DUDLEY CLINICAL COMMISSIONING GROUP BOARD AGENDA

Thursday 7 January 2016 1.00pm – 4.00pm 3RD FLOOR SEMINAR ROOMS, STOURBRIDGE HEALTH AND SOCIAL CARE CENTRE, JOHN CORBETT DRIVE, STOURBRIDGE, DY8 4JB

QUORACY Meetings of the governing body will be quorate when four elected GP clinical members and two other governing body members (one from the lay members or secondary care doctor and one from the Chief Accountable Officer, Chief Finance Office or Chief Quality and Nursing Officer) are present, (provided that if the Chair is not present, then either the Accountable Officer or Chief Finance Officer must be present).

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 Board held on 12 November 2015 Enclosed Dr D Hegarty

1pm 4. Matters Outstanding Enclosed Dr D Hegarty 5. Public Voice

1.05pm 5.1 Questions from the Public Verbal Mrs J Jasper To respond to questions from members of the public received prior to the Board, in writing, on the provision of health care to the population served by the CCG. 1.10pm 5.2 Feedback from #ME Festival Presentation Mrs L Broster 1.30pm 5.3 Public Update Enclosed Mrs L Broster

1.40pm 6. Chairman & Chief Executive Officer Report Verbal Mr P Maubach 7. Strategy

1.50pm 7.1 Corporate Objectives Update Enclosed Mr M Hartland 2.00pm 7.2 Health Inequalities Presentation Ms D Harkins 2.10pm 7.3 Delivering the Forward View: NHS Planning Guidance Presentation Mr N Bucktin 2016/17 – 2020/21 2.20pm 7.4 Partnership Board Report Enclosed Mrs S Cartwright 8. Quality & Safety

2.30pm 8.1 Report from Quality and Safety Committee Enclosed Dr R Edwards 9. Governance

2.40pm 9.1 Report from Audit Committee Enclosed Mrs J Jasper 2.50pm 9.2 Combined Board Assurance Framework and Risk Register Enclosed Mrs J Jasper 2.55pm 9.3 Report from Remuneration Committee Enclosed Mr S Wellings

BREAK

1 | Page Time Agenda Item Attachment Presented By 10. Finance and Performance

3.05pm 10.1 Report from Finance & Performance Committee Enclosed Mr S Wellings 11. Acute & Community Commissioning

3.15pm 11.1 Public Involvement and Duty to Consult Enclosed Mrs L Broster 3.25pm 11.2 Report from Clinical Development Committee Enclosed Dr S Mann 3.35pm 11.3 Integrated Commissioning Executive Report Enclosed Mr N Bucktin 3.40pm 11.4 Health and Wellbeing Board Report Enclosed Mr N Bucktin 12. Primary Care Commissioning

3.45pm 12.1 Report from Primary Care Commissioning Committee Enclosed Mr S Wellings

3.55pm 13. Reflection Time 14. Exclusion of the Press and Public

That under the Public Bodies (Admission to Meetings) Act 1960, the public and representatives of 4.00pm the press and broadcast media be excluded from the meeting during the consideration of the following items of business as publicity would be prejudicial to the public interest because of the confidential nature of the business to be transacted. 15. Date and Time of Next Meeting

10 March 2016 1pm – 4pm Boardroom, BHHSCC

31 March 2016 1pm – 4pm Boardroom, BHHSCC

A Glossary of terms is included at the end of the papers

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD PUBLIC MINUTES

MINUTES OF THE MEETING HELD IN PUBLIC ON THURSDAY 12 NOVEMBER 2015 AT 1.00 PM, BOARDROOM, BRIERLEY HILL HEALTH AND SOCIAL CARE CENTRE

ATTENDEES:

Members

Dr D Hegarty Chair & GP Board Member – Dudley CCG Mrs T Curran Interim Chief Nurse – Dudley CCG Dr J Darby Clinical Executive & GP Board Member – Dudley CCG Dr R Edwards Clinical Executive & GP Board Member – Dudley CCG Dr P D Gupta GP Board Member – Dudley CCG Mr M Hartland Chief Operating and Finance Officer – Dudley CCG Dr M Heber Secondary Care Clinician – Dudley CCG Mrs J Jasper Lay Member for Patient & Public Engagement – Dudley CCG Dr R Lewis GP Board Member – Dudley CCG Dr S Mann Clinical Executive & GP Board Member – Dudley CCG Mr P Maubach Chief Executive Officer – Dudley CCG Dr R Tapparo GP Board Member/Vice Chair – Dudley CCG Mr S Wellings Lay Member for Governance – Dudley CCG

Non-Voting Members

Ms J Emery Chief Executive – Healthwatch Ms D Harkins Chief Officer of Health & Wellbeing (Director of Public Health) – Dudley MBC Dr T Horsburgh LMC Representative – Dudley LMC Mr D King Head of Membership Development & Primary Care – Dudley CCG Mr T Oakman Strategic Director, People – Dudley MBC

In Attendance:

Mr N Bucktin Head of Commissioning – Dudley CCG Mrs H Codd Community Engagement Manager – Dudley CCG Dr R Gee GP Engagement Lead – Dudley CCG Ms S Johnson Deputy Chief Finance Officer – Dudley CCG Mrs T Downton Minute Taker – Dudley CCG

CCG110/2015 APOLOGIES

Apologies were received from Dr C Handy, Dr M Mahfouz, Mrs S Cartwright and Mrs L Broster.

CCG111/2015 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.

Mrs Jasper declared her standing interest as Chair of the Audit Committee, Sandwell and West Birmingham CCG.

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It was duly noted that within the report from Remuneration Committee, the CCG clinical and lay members of the Board would declare an interest as it related to Office Holder Contracts.

CCG112/2015 MINUTES FROM BOARD HELD ON 10 SEPTEMBER 2015

The minutes of the meeting held on 10 September 2015 were accepted as a true and accurate record with the following amendments:

Page 13 – West Midlands Ambulance Service Contract 2015/16 – sentence to be changed from over performance to under performance.

The exclusion of the press and public statement to be included.

Resolved: The Board accepted the minutes from the 10 September 2015 as a true and accurate record subject to the aforementioned amendments being made

CCG113/2015 MATTERS OUTSTANDING

It was noted that updates for both matters outstanding, which related to issues within the Urgent Care Centre and the schematic which explained how the organisations involved in the Partnership Board report back to their own organisational Boards, would be provided at the relevant points within the Board meeting.

In addition to the matters outstanding, Dr Hegarty requested an update from Mrs Curran with regards to an incident which had occurred at Saltbrook Place.

Mrs Curran advised the Board that the incident had involved a GP being assaulted by an individual who had previously been a resident at Saltbrook Place. A table top exercise would be taking place on 25 November 2015 to consider whether any further actions should be taken to safeguard staff and the public to prevent such an occurrence happening in future.

Dr Horsburgh advised that the incident had been discussed at the LMC who supported a risk assessment being undertaken for individuals when they become residents at Saltbrook Place. In addition, it had been suggested having a Link Worker based within Saltbrook Place to support residents who may have access difficulties or long term mental health or physical issues. This is available within some Midland Heart facilities.

PUBLIC VOICE

CCG114/2015 QUESTIONS FROM THE PUBLIC

Mrs Jasper reported that two questions had been received from the public in advance of the Board. The first asked “Many presentations have been given to the public and POPs (Patient Opportunity Panels) around the Five Year Forward View (FYFV) and the challenges etc in primary care, estates and the opportunities. What conversations have taken place with GPs to share the information with them and to allow them to have their say and provide feedback? How are we enabling the conversations to take place?”

Mr King responded to this question by reporting that conversations are being held through monthly locality meetings and bi-monthly with GPs across the membership. In addition, Mr King, Dr Gee and Dr Horsburgh are meeting with every GP in Dudley to discuss the challenges and future of primary care. Once this exercise was completed, it would be presented to the Board for discussion and also be taken to a membership event.

The second question asked “Have GPs been given an indication of timescales for these changes?” Mr King advised that the timescales are set out in the Strategic Plan and Commissioning Intentions which have been produced and are published on the Dudley CCG website: http://www.dudleyccg.nhs.uk/

Dr Horsburgh advised that Mr Hartland would be attending all locality meetings to feedback on the estate information which had been collected through Capita. GPs would be provided with this information in 2 | Page regards to the suitability of premises and this would lead onto conversations within the localities on how the estate may develop in the future.

Resolved: The Board received questions from the Public

CCG115/2015 FEET ON THE STREET: COMMISSIONING INTENTIONS

Mrs Helen Codd introduced this item and informed the Board that CCG staff had been out speaking to members of the public in relation to continuity, access and co-ordination which is a key focus for the CCG within the Commissioning Intentions.

Following the presentation, members agreed to address the comments in subsequent agenda items.

Resolved: That the Board received the presentation for information

CCG116/2015 PUBLIC UPDATE

Mrs Jasper spoke to this item and advised the Board on the following key areas:

Commissioning Intentions Dr Hegarty had requested that staff summarise the Commissioning Intentions document within a paragraph. The chosen summary was read out and members felt this was an innovative way of understanding the document.

Patient Voice POPs, PPGs and Healthcare Forums continue to meet and discuss a variety of issues including the future of primary care, updates on the Urgent Care Centre and the Commissioning Intentions.

ME Festival Following the success of last year’s, a second event would be taking place on 26 November 2015 at Himley Hall and Park. Mrs Codd and the Communications team would be co-ordinating the event and it is hoped that this would be a formative event for the younger members of the borough.

The Social Care Institute for Excellence (SCIE) It was noted that the paper stated there was a ‘possible’ collaboration with SCIE. Mrs Jasper confirmed that this was now a definite piece of collaborative work that would be taking place relating to a programme of research and policy analysis on ‘wicked’ issues surrounding the implementation of the Five Year Forward View (FYFV) ‘new models of care’.

Primary Care Friends and Family Test It was recognised that a large number of responses had been received from members of the public on the primary care friends and family test. The average response rate across the CCG was above national average. However there are still practices with very low response rates with some practices not submitting any data. Dudley practices remain above national average for people saying they would not recommend Dudley but work is being carried out to address those issues.

Listening Exercise A listening exercise would be undertaken in the New Year aimed at ensuring people are informed about the challenges within the health and care system and through listening to the public, help find solutions to some of the ‘wicked’ issues.

Ms Emery reported on the work being carried out by Healthwatch Dudley which included:

Urgent Care Centre The full report from Healthwatch Dudley would be presented to the Urgent Care Stakeholder Group and the CCG’s Quality and Safety Committee.

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Youth Voice A new group of Young Health Researchers had been established with the support of NHS England funding made up of 23 young people discussing their own personal health experiences. The group is in the process of researching the views of other young people around issues which matter most to them. The intention was to bring the findings of these discussions to the January Board.

Resolved: The Board noted the report for assurance

CHAIRMAN AND CHIEF EXECUTIVE OFFICER REPORT

CCG117/2015 REPORT

Mr Maubach updated the Board on the following:

Notices and Acknowledgements

Dr Gibran Ali Regrettably Dr Ali had decided to step down from his role as GP Board Member for Sedgley, Coseley and Gornal (SCG) Locality in order to devote time to his practice. Dr Gee had agreed to represent the SCG locality at Board, at their request, until a new appointment is made to the Board.

Recent and Upcoming Events

Reconfiguration of the Clinical Executive Roles The Clinical Executive roles are to be restructured to reflect the new model of care which will include the statutory function of a Designated Medical Officer. Interim arrangements will continue until roles are finalised and a recruitment process completed.

NHS England Annual General Meeting Dudley CCG had received recognition recently in that Dr Hegarty had attended the NHS England Annual General Meeting and Dudley was recognised as a national exemplar in terms of the Five Year Forward View. Dr Hegarty was invited to question the panel at the AGM on some aspects of the work that NHS England is leading on.

National Clinical Senate Chair’s Meeting NHS England’s patient experience team made reference to Dudley CCG at the recent National Clinical Senate Chairs meeting in terms of the work being undertaken around patient engagement and experience reporting. They will be using this to inform national developments.

Mrs Curran advised that NHS England had also been speaking to the CCG on staff experience and are eager to meet with the CCG and this would be a piece of work that would be taken forward.

New Models of Care Confirmation had been received from the New Care Models (NCM) team on funding to support the development of primary care capacity; implementation of new technologies; and expanding the capacity for generic workers as part of the community Multi-Disciplinary Teams (MDTs).

Visits to Dudley CCG The CCG had received a number of visits from different organisations including the Department of Health which had looked at the effectiveness of community services; South Worcestershire CCG; Gloucestershire CCG and Hackney CCG. Further visits were planned over the coming months from NHS England; Health Education England; and Ashford, Hertfordshire Vale, Staffordshire & Stoke, Canterbury and Coastal CCGs.

Five Year Forward View (FYFV) Vanguard A national event was to be held to review the progress during the first 200 days of becoming a Vanguard. Dudley CCG will be leading the discussions on workforce development.

NHS England Contract Advisory Group Dudley CCG had been invited to contribute to this national advisory group to work on the draft of the new 4 | Page national contract for MCPs. This would be extremely important as the way in which services are contracted for has a significant bearing on the way it incentivises behaviours. Current contracts are not deemed fit for purpose so being able to participate in this group was a crucial development. The National Team is aiming to develop a first draft by the end of the financial year with an implementation date of April 2017.

Members Event The development of the care model and the MDTs working within primary care had been discussed at the recent members’ event. Positive feedback was received from practices and a useful debate was had on how teams were working and future development of the teams. The feedback from the event would be used to inform the next stages of development of the MDTs, the CCG’s Commissioning Intentions and plans for next year’s contract.

Commissioning Intentions The Commissioning Intentions set out an 18 month timetable to fully commission the new care models from April 2017. Contracts for 2016/17 will provide an important transition period to enable early implementation of some aspects of the contract and model of care, as well as ensuring the services commissioned are fully mapped to the new care model.

Provider Summit A Provider Summit would be taking place on 30 November 2015 to discuss the Commissioning Intentions with the main providers and to understand where they are with implementing the new changes. The outcome of the Summit will be reported back to the Board in January 2016.

Conflicts of Interest Dudley CCG had agreed to contribute to a NHS England review around conflicts of interest in primary care and best practice to manage the conflicts within CCGs. Deloitte were undertaking the work and they will be producing advice and recommendations to CCGs.

Following press coverage in The Times around conflicts of interest, Dr Horsburgh reassured members of the public that Dudley CCG had involved external experts in developing its governance arrangements in respect of primary care commissioning including managing conflicts of interest and they can have confidence that there are robust processes in place.

Dr Hegarty clarified that the headlines which were placed in The Times related to contracts being placed with companies in which CCG Board members had a financial interest. Dr Hegarty stated that this had been discussed with Mr Maubach, Mr Hartland and all the Non-Executive Directors and was able to confirm that there is no financial allocation to organisations in which Dudley CCG Board members have a direct interest.

Resolved: The Board noted the report for assurance

STRATEGY

CCG118/2015 CORPORATE OBJECTIVES UPDATE

Mr Hartland spoke to this item and advised members that following discussions at the September Board, the intention of the paper was to give an ongoing update to the corporate objectives set in May 2015. It was noted that the document now referred to how each objective delivers the four overarching objectives for the CCG. It was recognised that there was slippage in a couple of the areas and these were due to circumstance and involvement with the national team around contracts and also the work being carried out with Monitor on Tariff & Pricing and Procurement. Once the outcomes of those discussions were understood, the Procurement Strategy would be presented to the Board for approval. Mr Hartland advised that all items within the report would be resolved and fully met by the end of the financial year.

Mrs Jasper noted that the corporate objectives had been mapped to the different Committees, but highlighted that one of the principal duties of the Audit Committee was to give overall assurance to the Board that the CCG was not at risk and queried why this was not included within the report. Mr Hartland acknowledged Mrs Jasper’s comment and confirmed that this overarching objective would be included when the paper is presented to the Board in January. 5 | Page

Dr Mann asked if an addition could be incorporated in the document in relation to budgetary constraints. Mr Hartland confirmed that this could be included as part of the refresh being presented in January.

Resolved: 1) The Board noted the report for assurance 2) The Board noted that a further update would be presented in January

CCG119/2015 PARTNERSHIP BOARD REPORT

Dr Hegarty spoke to this item in the absence of Mrs Cartwright and reported that the Partnership Board continued to meet with representatives from all organisations involved in the implementation of the new model of care.

Resolved: 1) The Board received the report for assurance

QUALITY AND SAFETY

CCG120/2015 REPORT FROM QUALITY AND SAFETY COMMITTEE

Dr Edwards spoke to this item and confirmed that the report summarised the key issues raised at the Quality and Safety Committees held in September and October 2015.

Coppice Lodge Issues were being addressed at Coppice Lodge regarding infection prevention and control within the home and the CCG is seeking assurance that measures are in place. This will be reviewed at the Quality and Safety Committee in November.

Transforming Care This was an ongoing national workstream to address concerns arising from Winterbourne View with the aim of reducing the number of people who continue to live in institutional care homes by 10% over the next 12 months. An action plan for Dudley had been submitted.

Dr Horsburgh raised a concern about having to reduce the number of people by 10% and questioned whether the figure should be purely based around the suitability for the person. Mrs Curran advised that 10% is a national figure and it is targeted at the number of beds. She assured the Board that principles had been followed in that the care is appropriate for the person and NHS England are satisfied with the plan in place. Work was also taking place in close collaboration with the Continuing Healthcare Team and the Local Authority.

Dr Gupta asked who would pick up the workload of those patients coming into the community as part of the transfer of care. Mrs Curran confirmed that any professional involved in an individual’s care would be informed, dependent on where the patient lived and all risk assessments would be carried out in advance. Mrs Curran highlighted that for Dudley this related to six people.

Health Visiting All health visiting teams have been commissioned nationally by the Office of Public Health from 1 October 2015. As a consequence health visiting services in Dudley will deliver a service to children resident in Dudley only. Those children registered with a Dudley GP but not a Dudley resident will no longer receive a service from Dudley health visiting and vice versa. This puts a risk in the system which has been included on the risk register.

Ms Harkins expanded on the issue around the health visiting teams and informed Board members that a number of GPs were concerned about the children who are registered with a GP in Dudley but not resident. She advised that discussions were taking place with the health visiting service to have a liaison service until such time that the change was managed through. This would enable someone to assist the GPs to liaise for those patients who are registered but require ‘handing over’ to a neighbouring health visiting service. More detail would be given once the service is available.

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Mrs Curran confirmed that she was assured there are robust systems and processes in place for those children moving out of the borough but the risks relate to those children who will be transferring to the Dudley service and whether the processes are as robust. This was an issue being addressed by the Quality and Safety Committee and work is being carried out with the Office of Public Health who provide the Committee with updates on the situation.

Dr Gupta asked if a communication could be sent out to GPs which clarified the process. Ms Curran and Ms Harkins agreed to liaise to do this and also ensure a communication is sent out through Members News.

Dr Horsburgh stressed that reciprocal arrangements should be put in place across boundaries and this should be resolved as soon as possible. In addition Dr Horsburgh highlighted there was a gap in the IT system which needed addressing where the health visiting service is alerted about any new children being registered on the system.

Ms Harkins confirmed that the child health information system was currently being re-procured so cross boundary issues should be resolved once that was in place.

Urgent Care Centre Concerns continue to be raised at the Committee around the stability of the workforce and suitability of the estate. This would be discussed later.

Safeguarding Children and Adults The Committee had been assured on several issues around safeguarding of children and adults and had been further assured by reports from internal audit which concluded that significant assurance could be given on the system’s internal controls.

Antibiotic Stewardship A report was received by the Committee on the delivery of an antimicrobial stewardship programme across primary care to measure indicators which would be monitored throughout the year.

Independent Review of Drug and Alcohol Related Deaths A review had been carried out which was commissioned by the Office of Public Health. The conclusion was that there needed to be more inter agency working and policies & protocols required to ensure consistency across the system.

Healthcare Associated Infections There had been an increase in Clostridium difficile compared to the same period last year across both hospital and community services. A cross economy meeting had taken place with the Office of Public Health, Dudley Group NHS Foundation Trust and the CCG. This had identified areas where these incidents could be managed more effectively.

Three cases of MRSA bacteraemia had been reported; two attributed to DGFT and one attributed to the CCG. These were all being investigated thoroughly and route cause analyses were being carried out.

Never Events Two never events had been reported by DGFT which both related to obstetric cases. A thorough investigation had been carried out by the Trust for both incidents, one of which had been concluded as satisfactory and the second incident would be reviewed on the 13 November with the Committee being updated at its subsequent meeting.

Risk Register Two risks had been added to the risk register with regards to health visiting and the non-emergency patient transport contract.

Resolved: 1) The Board noted the report for assurance 2) The Board noted concerns raised by Board members with regards to Transforming Care and Health Visiting 3) The Board recognised the risks highlighted and that these would be scrutinised by the Quality and Safety Committee 7 | Page

CCG121/2015 REPORT FROM CHIEF NURSE

Mrs Curran spoke to this item and informed the Board that the Nursing and Midwifery Council approved revalidation for all nurses and midwives in the UK from 1 April 2016 at a meeting held on 8 October.

It was noted that employers have a duty to support nurses in revalidating and Mrs Curran had been liaising with all providers to ensure their registrants are fit to revalidate. A software tool had been explored to help and assist nurses in the revalidation process and this had been discussed at the IT Strategy Group. Although no final decision had been made on which tool would be used, it was supported by the IT Strategy Group and further liaison would take place with practices and nurses.

Mrs Curran advised the Board on changes to the legal requirements which related to a midwife’s practice if concerns are raised. These reports would now be shared with the commissioner as well as the practitioner and the organisational provider.

Dr Tapparo raised a question around practice nurse education and whether this would be made available, which is similar to what the GPs currently receive. Mrs Curran clarified that she was not aware of any funding being available in order to do this but recognised there was an issue around practice nurses being released to carry out training which needed to be addressed.

Dr Lewis asked whether there was any likelihood that nurses would retire rather than going through revalidation, similar to when GPs were required to revalidate. She also highlighted that there was a time element in order for practice nurses to prepare. Mrs Curran advised that some nurses had suggested retiring but felt that if a software tool was put in place this would help to mitigate some of this risk.

Mr King suggested these issues be discussed at the Primary Care Operational Group as there might be an opportunity to look at this as part of the new contractual framework and how practices might be commissioned to release both GP and Practice Nurse time in order to attend training.

Resolved: 1) The Board noted the report for assurance 2) The Board noted the decision by the NMC around revalidation for nurses within Dudley 3) The Board noted the changes to the sharing of investigation reports 4) The Board requested further discussion take place at the Primary Care Operational Group around an education approach for Practice Nurses, similar to the programme currently in place for GPs, and to secure a software tool after ensuring that the tool is acceptable for use

GOVERNANCE

CCG122/2015 REPORT FROM AUDIT COMMITTEE

Mrs Jasper spoke to this item and confirmed that the report summarised the key issues discussed at the Audit Committee held on 1 October 2015.

The Board were advised that within the key indicator summary, there was one indicator rated amber which related to Business Continuity. The Board were advised that it should be rated green by the end of the financial year.

Following the Board Development Session to consider the recommendations following the Good Governance Institute (GGI) review, the actions had been aligned into themes and the CCG had incorporated its own which would be presented to the Audit Committee and subsequent Board.

Mrs Jasper advised that the CCG had agreed to take part in the NHS England/Deloitte audit regarding conflicts of interest and feedback would be received and shared with the Committee in due course.

The Board were advised of the decisions taken under delegated powers to approve the closure of five risks from the Board Assurance Framework and Risk Register. In addition, the Audit Committee also

8 | Page recommended the closure of risks 14, 16, 41 and 65 to the Board. This recommendation would be presented under the next agenda item related to the BAF and Risk Register.

Dr Horsburgh raised his concerns about closing risk 41 which related to the phlebotomy services as he highlighted that there was still a 3-4 week wait in phlebotomy services. His concerns were noted but the Board was reminded that the original risk was in relation to the location of phlebotomy services and it was appropriate to close this now. If necessary a new risk could be opened around the community domiciliary phlebotomy services.

Resolved: 1) The Board noted the report for assurance 2) The Board approved the closure of risks 14, 16, 41 and 65 3) The Board proposed that the Clinical Development Committee consider whether a new risk be opened in respect of the community domiciliary phlebotomy services

CCG123/2015 COMBINED BOARD ASSURANCE FRAMEWORK AND RISK REGISTER

Mrs Jasper spoke to this item and reported that the Audit Committee considered the overall Board Assurance Framework and Risk Register at its meeting held on 1 October 2015.

The Board were advised that the description for risk 6 had been changed which related to financial pressures at DGFT. The description for risk 10 had also been changed which related to the health economy working together to implement service change.

One amendment had been made to the residual risk score for risk 43 which was in relation to additional control and assurance mechanisms resulting in the residual risk score being reduced from 25 to 16.

Four new risks have been opened:

Risk 75: NURSING REVALIDATION – the Nursing and Midwifery Council covering all registrants across England, Scotland, Northern Ireland and Wales intend to introduce nursing and midwifery revalidation from 1 April 2016. This is a three year process and more onerous than current practice requirements - many nurses are stating their intention to take early retirement rather than go through the process. For the CCG there is particular concern about the resilience of practice nurse workforce particularly given the age profile of the current nurses working in Dudley.

Risk 77: Failure to realise financial savings outlined in the value proposition because the MCP care model is not implemented

Risk 82: HEALTH VISITOR TRANISTION FROM REGISTRANT TO RESIDENT POPULATION i.e. transfer of children in the care of a Health Visitor (HV) from being with a GP to where they live (their home address) - this creates risk regarding the number of children whose health visitor will change (700 out and 1200 in). The risk is that there are robust processes in place to transfer care and records out of borough but this is not replicated for those children transferring into the borough, particularly the transfer of their records. This is also a safeguarding concern as children could be 'lost' to the HV service

Risk 83: Provider of non-emergency patient transport commissioned by the CCG is unable to deliver the quality KPI's in the contract and have given notice on the contract

Four risks were presented to Board for closure:

Risk 14: Failure to engage with Public Health, Health and Well Being Board and the Local Authority will limit the effectiveness of health care commissioning

Risk 16: Providers may be reluctant to develop and implement alternative approaches to service delivery

Risk 41: Lack of capacity in the right place for patient access to phlebotomy services

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Risk 65: Risk that contracts with healthcare providers will not be signed by NHSE deadline with delay due to: (1) Tariff consultation process; (2) Late issue of National Contract; (3) Late issue of National CQUINS

Resolved: 1) The Board noted the report for assurance 2) The Board approved the closure of risks 14, 16, 41 and 65

CCG124/2015 GOVERNANCE UPDATE – CHANGES TO THE CONSTITUTION UNDER DELEGATED AUTHORITY

Mr Maubach spoke to this item and reported that the CCG had the opportunity to update the Constitution every six months for NHS England’s approval. Due to the timing of the submission the last Board had delegated authority to the CCG Chair and Accountable Officer.

Mr Maubach informed the Board that the changes to the Constitution submitted were not significant and could be summarised as:

• amending the name of member practices; • Redefining Clinical Executive roles so that they remained appropriate and fit for purpose; • To reflect the requirements of the new model of care; • Amend the composition of the Governing Body by replacing the Chief Executive of Dudley MBC with the Strategic Director for People and include the CCG Executive Managers who attend the Board as non-voting members.

In readiness for the next Constitution changes for submission in June, consideration was being given to the future Clinical Executive roles required and whether certain ones might be recruited to outside the Dudley performers list. Any proposal to do this would require consultation with the membership.

Mrs Jasper queried how members are informed about changes to the Constitution. Mr Maubach advised that members would be informed via members news for routine changes.

Resolved: 1) The Board noted the report for assurance 2) The Board approved the revisions to the Constitution

CCG125/2015 REPORT FROM REMUNERATION COMMITTEE

Mr Wellings spoke to this item and confirmed that the report summarised the key issues discussed at the Remuneration Committee held on 7 October 2015.

Mr Wellings highlighted the levels of sickness absence and that it had increased slightly to above the 3% national average due to four members of staff being on long term sick leave.

Compliance with mandatory training requirements had improved significantly and it was noted that the CCG strives for 100% completeness and this is managed through line managers.

The Remuneration Committee was currently reviewing the office holder contracts and a consultation period had been undertaken and concluded on 31 October so a decision would be made at the December Committee regarding any contract changes.

Dudley CCG had been without a formal Unison staff representative but a member of the Quality & Safety team had expressed an interest and was undergoing training to take on this role.

Dr Horsburgh requested that a meeting take place prior to the next Remuneration Committee with those people that are affected by the office holder contract. This was recognised and it was understood that a meeting was scheduled to take place imminently.

Resolved: 1) The Board noted the report for assurance

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FINANCE AND PERFORMANCE

CCG126/2015 REPORT FROM FINANCE AND PERFORMANCE COMMITTEE

Mr Wellings spoke to this item and confirmed that the report summarised the key issues discussed at the Finance and Performance Committee held on 29 October 2015.

It was noted that the CCG continued to meet the requirements of the CCG as set by NHS England in meeting all of its financial duties and was also achieving all of its assurance performance indicators. Performance overall, particularly at Dudley Group NHS Foundation Trust, had improved.

The Better Care Fund was currently underperforming but work was being undertaken in order to address this.

The QIPP target for 2015/16 was forecast to be achieved and it was noted that new schemes had been brought in to compensate for other schemes which were not meeting their target, i.e. the Urgent Care Centre and Rapid Response Team.

Mr Wellings asked the Board to note the proposed transfer of the Medicines Management function from Dudley MBC to Dudley CCG which had been presented to the Committee and approved.

Dr Edwards raised her concerns about the challenges to the primary care workforce supporting MDTs and the Long Term Conditions Framework. She indicated that there needed to be a Workforce Strategy Group to support the key areas in going forward.

Dr Hegarty advised the Board that the requirement for this group had been discussed at the Clinical Executive Team. It was felt that this would be a key responsibility of the new executive role linked to the MCP but it would be resourced by the Vanguard allocation but it has to be raised at Board in order to utilise that funding to ensure it is put in place. Dr Hegarty suggested further discussions take place at the Clinical Executive Team but that it should as part of the clinical role in the MCP.

Mr Maubach informed members that ambulance handovers were red rated across the system. He reported that a positive meeting had been held with WMAS to discuss how the CCG can engage with them. Options were explored around data sharing and how WMAS might be able to access Dudley registered patients’ records which would assist them in their decision making. WMAS indicated their willingness to work with the CCG.

Dr Hegarty highlighted that the private section of the agenda dealing with the allocation of reserves referred to sensitive information pertaining to other organisations, hence why it could not be put in the public domain. There is an awareness of other parts of the health economy within the West Midlands, particularly CCGs, who are financially challenged and there are concerns that NHS England was looking at the financial reserves held this year in order to manage the financial challenges of other CCGs. Dr Hegarty continued by saying that Dudley currently has a hospital and a local authority that have significant financial challenges whilst the primary care system from which the CCG commissions has significant capacity and workforce challenges . Dr Hegarty sought approval from Board members to ensure that “Dudley health pounds stay within Dudley”.

Mr Maubach explained to Board members that raising these issues was because the regulatory bodies within the system look at the financial position as a whole and are required to ensure the NHS delivers services within financial balance. External pressures can be put onto the CCG Executive Team to relinquish resources that have been carefully managed to ensure effective financial balance across the region or indeed across the country as a whole and it is important that as a Board, it understands that the priorities should be invested in resources that benefit the local system.

Resolved: 1) The Board noted the report for assurance

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2) The Board unanimously supported the need to ensure that Dudley resources are maintained and kept within the Dudley health economy

ACUTE AND COMMUNITY COMMISSIONING

CCG127/2015 REPORT FROM CLINICAL DEVELOPMENT COMMITTEE

Dr Mann spoke to this item and confirmed that the report summarised the key issues discussed at the Clinical Development Committees held on 23 September and 21 October 2015. He drew attention to the following points:

Finance and Performance Dudley Group NHS Foundation Trust and Ramsay Healthcare were forecasting a significant over performance specifically in relation to orthopaedics. A coding change with regards to orthopaedics and ophthalmology was being challenged.

Medicines Management Although an overspend was indicated, positive work was being carried out with St Margaret’s Well Surgery in Halesowen, working with practice pharmacists with the intention of moving the budget into a more positive position than it currently is.

End of Life and Palliative Care Local Improvement Scheme The End of Life and Palliative Care Local Improvement Scheme had contributed to a reduction in hospital admissions and had shown it was beneficial both financially and for patients. The Committee agreed the scheme should continue and be incorporated into the proposed new contractual framework for primary medical services.

Risk Stratification The Committee had agreed to examine a new risk stratification tool, SAS, which would identify high risk patients as effectively as possible.

Mr King advised that a pilot was being run in eight practices looking at the extended scope of pharmacists which was a new way of providing primary care. An application on behalf of every Dudley GP practice had been submitted to be involved in a national pilot and the CCG would know if it had been successful within the next month.

Dr Horsburgh questioned what the impact of the pharmacy first scheme had been and whether it was found to be successful.

Mr Stenson, a member of the public in attendance at the Board meeting, who had been involved in the scheme, was asked to report on feedback from the scheme. He advised that he visited nine pharmacists and only two were aware of the scheme and how it might work. He did report however that it had worked well at High Oak Surgery where both the practice and pharmacy saw the benefits. One of the key issues highlighted was around patients making unnecessary appointments when they could have seen their pharmacists.

A formal evaluation of the pilot was expected and it would be helpful to compare the results to a pilot which was carried out approximately nine years ago.

Resolved: 1) The Board noted the report for assurance

CCG128/2015 REPORT FROM INTEGRATED COMMISSIONING EXECUTIVE

Mr Bucktin spoke to this item and confirmed that the report summarised the key issues discussed at the Integrated Commissioning Executive held on 17 September 2015.

It was reported that the Integrated Commissioning Executive discussed the operation of the MDTs and the risk stratification tool to enable them to focus on the patients who require more attention.

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With regards to the Better Care Fund and the function of the Community Rapid Response Team, Mr Bucktin reported that the Commissioning Manager for Integration Services had spent some time with the despatch desk at West Midlands Ambulance Service and had identified a number of areas where the team might operate more effectively. This would be reported back to the Ambulance Service and should contribute to building relationships with them.

In addition, further work was being carried out on palliative care; community equipment; telehealth/telecare; rehabilitation; and dementia services. A meeting would be taking place to discuss these further.

Resolved: 1) The Board noted the report for assurance

CCG129/2015 REPORT FROM HEALTH AND WELLBEING BOARD

Mr Bucktin spoke to this item and confirmed that the report summarised the key issues discussed by the Health and Wellbeing Board held on 9 September 2015.

Children and Young People’s Arrangements Work was taking place in terms of refocusing the children and young people’s arrangements in Dudley for partnership working.

Collective Commissioning Ms Harkins had presented a report to the Health and Wellbeing Board on those areas where a more collective approach could be taken on the commissioning arrangements.

Joint Strategic Needs Assessment (JSNA) Work had taken place in relation to the JSNA led by Neil Griffiths at the Fire Service. Further work was also being carried out in order to have a more accessible JSA that Commissioners could use to inform commissioning decisions.

Mr Maubach highlighted that one of the outstanding issues raised with the Chair of the Health and Wellbeing Board is the governance and voting of the HWBB. Mr Bucktin was asked to take this action to the next HWBB.

Resolved: 1) The Board noted the report for assurance 2) Mr Bucktin to raise the governance of the Health and Wellbeing Board at its next meeting

PRIMARY CARE COMMISSIONING

CCG130/2015 REPORT FROM PRIMARY CARE COMMISSIONING COMMITTEE

Mr Wellings spoke to this item and confirmed that the report summarised the key issues discussed by the Primary Care Commissioning Committees held on 18 September and 16 October 2015.

It was highlighted that the Committee meets in public and members of the public were urged to attend.

Mr Wellings reported that there was a piece of work currently being carried out on how primary care will be funded in the future and how the formula works. This determines what allocation GP practices receive and the way in which this is carried out has to be clear, open, transparent and understandable. In addition to this, reassurance was given to the Board that managing conflicts of interest is integral to the CCG and the reason for having non-clinical voting members only on the Committee was to manage that balance.

Dr Gupta questioned how big the risk was in closing a branch surgery. Mr Maubach responded by saying that the risk of closure is significant and it is addressed in the CCG by looking at the implications for patients and also considering the CCG’s Estate Strategy and the distribution of practices across the borough.

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Mr King advised that the risks were being managed by the Primary Care Commissioning Committee and as part of the consultation, the primary care development team was supporting practices going through the process including undertaking public consultation where that is required. It was noted that the Committee also needed to considered whether the risk could be greater if branch surgeries were not closed.

In response to Dr Gupta’s question, Mr Wellings also added that the changes in the way in which services are provided have been going on for some time and because the CCG has delegated responsibility for primary care, it is now able to report in more detail.

Dr Horsburgh felt it was important for members of the public to understand that a lot of work is also being carried out with practices and communicating with them so they are clear on the decision making process and how contracts are being taken forward.

With regards to the Primary Care Operational Group Terms of Reference which were presented in the report, Mrs Curran requested that the Quality Assurance Manager be included in the membership.

Dr Hegarty highlighted the importance around managing conflicts of interest and stated that it is extremely important that they are managed appropriately. One of the reasons the CCG had been successful in secondary care commissioning was due to the insight and professional skills clinicians could offer. The CCG could not allow a conflict of interest process to exclude the expertise that is incredibly important.

Resolved: 1) The Board noted the report for assurance 2) The Board approved the amended Terms of Reference for the Primary Care Operational Group with the inclusion of the Quality Assurance Manager within the membership

CCG131/2015 REFLECTION TIME

No comments were made by Board Members.

Dr Hegarty took the opportunity to thank Mrs Curran, Interim Chief Nurse as she would be leaving Dudley CCG. Mrs Curran was thanked for the work she had been involved in and the insight and support she has provided not only to the Board and CCG, but also to Dr Hegarty. The Board supported Dr Hegarty’s comments.

EXCLUSION OF THE PRESS AND PUBLIC

That under the Public Bodies (Admission to Meetings) Act 1960, the public and representatives of the press and broadcast media be excluded from the meeting during the consideration of the following items of business as publicity would be prejudicial to the public interest because of the confidential nature of the business to be transacted.

DATE AND TIME OF NEXT MEETING

Thursday 7 January 2016 1pm – 5pm Boardroom, Brierley Hill Health and 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

THURSDAY 7 JANUARY 2016 – PUBLIC BOARD MEETING

ITEM NO AGENDA ITEM ACTION TO BE TAKEN/UPDATE ACTION FOR DEADLINE

Discussion to be held at the Primary Care Operational CCG121/2015 REPORT FROM CHIEF NURSE Mr King January 2016 Group with regards to Practice Nurse Education

Clinical Development Committee to consider opening a Dr Mann/ CCG122/2015 REPORT FROM AUDIT COMMITTEE new risk in respect of the community domiciliary January 2016 Mr Bucktin phlebotomy services

REPORT FROM HEALTH AND Mr Bucktin to raise the governance and voting of the CCG129/2015 Mr Bucktin January 2016 WELLBEING BOARD Health and Wellbeing Board at its next meeting

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Public Update

Introduction This report is presented with the aim of keeping Board Members up to date with important Communications and Engagement issues and ‘hot topics’.

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 (PPGs), Patient Opportunity Panel (POP) and Healthwatch Dudley.

The Feet on the Street section of today’s Board meeting is an update from this year’s Me Festival.

Patient Opportunity Panel (POP) Meeting The POP group met in December and approximately 20 Patient Participation Group were represented. Clair Huckerby and Minesh Parbat from the Office of Public Health attended to give a presentation around pharmacy and antibiotic awareness.

The group raised concerns with regard to the Pharmacy First scheme including lack of promotional material and lack of pharmacy awareness. We will raise this issue with NHS England. The group also raised two questions for public Board, which will be answered in the meeting.

Young Health Champions (YHCs) A job description and person specification has been developed for a Young Persons Health and Wellbeing Change Maker. The post will be hosted by Dudley Council for Voluntary Services (DCVS). We anticipate the post to be advertised in January with a view to making an appointment for the start of the new financial year. Part of the funding will be used to support the voluntary sector in mentoring the YHCs to improve life skills, confidence and experience thus making the voluntary sector more sustainable and having a wide support network for YHCs.

Dudley Borough Healthcare Forum (HCF) The HCF took place in early December and approximately 80 participants took part in structured workshops around key work streams which will inform the development of the New Care Model (NCM). A presentation was delivered at the start which explained the NCM and why changes were necessary. The Multi-Disciplinary Team (MDT) also presented to participants to explain how their roles had changed since they had started working closer together. Structured workshops included:  primary care;  care closer to home;  connecting communities and building relationships ;  accessing services; 1

 buildings fit for the future;  feeding back on your experiences;  teams without walls.

The next HCF takes place on 3 March 2016, 4.30pm until 6.30pm at Brierley Hill Civic Hall. The agenda for this forum is yet to be set.

Kingswinford, Amblecote & Brierley Hill (KAB) POD (group of PPGS) The last KAB POD meeting took place in November. Members were pleased to hear that 3 PPG members had been recruited to participate in future KAB locality MDT meetings. The group also heard an update on how complaints were handled within the NHS. The topic of Pharmacy First was raised at this group.

Me Festival Me Festival 2015 took place at Himley Hall on 26th November.

The aim of the day was to work collaboratively with partners in providing a fun and interactive day for year 8 students in a safe environment. It was attended by over 120 pupils and 19 teachers from 11 schools across the Dudley borough.

The day involved a number of structured workshops delivered by different agencies, including; Loudmouth, Urban Strides, Kick Ash Dudley and UTV Media. There was also a ‘Let’s Get Active’ tent hosted by the Office of Public Health with an opportunity for young people to compete with each other in various activities; sit down volleyball, fencing, rowing and a fire hose challenge. The Courtyard at Himley Hall hosted some emergency vehicles with an ambulance, motorway collision unit and fire engine as well as Black Country Radio who supplied music for the outdoor area.

The VIP tent within the hall, hosted a number of different agencies and interactive activities for young people to get involved with, including;  a graffiti wall offered by KicFM,  smoothie bike by the Office of Public Health,  School Nurses,  The What Centre,  Switch,  Kooth, Dudley & Walsall Mental Health Trust representatives  Healthwatch Dudley,  Young Health Researchers.

The YHRs were also doing surveys with the students to find out about the things that make us healthy and get some feedback on services for young people.

The day was enjoyed by those who attended, with lots of positive comments and feedback, evaluation forms were completed at the end of the day. All students and teachers were given a goody bag which contained various ‘freebies’ from the agencies involved with Me Festival and lots of useful information around Health and Wellbeing.

The Social Care Institute for Excellence (SCIE) The CCG were selected to work with SCIE on a piece of work they are doing called, ‘Changing Together’. The work, which aims to inform future policy, focuses on how to have constructive conversations on the ‘wicked’ issues surrounding the implementation of the Five Year Forward View (FYFV). A policy paper will be produced for June 2016 and will include Dudley as a case study.

In December, CCG representatives attended a meeting hosted by SCIE in London with participants from various organisations including, Nottinghamshire Council, PPL Consulting, the Co-production Network. A facilitated session took place to discuss research findings around ‘wicked’ issues and

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constructive conversations and how to find best ways forward including lessons for new models and an action research approach to solutions.

The next step is for us to work with SCIE as they conduct Action Research into our development of the New Care Model with partners.

Listening Events The team are busy preparing for the listening events around the New Care Model. We are identifying meetings that we can join in with and are working with Healthwatch Dudley to adopt a ‘train the trainer’ approach with community groups to ensure we have conversations as wide as possible.

We want to hear from Dudley people, to find out what matters to them. Findings will be analysed by Healthwatch Dudley and be presented back to the Partnership Board.

Quarter 2 2015-16 Patient Experience key updates During the quarter, we demonstrated the integrated reporting system at the Kings Fund, Department of Health and NHS England. The feedback has been positive with discussions around us supporting some of the national developments in 2016/17.

We continue to work well with DGFT on the presentation and integration of patient experience feedback. A number of improvements which were highlighted in the 2015/16 target setting have been taken on board and we continue to work to achieve these. This quarter’s focus has been around communication.

Conversations with other providers have continued throughout the quarter and new integrated dashboards have been developed for Malling Health and some elements of primary care. We aim to develop a similar style of reporting with all providers throughout 2016/17.

There are still a number of practices who are not completing the Friends and Family Test (FFT). These practices have been highlighted in the most recent Quality & Safety paper; there have also been a number of messages in members’ news around this subject. Discussions are on-going with regard to how we can support practices that still have a low FFT response rate.

One of the quality premium targets for 2014/15 was to demonstrate an improvement in the overall experience of services at DGFT through the inpatient survey. In July 2015 we reported that there had been a decline of 0.2% in the rating of the overall experience at the trust resulting in a loss of £235,000 for Dudley CCG. However, NHS England have chosen to accept this small decline and we are pleased to announce we have received the quality premium.

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Urgent Care Centre- The Urgent Care Centre report is now complete and was presented to the UCC stakeholder group on 17 November 2015. Recommendations by Healthwatch Dudley are currently being considered.

The report can be accessed via the following link http://www.healthwatchdudley.co.uk/research- reports

Youth Voice- Dudley Youth Health Researchers is an NHS England funded joint Healthwatch Dudley/Dudley Youth Service project involving local young people with a wide range of differing health and wellbeing experiences. The group has gathered the views of other local young people to influence a survey that is in the process of being completed by 1000 (+) young people. Survey topics include mental health, social media, self-harm, eating disorders and knowledge of local support services.

Members of the group have presented at the annual Partners in Paediatrics conference in Birmingham, attended NHS Expo in Manchester and ran workshops at the British Youth Council annual forum.

In November group members tested their survey at Me Festival with students and arranged for schools to take further surveys back to complete. A series of focus groups led by young people will take place in the new year to explore survey questions in more detail.

The group are hoping to present their findings in March to CCG Board.

Young Health Champions- Healthwatch Dudley is working with colleagues from Dudley Council for Voluntary Service, Office of Public Health and Dudley CCG to look at an innovative approach and delivery model for the Young Health Champion project.

At the last planning meeting Healthwatch Dudley presented key themes outlined in Dudley MBC, Dudley CCG, Public Health, Dudley CVS and Healthwatch Dudley youth engagement reports. The report included what young people thought was good about local services and what could be better. A small subgroup will meet in January to finalise the recruitment process.

Low Vision - Healthwatch met with the Low Vision Strategy Stakeholder Group on 24 November. The group comprises several organisations including the CCG, Dudley MBC, optometrists, Local Eye Health Network and support groups. The format was agreed for the Low Vision Strategy document to be presented to the Health & Wellbeing Board early in 2016. This document will summarise the objectives moving forward.

Dudley Tobacco Strategy- A number of focus groups have been held over the last few weeks including Switch, CRI (drug and alcohol services), current and ex-smokers. A member of the local authority Stop Smoking service helped to facilitate the meetings with the smokers and ex-smokers.

As part of the research, Healthwatch also met with Dudley Group’s Stop Smoking Service to gain an insight on how people are encouraged and supported to stop smoking when admitted to hospital.

Findings from the focus groups and questionnaires are being analysed and included within a report which will be presented to Dudley Office for Public Health within the next couple of months. Following this, Healthwatch will be working jointly with Public Health to hold individual focus groups

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with CCG colleagues, Dudley Group and the voluntary sector to share findings and to encourage buy-in and involvement in the development of the Tobacco Strategy for Dudley.

Community Information Points/Information Champions- The Community Information Point Network continues to grow with information giving training being delivered to in the region of 200 people (staff members and volunteers) from local organisations. The network includes community drop in centres, council reception points, cafes, pharmacies and GP surgeries (including Eve Hill Medical Practice). A presentation was recently made to Albion House Patient Participation Group, which is supportive of members becoming information champions to signpost patients to community support and services.

Orthodontics Commissioning- Healthwatch have been attending meetings of the NHS England review group for the commissioning guide on orthodontics.

The final document has now been published by NHS England and is available for commissioners. All commissioners of orthodontic services in England can now access the document to help them plan commissioning of orthodontic services.

Paediatric Dentistry Commissioning Guide- Healthwatch Dudley are now involved in an NHS England review group for the commissioning of paediatric dentistry. The commissioning guide is expected to finalised in early 2016.

Deaf Community- A good relationship is being built up within the deaf community following their attendance at the September People’s Network where interpreting services were provided. Healthwatch Dudley have since met with members of the Dudley Deaf Group at Queens Cross Network and agreed to meet on a regular basis to listen to their views and experiences and feed back responses from professionals.

As a result of the first meeting with the group in October, Healthwatch met with Sandwell & West Birmingham Hospital Bank Interpreting Services as members of the group told us their services were excellent whereas interpreting services in Dudley were poor. The group’s experiences and findings from the meeting with Sandwell have been passed on to Dudley Group who are very keen to involve the deaf community in developing a service specification to provide interpreting services in Dudley Group. Healthwatch will be facilitating meetings to enable this to happen early in the new year.

Healthwatch have also met with a private company called BSL Health Interpreters who are also aware of the lack of a joined up service in the Dudley Borough and want to work together with Healthwatch and Dudley Group. Malling Health have already commissioned BSL Health Interpreters so that anyone attending the Urgent Care Centre will automatically be provided with an interpreter.

Case Studies- A number of visits have been made to people in their own homes to tell us their experiences of a variety of health and care settings. Each visit has been quite complex and covered a range of issues such as social care, hospital care, sheltered accommodation and safeguarding. Healthwatch have taken away the issues raised and are liaising with appropriate providers.

Dudley Adult Safeguarding, Quality Assurance - Healthwatch were invited to participate in Dudley Adult Safeguarding Board’s Multi-agency Audit in November. This involved scrutinising a number of cases to test the robustness of processes from start to finish and ensure the individual has been fully engaged at all times.

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This section of the report includes updates on proactive and reactive media activity and any other current issues.

Developing the New Care Model in Dudley- This work is a key priority for the team both in terms of raising awareness for Dudley as a Vanguard and in seeking the views of local people on the principles that our model is based on. Through our conversations with the public and other key stakeholders, we have identified four key requirements: • better communication both to patients and between staff; • improved access to consultation and diagnostics; • continuity of care in supporting the management of their long term condition(s); • effective coordination of care for the frail elderly and those with complex conditions.

Engagement to inform the model- There have been many conversations with the public to inform them of the model so far. This on-going engagement and involvement continues as we shape some of the specific work stream activity. We can assure Board that our engagement principles are being followed and that we are actively encouraging as many constructive conversations on the development of the model with the public.

The diagram below (and in appendix 2) describes the conversations so far.

Promotional Materials- A set of promotional materials have been agreed by the partnership and made available for use. There is a Statement of Intent, which has been signed up to by each organisation involved in developing the New Care Model along with a high level descriptor of the work we are doing.

These are aimed at a more professional audience such as other vanguard sites. We are now working on the public text.

Conferences & Presentations- We are committed to promoting our work and believe that we should share our learning as a Vanguard. We are frequently speaking at national events about the work here in Dudley.

Visits- As a Vanguard, Dudley is getting many requests for visits from national teams and other organisations. Since the last board meeting we have arranged the following visits.

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 Worcestershire Acute Hospitals NHS Trust visited one of our MDTs on 8 December 2015;  a Wolverhampton MP is coming to visit on 15th January 2016, to look at Integrated Health & Social Care in Dudley;  Thurrock CCG are holding a video-conference with us on 20th January 2016 to discuss our Integrated Community Teams;  Staffordshire & Stoke on Trent Partnership Trust are visiting us on 4th February 2016 to discuss our model and experience in order for them to implement MDTs in Staffordshire & Stoke on Trent.

Winter- We continue to support the national ‘Stay Well’ winter campaign along with our Do It Right Dudley! campaign as a local channel. We believe that Do It Right Dudley! provides a valuable opportunity for agencies to work together, to share the key messages about appropriate use of healthcare services. The road shows worked really well and will continue throughout 2016.

Artwork and toolkits are shared weekly by the national team and on the Office of Public Health website. These are being used to plan our local weekly activity.

Proactive and Reactive Media Activity- The table in appendix 1 gives a breakdown and hyperlinks to recent media activity for the CCG.

GP Members Event- The CCG held its last members event of 2015 at the Village Hotel on 10 December. Over 100 members attended to discuss the Long Term Conditions Framework.

This framework has been under development for the last 18 months after our members told us that they wanted better care for patients, reduced workload and to have a framework which had a strong evidence base for improved outcomes.

We presented back to them the work on this framework and there was an opportunity to ask questions. The membership team are proposing to finalise the indicators in January 2016 with a view to formally offering the contract in February 2016. This work is being overseen by the Primary Care Commissioning Committee.

Accessible Information Standard- All practices have been made aware of the new Accessible Information Standard and are working towards being compliant by the July 2016 deadline.

A new poster and an information request form have been designed in partnership with Practice Managers. All materials have been distributed to our 47 practices and are currently being displayed on the screens in patient waiting areas.

A plan was presented at the Primary Care Operational Group in November to inform them that the working group is set up to keep track on the progress of implementation in order to ensure all practices are equipped to be compliant by the deadline. We also attended the Dudley Practice Managers Alliance (DPMA) in December to give an update on the resources and interpretation services.

We will take a future paper back to Board and the DPMA to check and report on progress and identify any issues in implementation.

Patient Online- We have worked with all practices to ensure they are using and promoting Patient Online to patients. 7

We attended the DPMA in December to give an update on the resource pack from NHS England and to confirm the text for the patient application form. Practice Managers are happy with progress and resources supplied so far, they requested that photo ID is include on the application form to ensure access is given to the right person and this should also be available in different languages.

The national team have been working with Barclays to trial some of their Tea and Teach sessions focussing on Patient Online. Barclays in Dudley hosted the first one on 9 December however this did not generate much interest due to the lead time for promoting the sessions. No further local dates have been confirmed as yet.

Next steps for the CCG are to design the application form in a range of different languages, arrange a patient online event if required and promote this through local press and via our social media channels.

Laura Broster Head of Communications & Public Insight

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Appendix 1 Media Update- Nov/ Dec 2015

Title/weblink Summary Release Coverage (with links where available) Date

NHS England abandons Media Story 02.11.2015 Health Service Journal (HSJ) CSU procurement timetable Article

Top council earners Media Story 04.11.2015 Express & Star (All Main) pocketing over £1m Article

Come Together Over Media Story 05.11.2015 Health Service Journal (HSJ) Integration Article

HELP PROTECT YOUR Press Release 06.11.2015 CHILD FROM FLU – IT’S Release A SAFE AND PAINLESS NOSE SPRAY Dudley CCG Invites Public Press Release 06.11.2015 Release to attend Board Meeting… 37,000 patients use urgent Coverage of 10.11.2015 Dudley Chronicles care centre media enquiry Article Public Invite to Healthcare Press Release 12.11.2015 Forum Meeting Release

COMMISSIONING Media Story 12.11.2015 Health Service Journal (HSJ) SUPPORT Procurement dates relaxed following Article CCGs' apathy NHS England eases CSU deadlines Diabetic? Get your jab! It’s Press Release 13.11.2015 World Diabetes Day Release

Pregnant women are Coverage of 13.11.2015 Stourbridge & Dudley News urged to get protected media enquiry against flu Article

Somerset QOF alternative Media Enquiry 13.11.2015 Pulse – Caroline Price evaluation report Response

Public Invited to Dudley Press Release 13.11.2015 CCG’s Primary Care Release Commissioning Committee Meeting Change to shape future of Coverage of 16.11.2015 Dudley News, Stourbridge News, Halesowen News Dudley's health care Press Release Article

Public invite to health Coverage of 16.11.2015 Express and Star meeting Press Release Article

Patient Groups in Dudley Press Release 16.11.2015 are Promoting Self Care Release Week Practice Closures Media Enquiry 16.11.2015 Express & Star- David Cosgrove

Lower Gornal & Wordsley Response Green GP Practices in line for Coverage of 17.11.2015 Express & Star (Main) (Web) closure Media Enquiry Article 9

Attend healthcare forum to Coverage of 19.11.2015 Stourbridge News improve service issues Press Release Article

Wait times plummet after Coverage of 20.11.2015 Express & Star care unit opens Media Enquiry Article

Public Invited to Health Coverage of 20.11.2015 All Local Chronicles Meeting Press Release Article

Practice Closures Media Enquiry 23.11.2015 Stourbridge News – Louise Jew Lower Gornal, Wordsley Green & St Thomas’s Response

Three GP surgeries set to Coverage of 24.11.2015 Stourbridge News, Dudley News, Halesowen News be axed Media Enquiry Article

GP Federation Enquiry Media Enquiry 24.11.2015 Health Service Journal - HSJ - Nick Renaud- Komiya

Response

MAN FLU OR ACTUAL Press Release 24.11.2015 FLU? IT’S MOVEMBER! Release Local Team Attend Press Release 24.11.2015 Downing Street Reception Release

GP surgeries in West Coverage of 24.11.2015 Practice Business (Web) Midlands set to be axed Media Enquiry Article

Psychological therapy Media Story 24.11.2015 OnMedica.net (Web) outcomes vary vastly between CCGs Article

Wide variation in recovery Media Story 24.11.2015 Mental Health Today (Web) rates by those using psychological therapies Article across England #MEFESTIVAL Returns Press Release 25.11.2015 for Second Year Release

Concerns raised over the Coverage of 25.11.2015 Dudley News future of GP surgeries Media Enquiry Article

Reception with PM for Coverage of 26.11.2015 Express & Star caring NHS staff Press Release Article

GP practice facing closure Coverage of 27.11.2015 Stourbridge News Media Enquiry Article

Depression `postcode Media Story 27.11.2015 Health Insurance Daily lottery? revealed Article

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December 2015

Title/weblink Summary Release Coverage (with links where available) Date

Learn to Book GP Press Release 08.12.2015 Release Appointments Online at Tea and Teach Session West Midlands CCGs Media Story 08.12.2015 The Commissioning Review award five contracts worth #54 million Article

PLAN AHEAD FOR Press Release 09.12.2015 Release CHRISTMAS AND NEW YEAR PM reception for NHS Coverage of Press 10.12.2015 Local Chronicles staff Release Article

Public Invited to Dudley Press Release 14.12.2015 CCG’s Primary Care Release Commissioning Committee Meeting

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD

Date of Board: 7 January 2016 Report: Corporate Objectives Update Agenda item No: 7.1

TITLE OF REPORT: Corporate Objectives Update

To update the Board on the achievement of the CCG’s corporate PURPOSE OF REPORT: objectives.

AUTHOR OF REPORT: Mr M Hartland, Chief Operating and Finance Officer

MANAGEMENT LEAD: Mr P Maubach, Chief Executive Officer

CLINICAL LEAD: Dr D Hegarty, Chair

1. Update to Corporate Objectives agreed by Board in May 2015 2. The schedule is structured to map to the Corporate Objectives they are intended to deliver 3. Most updates relate to assurance provided to the Board via regular KEY POINTS: updates from Committees 4. The only significant deviations from plan relate to formulation of commissioning intentions and resulting contracting/provider options plus NHS England no longer requiring a business plan to be produced for Primary Care

RECOMMENDATION: 1. To receive the report for assurance 2. To note that a further update will be presented to the Board in March

FINANCIAL IMPLICATIONS: None

WHAT ENGAGEMENT HAS None TAKEN PLACE:

Decision ACTION REQUIRED: Approval  Assurance

1 | Page DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 7 JANUARY 2016 CORPORATE OBJECTIVES UPDATE

1.0 INTRODUCTION

1.1 At its meeting in May 2015 the Board approved the CCG’s Corporate Objectives for 2015/16 and was advised when it could expect to be asked to make strategic decisions and receive assurance throughout the year. Additionally the paper outlined the risk management approach to the delivery of these objectives.

1.2 The appendix listing the Corporate Objectives for 2015/16 now includes a summary update to provide assurance to the Board on the progress made to date.

1.3 The schedule has been structured to map to the ‘actions’ required by the Corporate Objectives they are intended to deliver, as described in the CCG’s 2015/16 Operational Plan, namely:

1. Reduce health inequalities 2. Deliver the best quality outcomes 3. Improve quality and safety 4. Secure system effectiveness

1.4 The CCG is assessing contractual options in relation to the New Model of Care with Monitor and the New Models team. The outcome of this will influence 2016/17 contracting round (and beyond), the CCG’s procurement strategy and outcome objectives.

2.0 DECISIONS REFERRED TO THE BOARD

2.1 None

3.0 RECOMMENDATION

3.1 The Board is requested to:

• Receive the report for assurance • Note that a further update will be presented to the Board in March

APPENDICES

Corporate Objectives 2015/16 – Update December 2015

Mr M Hartland Chief Operating and Finance Officer December 2015

2 | Page APPENDIX 1 Corporate Objectives 2015/16

Corporate Reporting to Deliverable / Action Committee Summary Update Objectives* Board Implementation of the CCG’s Clinical Development Included within Strategic Intent paper to September All Every Board 2015/16 operational plan (CDC) Board. Updates via CDC [Agenda 11.2] Implementation of the Vanguard Individual report to each Board from Partnership programme and the new models All Partnership Board Every Board Board with progress. [Agenda 7.4] of care Ensuring the public voice is Regular ‘Public Update’ to each Board. integral to the decisions of the 1, 2 and 4 CCG Board Every Board [Agenda 5.1-5.3] Board Individual report to each Board. [Agenda 11.3] Implementation of the Better Care Integrated Commissioning Implementation in line with expectations. 1 and 2 Every Board Fund arrangements Executive (ICE) Performance element underwriting agreed November Board subject to due diligence. Implementation of the CCG’s Primary Care Board updated via report from PCC Committee. 2 Every Board primary care strategy Commissioning (PCC) [Agenda 12.1] Board updated via report from Committee. Achievement of 2015/16 QIPP and Clinical Development [Agenda 11.2] 2 Every Board service line budgetary control (CDC) QIPP forecast to achieve in total but 2 significant schemes not on target although position improved. Board updated via report from Committee. Achievement of 2015/16 Primary Care 4 Every Board [Agenda 12.1] budgetary control in Primary Care Commissioning (PCC) PCCC delegated budget forecast to break-even. Ensuring appropriate contracts in Finance and Performance 2015/16 Report presented to July Board. All 15/16 contracts place for all commissioned 2 and 4 (F&P) contracts: July agreed & signed services Plan for 2016/17: Contractual framework for

2016/17 still under consideration Delivery of a robust financial plan Financial Board updated via report from Committee. Finance and Performance and compliance with financial 2 compliance: [Agenda 10.1] (F&P) duties Every Board 15/16 financial duties forecast to be achieved. Refresh Long- LTFM Jan 16: Allocations yet to be published. To term financial be presented February/March 2016 plan: January 2016/17 Budget Budget book Mar 16: in progress plan: March

3 | Page Corporate Reporting to Deliverable / Action Committee Summary Update Objectives* Board Board updated via report from Committee. Ensuring provider adherence to Finance and Performance [Agenda 10.1] 4 Every Board contract terms and performance (F&P) Contract mechanisms adhered to and penalties applied. Board updated via report from Committee. Ensuring provider adherence to [Agenda 8.1] appropriate quality and safety 3 Quality and Safety (Q&S) Every Board Robust CQRM’s with providers and active standards management of issues as arise. Board updated via report from Committee. [Agenda 12.1] Ensuring Primary Care provider Primary Care Committee receives assurance from Primary Care adherence to contract terms, 2, 3 and 4 Every Board Commissioning (PCC) Operational Group - no significant performance quality standards and performance issues or contractual breaches; new performance reporting tool developed. Board updated via report from Committee and Ensuring provider delivery of high 2 and 3 Quality and Safety (Q&S) Every Board ‘Public Voice’. [Agenda 5 & 8.1] quality patient experience Committee considers quarterly detailed reports. Board updated via report from Committee. Ensuring the effectiveness of our [Agenda 9.3] workforce through our HR policies 2 Remuneration Committee Every Board All policies updated for 15/16 and compliance, and procedures metric performance and appropriate actions managed by Committee. Board updated via report from Committee. Finance and Performance [Agenda 10.1 & 7.4] Implementation of our IT strategy 2 and 4 (F&P) – link to Every Board In progress to achieve objectives in 15/16, noting Partnership Board increasing IT agenda. Board updated via report from Committee. Finance and Performance Estate strategy for redesigning the [Agenda 10.1 & 7.4] 2 and 3 (F&P) – link to September estate and its use Health Infrastructure Strategy v1 presented to Partnership Board Board in September 2015 Finance and Performance Board updated via reports from Finance & (F&P) – link to Performance framework for the Performance Committee and Integrated 1, 2 and 4 Partnership Board & July BCF and new models of care Commissioning Executive. Integrated Commissioning [Agenda 10.1, 7.4 & 11.3] Exec (ICE)

4 | Page Corporate Reporting to Deliverable / Action Committee Summary Update Objectives* Board Framework in place and reporting to DMBC and CCG Committees. Detailed reporting at MDT level being trialled. Board updated via report from Committee. Plan for reinvestment of PMS Primary Care [Agenda 12.1] 1, 2 and 3 July resources Commissioning (PCC) To be incorporated into new Long Term Conditions Framework Refresh future outcome objectives Clinical Development 2 July based on JSNA (CDC) Refresh procurement strategy – Finance and Performance approach to cooperation vs 2 July (F&P) competition The CCG is assessing contractual options in Produce proposals for piloting Clinical Development Proposals for relation to the New Model of Care with Monitor and incentives for commissioning 2 and 3 (CDC) – link to Clinical consultation: the New Models team. The outcome of this will pathways of care Strategy Board September influence the 2016/17 contracting round, our Sign off for procurement strategy and outcome objectives. implementation: January Clinical Development 2016/17 Commissioning intentions All September (CDC) Clinical Development Medicines and Consumables 2 and 3 (CDC) – link to September To be reported to a future Partnership Board. whole system strategy Partnership Board Primary Care Primary Care Business plan 1 and 2 September Removed Commissioning (PCC) Proposals for Develop new LTC framework / GP Primary Care 1 and 2 consultation: Consultation commenced August 2015. contract for 2016/17 Commissioning (PCC) September Sign off for Sign off expected by January deadline in line with

implementation: April 2016 commencement. January Workforce development strategy Quality and Safety (Q&S) for a new competency-based 2 – link to Partnership November In progress workforce Board New 2-year operational plan and All CCG Board January In progress update to Strategy

5 | Page Corporate Objectives*

1) Reduce Health Inequalities 2) Deliver the best quality outcomes 3) Improve quality and safety 4) Secure System Effectiveness

* Corporate Objectives Taken from Operational Plan 2015/16 approved by Board in March 2015

6 | Page

DUDLEY CLINICAL COMMISSIONING GROUP BOARD

Date of Board: 7 January 2016 Report: Partnership Board Agenda item No: 7.4

TITLE OF REPORT: Update from Partnership Board

PURPOSE OF REPORT: To update the Board on the developments of the Partnership Board

Mrs Stephanie Cartwright AUTHOR OF REPORT: Head of Organisational Development and Human Resources

Mrs Stephanie Cartwright MANAGEMENT LEAD: Head of Organisational Development and Human Resources

Dr David Hegarty CLINICAL LEAD: Chair

• Since the last report the Partnership Board has met in November; and is due to meet again on 23 December • The Partnership Board includes representatives from all KEY POINTS: organisations involved in implementing the new model of care • The development of the new model of care in Dudley is receiving very positive national support

RECOMMENDATION: That the CCG Board notes the progress of the Partnership Board to date

FINANCIAL IMPLICATIONS: None

There is a specific workstream dedicated solely to communications and WHAT ENGAGEMENT HAS engagement on the new models of care that includes representation from TAKEN PLACE: all organisations involved.

Decision ACTION REQUIRED: Approval  Assurance

1 | Page DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 7 JANUARY 2016 PARTNERSHIP BOARD REPORT

INTRODUCTION

The Dudley New Model of Care Partnership Board includes representation from all organisations included in developing the Dudley multi-speciality community provider. These organisations are as follows:

• Dudley CCG (lead organisation) • Dudley Metropolitan Borough Council • Dudley Group Foundation NHS Trust • Dudley and Walsall Mental Health Partnership NHS Trust • Dudley Council for the Voluntary Sector • Black Country Partnership NHS Foundation Trust

REPORT

The Partnership Board meets on a monthly basis to review the progress of implementation of the new model of care. The Partnership Board has met once since the last report to the Board which was in November 2015. Another meeting of the Partnership Board is due to take place on 23rd December which will be after this paper to Board has been submitted. A Summit of the partnership organisations that are involved in the Partnership Board also took place on Monday 30th November 2015. An update from this Summit is included in this paper.

The November meeting of the Partnership Board included a detailed discussion on the workstreams forming part of the programme plan. Each workstream was discuss in detail and an update on the progress of each workstream was included. Concern was raised around mental health pathways and it was agreed than an additional workstream for mental health pathways would be established. It was also agreed that clinical representation from Dudley and Walsall Mental Health Partnership NHS Trust would be invited to attend the Clinical Strategy Group. It was also agreed that Childrens would be added as an additional workstream. The Risk Register was discussed and agreed that it needed updating by all workstream leads.

A detailed discussion was held on the Logic Model that has been developed for the Dudley vanguard and is being promoted nationally as an excellent model to follow. This model supports the evaluation of the new care model programme of work. The Partnership Board Dispute Resolution Process was discussed and taken to each partner organisation for approval. The communications update included an agreement that any partner consultation and listening events that will be commencing in January need to be consistent and complimentary of each other.

In addition to Partnership Board, a health and care economy Summit was held on 30th November at which all partner organisations were represented. A summary of agreed actions is shown below:

Output from the summit and next steps:

1. Key themes that came from the summit:

• Broad support for the model of care but more clarity needed on scope – which will come out of the mapping process; • A recognition that every organisation will need to change and contribute to the benefit of the population and wider system ; • A recognition that we will need to make different decisions on the prioritisation and distribution of resources (such as protecting and supporting the voluntary sector)

2. Actions and principles agreed at the summit:

2.1 The principles behind the mapping process that we are currently undertaking are as follows: 2 | Page

• We are firstly mapping services into groups, aligning them where they should be working to shared outcomes; • Subsequently determining which groups of services should be in the MCP, which might be part of a future risk-share arrangement, which are outside of scope but still part of the system as a whole; • We will look at cost as well as income in the mapping of those services.

2.2 The principles behind future workforce planning should be that:

• We produce a description of the position as we expect it, say 5 years from now; • The model of care (and future position), not organisations, should form the basis of future workforce plans; • We will use bottom-up development (such as the MDTs and Lion Health) as a proof of concept, with external evaluation from the strategy unit, to inform future planning;

2.3 There are some work-streams that either need more capacity or clearer progress reporting to the Partnership Board (eg: ensuring the estate group meets to review the wider estate issues);

2.4 Each organisation will take to the workforce group what they see are the ‘catastrophic’ ‘pinch- point’ workforces pressures and share their respective risk assessment accordingly

2.5 The Pathways work needs to go back to the Clinical Strategy Group to establish realistic expectations on opportunities for improvement;

2.6 We need to consider how the model relates to the wider public sector in the context of reducing public resource overall.

2.7 We agreed that 16/17 needs to be a year of stability to free up time to focus on how we implement the future arrangements:

• This is a key joint task for how we establish the 16/17 contracts; • We will need to take a collective view on use of resources, prioritisation of service changes, implementation of efficiency and QIPP across the system; • Shift 16/17 contracts to a risk-management based approach rather than activity-based (whilst still meeting key standards)

3. Value Proposition

The core of the proposition will remain as this is part of the golden thread relating to our original bid to the new care models team – although we will need to update some of the service components to take account of how areas have developed.

However a key issue that came out of the summit was the need for substantial additional capacity if we are to both make the changes we need successful and effectively manage the risks with this. The points made at the summit which relate to the need for this additional capacity can be themed into three groups. We agreed at the summit that we are going to adopt a collaborative rather than competitive approach so these are all areas where we should be working together:

It may be that some of these activities could be secured through the national support offer to Vanguards, rather than via the Value proposition. This will need to be tested out with the New Care Models Team before submission.

3.1 Additional management capacity to steer the programme. This includes:

• more robust oversight of each workstream, • distribution of leadership across the workstreams, • additional shared capacity for workforce planning • additional capacity on estate management/planning 3 | Page

3.2 External support to help develop the new contractual arrangements:

• Determining the scope of the MCP within our system focussing on materiality and aligning services to shared outcomes; • Specialist contractual support to help us build the new contract for 17/18 (and the impact for both commissioning and provision); • Additional clinical input to help build the desired quality and outcome measures; • Determining the extent of future risk sharing arrangements between the MCP and the CCG; • Ensuring a robust and fair process for establishing the contract.

3.3 External support to help develop the future organisational form for the MCP:

• Determining the preferred characteristics of the new organisational form; • Establishing the basis for determining the most suitable provider model; • Developing the future governance for the preferred provider model; • Undertaking the quality and organisational impact assessments on the proposed provider model and any consequential risk management arrangements needed.

4. Defining the characteristics of the MCP

It was agreed that it would be helpful to undertake some work on defining the characteristics of the MCP – as this will help inform the partnership on the potential future operating model and organisational forms that the MCP might take.

Consequently, since the last Partnership Board the following is being put in place:

4.1 A development workshop of the Health and Wellbeing Board will explore the progress of the Vanguard and how this should relate to the wider public sector agencies across Dudley. 4.2 A workshop with partners and other stakeholders is being organised in January (date to be confirmed) – to explore the key characteristics that will be most important to the MCP. 4.3 A series of public engagement events are being put in place (including community resilience forums) during January-February at which the expectations and interests of the public will be explored.

We anticipate bringing a report with recommendations that come out of these events to the March Partnership Board meeting.

CONCLUSION

The new model of care Partnership Board has been established with agreed representation from all partner organisations. Each organisation has responsibility (as stated within the Terms of Reference) to report back to their own organisations board through organisational governance arrangements. This report to Dudley CCG Board serves this purpose.

RECOMMENDATION

That the Board notes the progress of the Partnership Board to date.

Stephanie Cartwright Head of Organisational Development and Human Resources Vanguard Management Lead

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD

Date of Board: 7 January 2016 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

AUTHOR(S) OF REPORT: Ms Marcia Minott, Head of Quality & Safety / Dr Ruth Edwards

MANAGEMENT LEAD: Mrs Caroline Brunt, Chief Nurse

CLINICAL LEAD: Dr Ruth Edwards, Clinical Executive Lead for Quality

Report of the Quality & Safety Committee from meetings held on 17 November and 15 December 2015 KEY POINTS:

This report contains key updates on issues discussed by the Committee.

The Board is asked to:

RECOMMENDATION: Accept this report as a source of on-going 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

FINANCIAL IMPLICATIONS: None

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.

ACTION REQUIRED:  Assurance

1 | Page DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 7 JANUARY 2016 QUALITY & SAFETY COMMITTEE REPORT

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 November and December 2015.

1.2 The Governing Body will be briefed on any contemporaneous matters of consequence arising after submission of this report at its meeting.

2. KEY ISSUES DISCUSSED

2.1 Health Watch

2.1.1 The committee received a comprehensive report detailing findings of the Healthwatch review of the Dudley Urgent Care Centre (UCC) in July 2015. A number of recommendations were made regarding the provision and delivery of care to improve the patient and visitor experience. These included a focus on upgrading the UCC infrastructure and surroundings to ensure patients felt safe and comfortable.

2.2 Urgent Care Centre

2.2.1 The quality and safety team continue to focus on gaining assurance around workforce training and in particular achieving safeguarding mandatory training targets.

2.3 Primary Care

2.3.1 The committee received a presentation which outlined the quality team oversight of primary care. The presentation contained details of the component parts of a governance framework which together provides quality and safety assurances.

2.3.2 Reference was made to the limitations which impact on the delegated commissioning arrangements given there are currently no contractual levers in place to support the reporting of incidents to the commissioner.

2.3.3 The Primary Care Commissioning Committee (PCCC) received a report from the quality and safety lead for primary care offering assurance regarding key performance indicators; there are no material issues to report to the board.

2.4 NSL Update

2.4.1 The CCG continues to maintain oversight of this organisation through regular meetings and conference calls to monitor the remedial action plan in place to address performance issues.

2.5 Final Internal Audit Report on CCG Safeguarding Arrangements

2.5.1 A final report has been produced by Internal Audit regarding the CCG’s safeguarding arrangements. The report concluded that ‘significant assurance can be given on the design and operation of the system’s internal controls to prevent risks from impacting on achievement of the system’s objectives’. The CCG is meeting its statutory requirements for Safeguarding.

2.6 Safeguarding children and young people review process

2.6.1 The committee received a report outlining the current situation regarding safeguarding Serious Case Reviews (SCR) which are being undertaken within Dudley; it identified a number of

2 | Page themes and outlined the rigor associated with these complex reviews. The Dudley Designated Nurse is also working closely with the Dudley Safeguarding Children’s Board (DSCB) interim manager to ensure timely completion of case reviews which do not reach the threshold for a SCR.

2.7 Electronic Discharge Letters

2.7.1 The committee received a report regarding an audit undertaken on electronic hospital discharge letters. An audit of 100 letters randomly selected was carried out in October 2015. The findings provide evidence that 96% of letters were successfully sent and received. A review of the issues related to the remaining 4% is underway. Following a detailed discussion of the audit findings the committee agreed the current practice of sending paper versions of the electronic summaries was no longer required.

2.7.2 The audit highlighted procedural issues within primary care practices which are being addressed; members of the quality and safety team will continue to focus on the timeliness of summaries being received within primary care.

2.7.3 An audit in March 2016 will focus on the quality of information contained within discharge summaries.

2.8 Continuing Health Care; Previously Unassessed Period of Care (PUPOC) Cases

2.8.1 The committee received a report from the reablement manager regarding the progress of historical reviews requiring assessment; 281 local applications were received with the initial expectation that retrospective reviews would be completed by March 2015. NHS England, in discussion with continuing healthcare leads, has now set CCG trajectories to September 2016 with monthly reporting from August 2015. At the time of the report in November 2015, 19 cases remained outstanding and 5 new cases had been received for assessment.

2.9 Healthcare Associated Infections (HCAI)

2.9.1 The committee received the Healthcare Associated Scrutiny Report which outlines the current information available on HCAI trends at the Dudley Group Foundation Trust and across the Dudley CCG registered population. Incidents of Clostridium difficile continue to rise. Both Dudley CCG and the Acute Trust have breached the thresholds set.

2.9.2 Dudley CCG and the whole health economy are working on plans to manage Clostridium difficile and to prevent further cases of MRSA bacteraemia. Work is on-going to ensure all measures to manage HCAI incidents are in place.

2.9.3 A report was presented to the committee summarising a recent case of Diphtheria in Dudley. Care providers and other agencies were involved in contact tracing processes; screening patients, staff and where necessary relatives. ‘Vaccination UK’ was commissioned by NHS England to ensure that all those affected were appropriately treated.

2.9.3.1 The case has raised the profile of provider and system resilience to respond to similar future incidents; the quality and safety team continue to work closely with providers to learn the lessons from this incident and an update will be available to the committee in January 2016.

2.10 Never Events at DGFT

2.10.1 The Never Event reported by DGFT has been investigated and closed following identification of lessons learned.

3 | Page 2.11 Revised Serious Incident Policy

2.11.1 The committee reviewed the Serious Incident Policy which reflects all aspects of the Serious Incident Framework, updated in March 2015 by NHS England. The new version, which will be embedded locally, offers greater detail regarding incident management.

2.12 Risk Register

2.12.1 The committee reviewed the risk register and have requested that two new risks be added; managing aggressive and violent behaviour directed towards staff in primary care and Perinatal Mental Health. These risks will be included in the January 2016 risk register.

3. RECOMMENDATIONS

Board is asked to:

3.1 Accept this report as a source of on-going assurance that the CCG Quality & Safety Committee continues to maintain a rigorous oversight of all clinical quality standards in line with the CCG’s statutory duties.

Caroline Brunt Chief Nurse 21 December 2015

4 | Page

DUDLEY CLINICAL COMMISSIONING GROUP BOARD

Date of Board: 7 January 2016 Report: Audit Committee Report Agenda item No: 9.1

TITLE OF REPORT: Audit Committee Report

To advise the Board of the key issues discussed and agreed at the Audit PURPOSE OF REPORT: Committee meeting on 25 November 2015

AUTHOR OF REPORT: Mr M Hartland, Chief Operating and Finance Officer

Mr M Hartland, Chief Operating and Finance Officer MANAGEMENT LEAD: Mrs J Jasper, Chair – Audit Committee.

CLINICAL LEAD: Dr J Darby, Clinical Lead for Systems Redesign • IG Update received with IG Toolkit at a score of 53% • Combined BAF & Risk Register as at 6 November reviewed. Risks 72 and 78 approved for closure. Committee noted approval of risk 41 by the Board • Internal Audit Progress report and three audit reports with significant assurance received • Anti-Fraud update for 2015/16 received and Counter Fraud, Bribery and Corruption Policy approved KEY POINTS: • Evaluation of Consultants for the period to 31/03/15 considered and expenditure for the period 1 April-30 September 2015 received. • Update on CCG Policies received. Gifts & Hospitality, Standards for Business Conduct and Policy Development policies approved • Proposal for Auditor Panel considered • Internal Audit contract extended to 31 March 2016 • Other matters considered-Revised Terms of Reference; Financial Control Environment; CSU Service Auditor reporting 2015/16; Monitoring compliance with Prime Financial Policies The Board is asked to:

RECOMMENDATION: • Receive this report for assurance • Note the decisions taken under delegated powers

FINANCIAL IMPLICATIONS: None

WHAT ENGAGEMENT HAS None TAKEN PLACE:

Decision ACTION REQUIRED: Approval  Assurance

1 | Page DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 7 JANUARY 2016 AUDIT COMMITTEE REPORT

1.0 INTRODUCTION The report summarises the key issues discussed at the Audit Committee meeting on 25 November 2015.

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 Constitution submitted to NHSE in November for approval. Await formal approval. Scheme of Delegation To be reviewed following outcome of governance review Compliance with Prime Financial Policies No issues Board & Committee Effectiveness Governance action plan revised into themes and considered October Audit Committee. Report due to February Audit Committee. 2. Annual Report and Accounts 2014/15 Annual Report & Accounts approved and submitted by national deadline. AGM held. Annual Report and Accounts 2015/16 NHSE Workshop attended. Further workshops by HFMA and External Audit to be attended by finance and communications staff. 3. Operational & Risk Management Good Progress Anti-Fraud and Security Annual Report 2014/15 approved; 2015/16 Plan approved; revised Counter Fraud, Bribery and Corruption Policy approved; Updates received. Risk Management Arrangements – Combined BAF & BAF & Risk Register updated monthly Risk Register in place; Chairs/Management Leads of and actively managed. Risk appetite committees attending & updating Audit Committee; being considered following GGI review. Report newly commissioned services Procurement Strategy & reporting being updated to reflect new managing conflicts of interest guidance External Audit Unqualified opinion for 2014/15 Internal Audit Internal Audit Plan approved by March Committee. Audits progressing with significant assurance overall. - Other Policies 3 revised policies approved November 2015 - Other Policies – Business Continuity Policy Business Continuity Policy approved. Business Continuity Plan – Business Impact Assessment being moderated 4. Information Governance IG Support Officer started June 2015, based in CCG 2 days per week Information Governance Group established Meeting to be held once new IAOs & IAAs trained by IG Support Officer Compliance with Information Governance toolkit Work progressing with Toolkit, score at 53%. IG mandatory training at 61% Information Asset Management structure to be Additional IAAs identified. Training in established with IAOs and IAAs identified from CCG small groups underway. Progress in staff populating asset register slow. IG Policy 2015/16 Overarching IG Policy updated and approved. Freedom of Information requests (FOIs) All responded to within required timescale

2 | Page 3.0 ITEMS DISCUSSED – 25 NOVEMBER 2015

3.1 Information Governance (IG) The Committee received a bi-monthly IG Report providing an overview of progress against the IG Toolkit including the IG improvement plan; mandatory IG training; information risk management plan; IG spot checks; privacy impact assessments; Caldicott issues and data protection requests.

The Committee was informed that the current IG toolkit score was at 53% which was where the CCG was expected to be at this stage of the year, with a final score of 89% required to achieve compliance with the Toolkit. However mandatory training was only at 61% (target 95%) - an additional face to face training session would be arranged for January 2016 otherwise staff would be required to complete their training on line. The Committee was also advised about the limited progress in the logging of assets on the CCG’s Information Asset Register which represented 40% of the Toolkit. The Audit Committee were concerned about the lack of progress and asked that the matter be escalated through senior management and be included as a risk on the Risk Register.

IG spot checks had highlighted a number of areas for improvement.

The Committee received a report on FOI requests for the period 01/09/15 – 31/10/15 and noted that all 38 requests received in the period had been responded to within the required timeframe.

3.2 Board Assurance Framework and Risk Register The Committee received the Combined Board Assurance Framework (BAF) and Risk Register as at 6 November 2015 for assurance. The Committee noted changes to the residual scores for risks 67 and 79 and that the CCG Board had approved a recommendation directly from the Clinical Development Committee to close risk 41. The Committee approved the closure of risks 72 and 78. It agreed that Dr Darby should become the accountability sponsor and owner for the risks currently assigned to Dr Rathore.

A separate report to the Board based on the Board Assurance Framework (i.e. risks 16 and over) as at 7 December 2015 reflects these changes and provides further details.

3.3 Internal Audit The Committee received a report on progress against the internal plan and the position on the recommendation tracker. Currently there were only 10 recommendations not fully implemented, none of which were high risk.

Based on the work carried out to date, internal audit was predicting “significant assurance” overall for the Head of Internal Audit Opinion. No significant concerns or issues had been raised by the auditors.

The Committee received three 2015/16 audit reports for assurance - Safeguarding Arrangements; Continuing Health Care and Personal Health Budgets; Provider Contract Management and Assurance. All gave significant assurance overall.

3.4 Local Anti-Fraud The Committee received an Anti-Fraud update for 2015/16 for assurance. It was noted that CW Audit had introduced a process that identified the fraud risks that need to be considered by the CCGs and this would be used to form the planning tool for next year’s audit plan.

The Committee was updated on the National Fraud Initiative (NFI) matches identified via the 2014/15 scan for the CCG and were assured that there were no issues of fraud.

The Committee approved the revised Counter Fraud, Bribery and Corruption Policy under its delegated authority. A new format had been introduced to reflect NHS Protect standards.

3.5 Evaluation of Consultant Contracts The Committee considered the evaluation for the period 1 October 2014 – 31 March 2015 for assurance. It raised a number of issues and asked that it be involved in any future decisions to use one of the consultancies and that also the lead officer in all cases be asked if the work undertaken represented value for money.

3 | Page

The Committee received details of the consultancy expenditure for the period 1 April – 30 September 2015, although the evaluations were not included. It queried the level of expenditure on one consultancy and it was agreed that a separate report would be brought to the next meeting with the evaluations.

3.6 CCG and Audit Committee Policies The Committee received an update on the status of CCG Policies as at November 2015 for assurance. It was agreed that the control sheet would be circulated to management leads to update for their Committees for the February meeting. It was also agreed that the Primary Care Operational Group would be asked to identify potential policies.

The Committee also received and approved a number of revised policies for approval under its delegated authority. These were the Gifts and Hospitality Policy; Standards for Business Conduct Policy; and the Policy on Policy Development. The review had taken account of any changes to legislation and guidance appropriate to the policy.

3.7 Auditor Panels From 2017/18 onwards CCGs would be required to have an auditor panel to advise on the appointment of their external auditors. The appointment must be made by 31 December 2016 and therefore the auditor panel would need to be in place early in 2016.

The guidance indicated that existing Audit Committees could be nominated to act as the panel. The Audit Committee agreed that, in addition to the lay members, Ms Johnson, Mr Hartland and Dr Darby would join the panel, which was permissible within the guidance. A proposal for the establishment of the auditor panel and the process would be presented to the Audit Committee in February 2016 prior to submission to the Board.

3.8 Internal Auditor Tender The CCG’s contract with its current provider had expired on 1 April 2015 although it continued to obtain services from the auditors.

The Committee agreed to roll forward the contract with CW Audit Services under its delegated powers, which would also include the finalisation of the annual accounts in June 2016. This was on the basis that the Committee, external audit and the CCG finance team were satisfied with the services provided by CW Audit Services and that the auditors provided services which represented value for money.

3.9 Other Issues The Audit Committee considered and received updates and assurance in respect of: • Revised Terms of Reference for CCG Committees, noting that these needed to be further revised to take account of changes in the draft Constitution submitted to NHSE • Positive feedback on the Financial Control Environment Assessment by NHSE • CSU Year-end reporting in respect of service auditor reporting in 2015/16 • Monitoring compliance with Prime Financial Policies

4.0 DECISIONS TAKEN UNDER DELEGATED POWERS • Approval of the revised Counter Fraud, Bribery and Corruption Policy; the Gifts and Hospitality Policy; Standards for Business Conduct Policy; and the Policy on Policy Development. • Extension of the Internal Audit Contract to 31 March 2016

5.0 DECISIONS REFERRED TO THE BOARD • None

6.0 RECOMMENDATIONS The Board is asked to: • Receive this report for assurance and note the decisions taken under delegated powers

APPENDICES • None

4 | Page

Mr M Hartland Chief Operating and Finance Officer December 2015

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD

Date of Board: 7 January 2016 Report: Combined Board Assurance Framework and Risk Register Agenda item No: 9.2

TITLE OF REPORT: Combined Board Assurance Framework and Risk Register

To update the Board on the combined Board Assurance Framework PURPOSE OF REPORT: (BAF) and Risk Register and present it as at 7 December 2015

AUTHOR OF REPORT: Mr M Hartland, Chief Operating and Finance Officer

MANAGEMENT LEAD: Mr M Hartland, Chief Operating and Finance Officer

CLINICAL LEAD: Dr D Hegarty, Chair

• Update on combined BAF & Risk Register KEY POINTS: • Summary of risks as at 7 December 2015 presented • Details provided of changes made since 6 November 2015

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 – 7 JANUARY 2016 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 7 December 2015.

The Audit Committee considered the overall combined BAF and Risk Register as at 6 November at its meeting on 25 November 2015.

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 are also summarised in the table below.

Initial Residual Accountable Risks 16 or higher as at 6 November 2015 Risk Risk Committee 6. Failure of a main provider (Dudley Group NHS FT) 20 20 Finance & due to financial pressures will result in inadequate Performance care for the 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 Development impact commissioning and delivery of health services. 17. Tensions between innovation, quality and financial 16 12 Clinical pressures could limit the innovation shown by the Development CCG 19. Failure to ensure meaningful public engagement 16 8 Clinical including with the Health Overview and Scrutiny Development Committee will prevent effective commissioning and patient centred services 34. The impact of significant individual performance 16 6 Primary Care issues in relation to primary medical services that Commissioning could result in removal of GP member from the Performers' List 36. Failure to achieve whole of Quality Premium 16 16 Clinical resulting in lost income and reputational damage. Development 43. Failure to deliver significant QIPP targets in 15/16 25 12 Finance & puts the future financial stability of the CCG at risk. Down Performance from 20 48. Failure of Black Country Partnership FT due to 20 15 Finance & financial pressures will result in inadequate care for Performance the local population. 58. The JAC electronic system is not operating 20 12 Quality & Safety efficiently 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, inaccurate. 71. DGFT CIP PROGRAMME 2015/16 is challenging - 16 12 Quality & Safety the plan includes the removal of up to 200 posts from its workforce (in addition to the 200 removed in 2014/15) - this could have significant impact on the quality of services.

2 | Page Initial Residual Accountable Risks 16 or higher as at 6 November 2015 Risk Risk Committee 75. NURSING REVALIDATION - The Nursing and 16 12 Quality & Safety Midwifery Council covering all registrants across England, Scotland, Northern Ireland and Wales intend to introduce nursing and midwifery revalidation from 1 April 2016. This is a three year process and more onerous than current practice requirements - many nurses are stating their intention to take early retirement rather than go through the process. For the CCG there is particular concern about the resilience of practice nurse workforce particularly given the age profile of the current nurses working in Dudley. 77. Failure to realise financial savings outlined in the 16 9 Clinical value proposition because the MCP care model is Development not implemented. 82. HEALTH VISITOR TRANISTION FROM 16 16 Quality & Safety REGISTRANT TO RESIDENT POPULATION i.e. transfer of children in the care of a Health Visitor (HV) from being with a GP to where they live (their home address) - this creates risk regarding the number of children whose health visitor will change (700 out and 1200 in). The risk is that there are robust processes in place to transfer care and records out of borough but this is not replicated for those children transferring into the borough, particularly the transfer of their records. This is is also a safeguarding concern as children could be 'lost' to the HV service. 83. Provider of non-emergency patient transport 20 15 Quality & Safety commissioned by the CCG is unable to deliver the quality KPI's in the contract and have given notice on the contract. 84. Failure to identify and deliver significant QIPP 25 20 Finance & savings targets in 16/17 puts the future financial Performance stability of the CCG at risk. 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 6 November at its meeting on 25 November 2015: Review & Updates – Updates were received from the leads for the Finance & Performance and Quality & Safety Committees. The leads for the Clinical Development; Primary Care Commissioning and Remuneration Committees reported no changes.

3.1 Risk Description, related controls, assurances, actions and comments

Risk 58: The timescale against this risk has been amended to January 2016 to reflect when the results of an audit of the JAC electronic system should be completed.

Risk 71: The timescale against this risk has been amended to January 2016 for further updates to the Quality and Safety Committee through Clinical Quality Review Meetings (CQRM) and Collaborative Leadership Team (CLT) meetings.

Risk 75: The timescale against this risk has been amended to April 2016 to reflect when revalidation sessions for CCG and Practice nurses will have been facilitated and preparation materials shared with them.

3 | Page 3.2 Changes to the Residual Risk Scores

Risk 43: As sufficient additional QIPP schemes for 2015/16 have been identified and through robust management are on track for delivery, the residual impact has been revised to reduce the residual risk from 16 to 12.

3.3 New Risks

Risk 84: The level of QIPP savings required in 2016/17 is significant and this challenge puts the future financial stability of the CCG at risk. Although the CCG has robust control processes in place and a record of delivery, the Finance & Performance Committee believes this risk needs to be recognised. It was given an initial score of 25, with a residual score of 20 to recognise the controls that are already in place. The actions to reduce the level of risk are focused on robust Project Initiation Documents (PIDs) for new schemes.

3.4 Risks Proposed for Closure

There were no risks proposed for closure that had an initial score of 16 or over.

4.0 RECOMMENDATIONS

4.1 The Board is asked to receive the report for assurance.

5.0 APPENDICES Appendix 1 – Combined BAF & Risk Register as at 7 December 2015 (risks 16 and over)

M Hartland Chief Operating and Finance Officer December 2015

4 | Page Dudley CCG Combined Board Assurance Framework and Corporate Risk Register 2015/16 07-Dec-15 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 Date Last Update Risk Description Accountable Accountability Management Lead P I Initial Risk Key Controls Gaps in Control Gaps in Assurance (R) P (R) I Residual Risk Trend Internal Assurances External Assurances Actions Timescales COMMENTS Committee Sponsor & Owner Score What controls/systems are in Where are we failing to put Where are we failing to gain Risk Score Board Reports, Internal and External To improve Date action will (PxI) place to assist in securing controls/ systems in place. / evidence that our controls/ (PxI) Minutes of meetings Audit Reports, CQC control, ensure be completed Score delivery of our Where are we failing in systems, on which we place Score Reports delivery of before any objective. Such as strategies, making them effective. For reliance, are effective. Such as following principal controls policies and procedures example lack of training or no no assurance a strategy or controls put objectives, gain

ABOVE) are in regular review of policy is effective in place assurance place. performance OBJECTIVE (SEE KEY LINK TO CORPORATE

Reports to F&P & Q&S, Board reports - minutes Ensure contracts of CRM and QRM AT review, Monitor are compliant with Robust contract management via Failure of a main provider (Dudley meetings. Performance financial rating-under PbR contract review meetings, Group NHS FT) due to financial report across a range of formal review due to Committee has confirmed the risk performance management, joint pressures will result in inadequate KPIs. Monthly meetings deficit position in financial Review of health continues to exist and is strategic planning. Financial Plan care for the local population (note: Review of methods to mitigate between CCG and DG plans, Internal Audit economy financial discussed at each F&P and contracts agreed with 6 01/05/2013 28/05/2015 2 this accounts for legacy risk brought F&P Dr Jonathan Darby Matt Hartland 4 5 20 financial risk to provider and 5 4 20 FT Senior Manager review. Regular CLT position On-going committee. providers. Financial Assurance = forward from Cluster regarding failure CCG. Teams now being held. meetings KPIs reported to Board. Joint to manage demand, creating financial Board to Board Formation and Financial Modelling Increased uncertainty on DGFT monthly payment reconciliation pressures within the local health (including lay member representation of CCG of vanguard financial position. process including validation of system) only) meetings being and DGFT on Vanguard programme activity. held. Monthly finance Partnership Board meetings between both Incentivise Quality organisations.

1.Develop and QIPP plan and implementation. implement service Joint approach to QIPP improvement development with Dudley Group. development plans Service Improvement Delivery with JHWS External Plans in place with providers. peer plans with all Collaborative Leadership Teams - providers.. DGFT and DWMHPT Health and 2. Health and Social Social Care Leadership Group. Care Leadership BCF Section 75 Agreement. QIPP reporting to CDC Internal and external audit Group to be Failure of the health economy and and governing body. reviews responsible for social care to engage and work Development of Commissioning Regular updates to CCG major system together to implement service Dr Steve Mann / To be Plan subject to endorsement by governing body on wider 10 01/05/2013 22/04/2015 2 CDC Neill Bucktin 4 4 16 None 4 3 12 Report to Board on CCG Review of Performance change: On-going Partnership Board established. changes which will adversely impact updated Health and Wellbeing Board. stakeholder engagement as = contribution to HWB with Health and - Urgent Care commissioning and delivery of health Series of joint strategies beneath appropriate activity. CCG Wellbeing Board, Internal - Service Integration services. JSNA overseen by Partnership compliance with JHWS Audit review 3. Reporting Bodies/Boards BCF Section 75 mechanism on Agreement. Better Care Fund implementation to Memorandum of Understanding be agreed. with Public Health, membership of 4. Reports to be H&W Board, contribution to JSNA made to CDC along with Outcome Commissioning intentions, Change Ambitions and Meetings with providers Better Care Fund.

£200k to be invested in innovation Significant Tensions between innovation, quality pilots for 2013-14. Innovation bid innovation 17 01/05/2013 22/04/2015 2 and financial pressures could limit CDC Dr Jonathan Darby Neill Bucktin 4 4 16 4 3 12 reports to CDC On-going process to be handled through = programme in the innovation shown by the CCG localities Operational Plan.

Establish revised Communications & Engagement business case Strategy process. Ensure Health Care Forum clear exposition of Individual Service User Groups, engagement Report to Business case process, Compact process is followed Commissioning Health Watch, Overview Failure to ensure meaningful public with local community, Relationship before The Business Case Business cases / service Development Committee & Scrutiny Committee engagement including with the Health with Overview & Scrutiny Reporting on proper engagement recommendations documentation includes a change proposals need to through business cases, 19 01/05/2013 22/04/2015 2 Overview and Scrutiny Committee will CDC Dr Steve Mann Neill Bucktin/Laura Broster 4 4 16 Committee. Regular attendance at through the business case 2 4 8 to Board through the Jan-16 requirement to identify what identify that appropriate = assurance that Minutes of OSC, prevent effective commissioning and OSC meetings by the Clinical process revised business engagement procersses have engagement has taken place engagement is taking newspaper coverage from patient centred services Chair; CCG participation in agenda case process input taken place place to Comms & meetings setting meetings into governance Engagement Committee. Additional control- Engagement review to check Manager to attend CDC to pick up committee engagement issues that fall outside responsibility for of the business case process. engagement taking place.

GP / Nurse GP Contracts / Appraisals Primary Care Group Mentoring The impact of significant individual Peer Review Audit reporting into Primary Commissioning of performance issues in relation to Training and Education GMC Registration Care Commissioning Services for Primary 34 22/04/2013 05/10/2015 2 primary medical services that could PCC Steve Wellings Dan King 4 4 16 GMC Registration None identified. None identified 2 3 6 Two way communication On-going = Committee and Quality Care result in removal of GP member from GP under performance referred to between the CCG PCOG and Safety Committee GP Education, the Performers' List the NHS England Professional & and the PIGG at NHS training and Practice Information Gathering England Development Group (PIGG)

Regular report on Plans for local targets mostly in actions and Failure to achieve whole of Quality place and on track, but still Quality Premia performance to Original risk no longer remains, Successful plans for domain 1 36 16/05/2013 22/04/2015 3 Premium resulting in lost income and CDC Neill Bucktin Neill Bucktin 4 4 16 significant risk of not achieving None 4 4 16 achievement reporting to None CDC linked to Nov-15 however, risk renewed in respect and 5 need to be put in place = reputational damage. national domains 1 and 5 (PYLL CDC and governing body Outcome Ambitions of current year's performance and HCAI) and Better Care Fund. ID Original Date Last Update Risk Description Accountable Accountability Management Lead P I Initial Risk Key Controls Gaps in Control Gaps in Assurance (R) P (R) I Residual Risk Trend Internal Assurances External Assurances Actions Timescales COMMENTS Committee Sponsor & Owner Score What controls/systems are in Where are we failing to put Where are we failing to gain Risk Score Board Reports, Internal and External To improve Date action will (PxI) place to assist in securing controls/ systems in place. / evidence that our controls/ (PxI) Minutes of meetings Audit Reports, CQC control, ensure be completed Score delivery of our Where are we failing in systems, on which we place Score Reports delivery of before any objective. Such as strategies, making them effective. For reliance, are effective. Such as following principal controls policies and procedures example lack of training or no no assurance a strategy or controls put objectives, gain

ABOVE) are in regular review of policy is effective in place assurance place. performance OBJECTIVE (SEE KEY LINK TO CORPORATE

QIPP challenge process; F&P Committee oversight; internal audit reviews. Gap in 2014/15 was covered non recurrently. The QIPP target for 2015/16 has been reduced and The QIPP challenge process is Final QIPP plan has proposals for new robust and the CCG has a history been agreed. schemes have been of delivery. The process was agreed by CDC. enhanced in 14/15 with project Additional QIPP plans required for schemes; schemes to be Challenge meetings with monthly challenge meetings; and identified by the commissioners actions creation of a QIPP reserve. The Reports to NHS England. commissioning Failure to deliver significant QIPP are logged. revised process reflects internal team. 43 05/12/2013 07/12/2015 2 targets in 15/16 puts the future F&P Dr Jonathan Darby Matt Hartland 5 5 25 None identified. None identified 3 4 12  Additional Schemes No further plans have been audit recommendations. QIPP Forms part of internal Commissioners to Nov-15 Mar-16 financial stability of the CCG at risk. have been identified developed at present challenge days focus on the entire audit process review. deliver against which includes care commissioners portfolio including existing QIPP home and elective performance and financial schemes. QIP pathways elements. They are attended by delivery to CDC through the new the CO&FO and Head of monitored against financial framework are commissioning and meetings plan until the end of taking a more active role actions are fully minuted. the year. in QIPP delivery. Responsibility for developing QIPP schemes for 16/17 for MCP, Primary Care & Elective Pathways is given to the 'Teams without walls' CCG CAO has met the Contract Review FT CE and agreed a number of actions to Review of health ensure the CCG economy financial receives regular updates position Failure of Black Country Partnership and assurance. FT due to financial pressures will Performance management. CQRM The LTFM across the Monitor action plan and 48 05/06/2014 28/05/2015 2 F&P Dr Jonathan Darby Matt Hartland 4 5 20 Not determined at this stage. Not determined at this stage. 3 5 15 Financial Modelling On-going result in inadequate care for the local to monitor quality. = Dudley Health Economy oversight. of vanguard population. has been reviewed and programme presented to local providers. Incentivise quality BCP is a member of the partnership board

1. Review of current process is on-going. 2. Oversee The JAC electronic system is not administrative Electronic discharge letters were Medicines management operating efficiently which has Electronic letters are no longer arrangements put in re-instated in July 2015. The Patients with inaccurate detail team continues to monitor resulted in an unspecified number of sent out to patients or GPs. place by Provider. situation will be closely monitored relating to prescribing not yet high risk medicines; Discharge Letters not being received Patients are being provided with Awaiting a fully and quality checked. A paper copy identified. Provider to carry out DGH FT have placed on by GPs. This risk affects patients paper copies of discharge details Escalated to trust risk templated letter to is also given to the patient to share 58 07/10/2014 06/11/2015 3 Q&S Dr Ruth Edwards Trisha Curran 4 5 20 retrospective review. CCG and 4 3 12 their Risk Register and returning to primary care following and medication to share with GPs = register reduce risk. JAC to with their GP. The paper copy will provider taking part in reviewing risk monitored through Jan-16 changes in treatment medication. to support treatment. Letters are be switched on continue until the electronic the changes to the use of interim Board. Detail to medication changes additionally being sent to GPs by once 8,500 open system has been audited for system. Manual sign-off remains following review, in some cases, post episodes are further assurance - this should be in place. inaccurate. closed. In May 2016 completed by December 2015. JAC should be able to deliver on electronic double signing.

Board reports to Q&SC DGFT CIP PROGRAMME 2015/16 is Challenge through Quality oversight is through the challenging - the plan includes the Collaborative Leadership monthly CQRM and which removal of up to 200 posts from its Assurance that QIA process is Evidence of the process in Team meetings and Monitor reports concerns are flagged in addition to 71 14/07/2015 06/11/2015 3 workforce (in addition to the 200 Q&S Dr Ruth Edwards Trisha Curran 4 4 16 4 3 12 embedded at the Trust action at the Trust = Board to Boards . Quality CQC reports the monthly Collaborative removed in 2014/15) - this could have Jan-16 oversight is maintained Leadership Team meetings significant impact on the quality of through the monthly between the provider and the services. Clinical Quality Review CCG. Meetings.

Support for all staff going through the revalidation process. NURSING REVALIDATION - The Close links with regional and Revalidation Nursing and Midwifery Council national revalidation boards. Board reports briefings and covering all registrants across Support from the CCG Chief Nurse Q&SC reports regular updates England, Scotland, Northern Ireland for all registrants going through the PCCC reports provided by the and Wales intend to introduce revalidation process. Updates at professional CCG Chief Nurse. nursing and midwifery revalidation fro Revalidation briefings and regular nurses forum Explore the use and 1 April 2016. This is a three year updates provided by the CCG Chief Revalidation sessions for deployment of an process and more onerous than Reports to national board 75 14/07/2015 06/11/2015 3 Q&S Dr Ruth Edwards Trisha Curran 4 4 16 Nurse. Workforce planning is weak. 4 3 12 CCG nurses and electronic tool to Apr-16 A further update will be provided in current practice requirements - many = at NHSE and NMC Explore the use and deployment of Practice Nurses have support portfolio November 2015. nurses are stating their intention to an electronic tool to support been facilitated by the management for take early retirement rather than go portfolio Ensure CCG Chief Nurse. practice nurses - through the process. For the CCG practice nurses are included in the Preparation materials CCG nurses can there is particular concern about the workforce planning work-stream to have been shared with use ESR. resilience of practice nurse workforce support future resilience. all nurses. Ensure practice particularly given the age profile of the Management for practice nurses. nurses are included current nurse working in Dudley. in the workforce planning work- stream to support future resilience. ID Original Date Last Update Risk Description Accountable Accountability Management Lead P I Initial Risk Key Controls Gaps in Control Gaps in Assurance (R) P (R) I Residual Risk Trend Internal Assurances External Assurances Actions Timescales COMMENTS Committee Sponsor & Owner Score What controls/systems are in Where are we failing to put Where are we failing to gain Risk Score Board Reports, Internal and External To improve Date action will (PxI) place to assist in securing controls/ systems in place. / evidence that our controls/ (PxI) Minutes of meetings Audit Reports, CQC control, ensure be completed Score delivery of our Where are we failing in systems, on which we place Score Reports delivery of before any objective. Such as strategies, making them effective. For reliance, are effective. Such as following principal controls policies and procedures example lack of training or no no assurance a strategy or controls put objectives, gain

ABOVE) are in regular review of policy is effective in place assurance place. performance OBJECTIVE (SEE KEY LINK TO CORPORATE

Failure to realise financial savings Accountability framework including Confirmation of external Approval of the outlined in the value proposition Performance Monitoring 77 22/07/2015 22/07/2015 1, 2, 3, 4 CDC Dr Steve Mann Neil Bucktin 4 4 16 its Terms of Reference agreed by None performance management 3 3 9 Reports to Board economic case because the MCP care model is not = NCM Team Dec-15 Partnership Board arrangements across the Local implemented. Health Economy HEALTH VISITOR TRANISTION The HV Supervisor FROM REGISTRANT TO RESIDENT at BCPT has put in POPULATION i.e. transfer of children place robust in the care of a Health Visitor (HV) processes to from being with a GP to where they transfer care live (their home address) - this records out to the creates risk regarding the number of LA of residence. children whose health visitor will Reports from NHSE and The supervisor is The risk is that there are robust change (700 out and 1200 in). The LA regarding transition trying to establish processes in place to transfer care risk is that there are robust processes from registered to processes with and records out of borough but The Dudley HV Supervisor has set in place to transfer care and records resident situation i.e. other LA's to ensure this is not replicated for those up exemplary processes to Board reports out of borough but this is not Lack of records / processes Lack of records / processes from transfer of children in the paper records for children transferring into the manage the transfers in and out of Q&SC reports 82 05/10/2015 05/10/2015 3 replicated for those children Q&S Dr Ruth Edwards Trisha Curran 4 4 16 from other CCGs transferring other CCGs transferring children 4 4 16 care of a HV from being those transferring in Nov-15 borough, particularly the transfer the borough and is in close liaison = PCCC reports transferring into the borough, children into Dudley into Dudley with a GP to their home are received. It of their records. This is also a with colleagues in other LA areas. CQRM meetings particularly the transfer of their address. cannot be safeguarding concern. The All HV teams are fully briefed. records. This is also a safeguarding established at this situation is being tracked by the concern as children could be 'lost' to This risk is also on the LA stage how long it Chief Nurse and reported to the the HV service. risk register. will take to be Q&SC. An update will be provided assured that Dudley to the November 2015 Q&SC. Borough has received all the names and care records of children transferring into the borough. Re-Procurement of CQRM meetings with the the service Provider of non-emergency patient provider at which CQRM meetings with the transport commissioned by the CCG complaints received from NEW RISK FROM NOVEMBER Terms of the Contact between the Potential gap in robustness of provider at which Reviewing finance 83 06/11/2015 06/11/2015 3 is unable to deliver the quality KPI's in Q&S Dr Ruth Edwards Trisha Curran 5 4 20 None 5 3 15 all sources. Dec-15 2015. Update to be given in provider and commissioner the procurement process = complaints received and activity the contract and has given 12 months Discussions with Co- December 2015. from all sources. elements of any notice on the contract. Commissioner about its future procurement Monitoring Processes process The QIPP challenge process is robust and the CCG has a history of delivery. Internal audit recommendations have been Monthly QIPP challenge reflected in the processes and process. Challenge QIPP challenge days focus on the meetings with entire commissioner portfolio commissioners actions Failure to identify and deliver Identification and which includes both financial and are logged. F&P Reports to NHS England. significant QIPP savings targets in sign off of robust 84 07/12/2015 07/12/2015 3 F&P Dr Jonathan Darby Matt Hartland 5 5 25 performance elements. Greater None None identified 4 5 20 committee oversight. Forms part of internal Feb-16 16/17 puts the future financial stability NEW PID’s and schemes accountability is placed on the Internal audit reviews. audit process reviews of the CCG at risk. for 16/17. commissioner to ensure delivery CDC through the new following the new financial financial framework take framework. Meeting actions are an active role in QIPP fully minuted and are attended by delivery. the head of financial management – commissioning and head of commissioning.

DUDLEY CLINICAL COMMISSIONING GROUP BOARD

Date of Board: 7 January 2016 Report: Remuneration Committee Report Agenda item No: 9.3

TITLE OF REPORT: Remuneration Committee Report

To provide assurance to the Board regarding key issues discussed and PURPOSE OF REPORT: approved by the Remuneration Committee held on 3 and 10 December 2015.

Mrs S Cartwright, Head of Organisational Development and Human AUTHOR OF REPORT: Resources

Mrs S Cartwright, Head of Organisational Development and Human MANAGEMENT LEAD: Resources

CLINICAL LEAD/LAY MEMBER: Mr S Wellings, Lay Member for Governance

• Office holder contracts consultation update • Confidential staff issues discussed • Office Holder Mandatory Training KEY POINTS: • Statutory Exit Payments Cap • Staff side representation • Special payment request • Workforce report

RECOMMENDATION: The Board to note the report for assurance

FINANCIAL IMPLICATIONS: Within financial plan

WHAT ENGAGEMENT HAS n/a TAKEN PLACE: Decision ACTION REQUIRED: Approval  Assurance

1 | Page DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 12 NOVEMBER 2015 REMUNERATION COMMITTEE REPORT

1.0 INTRODUCTION

1.1 This report provides assurance to the Board with regard to key issues discussed and approved by the Remuneration Committee on 3rd December 2015. The following items are a description 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.

1.2 Due to the nature of the Committee, there is not a set of key indicators to report to Board.

2.0 ITEMS DISCUSSED

2.1 HR/Workforce Metrics

The Committee receives regular updates on HR and workforce metrics applicable to the CCG. This includes analysis of vacancies, banding/skill-mix ratios, sickness, Personal Development Review completion and mandatory training compliance.

Highlights to report to the Board include that the level of sickness absence has risen again and is above the 3% national guideline. Reasons for this increase are three members of staff who are currently on long term sick leave. We are continuing to support these staff as well as the staff who have had prolonged sickness issues. Compliance with mandatory training requirements has improved significantly over the last quarter; however we strive for 100% completeness and this is managed through line managers. Compliance with Personal Development Review compliance is lower than expected however this is due to recording issues on our ESR system, not that the Personal Development Reviews have not taken place. The recording issue continues to be addressed by the senior management team.

2.2 Office Holder Contracts

Feedback was given to the Committee on the outcome of the consultation which resulted in new clinical leads expressing a desire to move to an employment contract whilst clinical leaders who have been in post longer expressed an interested in continuing on the office holder contract. After detailed discussion the following was agreed:

• Elected GPs will move to a revised Office Holder contract. • Appointed GPs will move on to an employment contract. • Existing appointed GPs will move across to an employment contract once they have completed their term and if they are reappointed. New appointments will automatically commence on an employment contract. • Lay members will move to a revised Office Holder contract. • The Chairman will move to a revised Office Holder contract.

All individuals affected will be written to outlining the decision that has been made.

2.3 Staff Side Representation

Joe Cahill was welcomed to his first Remuneration Committee as staff side representative.. Mr Cahill is undertaking a period of training with Unison.

2.5 Confidential Staff Issues

The Committee received an update on two independent confidential staff issues, and took relevant appropriate action.

2 | Page 2.7 Office Holder Mandatory Training

The mandatory training needed to be undertaken by Office Holders was discussed and agreed. Where possible, mandatory training for Office Holders will be built into Board Development sessions during 2016.

2.8 Statutory Exit Payments Cap

The committee discussed the agreement by the government to cap exit payments to staff at no more than £95,000. Those staff affected by this decision have been informed.

2.9 Special Payment Request

The Committee considered at length a special payment request from a member of staff who is due to enter into half pay from the end of December as they have been off sick for a period of six months. A special payment enables the CCG to offer additional payment if an individual meets a predetermined set of criteria. Following a lengthy debate the Committee asked for further legal advice and agreed to hold an extra-ordinary meeting of the Remuneration Committee on 10 December to specifically consider the additional advice that had been received. The Committee met on 10 December and decided that this particular case did not warrant a special payment as the circumstances involved do not meet the majority of criteria required.

3.0 RECOMMENDATION

The Board to note the report for assurance.

Mrs S Cartwright Head of Organisational Development and Human Resources December 2015

3 | Page

DUDLEY CLINICAL COMMISSIONING GROUP BOARD

Date of Board: 7 January 2016 Report: Finance and Performance Committee Report Agenda item No: 10.1

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 26 November 2015 and 17 December 2015.

AUTHOR OF REPORT: Mr M Hartland, Chief Operating and Finance Officer

MANAGEMENT LEAD: Mr M Hartland, Chief Operating and Finance Officer

CLINICAL LEAD: Dr J Darby, Clinical Lead for Systems Redesign • The CCG expects to meet all financial duties in 2015/16 • The CCG is reporting a year to date underspend of £5,483,000 and expects to achieve its year end control total of £6,337,000 as agreed with the NHS England • All NHS England financial assurance indicators are being achieved to date • All NHS Constitution aggregate standards are being achieved KEY POINTS: with the exception of 6 weeks Diagnostics (97.91% against target of 99%), MRSA and C.Diff • Under delegated authority from the Board the Committee approved the award of CSU contracts for Lot 1 – end to end services to Arden and GEM CSU, Lot 1 – business intelligence to Midlands and Lancashire CSU and Lot 2B – individual funding requests to Arden and GEM CSU from 1 April 2016 The Board is asked: (i) to receive the report for assurance (ii) to endorse the action taken by the Committee, under RECOMMENDATION: delegated authority from the CCG Board, to approve the award of CSU contracts from 1 April 2016, as detailed in the report. FINANCIAL IMPLICATIONS: As outlined in report and key points above

WHAT ENGAGEMENT HAS None TAKEN PLACE:

Decision ACTION REQUIRED: Approval  Assurance

1 | Page DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 7 JANUARY 2016 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 26 November 2015 and 17 December 2015.

This report has been revised to provide an overall assurance position for all finance and performance key performance indicators. The report to the Board presents the new financial governance framework where responsibility and accountability has been delegated to Committees, commissioners and budget holders for their portfolios of work.

In line with the framework, the report identifies the Committees responsible for finance and performance metrics. The overall financial position and QIPP are also reported in this format. Responsible Committees will report on any material variances in relevance to their portfolios and individual reports to Board.

2.0 KEY INDICATOR SUMMARY

The table below identifies the CCG’s performance against key financial and performance indicators for 2015/16 to date. This represents November performance. It is followed by exception reporting and an explanation of key issues where required. The data is sourced from published data and not as indicators which have been published nationally.

2 | Page

3.0 STATUTORY FINANCIAL DUTIES

The Committee heard that the CCG had an annual budget at November 2015 of £447,295,000. This reflected the notified allocation from NHS England and CCG anticipated allocations. At this point in time, the CCG is underspent by £5,483,000 and is forecast to achieve a surplus on its Revenue Resource Limit of £6,337,000 in line with our financial plan.

Capital budgets, and the CCG’s programme and administration expenditure targets are expected to breakeven, and the cash limit is expected to be achieved.

At a summary level, there are three distinct areas of expenditure within the CCG, for which budget responsibility has been delegated to appropriate Committees. These are commissioning expenditure (Clinical Development Committee), running/staffing costs and reserves (Finance and Performance Committee) and primary care commissioning/membership development (Primary Care Commissioning Committee).

The table below identifies the financial position to date by Committee:

Annual Budget YTD variance Forecast variance £ £ Clinical Development Committee 377.9m 1.3m 1.5m Finance & Performance Committee 23.1m (1.3m) (1.5m) Primary Care Commissioning Committee 40.0m - - Surplus £6.3m (4.4m) (6.3m) Total 447.3m (4.4m) (6.3m)

Whilst the Finance and Performance Committee will retain oversight of the financial position of the organisation and advise the Board regarding any mitigating actions that may need to be taken, the

3 | Page clinical and management leads of appropriate Committees will be responsible and accountable for financial performance of their delegated portfolio.

The most significant financial pressures facing the CCG at this point in time are in relation to contract over-performance. The Dudley Group Foundation Trust (DGFT) acute contract is reporting a year to date over-performance of £0.86m consisting of significant over-performance against accident and emergency attendances, maternity, day cases and elective admissions. Ramsay Healthcare is reporting a year to date over-performance of £0.46m caused by an increase in expenditure on day case and elective Activity. We are also experiencing over-performance on CAMHS activity and an additional cost pressure for temporary assessment support for discharge. The impact of this over-performance is reflected in the Clinical Development Committee overspend shown above.

Discussions on the respective financial positions have been held at the Clinical Development Committee and Primary Care Commissioning Committee, and reports to the Board from the Committees will outline their response to the presented position.

4.0 NHS CONSTITUTION STANDARDS/CCG ASSURANCE

The CCG is meeting all NHS Constitution standards at November 2015 with the exception of diagnostics. There is concern regarding sub-elements of particular standards as described below. Both issues are under review by the Clinical Development Committee.

The CCG continues to be rated as ‘outstanding’ by NHS England, one of the few CCGs in the country to achieve this rating. This will be re-assessed in April 2016 based on 2015/16 performance, but may be at risk due to HCAI breaches described later in the report.

5.0 PERFORMANCE EXCEPTION REPORTING

5.1 Diagnostics

DGFT failed to meet the headline diagnostics standard in October achieving 2.1% against the 1% threshold namely in cystoscopy, dexa scans and non-obstetric ultrasound.

A Remedial Action plan is in place with a recovery date of December 2015 at headline level and all failing individual tests, with the exception of non-obstetric ultrasound which has a recovery date of February 2016. Performance is monitored contractually on a monthly basis at all levels (including NHS England), with progress against the recovery plan discussed monthly at the Contract Review Meetings.

5.2 Referral to Treatment (RTT)

Overall DGFT is achieving the headline target of 92% for RTT across all specialties. However in August, three specialties failed to meet this standard; gastroenterology (85.1%), general medicine (83.3%) and urology (82.2%). All contractual levers are being deployed by the CCG including Performance Notices, Remedial Action Plans and financial penalties.

6.0 NHS ENGLAND INDICATORS

6.1 A&E

A&E performance remains strong moving into the winter months, with DGFT’s four hour percentage being amongst the highest nationally. DGFT are on track to meet the 95% standard in Quarter 3.

6.2 Cancer

DGFT met the 62 day cancer wait in October for the first time in four months, achieving 88.34% against the 85% standard. This recovery is one month ahead of the planned trajectory of November 2015 and means that there is now a possibility of meeting 85% in Quarter 3. Performance will

4 | Page continue to be monitored closely on a monthly basis and discussed at the Contract Review Meetings.

6.3 Ambulance Handovers

Performance against both 30 and 60 minute breaches continues to improve, with nine 30 minute breaches recorded in October and zero 60 minute breaches.

6.4 MRSA

Three MRSA cases were confirmed in September, which breached the 2015/16 zero threshold. This indicator will remain red for the remainder of 2015/16.

6.5 C.Difficile

There have been 74 year to date confirmed cases with a further nine provisional cases reported in November. Once November’s provisional cases are confirmed then the 2015/16 threshold of 76 cases will be confirmed as a breach and this indicator will remain red for the remainder of 2015/16. Please note that incidents of C.Difficile are contractually managed on the basis of lapses attributable to providers.

7.0 QIPP 2015/16 AND 2016/17

The CCG is forecasting to over-achieve the 2015/16 QIPP target of £7,190,000 by £42,000 giving total savings of £7,232,000. The Clinical Development Committee is reporting an under- achievement of £701,000 against its QIPP target as a result of reduced activity from the schemes relating to the Urgent Care Centre and Rapid Response Team. Actions have been developed for both areas to improve activity.

Recurrent reductions in both property charges and running costs alongside an increase in prescribing rebates will enable the CCG to achieve the QIPP target for this financial year.

The CCG will hold a QIPP workshop in January to review the latest Commissioning for Value and QIPP Opportunities packs to help inform the QIPP programme for the next financial year. The Committee acknowledged that engagement with the provider could be improved and that the option of risk sharing should be explored. This would encourage all organisations to focus on QIPP delivery and help to align schemes with provider CIP programmes.

The revised QIPP position by Committee is therefore:-

Financial Plan YTD variance Forecast outturn £ £ Clinical Development Committee 7.190m 0.585m 0.701m Finance and Performance Committee 0 (0.610m) (0.743m)

The Committee agreed that a process was required to formally review QIPP schemes throughout the year to decide whether, based on their success, they should continue.

8.0 LOCAL INDICATORS

8.1 Better Care Fund

There are a number of conditions the health economy must meet to achieve the performance payment associated with the Better Care Fund. The first period upon which the health economy is measured is Quarter 1 of 2015/16, and as an economy we have not achieved four of the five indicators. The main issues relate to a continual rise in non-elective admissions and delays in transfers of care. Rectification plans for all indicators are being prepared, to be overseen by the System Resilience Group, in order to ensure the health economy meets the targets moving forward.

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8.2 GP Balanced Scorecard

The Committee heard that the GP balanced scorecard metrics are split over four domains. At CCG level, all measures are being achieved except emergency admissions and A&E attendances from the secondary care domain.

9.0 OTHER ITEMS DISCUSSED

9.1 Combined Board Assurance Framework and Risk Register

The risks assigned to the Committee were reviewed and accepted. The Committee agreed that additional risks be created relating to the identification and delivery of 2016/17 QIPP schemes and the actions required to achieve the IT Toolkit.

9.2 Lead Provider Framework – Commissioning Support Services Award Authorisation

The Committee considered the report on the outcome of the procurement exercise for commissioning support services against the Lead Provider Framework. This exercise was undertaken by a Project Board acting on behalf of Birmingham, Solihull and Black Country CCGs. The CCG Board had delegated authority to the Finance and Performance Committee to approve the award of the contract for those services relevant to the CCG.

For the procurement process the services had been identified into a number of Lots. The CCG was purchasing services from three Lots; Lot 1 – end to end services (excluding business intelligence and IT); Lot 1 – business intelligence and Lot 2B – individual funding requests and continuing healthcare.

Under delegated authority, the Committee approved the award of the contracts for Lot 1 – end to end services to Arden and GEM CSU, Lot 1 – business intelligence to Midlands and Lancashire CSU and Lot 2B – individual funding requests and continuing healthcare to Arden and GEM CSU.

The new contracts were operational from 1 April 2016 for four years with an option to extend for a further one year. There had been no legal challenges and the contracts were awarded on 8 December 2015.

9.3 IT Contract Extension

Dudley IT Services provides IT support to Dudley CCG and the GP community. The CCG has given formal notice on the contract which is due to expire on 31 March 2016. This has led to the CCG tendering for a service from 1 April 2016. The Committee agreed an extension to the current contract for 12 months to March 2017 to allow sufficient time to complete the tender exercise and the transition to the chosen supplier.

9.4 IT Procurement Steering Group – Delegated Authority

The Committee was asked to give delegated authority to the IT Procurement Steering Group to make key decisions regarding the procurement of IT services to the CCG and GP community. The Committee required a project plan, with key milestones, before it was able to make a decision about the extent of the delegation. Certain elements could not be delegated to the Group.

9.5 On-line Collaboration Tool

The CCG, on behalf of NHS England, has been asked if it would procure an on-line collaboration tool. This national system would allow all Vanguard sites to share documentation. Discussions were continuing about whether the CCG should participate in the project.

6 | Page 9.6 Urgent Care Centre

The Committee received a report prepared in order for the CCG to understand activity levels within the Malling contract. It was agreed that further information was required on the impact of the activity during the current year and in future.

10.0 REPORTS FROM GROUPS ACCOUNTABLE TO THE COMMITTEE

10.1 IT Strategy Group

The Committee received a report on the issues discussed by the IT Strategy Group and noted good progress on implementing projects within the strategy.

The Committee discussed issues with EMIS capability, which was impacting on the delivery of ongoing local initiatives. These were being documented and would be raised at a national level. It was also recommended that a meeting of senior managers from EMIS and the CCG was required to try to resolve the issues.

10.2 Estates Strategy/Operational Group

Estates operational issues are discussed at the Estates Operational Group.

An outcome from the discussion with localities on the Health Infrastructure Strategy was that some practices were willing to discuss with the CCG the possibility of progressing with their developments in tranche one. The report to the CCG Board in March would be seeking approval to proceed with the strategy on that basis. This decision had been endorsed by the Clinical Executive.

Work on developing the estates strategy must align with the discussions currently underway with practices about the future of primary care.

The Committee noted the useful and positive discussions that the Chief Operating and Finance Officer had had with the Local Authority regeneration and planning team and the newly established health economy estates strategy group.

The CCG was required to submit its estates strategy to NHS England by 18 December 2015.

11.0 DECISIONS TAKEN UNDER DELEGATED POWERS

The Committee approved the award of the CSU contracts for Lot 1 – end to end services to Arden and GEM CSU, Lot 1 – business intelligence to Midlands and Lancashire CSU and Lot 2B – individual funding requests and continuing healthcare to Arden and GEM CSU from 1 April 2016.

12.0 RECOMMENDATION

The Board is asked to receive the report for assurance and endorse the action taken by the Committee under delegated authority to approve the award of CSU contracts.

Mr M Hartland Chief Operating and Finance Officer December 2015

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD

Date of Board: 7 January 2016 Report: Duty to Consult Update Agenda item No: 11.1

TITLE OF REPORT: Public Involvement & Duty to Consult • To update the Board on public involvement requirements when making changes to services • To ensure the Board are aware of the legal obligations when PURPOSE OF REPORT: reconfiguring services • To update Board on Engagement Principles for the New Care Model work AUTHOR OF REPORT: Mrs Laura Broster – Head of Communications and Public Insight

MANAGEMENT LEAD: Mrs Laura Broster – Head of Communications and Public Insight

CLINICAL LEAD: Dr David Hegarty – Chair, Dudley CCG • Public involvement goes far beyond the need to consult on specific proposals for major service redesign • We have a strong network for on-going engagement, which is key KEY POINTS: • We actively engage with our Health overview and Scrutiny Committee • There are some key tests which we should take before embarking on any public consultation • There are key principles to follow That the Board: • Note the contents of this report • Be assured that there is a Communications and Engagement Strategy for the New Care Models work • Endorse the principles set out in this strategy RECOMMENDATION: • Note the intention to use this as part of a future Board development session • To review our published arrangements for public involvement including in our constitution a description of the arrangements that we have made, and a statement of the principles we will follow in implementing those arrangements • The CCG has a statutory duty to involve. Failure to do so could result in costly judicial proceedings. • Engaging people in service development will ensure that our FINANCIAL IMPLICATIONS: decisions are as well-informed as possible. Involving those who currently use services, and those who may need them in the future, will help us to make better commissioning decisions. A conversation on how we involve people in future service changes took WHAT ENGAGEMENT HAS place at the Healthcare Forum on the 3rd December 2015. Our on-going TAKEN PLACE: engagement is pivotal for us in listening to people to understand when our conversations need tweaking.  Decision ACTION REQUIRED: Approval  Assurance 1 | Page 1.0 INTRODUCTION

The legal obligations on the NHS to involve the public when commissioning services are more complex and more widespread than simply a duty to consult on specific proposals. What is meant by “involving the public” will vary from case to case.

At the “top end” of major, system-wide service redesign, a crucial lesson of recent years (reinforced by NHS England guidance) has been that consultation alone is not enough.

This paper aims to update the Board on public involvement requirements when making changes to services. It also aims to ensure the Board are aware of the legal obligations on the CCG as a commissioner when reconfiguring services, and to give assurance on the engagement principles signed up to by the Partnership Board.

The content is largely based on a Mills and Reeve briefing and there will be more opportunity to discuss the impact of this for Dudley CCG at the Board development session in February, which will be attended by Mills and Reeve.

2.0 THE LEGAL DUTIES

The statutory duties on NHS bodies are set out in the NHS Act 2006. CCGs are governed by section 14Z2 of the 2006 Act, the most relevant parts of which state:

(1) This section applies in relation to any health services which are, or are to be, provided pursuant to arrangements made by a clinical commissioning group in the exercise of its functions (“commissioning arrangements”). (2) The clinical commissioning group must make arrangements to secure that individuals to whom the services are being or may be provided are involved (whether by being consulted or provided with information or in other ways): (a) in the planning of the commissioning arrangements by the group, (b) in the development and consideration of proposals by the group for changes in the commissioning arrangements, where the implementation of the proposals would have an impact on the manner in which the services are delivered to the individuals or the range of health services available to them, and (c) in decisions of the group affecting the operation of the commissioning arrangements where the implementation of the decisions would (if made) have such an impact.

Similar duties are imposed on NHS Trusts and Foundation Trusts by section 242 of the 2006 Act; and on NHS England by section 13Q of the 2006 Act.

For Dudley CCG the core duty is for us to have made arrangements to ensure public involvement. The arrangements that we are required to put in place must secure the involvement of people who “may” use services as well as those who currently do.

So, in terms of the section 14Z2 statutory duty, what matters is the “arrangements” that we have made. We are required (by section 14Z2(4))to have regard to guidance published by NHS England when discharging this duty.

We are also required, by section 14Z2(3), to include in our constitution a description of the arrangements that we have made, and a statement of the principles we will follow in implementing those arrangements.

3.0 WHAT DOES IT MEAN “TO INVOLVE” THE PUBLIC?

The public can be involved “by being consulted or provided with information or in other ways” (section 14Z2(2)).

For smaller service changes, it is likely to be sufficient simply to inform the public that changes are proposed or are being made. In those cases where it is not clear whether or not a formal consultation is required then

2 | Page the latest guidance advises the CCG to discuss the point with NHS England and also with local stakeholders, such as the Local Authority.

4.0 WHEN MUST THE PUBLIC BE INVOLVED?

Section 14Z2 makes it clear that the public must be involved in the planning of service changes; in the development and consideration of proposals for change; and at the decision-making stage, ie. when deciding whether or not to implement the proposals.

It is not enough for us to work up a set of proposals and then present them to the public for consultation. The new and updated NHS England Guidance is clear, however, stating in terms: “It is critical that patients and the public are involved throughout the development, planning and decision making of proposals for service reconfigurations.”

For us to fulfil this responsibility it is vital that we have a strong network and process for engaging with the people and communities of Dudley, which are embedded into the commissioning process. The role of our Patient Participation Groups, Patient Opportunity Panel and the Healthcare Forum are key to this.

Another crucial aspect of securing on-going public involvement is by continual engagement with the local authority scrutiny function.

It is also important that we are able to clearly articulate the ‘four tests’ for service redesign as these remain fundamental. They are: • Strong public and patient engagement; • Appropriate availability of choice; • A clear, clinical evidence base for the proposals; • Clinical support for the proposals.

5.0 THE KEY REQUIREMENTS OF A LAWFUL CONSULTATION

In October 2014, the Supreme Court considered for the first time what is needed to for a proper, lawful public consultation.

The court restated the four core requirements of a consultation as follows:

“First, that the consultation must be at a time when proposals are still at a formative stage. Second, that the proposer must give sufficient reasons for any proposals to permit of intelligent consideration and response. Third,… that adequate time must be given for consideration and response and, finally, fourth the product of consultation must conscientiously be taken into account in finalising any statutory proposals”.

6.0 OUR APPROACH

For Dudley CCG we believe that in all our engagement we should adopt an Empowering Approach.

Since 2007, organisations in Dudley Borough have been developing and using an empowering approach to engagement. The five community empowerment dimensions (see below) have proved to be very helpful in thinking about how we work with people.

Empowerment is not just about the people and communities, it is also about organisational structures and processes being empowering.

When developing new care models in Dudley we will take an empowering approach to engagement and these dimensions are included in the Communications & Engagement Strategy for the new care model work. (addendum to board papers for information).

3 | Page Community Empowerment Dimensions

By ‘confident’, we mean, working in a way which increases peoples skills, knowledge and confidence – and instills a belief that they can make a difference.

By ‘inclusive’, we mean working in a way which recognises that discrimination exists, promotes equality of opportunity and good relations between groups and challenges inequality and exclusion.

By ‘organised’, we mean working in a way which brings people together around common issues and concerns in organisations and groups that are open, democratic and accountable.

By ‘cooperative’, we mean working a way which builds positive relationships across groups, identifies common messages, develops and maintains links to national bodies and promotes partnership working.

By ‘influential’, we mean working in a way which encourages and equips communities to take part and influence decisions, services and activities.

Recognising our commitment to an empowering approach, we can make the following statements,

Giving the right information, at the right time in the right way

By listening to what you tell us and taking the time to hear what you are saying

By making it easy for you to get in touch with us

By making it easier for people to work better together

By working with partners to give you the skills, knowledge and confidence you need to participate

By being transparent in our decision making processes

By recognising and valuing your contributions

By learning to appreciate and make better use of what we already have in our communities

By feeding back to you – even if it is a difficult conversation

This is our pledge to Dudley people!

These pledges mirror those endorsed by Dudley CCG Board in 2013 in the Communications and Engagement Strategy (appendix 1).

7.0 CONCLUSION

This paper has been presented to Board to ensure that we are aware of our legal obligations. A Board development session will take place and time will be given to consider our requirements to consult on any service changes resulting from the New Care Model work. Board are reminded of the principles by which we will involve the Public.

4 | Page 8.0 RECOMMENDATIONS

That the Board:

1) Note the contents of this report 2) Be assured that there is a Communications and Engagement Strategy for the New Care Models work 3) Endorse the principles set out in this strategy 4) To review our published arrangements for public involvement including in our constitution a description of the arrangements that we have for involving people in our decisions, and a statement of the principles we will follow in implementing those arrangements 5) Note the intention to use this as part of a future Board development session

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6 | Page Sign off by Partnership board August 2015

Dudley Communications & Engagement Strategy

Developing New Models of Care in Dudley

NHS Partners include, Dudley Clinical Commissioning0 Group, The Dudley Group Foundation Trust, Black Country Partnership Foundation Trust & Dudley and Walsall Mental Health Partnership Trust. Sign off by Partnership board August 2015

1. Executive Summary

Dudley is one of the areas selected to develop new models of care following the publication of the Five Year Forward View (5YFV) in October 2014. This document gives a clear message that we need to adapt to take advantage of the opportunities that new technologies offer and evolve to meet the population and financial challenges that we now face.

Other key legislation including the Care Act 2014 set the scene for public sector. This document sets out expectations of a care service fit for the 21st century, and the tightest squeeze on public finances since the 1970s.

More of the population now have a mixture of needs that involve medical care as well as social care support. These exceed the separate responsibilities of individual organisations making it impossible to consider how we meet these challenges in isolation, for organisations across Health & Social Care our futures are intertwined!

The challenges set out nationally can be summarised as people are living longer, with more complex health issues and financial pressure on public services. These are mirrored locally. The local health and care system recognises that to really meet these challenges we must take a longer view, they are not things that can be fixed overnight and we need to look at new ways of thinking and doing to make the difference that we have not been able to make to date. This requires changes to the way that we provide services to meet the changing needs and wants of our population.

Dudley is an area that has risen to that challenge. We are working differently to make the changes required, to think about solutions and make them happen, regardless of the traditional barriers that exist. We are refining organisational boundaries and have established teams without walls who focus on the person at the centre and their care needs.

We also know that we cannot address these challenges without a fresh look at our relationship with the people and the communities of Dudley and in turn the relationships that those people and communities have with each other.

This plan sets out our ambition to involve, inform and inspire key audiences to work in new ways and develop a Dudley Multispecialty Community Provider which is truly person centred.

It articulates our approach to engagement and gives a clear message that our ambition to work together to develop a new model of care is not achievable unless we take people, communities and staff with us.

1 Sign off by Partnership board August 2015

2. Introduction

This strategy has been written by members of the Communication and Involvement work stream and approved by the Partnership Board which is overseeing the development of new care models in Dudley.

This is a document which outlines our plans on engaging and communicating effectively with our patients, public, partners, staff and stakeholders over the next three years.

The demands on health and care resources are rising year on year – Dudley people are living longer with ever more complex conditions; continuing progress in treatments and medical techniques comes with new costs and expectations; and modern lifestyle issues such as obesity are causing an increase in long term conditions.

For the future, we must transform services to adapt to these rising demands. We must make the most of modern healthcare through innovation and best practice in order to change the way we spend money and use our limited resources.

Our vision is to put Dudley people at the heart of integrated GP-led health and care services, with a focus on improved health and wellbeing, better outcomes and a more engaged community.

This demands a whole-system transformation in the way we commission health and social care. That aim has fresh impetus and sharper focus following our successful bid for Five Year Forward View Vanguard status.

Communication, involvement and engagement need to be at the heart of these changes in order to make them sustainable for the future and responsive to the needs of the Dudley population; in other words, the patient voice needs to be at the heart of everything we do.

3. Profile

We are now moving ahead at pace with our person centred, Multispecialty Community Provider (MCP) model. Through our conversations with the public and other key stakeholders, we have identified four key requirements: • better communication both to patients and between staff; • improved access to consultation and diagnostics: • continuity of care in supporting the management of their long term condition(s); • effective coordination of care for the frail elderly and those with complex conditions.

To respond to this the focus of our model of care builds on a joined up network of GP-led, community-based multi-disciplinary teams which enable staff from health, social care and the voluntary sector to work better together.

The support for developing and implementing this model is also underpinning our work towards a complementary process of developing standardised best practice pathways of care. Through this we will ensure that all services provided outside of the MCP are commissioned in a way which incentivises optimum outcomes for the patient, maximises efficiency and enables effective communication back with the GP.

2 Sign off by Partnership board August 2015

In addition we continue to redesign urgent care services, building on a successful single point of entry to the service through the opening of the Urgent Care Centre in April 2015. This new way of working brings together Dudley CCG, General Practitioners (GPs), the local authority (Dudley Metropolitan Borough Council) and our main providers (Black Country Partnership NHS Foundation Trust, Dudley Group NHS Foundation Trust, Dudley and Walsall Mental Health Partnership NHS Trust) as well as Dudley Council for Voluntary Services (DCVS).

4. National context – new care models programme

The new care models programme is an integral part of the NHS Five Year Forward View.

Vanguards are moving at pace, developing new models that will act as blueprints for the future of health and social care. The aim is to secure its future so everyone continues receiving high quality care when need it.

Dudley was in the first wave of vanguards, announced in March along with 28 other areas. There were three vanguard types – integrated primary and acute care systems; enhanced health in care homes; and, multispecialty community provider vanguards. • Integrated primary and acute care systems – joining up GP, hospital, community and mental health services. • Enhanced health in care homes – offering older people better, joined up health, care and rehabilitation services. • Multispecialty community providers (MCP) – moving specialist care out of hospitals into the community

Dudley is one of the areas selected as a vanguard for MCP development.

In July, a second wave of eight vanguards was announced, known as urgent and emergency care vanguards, looking at new approaches to improve the coordination of services and reduce pressure on A&E departments.

Each vanguard site will take a lead on the development of new care models which will act as the blueprints for the NHS moving forward and the inspiration to the rest of the health and care system.

A further wave of vanguards will be announced in the autumn – known as acute care collaborations, they aim to link local hospitals together to improve their clinical and financial viability.

5. Partnership and Programmes Principles

The priorities of tackling the health, care and finance gaps are achievable only by fundamentally changing the NHS’s relationship with people and communities as set out in chapter 2 of the 5YFV. The new care models programme is being developed collaboratively, built with patients and all those affected by change and the health and care system.

Locally our program is being delivered in line with the principles set out in the 5YFV of clinical engagement, patient involvement, local ownership and national support.

We are developing a new health system which is built with patients and the health and care system, clinical leadership is central to all the activities.

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We recognise that fundamental to our success is the new way of working being shaped by those affected by change. Our programme is supported by significant organisational development support to ensure that any local changes are designed in partnership with staff and those using services.

6. Vision

Our model is based on the principles of, shared ownership, shared responsibility & shared benefits.

Maximising the potential of: • The individual (in their community) • Our staff in supporting the individual • Our staff working effectively with each other

Our shared vision is to put Dudley people at the heart of integrated GP-led health and care services, with a focus on improved health and wellbeing, better outcomes and a more engaged community.

Our ambition is for • better communication with patients and between staff; • improved access to different consultation and diagnostics in the community; • continuity of care in supporting the management of people’s long term condition(s); • effective coordination of care for the frail, elderly and those with the most complex conditions.

7. Programme Governance

Accountability for oversight and steering of the MCP Programme is delegated to the MCP Partnership Board with representatives from each partner organisation, whilst accountability for oversight and delivery of programme activities within designated work streams is further delegated to the Clinical Strategy Group and the Integration Strategy Group.

The Partnership Board also reports into Dudley Health and Wellbeing Board.

In total, there are 12 projects within which all the activities of the programme should be delivered. These projects are as follows: • Care Pathways • Medicines Management • Estates • IT & informatics • Organisational Development • Workforce Development • Frail Elderly • Communications & Involvement • Governance • Insight & Shared Intelligence • Modelling • Programme Monitoring and Oversight

The Head of Communications & Public Insight at Dudley CCG is a member of the Partnership Board to ensure appropriate messaging.

4 Sign off by Partnership board August 2015

The programme organisation and governance is set out in the diagram below.

8. Strategic aims

The 5YFV talks about harnessing the ‘renewable energy represented by patients communities’ and the need to ‘engage with communities and citizens in new ways, involving them directly in decisions about the future of health and care services.’

With this in mind the partners are working to develop a new, person centred, model of care which: o understands the position, needs and motivation of people and communities; o works with people and communities to hear their voices; o engages with people and communities to build relationships and offer genuine opportunities for influence; o embraces the assets of people and communities to create opportunities for co- production, building collaborative relationships that recognise that different roles and perspectives are a constructive force for change; o empowers staff to lead service changes to benefit people;

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o enables people and communities to put themselves at the centre of their care - so that they can make informed decisions about their health; be supported to manage their conditions and stay as independent and in control as possible; o creates an environment to support people using health and social care to drive change themselves.

Taken together, these approaches will improve health outcomes and allocate resources more efficiently to areas of need and want – especially for those with long term conditions and complex care needs.

Given our vision for maximising the potential of: • The individual (in their community) • Our staff in supporting the individual • Our staff working effectively with each other

MCP

Lines of communication

Health & People & Care Teams Communities

This strategy also plays a key role in connecting those staff to the communities they serve.

Our overall strategic aims are therefore to 1. design and produce person centred care with people and communities in the Dudley borough 2. ensure teams can effectively connect to their local communities to deliver person centred care.

8.1 Delivering our strategy We have developed 4 stages to guide delivery of the above aims. 1. Developing a collective understanding of the context, scope and boundaries of our new model of care; and of the motivations, assets, needs and constraints of our leaders, teams, local people and communities.

2. Supporting our leaders and teams to develop skills, knowledge and confidence to: a) communicate effectively using common key messages and information b) listen to what people say and understand how to share what is heard c) carry out consultation appropriately and inclusively, and involve people and communities in influencing decision making though clear, transparent processes d) facilitate co-production of health and care

3. Monitor and evaluate the effectiveness and impact of our communications and involvement of people and communities in the five year journey.

4. Draw out and share learning from evaluation and apply it to on going communication and involvement activities.

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9. Objectives

The strategic objectives are detailed below across the 4 stages of strategy delivery. Strategic Stages Objectives 1. Developing a collective understanding • Identify and analyse our current and future of the context, scope and boundaries stakeholders of our new model of care; and of the • Understand what is important to local motivations, assets, needs and people, communities and teams constraints of our leaders, teams, local • Manage and maintain stakeholder people and communities expectations • Have a shared understanding of how things will be different in the future 2. Supporting our leaders and teams to develop skills, knowledge & confidence to:

• Communicate effectively using • Raise the profile of new care models and common key messages and inform key audiences information • Share successes to inspire teams • All vanguard partners using consistent messages • Ensuring that information regarding new models of care is readily available if needed • Ensure all staff understand their role in the new model of care • Listen to what people say and • Patient voice is integral to plans of all understand how to share what is vanguard partners heard • Staff inspired to lead and encouraged to shape the future care model • Carry out consultation • Listen and share successes appropriately and inclusively, and • Create appropriate engagement opportunities involve people and communities in with real opportunity to influence for people, influencing decision making though communities and staff clear, transparent processes

• Facilitate co-production of health • Make real changes for person centred care and care • Steps are taken to move towards more and more services being co designed and co produced 3. Monitor and evaluate • Create an evaluation tool the effectiveness and impact of our • Ensure that patient voice and lived communications and involvement experiences form a key part of the overall of people and communities in the programme evaluation five year journey. • Ensure that staff experiences are reflected in the new model 4. Draw out and share learning • Organisations commitment to the from evaluation and apply it to communication principles and engagement ongoing communication and pledges involvement activities. • working together to use the knowledge and insight they have to inform the programme direction

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10. Situational analysis

In order to inform our strategic aims, consider areas for improvement and of opportunity, we have taken a ‘snap shot’ of the current state of affairs. Looking at communications and engagement activities along with any other relevant areas we have undertaken a situational analysis.

A SWOT (strengths, weaknesses, opportunities and threats) and PESTEL (political, environmental, social, technological, environmental and legal) and stakeholder analysis have been carried out and are included in full in appendix 1, 2 & 3.

Overall the Dudley Health and Social care economy is in a good position to achieve the changes proposed. We have political support for the direction of travel and whilst we have significant risks and challenges, presented by the financial and social climate, these present us with a perfect case for change.

We recognise that things cannot continue as they are with, • 1 in 5 people in Dudley have a limiting long term illness • A quarter of early deaths (40 – 59 age band) are due to smoking, obesity, cardiovascular disease and lack of physical activity • In two decades time there will be 25,100 more people 65+ & 9,900 85+ • 20% of single person households are in 60+ age group • Dudley’s proportion of long term unemployed in July 2012 higher than the West Midlands and England averages with 33.9% of all of Job Seeker’s Allowance (JSA) claimants in the Borough having been claiming for over 12 months. • Already high before the recession, unemployment among young people has increased significantly; between July 2007 and July 2012, the proportion of the borough population under 25 claiming JSA increased from 5.6% to 9.5%. • In 2009, 13,745 (23.8%), children under 16 years of age in Dudley Borough were classified as living in poverty. • Historically Dudley has experienced lower than average earnings and qualifications. In 2011 the median gross annual pay of full time employees living in Dudley borough was £23,390, below the regional and national figures.

The future sustainability of the system depends on us creating efficiencies, empowering people and communities to take responsibility for their own health and inspiring teams to grab opportunities for closer working and make the changes required to improve things for their patients and service users.

11. Positioning & Branding

The programme itself is led through the Partnership Board which is made up of multiple organisations. As the future organisational form is not known at this stage, communicating the changes will require leadership from within existing structures and across organisational boundaries.

The programme to develop new care models can only be successful if it brings together the teams working around the person. We must create a brand that helps to give these teams some identity.

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As the MCP has no legacy of its own we must strengthen its position externally and internally to ensure that it stands out in what is a very complex sector and develops a positive reputation of its own.

The positive is that stakeholders, patients, the public and the media have an affinity with the services that exist in Dudley and with the people who deliver these services. The positioning of the MCP will build on this in order to raise awareness of the work it does, enhance perceptions and stimulate interest in the new partnerships.

Positioning What we do? Scope: What area of activity are we in? Working with you to develop person centred care in Dudley. Status: What status do we want to achieve? Health planning decisions led by Clinicians and informed by the people of Dudley; Personalised health to the individual, with care decisions co-produced between them and their lead clinician

Why we do it? Ambition: What is our heart-felt ambition? Healthier lives for the people of Dudley Ethos: What are the principles behind our actions? Passionate about your health Compassionate about your care Supportive of local services for local people

How we do it? Style: How do we go about our business? Working differently / giving things a new perspective; Empowering front-line staff to take a shared responsibility together for the same population of patients to achieve shared (and better) outcomes; Partnerships focussed on outcomes for people not on organisations; Simple and straight forward/ plain talking Response: What impression do we want to create? I’m heard, My views are represented to, I’m healthier, I’m in control I’m cared for Focus: Our basis for making decisions The best results for people in Dudley

Branding Our brand identity is much more extensive than just a logo. Our identity is formed by what we do, how we exist in the minds of our stakeholders and the things that users of health and care services value.

The NHS mark has over a 90% spontaneous recognition rate amongst the public and has high levels of trust and credibility. This programme to develop an MCP extends beyond the NHS though. In fact the extension beyond these boundaries is integral to what we are trying to achieve.

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The challenge is to find a brand identity solution which addresses the challenges of communicating a change which requires partnership and mutuality from each partner organisation and one that is endorsed by the strength of the NHS brand.

The branding of the Dudley MCP needs to ensure it is clear who the partner organisations are that are accountable and responsible for delivering the programme, whilst at the same time helping staff from the different organisations feel like they are working together as a single, unified team.

Therefore, we recommend that stakeholder and staff communications lead with the NHS lozenge top right and the Dudley MBC logo top left. By using the generic NHS lozenge, the communications materials are then applicable to any of the NHS organisations.

We will create a visual style for these communications to help stakeholders and staff feel that the partner organisations are working ‘as one’. This would be a ‘neutral’ visual style i.e. neither the NHS nor the council’s individual identities dominate. The visual style will include a graphic device and a strapline. The graphic device and strapline will be developed with the frontline staff representatives. The graphic device will not be positioned where organisation logos are usually expected i.e. at the top of the page. Placement is suggested as bottom left.

We need to ensure that acknowledgement and credit for the partnership relationship is evident in all communications. Broadly, this is the placement of a programme device with NHS lozenge and Local Authority Logo. We may also need to use an explanatory statement about the CCG, Providers, DCVS in a prominent place on high-end materials. The statement to be included should provide the reader with a greater level of understanding of who is involved in the partnership and their role in developing new care models.

11. Our Approach

We are committed to an empowering and collaborative approach.

An Empowering Approach Since 2007, organisations in Dudley Borough have been developing and using an empowering approach to engagement. The five community empowerment dimensions (see below) have proved to be very helpful in thinking about how we work with people.

Empowerment is not just about the people and communities, it is also about organisational structures and processes being empowering.

When developing new care models in Dudley we will take an empowering approach to engagement.

Community Empowerment Dimensions

By ‘confident’, we mean, working in a way which increases peoples skills, knowledge and confidence – and instills a belief that they can make a difference.

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By ‘inclusive’, we mean working in a way which recognises that discrimination exists, promotes equality of opportunity and good relations between groups and challenges inequality and exclusion.

By ‘organised’, we mean working in a way which brings people together around common issues and concerns in organisations and groups that are open, democratic and accountable.

By ‘cooperative’, we mean working a way which builds positive relationships across groups, identifies common messages, develops and maintains links to national bodies and promotes partnership working.

By ‘influential’, we mean working in a way which encourages and equips communities to take part and influence decisions, services and activities.

A Collaborative Approach The development of the MCPs communications and engagement takes place in a wider context. Collaboration is essential across the partner organisations and can help us to maximise use of resources.

The Partnership Board will take overall strategic responsibility for collaborative working between the different partner agencies, for reducing barriers and duplication.

12. Model/ engagement and communication principles

We will be true to the following principles in all our conversations.

Open and transparent - Our communication will be as open and transparent as we can be, ensuring that when information cannot be given or is unavailable, the reasons are explained

Consistent – There are no contradictions in the messages given to different stakeholder groups or individuals. The priority to those messages and the degree of detail may differ, but they should never conflict

Two-way – There are opportunities for open and honest feedback and people have the chance to contribute their ideas and opinions about issues and decisions

Clear – Communication should be jargon free, to the point, easy to understand and not open to interpretation

Planned – Communications are planned and timely rather than ad-hoc and are regularly reviewed to ensure effectiveness

Accessible – Our communications are available in a range of formats to meet the needs of the target audience

High quality – our communications are high quality with regard to structure, content and presentation at all times

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Recognising our commitment to an empowering approach, we can make the following statements, Giving the right information, at the right time in the right way

By listening to what you tell us and taking the time to hear what you are saying

By making it easy for you to get in touch with us

By making it easier for people to work better together

By working with partners to give you the skills, knowledge and confidence you need to participate

By being transparent in our decision making processes

By recognising and valuing your contributions

By learning to appreciate and make better use of what we already have in our communities

By feeding back to you – even if it is a difficult conversation

This is our pledge to Dudley people!

13. Audience

To be successful in developing new models of care we must involve, inform & inspire a wide range of audiences (stakeholders) including, • People who use services- Patients, Public & Carers • Dudley Health and Social Care Employees • General Practitioners and their staff • Community & Voluntary Sector Partners • Members of Parliament • New Models of Care Team & NHS England • Local Councillors • Neighbouring Health Economies • Providers (Statutory, independent & voluntary sector) • Media & Trade Press • Healthwatch Dudley • Health & Wellbeing Board

Each audience will require its own communication channel and approach but to ensure consistency we must create protocols for consistent, timely and effective conversations with each of these groups.

The mapping and segmentation for the stakeholder analysis will help us to consider the: Messages to communicate and the objectives of the messages The strategy by which we wish to reach the target audience Tactics for reaching them, to be selective in the approach The timescale in which to work, and to hit trigger points Resources that we have to reach the target audiences (either individually, or collectively if we choose to work in partnership with other organisations)

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A map of these stakeholders can be found in appendix 3 this prioritises and ranks the target audiences, and management of them falls into four areas: inform, consult, involve and partners. Group 1 – high power, high interest - Partner. The relationship we have with these stakeholders and our ability to meet their communication needs is essential to the successful recognition and positioning of the MCP. The stakeholders in this grouping require individually tailored information and their involvement in the process is to be encouraged.

Group 2 – high power, low interest - Involve. Whilst not requiring in-depth information about developing new care models at this stage, it will be useful to provide this group with specific information when requested and general information on a regular basis. Decisions will need to be made by the Partnership Board as to how to manage these relationships and by who, as these groups could very soon gain interest and will have a high level of influence.

Group 3 – low power, high interest - Consult. It is important that we keep this grouping involved and aware of the project developments. Many of these stakeholders are routinely involved in a number of groups.

Group 4 – low power, low interest - Inform. Whilst not essential to the success of the programme, this group will be valuable in enabling access to a wide range of the public and other stakeholders and good relationships with them will make the programme run smoother. Mass media will be the usual form of communication.

14. Narrative and key messages

Our narrative will be built upon a statement of intent which is being developed by partners. Some of the key messages are: • Our model of care builds on a joined up network of GP practice led, community- based multi-disciplinary teams which enable staff from health, social care and the voluntary sector to work better together. • We will work differently to make the changes required, to think about solutions and make them happen, regardless of the traditional organisational barriers that exist. We will focus on the person at the centre and their care needs. • We will develop standardised best practice pathways of care so that all services which need to be delivered in hospital are commissioned in a way which incentivises optimum outcomes for the patient, maximises efficiency and enables effective communication back with the GP. • We will support people to remain at home wherever possible. • We will enable the integrated delivery of 7 day community health and social care services through an accessible and fit for purpose estate. • We will improve the care for the elderly through the development of the elderly care pathway and the integrated MDT model • We will ensure patients; staff and other stakeholders are informed of, and able to contribute to, the new model, taking every opportunity to shape care that is person centred. • We will be a person-centred- Doing things ‘with you’ not ‘to you’, acting as advocates for patients, helping patients care for themselves. • We value partnerships- we are committed to working together with other organisations who can help us to achieve the best health outcomes for the people of Dudley • We are listening - we will actively seek out and value the views of staff, members, patients and the public, acting on their feedback to shape and improve services

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15. Channels

Given the span of organisations which come under the development of new ways of working and the development of a new model of care, it is important that we make best use of existing communication channels whilst building a new MCP brand and identity which has no organisational host.

See appendix 4 for details on the channels available for each key audience.

16. Resources

The resources required to deliver this strategy will be met in part through the existing communications and engagement infrastructure in that we are utilising existing channels.

The value proposition for the Vanguard also includes a sum of money to be used to further develop our ‘engaging communities’ programme and to enable the impact of the patient voice.

17. Risks

The programme will manage its own risk register with the Communications and Engagement work stream escalating appropriate risks to the Partnership Board.

Risks in relation to this work stream and those that impact directly on the ability to deliver these strategies aims are detailed below. Mitigation to these comes through the delivery of the strategy and its action plan.

• Inability to bring all stakeholders with us • Inability to align partner organisation to the direction of travel • Inability to articulate case for change to stakeholders resulting in opposition to plans • Lack of public and patient voice in developing the model leading to judicial review and other challenges • Reputational damage to partner organisations as a result of failure to deliver on new models of care

The last point is particularly relevant given the direct political context within which the programme is operating. As far as reputation is concerned, being a vanguard, and getting things wrong is a high risk activity. The spotlight is on Dudley and much more emphasis needs to be on clear messaging.

A press and media protocol will be established to ensure that all media enquiries are handled in the same way, regardless of their point of entry into the organisation and at what level. It is essential that the protocol is followed to ensure that the partnership as a whole protected; responses thoroughly researched and approved, avoiding ad-hoc answers being given to the media.

18. Roles and responsibilities

The delivery of this strategy will fall to the Communications and Engagement Work stream, reporting to the Partnership Board on progress.

Membership of the work stream is detailed below,

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• Dudley CCG, Laura Broster, Head of Communications & Public Insight Helen Codd, Engagement Manager

• The Dudley Group FT, Liz Abbiss, Head of Communications

• Healthwatch Dudley, Jayne Emery, Chief Executive

• Dudley Council for Voluntary Services- Kate Green, Sustainability Office Lorna Prescott, Senior Development Officer

• Dudley MBC, Shelley Brooks, Senior account manager Katherine Finney, Senior account manager

• Dudley and Walsall Mental Health Partnership NHS Trust, Michelle Carr, Communications and Engagement Manager

• Black Country Partnership Foundation Trust, TBC

Laura Broster will represent the group at the Partnership Board and link the group to the national new models of care team. All members have a responsibility to act as the communication channel back to respective organisations.

19. Implementation

An action plan outlining the specifics of how the engagement and communications strategy will be delivered is included in appendix 5.

Progress against these actions will be delivered through the communications and engagement work stream and overseen by the Partnership Board.

20. Measurement and evaluation

Expected measures and indicators for the communications and engagement are included in more detail in the action plan. We are also hopeful that the national support package from the New Models Team will support us in evaluation of this element of our strategy.

However there are important outcomes that the programme is monitoring which work on this strategy areas will inform and support.

The Dudley Vanguard programme is ‘whole system’; this has important implications for evaluation • This is not a discrete ‘intervention’ with a clear beginning, end or boundary: it’s a programme of system change • Comprises multiple, interrelated actions within different parts of an open system • System characteristics: interdependence, feedback loops, emergence, etc. • Likely to evolve over time and also to look different in different local places according to different local needs • Some activity is already well-established; some is in the planning • Evaluation therefore needs to account for this variety and complexity: • Changes in systems and culture • Evolution over time

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• Non-linear model of causation • Plus, evaluation should be both formative (support programme evolution and implementation) and summative (document effects, help others learn)

Methodology As this is a whole system approach to new ways of working there is not a single indicator that can best track improvements in patient experience. It is also an emerging model, with areas of implementation at various phases of development. The patient group is fluid but can be broken down into key segments by risk stratification. Those at high risk having more interaction with the service model that others. All of these factors mean that the evaluation methodology needs to both draw on existing metrics and create new ways of understanding the impact on individuals as a result of these new ways of working.

We are talking to the public about our plans and they are shaping what successful integrated care means for them.

People have told us that access, continuity of care and coordination are key to them. We will test in more detail what that means and apply all our evaluation around these key themes. In that sense, patient experience is an inherent part of all our evaluation as it has shaped the framework for which we are looking at our success.

We will draw on insight that we already have to form some baseline data, for example the GP survey has indicators for Access.

Evaluation will also be able to draw on Dudley’s Integrated Patient Experience Reporting System, which is being expanded into community and primary care. This will provide us with an excellent means of examining the vital outcome of improved patient experience.

Expected measures and indicators for the programme

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Measure(s) Key Measures of Success Possible Indicator(s)/ evidence

Increased Patients describe changes in their Self reporting tools such empowerment / knowledge / ability to manage their as used by ability to self-manage condition(s) following introduction of MDT #HelloOurAimIs campaign (patients) Personal Social Impact Action Measurement System (PSIAMS) Improved social / Change in % of patients reporting that their Self reporting tools such care outcomes desired outcomes were achieved as used by (patients) #HelloOurAimIs campaign

PSIAMs Improved Access to People know where to go to get advice GP access survey Services People can get an appointment to see a Patient experience GP when they need to reports drawing on F&F data etc.

Care and support are People feel supported to attain their own Care plans person-centred: health & well-being goals: what matters to them Living review of people personalised, in MDT coordinated, People’s experiences of: empowering Self reporting tools • involvement in decisions, such as used by • control & independence, #HelloOurAimIs • wellbeing, campaign • confidence to manage, • feeling supported PSIAMs

People’s reported access to personalised OD and shared learning care and support planning process with front-line staff to empower them People’s experience of care coordination – to engage together and including discharge & transitions with the MCP

Access to records and personal budgets Care professionals’ knowledge, confidence & skills in person centred approaches

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Services are created Different groups of people reporting their Audit trail of in partnership with experiences of being listened to, involved, engagement with citizens and supported, worked with in partnership relevant citizens, communities community groups, Improvement in the number of less heard service users etc to people/groups listened to and relevant review/redesign actions taken services, inc reported Experts by experience/patient and lay experience of leaders report that they are making real engagement difference Lay involvement at all key levels inc programme leadership, planning & steering groups, redesign/task & finish groups

21. Appendices 1. SWOT analysis 2. PESTEL analysis 3. Stakeholder map 4. Channels for key audiences 5. Detailed action plan

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Appendix 1- SWOT analysis

• Good staff survey results- highly • Low public awareness of existing motivated workforce organisational structures and decision • Clinical leaders know the population making needs • Traditional organisation boundaries to • Great voluntary sector networks new ways of working • Frontline staff committed to improving • Some areas of intent not fully agreed services for patients • Organisations have competing • Existing collaboration between organisational priorities and budget communications and engagement priorities teams • Strong Relationship with local media • Active patient and public involvement

• Learn from other vanguard • Competing priorities • To reduce duplication • No single organisation leading the • Change things for better of people change- could lead to fragmented • People to shape their own healthcare messaging • Create sustainable healthcare in Dudley • Limited sharing of resources across • Promote Dudley as centre of excellence communications & engagement at • Raise reputation of local health and care present due to mis alignment of priorities organisations • Financial implications of new models • Shared outcomes for shared benefits • Pace of change across the HSC system • Staff burn out • Positive media coverage/ engagement • Change apathy • Political interest and opportunity for • Timescales influence • Potential change in government • Build on best practice and share ideas administration (local election) • Healthwatch Dudley contract changes

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Appendix 2- PESTEL analysis

Political • Nationally stable Technological • Many different IT • All parties are systems supportive of 5YFV • Telehealth and • potential for change sense.ly app in local government administration Economic • Combined authority Environmental • Ageing estate looking to bring • Pressure nationally more economic to be carbon regeneration for neutral etc.. Dudley • BCA offering opportunity for stability • Reduction in real time budgets for health and social care

Sociological • LB to add bullets from Legal • Health and social JSNA care act • People’s expectations • 5YFV are increasing • Data protection act • People are becoming (data sharing more independent • People living longer, agreements) with more complex • Clinical health issues Commissioning • Lifestyle health Groups have a indicators – High legal obligation to prevalence obesity, involve patients smoking teenage pregnancies

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Appendix 3- Stakeholder map

Involve Partner High Professional media i.e. HSJ and Pulse Local media NHS England Fellow members of Partnership National Media Board Local Media GPs Practice Managers West Midlands ambulance Service Service user representatives Local Medical Committee Healthwatch Dudley Health and Wellbeing Board Health & Care Team leaders Health Overview & scrutiny Public Health Dudley Committee NHS England New Models Team Membership of Provider organisations

Power Inform Consult

Schools Community & voluntary groups Dudley public MPs

Local Councillors Local Pharmaceutical Committee Local Dental Committee Patient Members Local Ophthalmology Committee Care/Nursing Homes

Staff Neighbouring CCGs Neighbouring providers Neighbouring Local authorities

Low

Low Interest High

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Appendix 4- Channels for key audiences

Stakeholder Current and future comms and Risks / opportunities Group engagement plans Service users, Risks of poor engagement Current channels carers, families • Complaints / concerns • Healthcare Forum • Media activity • Mental Health Forum (quarterly) • Disengage from services • One in 4 magazine (quarterly) • National and local surveys Opportunities • Trust Information - Patient screens / • Feedback and contribution Patient leaflets • Be ambassadors for the programme • Patient experience • Help shape our services • Community events / national awareness days • Websites • Twitter feeds • Facebook Pages • Media/press coverage • Publications • Mobile Apps • Tea and chat • Envisage screens in GP practices Children and Risks of poor engagement Current channels - As above plus Young People • Complaints / concerns • Disengage from services • Healthwatch youth workers • #mefestival Opportunities • Feedback and contribution • Be ambassadors for the Trust • Help shape our services Staff Risks of poor engagement Current channels • Demotivation • Feeling undervalued • Staff survey / Staff FFT • Critial of the programme objectives to • Board meetings others • AGM • Focus on the wrong things • Website • Poor productivity • Media coverage • Absenteeism • Publications • Twitter Opportunities • Mobile Apps • Ambassadors for the new ways of • Team meetings and briefings working • Intranet site • Develop new ways of working / innovators Specific to DMBC • Promote the work of the MCP to others • Council News – online • Promote Dudley as a great place to work • Leadership forum (managers)

• Express briefings for staff • Message of the Day • Email (members or staff) • Chief execs blog • Internal social media (yammer and professional networks)

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• Directorate and divisional briefings

Specific to DCCG • Weekly team brief • Staff forum • Bi- Monthly Staff development sessions • CCG newsletter weekly • Clinical forum • Intranet

Specific to DWMHPT • Wednesday Wire (weekly) • Team Brief (monthly) • Active Desktop messages • Ask Gary • CEO blog • In the Loop • The Exchange • All staff emails • One in 4 magazine (quarterly) • Governor meetings • Recognising Success Awards GPs Risks of poor engagement Current channels • GPs take leave the system because they feel the programme will not support them • Membership meetings with increasing workforce challenges • CCG news (weekly) • Members feel like they don’t have the • Locality Meetings opportunities to get involved • GP education events • Practice visits Opportunities • Ambassadors for new model • Attracting more GPs to work in Dudley • More co-ordinated and streamlined patient journey NHS England Risks of poor engagement • Involvement & participation in national New Models • National team not aware of our progress work streams Team towards new model • Participation in teleconferences • Dimissied support to delive our • Attendance at events programme • Expo • Missed promotional oprtunities

Opportunities • Support • Funding • Sharing best practice

Press and Risks of poor engagement Current channels media • Negative media coverage • Media presence at public meetings • Limited understanding of new model of • Pro-active press releases

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care • Features/interviews/case studies • Information sourced from inaccurate • Photocalls and event invites sources • Reactive press statements • Story grows into wider issues • Publications • Twitter Opportunities • facebook • Tell our story • Gather support for new model • Highlighting case studies • Recognition • Raising our profile wider Local Council, Risks of poor engagement Current channels MPs and • PMQ's (Prime Minister’s questions) • Overview and scrutiny committee councillors • Often asked to comment by the media • MP briefings with CEOs / Chairs • Can often cause delay to processes • Invitation to events • Website Opportunities • Press / Media coverage • Ability to publicly support the programme • Political influence • Frequent contact with constituents and the media

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Appendix 5- Action plan

Strategic Stages Objectives Our pledge Key deliverables/ outputs Measures 1. Developing a collective • Identify and analyse our • Establish a database of • Level of challenge to understanding of the current and future key stakeholders that is plans context, scope and stakeholders clearly categorised and • Level of challenge to boundaries of our new • Understand what is managed decision making model of care; and of the important to local people, • Meet/engage with key processes motivations, assets, needs communities and teams stakeholder groups to and constraints of our • Manage and maintain understand what they leaders, teams, local people stakeholder expectations want/need to know and communities • Have a shared • Engage first on the key understanding of how programme areas of things will be different in access, continuity, the future coordination and communication before shaping a full engagement plan to include statuary consultation

2. Supporting our leaders and teams to develop skills, knowledge & confidence to:

a) communicate effectively • Raise the profile of Giving the right • Develop visual brand • Media coverage using common key new care models and information at the • Create partnership • Awareness of messages and information inform key audiences right time board newsletter to programme • Manage reputation cascade to • 360 stakeholder survey • Share successes to Make it easy for stakeholders • Staff opinion survey inspire teams you to get in touch • Develop media • • All vanguard partners with us handling protocol using consistent • Participate in national messages Feedback to you and local awareness • Ensuring that even if it’s difficult events information regarding • Develop sections on new models of care is the partner website for readily available if new models

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needed • Ensure all staff understand their role in the new model of care b) listen to what people say • Patient voice is Listen to what you • Listening events with and understand how to integral to plans of all tell us and take staff and other key share what is heard vanguard partners time to hear what audiences • Staff inspired to lead you’re saying • Report to each and encouraged to partnership Board on shape the future care Recognise and what we have heard model value your • Listening into action contributions events • Staff champions

c) carry out consultation • Listen and share Be transparent in • Engagement plan to be • Audit trail of appropriately and successes our decision developed engagement with inclusively, and involve • Create appropriate making relevant citizens, people and communities in engagement community groups, influencing decision making opportunities with real Recognise and service users etc to though clear, transparent opportunity to value your processes influence for people, contributions review/redesign communities and staff services, inc reported experience of engagement

• Lay involvement at all key levels inc programme leadership, planning & steering groups, redesign/task & finish groups d) facilitate co-production of • Make real changes Recognise and Raise awareness of publics Care plans health and care for person centred value your views on how they want care contributions their care to be Living review of people in • Steps are taken to MDT move towards more Appreciate and Encourage staff to come and more services make better use of forward with ideas for Patients describe changes

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being co designed what we already changes to improve person in their knowledge / ability to and co produced have in our centred care manage their condition(s) communities following introduction of MDT

Self reporting tools such as used by #HelloOurAimIs campaign

PSIAMs Monitor and evaluate • Create an evaluation Work with national team on Staff survey the effectiveness and impact of our tool evaluation tools communications and involvement of • Ensure that patient people and communities in the five voice and lived Ensure that the logic model year journey. experiences form a used to evaluate the key part of the overall programme includes lived programme experiences and patient evaluation experience metrics • Ensure that staff experiences are Create an evaluation matrix reflected in the new for this strategy to monitor model key performance indicators such as media

Keep a log of all activities

OD work stream (project team) Draw out and share learning • Organisations Regular workstream from evaluation and apply it to commitment to the meetings to capture ongoing communication and communication learning across the involvement activities. principles and partnership and feed up to engagement pledges board • working together to use the knowledge Close working with partners and insight they have in Healthwatch to capture to inform the wider public views on programme direction changes

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD

Date of Board: 7 January 2016 Report: Clinical Development Committee Report Agenda item No: 11.1

TITLE OF REPORT: Report of the Clinical Development Committee

This report sets out the main issues considered by the Clinical PURPOSE OF REPORT: Development Committee at its meetings on 18 November and 16 December 2015

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. Over performance noted in relation to increased activity at Royal Orthopaedic Hospital, increased CAMHS activity and increased cost associated with temporary social work assessment capacity, deterioration in performance on delayed transfers of care. 2. Updates received in relation to the Urgent Care Centre and the Community Rapid Response Team. In both cases, recent changes to KEY POINTS: operational performance were likely to result in better delivery of

anticipated QIPP savings.

3. New services models for adults and older adult’s mental health services approved. 4. New service models for diabetes and respiratory services approved. 5. Implications of revised nutricia contract noted. 6. Procurement arrangements for non-emergency patient transport service approved.

That the matters considered by the Clinical Development Committee be RECOMMENDATION: noted

1. Implications in relation to financial performance and the QIPP Programme are identified in the Finance and Performance Committee report. 2. Projected underspend of £62,000 in relation to the GP Prescribing Budget. Projected cost pressure of £145,000 in relation to the FINANCIAL IMPLICATIONS: nutricia contract. 3. Financial modelling work is being carried out in relation to the non- emergency transport contract. In the event that this shows a requirement for additional investment in this contract, a further report will be submitted to Committee.

Some initial engagement has taken place in relation to the proposed new WHAT ENGAGEMENT HAS service model for adult mental health, older adult mental health, diabetes TAKEN PLACE: and respiratory services. Decision ACTION REQUIRED:  Approval Assurance 1 | Page DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 7 JANUARY 2016 REPORT OF THE CLINICAL DEVELOPMENT COMMITTEE

1.0 PURPOSE OF REPORT

1.1 This report sets out the main issues considered by the Clinical Development Committee at its meetings on the 18 November and 16 December 2015.

2.0 BACKGROUND

2.1 The Clinical Development Committee met on 18 November and 16 December 2015. The main items considered are set out below.

3.0 FINANCE AND PERFORMANCE

3.1 The Committee noted a forecast overspent of £1.51 million for 2016/17. The main causes of the deterioration in financial performance were cost pressures associated with increased activity at the Royal Orthopaedic Hospital and the additional cost associated with support for temporary social work assessment capacity.

3.2 In addition, the Committee noted that over performance in relation to CAMHS had increased to £436,000. In the context of increased CAMHS activity the Committee has agreed to increase the value of the grant given to the What? Centre in the sum of £82,000.

3.3 The Committee was concerned about the current performance with delayed transfers of care, where Dudley was in the worst percentile in the country for delays in relation to the social care assessment process. It was noted that a similar situation existed in the CCG’s commissioned intermediate care beds.

3.4 An update was received in relation to the Urgent Care Centre (UCC) and the Community Rapid Response Team (CRRT). Changes to the management of minor injuries and ambulance patients in the UCC were anticipated to lead to further patients being streamed to the UCC. The presence of an ANP from the CRRT in the ambulance control room was expected to lead to increased activity for the CRRT.

3.5 The Committee requested a further report on CRRT performance and the impact of the Malling Health care home service at its January meeting.

2 | Page 4.0 ADULT MENTAL HEALTH AND OLDER ADULTS MENTAL HEALTH – PROPOSED NEW SERVICE MODELS

4.1 The Committee has approved proposed new service models for adults and older adults mental health services.

4.2 Both models are consistent with the CCG’s new model of care with an emphasis being placed on community based services as a means of avoiding the unnecessary use of secondary care.

4.3 Both models will now be the subject of further discussions with Dudley and Walsall Mental Health NHS Partnership Trust.

5.0 DIABETES AND RESPIRATORY SERVICES – PROPOSED NEW SERVICES MODELS

5.1 The Committee has approved proposed new service models for diabetes and respiratory services.

5.2 Both models are consistent with the CCGs new model of care with services being provided either in primary care, by community based teams or within secondary care.

5.3 For both services it is proposed to have an incentive based contract linked to clinical outcomes.

5.4 Both proposals will now be the subject of further discussions with Dudley Group NHS Foundation Trust.

6.0 MEDICINES MANAGMENT

6.1 The Committee has received a report on matters considered by the Prescribing and Area Clinical Effectiveness Sub Committees.

6.2 The primary care prescribing budget is currently predicted to underspend by £62,000. The Committee has noted however, that there is potentially a cost pressure associated with the revised nutricia contract. The Committee has agreed to explore alternative means of procuring this service.

7.0 NON EMERGENCY PATIENT TRANSPORT SERVICE

7.1 The Committee has approved a proposal to enter into a joint arrangement with Wolverhampton CCG for the procurement of a non-emergency patient transport service. The existing contract will expire in October 2016 following the withdrawal of the current service provider, NLS.

7.2 In addition, the Committee has noted a potential liability in relation to additional costs associated with pensions from the original procurement.

8.0 RISK REGISTER

8.1 The Committee wishes to propose that the current risk associated the non-emergency patient transport service be transferred from the Quality and Safety Committee to this Committee. In addition, the Committee wishes to propose that the risk described as “failure to embrace or implement our IT strategy and health care technology could reduce the performance of the CCG” is removed from the risk register on the basis of the extensive work taking place in relation to the use of IT.

9.0 RECOMMENDATION

9.1 That the matters considered by the Clinical Development Committee be noted.

Dr S Mann, Clinical Executive Mr N Bucktin, Head of Commissioning December 2015

3 | Page

DUDLEY CLINICAL COMMISSIONING GROUP BOARD

Date of Report: 7 January 2016 Report: Report of the Integrated Commissioning Executive Agenda item No: 11.2

TITLE OF REPORT: Report of the Integrated Commissioning Executive

This report sets out the main issues considered by the Dudley Integrated PURPOSE OF REPORT: Commissioning Executive at its meeting on 19 November 2015

AUTHOR OF REPORT: Mr N Bucktin, Head of Commissioning

MANAGEMENT LEAD: Mr N Bucktin, Head of Commissioning

CLINICAL LEAD: Dr S Mann

1. The Executive noted the revised financial arrangements agreed by the CCG in relation to the Better Care Fund KEY POINTS: 2. The Executive has considered an analysis presented by the

Commissioning Support Unit following an analysis of integrated

health and social care data. This has identified areas for further examination.

That matters considered by the Integrated Commissioning Executive be RECOMMENDATION: noted

The financial implications of the operation of the Better Care Fund are FINANCIAL IMPLICATIONS: dealt with elsewhere on this agenda.

WHAT ENGAGEMENT HAS No direct engagement TAKEN PLACE:

Decision ACTION REQUIRED: Approval  Assurance

1 | Page DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 7 JANUARY 2016 REPORT OF THE INTEGRATED COMMISSIONING EXECUTIVE

1.0 PURPOSE OF REPORT

1.1 To note the main issues considered by the Integrated Commissioning Executive at its meeting on 19 November 2015.

2.0 BACKGROUND

2.1 The Integrated Commissioning Executive was established in order to oversee the management of the Better Care Fund (BCF). The main items considered at its meeting on 19 November 2015 are set out below.

3.0 FINANCE AND PERFORMANCE

3.1 The Executive has noted the decision taken by the CCG Board at its last meeting to underwrite the performance related element of the BCF. This will require each partner to be responsible for managing any over/ underspends within its element of the BCF, without any risk sharing agreement.

4.0 INTEGRATED HEALTH AND SOCIAL CARE DATA

4.1 The Executive received a presentation from Midlands and Lancashire Commissioning Support Unit on the outcome of a project to integrate health and social care data and identify areas of activity where there may be scope for efficiency gains.

4.2 As a result of this analysis the Executive has agreed to review the following areas in more detail: -

• dementia care • falls • integrated mental health and social care pathways • integrated discharge pathways from secondary care • activity in relation to nursing homes

4.3 The Executive anticipates that these areas of activity will be the main features of the BCF Plan that will be required to be submitted to NHS England as part of the 2016/17 planning process. Guidance on this is still awaited.

5.0 RECOMMENDATION

5.1 That matters considered by the Integrated Commissioning Executive be noted.

Mr N Bucktin, Head of Commissioning December 2015

2 | Page

DUDLEY CLINICAL COMMISSIONING GROUP BOARD

Date of Report: 7 January 2016 Report: Report of the Health and Wellbeing Board Agenda item No: 11.3

TITLE OF REPORT: Report of the Health and Wellbeing Board

This report sets out the main issues considered by the Dudley Health and PURPOSE OF REPORT: Wellbeing Board at its meeting on 2 December 2015

AUTHOR OF REPORT: Mr N Bucktin, Head of Commissioning

MANAGEMENT LEAD: Mr N Bucktin, Head of Commissioning

CLINICAL LEAD: Dr D Hegarty, Chair

1. Reports considered on further actions undertaken to refresh partnership arrangements for children and young people’s services 2. Presentation received on the “Sandwell hub” – an integrated referral KEY POINTS: system

3. Arrangements for the refresh of the Joint Strategic Assessment

process approved 4. The Board’s Terms of Reference and development plan approved 5. Progress reports received on the Vanguard Programme

RECOMMENDATION: That matters considered by the Health and Wellbeing Board be noted

FINANCIAL IMPLICATIONS: None arising directly from this report

WHAT ENGAGEMENT HAS No direct engagement TAKEN PLACE:

Decision ACTION REQUIRED: Approval  Assurance

1 | Page DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 7 JANUARY 2016 REPORT OF THE HEALTH AND WELLBEING BOARD

1.0 PURPOSE OF REPORT

1.1 To note the main issues considered by the Health and Wellbeing Board at its meeting on 2 December 2015.

2.0 BACKGROUND

2.1 The Health and Wellbeing Board met on 2 December 2015 and the main items considered are set out below.

3.0 CHILDREN AND YOUNG PEOPLE’S ALLIANCE

3.1 The Board has received a further report on actions that have been taken to refresh arrangements for partnership working in relation to children and young people.

3.2 The Children and Young People’s Alliance Board to now adopt a vision and identify key health and wellbeing themes for children and young people. These include the creation of a range of training and employment opportunities for children and young people which was considered to be of particular importance.

3.3 The Board noted that the Alliance would now be developing a plan to engage with children and young people, as well as a delivery plan and outcomes framework to monitor agreed activities.

4.0 “SANDWELL HUB” INTEGRATED REFERRAL SYSTEM

4.1 The Board received a presentation on an online referral system available in Sandwell.

4.2 It was noted that this was predominantly for social care referrals and there were clear links between this development and the creation of a single point of access envisaged within the Vanguard Programme.

5.0 JOINT STRATEGIC ASSESSMENT

5.1 The Board to note actions taken to develop the Joint Strategic Assessment.

5.2 A sub-group will be established to manage the JSA process. It was recognised that the intelligence informing this process needed to take proper account of the voice of communities.

5.3 It was intended that the JSA would produce various “products” on particular issues that required addressing through the commissioning process, for example the emotional health needs of young people. It was recognised that it was important to ensure that all partners used this intelligence to inform their commissioning decisions.

6.0 BOARD DEVELOPMENT

6.1 The Board noted the outcome of its last development session and received a revised set of terms of reference, together with an associated development plan.

7.0 VANGUARD PROGRAMME

7.1 The Board received an update on the implementation of the Vanguard Programme. The CCG Board will be familiar with this from other items on this agenda.

8.0 RECOMMENDATION

8.1 That matters considered by the Health and Wellbeing Board be noted.

Mr N Bucktin, Head of Commissioning December 2015 2 | Page

DUDLEY CLINICAL COMMISSIONING GROUP BOARD

Date of Board: 7 January 2015 Report: Report from the Primary Care Commissioning Committee Agenda Item No: 12.2

TITLE OF REPORT: Report from the Primary Care Commissioning Committee

To advise the Board on key issues discussed at the meeting of the PURPOSE OF REPORT: Primary Care Commissioning Committee on 20 November and 18 December 2015

AUTHOR OF REPORT: Mr D King, Head of Membership Development & Primary Care

MANAGEMENT LEAD: Mr D King, Head of Membership Development & Primary Care

CLINICAL LEAD: Dr T Horsburgh, Clinical Lead for Primary Care Primary Care Strategy Implementation • Membership team visits to all practices concluded in December • Two events planned in January to feedback to member GPs – first event with National Lead for GP Development on different organisational models, second event extraordinary membership event to feedback findings and discuss support required by member practices Primary Care Contracting • There are no significant performance issues or contractual breaches • Merge application of St Thomas and Bean Road Medical Practice approved • Proposed functions of NHS England Primary Care Hub considered and accepted by Committee – detailed response provided to NHS KEY POINTS: England • Other contractual changes considered and approved as set out in report New Contractual Framework • Excellent feedback from members, extensive support received including from National Lead for Long Term Conditions • Indicators to be finalised and approved at January Committee Quality • There are no significant quality issues that are resulting in practices breaching their contracts Risk Register • The Committee noted and approved comprehensive updates to the key controls in the register. • There have been no changes to the residual risk scores. • One new risk to be added in relation to junior doctor strike • The Board is asked to note for assurance the issues discussed, RECOMMENDATIONS: and decisions taken by the Primary Care Commissioning Committee

1 | Page • The budgets reported to Committee are showing a year to date FINANCIAL IMPLICATIONS: underspend of £50,000 and an under spend of £80,000 is forecast at year end WHAT ENGAGEMENT HAS None TAKEN PLACE: ACTION REQUIRED:  Assurance

2 | Page DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 7 JANUARY 2016 REPORT FROM THE PRIMARY CARE COMMISSIONING COMMITTEE

1.0 INTRODUCTION

This report summarises the key issues discussed at the Primary Care Commissioning Committee on 20 November and 18 December 2015.

2.0 ITEMS DISCUSSED

2.1 Primary Care Strategy Implementation

2.2 The Committee noted that the CCG has, unfortunately, not been successful in its application to participate in the National pilot announced by NHS England for extended scope clinical pharmacists.

2.3 The CCG continues to pilot extended scope clinical pharmacists in 8 practices and evaluation will be available to the Committee in February 2016.

2.4 Dr Gee, GP Engagement Lead, Dr Horsburgh, Clinical Lead for Primary Care, Mr D King, Head of Membership Development and Mr P Cowley, Primary Care Finance Manager have concluded visiting each practice and GP in Dudley to ascertain their views on the future of primary care.

2.5 The membership team have arranged two events to feedback to member practices following the visits.

2.6 The first event takes place on 13th January and has been organised by the Midland and Lancashire Commissioning Support Unit and Health Services Management Centre in Birmingham. The intention this event is to provide practices with the evidence base for working at scale, and examples of where this is happening elsewhere in the Country. Dr Robert Varnam, Head of General Practice Development at NHS England will be speaking at the event.

2.7 The second event takes place on the 19th January and has been organised the CCG membership team to feedback to practices following the practice visits to discuss the future of primary care. The intention of the event is understand what support the CCG can provide to member practices moving towards operating at scale.

2.8 The Committee received feedback from the Midlands and Lancashire Commissioning Support Unit on the Enhanced Primary Care Development Programme. The first cohort of 8 practices completed the programme in November 2015.

2.9 The full evaluation and proposals for the next cohort of the programme will be available to the Committee in February, but initial feedback suggests that 80% of the support activities were provided on business management and performing as a team, and 20% enabling transformational change.

2.10 The focus of the development programme will therefore need to be considered at the Committee in February with a view to changing the focus to creating capacity and capability to manage change.

3.0 PRIMARY CARE CONTRACTING

3.1 The Committee received assurance from the Primary Care Operational Group (the Group)

3.2 There were no significant performance issues or contractual breaches in any Dudley practice holding a contract for General Medical Services.

3.3 The Committee accepted recommendations from the Group and approved the application to merge St Thomas Medical Practice and Bean Road Medical Practice.

3 | Page 3.4 The St Thomas’s site is closed on 18th December 2015 as a result of the merger. The closure of the site was predicated on the fact that Dudley Council has taken possession of the site at St Thomas’s and were clearing the site, and were unable to offer a long term lease to the practice. Dr Manivasagam and the Council had agreed terms on a short term lease until December. The Committee were assured that the practice had followed statutory guidance and undertaken full consultation, supported by the communication and engagement team at the CCG.

3.5 The Committee agreed not to provide additional transitional support for practices affected by the Minimum Practice Income Guarantee (MPIG) reductions. The practices were receiving tapered reductions agreed by NHS England and there no precedents established in other CCGs.

3.6 The Committee has considered and agreed a response to NHS England on the establishment of a Primary Care Hub. The Committee supported the principle and will be working with NHS England to agree and sign off the detail. The Hub will be set up by NHS England and provide a range of contractual, financial and administrative support to all CCGs across the West Midlands.

3.7 The Committee approved the following contractual changes

3.7.1 The addition of a new partner at Clement Road Medical Practice 3.7.2 The retirement of Dr Sarkar from Bath Street Medical Practice with effect from 31st December 2015 3.7.3 The name change of Netherton Surgery to the Links Medical Practice

4.0 NEW CONTRACTUAL FRAMEWORK

4.1 The Committee received an update on the development of the new indicators and approved that the scheme be offered as a pilot in 2016/17 with a view to commissioning the scheme from 2017/18.

4.2 The Committee approved the following 4.2.1 offer practices the option to receive their QOF value and Local Incentive Scheme (LIS) values based on 2015/16 achievement adjusted for any uplift agreed Nationally 4.2.2 offer the PMS premium on a capitation basis to all practices in addition to the GMS and QOF values as part of the offer 4.2.3 total sum available not guaranteed at this stage given implication of any National changes that are unknown at present 4.2.4 CCG prepares a detailed agreement for use from 1st April 2016 between the CCG and the pilot practices

4.3 The membership event on the 10th December 2015 was given over to presenting the indicators developed, EMIS templates, financial principles and questions and answers. The feedback from the event was very positive. The membership team have set up an event for small practices on the 19th January 2015 to explore the potential of collaboration in delivering the access components.

4.4 The Committee will receive a paper in January 2016 to sign off the final version of the indicators and timescales for implementation.

5.0 QUALITY

5.1 The Committee noted that there are no quality issues that are resulting in practices breaching their contracts.

5.2 The Quality and Safety report to the Board will set out in more detail those areas and issues pertinent to primary care.

6.0 FINANCE

6.1 The Committee received a report setting out the revenue allocation, financial reporting arrangements, payment processes and risks.

4 | Page 6.2 The budget has been increased by £1,000,000 to reflect the non-recurrent allocation to support winter pressures in primary care.

6.3 The budgets reported to Committee are showing a year to date underspend of £50,000 and an under spend of £80,000 is forecast at year end.

6.4 The Committee approved the detailed working arrangements that will be carried out by the Primary Care Hub of NHS England

8.0 RISK REGISTER

8.1 The Committee approved significant updates to the key controls following a thorough review of all the risks.

8.2 The Committee agreed to add a new risk in relation to the risks associated with the Junior Doctors strike and the implication on the delivery of general medical services

9.0 RECOMMENDATIONS

9.1 The Board is asked to note for assurance the issues discussed, and decisions taken by the Primary Care Commissioning Committee on 20 November and 18 December 2015

Mr D King Head of Membership Development and Primary Care January 2016

5 | Page

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 NHS 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 BSCCP British Society of Colposcopy and Cervical Pathology CAB Citizens Advise Bureau 1

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 CRRT Community Rapid Response Team CSSD Central Sterile Services Department CT scan Computer Topography CQNO Chief Quality and Nursing Officer 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 DGFT Dudley Group Foundation Trust 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 Healthcare Associated Infections 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 PCCC Primary Care Commissioning Committee 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 6

QOF Quality and Outcome Framework 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 TTO To Take Out UCC Urgent Care Centre 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 7