified significant variation in pathways between acute providers, individual consultants in providers and GP practices. A number of actions were identified to progress the findings of the analysis to date which includes sharing the outputs with DGFT at management, specialty and consultant level. The outcome is expected to feature in the CCG’s QIPP programme for 2015/16.
14.0 KEY INDICATOR SUMMARY – PERFORMANCE The table below identifies key performance indicators as at August 2014, (September where available) the last period for which validated data has been received.
DUDLEY GROUP OF HOSPTALS FOUNDATION TRUST Indicator Target/ Threshold Apr May Jun Jul Aug Sep YTD RAG National Quality Requirements MRSA Acute 0 0 0 0 0 0 0 0 Clostridium difficile Acute =<48 Annum 3 1 3 2 6 0 15
RTT waits over 52 weeks 0 1 0 0 0 0 1
Ambulance Handover between 30mins & 60mins Target 15m, Threshold =30m 277 337 306 207 196 306 1629
Ambulance Handover > 60mins Target 15m, Threshold =60m 29 28 24 9 7 13 110
Trolley Waits in A & E Any trolley wait > 12 hours 0 0 0 0 0 0 0 Number of urgent operations Cancelled Operations (Urgent) 0 0 0 0 0 cancelled for a second time
Publication of Formulary Yes/No Yes Yes Yes Yes Yes Each failure to notify the Duty of Candour Yes Yes Yes Yes Yes Relevant Person of a suspected Operational Standards 18 Weeks RTT (Admitted) 90% 90.15% 90.04% 90.06% 90.03% 90.31% 90.1% 18 Weeks RTT (Non Admitted) 95% 99.22% 99.17% 99.21% 99.19% 98.97% 99.2% 18 Weeks RTT (Incomplete) 92% 93.60% 95.40% 95.20% 96.00% 95.93% Diagnostic Waits 99% 98.80% 98.998% 97.38% 97.82% 95.46% 97.7% A&E 4 Hour Wait 95% 91.4% 91.4% 93.4% 96.9% 97.2% 94.20% 94.1% Cancer 2 Week Waits 93% 97.7% 97.8% 95.5% 96.27% 96.8% 96.8% Breast Symptoms 2 Week Waits 93% 96.8% 97.2% 97.9% 93.45% 95.9% 96.3% Cancer 31 day Waits 96% 100% 100% 99.3% 100% 99% 100% 31day - Susequest Surgery 94% 100% 94.7% 100% 100% 100% 98.9% 31 day Anti Cancer Drug Regimens 98% 100% 100% 100% 100% 100% 100% 31 day wait - Radiotherapy 94% 100% 100% 100% 62 day - RTT Cancer 85% 92.6% 87.4% 87.3% 86.8% 87.7% 88.4% 62 day - RTT (Screening) 90% 100% 100% 100% 100% 100% 100% 62 day - RTT (Upgraded Priority) 85% 99.1% 95.8% 100% 99% 100% 98.7% MSA Breaches 0 0 0 0 0 0 0 Cancellations of Operations 0 0 0 0 0 0
6 | Page DUDLEY GROUP OF HOSPTALS FOUNDATION TRUST
2013 2014
Indicator Target / Threshold Apr May Jun Jul Aug Sep Oct Nov Dec Jan YTD RAG Mortality (SHMI) CSU HED Data - Rolling 1.00 1.098 1.07 1.07 1.04 N/A 12 months
Mortality (SHMI) CSU HED Data - monthly 1.00 1.18 1.07 0.95 0.97 0.89 0.98 0.93 1.03 0.95 1.04
Mortality (HSMR) CSU HED Data - Rolling 2.00 1.023 1.020 1.030 1.03 N/A 12 months Mortality (HSMR) CSU HED Data - 3.00 1.1422 0.8851 0.9773 1.1065 0.9587 1.0549 1.1663 1.0162 98.29 97.33 1.03 monthly
West Midlands Ambulance Service YTD Indicator Target Apr May Jun July Aug Sep Oct Nov Dec Jan Feb Mar RAG Performance Category A Red 1 Response 75% 87.9% 88.1% 93.8% 79.2% 92.3% 94.9% 89.0%
Category A Red 2 Response 75% 78.2% 77.7% 76.6% 76.3% 76.9% 77.4% 77.2%
Category A 19 Minute Response 95% 99.3% 99.6% 99.5% 99.3% 99.2% 99.1% 99.2%
Target 15m, Ambulance Crew Readiness (a) 11 10 11 13 7 7 59 Threshold =30m Target 15m, Ambulance Crew Readiness (b) 0 0 0 0 0 0 0 Threshold =60m
Dudley & Walsall Mental Health YTD Indicator Target Apr May Jun July Aug Sep Oct Nov Dec Jan Feb Mar RAG Performance Improved Access to Trust 10585 1003 925 1055 847 797 1094 5721 Psychological Therapies (882 mth)
IAPT - 2 Sessions completed 50.5% 56.8% 46.9% 55.9% 53.5% 47.7% 44.7% 50.9%
Ramsay Healthcare 2014/15
Item Indicator Target Apr May Jun July Aug Sep Oct Nov Dec Jan Feb Mar YTD RAG
National Quality Requirements 1 Zero 0 0 0 0 0 0 MRSA 2 Cdiff Zero 0 0 0 0 0 0 52 Week 3 Zero 0 0 0 0 0 0 Waits Publication of 5 Yes/No Y Y Y Y Y Y Formulary Duty of 6 Compliancy Y Y Y Y Y Y Candour
Operational Standards 18 Weeks RTT Operating 7 100% 98.4% 100% 99.5% (Admitted) standard of 90% 18 Weeks RTT 8 (Non- Operating 100% 99.3% 100% 99.6% Admitted) standard of 95% 18 Weeks RTT Operating 9 100% 99.9% 100% 99.9% (Incomplete) standard of 92% Diagnostic 10 Operating 100% 100% 100% 100% 100% Waits standard of >99% 11 MSA Breaches Zero 0 0 0 0 0 0 Progressive targets measured Cancellation Quarterly to be 12 1 0 0 0 0 1 of Operations agreed based on 2011/12 achievement data.
15.0 EXCEPTION REPORTING
15.1 National Quality Requirements - Dudley Group Foundation Trust (DGFT)
• Ambulance Handovers >30 minutes • Ambulance Handovers >60 minutes
7 | Page 15.2 Ambulance Handover The breaches at +30 minutes and +60 minutes have continued at the previous levels. A&E turnaround measures are likely to have a positive impact on this performance. The Trust has been fined based on previously agreed methodology.
15.3 National Operational Standards DGFT failed two National Operational Standards - A&E 4 hour waits and Diagnostics.
15.4 Supplementary Paper A supplementary paper was submitted to the Finance and Performance Committee in October which gave an in depth view of performance and action plans on the following:-
• A&E 4 hour waits • Referral to Treatment Times • Non-Elective Admissions • Winterbourne View • Improved Access to Psychological Therapies • Dementia
15.5 A&E 4 hour waits DGFT failed the target in September. More recent data has shown an improvement in performance; however, this will need to be sustained if the target is to be met in Q3. The Trust needs to meet 96% daily between now and year-end to achieve the target.
In 2014/15 A&E waits carry an increased penalty, which is approximately three times greater than in previous years.
15.6 18 Weeks Referral to Treatment (RTT) Performance (DGFT) DGFT achieved the aggregate RTT targets year to date, but at specialty level failed the 90% target in ENT, Ophthalmology, Trauma and Orthopaedics and Urology for admitted patients.
Detailed recovery plans have been introduced with a range of initiatives such as extra sessions and outsourcing. These recovery plans have continued to deliver reductions in the waiting lists and progress is monitored by the CCG on a weekly basis.
15.7 Emergency Admissions Emergency admissions have increased in 2014/15 compared to the previous year. This trend is against the intention the CCG has described in its Strategic and Operational Plans for a significant reduction in admissions. 8.2% of emergency admissions are from the care home environment. The Community Rapid Response Team is a key intervention to reduce emergency admissions as part of the Better Care Fund, Integration and QIPP programme. We are likely to be in a position where we reduce our ambition on the timeframe within which we expect to achieve our declared ambitions. The Board will be kept informed of progress.
15.8 Winterbourne View The CCG continues to monitor Tier 1 CCG funded placements ensuring patients within a hospital setting with a learning disability who no longer require this level of care are transferred to care within a community setting. There are no areas of concern to date.
15.9 Improving Access to Psychological Therapies (IAPT) (Dudley and Walsall Mental Health Trust) Dudley and Walsall Mental Health Partnership are achieving the service targets for this indicator. However the Black Country Partnership Trust and Big White Wall IAPT providers do not currently submit IAPT information to UNIFY. However, Dudley CCG as a whole is not meeting the required trajectory. The CCG is scoping extra capacity with providers. The delivery of this indicator is potentially at risk due to a lack of appropriate providers and capacity.
8 | Page 15.10 Dementia Dudley CCG is currently achieving 42.88% dementia diagnosis against estimated prevalence. The year-end target is 67%. Dementia registers are currently being updated and it is anticipated that this action will improve the current level of achievement substantially. A contingency plan is being developed should the target appear at risk of delivery.
15.11 Other indicators
Diagnostics DGFT failed the diagnostics target in August due to poor performance in non-obstetric ultrasounds. Alternative capacity for this diagnostic is being scoped urgently.
Mortality Indicator (DGFT) The SHMI has shown continued improvement month on month and quarter on quarter. Also the hospital specific metric (HSMR) shows DGFT within normal variance of the number of expected deaths.
Mortality as an issue is discussed in greater detail at the Quality and Safety Committee.
15.12 Quality Premium Indicators (CCG Focused Indicators) The provisional NHSE assessment of achievement shows Dudley CCG achieving 62.5%. However, due to DGFT not meeting the 4 hour wait standard a reduction was applied meaning that the revised achievement was 46.8%.
16.0 SCORECARD REPORT The CCG Scorecard Report was presented to the Committee.
16.1 Community Indicators Almost all of the aggregated practice scores for localities demonstrated performance at the Platinum or Gold levels. However, it is worth noting that many of the percentage achievements at practice level were derived from very low levels of activity. This is less of an issue with the aggregated locality view, but is important when comparing individual practices.
16.2 Secondary Care Indicators Emergency admissions are the one indicator which demonstrated a Red category performance.
16.3 Primary Care Indicators All localities performed between the Silver and Platinum standard for primary care indicators.
16.4 Finance Indicators This indicator scored red on the basis the aggregated achievement was an overspend of 0.72%.
Balanced scorecard performance exceptions are reported at the Finance and Performance Committee and addressed in the Practice Performance reviews. The scorecard is being reviewed and a revised version is to be submitted to Committee and localities in due course.
17.0 REPORTS FROM GROUPS ACCOUNTABLE TO THE COMMITTEE
17.1 IT Strategy Group Mr Paresh Patel, Primary Care IT Manager has joined the CCG.
A significant volume of work is being undertaken to deliver the CCG’s IT strategy. Work is now focussing on developing the requirements for the electronic shared care record, a community system and mobile solution and the data and systems required to support the Urgent Care Centre. All are expected to be delivered in the agreed timeframes.
9 | Page 17.2 Estates Strategy/Operational Group The Chief Finance Officer has attended all locality meetings to discuss the Health Infrastructure Strategy. Thoughts from localities will be formulated and included in the review. Feedback will be presented to a Board Development session shortly.
The Health Infrastructure Strategy was on track for publication by the end of March 2015.
18.0 DECISIONS TAKEN UNDER DELEGATED POWERS None
19.0 RECOMMENDATION The Board is asked to approve the report.
Matthew Hartland Chief Operating and Finance Officer October 2014
10 | Page
DUDLEY CLINICAL COMMISSIONING GROUP BOARD
Date of Report: 13 November 2014 Report: Primary Care Development Committee Report Agenda item No: 13.1
TITLE OF REPORT: Primary Care Development Committee Report
To advise the Board on key issues discussed at the Primary Care PURPOSE OF REPORT: Development Committee on 12th September 2014 and 16th October 2014 AUTHOR OF REPORT: Mr D King, Head of Membership MANAGEMENT LEAD: Mr D King, Head of Membership CLINICAL LEAD: Dr J Rathore, Clinical Executive for Finance and Performance • Web based quality reporting tool being developed in partnership with NHS England • Non recurrent spending plans approved for Primary Care Transition Fund • Online training package rolled out to all practices to ensure CQC compliance • Extended Hours Plus enhanced service specification developed to provide additional primary care appointment capacity throughout the winter • Update received from the interface group between NHS England and the CCG: The CCG continues to have lower number of outlying practices compared to the Area Team and Nationally. KEY POINTS: • Update received from the Co Commissioning task and finish group which will be reporting to Audit Committee • Quarter 1 immunisation screening report received from the Office of Public Health • NHS England Pharmacy Flu Vaccination pilot discussed: the Committee will be formally feeding back their concerns to NHS England • The final draft of the NHS England Primary Care Strategy was shared with the Committee • A new risk was added to the risk register regarding the ability of member practices to fulfil their contractual obligations to NHS England as a result of difficulties recruiting substantive GPs. The Board is asked to note, for assurance, the issues discussed at the RECOMMENDATION: Primary Care Development Committee. FINANCIAL IMPLICATIONS: None WHAT ENGAGEMENT HAS None TAKEN PLACE: Assurance ACTION REQUIRED: Approval Decision
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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 13 NOVEMBER 2014 PRIMARY CARE DEVELOPMENT COMMITTEE REPORT
1.0 INTRODUCTION This report summarises the key issues discussed at the Primary Care Development Committee on 12th September 2014 and 16th October 2014.
2.0 ITEMS DISCUSSED
2.1 Quality Reporting Tool The Committee received a presentation on a tool being developed to measure primary care quality. The tool brings together quality measures from NHS England, the CCG, the Office of Public Health and contract values, to look at the relationship between quality and cost in primary care.
A task and finish group has been established to develop the quality measures. The group developing the tool is predominantly clinical and involves representation from NHS England.
2.2 Non Recurrent Spending Plans The Committee received and supported a spending plan for the non-recurrent primary care transition fund. The plan approved by the Committee would be sent the Finance and Performance Committee for approval.
The Committee noted that the plan had been developed, prioritised and scored by clinical board members against the criteria that measured the compatibility of each bid against strategic fit, service integration, improvements workload and access within primary care, scale and sustainability and quality improvement.
2.3 Blue Stream Academy’s GP Practice eLearning Tool The Committee received a presentation from practice managers that had been piloting Blue Stream Academy’s GP Practice eLearning Suite. The tool helps practices to ensure CQC compliance, is module based, CPD accredited and provides 50 hours of training. The Committee supported the Dudley Practice Management Alliance purchasing licences for all member practices from its training budget.
2.4 Extended Hours Plus Service Specification The Committee agreed the content for a proposed enhanced service to be commissioned to extend routine appointment access over and above extended hours commissioned by NHS England. The service specification has been considered by the Clinical Development Committee and further recommendations sent back to Primary Care Development Committee for final approval.
2.5 Update from the Interface Group with NHS England The Committee received a report from the Interface group. The key points to note are as follows: o The CCG continues to have a lower number of outlying practices compared to the Area Team and Nationally. o All practices affected by the NHS England Minimum Practice Income Garauntee funding reductions have been offered support visits from the CCG. 2/3 practices have taken up the offer of support. o There are no outstanding contractual breaches for any member practice. o The managing patient behaviour policy drafted by the CCG was accepted by NHS England and has been circulated to practices following feedback from the LMC. o The CCG has received and circulated Friends and Family boxes. Each box contains 500 cards, 2 A3 posters, and info leaflets. 2 | Page
2.6 Co Commissioning Task and Finish Group The Committee received an update for information that the task and finish group has been established and will be reporting to the Audit Committee.
2.7 Quarter 1 Immunisation Scrutiny Report The Dudley Office of Public Health Immunisation Team presented the quarter 1 immunisation report. The key points from which were noted: o There have been slight decreases in uptake at age 12 months this quarter and this phenomenon has been seen nationally too. o Uptake of MMR first dose by age 5 years this quarter reached an all time high of 98.2% o Annual uptake of HPV vaccine for adolescent girls in Dudley is higher than England average but has dropped since the first year of introduction (2008) o Neonatal Hep B vaccination remains at 100% due to bespoke monitoring by the Office of Public Health o The domiciliary Immunisation Service commissioned by the Office of Public Health remains successful and contributes significantly to the uptake of MMR and other missed pre-school immunisations o Numbers of children waiting for immunisation appointments continue to be between 100-200 each week o Pertussis vaccine uptake among pregnant women remains of concern especially since the data represents only 3 practices data for May and Jun this year. o NHS England restrictions on data sharing arrangements threaten the ability of the OPH to continue to access and produce reports on uptake data for all programmes and at a provider level.
2.8 NHS England Flu Vaccination Pilot The Committee received a summary of the Flu Vaccination pilot NHS England are commissioning from community pharmacies. The Committee fed back the following concerns to the NHS England representative at the meeting o The pilot had been established without sufficient consultation with the CCG o The majority of patients vaccinated are those aged 65 years and above and therefore outside the scope of the pilot o The pharmacies are already vaccinating patients when they already have an appointment booked with their GP or have an invitation to attend a clinic o GP practices are reporting that pharmacists are working outside the scope of the pilot e.g. doing home visits to vaccinate patients o GP practices reporting that they not assured that the reporting arrangements are satisfactory o Poor planning and lack of consultation on the pilot resulting in practices having unused stock at the end of the season o Practices considering reducing flu vaccine orders for 2015-16 in light of local pharmacy activity.
2.9 New Risk The committee made the following recommendations to the Audit Committee to add the following risk to the register
o The ability of member practices to fulfil their contractual obligations to NHS England as a result of difficulties recruiting substantive GPs resulting in contractual breach, or termination of contract.
3 | Page 3.0 DECISIONS TAKEN BY THE COMMITTEE UNDER DELEGATED POWERS FROM BOARD
None
4.0 DECISIONS REFERRED TO BOARD
None.
5.0 RECOMMENDATION The Board is asked to note the issues discussed at the Primary Care Development Committee on 12th September and 16th October.
Dr J Rathore Clinical Executive, Finance and Performance November 2014
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GLOSSARY
ABBREVIATIONS
Abbreviation Meaning #NOF Fractured Neck of Femur £K £1,000 equivalent A&E Accident and Emergency ABC / ABCD Above and Beyond the Call of Duty (Local surveys which include praise for nominated staff members as well as assessment of services) ACRA Advisory Committee on Resource Allocation ACS Acute Coronary Syndrome AD Assistant Director AfC Agenda for Change AHSN Academic Health Science Networks ALE Auditors Local Evaluation ALOS Average Length of Stay (in hospital) AMI Acute Myocardial Infarction AMMC Area Medicines Management Committee Anti-D An antibody occurring in pregnancy Anti-TNF Drugs used in the treatment of rheumatoid arthritis and Crohn’s disease ARIF Aggressive Research Intelligence Facility ASAP As soon as possible AVE Advertising Value equivalent BACs Bank Automated Credit BCC Black Country Cluster BCG Bacillus Calmette-Guerin BCPFT Black Country Partnership Foundation Trust BCUCG Black Country Urgent Care Group BFT Behavioural Family Therapy BLCCB Black Country Local Collaborative Commissioning Board BME Black Minority Ethnic BMJ British Medical Journal BPAS British Pregnancy Advisory Board 1
BSCCP British Society of Colposcopy and Cervical Pathology CAB Citizens Advise Bureau CABG Coronary Artery Bypass Graft CAO Chief Accountable Officer CAMHS Children and Adolescent Mental Health Service CASH Contraception and Sexual Health CAT Change Agent Team CBSA Commissioning Business Support Agency CCBT (CBT) Computerised Cognitive Behavioural Therapy CCF Capable Care Forum CCG Clinical Commissioning Group CCRN Comprehensive Clinical Research Networks CDC Clinical Development Committee CEO Chief Executive Officer CFO Chief Finance Officer CHADD The Churches Housing Association of Dudley & District Ltd CHC Continuing Healthcare CHD Coronary Heart Disease CIS Community Investment Strategy CMO Chief Medical Officer CNST Clinical Negligence Scheme for Trusts CNT Community Nursing Team CONNECT Mental Health information website for staff COSHH Control of Substances Hazardous to Health Regulations 2002 CPA Care Programme Approach CPN Community Psychiatric Nurse CRL Capital Resource Limit CSSD Central Sterile Services Department CT scan Computer Topography CQUIN Commissioning for Quality and Innovation CQRM Clinical Quality Review Meeting CVD Cardio Vascular Disease CWAS Coventry and Warwickshire Audit Services DACHS Directorate of Adult Children and Housing Services DCS Dudley Community Services DCVS Dudley Community Voluntary Service DES Directed Enhanced Service DfES Department for Education and Skills DGoH Dudley Group of Hospitals DNA Did not attend 2
DoH Department of Health DoLS Deprivation of Liberty Safeguards DoS Directory of Service DTC Diagnostic and Treatment Centre DWMHPT Dudley and Walsall Mental Health Partnership Trust DXA Dual X-ray Absorptiometry (measures bone density). E&D Equality and Diversity EAU Emergency Assessment Unit EBME Electro Bio-Mechanical Engineer ECA Extra Care Area ECM Every Child Matters ECT Electroconvulsive Therapy ED Emergency Department EI Early Implementer EI Early Intervention EMI Older People with Mental Illness (Elderly Mentally Ill) EPP Expert Patients Programme EPR Electronic Patient Record ERMA Emergency Response & Management Arrangements ERT Enzyme Replacement Therapy ESR Electronic Staff Record FCEs Finished Consultant Episodes FED Forum for Education and Development FHS Family Health Services FIP Computerised data collection facility used by community health teams. FMC Facility Management Centre FOI Freedom of Information FYE Full Year Effect GMS General Medical Services GOWM Government Office for the West Midlands GP General Practitioner GPAQ General Practice Assessment of Quality GPwSI GPs with Special Interest GU Genito-urinary GUM Genito-urinary Medicine HCAI Health Care Acquired infection HENIG Health Economy NICE Implementation Group HF Heart Failure HIC Health Improvement Centre HIV Human Immunodeficiency Virus 3
HPA Health Protection Agency HPS/S Health Promoting Schools / Service HPU Health Protection Unit HR Human Resources HSC Health and Safety Commission HSCQC Health and Social Care Quality Centre HSE Health and Safety Executive HT Home Treatment HV Health Visitor IAPT Improved Access to Psychological Therapies IC Infection Control ICAS Independent Complaints Advocacy Service ICNA Infection Control Nurses Association ICP Integrated Care Pathway ICSM Interim Customer Services Manager IFR Individual Funding Request IG Information Governance IOSH Institute of Occupational Safety and Health IT Information Technology IUCD Intrauterine Contraceptive Device JCAB Joint Clinical Advisory Board JCC Joint Consultative Committee JD Job Description JE Job Evaluators JM Job Matching KLOE Key lines of enquiry KSF Knowledge and Skills Framework KPI Key Performance Indicators LAA Local Area Agreement LAC Looked After Children LAT Local Area Team LBC Liquid Based Cytology LD Learning Disability LDP Local Delivery Plan LEA Local Education Authority LIFT Local Improvement Finance Trust LIG Local Implementation Group LIT Local Implementation Team LMC Local Medical Committee LNG Local Negotiating Committee 4
LPS Local Pharmaceutical Scheme LRF Local Resilience Forum LTC Long Term Conditions LVD Left Ventricular Dysfunction LVSD Left Ventricular Systolic Dysfunction MAPA Management of Actual and Potential Aggression MAU Medical Assessment Unit MBC Metropolitan Borough Council MDT Multi Disciplinary Team MIMT Major Incident Management Team MIRE Major Incident Response Executive MLSOs Medical Laboratory Scientific Officers MRSA Methicillin Resistant Staphylococcus Aureus MSS Medium Secure Service NCA Non contract activity NCB National Commissioning Board NCRS National Care Record System NELHI National Electronic Library for Health Information NICE National Institute for Clinical Excellence NGMS New General Medical Services NHS National Health Service NHSCPT NHS Community Practice Teacher NHSCSP NHS Cancer Screening Programme NHSE NHS England NHSLA NHS Litigation Authority NHSP National Healthy Schools Programme NICE National Institute for Clinical Excellence NOF New Opportunities Fund NPfIT National Programme for IT NPSA National Patient Safety Agency NRF Neighbourhood Renewal Fund NRLS National Reporting and Learning System NRT Nicotine Replacement Products NSF National Service Framework OAT Out of Area Treatment OBD Occupied Bed Day OD Organisational Development ODM Oesophageal Doppler Monitoring OOH Out of Hours OSC Overview and Scrutiny Committee 5
OT Occupational Therapist PALS Patient Advice and Liaison Service PAF Positive Assurance Framework PAS Patient Administration System PAU Paediatric Assessment Unit PbR Payment by Results PC Personal Computer PCDB Primary Care Delivery Board PCDC Primary Care Development Committee PCT Primary Care Trust PDF Portable Document Format PDP Personal Development Plan PDS Personal Dental Services PDSA Plan, Do, Study, Act PDU Professional Development Unit PE Pulmonary Embolism PEAK Database holding the main registered details of patients and associated referral, contact, caseload, outpatient, inpatient, MH Act and clinic information. PEAT Patient Environment Action Team PEC Professional Executive Committee PEPP Pooled Budget External Placement Panel PFI Private Finance Initiative PGD Patient Group Directives PICU Psychiatric Intensive Care Unit PID Project Initiation Document PIN Personal Identification Number PMLD Profound and Multiple Learning Difficulties PMS Primary Medical Services PPA Prescription Pricing Authority PPG Patient Participation Group PPIF Patient and Public Involvement Forum PSA Public Service Agreement PSHE Personal and Social Health Education PTCA Percutaneous Transluminary Coronary Angioplasty Q&A Questions and Answers Q&S Quality & Safety QA Quality Assurance QIPP Quality, Innovation, Productivity and Prevention QMAS Quality Management and Analysis System QOF Quality and Outcome Framework 6
QPDT Quality and Practice Development Teams RACPC Rapid Access Chest Pain Clinic RAS Respiratory Assessment Service RCA Root Cause Analysis RES Race Equality Scheme RHH Russells Hall Hospital RIDDOR Reporting of Injuries, Diseases and Dangerous Occurrences Regulations RMO Responsible Medical Officer RRL Revenue Resource Limit RSL Register Social Landlords RTT Referral to Treatment Target SAP Single Assessment Process SEPIA Mental health computer system SFBH Standards for Better Health SFI Standing Financial Instructions SIC Statement of Internal Control SLA Service Level Agreement SRE Sex and Relationship Education SSD Social Services Department SSDP Strategic Services Development Plan STI Sexually Transmitted Disease STRW Support, Time & Recovery Worker TB Tuberculosis TIA Transient Ischaemic Attack TP Teenage Pregnancy TPT Teenage Pregnancy Team UHBT University Hospital Birmingham Trust Vaccs & Imms Vaccinations and Immunisations WAN Wide Area Network WCC World Class Commissioning WIC Walk in Centre WMAS West Midlands Ambulance Service WMCSU West Midlands Commissioning Support Unit
WMHTAC West Midlands Health Technology Advisory Committee WMSCG West Midlands Strategic Commissioning Group WMSSA West Midlands Specialised Services Agency WTE Whole Time Equivalent
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