BOARD MEETING 14th December 2010 Community Services Contract with East London Foundation Trust

1.0 Background:

The Board will be aware of the transition of Newham Community Health Services from NHS Newham to East London NHS Foundation Trust.

The focus of this report is to brief on the process surrounding the production of the Community Services Contract which will come into force as from February 2011.

2.0 Process:

The contract document is based upon the NHS Standard Contract for Community Services, which is mandated by the Department of Health. The Contract itself is a template document with little scope for altering the wording or format, especially with regards to issues such as the terms and conditions of the contract, or setting out the process for counter-fraud and security measures.

However, there is scope to define the quality requirements, performance requirements and productivity levels, incentive schemes, and detailing the monthly contract monitoring and other information requirements. Other areas open to local input included defining policies for the safeguarding of children and adults in vulnerable circumstances, and establishing the process for dealing with serious untoward incidents and patient safety incidents.

As responsibility for many of these elements rests with different commissioners, a Project Board was established to ensure that all the work streams were completed in a timely fashion. Regular project update reports were produced, with a ‘call in’ approach utilised to scrutinise work streams that were felt to be more complex and thus had the potential to delay completion. The approach paid dividends in terms of delivering on time, with the Contract being sent to Monitor on 6th December.

Commissioners from NHS Newham, plus NCHS staff, plus senior managers from East London NHS Foundation Trust (ELFT) were all involved in the process; the author would like to note thanks to all those involved.

3.0 Specification Update:

By far the most laborious part of the process, but arguably the most important, was reviewing and updating the specifications for each service. There are over 35 individual service lines (detailed at Appendix A); with each specification’s contents typically being in excess of ten pages, the specification section of the contract alone covers circa 400 pages.

In line with the general approach of the Contract, a set format for the service specifications was prescribed by the Department of Health. This covers operational issues such as opening hours and service location, as well as broader issues such as detailing how the service interacts with other players within the health economy, and also how the service’s aims and objectives align to NHS Newham’s own corporate aims. 1 4.0 Commissioning Intentions:

The Contract template required commissioners to outline NHS Newham’s commissioning intentions, i.e. what is envisaged to change over the life of the contract.

Although initially the intention is to continue with the range of existing services, thereafter the commissioning intentions will be significantly influenced by the 2010 Government White Paper Equity and Excellence: Liberating the NHS, which sets a direction of travel for the NHS in terms of the need to extend choice, develop a greater understanding of activity and outcome, develop more service delivery within the community, and to develop appropriate payment systems (the Board may be aware work has been taking place in Inner North East London to address the issues of provider payment, and within NHS Newham work has taken place with phlebotomy, Musculoskeletal and Diabetic Retinopathy Screening to develop a number of shadow tariffs).

Another significant development listed as an intention is to re-commission the community teams with a view to creating a more integrated approach. The new service will be referred to as Integrated Health and Social Care Teams. This transition towards a ‘Virtual Ward’ model offers opportunities to consider how we might develop different pathways of care for high, medium and low intensity service users. As this work develops there is an opportunity to start to define the different types of care package that will be delivered and to look at how the payment for these services can be managed. Transition of Newham Community Health Services to ELFT provides the opportunity to develop innovative holistic models of care for patients; evidence suggests that a number of patients with long term conditions require additional mental health support. Integrated teams with both physical assessment and mental health input will provide robust alternatives to inpatient care in the secondary sector.

Additionally, another intention at the time of entering this contract is that it is planned to seek competitive tenders for the Urgent Care service.

In the separate APMS for the transitional practice it is anticipated that a competitive process may be run in 9-12 months time.

5.0 Local Engagement:

Commissioners recognise the importance of ensuring that the health needs of the local population are paramount, so a specific requirement was inserted to ensure that the Provider shall report to Commissioners on a quarterly basis giving details of the engagement undertaken with the local population. It is a further requirement that ELFT shall follow NHS Newham's "Community Ownership" approach, delivered through our "Communities of Health" network, which has set the standard nationally in terms of best practice. The Provider is also required to take account of other best practice documents that may be in place; at the time of contract signing this shall include the ‘Small Change Big Difference’ study and the ‘Real Involvement’ document published by the Department of Health.

6.0 Equalities & Diversity:

Being a standard NHS document, the Contract already contained requirements to ensure that the services are fully accessible to diverse sections of the population, that Patient service users are treated with dignity and respect taking equality considerations into account e.g. age, gender etc, and that Equality data monitoring and analysis is undertaken is across the equality characteristics (collection of equality data, disability, religion or belief, sexual orientation) to identify under-representation of population groups.

2 In addition, commissioners ensured that there were arrangements in place to ensure that Equality Impact Assessments are conducted on services to ensure no adverse impact on particular population groups exists, and that reports are available to detail the extent to which the Provider is complying with all the contractual requirements.

7.0 Involvement:

GP Commissioner involvement in the development of the contract has included nominated GPs from NHP and the LMC (Dr Lise Hertel and Dr Saidur Rahman). DR Prakash Chandra has been involved in the Virtual Wards Programme Board as well as Dr Saidur Rahman. The Clinical Directors have also been involved in specific service areas included in the contract. Briefing papers have been presented at the Newham GP Commissioning Board (chaired by LMC Dr Prakash Chandra/ Dr Jim Lawrie), with representation from NHP and NCG.

LBN involvement has been through regular briefing papers and updates at the Joint Commissioning Board (Children and Young People) and at the Children and Young Peoples Trust Board, the Integrated Commissioning Transformation Board and the Better Health and Well Being LAB.

8.0 Financial Information:

The final contract value for 11/12 is to be negotiated. A position has been included in the Heads of Terms.

9.0 Recommendation

An electronic link is provided to the full draft contract if Board members wish to access details in any specific areas of the contract prior to the contract being signed.

Link: N:\NPCT Shared\[final 5 dec 2010] 2011-14 contract ELFT.pdf N:\NPCT Shared\[final 5 dec 2010] 2011-14 contract ELFT APPEND A.pdf

3 Appendix – list of Services. o N e f c i e r v

r 0 e 1 S 0 2

1 Advoca cy s ervice & f2f l a ngua ge s upport 2 Ca rdi a c Reha bi lita ti on 3 Child Development Centre 4 Children in Ca re Tea m 5 Children's Hea lth Services 6 Community Children’s Nurs ing 7 Community Dis a bil ity Tea m 8 community ma trons 9 Community Support Service (Hea lth Centres ) 10 Conti nence Advis ory Service 11 Conti nui ng Ca re Beds (a lso referred to a s Continuing Ca re Wa rds Team) 12 Conti nui ng Ca re Nurs i ng tea m 13 Da y Hos pi ta l 14 Dia betes Speci a li s t Nurs i ng Tea m 15 Dia betic Retina l Screening Service 16 Dia na Team 17 Dis trict Nurs ing Service (i nc. EoLC s pecia lis t nurs i ng di s charge s ervice) 18 Enures is 19 Epileps y Nurs ing Service 20 Foot Hea lth Service 21 Hea lth Vis i ting 22 HRS (Communi ty Intermedi a te Ca re Service) 23 Intermedia te Ca re Beds (Ca za ubon) 24 Na viga tors 25 Occupa tiona l Thera py (OT) Adult / Children Community Team / end of life / Inpa ti ent / Stroke Rehab / Intermedia te Ca re 26 phlebotomy 27 Phys i othera py [inc. Intermedia te ca re tea m, outpa tient team, neuro OPD, s troke OPD] 28 Sa fegua rding Children’s Tea m 29 School Nurs ing 30 Sexua l & Reproducti ve Hea lth (NB: referred to on KPI a nd Nat Ta rget s heet a s Fa mi ly Pla nning) 31 Si ckl e Cel l & Tha l a s s a emia Service 32 SLT 33 Surgica l Applia nces 34 Ti s s ue Via bili ty Service 35 Tra ns i tiona l Prima ry Ca re Servi ces (NB - this s peci fica tion is in a dditi on to the APMS contra ct) 36 UCC Tea m (WIC) 37 Wheelcha ir Services

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