Nhs North Derbyshire Clinical Commissioning Group

Service Level Agreement

between

NHS NORTH DERBYSHIRE CLINICAL COMMISSIONING GROUP and

ST JOHN’S AMBULANCE

October 2014 to 31 August 2015

1 of 26 Contents

Main funding agreement

Section 1 Basis of agreement

Section 2 Funding details

Section 3 General responsibilities of the Provider

Section 4 Indemnities and insurance

Section 5 Service monitoring and consultation

Section 6 Financial monitoring

Section 7 Protection of children, young people and vulnerable adults

Section 8 Responsibilities of the Commissioner

Section 9 Joint responsibilities of the Provider and the Commissioner

Section 10 Disputes

Section 11 Termination

Section 12 Prevention of corruption

Section 13 Notices

Section 14 Freedom of Information Act 2000

Section 15 Contacts

Schedules and Appendices

Schedule A: Service Description Schedule B: Monitoring Schedule C: Payment details

2 of 26 Service Level Agreement

The Parties:

The Commissioner NHS North Derbyshire Clinical Commissioning Group (referred to in this Agreement as “the Commissioner”)

The Provider St John’s Ambulance (referred to in this Agreement as “the Provider”)

The Service: This agreement covers the service

1. Basis of agreement

1.1 The Commissioner agrees to provide funding to the Provider for the Service on the terms and conditions set out in this Agreement. 1.2 The Provider agrees to deliver the Service on the terms and conditions set out in this Agreement. 1.3 The Agreement will last for ten months commencing October 2015, and will be subject to review between the Commissioner and the Provider.

2. Funding details

2.1 The Commissioner will: (1) Provide total funding of £345,000 per annum to the Provider during the Agreement period, not withstanding any financial variation as agreed between the Commissioner and the Provider. (2) The Commissioner will pay the funding in monthly instalments unless varied by mutual agreement, as outlined in Schedule C, subject to satisfactory compliance by the Provider with the financial and service monitoring requirements set out in Paragraphs 5 and 6 and Schedules B and C of this Agreement. (3) The Commissioner will be entitled to withhold any or all of the funding payable under this Agreement or request a credit note be issued if the Provider breaches any of the conditions specified in this Agreement.

3 of 26 2.2 The Provider will: (1) Use all the funding provided under this Agreement solely for the purposes of providing the Services set out in the service description in Schedule A. (2) Tell the Commissioner about any proposed change in the Service, and obtain their agreement before it implements any material changes to the Service, which may affect performance against the contracted activity. (3) Obtain the Commissioner’s written consent before it makes any changes to the agreed level of charges, if any, which the Provider makes to service users under the Service. The Commissioner will not withhold their consent unreasonably. (4) Tell the Commissioner at the earliest opportunity of any reason why it cannot provide the Service, or any part of the Service, within the capacity commissioned under this service. (5) Repay to the Commissioner at their request any amount of money paid under this Agreement, unless the contract is coming to an end, which: (a) Remains unspent by the Provider at the end of the ten month period or (b) In the Commissioner’s opinion, has not been spent in accordance with this Agreement, or (c) Becomes repayable under the provisions of clause 11.6.

3. General responsibilities of the Provider

3.1 In carrying out the Service, the Provider will: (1) Comply with all statutory requirements and, in particular, will: (a) Not commit any act of discrimination rendered unlawful as detailed in Paragraphs 3.2 and 3.3. (b) Take all necessary steps to secure the health, safety and welfare of everyone involved in the Service and comply at all times with the Health and Safety at Work etc Act 1974 and the Working Time Regulations 1998. (c) Operate a lone worker policy for its employees. The Provider reserves the right to protect its employees by other means, including the refusal or cancellation of a referral, where it considers the environment to be unsafe. (2) Not subcontract any work required under this Agreement without first getting the Commissioner’s written consent which they will not withhold unreasonably. (3) Have, and comply with, or be working towards a written policy on personnel/human resources matters for paid staff, workers, volunteers and trustees. This must include appropriate procedures for recruitment, safeguarding, disciplinary and grievance issues, training and development, and equal opportunities. (4) Acknowledge the Commissioner’s financial assistance in any publicity promoting the Provider, or giving information and advice on the services provided (including Annual Reports and Accounts). The Commissioner will provide advice on appropriate acknowledgements. (5) Not accept referrals for nursing care for children under 16 years of age. Referrals between 16 and 18 years of age will be considered on a case by case basis and subject to consent from the Provider’s relevant regulatory body.

4 of 26 (6) Make sure all paid staff, workers, volunteers and users are offered equality of opportunity and treatment, and are not treated less fairly because of age, disability, gender reassignment, pregnancy and maternity, race (including ethnic or national origins, colour and nationality), religion or belief, sex, marriage and civil partnership and sexual orientation.

3.2 The Provider shall comply with, and in particular shall not discriminate within the meaning of all current equality legislation at all times, as amended, and shall ensure the implementation of any new equality legislation as soon as it becomes law. Equality legislation currently includes but is not limited to: (1) Equality Act 2010; (2) Public Interest Disclosure Act 1998; (3) Human Rights Act 1998; (4) Part-time Workers (Prevention of Less Favourable Treatment) Regulations 2000; (5) Fixed-term Employees (Prevention of Less Favourable Treatment) 2002; and (6) Employment Rights Act 1996.

3.3 The Provider shall adhere to the principles of the Public Sector General Equality Duty set out in section 149 of the Equality Act 2010 ("Public Sector General Equality Duty") whenever they are carrying out the Service in any respect.

3.4 The Provider must always deliver the Service having due regard to the need to:

(1) Eliminate unlawful discrimination; (2) Advance equality of opportunity between people who share a protected characteristic and people who do not share a protected characteristic; and (3) Foster good relations between people who share a protected characteristic and people who do not share it;

such that the Provider shall consider the three aims stated in this Paragraph in a meaningful way when making any relevant decision in respect of the Service (including but not limited to the development of policies, how the Service will be provided and any relevant decisions about the Service) so that the Public Sector General Equality Duty is integral to any decisions which are made.

3.5 The Public Sector General Equality Duty relates to the following protected characteristics: age, disability, gender reassignment, pregnancy and maternity, race (including ethnic or national origins, colour and nationality), religion or belief, sex, marriage and civil partnership* and sexual orientation. *The duty to have due regard to the need to eliminate discrimination covers marriage and civil partnership. The statutory duties to advance equality of opportunity and foster good relations do not apply to marriage and civil partnership.

5 of 26 3.6 The Provider shall ensure that any person who may make decisions in respect of the provision of the Service shall be aware of the requirements of the Equality Act 2010, including the Public Sector General Equality Duty and its implications in practice. In practice, meeting the general equality duty generally means:

(1) Removing or minimising disadvantages experienced by people due to their protected characteristics (2) Taking steps to meet the needs of people from protected groups where these are different from the needs of other people (3) Encouraging people from protected groups to participate in public life or in other activities where their participation is disproportionately low

3.7 The Provider shall keep all appropriate documents and records in respect of the requirements of Paragraph 3.5 and shall provide those documents to the Commissioner within seven days of being requested to do so. This shall include but is not limited to information regarding the make up of the Provider's workforce, any gender pay gap among the Provider's workforce, recruitment and retention data for workers with a protected characteristic and grievances and disciplinary issues for workers with a protected characteristic.

3.8 The Provider shall, on request from the Commissioner, provide information, documents and data on the profile of service users, service user satisfaction levels, complaints about discrimination from service users (all disaggregated by the protected characteristics) and any relevant data regarding the number of people with a protected characteristic who access the Service.

3.9 The Provider shall assist the Commissioner in collating information, documents and data in respect of the Public Sector General Equality Duty if requested to do so by the Commissioner and shall provide any information, documents and data which have been requested within seven days.

3.10 The Provider shall notify the Commissioner immediately of any investigation of or proceedings or enforcement against the Provider in respect of the Public Sector General Equality Duty and/or discrimination claim and shall cooperate fully and promptly with any requests of the person or body conducting such investigation, proceedings or enforcement, including allowing access to any documents or data required, attending any meetings and providing any information requested.

3.11 The Provider shall indemnify the Commissioner against all costs, claims, charges, demands, liabilities, damages, losses and expenses incurred or suffered by the Commissioner arising out of or in connection with any investigation conducted or any proceedings or enforcement brought in respect of the Public Sector General Equality Duty and/or discrimination claim due directly or indirectly to any act or omission by the Provider, its agents, employees or sub-contractors.

3.12 The Provider shall take all reasonable steps (at its own expense) to ensure that all employees employed in the provision of the Service do not unlawfully discriminate within the meaning of this Paragraph 3 and shall impose on any sub-contractor obligations in terms not materially different to those imposed on the Provider by this Paragraph 3.

6 of 26 3.13 The Provider shall provide all reasonable support to the Commissioner to enable the Commissioner to comply with its obligations under equality law, including the proactive responsibility to comply with the Public Sector General Equality Duty.

1. Indemnities and insurance

4.1 The Provider will indemnify the Commissioner against any liability, expense, loss, claim or proceedings arising out of the Service. This includes, but is not limited to, liability for personal injury to or death of anyone, unless such liability is due to the act or neglect of the Commissioner or any person for whom they are responsible. 4.2 While not affecting the liabilities set out in Paragraph 4.1, the Provider will take out and keep in force, and make sure that any sub-contractor takes out and keeps in force, adequate insurance with reputable insurers. This insurance must cover the Provider, or the sub-contractor, and their employees and agents, against all risks arising from the performance of this Agreement. This includes, but is not limited to, employers’ liability insurance, public liability insurance, building and contents insurance and, where appropriate, professional indemnity insurance. 4.3 The Provider will keep copies of all current insurance policies and evidence of premium payments and allow the Commissioner’s representatives to inspect these at any time on request.

5. Service monitoring, consultation and complaints

5.1 The Provider will:

(1) Keep effective records for monitoring the nature, level and quality of the Service and allow the Commissioner to inspect them upon reasonable notice. (2) Meet with the Commissioner on a quarterly basis to discuss performance to date (3) Submit quarterly activity reports to the Commissioner as specified in Schedule B. (4) In the final quarter submit the additional information specified in section 2 of Schedule B. (5) Comply with any reasonable request made by the Commissioner to co-operate with their general inspection, monitoring and evaluation surveys. (6) Consult with service users and take their views into account as detailed in Schedule B section 2. (7) Operate a complaints procedure for service users, and inform all service users about the procedure. If the Provider does not have its own complaints procedure, it should use the complaints procedure for voluntary organisations produced by the Commissioner. Any complaints procedure established by the Provider must tell users that they also have a right to complain to the Commissioner about the Provider, by using the Commissioner’s own complaints procedure. (8) Allow representatives of the Commissioner to visit the Hospice for the purposes of monitoring and audit at first hand, to review facilities and

7 of 26 services provided under this Agreement. Such meetings will be arranged in conjunction with the Provider.

6. Finance

6.1 The agreed budget for the commissioned services in the coming year is detailed in Schedule C. 6.2 The Provider will issue a monthly invoice based on the agreed budget. This will be paid according to the schedule agreed in Schedule C. For any other invoice issued under this contract, payment is to be made within 30 days. 6.3 In subsequent years, Schedule C will be updated and should be agreed by 31st January where practicable. If the budget has not been agreed by 31st March the provider will issue an interim invoice based on activity from the previous year and an assumed budget increase in line with the Government’s published Retail Prices Index (RPI). 6.4 Where actual activity significantly exceeds budget, the Commissioner and the Provider may agree a revised budget at any time. The Commissioner retains the right to limit any additional budget in excess of that agreed at the beginning of the financial year where actual activity exceeds the planned outturn significantly. 6.5 Where the Commissioner fails to make a payment in accordance with the agreement, the Provider reserves the right to charge statutory interest as provided for in the Late Payment of Commercial Debts (Interest) Act 1998. 6.6 The Provider will submit to the Commissioners a copy of its annual Reports and Accounts for its preceding year by 31 October of the current year.

7. Protection of children, young people and vulnerable adults

7.1 Where the Service involves working with children, young people under 18 and vulnerable adults, the Provider must take all reasonable and thorough steps to make sure that the Provider has complied with all requirements for registration under the Children Act 1989. 7.2 The Provider must follow any advice given by the Commissioner against the paid or voluntary employment of anyone who appears to be unsuitable for work with children, young people or vulnerable adults. 7.3 The Provider must ensure that appropriate procedures are in place to ensure that staff report, and deal appropriately, with allegations or concerns about vulnerable Service Users.

8. Responsibilities of the Commissioner

8.1 The Commissioner will: (1) Collate information about the need for appropriate services, and suggest and receive suggestions for areas in which services might be developed. (2) Make sure that the Provider is informed of, and consulted about, any new Commissioner policies or reviews which are relevant to the Service. (3) Nominate one of its officers to act as the first point of contact between the Commissioner and the Provider for any matters arising relating to this agreement. Where it is agreed that close links are also needed with the Commissioner’s operational services, the Commissioner will 8 of 26 identify an appropriate Project Liaison Officer to act as a further point of contact between the Provider and the Commissioner.

9. Joint responsibilities of the Provider and the Commissioner

9.1 The Provider and the Commissioner: (1) Will make sure there is a regular and appropriate exchange of information between them so that the Service operates in accordance with this Agreement. (2) Will notify the other Party in writing immediately of any significant amendments or alterations to, or postponements or cancellation of the Service, or any events which may lead to such an occurrence. (3) Can mutually agree to amend the terms of this Agreement. 9.2 Nothing in this Agreement limits the Provider or the Commissioner from pursuing any other lawful activity which they are empowered to pursue, providing that:  the activity does not prejudice their respective obligations under this Agreement

10. Disputes

10.1 If any disagreement arises between the Provider and the Commissioner about a matter which is relevant to this Agreement but does not constitute a fundamental breach as defined in Paragraph 12.1 (2), they will try to resolve it by routine liaison or review. If this is not possible after 21 days, either may submit a written statement to the other, setting out details of the disagreement, proposals for any action requested to resolve it, and giving a reasonable timescale for this to take place. 10.2 The written statement will be accepted as submitted on the date that it is received. 10.3 If the disagreement is not resolved to the satisfaction of the party submitting the written statement, nor significant steps taken towards resolving the complaint within 21 days, any Party may terminate the Agreement by serving a notice under Paragraph 11.4 of this Agreement.

11. Termination

11.1 This agreement can be terminated by written notice from either party and following a period of 3 months’ notice or such other period as may be agreed by both parties. 11.2 If the Provider breaches any of its obligations in this Agreement, the Commissioner have the right to serve a notice to remedy the breach on the terms and within the time stated in the notice. 11.3 The Commissioner will treat the following circumstances as a fundamental breach causing this Agreement to cease immediately: (1) The Provider fails to comply with a notice to remedy a breach (2) The Provider becomes insolvent, subject to a winding-up resolution or order, is otherwise dissolved, or has an administrator or receiver appointed (3) The Provider is dissolved, for whatever reason, during the period of this Agreement

9 of 26 (4) There is a breach relating to the prevention of corruption as specified in Paragraph 12 of this Agreement. 11.4 The Provider or the Commissioner can terminate this Agreement by giving notice in writing to the other parties to expire not less than 3 months from the date of the notice or such other period as may be agreed by both parties. 11.5 If the reason for terminating the Agreement relates to a dispute that has arisen between the Provider and the Commissioner, the dispute procedure set out in Paragraph 10 must have been implemented before either Party gives notice of termination. 11.6 If this Agreement is terminated, the Commissioner is entitled to a refund of funding advanced under this Agreement, but without prejudice to any right to claim for insured losses. The Provider must repay any amount payable under Paragraph 2.2 (5) of this Agreement to the Commissioner and, in addition, whichever is the greater of: either  an amount proportionate to the part of the period for which the funding or the particular instalment has left to run or  the actual amount of funding remaining unspent, less any reasonable amount which the Provider was contractually committed to pay before the Commissioner gave notice of termination. 11.7 Where funding is repayable to the Commissioner by the Provider under the terms of this Agreement, the Commissioner will be entitled to take equipment, furniture or other assets bought by the Provider using the funds provided under this Agreement, to settle the amount owed to the Commissioner.

12. Prevention of corruption

12.1 The following circumstances are considered to be a fundamental breach and will cause this Agreement to cease immediately: (1) If the Provider, or anyone employed by it or acting on its behalf, with or without its knowledge, has offered, given or agreed to give any person any gift or consideration of any kind as an inducement or reward for doing or not doing anything in relation to this Agreement or any other contract with the Commissioner (2) The Provider, or anyone employed by it or acting on its behalf has been guilty of a corrupt or illegal practice, or bribery or corruption of a member or officer of a public body, contrary to the Bribery Act 2010.

13. Notices

13.1 Any notice to be served on any party must be sent either by pre-paid recorded delivery or registered mail, or delivered by hand, to the address of the other Party set out at the head of this Agreement, or, where a Party has changed address, the address which that Party has notified to the other Party in writing.

14. Freedom of Information Act 2000 and Transparency

St John’s Ambulance acknowledges that the Commissioners are subject to the requirements of the FOIA. The Hospice must assist and co-operate with each Commissioner to enable it to comply with its disclosure obligations under the FOIA. The Provider agrees:

10 of 26 14.1 that this Contract and any other recorded information held by the Hospice on a Commissioner’s behalf for the purposes of this Contract are subject to the obligations and commitments of the Commissioner under FOIA;

14.2 that the decision on whether any exemption to the general obligations of public access to information applies to any request for information received under FOIA is a decision solely for the Commissioner to whom the request is addressed;

14.3 that where the Hospice receives a request for information under FOIA and the Provider itself is subject to FOIA, it will liaise with the relevant Commissioner as to the contents of any response before a response to a request is issued and will promptly (and in any event within 2 Operational Days) provide a copy of the request and any response to the relevant Commissioner;

14.4 that where the Provider receives a request for information under FOIA and the Provider is not itself subject to FOIA, it will not respond to that request (unless directed to do so by the relevant Commissioner to whom the request relates) and will promptly (and in any event within 2 Operational Days) transfer the request to the relevant Commissioner;

14.5 that any Commissioner, acting in accordance with the codes of practice issued and revised from time to time under both section 45 of FOIA, and regulation 16 of the Environmental Information Regulations 2004, may disclose information concerning the Provider and this Contract either without consulting with the Provider, or following consultation with the Provider and having taken its views into account; and

14.6 to assist the Commissioners in responding to a request for information, by processing information or environmental information (as the same are defined in FOIA) in accordance with a records management system that complies with all applicable records management recommendations and codes of conduct issued under section 46 of FOIA, and providing copies of all information requested by that Commissioner within 5 Operational Days of that request and without charge.

14.7 The Parties acknowledge that, except for any information which is exempt from disclosure in accordance with the provisions of FOIA, the content of this Contract is not Confidential Information.

14.8 Notwithstanding any other term of this Contract, the Provider consents to the publication of this Contract in its entirety (including variations), subject only to the redaction of information that is exempt from disclosure in accordance with the provisions of FOIA.

14.9 In preparing a copy of this Contract for publication the Commissioners may consult with the Provider to inform decision making regarding any redactions but the final decision in relation to the redaction of information will be at the Commissioners’ absolute discretion.

14.10 The Provider must assist and cooperate with the Commissioners to enable the Commissioners to publish this Contract.

11 of 26 15. Contacts The Commissioner: The Provider: Mark Smith Chris Thornton, Chief Finance Officer, NHS North Director of St John Ambulance, Derbyshire CCG East Midlands Region Scarsdale Derby Rd, Nightingale Close Chesterfield, Chesterfield Derbyshire, S41 7PF S40 2ED

Signed: Date:

(Duly authorised for and on behalf of the Commissioner)

Position:

Signed: Date:

(Duly authorised for and on behalf of the Provider)

Position:

12 of 26 Schedule A – Description of Service

Note, not all services listed here are commissioned under this service level agreement but are included nonetheless as they may be provided and subsequently charged as non contracted activity.

A. Service Specifications

Mandatory headings 1 – 4. Mandatory but detail for local determination and agreement Optional headings 5-7. Optional to use, detail for local determination and agreement.

All subheadings for local determination and agreement

Service Specification No. Service Falls Immediate Response and Support Team (FIRST) Commissioner Lead NHS North Derbyshire Clinical Commissioning Group (NDCCG) Provider Lead St John’s Ambulance Service Derbyshire County Council Adult Social Care (ASC) Period October 2014 – August 2015 Date of Review March 2015

1. Population Needs

1.1 National/local context and evidence base

Introduction Falls and fall-related injuries are a common and serious problem for older people. People aged 65 and older have the highest risk of falling, with 30% of people older than 65yrs and 50% of people older than 80yrs falling at least once a year.

The human cost of falling includes distress, pain, injury, loss of confidence, loss of independence and mortality. Falling also affects the family members and carers of people who fall. Falls are estimated to cost the NHS more than £2.3 billion per year. Therefore falling has an impact on quality of life, health and healthcare costs. NICE Clinical Guideline 161 Falls: assessment and prevention of falls in older people (June 2013)

 10% of all > 65yrs who fracture their hips will die within 30 days

 30% of all > 65yrs who fracture their hips will die within 1 year

 50% of fragility fractures go onto fracture their hips.

 50% never regain their current mobility

 Ageing population means that incidence will increase by 50% by 2030

Background

Why do we need a Falls Immediate Response Support Team (FIRST)?

In 2011/12 Derbyshire saw 2,872 falls and 840 hip fracture related acute admissions for the >65yr which cost approximately £12 million (excluding social care and ambulance costs).

In North Derbyshire between April 2012 and March 2013 there were 1599 emergency admissions for falls. Of these over 90% were admitted through A&E and 13% had a fractured Neck of Femur. 13 of 26 Between 1st April 2012 and 31st March 2013 the number of emergency admissions for falls in 2012/13 for High Peak and North Dales were 400 and 270 respectivley.

12.2% (n= 82) of High Peak and North Dales falls resulted in a fractured neck of femur (#NOF) which is higher than the national benchmark of (n= 103) per 100,000.

Between 1st April 2012 and 31st March 2013 East Midlands Ambulance Service (EMAS) attended (n= 1,906) High Peak and North Dales patients following a fall.

1291 of High Peak and North Dales patients following a fall were conveyed by EMAS to hospital and the remaining 615 were not conveyed.

In High Peak and North Dales there were 670 emergency admissions for falls in High Peak and North Dales combined (2012/13). Using £2,850k per admission this equates to £1.9m (excludes costs for #NOFs).

Based on the costs associated with admission avoidance following a fall (£2,850K) the service would need to evidence that 125 people over a twelve month period were not admitted to hospital following an intervention by the service (equipment provided/onward referral to other services etc). This would represent 18.6% of the emergency falls for High Peak and North Dales. The non-conveyance rates are already at 28% and 33% respectively so this would mean a minimum target of 46.6% of non-conveyance for the High Peak and 51.6% non- conveyance for the North Dales.

2. Outcomes

2.1 NHS Outcomes Framework Domains & Indicators

Domain 1 Preventing people from dying prematurely √ Domain 2 Enhancing quality of life for people with long-term √ conditions Domain 3 Helping people to recover from episodes of ill-health or √ following injury Domain 4 Ensuring people have a positive experience of care √

Domain 5 Treating and caring for peo ple in safe envi ron men t and prot ecti ng the m fro m avoi dabl e har

14 of 26 m √

2.2 Local defined outcomes  To provide patients with a quick, effective qualitative service ensuring rapid access to clinical intervention, community services or equipment that would improve their quality of life and allow them to remain independent and continue living at home.  Reduce conveyance and Emergency Department (ED) and other acute admissions.  Increase the number of High Peak and North Dales patients that are seen and treated by the FIRST.  Appropriate onward referral to other health and social care services.

3. Scope

3.1 Aims and objectives of service

The aim of this service is: • To reduce inappropriate hospital admissions of falls patients; • To provide immediate holistic assessment using a multifactorial approach to fallers at home or their usual place of residence (>50yrs) within the High Peak and North Dales area. • To provide safe appropriate admission avoidance solutions, which promote independent living with patient centred goals; • To assess, investigate, diagnose, treat and make appropriate referrals for a wide scope of conditions relating to falls, including elderly health and elderly care needs; • To promote falls prevention; • Ensure professional collaboration & networking; • Provide simple and complex case management in conjunction with other Health and Social Care Professionals • Provide both emergency ambulance call out utilising 999 and direct GP referals. • Provide a specialised dedicated response to patients (>50yrs) who have fallen at home or their usual place of residence in the High Peak and North Dales area; • Have a range of lifting and handling equipment available that enables on scene support to falls patients up to 23 stones / 150 kg in weight.

3.2 Service Model/Care Pathway

3.2.1 General Overview  The FIRST will provide a 50/50 primary/secondary response to people (> 50yrs) who have fallen at home or their usual place of residence.  The FIRST will fully integrate into the 999 ambulance pathway and be used as an alternative to an ambulance crew attending the patient following appropriate triage by ambulance control.  GP’s will be able to directly refer any patients into the FIRST that have been identified as a high risk of future falls.

3.2.2 Service Model • The FIRST is commissioned by North Derbyshire CCG and will be delivered by St. John’s Ambulance Service and Derbyshire County Council Adult Social Care. It is a multidisciplinary team which comprises of Emergency Care Practitioners (ECP), Personal Care Practitioners (PCP)s and access to a consultant geriatrician. Therapeutic input will be via the Single Point of Access (SPA). Nursing skills will be provided via SPA or through direct referral. Out of Hours (OOH) referrals would be provided via Derbyshire Health United (DHU); • The aim of the service is to avert inappropriate hospital admission for patients who fall and which would likely result in an acute admission. It is able to deliver an immediate response to the multi-faceted issues of patients who fall bringing together services that have previously worked independently;

15 of 26 • The FIRST will respond to 999 calls for falls and will accept direct referrals from GP’s. The OOH and 111 services will able to refer falls patients through the 999 pathway. • The FIRST team will look to provide a comprehensive falls assessment which is holistic and patient centred. This can include the patient’s physical health, functional ability, cognitive function, nutritional status, mobility and falls, and an environmental assessment; • The FIRST team has the ability to provide many interventions at the time of contact such as meeting the patient’s personal care needs, contacting family or friends, functional equipment and walking aids, wound closure and care. • The FIRSTteam can make appropriate onwards referrals for further assessment. • Where it is appropriate for a patient to be transported to an acute facility, an access visit report (environmental) is provided alongside the medical assessment with any relevant information to assist the hospital staff in ensuring a timely discharge; • The patient’s GP will receive notification that the FIRST team has visited one of their patients which details the nature of the contact and any outcome from it. • If the contact is via GP direct referral, the FIRST team will make telephone contact with the referring GP to make any final decision regarding the patient’s care jointly.

3.2.3 Staffing of FIRST Staff required for x 1 (one) Falls Partnership Service working Monday to Saturday 06:30 to 18:30hrs in the High Peak and North Dales area are as follows:  Emergency Care Practitioners (ECP’s)  Access to Domicilliary Service Operatives via DCC

3.2.4 Days and hours of operation • Monday to Saturday 06:30 to 18:30hrs

3.2.5 Referral route into FIRST • Out of Hours 999 call • 111 999 call • Tele-Health/Care line 999 call • MDT/GP referral FIRST direct referral form completed • 999 call triage FIRST

3.2.6 Response Time and detail and prioritisation

The following response times shall be adhered to:

Category Red 1 – life threatening requiring de-fib. Response time within 8 minutes of call received (19 minute standard transport standard);

Category Red 2 – immediately life threatening. Response time within 8 minutes of call received (19 minute standard transport standard);

Category Green 1 – serious but not life threatening (serious clinical need). Response within 20 minutes of call received;

Category Green 2 – serious but not life threatening (less serious clinical need). Response within 30 minutes of call received;

Category Green 3 – non life-threatening (non-emergency). Telephone assessment within 20 minutes of call received;

Category Green 4 – non life-threatening (non-emergency). Telephone assessment within 60 minutes of call received;

Blue Light Diversion – from time to time, the FIRST may be diverted to assist a blue light emergency incident (Category Red 1 & 2) as the nearest equipped vehicle and responder. This will take precedence over the current service being delivered, if the vehicle is not already engaged in a call.

16 of 26 3.2.7 Onward referral

 Patients will be referred or signposted to the appropriate services

3.2.8 Care Pathway The current 999 falls care pathway will be identified in Appendix A. The Falls Immediate Response Support Team (FIRST) care pathway will be identified in Appendix B. The Out of Hours (OOH) care pathway will be identified in Appendix C.

3.3 Population covered This service will cover High Peak and North Dales GP registered patients. Appendix D & E

3.4 Any acceptance and exclusion criteria and thresholds

3.4.1. Acceptability • Patients registered with High Peak and North Dales GP practices • High Peak and North Dales Patients who have fallen at home or their usual place of residence • High Peak and North Dales Patients aged (>50yrs)

3.4.2 Exclusion Criteria and Thresholds • Patients registered with other GP practices • Patients not registered with a High Peak or North Dales GP practice1 • High Peak and North Dales patients who have not fallen at home or their usual place of residence • High Peak and North Dales Patients who require a fully equipped 999 ambulance • High Peak and North Dales Patients aged (<50yrs) • Patients with red flag symptoms • Patients who require 24 hour care • Patients experiencing social care breakdown (eg main carer unwell and partner requires respite) • Single needs patients with no urgent requirement (eg physiotherapy, minor wound care) • Alcohol abuse/intoxication • Patients requiring IV treatment • High Peak and North Dales patients over 23 stones/150kg in weight

3.5 Interdependence with other services/providers • North Derbyshire Clinical Commissioning Group (NDCCG) • East Midlands Ambulance Service (EMAS) • Derbyshire Community Health Services (DCHS) • South Dales CCG • Derbyshire Health United (DHU) • Derbyshire County Council • Nursing and Residential Homes • Derbyshire Healthcare NHS Foundation Trust (DHcFT) • Acute Hospital Providers • Voluntary Sector

The above is not an exhaustive list and other interdepencies will be included as appropriate.

4. Applicable Service Standards

4.1 Applicable national standards (eg NICE)

 NICE Clinical Guideline 161 Falls: assessment and prevention of falls in older people (June 2013);

 NICE Clinical Guideline 124 Hip Fracture (June 2011);

1 Following evaluation, for patients not registered with a Hardwick CCG practice, a surcharge will be applied. 17 of 26  NICE Quality Standard 16 Hip Fracture in Adults (March 2012)

 NICE Commissioning Management Guide 46 Management of hip fracture in adults(November 2012)

 Quality Care for Older People with Urgent and Emergency Care Needs (aka The Silver Book) (June 2012) Silver Book - British Geriatrics Society (The Silver Book recommends ways in which emergency admissions can be reduced and the experience of those admitted improved).

4.2 Applicable standards set out in Guidance and/or issued by a competent body (eg Royal Colleges)

 Royal College of Paramedics  Health and Care Professions Council (HCPC)

 The Chartered Society of Physiotherapists

 College of Occupational Therapists  British Geriatrics Society

 Royal College of Physicians

 Royal College of Orthopaedic Surgeons

4.3 Applicable local standards Not Applicable

5. Applicable quality requirements and CQUIN goals

5.1 Applicable quality requirements (See Schedule 4 Parts A-D)

Quality and Quality and Performance Thresh Method of Comments Performance Indicator Detail old Measurement Indicators Financial Clear range of achievable St Johns and To record all savings based on the best ASC data patient case scenario of maximum collation and contacts with number of predicted evaluation the FIRST admissions avoided tool.

Patient and Improved patient St Johns and To record all Carer satisfaction; through the ASC data patient Experience provision of timely, high collation and contacts with quality assessment and evaluation the FIRST, intervention in patient’s tool including own home reducing the interventions need for unnecessary and onward transfer to ED and potential referrals/sign inappropriate subsequent posting to admission to acute other hospital. organisations

Patient and Longer term patient benefit NDCCG data Post fall data Carer from early intervention with collation and analysis of Experience longer term solutions to evaluation emergency problems. tool admission at 7, 14 and 30 days. Patient and To understand the benefit Service user On-going 18 of 26 Carer from immediate response experience evaluation of Experience at home and follow-up questionnaire/ service user intervention for the service evaluation experience user. tool/patient questionnaire/ stories (Full- evaluation Circle) tool/patient stories Service Reduced unnecessary St Johns data To record all Quality hospital admissions collation and contacts with through the provision of a evaluation the FIRST, direct alternative to ED and tool including links to a broad range of reduction in prevention services. A+E attendances and referrals onto other agencies

Service To see a reduction in NDCCG data To evaluate Quality patients presenting to ED collation and #NOF acute with a #NOF in comparison evaluation data for to 2013/14 data. tool. 2014/15 in comparison to 2013/14 data.

Service To identify the number of St Johns Quality occasions the FIRST has data collation been diverted to a blue and light incident and not evaluation attended a falls patient. tool.

5.2 Applicable CQUIN goals (See Schedule 4 Part E)

Not applicable.

6. Location of Provider Premises

The Provider’s Premises are located at

To add

19 of 26 Appendix A Current 999 Falls Pathway HCCG

(No Falls Partnership Service in operation)

999 Call received following a fall

Ambulance responds to 999 call

Leave Take patient patient at to ED home Refer patient to own GP

Patient admission Single Point of Access (SPA)

Patient Discharged DCHS Falls Service

Postponed response waiting list( currently Service already at full capacity up to 13weeks for OT assessment)

20 of 26 Appendix B: High Peak & Dales CCG Falls Partnership Service Immediate Assessment at Home Pathway

F.I.R.S.T - Falls Immediate Response & Support Team (Dales and High Peak)

OOH 111 Careline or Telehealth MDT

999 Call GP Referral Urgent GP Referral for anyone who has fallen at least once

If necessary convey to Emergency Care Practioner to attend as an urgent response Hospital

ECP to Carry Out Comprehensive Gerontology Assessment and Develop a Plan with Individual (and Carers as Appropropriate) to Reduce the risk of Further Falls. Rapid Assessment in line with NICE Clinical Guidance Emergency Care Practioner · Medical Assessment · Ensures the person is comfortable and deals with any personal care needs ECP discusses DCC Falls Alert Service · Functional Mobility TeleCare and Makes referral . Agreed with · Environmental check and response if necessary Individual(this includes wellbeing checks, · ECP to arrange appropriate care pathway if required advising and removing hazards, and · Complete patient report form and FRAT documentation information/installation of Telecare · Contact duty DSO to implement Falls Service Sensors and Alert. · ECP advises that they will return within 24 hours to check on progress at earliest availability thereafter · Notify GP

ECP Informs Care Coordinator of the Plan to Feedback to MDT

DSO arranges carer to visit within 2 hours

· Social network assessment and contact · If necessary carer phone ECP for advice and possible visit · DSO arranges carer to visit 4 times within next 10 days · 1 hour per day for 2 days · ½ hour per day for 2 days · With aim to build confidence, to reduce/remove any hazards, to provide reassurance. · Carer does follow up visit 4 weeks later to check confidence and environment

· Hospital Avoidance · Patient stays at home with appropriate support

21 of 26 Hospital Avoidance Patient stays at home with appropriate support

Appendix C Falls Partnership Service Out of Hours (OOH) Falls Pathway (Hours of FPS Mon-Sat 06:30 to 18:30)

999 Call received following a patient fall

Ambulance crew attend patient

Convey the patient to Emergency Leave the patient at home Department (ED)

Inform patients GP of fall Hospital Patient and contact with admission discharged ambulance crew

22 of 26 Appendix D: FIRST Operating Boundary for High Peak & Dales Participating Practices

Code Practice name Postcode Locality

C81013 Baslow Health Centre (formerly Ashenfell) DE45 1SP Dales C81016 Bakewell Medical Centre DE45 1ED Dales C81028 Imperial Road Surgery DE4 3NL Dales C81030 Darley Dale Medical Centre DE4 2SA Dales C81039 The Surgery (Eyam) S32 5QH Dales C81076 The New Surgery (Tideswell) SK17 8NS Dales C81092 Evelyn Medical Centre S33 6RJ Dales C81101 Lime Grove Medical Centre DE4 3FD Dales C81611 Ashover Medical Centre S45 0BA Dales C81082 Hartington Surgery SK17 0AQ High Peak C81034 Stewart Medical Centre SK17 6JP High Peak C81074 Elmwood Medical Centre SK17 9AY High Peak C81065 Buxton Medical Practice SK17 9BZ High Peak C81634 Arden House Medical Practice SK22 4AQ High Peak C81003 Sett Valley Medical Centre SK22 4BP High Peak C81063 Thornbrook Surgery SK23 0RH High Peak C81080 Goyt Valley Medical Practice SK23 7SR High Peak

23 of 26 Schedule B - Monitoring

All quarterly monitoring reports submitted to the Commissioner by the Provide should include actual figures detailing (by month) the total number of sessions/contacts/visits provided. Data items required:

The following KPI’s have been agreed with the provider:-

 Falls admissions avoidance (% and Numbers) this KPI will be sourced from St Johns Ambulance (SJA).  % reduction in EMAS call outs for fall’s patients age 50 and over.  % reduction in subsequent conveyances to Emergency Department (ED) age 50 and over.  We may see an increase in falls conveyance rates if the proportion of more serious calls (Govt. standard classification) increases for EMAS. We need to monitor/evaluate Govt. standards classification at appropriate periods.  % reduction in Emergency Admissions for falls patients.  % reduction in Fracture neck of Femur (#NOF).  % reduction in ED attendances for fall’s patients. Currently ED do not code falls patients as fallers. We will have to use of proxy of admissions via A&E v’s other admissions to look for this reduction.  Number of inappropriate calls to be broken down by reason.

24 of 26 1. Quality Schedule – USE DCHS FIRST Quality

3. In addition, a report should be submitted to the Commissioner by the Provider in the final quarter, as specified under Paragraph 5.1(3) of this Agreement, providing information on:  Progress against each of the quality indicators at page 24 and 25 of this agreement  surveys, questionnaires or consultation undertaken  how services have benefited users and carers  any new user groups during the year  main achievements and successes during the year  new developments during the year or planned for the next year – A vision (strategic plan) which should be congruent with the strategic plan of the local CCGs.  the number of complaints received and how they were resolved  any significant problems during the year

25 of 26 Schedule C – Payment Details 2014/15

St John’s Ambulance funding summary 14/15

Total Recurrent/Non- Funded Value (£s) recurrent via Duration Comments 10 Value of agreement 345,000 Non Recurrent months From service start date

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