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Cannock Chase CCG Governing Body Meeting (IN PUBLIC) to be held on Thursday 4th February 2016 14:00 – 16:00 at the Aquarius Ballroom and Banqueting Suite, Victoria Shopping Park Hednesford WS12 1BT
AGENDA A=Approval R=Ratification D=Discussion I=Information Enc Lead A/R/D/I 1. Welcome by the Chairman Verbal MH I 2. Apologies for Absence Verbal MH I 3. Quoracy Verbal MH I 4. Declaration of Conflicts of Interests Enc. 01 MH I Minutes of the last Meeting & Actions 5. Enc. 02 MH A 5th November 2015 6. Chair’s Report Verbal MH I 7. Chief Officer’s Report Enc. 03 AD I 8. Quality Report Enc. 04 HJ I 9. Performance Report Enc. 05 CB I 10. Board Assurance Framework (BAF) Enc. 06 SY D 11. Finance Report Enc. 07 PS D/I Medicines Optimisation 2016/17 QIPP 12. Enc.08 SR I Schemes Overview Joint Communications & Engagement 13. Enc. 09 SY R Strategy Commissioning Support Unit – Lead Provider 14. Enc. 10 PS A Framework 15. Items for information Finance, Performance & Contracts Enc. 11 MH I Committee Minutes 22/09/15 & 20/10/15 16. Glossary of Terms Enc. 12 MH I 17. Any Other Business Verbal All I 18. Questions from members of the public Verbal All I Date of Next Meeting in Public: Thursday 3th March 2016 (14:00 – 16:00) The Aquarius Ballroom, Hednesford
Declarations of Interest Register for Cannock Chase Governing Body
Name Position/Role Designation Potential or actual area where interest could occur
Neil Chambers Lay Member for Cannock Chase Non Exec Board Member Wyre Forest Community Governance CCG Housing Group Andrew Donald Chief Officer CC & SaS CCG Spouse - Chief Operating Officer North division Staffordshire & Stoke on Trent Partnership Trust. Chief Officer for Cannock Chase and Stafford & Surrounds CCGs Chief Officer for South East Staffs and Seisdon Peninsula CCG Gary Free GP Cannock Chase Berrifree Limited CCG GP First & Holding Company Red Lion Surgery Paul Gallagher Lay Member for Cannock Chase Chair IFR (individual funding request) PPI CCG Chair NHS England Performers List Decision Panel
Dr Mohammed Chair Aelfgar Surgery Partner Aelfgar Surgery Huda GP Practice registered with GP First AQP Provider for Ultrasound scans and Hearing Aid Chair Educational meetings for various PHARMA companies Heather Director Quality South East Works for East Staffs CCG Johnstone & Safety/ Chief Staffordshire and Convenor for: Nurse Seisdon Peninsula Cannock Chase CCG, South East Staffordshire & CCG Seisdon Peninsula CCG and Stafford & Surrounds CCG Dr Anna GP Nile Practice Partner at Nile Practice Onabolu Member of Lions Club International, Castle Bromwich (not related to NHS Contracts) Spec Savers use practice Training practice for GPs Ultrasound diagnostic work Practice member of GP First
Doug Secondary Care CC & SaS CCG No direct connection Liaison with various Robertson Consultant organisations in NHS role. Honorary lecturer at Warwick University Medical School. Employed by Mid Cheshire Hospitals FT as Consultant Physician and Associate Medical Director. Small research interest – Grants go through Sandwell research fund. Secondary Care consultant for North Staffs CCG, South East Staffordshire & Seisdon Peninsula CCG and Stafford and Surrounds CCG Has received Educational Grants in 2015 from Novo Nordisk Ltd and Sanofi Aventis Paul Simpson Director of CC & SaS CCG Working across Cannock Chase CCG, South East Finance Staffordshire and Seisdon Peninsula CCG and Stafford and Surrounds CCG
January 2016 Page | 1
Declarations of Interest Register for Cannock Chase Governing Body
Name Position/Role Designation Potential or actual area where interest could occur
Mukesh Singh GP Horsefair Practice Participate in OOH Cover GP Trainer, West Midland Deanery GP First Dispensing Practice Surgery Branch site is site where AQP Ultrasound performed by Diagnostic Health Practice Clinical Tutor, Keele Medical School CC CCG Clinical Lead for LTC, Unplanned admissions & Paediatric services Delivers non-promotional Pharma companies sponsored educational lectures to Health Care Professionals
Janet Toplis Lay Member Cannock Chase Vice Chair of Adoption Panel for Walsall Borough (Non Statutory) CCG Council Chair of Governors at Cheslyn Hay Primary School Independent Social Work Consultant Chair of Primary Care Co-commissioning Committee.
Paul Lay Member Cannock Chase PEW Consultancy Limited Woodhead (Non Statutory) CCG Practitioner - Tutor De Montfort University Faculty of Health and Life Sciences Chair of Governors - St Peter's C of E (VC) Primary School, Hednesford Consultant through PEW Consultancy engaged by Staffordshire County Council via Entrust Support Services Ltd to support Governor development with the County Parent Governor Representation of Staffordshire County Council – Prosperous Staffordshire Select Committee Member Staffs School Forum Presenter on Cannock Radio Local Party Co-ordinator for the Green Party in Cannock Chase PEW Consultancy also engages in Environmental & Waste Consultancy services for a private client base principally through Albion Environmental Ltd
January 2016 Page | 2
Declarations of Interest Register for Cannock Chase Governing Body
Name Position/Role Designation Potential or actual area where interest could occur
Non- voting – In attendance Ian Baines Director of South East Staffs Working across Cannock Chase CCG, South East Transformation CCG Staffordshire and Seisdon Peninsula CCG and Stafford and Surrounds CCG
Chris Bird Associate South East Staffs Working across Cannock Chase CCG, South East Director of CCG Staffordshire and Seisdon Peninsula CCG and Performance Stafford and Surrounds CCG
Adele Communications Midlands & Works for MLCSU Edmondson & Engagement Lancashire CSU Working across Cannock Chase CCG, and Stafford Manager and Surrounds CCG.
Lynn Millar Head of CC & SaS CCG Working across Cannock Chase CCG, South East Strategic Staffordshire and Seisdon Peninsula CCG and Change Stafford and Surrounds CCG
Sally Young Head of CC & SaS CCG Working across Cannock Chase CCG, South East Governance Staffordshire and Seisdon Peninsula CCG and Stafford and Surrounds CCG
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Cannock Chase CCG Governing Body Meeting in Public
Thursday 5th November 2015 2.00pm – 4.00pm Aquarius Ballroom and Banqueting Suite, Victoria Shopping Park, Hednesford WS12 1BT
Members: 07/05/15 04/06/15 03/09/15 05/11/15 04/02/16 03/03/16 Quoracy Quoracy Dr Mo Huda (MH) Chair CC CCG Andy Donald (AD) Chief Officer Paul Simpson (PS) Director of Finance and Deputy Chief Executive Val Jones (VJ) Director of Quality & Safety & Board Nurse Heather Johnstone (HJ) Director of Quality & Safety Dr Tim Berriman (TB) Clinical Leader Leaders Dr Gary Free (GF) Clinical Leader Dr Anna Onabolu (AO) Clinical Leader Clinical Clinical Leaders Dr Mukesh Singh (MS) Clinical Leader Doug Robertson (DR) Secondary Care Consultant Paul Gallagher (PG) Vice Chair & Lay Member for PPI at leastmember 2 and one lay at least 5 Voting Members including Chair/Vice Chair/Vice including Members 5 Voting Neil Chambers (NC) Lay Member for Governance Chair,Chief officer/Chief Officer, Finance Paul Woodhead (PW) Lay Member – Non-Statutory Janet Toplis – Lay Member Non-Statutory Dr Peter Gregory (PGr) – LMC Observer In attendance: Sally Young (SY) Assistant to the Chief Executive Lynn Millar (LM) Director of Primary Care Gill Hackett – Minutes (GH) Executive Assistant Adele Edmondson (AE) Comms & Engagement Jonathan Bletcher (JB) Director of Strategy & Collaboration Rob Lusuardi (RL) Director of Operations Chris Bird (CB) Director of Performance Mark Seaton (MS) Alex Bennett (AB) Director of Performance Laura McGarvie (LMcG) Minute Taker
Action 1.0 Welcome The Chair welcomed all members and public to the meeting.
2.0 Apologies Jan Toplis, Rob Lusuardi, Lynn Millar
3.0 Quoracy MH confirmed that the meeting was quorate.
4.0 Declaration of Conflicts of Interest
Action All Governing Body Members confirmed no conflict of interest in relation to items on the Agenda.
However, conflict of interest was noted for all GPs should GP First related items arise.
HJ declared that she also covered East Staffordshire CCG
5.0 Minutes of the last Meetings - Thursday 3rd September 2015 The minutes of the last meeting held on Thursday 3rd September 2015 were AGREED as a true and accurate record of the meeting.
Actions List Actions were noted on the Actions List
6.0 Chair’s Report – Verbal Update MH gave an update on the Stay Well this winter campaign and the services that were in place for this winter.
MH explained that other parts of the campaign focused on keeping warm, heating the home to around 18 degrees, and if patients start to become unwell with cough or cold to get help from pharmacists.
MH explained that Cannock Chase CCG did well on the flu program last year from being one of the worst to one of the best, by working together in the 3 Networks. MH explained that the practices started their programme in mid-September and were hoping to do as well as last year; regular updates on progress would be forwarded to practices to advise them of their progress.
MH advised that Pharmacists were providing, through NHSE and Cannock Chase CCG, the Common Ailments Scheme where various common problems such as coughs and colds, mild acne and mild eczema, allergies cold sores etc. could be supported by the pharmacists. He explained that this service commenced in October 2015 and would be available until the end of March 2016 at some local pharmacists. MH confirmed that this was being advertised at local surgeries and pharmacies.
MH confirmed that a 3rd car had been secured for the Acute Visiting Service, and that it would also be available between 1.00pm and 7.00pm. He explained that the service was for any patients who call the practice after 1.00pm who require an urgent visit where they would normally have called 999. MH advised that the extra car would support those who needed help and ensure those who need hospital intervention get it or those who can be managed at home get the necessary support
MH advised that the Prime Minister’s Challenge pilot for Cannock Town had been received very well and feedback was good from patients who have expressed an interest in the service being available after 31st March. MH confirmed that the pilot would be evaluated regularly and the CCG would then decide if it would be worth continuing the service long term as well as considering if this could be replicated in other localities within Cannock Chase CCG.
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PG wished to give his thanks to SY and the Comms Team on the flu advertising across the local surgeries and website.
PW asked if there was an increase on patients being seen at the moment. MH responded that there was a validation being carried out at the moment. AD also advised on Cannock’s activity and that emergency admissions were down. MH confirmed that there were less people going to A&E than planned. MH also advised that on 1st April there would be a need to evaluate the costs involved and obtain a clear indication from GPs on how this pilot was working, whether it was good quality and whether it was financially sustainable.
DR asked if there were means of getting patient level data. CB agreed that to look at the total numbers from each of the catchment areas and the admitted patients, we could get a feel as to whether it worked or not.
AO mentioned the Cannock town pilot to release the time for GPs and asked if this could also be extended to other networks.
ACTION: NC asked for a brief paper giving the dates and information LM behind the AVS.
The Governing Body RECEIVED and NOTED the Chair’s report 7.0 Chief Officer’s Report Haematology Consultation AD advised that the Consultation had been extended for two weeks in order to ensure all current users had been contacted.
AD confirmed that the Consultation events had gone very well in both Stafford and Cannock. PG agreed that all of the issues raised at the meetings were genuine. AD also stated that a Report would be compiled on consultation feedback and that this would be presented to both the Cannock and Stafford Governing Bodies early in December 2015.
Resilience Planning for winter – AD stated that although it was still warm at the moment, systems and services for patients during the winter period had been put in place.
AD advised that County hospital was still maintaining the 4hrs in seeing patients.
AD also advised that there were concerns about elective care (incompletes) and that the number of patients were increasing which the CCG was monitoring.
Joint Working across the three CCGs AD stated that he had now been working across the 3 CCGs for 93 days and that performance had not been lost in this time. He also confirmed that the single Management Team was working well.
AD advised that an event had been held last week which had been
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Action attended by 98 people across 3 CCGs. The outcomes were being written up and an action plan developed.
AD advised the Board that if the CCGs integrated, we would continue to maintain the local focus. However, the Clinical Chairs had been asked to raise the question with GPs through the Membership Board, although nothing would happen until April 2017. AD confirmed that this would be a clinical and Governing Body debate, but he had opened up the organisations to think about this possibility.
PG questioned that perhaps the CCG might lose identity. AD advised that locality offices had been created in order to keep a focus on locality.
Staffordshire Transformation AD confirmed that work on the Transformation was starting to gain pace and that a bridge for the Transformation across to the CCGs would be in place by the end of the month.
Performance Matters AD advised the Board that he had reviewed all three CCGs performance across all standards and advised that CB would go into more detail during his presentation.
AD advised that he was leading on planning for 2016/17 which would be brought to Governing Body in due course to show what the CCG would spend money on next year.
NC asked if there would be a take-over/merger and whether we were required to make them happen rather than for the better. AD advised there is no political requirement to do this and that it was for the Governing Body and Clinicians to decide and debate any restructuring.
NC stated that with regard to the Transformation, he did not feel that he had learnt a lot from Rita Symons during her visit to the Governing Body. AD advised that the Transformation Director that would be the bridge between the CCGs and the Transformation Programme.
ACTION: Notes from the OD session in October to be circulated to all GH members who were unable to attend.
AD spoke about the petition that had been received in June at the Governing Body and explained that of the 63,000 names on the petition, only 5,000 were found to be within the CCG’s area. He confirmed that the letter stated that it was all 4 CCGs and not just Cannock Chase CCG. AD also mentioned that he had explained in the response that we were not privatising the service and the money was being spent to integrate the provision of the providers to work better together on improving lives.
The Governing Body RECEIVED and NOTED the Chief Officer’s report. 8.0 Quality Report HJ updated the Governing Body of the quality issues and matters relating to health care services commissioned by the CCG. HJ explained that the information and reports related mainly to the month of October with some yet to be validated data for September.
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1. The RAG rating for UHNM County Site remains AMBER to reflect the overall RAG rating from the CQC report which was “Requires Improvement”. However, the Trust site continues demonstrate no safety concerns. The Trust action plan following the CQC visit has been shared with Commissioners for comments. 2. The RAG rating for UHNM Royal Stoke Site remains AMBER/RED to reflect the CQC rating. Although, this month has seen a decrease in C. Difficile, it remains above trajectory for the year. Friends and family In- patient scores remains high, but FFT in A & E remains lower than neighbouring Trusts. 3. The RAG rating for SSOTPT remains at AMBER which reflects the Trusts developing openness in regards to workforce and the cooperation with the DN focus groups across South Staffordshire.. The Trust has now reached its annual C. Difficile trajectory (10) at month 5 and were working with Commissioners on actions taken to reduce incidences. 4. The RAG rating for SSSFHT has been escalated to GREEN/AMBER to reflect the mixed sex breaches in a ward area. HJ explained that there had been no further updates from the unannounced visit to 3 wards in June 2015. 5. The RAG rating for BHT remains at GREEN and would be reviewed post quality summit. However, there appears to be no quality & safety concerns and the mortality measure remain stable with additional assurance from the Trust Medical Director on a weekly basis. 6. The RAG rating for RWT remains at AMBER to reflect the cancer breaches which are higher in urology, but the Trust have revisited their action plan to reflect the problem they are experiencing recruiting a consultant urologist 7. The RAG rating for WHT remains at AMBER as the Trust continues to report EMSA breaches in their high dependency unit. Their inpatient response rate remains high; however their response rate for A & E is at its lowest. 8. The RAG rating for the NHS 111 Service is GREEN as there are no immediate quality and safety concerns. Commissioner recognise the unintended consequence of trying to reduce ambulance dispatches and its impact on the call backs within 10 minutes
In addition to the general day to day work that the team do there is a lot of CQC work that has also been done.
HJ explained that C.Diff was a major challenge at the moment with all providers. However, Walsall hospital was achieving the C.Diff and the Quality Team would be finding out what they were doing in order to share with other providers.
PG stated that he felt that the Lay Members had received assurance when they were also involved in visits and whether these would continue. HJ confirmed that the visits would continue and would find out why the Lay Members had not been included more recently.
NC asked about the NHS111 service and whether there were any statistics
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Action on callbacks and whether there could be a separate item or report on the success or otherwise on the action points. It was agreed that a separate item could be put on the agenda and perhaps someone from NHS111 could come to the Governing Body to update them. PG advised that the Quality committee had already asked for this.
3.00pm MS arrived
HJ advised that the first CQRM with NHS111 would be taking place on Monday 9th December and would also include the OOH service in order to gain experience for both.
The Board NOTED the contents of the report. 9.0 Performance Report CB presented the report and the following points were noted:
Performance measures not achieved in August 2015: 18 week referral to treatment – 88.8 %, YTD 91.2% (Target 90%) Diagnostic 6 week wait – 98.7 %, YTD 97.9% (Target 99%) A&E 4 hour wait – 93.8%, YTD 93.4% (Target 95%) Cancer waits o 2 weeks Breast Symptom Referral – 79.4%, YTD 90.3% (Target 93%) o 31 day subsequent surgery – 92.3%, YTD 90.6% (Target 94%) o 62 day urgent GP referral – 81.0%, YTD 76.0%, (Target 85%)
Ambulance Category A calls resulting in an ambulance arriving at the scene within 8 minutes o Red 1 – 73.3%, YTD 74.9% (Target 75%)
18 weeks Changes to operational guidance in July 2015, applied retrospectively to 1st April 2015 mean CCGs cannot raise performance sanctions for 18 week admitted and non-admitted targets Remaining 18 week target, Incomplete Pathways of no less than 92%, remains in place and has been achieved Diagnostics 14/1098 patients waiting 6 weeks or more. 8/14 at UHNM, 5/8 are non- obstetric ultrasound. RAP in place although delivery dates for improvement have now passed. Will be raised at next UHNM Contract Review Board A&E waiting times Performance at County has been above 95% for 20 days during September, with 5 days breaching in one week.
UHNM – CB advised that a performance query notice had been served and a remedial action plan is currently in development.
Cancer 2ww (Breast Symptoms) – 7/34 patients treated after 14 days 3/7 UHNM – this equates to 50% performance and all 3 were seen within
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Action 16 days. 4/7 RWT – this equates to 84% performance, 1 patient seen within 16 days, 2 within 21 days and 1 within 28 No specific RAP but does form part of wider Service Improvement Plan and Cancer Joint Investigation
62 day standard – 4/21 patients treated after 62 days 2/4 UHNM and 2/4 RWT – all 4 treated within 90 days. UHNM have submitted Service Improvement Plan in response to national requirement through NHS England. This was rejected on the grounds that activity and recovery trajectories did not align and there was a lack of clinical leadership and SRG engagement. A resubmission is due in October 2015. RWT are delivering the 62 day standard at Trust level although performance is being actively monitored.
31 days – very low patient numbers. Aug – 1 patient not seen in 31 days.
Ambulance CB explained that although WMAS had not delivered the red 1 target for Cannock Chase CCG, it continued to deliver at a reasonable level. He advised that there was a remedial action plan in place and the local divisional meeting was working with WMAS on path finders to reduce the need for conveyance, which would free up ambulance capacity and support delivery of the standard. CB confirmed that WMAS remain one of the best performing ambulance Trusts nationally, however, the CCGs continue to raise their concerns with the Trust around local performance.
NC mentioned that with the referral to treatment there were 21 providers and asked if these were Choose and Book or just based on GP knowledge to send patients to any one of them. MH advised that it was down to the specialities from each provider.
The Governing Body therefore NOTED those areas where the current performance rating is below target and the remedial actions being taken to improve performance and mitigate risk. 10.0 Board Assurance Framework SY updated the Governing Body members on the Board Assurance Framework and the following was noted:
SY gave assurance to the Governing Body that the principle risks that could threaten the delivery of the CCG’s strategic aims/objectives, were being monitored and mitigating actions were being taken to reduce any threat.
NC explained that the Audit Committee had gained assurance from calling individual officers to explain their position within the risk register.
AD asked if the Audit Committee was happy with the way in which the register was being dealt with. NC agreed that there was an improvement on the risk register.
SY advised the SES-SP also had a Risk Group and would be bringing together a Joint Group at the beginning of December 2015.
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Action NC commented that there had been very positive feedback on the way the Comms & Engagement was now being received. PG confirmed that he had also received positive feedback from members of the public on the CCG’s Comms & Engagement.
The Board therefore NOTED the contents of the report. 11.0 Finance Report PS advised on the current financial status and explained that the paper provided the Governing Body with the financial position of Cannock Chase CCG for Month 6 of the financial year 2015/16, covering the period April to September 2015, which showed; Year to date underspend of £20k Assessment of risk to the delivery of the £6,377k deficit control total Assessment of delivery of the QIPP target.
PS advised that there were some overspends on CHC, prescribing and patient transport. PS advised that there were specific actions for each member of the EMT to ensure the pressures were mitigated as much as possible. He also explained that the QIPP programme in Cannock was performing well and that overall the position remained positive.
Financial Deep Dive PS advised that the letter received from NHSE was a summary of the meeting that had been held in September. PS confirmed that there was a significant regional and national issue of the financial position of the NHS as a whole.
PS reiterated that CC CCG was very much ahead of the curve. PS advised that there was a meeting with the Area Director at the end of this month and that JB had done a large amount of work for this meeting on a detailed financial plan for the CCGs together with evidence in our ability to achieve the control total.
NC – asked about the QIPP programme (appendix 5) and whether there was anything going on to reverse the admission avoidance figures. AD advised that there should be changes in the figures for admission avoidance which would show in the next few months.
AD advised that the CCG were predicting they would over perform on QIPP.
The Board therefore NOTED the contents of the report. 12.0 CCG Assurance Framework 2015/16 CB explained that NHS England had a statutory duty to conduct a performance assessment of each CCG and that it discharged this duty through the assurance process and for the 2015/16 year there would be a shift in emphasis to bring a sharper focus onto a CCGs record of performance and the improvements for patients.
CB explained that the new framework would have five domains:
1. Well-led organisation 2. Performance
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Action 3. Financial Management 4. Planning 5. Delegated Functions (Primary Care Co-Commissioning)
NHS England would draw upon a number of information sources to inform the assurance process and form a judgement from one of four outcomes:
1. Assured as outstanding 2. Assured with support 3. Limited assurance, requires improvement 4. Not assured
CB explained that Page 3 of the report provided more detail on these judgements and then went on to explain the actions available to NHS England for those CCGs assessed as needing support and/or intervention.
CB confirmed that the 2014/15 Assurance Framework had indicated that Cannock Chase CCG needed improvement.
Alongside the four assurance categories NHS England may apply a new ‘special measures’ regime designed to address persistent and chronic performance challenges, financial challenges and/or governance difficulties due to the CCGs lack of capacity and capability to provide leadership to deliver sustained improvement. The application of special measures would usually result from issues that have persisted over a period of two quarters although the trigger would be NHS England’s judgement as to the extent of the grip the CCG was able to demonstrate over the situation
The Governing Body NOTED the contents of the report. 13.0 Items for Information Finance Performance & Contracting Minutes 21/07/15 Audit Committee Minutes 22/07/15.
The Governing Body NOTED the minutes for information 14.0 Cancer & EOL Programme Update JP gave an update to the programme and advised that we were now in the procurement process. JP gave a brief reminder as to what the programme was doing. JP advised that there were low survival rates for cancer in the Cannock locality. JP advised that procurement had gone out for 2 separate services, one for cancer and one for EOL, which was based on an outcomes based contract for the best outcomes for the patients.
JP advised the Board that a number of roadshows had been held throughout the area during September, where patient champions were involved in meeting members of the public. She explained that they had established a Patient Champions Network in the south of the County two months previously that meet at Cannock Leisure Centre. JP also explained that they were working on public engagement with Macmillan and GP facilitators but needed more clinical engagement in the south of the County. She advised that Johnny McMahon had joined the Programme in June to lead on this.
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Action JP advised that a Cancer strategy had been published and was ahead of the curve in terms of the work that was taking place.
JM then explained that Lay Member involvement was inspiring and would develop further as the programme continued. JM explained that last month, an event for Primary Care to meet the Bidders had been held in Stafford and confirmed that there had been significant GP input from all GPs across the areas. JM advised that they had had competitive dialogue with the bidders this week. The Board were notified that there would be a update to the Membership Board on 8th December.
JM asked AD about the bridge with Transformation and asked where the CCG saw the bridge for the Cancer & EOL programme. AD explained that JP should speak with Rita Symons as the Cancer and EOL Programme was part of the Transformation programme.
JP said they were keen on having patient involvement in contract discussions with service integrators and therefore holding them to account. JP asked the Board if the Lay Members of the programme could shadow the CCG Lay Members and to accompany them to committee meetings.
NC recounted his experience over the past 12 months and explained that there was a long waiting list for hospice care. NC asked if efforts were being made to promote the fact that the patients and carers were redesigning the process and what progress was being given to the patients and carers who have applied for this. AD advised that the Pioneer Programme that came to Stafford showcased the people that received the care and not the carers. AD emphasised that it was not the care, but the system in which we worked and that we needed to change the nature of the system.
PG advised that he believed that the group in the south was now growing within the PPI and had received constructive feedback.
AD advised that there would be people going into local supermarkets where members of the public could tell them of their experiences of the system. AD also advised that most of the money that went to hospices was mainly voluntary.
JP advised the Board that the feedback facility with the messaging on the website had been changed.
DR mentioned that we would need to share learning from the Staffordshire Transformation Programme. JP advised that they were committed to publishing reports by April 2017.
The Governing Body NOTED the update for information 15.0 Glossary of Terms The Glossary of terms were noted for information.
16.0 Any Other Business
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Action There being no further business, the Chair closed the meeting and members of the Public were engaged in questions.
17.0 Questions from the Public Brian Gamble mentioned about the organisation in general, with the three roles of AD, movement towards a larger combination of the three CCGs and the failure rate of reorganisation in the past. AD responded that the unification across the three CCGs was only for more efficient working across the CCGs. AD also advised that there would be a debate in the public as well. Brian agreed that locality was quite a precious issue across the areas and that the CCG would need to make sure that people’s identity was not lost.
Johnny McMahon said that it seemed that the CCG would be in a cost neutral position in 2016/17 and if there was to be a merger, SES-SP CCG was not in the same financial position. AD advised that each of the three CCGs would help each other to reach their total. PS also advised that SES-SP CCG was some way away from the level of funding that it currently received and that was the reason why they were in so much deficit.
18.0 Next Meeting – Organisational Development Date: Thursday 3rd December 2015 Time: 2.00pm – 4.00pm Venue: Maple Suite, Yarnfield Park, Yarnfield Lane, Yarnfield ST15 0NL
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Item: 05 Enc: 02-2
CANNOCK CHASE CCG GOVERNING BODY MEETING LIVE PUBLIC ACTION LIST
MEETING Responsible Outcome/update AGENDA ITEM REFERENCE Action DUE DATE (Completed Actions remain on the Action List for the following FPC and are then DATE Officer removed to the 'Completed' Worksheet) 05.11.2015 Chair's Report 6 NC asked for a brief paper giving data and information on the AVS Feb-16 LM Chief Officers Report - Performance Notes from the OD session in October to be circulated to all members who were unable to 05.11.2015 7 Dec-15 GH COMPLETED - presentation distributed Matters attend. 03.09.2015 Finance Report 11 Foreword note at Month 7 to be captured Nov-15 PS 05-11-15 ONGOING to be completed by next meeting. Spending review on It was suggested that perhaps there should be some Q&A on the website around the 25th November. This could then be published on the website. Currently being 04.06.15 Finance Report 10 Jul-15 PS/Comms expenditure from the NHS - Comms developed. PS updated that the comms team are leading and PS/DR will chase up.
X:\CCG\Cannock Staffs and Surrounds\Corporate\Governance\Mtgs ‐ Leg Require\01 CC GB\2015‐16\11. 04 February 2016 ‐ PUBLIC\Public\Enc 02‐2 CC CCG PUBLIC Actions List ‐ 05 11 15 1 of 1 Item: 07 Enc: 03
REPORT TO THE Clinical Commissioning Group Governing Body Meeting TO BE HELD ON: Thursday 4th February 2016
Subject: Chief Officer’s Report Board Lead: Andrew Donald Officer Lead: Andrew Donald For For For For Recommendation: Approval Ratification Discussion Information
PURPOSE OF THE REPORT: To update Governing Body Members on:-
Winter Personal Medical Services Reviews Dementia Pilot Planning for 16/17 Staff Briefings Organisational Development Staffordshire Transformation Programme
KEY POINTS: Introduction As we move into the last quarter of the year not only are we focused on delivery the requirements of the CCG in 15/16 but the CCGs are also now firmly into planning for 16/17. Much work has already been undertaken in anticipation of the planning guidance.
The delivery of the control total for 15/16 continues to be the priority for the CCG as it puts the organisation in a good position for 16/17 and maintains the credibility of the organisation with regulators. Performance overall is generally fair but as we move through winter we may see a deterioration in some areas of performance and we need to mitigate against that as much as possible.
The integration of management teams and the working arrangements are generally working well. There are still gaps in key areas that need to resolve. Staff are working incredibly hard and the expectations on them at times are of concern.
There is still a disconnect between the work of the CCG and the understanding of the
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membership about what the CCG is about and what it is trying to achieve on the members behalf and the CCG management team need to keep working on this in support of the Chairs.
The following describes some specific matters of note for Governing Body Members.
1.0 Winter Not surprisingly the system has come under increased pressure in the early part of January 2016. The preparation for this period has been better than last year with the level of hospital beds available in line with the expected demand. The surge in the first week in January 2016 is no different to other parts of the country but the effects were i.e. a number of twelve hour breaches on the 4th or 5th January when compared to elsewhere was unusual.
The CCG continues to work with the Providers to mitigate the risks of 4 and 12 hour breaches and has spent a significant amount of time working on-site at the County to help alleviate the pressures where possible.
As Chief Officer I have held regular discussions with the Chief Executive of UHNM on this matter ensuring we are supportive as well as challenging.
The CCG remains vigilant and is working with its providers to put in place standard operating procedures to ensure patients who are Medically Fit for Discharge are able to be discharged from Hospital appropriately.
2.0 Personal Medical Services Reviews The CCG has recently been made aware by Practices of correspondence received by them with regards the proposed changes to Personal Medical Services Contracts from the 1st April 2016.
The CCG is aware of a number of concerns from Practices about the above for a number of reasons and the Local Medical Committee has requested an urgent discussion with NHS England and Clinical Commissioning Groups on this matter.
The CCG as co-commissioner is conscious of the need to implement this national policy but also wants to ensure the stability of Primary Care provision.
3.0 Dementia Pilot The Dementia Pilot commenced in 2014 and was commissioned through South Staffordshire and Shropshire Healthcare Foundation Trust. This pilot was jointly funded by Commissioners and the main Provider. The Trust sub-contracted the Primary Care element of the work to GP First (GP Provider Federation) and they worked alongside Palliative Care Solutions.
A significant amount of learning has been gathered from this pilot. However, there have also been elements that haven’t worked and this has been subject to discussions at the Membership Board on a regular basis.
The pilot came to an end in January 2016 and this has caused significant disquiet in the membership as this was work that GP First had been undertaking. The pilot came to end as Commissioners did not have support from all the partners to continue even though the CCG would have been content to fund the continuation until 31st March 2016. This led to the CCG having to develop transitional arrangements to ensure the patients had access to a service that was safe and appropriate. This had been in place since the beginning of the year.
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Work is underway to ensure the new specification for this service is in place by April 2016 and that the commissioning of that specification is now a priority.
4.0 Planning for 16/17 The attached slides set out the main points of the planning guidance.
The key points to note are that:- There are no new requirements on the NHS in 16/17 Delivering a stable system is the key message Allocations are above what was original planned for in the CCGs medium term financial plan There is a Health Economy wide Sustainability and Transformation Plan (STP) produced and signed off by July 2016
The management team are working through the implications of the guidance and the allocations which will be subject of further paper during March 2016.
5.0 Staff Briefings I have conducted three staff briefings during January 2016 at these briefings I went through the planning guidance, final process for full integration of the management teams and the proposed revision of accommodation that is underway.
These briefings will continue throughout 16/17 and will dovetail with the work on organisational development that has now been developed.
6.0 Organisational Development As Governing Body members will be aware the initial Organisational Development Plan was signed off prior to Christmas. This plan is now being enacted; alongside this the CCGs are planning a number of events for Clinicians, Staff, and Lay Members over the next few months. This work is being co-ordinated through the CCGs Management Team, in conjunction with the Midlands and Lancashire CSU and Julie Beedon Director of Tricordant who specialise in support organisations to develop into high performing organisations.
Ian Baines Director of Transformation will lead this work with partners.
Other Organisational Development work is on-going with specific programmes involving GP groups, reflecting the membership across the three CCGs.
7.0 Staffordshire Transformation Programme The Staffordshire Transformation Programme continues to make steady progress in developing its infrastructure and Case for Change.
A number of Governing Body members have expressed a level of concern that they are unsighted on the programme and its developments.
During the next few weeks the programme will be sending to CCGs the case for change document and this will detail the size of the challenge and the plans for address that challenge. This document will go to all Governing Bodies for debate, discussion and sign-off over the next two months.
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It is important to remember that transformation takes time and although the programme is tasked with ensuring clinical and financial sustainability in the long-term, the benefits to organisations may not start to be seen until the end of 2016 into early 2017. This means that the CCG will need to ensure local deliver of its QIPP programme to achieve its objective of financial balance by the 31st March 2017.
RELEVANCE TO KEY GOALS To reduce health inequalities across Cannock Chase through targeted interventions. To identify and support patients with Long Term Conditions to ensure care delivery closer to home. Not Applicable
To improve and increase overall life expectancy. To develop integrated services with simple, easy access.
IMPLICATIONS Legal and/or Risk N/A CQC N/A Patient Safety N/A Patient Engagement N/A Financial N/A Sustainability N/A Workforce/Training N/A
RECOMMENDATIONS/ACTION REQUIRED: The CCG Governing Body is asked to: That the Governing Body notes the Chief Officers Report
Not KEY REQUIREMENTS Yes No Applicable Has a quality impact assessment been undertaken? Has an equality impact assessment been undertaken? Has a privacy impact assessment been completed? Have partners/public been involved in design? Are partners/public involved in implementation? Are partners/public involved in evaluation?
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REPORT TO: The Clinical Commissioning Group Governing Body Meeting TO BE HELD ON: Thursday 4th February 2016
Subject: Quality Report Board Lead: Heather Johnstone Officer Lead: Lynn Tolley For For For For Recommendation: Approval Ratification Discussion Information
PURPOSE OF THE REPORT:
To update the CCG Joint Quality Committee of the quality issues and matters relating to health care services commissioned by the CCG. The information and reports relate mainly to the month of October with some yet to be validated data for November.
KEY POINTS: 1. The RAG rating for UHNM County Site remains AMMBER to reflect the CQC findings and recent completed independent review of a complex complaint, which has now been published. In addition the CCG unannounced visit identified internal escalation issues in relation to the High Dependency Unit closing, however there were no immediate risk to patients. 2. The RAG rating for UHNM Royal Stoke Site remaiins AMBERR/RED to reflect the CQC findings and the outcomes of the WMQRS review in June 20115. The Provider presenting the action plan in response to the CQC outcomes at the November CQRM. There are no immediate risks identified 3. The RAG rating for SSOTP remains at AMBER which reflects the initial workforce issues, early feedback from the District Nurse focus groups and the recent CQC visit. 4. The RAG rating for SSSFHT remains at GREEN/AMBER to reflect the unannounced visit to the George Bryan Centre by the CCG and NHSE Chief Nurse. An update is to be received at the January CQRM 5. The RAG rating for BHT remains at GREEN following the decision to remove the Trust from special measures and there being no safety concerns at the Trust 6. The RAG rating for RWT remains at AMBER to reflect the CQC findings. The announced quality visits to the Cannock site did not raise any immediate quality and safety concerns 7. The RAG rating for WHT remains at AMBER as the Trust continues to report EMSA breaches in their high dependency unit and the cancellation of the December 2015 CQRM 8. The RAG rating for the NHS 111 Service remains AMMBER and SDUC has been rated at AMBER due to workforce issues. The Provider have submitted a proposal for a new delivery model which includes Advanced Nurse Practitioners to be used autonomously in the out of hours service provision. 9. The RAG rating for WMAS remains AMBER due to performance issues. There are no immediate safety concerns and the next CQRM is 7th January 2016 10. The RAG rating for BPAS is GREEN as there has been no indication of safety concerns. The next
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Item: 08 Enc: 04 CQRM is 4th February 2016 11. The RAG rating for Rowley remains GREEN as there has been no indication of safety concerns raised between CQRMS.
RELEVANCE TO KEY GOALS To reduce health inequalities across Cannock Chase through targeted interventions.
To identify and support patients with Long Commissioning for quality will enable the CCG to Term Conditions to ensure care delivery put in place exemplary systems for closer to home. commissioning intentions and provider To improve and increase overall life performance management that will deliver its Key Goals. expectancy. To develop integrated services with simple, easy access.
IMPLICATIONS Legal and/or Risk Enable the CCG to meet its statutory responsibilities for commissioning quality; reduce and mitigate risks to the organisation and to patients. CQC Enable the CCG to meet commissioner responsibilities for CQC Essential Standards for Health including that providers have up to date registration with the CQC. Patient Safety Integral element of the Quality Strategy which describes the systems that will be deployed to “keep patients safe.” Patient Engagement Integral element of the Quality Strategy which describes how the CCG will use patient engagement and experience to form the intelligence essential for effective and safe commissioning Financial Following the baseline assessment of the CCG structure, systems and processes there maybe implications for additional funding. Sustainability A three year plan which will be refreshed on an annual basis through the annual Quality Improvement Plan Workforce / Training Organisational Development Plan for the CCG is in place to develop members, staff and leadership.
RECOMMENDATIONS / ACTION REQUIRED: The Governing Body is asked to: Note the key quality and safety issues in the report and actions taken to improve quality and reduce risk.
Not KEY REQUIREMENTS Yes No Applicable Has a quality impact assessment been undertaken? Has an equality impact assessment been undertaken? Has a privacy impact assessment been completed? Have partners / public been involved in design? Are partners / public involved in implementation? Are partners / public involved in evaluation?
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SAS & CC CCG Joint Quality Committee Quality and Safety Report December 2015 For January 2016 MB/GB
Main Issues/Top Themes For PROVIDER
1. University Hospital of North Midlands (UHNM) – County Hospital a. Complex Complaint – media interest b. Unannounced Visit 2. University Hospital of North Midlands (UHNM) – Royal Stoke a. Peer Review – Notification of Serious Concerns b. Pressure Ulcers c. Infection Control 3. Staffordshire Stoke On Trent Partnership Trust (SSOTPT) a. CQC Update b. Pressure Ulcer Reduction c. Workforce 4. South Staffordshire Shropshire Healthcare Foundation Trust (SSSHFT) a. CQC Update b. Unannounced responsive assurance visit c. Workforce - Staff Sickness d. Workforce - Turnover 5. Burton Hospital Foundation Trust (BHFT) a. Quality Assurance 6. Royal Wolverhampton Hospital Trust (RWHT) a. Adverse Media Interest b. Unannounced Visit – Cannock Site 7. Walsall Hospital Trust (WHT) a. CQC b. EMSA c. Cancelled CQRM 8. Staffordshire 111 / OOH a. Unannounced visits b. Speak To Dispositions c. Emergency Department (ED) Referrals 9. West Midlands Ambulance Service (WMAS) No CQRM for the December 2015 – Next CQRM 7th January 2015. 10. BPAS Next CQRM meeting takes place 4th February 2016. 11. Rowley a. Whistleblowing b. Workforce
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University Hospital of North Midlands (UHNM) – County site
REGULATORS INVOLVEMENT AND ISSUES
CQC Inspection No additional information to be reported.
MAIN ISSUES FOR PROVIDER
Complex complaint – media interest The independent case review report has been published into the death of three-year-old boy. The report can be found on the Cannock Chase and Stafford and Surrounds CCG website
Unannounced Visit The CCG made an unannounced visit on the 3rd December 2016 to the High Dependency Unit at County Hospital. Upon arriving on the unit, it was closed to admissions. The staff and the one remaining patient was being transferred. The closure was related to staffing issues at RSUH critical care department. It was also identified that the HDU at County had been closed from 27th November 2015 to 1st December 2015, but the escalation processes to ensure the CCG were made aware was not effective. The Provider is to receive the report from this visit and the outcomes of a second visit carried out on the 6th December 2015 are to be included.
INFECTION CONTROL
2015/2016 County Target Trend Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD MRSA 0 = 1 0 0 0 0 0 0 1 Bacteraemia C Difficile 24 4 0 1 2 2 1 1 11 *req uires validation against Public Health England data
MRSA The Trust reported no cases of MRSA for October 2015.
Clostridium difficile There was one case of C.Diff in October 2015.
Outbreaks and Serious Incidents D&V There were no wards closed in October 2015 due to D&V/Norovirus.
PATIENT EXPERIENCE
Friends and Family Test (FFT)
UHNM Sept UHNM County RWH BHFT WHT T October F & F Inpatient Percentage Rec 98 97 97 90 98 95
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F & F Inpatient Response Rate (%) 20.4 20.3 28.7 27.1 23.0 39.3 F & F A & E % Rec 75 69 82 79 84 92 F & F A & E Response Rate (%) 22.9 20.3 25.6 25.5 7.4 7.2 F & F Mat (Antenatal Care) % Rec 99 99 100 97 100 86 F & F Maternity (Antenatal Care) Total Res 88 84 15 30 26 43
F & F Maternity (Birth) % Rec 99 100 This service 98 98 98 is not F & F Maternity (Birth) Res Rate (%) 15.3 100 provided at 14.1 41.8 30.3 County
Data F & F Maternity (Postnatal Ward) % Rec 99 99 100 89 99 96 has been F & F Maternity (Postnatal Ward) Total Res 108 70 65 106 128 355 F & F Maternity Community % Rec 99 94 Not 100 93 100 F & F Maternity Community Total Res applicable to 87 31 this site 70 15 19 F & F – Staff Care– QUARTER 2 - % Rec 70 73 65 83 F & F – Staff Work– QUARTER 2 - % Rec 80 84 59 62 F & F – Staff – QUARTER 2 - % Total 979 631 604 1023 Responses revalidated using new percentage recommended methodology in place of the old Score rating. F & F Antenatal Care/Postnatal Ward does not have Percentage Recommended data. Data is collected on Total Responses, Percentage Recommended and Percentage not recommended only.
Eliminating Mixed Sex Accommodation There were no breaches reported for the month of October and November 2015 for both County and Royal Stoke sites.
Complaints County reported 16 complaints in October against 17 reported in September. This a reduction in the rate per 10000 episodes to numbers experienced prior to integration.
PATIENT SAFETY 2 serious incidents were reported in November 2015 by County Hospital compared to 1 for October 2015.
October 2015 November 2015 Slips/trips/falls meeting SI criteria 1 Slips/trips/falls meeting SI criteria 1 Pressure ulcer meeting SI criteria 1 Total = 1 Total = 2 * Please note All SIs were previously graded 0-2; the new Framework has removed the 3 grades and defines each SI reported with a level of investigation. Level 1 – Concise; internal, Level 2 comprehensive and Level 3 Independent. Full detail explanation can be made available on request.
University Hospital of North Midlands (UHNM) – Royal Stoke site REGULATORS INVOLVEMENT AND ISSUES
CQC Inspection April 2015 Update Following on from previous months report, a presentation was made to November CQRM by Director of Nursing, Quality and Safety and Head of Quality, Safety & Compliance outlining the Trusts response and actions to be taken.
MAIN ISSUES FOR PROVIDER
Peer Review – Notification of Serious Concerns National Office: Quality Surveillance Team notified trust by letter dated 22nd October 2015 of two serious concerns identified with the Haemato-oncology MDT at Royal Stoke University Hospital site. Trust Chief Executive has responded with actions .
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Pressure Ulcers The Trust reported a total of 34 hospital acquired pressure ulcers during October 2015. Nine were Grade 3.
Infection Control The Trust are 6 cases over trajectory year to date for C.difficile.
INFECTION CONTROL
2015/2016 Tren Nov Dec Jan Feb Mar UHNM Target Apr May Jun Jul Aug Sep Oct YTD d MRSA 0 1 0 0 0 0 1 1 3 Bacteraemia C Difficile 50 9 12 5 12 3 9 6 56 Clostridium difficile (CDI) The Trust reported 6 C-Diff cases for the month of October and year to date is currently 56 cases, which is 6 over the end of year trajectory. There were 5 trust apportioned cases of C.Difficile for Royal Stoke and 1 case apportioned to County Hospital. Actions continue to be taken across the local health economy.
MRSA 1 MRSA Bacteraemia was reported for the month of October 2015, this has been deemed as unavoidable with no lapses of care for UHNM. The Trust are now 3 cases over a trajectory of zero.
PATIENT EXPERIENCE Friends and Family Test (FFT)
UHNM Sept UHNM Royal RWHT BHFT WHT Stoke October F & F Inpatient Percentage 97 97 97 90 98 95 Rec F & F Inpatient Response 31.8 20.3 27.1 23.0 39.3 20.3 Rate (%) F & F A & E Percentage Rec 74 69 69 79 84 92 F & F A & E Response Rate 20 20.3 20.3 25.5 7.4 7.2 (%) F & F Mat (Antenatal Care) % 100 99 97 100 86 99 Rec F & F Mat (Antenatal Care) 46 84 30 26 43 69 Total Res F & F Mat (Birth) % Rec 100 100 99 98 98 98 F & F Mat (Birth) Res Rate 1.1 100 15.3 14.1 41.8 30.3 (%) F & F Mat (Postnatal Ward) % 100 99 99 89 99 96 Rec F & F Mat (Postnatal Ward) 28 70 70 106 128 355 Total Res F & F Maternity Community % 97 94 94 100 93 100 Rec F & F Maternity Community 79 31 31 70 15 19 Total Res F & F – Staff Care– QUARTER 70 73 65 2 - % Rec 83 F & F – Staff Work– 62 80 84 59 QUARTER 2 - % Rec 979 F & F – Staff – QUARTER 2 - 631 604 1023 % Total Responses There is a significant increase in the Friends and Family rates. This is a result of a change to the methodology for reporting in response to National Guidance. The impact of this is that there will be an increase in all scores. Quality Report_December 2015 Final_050116 4
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Complaints UHNM reported 72 complaints relating to Royal Stoke University Hospital in October 2015, this is an increase to the 57 received in September. The rate per 10,000 episodes has also increased. However, the RSUH site continues its longer term reducing trend.
Eliminating Mixed Sex Accommodation There were no breaches reported for the month of October and November 2015 for both Royal Stoke and County sites.
PATIENT SAFETY Serious Incidents (SIs) UHNM’s SI’s have been split by site, Royal Stoke reported 8 incidents for the month of November 2015, which includes 2 SI’s reported for County Hospital. There have been 4 falls with harm reported in November. The Trust reported 9 Grade 3 Pressure Ulcers for the month of October, 8 related to Royal Stoke and 1 to County these were reported in the monthly Quality Assurance Report, however these have not been reported on the national STEIS system.
October 2015 November 2015 HCAI/Infection control incident meeting SI 1 HCAI/Infection control incident meeting SI criteria 1 criteria Pressure ulcer meeting SI criteria 4 Maternity/Obstetric incident meeting SI criteria: mother and 1 baby (this include foetus, neonate and infant) Slips/trips/falls meeting SI criteria 2 Slips/trips/falls meeting SI criteria 4 Stoke Total = 7 Stoke Total = 6 NB The grading and definitions for reporting Serious Incidents has changed as a result of new national guidance. This may have the effect of a reduction in the number of reported SIs.
Staffordshire Stoke On Trent Partnership Trust (SSOTP) REGULATORS INVOLVEMENT AND ISSUES
CQC Visit November 2015 Awaiting publication of full CQC report.
MAIN ISSUES FOR PROVIDER Pressure Ulcer Reduction As previously reported, Pressure Ulcers continue to be the highest reported incident Cause Group in the South Division, with 15 being reported for the month of November 2015. The Trust continues to complete RCA’s on all Grade 3 and Grade 4 Pressure Ulcers.
Workforce The key workforce metrics continue to improve, however, SSOTP are aware that there will be increased pressure during the winter period. Achievement of agreed targets re Appraisals and Mandatory Training are recognised as being at risk, however sickness absence is on target.
INFECTION CONTROL
2015/2016 SSOTP Targe Tren Apr May Ju Jul Aug Sep Oc Nov Dec Jan Feb Mar YTD t d n t MRSA 0 = 0 0 0 0 0 0 0 0 Bacteraemia C Difficile 10 = 2 3 2 2 1 3 1 14
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MRSA The trust reported zero cases of MRSA Bacteraemia October 2015.
Clostridium difficile The Trust reported 1 case of C.difficile for the month of October, this means that the trust of 4 cases over their annual target of 10. CCG Infection Prevention and Control lead is monitoring with SSOTP Infection Prevention Lead.
Outbreaks and Serious Incidents No data has been received regarding ward closure for the month of October 2015.
PATIENT EXPERIENCE
Friends and Family Test (FFT) Trust Overall Jan Feb Mar Apr May Jun Jul Aug Sept Oct F & F Score 71% 97% 97% 98% 97% 97% 97% 97% 98% 96 Number of surveys 1826 1607 1754 1842 2312 2639 2746 2444 3088 3037 received *There is a significant increase in the Friends and Family rates. This is a result of a change to the methodology for reporting in response to National Guidance. The impact of this is that there will be an increase in all scores.
In October 2015, the Trust received 3037 User Experience surveys, which is a slight decrease compared to 3,088 received in September 2015.
Complaints 24 complaints were received for October 2015, a slight decrease compared to 28 complaints received in September 2015. Out of these 16 complaints related to Health (1 for south community teams, 3 for north community teams, 7 for community hospital and 5 specialised services).
Eliminating Mixed Sex Accommodation No breaches were reported for October 2015.
PATIENT SAFETY Serious Incidents (SIs) North & South Divisions There were 18 serious incidents reported during November 2015; a significant decrease from the 32 reported in October 2015. 15 of those reported in November were pressure ulcers which met SI criteria, 11 of which were reported as Grade 3.
Never Events Zero never events were reported for October 2015.
October 2015 November 2015 HCAI/Infection control incident meeting SI criteria 1 Abuse/alleged abuse of child patient by third party 1 Pressure ulcer meeting SI criteria 28 Pressure ulcer meeting SI criteria 15 Slips/trips/falls meeting SI criteria 3 Slips/trips/falls meeting SI criteria 2 SSOTPT combined North and South Total = 32 SSOTP combined North and South Total = 18
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South Staffordshire Shropshire Healthcare Foundation Trust (SSSHFT) REGULATORS INVOLVEMENT AND ISSUES
CQC Following on from the CQC visit on the 18th August 2015, a planned inspection is due to take place on the 21st March 2016
MAIN ISSUES FOR PROVIDER
Unannounced Responsive Assurance Visit The Clinical Quality Improvement Manager and Head of Quality and Nursing undertook an unannounced visit to the George Bryan Centre following receipt of soft intelligence. The CCG are monitoring the action plans staffing levels, supervision, appraisals, patient safety incidents and staff morale.
A further unannounced visit to West Wing, George Bryan Centre took place November by the CCG and was supported by NHSE Interim Chief Nurse. The visit focussed on the actions taken by the Trust following on from the previous unannounced visit, feedback is due to be presented to January CQRM.
Annual Staff Sickness Rate The Trust’s annual sickness absence rate as at 30 September 2015 was 4.77%. There are four Directorates whose sickness rate is above the Trust’s target of 4.6% and these are identified in the table below along with action being taken to address this. However it is noted that these absence rates are slowly decreasing month on month.
Annual Staff Turnover Rate The Trust-wide vacancy rate as at 30 September 2015 was 12.03% which is an improved position from last month (13.15%). The clinical directorate combined vacancy rate at the end of July 2015 was 11.24% which has improved from 12.38% at the end of August. The corporate directorate vacancy rate was 14.75, again an improved position from the end of August (15.89%). The largest vacancy rate in corporate services is 24.57% in Facilities and Estates, which has decreased by 2.5% since the end of August 2015. The highest commissioned hotspots were the Learning Disabilities Directorate and Facilitates and Estates. The Trust Head of Workforce attended CQRM to present the actions the Trust are taking to improve these.
INFECTION CONTROL
2015/2016 SSSFT Target Trend Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD MRSA 0 = 0 0 0 0 0 0 0 0 Bacteraemia C Difficile 0 0 0 0 0 1 0 0 1 *validation of figures
MRSA There were no reports of MRSA bacteraemia in October
Clostridium difficile There were no reports of C. Difficile in October 2015. Quality Report_December 2015 Final_050116 7
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Outbreaks and Serious Incidents There were no ward closures due to outbreak of infection during October 2015.
PATIENT SAFETY Serious Incidents (SIs) The number of SIs reported to commissioners for November 2015 is 11, an increase from the 8 reported for October 2015.
October 2015 November 2015 Apparent/actual/suspected self-inflicted harm 2 Abuse/alleged abuse of adult patient by staff 1 meeting SI criteria Failure to obtain appropriate bed for child who 1 Apparent/actual/suspected self-inflicted harm meeting SI 3 needed it criteria Pending review (a category must be selected 1 Pending review (a category must be selected before 6 before incident is closed) – Death - Cardiac Arrest incident is closed) Slips/trips/falls meeting SI criteria 4 Slips/trips/falls meeting SI criteria 1 Total = 8 Total = 11 *Captured by reported date so we can capture any serious incidents which are reported late
Never Events Zero never events were reported for September 2015.
Burton Hospital Foundation Trust (BHFT) REGULATORS INVOLVEMENT AND ISSUES
CQC No further information available from last report.
MAIN ISSUES FOR PROVIDER
Quality Assurance Based on the October Data and BHFT coming out of special measures the Quality Improvement Lead suggests assurance in respect of the quality and safety of services at BHFT.
Infection Control C.Difficile has exceeded monthly target.
INFECTION CONTROL
2015/2016 Burton Target Trend Apr May Jun Jul Au Se Oct Nov Dec Jan Feb Mar YTD g p MRSA 0 = 1 0 0 0 0 0 0 1 Bacteraemia C Difficile 20 2 1 2 3 3 2 3 16
MRSA There were no reports of MRSA bacteraemia during October 2015.
Clostridium difficile The Trust reported 3 cases of Clostridium difficile during October 2015, which means the Trust have exceeded their monthly trajectory. Investigations are underway to determine whether avoidable/unavoidable.
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Friends and Family Test(FFT) BHFT Sept BHFT UHNM RWHT WHT
October F & F Inpatient Score 97 98 97 90 95 F & F Inpatient Response Rate (%) 22.1 23.0 20.3 27.1 39.3 F & F Score - A & E 82 84 69 79 92 F & F - A & E Response Rate (%) 2.9 7.4 20.3 25.5 7.2 F & F Maternity (Antenatal Care) 83 100 99 97 86 Percentage Rec F & F Maternity (Antenatal Care) 18 26 84 30 43 Total Responses F & F Maternity (Birth) 96 98 100 98 98 Percentage Rec F & F Maternity (Birth)Response 34.7 41.8 100 14.1 30.3 Rate (%) F & F Maternity (Postnatal Ward) 97 99 99 89 96 Percentage Rec F & F Maternity (Postnatal Ward) 105 128 70 106 355 Total Responses F & F Maternity Community % Rec 100 93 94 100 100 F & F Maternity Community Total 10 15 31 70 19 Res F & F – Staff Care– QUARTER 2 - 73 83 70 65 % Rec F & F – Staff Work– QUARTER 2 - 84 62 80 59 % Rec F & F – Staff – QUARTER 2 - % 604 979 631 1023 Total Responses There is a significant increase in the Friends and Family rates. This is a result of a change to the methodology for reporting in response to National Guidance. The impact of this is that there will be an increase in all scores.
Complaints The Trust received 26 complaints during October 2015. This is a significant increase from the 16 reported in September 2015.
Eliminating Mixed Sex Accommodation The Trust reported 4 breaches for the month of October and 5 for November 2015.
PATIENT SAFETY Serious Incidents (SIs) The trust reported 6 serious incidents for the month of November 2015. A decrease from the 13 reported in October 2015.
October 2015 November 2015 Diagnostic incident including delay meeting SI 3 Diagnostic incident including delay meeting SI criteria 2 criteria (including failure to act on test results) (including failure to act on test results)
Maternity/Obstetric incident meeting SI criteria: 1 Pressure ulcer meeting SI criteria 4 baby only (this include foetus, neonate and infant) Pressure ulcer meeting SI criteria 8 Slips/trips/falls meeting SI criteria 1 TOTAL = 13 TOTAL = 6 *Captured by reported date so we can capture any serious incidents which are reported late
Royal Wolverhampton Hospital Trust (RWT)
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No further updates, but the Provider is to discuss at the December 2015 CQRM
MAIN ISSUES FOR PROVIDER
Adverse Media Interest A media article published in October 2015 following a whistle-blower raising concerns about non-standard chemotherapy treatment of patients with rectal cancer between, 2005-9. Internal and external reviews have taken place and the outcomes did not identify any significant harm as a result of the treatment given.
Unannounced Visit An announced quality visit took place on 16th December 2015 to the Cannock Site. Both SAS/CC CCG were represented by a lay member and Head of Quality and Clinical Quality Improvement Manager.
INFECTION CONTROL
2015/2016 RWT Target Trend A M J J A S O N D J F M YTD MRSA Bacteraemia 0 = 0 0 0 0 0 0 0 0 C Difficile 35 5 11 5 3 11 6 9 50
MRSA There were no cases reported in October 2015
Clostridium difficile The Trust reported 9 CDI cases in October, this is an increase of 3 cases from September. The Trust have reported 50 cases of CDI for the period April to October 2015, this means the Trust have now exceeded their month on month trajectory and overall yearly trajectory of 35.
PATIENT EXPERIENCE
Friends and Family Test (FFT)
Royal Wolverhampton Trust Sept Oct New Cannock UHNM BHFT WHT Com Cross Comb b October F & F Inpatient % Rec 90 90 90 100 97 98 95 F & F Inpatient Res Rate (%) 32.3 27.1 27.1 39.2 20.3 23.0 39.3 F & F A & E % Rec 80 79 79 69 84 92 F & F - A & E Res Rate (%) 21.8 25.5 25.5 20.3 7.4 7.2 F & F Maternity (Antenatal 97 97 99 100 86 100 Care) % Rec F & F Maternity (Antenatal 30 30 84 26 43 19 Care) Total Res F & F Maternity (Birth) % 100 98 98 100 98 98 Res F & F Maternity (Birth) Res 8.5 14.1 14.1 100 41.8 30.3 Rate (%) F & F Maternity (Postnatal 93 89 89 99 99 96 Ward) % Rec F & F Maternity (Postnatal 40 106 106 70 128 355 Ward) Total Res F & F Maternity Community 98 100 100 94 93 100 % Rec F & F Maternity Community 87 70 70 31 15 19 Total Res F & F – Staff Care– 70 83 73 65 Quality Report_December 2015 Final_050116 10
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QUARTER 2 - % Rec F & F – Staff Work– 80 62 84 59 QUARTER 2 - % Rec F & F – Staff – QUARTER 2 - 631 979 604 1023 % Total Responses
Complaints The Trust received 23 complaints in September 2015. Data has not been released for Quarter 3.
Eliminating Mixed Sex Accommodation There were no breaches reported for the months of October and November 2015 for both Cannock and Royal Wolverhampton sites.
PATIENT SAFETY
Never Events There have been no new never events in November
Serious Incidents RWT is a combined organisation who report by Acute (Division 1) and Community (Division 2). In total 42 new incidents were reported by the Trust in November, which is an increase from 37 reported in October 2015. 23 out of the 43 incidents reported related to pressure ulcers, 2 of which were Grade 4.
October 2015 November 2015 Grade 3 Hospital Acquired Pressure Ulcers 7 Grade 3 Hospital Acquired Pressure 9 Ulcers Grade 4 Hospital Acquired Pressure Ulcer 1 Grade 4 Community Acquired Pressure 1 Ulcer Grade 4 Trust Acquired (joint) Pressure 1 Grade 4 Hospital Acquired Pressure 1 Ulcer Ulcer Grade 3 Community Acquired Pressure 13 Grade 3 Community Acquired Pressure 13 Ulcers Ulcers Grade 4 Community Acquired Pressure 1 Infection 1 Ulcer Intrauterine Deaths 2 Slip/Trip/Fall 2 Confidential Leak 1 Unexpected admission to CCU 1 C. Diff 1 Unexpected Death 1 Slip/Trip/Fall 2 Medication Error 1 Unexpected admission to NNU 1 Surgical/invasive procedure 1 Unexpected Death 1 Unexpected admission to NNU 1 Infection-CPO 1 Unexpected death 1 Infection-MRSA 1 Confidential Leak 4 Surgical/Invasive procedure 1 Maternal transfer to ICCU 1
Missed Diagnosis 1 Delayed diagnosis 4 Safeguarding Incident/Missed Diagnosis 1 Delay in Reporting 1 RWT Combined Acute and community Total = RWT combined Acute and Community = 42 37 CCH = 0 CCH = 0
Walsall Hospital Trust (WHT) REGULATORS INVOLVEMENT AND ISSUES
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Planned CQC Visit No further update to report. The Commissioners are still awaiting the outcome of the planned CQC visit which took place in the first week of September 2015.
MAIN ISSUES FOR PROVIDER
Eliminating Mixed Sex Accommodation The Trust have reported 23 breaches, this is an ongoing challenge for the Trust. Walsall CCG, have issued a Performance Notice to the Trust.
CQRM The Provider could not attend December CQRM due to capacity issues, the meeting was cancelled. The Lead CCG are escalating further as this was not acceptable and concerns are being raised as key leaders within the organisation, leaving vacancies within the exec team. It was decided by the Lead CCG that challenges/queries should be made to the provider via e-mail.
INFECTION CONTROL
2015/2016 WHT Targe Tren Apr May Ju Jul Au Sep Oc Nov Dec Jan Feb Mar Apr YTD t d n g t MRSA 0 = 0 0 0 0 0 0 0 0 Bacteraemia C Difficile 18 = 1 0 1 1 0 1 0 4
MRSA There were not Trust attributable MRSAs for the month of October 2015.
Clostridium difficile The Trust reported zero cases of C.diff for the month of October 2015.
PATIENT EXPERIENCE Friends and Family (FFT)
Walsall Hospital Trust Sept WHT BHFT UHNM RWHT
October F & F Inpatient Score 97 95 98 97 90 F & F Inpatient Response Rate (%) 32.7 39.3 23.0 20.3 27.1 F & F Score - A & E 89 92 84 69 79 F & F - A & E Response Rate (%) 1.8 7.2 7.4 20.3 25.5 F & F Maternity (Antenatal Care) %e 87 86 100 99 97 Rec F & F Maternity (Antenatal Care) Total 110 43 26 84 30 Res F & F Maternity (Birth) % Rec 97 98 98 100 98 F & F Maternity (Birth)Response Rate 7.2 30.3 41.8 100 14.1 (%) F & F Maternity (Postnatal Ward) % 99 96 99 99 89 Rec F & F Maternity (Postnatal Ward) 155 355 128 70 106 Total Res
Quality Report_December 2015 Final_050116 12
Item: 08 Enc: 04
F & F Maternity Community % Rec * 100 93 94 100 F & F Maternity Community Total Res 4 19 15 31 70 F & F – Staff Care– QUARTER 2 - % 65 73 83 70 Rec F & F – Staff Work– QUARTER 2 - % 59 84 62 80 Rec F & F – Staff – QUARTER 2 - % Total 1023 604 979 631 Responses
Complaints No information has been received for the month of October 2015.
Eliminating Mixed Sex Accommodation The Trust reported 23 patient breaches for the month of November 2015, a significant increase over the 2 breaches reported for October 2015. These all occurred in HDU, the Lead CCG have received information from Provider around breaches, which has been received, but is not sufficient to give CCG assurance that actions are being taken to address the situation.
PATIENT SAFETY Serious Incidents There were 17 Serious Incidents reported by Walsall CCG in October 2015, 5 of which related to Grade 3 Pressure Ulcers. This is a decrease, compared to the 27 Serious Incidents reported in September 2015.
September 2015 October 2015 Delayed Diagnosis 2 Intra-uterine death 2
Complication of Birth 1 Unexpected Adult Death 1 Delay in Treatment 1 Breast Screening/Radiology 2 Non-adherence to policy/guidelines 1 Delayed Escalation of Diagnostic Results 2 Investigation Delay 1 VTE Incident 1 Slips/Trips/Falls 2 Information Governance 2 Surgical Incident 1 Diagnostic Issue 2 Ward Based Surgical Procedure 1 Community Acquired Pressure Ulcers 4 Hospital Acquired Grade 3 Pressure Ulcers 11 Hospital Acquired Pressure Ulcers 1 Hospital Acquired Grade 4 Pressure Ulcers 1 Community Grade 3 Pressure Ulcers 4 Community Grade 4 Pressure Ulcers 1 WHT Acute and Community combined Total = 27 WHT Acute and Community combined Total = 17 To note Hospital Acquired Pressure Ulcer figures have been validated
West Midlands Ambulance Service
No CQRM for the December 2015 – Next CQRM 7th January 2015.
SDUC – GP Out of Hours Service/NHS 111
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Item: 08 Enc: 04
REGULATORS INVOLVEMENT AND ISSUES Nil to report MAIN ISSUES FOR PROVIDER
Unannounced visits The South CCGs undertook unannounced visits to OOH and 111 bases across Staffordshire. There were no immediate quality and safety concerns, however it was evident that the staffing issues are impacting on the Providers performance as the visiting team observed the staff dealing with the volumes of call s as they came in.
Workforce (SDUC) The Nurse rota has improved by 4% coverage from September. There is a continuous steady increase in nursing hours covered as new contracted staff come on board. The Provider has submitted a new model which is being considered by commissioner, questions and clarification has been fed-back to provider.
Speak To Dispositions - SDUC continue to breach the “up to 2 hour” dispositions, however this is an improved position for October to 90%, the worst being DX77 (call-back by Healthcare Professional within 30 minutes) performance DX11 (Speak to Primary Care within 1 hour) and to be seen within 1 hour. Commissioners are still working with SDUC to improve these targets. Delays continue to be the highest reported breach. There remains no apparent harm to any patients as a result of the delays.
INFECTION CONTROL (SDUC) Anti-Microbial Programme – SDUC report that this is ongoing and the CQRM have noted positive progression.
Infection Prevention and Control – The provider has given good assurances, the CCG Lead has requested a rigorous approach and invited the organisation to supply a representative for the Stewardship Programme.
PATIENT EXPERIENCE (SDUC)
Friends and Family Test - The provider reported at the November 2015 CQRM returns were the highest that they have been since commencing the friends and family scheme in April 2016, a total of 376 responses were received in October 2015. Analysis will be reported to the December 2015 CQRM
KPIs – North and South Staffordshire have met to align OOH KPI reporting to a single stream. Quality and Contracting are undertaking actions from this meeting to have a cohesive set of reporting indicators. Once completing this will be passed to contracting for discussion with the provider.
SIs – No serious incidents in OOH/111 reported for the Organisation from the November 2015 CQRM.
Green Ambulances - A contractual breach has been identified, which has been resolved, as assurance has been given by the provider that no harm has come to South Staffordshire patients. All patients received an ambulance dispatched within the 30 minute timeframe which is deemed safe and appropriate by the national licence. There remains a contractual issue on whether the pathway was used correctly from 111 to OOH by using GPs to revalidate (review) the calls. This is now being reviewed by the contract teams.
MAIN ISSUES FOR PROVIDER (111)
Workforce (111) The provider highlighted nursing vacancies as 10.9 FTE which includes contingency. Roles are being advertised in a number of ways to ensure they attract as many staff as possible i.e. fixed term contracts, full time posts, specific sites i.e. Stafford/Cannock, over multiple sites. The current GP workforce exceeds the
Quality Report_December 2015 Final_050116 14
Item: 08 Enc: 04 contract requirements; however, there is an ongoing challenge in the long term recruitment and retention of GP’s. Therefore, alternative solutions to this problem are being explored.
Speak To Dispositions (111) SDUC continue to breach the “up to 2 hour” dispositions, the worst being DX77 (call-back by Healthcare Professional within 30 minutes) performance DX11 (Speak to Primary Care within 1 hour) and to be seen within 1 hour. Commissioners are working with SDUC to improve these targets. SDUC are considering implementing nurse triage to improve these elements of performance. Delays continue to be the highest reported breach. This is being managed via the contract process and CQRM hold quality discussions around the impact this is having on patients. The report received suggests there was no apparent harm to any patients as a result of the delays.
INFECTION CONTROL Anti-Microbial Programme – SDUC report that this is ongoing and the CQRM have noted positive progression. Infection Prevention and Control – The provider has given good assurances, the CCG Lead has requested a rigorous approach and invited the organisation to supply a representative for the Stewardship Programme.
PATIENT EXPERIENCE Friends and Family Test - The provider reported at the September CQRM 100% would recommend the Service in Lichfield, Burton and Tamworth.
Patient Safety Incidents There were 4 Incidents reported in July 2015.
BPAS
Next CQRM meeting takes place 4th February 2016.
Rowley
REGULATORS INVOLVEMENT AND ISSUES
Nil to report MAIN ISSUES FOR PROVIDER
Whistleblowing In October Rowley Hall Hospital received an anonymous whistle-blower to the CQC regarding Medical Records. CQC have confirmed that the concerns raised have been logged and closed.
Workforce
Sickness rates remain above Rowley Halls target of 4%. All staff received a return to work interview.
June 2015 July 2015 August 2015 4.6% 4.8% 5.14%
Rowley Hall have faced challenges in in recruiting to Theatres for scrub and anaesthetic specialities. However, have since recruited 2 new members of staff for theatre, with a further 4 being interviewed on the 15th December 2015.
Quality Report_December 2015 Final_050116 15
Item: 08 Enc: 04
Appraisal rates are below the target for Quarter 2, however this is being addressed and should show an improvement in Q3. A new Theatre Manager has been employed and will commence appraisal of staff once probation period has ended.
PATIENT SAFETY
Rowley Hall have consistently reported low levels of reported Patient Safety incidents. Five Patients Safety Incidents were reported in Quarter 2, no patients came to harm. Rowley also reported 2 Security Incidents, in both cases the Trust contacted the Police, who now make it routine to patrol the grounds of Rowley Hall.
INFECTION CONTROL
There are no infection control issues to report in Quarter 2. Head of Infection Control for the CCG participated in an infection control visit with Rowley’s Infection Prevention Lead, no issues were raised.
PATIENT EXPERIENCE
Rowley Hall continues to have low numbers of formal complaints, 5 complaints in total were received in Quarter 2. These related to:-
Administration x 3 Clinical Care x 2
One complaint remains unresolved, but is still within timescale.
Acronym Explanation BADGER Birmingham And District General Emergency Rooms BHFT Burton Hospitals Foundation Trust BPAS British Pregnancy Advisory Service CCG Clinical Commissioning Group CHKS Leading provider of healthcare intelligence and quality improvement services CHRT Crisis Home Resolution Team CDIFF Clostridium Difficile CQRM Clinical Quality Review Meeting CSU Clinical Support Unit D & V Diarrhoea and Vomiting EMSA Eliminating Mixed Single Sex Accommodation EOL End of Life EPR Electronic Patient Record FFT Friends and Family Test FGM Female Genital Mutilation GC 28 Provider cannot be fined for services which are below trajectory due to industrial action or other reasons beyond their control GUM Genito-Urinary Medicine HCAI Health Care Associate Infections HEFT Heart of England Foundation Trust IAPT Improving Access to psychological therapies IPC Infection Prevention and Control M&L Midlands & Lancashire Commissioning Support Unit CSU MRSA Methicillin Resistant Staphylococcus Aureus
Quality Report_December 2015 Final_050116 16
Item: 08 Enc: 04
NHQA Nursing Home Quality Assurance NICU Neonatal intensive care unit NSL Non Urgent Patient transport provider OFSTED Office for Standards in Education, Children’s Services and Skills PALS Patient Advisory Liaison Service RAP Remedial Action Plan Red 1 Life Threatening emergency - primarily cardiac arrest patients - target response time 8 mins - Airway obstruction (e.g. choking); Ineffective breathing; Unconscious with abnormal breathing; Hanging; In labour with an imminent delivery, baby’s head is out Red 2 Life Threatening emergency - target response time 8 mins. Red 19 Red 1 and Red 2 incidents, measuring the time to get a conveying vehicle to scene - target response time 19 mins. Green 2 Non immediate life threatening emergency -target response time 30 mins. Green 4 Non-life threatening emergency - target response time - response in 60 mins or telephone triage in 30 mins. RCA Root Cause Analysis RTT Referral to Treatment Times RIO Electronic care system RWT Royal Wolverhampton Trust SDIP Service Delivery Improvement Plan SSOTPT Staffordshire and Stoke on Trent Partnership Trust SSSFT South Staffordshire and Shropshire NHS Mental Health Foundation Trust Warm Where additional information is obtained the clinical floor walker WILL ADVISE the call advisor Transfer to continue through to the final outcome and WARM TRANSFER immediately to the next available nurse, ensuring minimal risk. This provides an enhanced, more accurate clinical review and ensures the most appropriate outcome for the patient. WMQR West Midlands Quality Review
Quality Report_December 2015 Final_050116 17
Item: 09 Enc: 05
REPORT TO THE Clinical Commissioning Group Governing Body Meeting TO BE HELD ON: Thursday 4th February 2016
Subject: Performance Report – November 2015 Board Lead: Chris Bird – Director of Performance & Assurance Officer Lead: Chris Bird For For For For Recommendation: Approval Ratification Discussion Information
PURPOSE OF THE REPORT: To provide a high level summary of the key performance issues for the CCG for November 2015. Performance is shown for the NHS Constitution measures. To provide assurance and details of remedial action being taken to improve performance and mitigate risk and, where applicable, contract queries that have been issued and financial consequences applied
KEY POINTS: CCG continues to experience difficultly in delivering the full set of NHS Constitutional Standards including several high profile areas such as A&E and Cancer. CCG performance is taken as a composite picture across several providers and for the CCG to perform consistently, at least 3 major providers need to perform at the same level – this has not been the case for several months. The issues differ across providers although there are pockets of commonality across them. The slide deck provides a summary position for the CCG and is supported by detailed analysis of areas of underperformance together with the contractual and performance actions being taken
RELEVANCE TO KEY GOALS To reduce health inequalities across Cannock Chase through targeted interventions. To identify and support patients with Long Term Conditions to ensure care delivery Performance metric to be developed to closer to home. show improvement. To improve and increase overall life expectancy. To develop integrated services with simple, easy access.
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Item: 09 Enc: 05
IMPLICATIONS Note the risks identified relating to delivery of Quality, Improvement, Productivity and Prevention (QIPP), Acute Trust Activity and Continuing Legal and/or Risk Care. Reputation risks if any of the elements of the national operating framework are not delivered. CQC None Patients and their safety are at the centre of everything the CCG Patient Safety commission. Poor performance in services where patients are waiting longer than required to access services may be a patient safety risk. The inclusion of patient feedback in performance reporting is essential Patient Engagement for Board assurance. Work is ongoing with colleagues in the Quality and Governance team to establish lines of reporting. Financial risks associated with delivering key performance targets and Financial delivering contracts in line with contract values. Sustainability None Workforce / Training Work to develop understanding of performance management
RECOMMENDATIONS/ACTION REQUIRED:
The CCG Governing Body is asked to: Note those areas where the current performance rating is below target and the remedial actions being taken to improve performance and mitigate risk.
Not KEY REQUIREMENTS Yes No Applicable Has a quality impact assessment been undertaken? Has an equality impact assessment been undertaken? Has a privacy impact assessment been completed? Have partners / public been involved in design? Are partners / public involved in implementation? Are partners / public involved in evaluation?
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Performance Overview
SaS Cannock SES&SP Indicator Target YTD Sep-15 Oct-15 Nov-15 YTD Sep-15 Oct-15 Nov-15 YTD Sep-15 Oct-15 Nov-15
Healthcare Acquired Infections MRSA (incidence of HCAI) 0 3 0 0 0 2 0 0 0 4 0 0 0 C-diff (incidence of HCAI 59/48/42 42 6 2 6 27 4 1 4 35 2 2 2
Referral to Treatment Times RTT admitted N/a 85.1% 83.8% 80.5% Not Released 89.4% 86.0% 83.8% Not Released 88.9% 88.6% 85.4% Not Released RTT non-admitted N/a 97.0% 96.4% 96.5% 96.4% 97.1% 96.3% 95.6% 96.2% 96.6% 95.7% 95.3% 95.6% RTT incompletes 92.0% 94.7% 94.6% 94.3% 94.9% 95.0% 94.7% 94.5% 94.3% 93.9% 93.2% 93.2% 94.0% RTT 52 week + waiters 0 5 0 0 1 5 0 2 4 4 0 0 0
Diagnostic test waiting times Diagnostics 6 weeks + 99.0% 99.1% 99.2% 99.3% 99.5% 98.2% 99.0% 99.2% 99.5% 96.6% 97.9% 98.9% 99.2%
Cancer waits Cancer 2 week wait 93.0% 94.1% 92.6% 94.3% 93.7% 94.6% 94.7% 96.4% 96.0% 92.6% 91.9% 93.4% 93.5% Cancer Breast Symptom 2 week wait 93.0% 87.5% 85.7% 85.1% 58.3% 91.0% 91.3% 94.0% 95.7% 91.1% 93.0% 97.0% 85.3% Cancer 31 day first definitive treatment 96.0% 98.2% 97.4% 98.5% 100.0% 97.1% 97.7% 97.0% 100.0% 97.2% 99.0% 100.0% 96.6% Cancer 31 day subsequent treatment - surgery 94.0% 91.7% 88.2% 89.5% 87.5% 92.0% 85.7% 100.0% 87.5% 96.8% 100.0% 95.7% 100.0% Cancer 31 day subsequent treatment - drug 98.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% Cancer 31 day subsequent treatment - radiotherapy 94.0% 98.8% 100.0% 96.6% 96.2% 97.6% 100.0% 100.0% 100.0% 97.8% 100.0% 97.1% 100.0% Cancer 62 day standard 85.0% 72.8% 72.2% 68.8% 92.7% 73.6% 79.2% 60.6% 89.7% 78.5% 81.8% 75.6% 80.9% Cancer 62 day screening 90.0% 78.9% 60.0% 100.0% 100.0% 87.0% 100.0% 100.0% 66.7% 96.2% 100.0% 100.0% 100.0% Cancer 62 day upgrade N/a 92.6% 81.0% 95.2% 90.0% 96.5% 93.3% 100.0% 100.0% 85.9% 93.3% 93.3% 81.8%
Accident & Emergency A&E 4 hours 95.0% 84.2% 88.5% 87.4% 85.2% 79.5% 86.7% 86.6% 81.2% 93.0% 95.9% 92.1% 93.1% 12 hour trolley breaches 0 39 0 - Not Released 11 0 - Not Released 9 0 0 Not Released
Ambulance Cat A 8 mins - Red 1 75.0% 69.2% 56.3% 71.4% 70.6% 75.6% 73.3% 81.3% 80.9% 66.7% 66.7% 61.3% 66.7% Cat A 8 mins - Red 2 75.0% 72.3% 72.6% 70.7% 71.9% 77.2% 75.6% 78.1% 76.0% 67.2% 64.7% 69.4% 62.0% Cat A 19 mins 95.0% 95.6% 94.8% 94.7% 94.4% 96.9% 96.8% 96.2% 96.3% 95.5% 95.4% 96.1% 95.2%
Mixed Sex Accommodation Breaches Mixed Sex Accommodation Breaches 0 0 0 0 0 9 2 0 2 4 0 0 1
• The table above provides a YTD and 3 month view of the CCGs performance against the NHS Constitutional Standards • Each CCG is experiencing difficulties in the delivery of A&E and Cancer Targets for which more detail is provided in the pack • There are local issues affecting performance in one or more of the CCGs, e.g. WMAS and 52 week waiters. • 52 week waits are concentrated in Stafford and Cannock. The Stafford patient is on a general surgery pathway and does not yet have a TCI date, all Cannock delays are attributed to specialist paediatric spinal services at ROH/RJAH and though recorded against the CCG, relate to specialised commissioning • EMSA breaches relate to HDU step down and are all linked to increased escalation levels in the Trust – it is anticipated there will be further breaches2 throughout Winter and in the reporting over the coming months A&E
A&E 4 hour target - CCG performance 100.0% 95.0% 90.0% 85.0% 80.0% 75.0% 70.0% Apr May Jun Jul Aug Sep Oct
SaS CC SES Target
HEFT UHNM RWT 100.0% 100.0% 100.0% 95.0% 95.0% 95.0% 90.0% 90.0% 90.0% 85.0% 85.0% 85.0% 80.0% 80.0% 80.0% Apr May Jun Jul Aug Sep Oct Nov Apr May Jun Jul Aug Sep Oct Nov Apr May Jun Jul Aug Sep Oct Nov
HEFT Target UHNM Target RWH Target
• None of the 3 CCGs achieved the A&E 4 hour waiting target in the month of November. This is a continuation of a sustained pattern of non-delivery for both SaS and CC CCGs. However, it is the first month since June 2015 that SES has failed to meet the national threshold. • SaS and CC CCGs performance continues to be adversely impact by both UHNM and RWT • UHNM had a poor month against the target although consistent with performance levels in the month previous. UHNM are working to a recovery plan which sets a trajectory of 90% performance in each month November 2015 – March 2016 and sustained delivery of 95% from April 2016. As the first milestone month within that plan has not been achieved an Exception Notice will be published. • RWT did see a slight improvement in performance and a recovery trajectory has been agreed that requires sustained improvement in each consecutive month and delivery of the 95% target with effect February 2016 onwards – failure to deliver against this target will generate 2% withholding of funds of the actual contract value for the month in question • HEFT performance has held steady against October but not improved. November attendance levels were 8% higher than the same period last year but nonetheless, performance is below the agreed recovery trajectory and will be subject to further contractual action by Birmingham CrossCity as the host3 commissioner A&E: LoS 0-1 days and Conversion rates Burton HEFT 18.00% 900 500 44.00% 16.00% 800 450 42.00% 400 14.00% 700 350 12.00% 600 40.00% 300 10.00% 500 38.00% 250 8.00% 400 36.00% 200 6.00% 300 150 34.00% 4.00% 200 100 32.00% 2.00% 100 50 0.00% 0 30.00% 0 201504 201505 201506 201507 201508 201509 201510 201511 201504 201505 201506 201507 201508 201509 201510 201511 A&E Conversion Emergency Admissions with LOS of 0-1 A&E Conversion Emergency Admissions with LOS of 0-1
UHNM RWHT 35.00% 4000 25.00% 400 34.50% 3750 350 34.00% 3500 23.00% 33.50% 300 3250 33.00% 21.00% 250 32.50% 3000 200 32.00% 2750 19.00% 150 31.50% 2500 100 31.00% 17.00% 30.50% 2250 50 30.00% 2000 15.00% 0 201504 201505 201506 201507 201508 201509 201510 201511 201504 201505 201506 201507 201508 201509 201510 201511 A&E Conversion Emergency Admissions with LOS of 0-1 A&E Conversion Emergency Admissions with LOS of 0-1
• To further the understanding of the contributing factors influencing delivery of the 4 hour target the tables above map A&E conversion rates (x axis, blue bars) and Lengths of Stay (LoS) (y axis, red lines) of less than one day at individual provider trusts. • The A&E conversion rates – though variable by Trust – all show an upward trend as the data moves through Autumn into Winter. This is an expected pattern as patients with higher acuity levels are brought into the system. This has an adverse effect on a Trusts ability to manage the 4 hour target as it reduces flow through the hospital and means there is less capacity to accommodate patients needing admission • The significant drop off at RWHT is due to the advent of Cannock MIU data being reported in the RWHT submission. This brings the RWTHT conversion ratio in line with that of Burton which also includes MIU • Similarly, LoS 0-1 days are also increasing which again is an expected pattern throughout the Winter period as patients need a longer assessment period than available in E.D. This can also be a symptom of providers decision making being influenced by the 4 hour target 4 WMAS
WMAS R1 Performance v SES&SP CCG Improvement WMAS R2 Performance v SES&SP CCG Improvement Trajectory Trajectory 90.0% 90.0%
80.0% 80.0%
70.0% 70.0%
60.0% 60.0%
50.0% 50.0% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
SES Target Trajectory SES Target Trajectory
• WMAS continue to deliver contract level performance above targets but struggle at individual CCG • The charts above map WMAS performance and local CCG recovery for SES&SP CCG against agreed recovery trajectories built into contract for 2015/16 • SES&SP activity levels YTD are 2.0% less than plan however performance is not at required level • R1 54/81 patients responded to within target – distance from target of 6 patients • R2 709/1,144 patients responded to within target – distance from target of 149 patients • RCA’s for any R1 > 10 mins. Review indicates there has been fewer instances of > 10 mins than in 2014/15 • JQC – commissioned further analysis of spread of response across time bands 5 RTT
CCG Waiting Lists CCG 18 week backlogs 16,000 1,200
14,000 1,000 12,000 800 10,000
8,000 600
6,000 400 4,000 200 2,000
0 0 Apr May Jun Jul Aug Sep Oct Nov Apr May Jun Jul Aug Sep Oct Nov
SES&SP SaS CC SES&SP SaS CC
• Analysis of the CCGs Waiting List activity shows that for both SES&SP and Cannock there has been a slight reduction in the overall number of patients awaiting treatment. This equates to a 8% reduction for SES and a 3% reduction in Cannock. • Waiting List numbers have increased for SaS by 8% which is consistent with the level of over-performance identified through the activity returns to NHS England. • However, the pattern in W/L is not being translated through to a similar pattern in patients waiting more than 18 weeks – this is explained through two reporting changes; a focus on the overall percentage of incomplete pathways from 1st April 2015 and a technical change in the 18 week backlog reporting arrangements with effect October 2015 • The sizeable reduction in SES&SP backlog over recent months is driven by performance improvements at HEFT who have narrowed the distance from target across several access related targets, notably diagnostics. However, patients at HEFT continue to make up a disproportionate percentage of the backlog compared to their share of the waiting list (30% v 21%) • Cannock CCG main providers (RWT & UHNM) are experiencing increasing backlogs driven by difficulties at RWT – compared to a 60% share of waiting list activity, RWT accounts for 69% of the backlogs. Recovery plans are in place between the host commissioner and provider across several specialities • SaS CCG main providers (UHNM & RWT) have a broadly equal share of both backlog and waiting list – UHNM have a slightly larger share6 of the backlog relative to their waiting list but not significant
Diagnostics
CCG Diagnostic Performance 100.0% 98.0% 96.0% 94.0% 92.0% 90.0% Apr May Jun Jul Aug Sep Oct Nov
SaS CC SES Target
HEFT Diagnostics - Patients not seen within 6 weeks HEFT 700 100.0% 600
98.0% 500 400 96.0% 300 94.0% 200 92.0% 100 90.0% 0 Apr May Jun Jul Aug Sep Oct Nov April May June July August Sept Oct Nov Colonoscopy Flexi-Sigmoidoscopy Gastroscopy HEFT Target
• SaS and Cannock CCGs have sustained achievement of the Diagnostics Standard for the third consecutive month – there is no indication from provider contract details to suggest this pattern will be interrupted moving forward • SES has now achieved the target for the first month of the year – this is driven by a further improvement at HEFT and sustained narrowing of their failure margin. It is now at such a level that over-delivery of the standard at Burton and RWT are sufficient to make up the gap • HEFT Diagnostics are due to be on target by December 2015 – unvalidated data for the month indicates there will be further improvement on November but will fall slightly short of the 99%. It is expected this will be delivered from January 2016 onwards 7 Cancer – 2ww & 31 Day
SaS 2 ww (breast) pathway 100.0% • SaS CCG has failed the 2 ww (breast) pathway for the 90.0% sixth consecutive month driven by sustained pressure on services at UHNM 80.0% • In November, 29 / 470 patients were not seen within 2 weeks – of which 23 were at UHNM. The remaining 6 at 70.0% RWHT. 60.0% • On a YTD basis – a total of 207 / 3,461 (6%) of patients have been seen outside of the target time period. 70% 50.0% of these breaches are at UHNM April May June July August Sept Oct Nov
UHNM RWHT Target
SaS 31 day pathway Cannock 31 day pathway 100.0% 100.0%
90.0% 90.0%
80.0% 80.0%
70.0% 70.0% 60.0% 60.0% April May June July Aug Sept Oct Nov April May June July Aug Sept Oct Nov UHNM RWHT Target UHNM RWHT Target
• Both SaS and CC CCGs have failed the 31 Day Diagnosis to Treatment targets – where that treatment was surgery • For SaS this equates to 2 / 16 patients and for CC 1 / 8 patients. 2 of the breaches were at UHNM and the remainder at RWT • The low volume of patient numbers drives disproportionate percentage variation – the headline measure of 31 Days Diagnosis to Treatment is being delivered for all 3 CCGs 8 Cancer – 62 day
SaS 62 day pathway Cannock 62 day pathway SES 62 day pathway 100.0% 100.0% 100.0%
90.0% 90.0% 90.0%
80.0% 80.0% 80.0%
70.0% 70.0% 70.0%
60.0% 60.0% 60.0%
50.0% 50.0% 50.0%
40.0% 40.0% 40.0%
Oct Oct Oct
July July July
Nov Nov Nov
May May May
Sept Sept Sept
June June June
April April April
August August August
UHNM RWHT Target RWHT UHNM Target Burton HEFT RWH Target
• The analysis above focusses on CCG patient flows and not overall provider performance, however, several providers continue to experience difficultly in sustained delivery of the 62 day Referral to Treatment pathway • The contributing factors include; capacity (in part driven by recruitment of consultants), late tertiary referrals and timely access to diagnostics (linked to the 2 ww pathway delays) • Whilst clearly outside of the national threshold the patient numbers at individual CCG level are small: • SaS 3 / 40 patients – all UHNM • CC 3 / 23 patients – 2 RWHT, 1 UHNM • SES 7 / 43 patients – 3 HEFT, 3 RWHT, 1 Dudley • HEFT and UHNM both have remedial actions plans in place. HEFT are on track to deliver the improvements by the target date of January 2016. UHNM have a recovery date of 31st March 2016 which is monitored through the Cancer Local Improvement Group. • RWHT have recently agreed a remedial action plan which does not provide for delivery of the national standard until June 2016 – this has been flagged with NHS England given the crossover into the new contractual year
9 Dementia
CCG Dementia Diagnosis Dementia Recovery Trajectory 70.0% November 2015 - March 2016 70.0%
65.0% 65.0%
60.0% 60.0%
55.0% 55.0%
50.0% 50.0% Sept Oct Nov October November December January February March
SES CC SaS Target CC SES SaS Target
• All 3 CCGs continue to experience difficultly in delivering the national target – this requires a dementia diagnosis rate of 67% of a nationally determined dementia prevalence population • The quantified patient gap at November is: • CC 23 patients • SaS 229 patients • SES 361 patients • A ‘top ten tips’ has been published along with individual GP Practice level data enabling focussed discussions on those with a greater distance from target • SSSFT have provided an additional 5 clinics per week which should result in 25 additional patient appointments above the normal capacity to enable a reduction in the backlog of patients waiting for memory clinic appointments and assessments • The CCGs have previously submitted a recovery plan to NHS England which forecasts delivery by the end of March 2016 (see 10 table top right) – it is not expected that SaS and SES will achieve this recovery given the current distance from target
CPNs and RAPs
Burton • RTT Incompletes – CPN Rheumatology 30/06/15. RAP agreed – referral suspension now removed though no material impact on performance. RAP milestone not delivered, Exception Notice published following CRB 14/01/16. Urology now being achieved – agreed to keep RAP open until standard has been delivered for 3 consecutive months • A&E 4 hours – delivering but new CPN raised 22/10/15 to focus on associated measures (Ambulance handover, Unplanned re-attendance rate and DTOCs). RAPs approved and monitoring established. Winter pressures are impacting on delivery – DTOC’s especially remain at very high levels and it is not expected the recovery plan will be achieved. SRG 20/01/16 will be considering whole system response. Currently 25 additional beds open with no plan to de-escalate. • 62 day cancer (con upgrade not main standard) – Q2 confirmed fail. CPN raised at 12/11/15. RAP due w/c 30/11/15 – focussed on ESCCG rather than SES&SP. RAP approved. No SES patients on Con Upgrade pathway in November
HEFT • Integrated Improvement Plan agreed between Monitor, NHS E and BXC CCG (host) – supercedes need for individual CPNs/RAPs unless otherwise stated • A&E recovery trajectory will not be delivered – new trajectory to be agreed. Expected HEFT will fail target for 2015/16 as now insufficient opportunity recover through Winter period • RTT Incompletes recovery trajectory agreed through IIP – target date March 2016. Expect will be achieved ahead of projected timelines at headline level though some individual specialities will continue to fail. • 62 day cancer (cons upgrade)– RAP under discussion with BXC CCG & Trust – delivery agreed for January 2016. On track to deliver. • 2WW cancer RAP agreed with trajectory for December 2015. Unvalidated data for December indicates target has been acheived
UHNM • A&E 4 hour – RAP will not be delivered - exception notice issued and 1% withheld per business rules. New RAP in process of being agreed. Expect Trust will not achieve target in coming months. • RTT Incompletes –new CPN issued at November CRB. Revised RAP has been in development and was due for sign off 15/01/16 • 62 day cancer – CPN 07/07/15, RAP 13/10/15 – overtaken by national SIP process. UHNM original submission rejected, resubmitted October 2015 & approved by NHS E. New Cancer Improvement Plan due for presentation to SRG 14/01/16
Walsall • A&E 4 hour – Trust met original RAP one month ahead of schedule but did not sustain delivery. New CPN 28/09/15 requiring RAP to be in place 09/10/15 • RTT non-reporting – now > 12 months. Working to end of October timeline for reporting to resume • 62 day cancer – RAP trajectory not being met. Provider asked to refine RAP and aligned trajectory, to state explicitly when 85% target will be met. Deadline for submission 18/01/16
RWT • A&E 4 hour CPN issued this week – RAP meeting booked for next week – RAP rejected w/c 23/11/15, Trust have challenged host CCG rejection. Will be discussed CRB 17th December. • 62 day cancer CPN issued this week – RAP meeting booked for next week – RAP rejected w/c 23/11/15, Resubmisson due 18th December. RAP agreed, recovery timeline extends to June 2016. WM Cancer Network support RWHT on plans to recover • RTT – local improvement plan in place for individual specialities not delivering to threshold 11 CPNs and RAPs Community
SSOTP • A number of CPNs have been issued in recent weeks following resolution of a long running argument regarding the KPI’s in Schedule 4 of the SSOTP Contract, these include: Community Intervention Service, Home oxygen, Speech & Language Therapy and Podiatry • RAPs have been submitted as per the due date of 15th January 2016 and these are being actively reviewed by Commissioners. • SALT – CCGs agreed to a Joint Investigation as evidence indicates patients are being discharged from 2°care services earlier than in previous years which is driving excess demand over capacity in the provider
SSSFT • CPN issued at November CRB for failure to deliver IAPT Recovery target of 50% for SES contract • Teleconference with NHS England 11th December re CCG grip on IAPT targets – assurance provided • Recovery date agreed for Q4 and remains under active monitoring
12 Activity
Activity Elective Non-Elective OPFA A&E GP Referrals Plan CCG Var Plan CCG Var Plan CCG Var Plan CCG Var Plan CCG Var SES 19,013 18,334 -3.6% 16,349 14,318 -12.4% 41,656 38,167 -8.4% 59,047 62,663 6.1% 37,663 36,273 -3.7% CC 12,155 11,829 -2.7% 9,535 8,553 -10.3% 33,720 26,833 -20.4% 26,146 25,550 -2.3% 19,141 20,356 6.3% SaS 13,053 13,780 5.6% 10,495 9,702 -7.6% 35,907 30,438 -15.2% 27,976 29,467 5.3% 20,438 22,796 11.5%
CCG Month 8 Activity variance against plan 15.0% • The chart on the left maps the variance between CCG Plan and CCG Actual activity at Month 8 • Elective activity variations have remained broadly stable over 10.0% recent months. SES underperformance has fallen back towards plan as expected following a blip in M7. SaS activity is not showing the expected reductions in Daycase activity and is being driven by the 5.0% increased GP Referrals which are running well above plan. • NEL activity remains well below plan and is also tracking at significantly less on a YoY basis. The variation in SES is expected to 0.0% reduce somewhat in the coming months due to plan phasing but it is not anticipated this will move significantly • -5.0% OPFA reports significant under-performance – two hypotheses are being tested, first a shift in coding from G&A to All Specs and second, the impact of MSFT dissolution on double OPFA now being -10.0% OPFA and OPFUP • A&E activity variation for SES and SaS is subject to active review through the T&F Group. For SES, the pattern has confirmed as -15.0% being due to the removal of backloaded QIPP reductions in the August QIPP recast and will be sustained for the remainder of the year. -20.0% • GP referral activity shows an adverse variance for SaS and CC. The T&F Group is reviewing GP Referral activity. YoY increases are not significant, 0.8% Cannock and 3.5% SaS. After adjusting for QIPP, -25.0% the rates of over-performance remain well above plan and the T&F Elective NEL OPFA A&E GP Ref Group is now looking at individual GP Practice levels to understand SES CC SaS the variation in more detail. 13 Item: 10 Enc: 06
REPORT TO: Clinical Commissioning Group Governing Body Meeting TO BE HELD ON: Thursday 5th November 2015
Subject: Board Assurance Framework Board Lead: Paul Simpson Officer Lead: Sally Young For For For For Recommendation: Approval Ratification Discussion Information
PURPOSE OF THE REPORT:
To give assurance to the Governing Body that the principle risks, that could threaten the delivery of the CCG’s strategic aims/objectives, are being monitored and mitigating actions are being taken to reduce any threat to the CCGs.
KEY POINTS: The Board Assurance Framework has been updated to reflect the new working arrangements with South East Staffordshire and Seisdon Peninsula CCG.
SESSP have held a risk meeting monthly to review the Board Assurance Framework and the Risk Register, which performs the overview and assurance role. The first joint risk meeting took place on December 1st for all three CCGs and followed the standard SES&SP agenda. It was agreed this group will be extended to cover the three CCGs to ensure all three CCGs can share the learning. The membership of this group are the Directors of Finance and Transformation, and Quality and Safety, as well as the Assistant to the Chief Executive and both Governance Managers. All risk owners across the three CCGs are being asked to update the Risk Register and the Assurance Framework, plus identify any emerging risks.
The updated risks are then shared with the relevant committees in the normal way for scrutiny and the Governing Body. Both quality and financial risks have been reviewed at these committees during this intervening period.
The Risk Management strategy will also be updated to reflect these new arrangements, which will be presented to the Audit Committee in March.
The Assurance Framework is attached for information and discussion.
Page | 1
Item: 10 Enc: 06
RELEVANCE TO KEY GOALS To reduce health inequalities across Cannock Chase N/A through targeted interventions To identify and support patients with Long Term N/A Conditions to ensure care delivery closer to home To improve and increase overall life expectancy N/A
To develop integrated services with simple, easy N/A access
IMPLICATIONS Legal and/or Risk CCG has to have a regularly updated BAF and risk register that effectively monitors and mitigates the risks to the organisation. CQC N/A Patient Safety Risks relating to patient safety are reflected on both the BAF and Risk register. Patient Engagement The CCG is concerned that it is not engaging with the wider population it serves and as such has included this as a key risk on the BAF. Financial Risks relating to finance are reflected on both the BAF and risk register. Sustainability N/A Workforce/Training N/A
RECOMMENDATIONS/ACTION REQUIRED: The Governing Body is asked to: Note the BAF updates and note the work to be undertaken in the review of the BAF and risk register.
Not KEY REQUIREMENTS Yes No Applicable Has a quality impact assessment been undertaken? Has an equality impact assessment been undertaken? Has a privacy impact assessment been completed? Have partners/public been involved in design? Are partners/public involved in implementation? Are partners/public involved in evaluation?
Page | 2
BAF 003 BAF 002 BAF 001 Risk ID 12/11/2014 12/11/2014 12/11/2014 Date Added
Commissioning Commissioning Finance Source of Risk will need towill shift) (DN these of some 44,108, 51, 27, 121 22, 124, 139, 136, 24, 53,138 128, 25, 142 140, 141, 146, 181, Risks Associated requirements) (DN move this to Performance) national targets and and legislative compliance (Delivering the NHS Constitution Standards, Contract Management Dissolution/Transaction and Transition Trust StaffordshireMid NHS Financial Performance Area Strategic Risk and Performance Standards and other key performance metrics. its contracts with its main providers deliver Constitutional the NHS The CCG does not have robust arrangements in place to ensure that Additional costs from the dissolution will fall to the CCG. transfer care.of Risk that patients waiting on lists be lost could in transition and Implementation stemming of the flow. * * Non-delivery QIPP of * commitments BCF. through emergency activity will be insufficient to cover costs additional of * care. within planned, care, unplanned specialised services and primary * the control total 15/16 be as could a result the of following: toThe control CCG deliverfails 15/16 its total Description Risk of and control expenditure effectively Lack effective of collaboration with other CCGs to manage contracts Material and costs number increased CHC placements. of Better Care Fund. Contract over performance
unanticipated running costs Additional savings reduction in through on all on acute and community contracts . The non-delivery of
Initial 5 4 4 Likelihood
Initial 3 4 5 Consequence 15 16 20 Initial Risk Score
Current 3 2 4 Likelihood
Current 3 4 4 Consequence 12 12
8 Current Risk Score Yes yes No Clinical Risk This approach needs bereplicated with to UHNM. managementofthe Wolverhampton the contract. fromcapacity CSU the (P Butterworth, C Harris), particularly in relation to collaboration amongst partner CCGs, supported additional bythe The 2015/16 round contracting has involved asignificantly higher of level 2015March - for 2016/17 round. contracting effective. This positivedirection of travel needs befurther to developed other CCGsbeen significantly have and strengthened areproving be to risegiving issues the to hadand anticipated been relationships that with schemes withproviders. main the acute Associatestatus of CCGs the not very successful in contractualisation securing the of 2015/16 QIPP Collaborativeagreements with lead providers now in CCGs place. were 2015 July with team South East Management joint Staffs &Seisdon Peninsula CCG. 2015September tracker process,contract first established for 2015/16. round areinand place effective. This will relaunch include the of the managed appropriately preparations and that for 2016/17 the contracting CCGs and inarrangements is place putting ensure to allare contracts that 01/12/2015: 29.01.2016 archived commentary Previous CCG agreedtoincreaseDistrict Nursing resource,Stafford. Re-ablement* Ambulatory* unit care 2015 - January recruitment of extra children's nurses. undertake further consultation. 17.06.2015 20.08.2015 25.09.2015 25.11.2015 29.01.2016 produced for EMT, this will bepresented on aregular basis. being identified. Updated financial risks and opportunities summary (i.e. delivering in-year the notjust control total). Additional savings QIPP The CCGs anambitionset have of delivering in 15/16 abalanced budget with place Area the Team with revised monitoring systems and processes. 2015June referrals. CareTeam, including working with thosewithpractices highlevels of problematic in S&S). A series of actions arebeing pursued Primary by the someemerging risks, referrals notably in GP (which appears particularly CCGs remain 2015/16 on coursethe achieve to control totals, thereare 2015September withrecently NHSE via aFinancial Dive'. 'Deep will deliver their 2015/16 control totals. This has also shared been verified analysisrecently byadetailed activity and forecast) CCGs the that CC, and thereis areasonably degree of high confidence(which has been The performance levels of QIPP in bothCCGs remain particularly high, in could yield unplanned financial benefits. CCGthe is also pursuing anumber of (particularly challenges S&S) that is providing of adegree headroom offset to other pressures the cost and Primary Care. The overall levelofunderperformance acute in bothCCGs totals despiteemerging pressures in anumber of areas as such CHC and 01/12/2015: 29.01.2016 Last ControlsLast to Mitigate 15.04.2015 18.05.2015 - New monthly assurance financeand activity meetings now in - No previousto change update. Outstanding issue with Haematology/Oncology moving, to No previousto change update - No previousto change updates. - Controls remain inand through place havebeenenhanced Controls with us as most risks removed/down graded. - No Change previousto updates. - No previousto change update. - No previousto change update. The DoF for CC and convenor S&S for iscontract the 3 the The CCGs remain on course deliverto 2015/16 the control Team remains in UHNM place. agreedtofund - Whilst and financial overall activity plans the for both - Cannock Chaseand Stafford &Surrounds nowa have Previous commentary archived. commentary Previous forward. Host CCG is in-housing contemplating managementwhich needs contracting careful consideration. feedback from host CCG. An improving working relationship and collaboration seeking better going contract tomanagethe UHNM - Contract is finalised and awaiting signaturefrom UHNM. Collaborativeagreement with Host proposed, awaiting Finalising contract. the collaborative signingto main precede agreement to contract. 18.05.2015 All are contracts now signedand collaborative the agreements arein place. 09.07.2015 lead commissioners. and arestrengthening their arrangements for application the of levers CSU via the contract and in collaboration with the negotiation. The managementand CCGs contract contract are developcontinuing to their role as associatecommissioners convenor portfolio acrosscontract contracting the of all three CCGs. This will ensurethereis acommon approach toin-year Themanagement of Director contract. the of FinanceCC &SaS CCGs has also as beennominated the recently act to has directormanagement team anominatedEachcontract responsible major executive acute for leading on the 2015September 01/12/2015: ensurepreparations remain deliver on to 2016/17 track the controls numerous and the submissions required byNHSE. to weekly Officer alsoaremeeting ofAccountable Commissioning Director the and of Finance, round.The Director planning 29.01.2016 archived commentary Previous 15.04.2015 transferPaediatric Service on coursefor transition 2015. 1 May model. but workthis once years commence to work programmeestablished tolook long term at financially sustainableservice providing £1m non-recurrent funding support to transformation programme. Team focused on delivering 15/16 present at 19.04.2015 17.06.2015 20.08.2015 25.09.2015 25.11.2015 materials now complete. 29.01.2016 archived. commentary Previous 18.05.2015 First iteration of new financial risk and opportunity presented EMT to on Wednesday 1st July 2015. undercontract performance. acute Further work underway of determine to level the within backlog Providers. 30.06.2015 analysis. address referral GP risks. A Workshop EMT at is also planned for 01/10/2015 overall updatethe to risks and mitigations 2015September - thiscontinues have to as their number one priority. 01/12/2015: control totals remain high. control totals. Discussions with CCG's the providers key forecast on the out-turn positions confident but of delivery. The 29.01.2016 Last Action Comment Last - The Director of Financeis chairing aweekly with leads meeting all contract on preparations for 2016/17 the - Assurance forPanel Paediatrics agreedtransfer in May. - Aspects of flow stemming the progressed being as part of 15/16 the for QIPP Unplanned FRP Care. UHNM Consultation on Haematology and Oncology willover summer. place take the Haematology Oncology & Consultation willfrom place take 14th September 2015 agreedby NHS England - No previousto change update. - Control totalmet. - 1 Months &2 reported financeand Area activity to Team. Initial yearand date forecast to out-turn suggest - RWTledbyWolverhampton contract CCG strong continued work relationship delivery managing the jointly of - No previousto change updates. - Paediatrics transferred on time,final transfer of specialist Haematology/Oncology aimed. being All dissolution - The CCGs arepreparing for year the end closedown, akeycomponent of which is delivery the of 2015/16 the No further update Thereare regular updates of financial the CCG and Team the positionManagement Meetings Executive the at - The CCGs areworking ensure to together thereis approach aconsistent managementof tothe contracts. A force' 'task of Director the of Commissioning, Director of Financeand others, will work on options to None identified. an area of priority high for CCGs. the management and businesssupport. intelligence This is colleagues within CSU the regarding contract 01/12/2015: 29.01.2016 *Financefor Flow" the "Stemming agreedand in place. 18th 2015. May Final* transfer of major services willon place the take Risk* of dissolution costs falling CCG to fully mitigated. 18.05.215: 17.06.2015 20.08.2015 25.09.2015 25.11.2015 29.01.2016 *Financefor Flow" the "Stemming agreedand in place. 18th 2015. May Final* transfer of major services willon place the take Risk* of dissolution costs falling CCG to fully mitigated. 18.05.215: over months. coming the of may materialise inthat anybacklog planned activity positive,further work required determine to level the 30.06.2015 further analysis understand to root the causes. and on first aknockimpact out-patient episodes, needs 2015September areno gaps in assurance. deliver its 2015/16 controlthere totaland this at stage, 01/12/2015: 29.01.2016 Gaps in Assurance - No previousto change update. No previousto change update. No previousto change update Whilst initial in-year projections look No previousto change updates. - No previousto change updates. - No previousto change update. - No previousto change update. Thereis ongoing discussion with senior The CCGs are alltaking necessary steps to - The issue of referrals, increased GP CC/SaS CCGs - BOARD ASSURANCE FRAMEWORK -BOARD CCGs CC/SaS
29/01/2016 29/01/2016 29/01/2016 Last Review Date both both both CCG
29/02/2016 29/02/2016 29/02/2016 Date of Next Review
Director of Finance Chief Officer Director of Finance Exec Lead BAF 006 BAF 005 BAF 004 Risk ID 12/11/2014 12/11/2014 12/11/2014 Date Added
Comms & Engagement Corporate Commissioning Source of Risk 21 34,131, 183, 184, 83 48,133, 148, 143, 119, 120, 147, 137, 135 Risks Associated Communications & Engagement Capability and Capacity Collaboration/Partnerships Area Strategic Risk and financial performance partners and staff to deliver qualityhigh safe services, constitutional Failure to appropriately communicate and engage with the public, Lack CCG of capacity. Lack resilience of from CSU to provider support CQRM. Key individuals not in post. Capacity to manage contracts. Local Authority capacity to deliver MCA/DOLS for vulnerable adults. Winterbourne. CSU failing to deliver the quality services of required. Lack performance of team. Distressed Report recommendations. Economy The risk is the lack capability of and capacity to implement the KPMG home packagesprocess for non-nursing care. of rolled out to Homes, Nursing however, CCG still need to establish a include adoes now formal governance mechanism is which being The collaborative commissioning arrangements for the contract CHC Description Risk of
Initial 4 4 4 Likelihood
Initial 4 4 5 Consequence 16 16 20 Initial Risk Score
Current 4 3 3 Likelihood
Current 3 4 4 Consequence 16 12
9 Current Risk Score yes No No Clinical Risk Previous commentary archived commentary Previous Engagement further being senior at enhanced level. 15.04.2015 on team workengagement streams and priorities. Engagement specialist in Clarification place. for current comms and 20.05.2015 for for strategy the bothCCGs during 2015/16. Members is Lay held being 15thand on the PPI July identify to priorities Comms Committee &Engagement 23rd on the June. Workshop with EMT 30.06.2015 priorities and work streams. C&E Committee on 18 met August. 20.08.2015 Comms Committee &Engagement 20 October 2015. 28.09.2015 Engagement. 26.11.2015 Comms plan &Engagement written programme. support to QIPP each CCto 03/02/16 GB for approval. 29.01.2016 mitigations areinsee risk place 58. establishment of For aCMB and CQRM. nursing homeresidents specific roles and responsibilities of lead and AssociateCCGs formal and the AFrameworkcontract. Governance is in development which clarifies ProgrammeBoard tooversee managementandof governance the CHC procurement process has established been for CHC the and a contract See mitigation toAssociated risks 113 and 123 (closed). A new Previous commentary archived. 18.05.15 17.06.2015 20.08.2015 25.09.2015 25.11.2015 29.01.2016 ControlsLast to Mitigate -Resource for May remains in place and functioning. - Review of resourcebase. Resources for Communications & - Additional support from senior Comms level and - The draft and comms strategy plan was discussed the at - C&E Committee held aworkshop 8.7.15 determine to - Draft under strategy development besignedoff to bythe - Working with three CCGs share to learning from Comms and - Comms approved Strategy &Engagement SAS at will GB, go No change to No previous update. change to No previous update Transformation programme in place. - No change to- No previous updates. change to- No previous update. . Previous commentary archived. commentary Previous well as quarterly Governing to Body. - Committee expressed increased assurance workat in play. - formatting Redesign C&E reports. - Three new C&E risks riskbeen added have tothe register. - Updates provided on Engagement work streams including Haematology consultation. and besignedoffstrategy to Governing goingto Bodies. in October withthen strategy the 20.08.2015 sector and agood Q&A session end of with the public. at meeting the the September. Stafford and Surrounds held AGM on 22 September was asuccessful with AGM agood rangeof stalls from their 28.09.2015 CCGs develop to robust plans scheme. engagement for QIPP each 26.11.2015 staff, capture OD to events and patient public feedback. Communication with staff improved with Chief Officer brief and with regularinformation. cascade to meetings team awayand day- PPG 2ndPractice 2016. March Focus on howand priorities.better alignthe engage to Work plan for 12 next months bedeveloped February to Comms at Committee. &Engagement 29.01.2016 archived. commentary Previous 15.04.2015 - CCG full at capacity - Fully staffed local teams - Contract in team place - Winterbourne resourceallocated - Performance inteam place A* number of risks now adequately mitigated: Preparation* toremove needfor the Director 13/5/15 on transformation plan for Staffordshire. 18.05.2015: 17.06.2015 20.08.2015 25.09.2015 25.11.2015 29.01.2016 - archived. commentary Previous through IPA ProgrammeBoard. 15.04.2015 beginning of for May ratification June at CCG Governing Bodies. work agreethe to met programme commissioning strengthen to andarrangements. governance Proposals befinalised to 19.04.2015 18.05.2015 commissioned services tobefinalised in July 2015. Operations and Director of Overall Quality. governanceprocess and quality monitoring of other CHC and activities 28.06.15: is moreand programme extensive the of work will requirea further two monthsprior complete to implementation. to 29/07/15: November 2015. Board for delivery. implementation Confirmation aligned toQIPP of implementation beadvisedto timescale byend 30/09/15: First discussions on reports heldNursing at Homes group Quality (sub-committee of IPA ProgrammeBoard). 26/11/15: Last Action Comment Last 30.06.2015 CHC work programmeand nursing homearrangementsgovernance agreedfor implementation by Director of Work associated with mapping pathways and furtherand governance quality assuranceregarding CHC processes Nursing Homes quality havecommenced reporting in line with NHS Standard Contract information requirements. C&E review to met committee draft Additional strategy. up in set being September meeting work to through - The newspaper wraps werepublished in Express the &Star Cannock and the Chronicle during last week the in - Regularwith meetings team CSU across three CCGs the drive to work programme. - Single transformation pursued being team for Staffordshire. Clinical leads group in place. - CCG AO's approved newarrangement Governance in February 2015. Officers Lead currently implementing - Following CCG AO approval of recommendations for CHC commissioning responsibilities, six Staffs CCGs have - Paperwork prepared being for submission toJuneGoverning Bodies for approval. Comprehensivework programmebeing finalised in October for presentation toJQC and CHC/IPA Programme - reports Monthly arebeing developed which will EMT goto on amonthly basis senior and each to as committee lead Engagement from Confirm SES QIPP the attended and Challenge for across schemes event three the QIPP No previousto change update. No previousto change update - No previousto change updates. No previousto change update. engage with ourengage population. significant amount of work doand to communicate to 20.05.2015 focus to team the on. wideranging and we identifyneed to clearpriorities for 30.06.2015 for asmall teamarea concern. confirmed - volumeand breadth of C&E work streams 20.08.2015 CCG. CCGs as well as South East Staffs &Seisdon Peninsula Boyd confirmed lead for strategic as the SaS and CC Edmondson is confirmed as Business and Manager Ruth band 6 C&E support is beconfirmed. to Adele 25.09.2015 - December 2015. Commsthe 15 until the committee &Engagement isstrategy carried being outanwill not beshared with 26.11.2015 widely as weneed to. 29.01.2016 capability and capacity. leadership tobelisted as anissue BAF on the under 15 January 17.06.2015 20.08.2015 Transformation Programme. Director appointmentMedical * Staffordshire to 25.09.2015 25.11.2015 29.01.2016 risk to patients. risk sharing from Associate CCGs increases the insufficient and lack funding commitment of to patients. In addition the associated risks of poses a potential Quality and Safety risk to The absence a of formal governance mechanism Gaps in Assurance - SaS Governing Body asked for clinical - Acknowledgement byCCG thereis that a - The draft and comms strategy plan is very - CSU staffing arrangements be to Wearewithnot population engaging as No previousto change update. No previousto change update - Further work on Comms and Engagement - No previousto change updates. - No previousto change update. CSU staffing arrangements regarding the CC/SaS CCGs - BOARD ASSURANCE FRAMEWORK -BOARD CCGs CC/SaS
29/01/2016 29/01/2016 26/11/2015 Last Review Date both All CCGs Both CCG
29/02/2016 29/02/2016 22/01/2016 Date of Next Review
Assistant to Chief Executive Chief Officer Director of Operations Exec Lead BAF 008 BAF 007 Risk ID 12/11/2014 12/11/2014 12/11/2014 Date Added
Performance Quality Quality Source of Risk 108,44,51,27,121 108,44,51,27,121 147 53, 135, 133, 147 53, 135, 133, Risks Associated compliance other regulatory standards Delivery Constitution standards NHS of and Quality and Safety Quality and Safety Area Strategic Risk patient care Failure to deliver Constitution StandardsNHS and therefore affect with MSHFT. and UHNM RWT of identified a greater distance between the quality monitoring schedule compare and contrast exercise prior to transfer conducted also provided mitigation for the restrictive a of approach HoTs. The MOU for the quality metrics it which was able to with do that UHNM receiver Trusts. The CCG has been unable to agree with thean RWT the risk relating conditions to the transferservices to MHSFT of the Royal Wolverhampton Trust -Please see risk BAF describes which 007 potentially large scale, strategic change across Staffordshire. The CCGare functions being undertaken within the context a of i.e. CHC, dementia require strengthening. The governance frameworks for traditionally underdeveloped services- particular SSOTP. sustainability the of CSU to support the CCG forthose Providers; in meeting those requirements. In addition to the resilience and There are going capacity on issues within the CCG team itself in holders to assure their safe and acceptable transition. public. The CCG has to work with a range statutory of and local stake (obstetrics/paediatrics) are which of highly contentious with the specificSome services are being transferred early. Two assure quality. theimposed CCG, upon potentially which restricts the CCG's ability to theFor remainder contract a 2014/15 of CVO arrangement has been Bodies and the the of public quality and safety those of services. and WolverhamptonNorth CCG's to assure and CC SAS Governing The CCG is not the lead Commissioner and will need to work through services will transfer across Providers more than once. have been now transferredfrom MSHFT to new Providers. Some As a result clinical of and financial sustainability issues, the services assure the quality and safety Commissioned of services. The is a risk that the CCG will be unable to fulfil its statutory duty to Description Risk of
Initial 5 5 3 Likelihood
Initial 4 4 4 Consequence 20 20 12 Initial Risk Score
Current 2 2 2 Likelihood
Current 2 2 4 Consequence 4 4 8 Current Risk Score Yes Yes yes Clinical Risk Assurance andMeetings Governing Body Performance Lead, Contract Reviews, Executive Team, AT April 14 meetswhich monthly. meets fortnightly and the Area Quality Surveillance (QSG) Group transition process the through Local Transitionwhich (LTB) Board Wide AssuranceEconomy -There is economy wide scrutiny the of paediatrics, critical care, acute surgery. review foreach 4early of transitioning services -obstetrics, involvesprocess which an assessment framework and panel Early Transition Services of -The CCG has developed an assurance *CCG representation at Director and Nurse Director are for RWT in attendance. * CCG representation at the monthly COG where the Medical Wolverhampton Trust - - 01/12/2014 Quality meets Surveillancewhich (QSG) Group monthly. meets Transitionwhich (LTB) Board fortnightly and the Area wideeconomy scrutiny the of transition process the through Local Wide AssuranceEconomy Wide Assurance -Economy -There is paediatrics, critical care, acute surgery. review foreach 4early of transitioning services -obstetrics, involvesprocess which an assessment framework and panel Early Transition Services of -The CCG has developed an assurance * CCG representation the on monthly CQRM UHNM Directors the of receiving Provider Trusts. (COG)where the TDA meet with the Nurse Directors and Medical * CCG representation at the monthly TDA Clinical Oversight Group Committee meeting a on monthly basis * CCG attendance at the County Hospital internal Quality CCG. Other measures include: reported in a separate County Quality Assurance Report to the priority for the County Hospital is (Stafford) specified These will be where the majority the of quality metrics identified as high theHoTs CCG Quality team have negotiated a MOU, with UHNM - 01/12/2014 ControlsLast to Mitigate -Monthly Performance monitoring standardsof through UHNM - To mitigate -To UHNM the restrictive a of approach Previous commentary archived commentary Previous WMAS diverts RSUH to and New Cross. Full recovery in June. anticipated immediaterecovery plan. issues Key arean increasing complexity of frail elderly patients combined with cessation of the the 18.05.2015 rates. Trusts improved responsiveness discharges. to two weeks Last of over Junehave achieved 95% against veryattendance high particular result the of new operating models for Ambulatory the Assessment Unit within County Hospital and Partnerships 28.06.15: and Cancer waiting timesand Ambulanceresponse times risk. being deemedbehigh to and internalcontract performancemanagement processes, with no performanceissues pertaining A&E, to RTT (18 week), Recommend this risk bedowngraded can as all NHS Constitution are targets currently beingmanaged as part of routine overall demand now well being local system. manged bythe 29.07.15: and Trusts are Remedialagreeing to Action Plans through formal the route. contract 30/09/15: developed. orthopaedics and b31/62 referral for treatment to pathways. cancer All areas under review; RAPs inor place being 95%. achieve to continue RTT and Cancer overall performancegood, with notable exceptionsaround specific services eg: 26.11.15: Previous commentary archived. adjusted following the meeting theof executive nurses. resolve this. Assurance and challenge is made the through CCG by representatives. QRM risk score will be still not been granted. Meeting to be arranged for the executive nurses for CC and Wolverhampton to meet to theby CC CCG Director for Strategy Planning is who also the lead commissioner however for RWT; access has 18.05.2015.- planned to progress this. Wolverhampton CCG to discuss access toAlthough STEIS. a decision has not been made, further discussions are - 22.06.2015 now is aThe risk residual one and should be de-escalated. the CQRM, robust followRWT and assertiveness through CC of as an associate with the Lead commissioner. transfer has servicessignificantly toof RWT from MSHFT the through reduced presence CC of CCG reps at the this is more a question inconvenience of than risk. The initial risk reducedquality of surveillance following the Wolverhampton CCG are responding speedily to any requests for information incidents around and therefore is not going for toRWT be supported.STEIS This has been escalated Area and to QSG team DoN. However - 25.09.15 removed from the BAF. 26.11.2015 Previous commentary archived. completed. and considering the role this of committee in the assurance process. Risk score will be reviewed this once is County Internal Quality Committee has been disbandedthe and by UHNM CCG will be raising this with UHNM reported in the CCG Quality and Safety report to the CCG Joint Quality Committee and the bad GBs. The MB CCG QIL, GP Clinical lead for Quality and the Director Qualityof and Safety. The outcomes and issues are 18.05.2015 where challenges are made to the RCAs being conducted assurance and theQuality South Manager attend is which the Commissioner Group Serious Incident Sub led and reporting siteby in one report. ClinicalThe North lead attends internal meetings at to UHNM gain additional 22.06.2015 quality and safety processes. This risk be de should -escalated. October is which a significant improvement. be now monitored This should normal through core and CQRM harm being reported. HCAI control of and staffing Good vacancy levels projected to be reducedto by 11% addressed either within oroutside as CQRM appropriate. County is stable with low levels risk of and patient quality leads & from SAS Stoke Trent on CCGs with recent examples issues of raised being byand SAS supported representation with GP Clinical Lead and QILare established and there is working good relationship between the 25.09.2015 removed from the BAF. - 25.11.15 Action Comment Last Enhanced collaborativeworking acrosspartners care urgent has seenan improvement in A&E performance,in County Hospital A&E Department routinely performing in of excess 95% the 4 hour standard, and fluctuations and A&E Performanceacross CCGs stable UHNM but performanceonly marginally improving. County Hospital A&E County95%. at achieve continuesto Planned Care(RTT and Cancer) across failing patch in arangeof areas - Significant deterioration in performance hasin ledtosenior May officer understand to meeting and agree Following Following further discussions with the from Wolverhampton DoN CCG it is clear that direct access to This risk has been reviewed, there is further no updates to be made, therefore this risk be can now - -Separate Quality Assurance reports are longer no being provided by UHNM, however they are provides CQRM comprehensive -UHNM assurance reports the on County site. SASCCG - Separate Assurance report County is on provided monthly. is CQRM Theattended UHNM by the The Director Qualityof and Safety has met with the Executive Lead for andQualityNursing for This risk has been reviewed, there is further no updates to be made, therefore this risk be can now The issue access of to toview STEIS serious RWT incidents for CC CCG has been raised at and QSG . robust monthly contract monitoring. 26.11.2015 Gaps in Assurance - None identified, -None monitored through CC/SaS CCGs - BOARD ASSURANCE FRAMEWORK -BOARD CCGs CC/SaS
26/11/2015 26/11/2015 26/11/2015 Last Review Date Both Both Both CCG
22/01/2016 To be removed from BAF To be removed from BAF Date of Next Review
Director of Operations Director of Quality & Safety Director of Quality & Safety Exec Lead BAF010 BAF009 Risk ID 21/08/2015 27/11/2014 Date Added
Corporate Primary Care Source of Risk Associated Risks Associated Corporate Primary Care Area Strategic Risk control totalscontrol and priorities required. the management team all of three CCGs being able to deliver the CCGs. The risk is the capacity and resilience the of Chief Officer and performing this role for Cannock Chase and Stafford & Surrounds East for South Staffs & Peninsula Seisdon CCG, in addition to The Accountable Officer has been asked to be the Accountable Officer reduce variation in quality and activity in primary care meet the current and future requirements. The CCG is unable to The risk is that the capacity and man-power in primary care does not Description Risk of
Initial 3 3 Likelihood
Initial 4 4 Consequence
12 12 Initial Risk Score
Current 3 3 Likelihood
Current 4 4 Consequence
12 12 Current Risk Score Yes No Clinical Risk supported. to ensure the Chief Officer and the management team are 21.08.2015 across all three CCGs. report to Chief Officer identifying cover/gaps for work streams working theirunder September during functions aand to produce 25.09.2015 will the discuss on December 3rd 2015. have andapproved SES this SaS approach already Cannock Chase presented to all three CCGs for approval comprising a two-stage 26.11.2015 for 31st March 2016. OD events being rolled out with full OD plan to be development 29.01.2016 Previous commentary archived engagement in Cannock in place. - 30.06.2015 in place for Stafford managed the through primary care team. indicators and against the primary care strategy. PLTprogramme practice and highlighting variation by the monitoring qualityof into a primary care strategy update supports sharing which best and referrals. Former aplan on page has document been updated CCGs. Map medicine of rollout to clinicians support in pathways 30.09.2015 26.11.2015 sustainable primary care in future. Draft primary care strategy to create by NHSE produced primarysupport care capability. held inIMT January Workshop to plan IMT programmes to estates planning. 29.01.2016 ControlsLast to Mitigate -Discussion at Governing both Bodies about the need -Convenors are all having one to ones with the staff in place FRP -Robust to deliver totals.control change -No to previous update. -Organisational Development plan has been - Clinical leads and network leads in place across both - Draft estates stratgy to future support produced New arrangements for clinical lead and network lead . Staff briefing is a going out on weekly basis to keep all staff members Governing and Body informed. streams so that where we things can do rather once than three times and economies scale of can be realised. with staff at all organisations to outline developments. Convenors have been putin place to help align work 21.08.2015 panel established and meeting weekly as required. working.of agendasEMT include an update and discussionfrom the each convenors week. Vacancy control 25.09.2015 with all staff. Message from Andy Donald goes out each week. away day to be held in January 2016. structuresJoint for all three CCGs have been developed and will be shared October28 with action plan to take forward key actions following this. Further staff away day, and primary care - 26.11.2015 29.01.2016 Previous commentary achieved Governance arrangements to be costed with CCG providers and NHSE. * Developments -AVS, Frail Elderly, Dementia, etc. for SaS * Extended 8am-8pm 7days per week access to Primary Care -CC * -SaS Technology * Workforce -SaS work streams: 20.05.2015 monitor progress against primary care strategy and quality indicators. 30.06.2015 retention GPs of and nurses. in the local area. into Look a resilience survey practices of to understand the issues relating to recruitment and team for Stafford to attend a future membership board. engage To further for deanery relating to recruiting GPs primary care by offering additional appointments are when none available in the participating practices. PMCF monthly basis. 1st Cannock commenced PMCF on September releasing on focussing additional capacity in 30.09.2015 GP fellowship post agreed to attract clinical leadership and newly qualified GP's to SaS. 26.11.2015 Practice merger agreed two practices in Great Wyrley providing greater resillience. 29.01.2016 Action Comment Last -Chief Officer thecommenced role at the beginning Augustof and has 2015 taken time to meet -Convenors pulling together teams covering the aligned functions to them and setting new ways up -Plans for management change of being developed. -Twosuccessful Prime Minister's Challenge Stafford and for Cannockbids both CCGs. Funding Four -Map medicine of implements. Former aplan on page updated and distributed to practices a on - reviews- PMS underway. Practice Two Nurse lead posts agreed & in SaS CC to capacity. DN support - All practices live web, EMIS single on operating system in place across and CC. SAS Successful organisational Successful development day held for all staff members Governing and Body the on Map Medicine of implemented in all practices. Plan a on page is currently being updated to . are not to be underestimated. 21.08.2015 advert. 25.09.2015 posts. 26.11.2015 this year across three CCGs. time to deliver willand for EMT be challenging 29.01.2016 * Legitimate increase in demand and expectation * Demographic "time-bomb" * Networks and collaboration in a fledgling state * Many small practices in Cannock Chase CCG 11.02.2015 be fulfilled. means that the recommendations TSA may not 11.02.2015 Prime Ministers Challenge in SaS. Fund 20.05.2015 membership board. inPMCF Stafford, team PMCF to attend a future 30.09.2015 26.11.2015 29.01.2016 Gaps in Assurance -The challenges facing all three CCGs -Some key posts are currently out to -Some difficulty appointing to key -The the endof financial year is a key -Lack capacity of in Primary Care -Further work to engage practices in change -No to previous updated. - Further work to engage practices in - Still difficulties in recruiting GP's. CC/SaS CCGs - BOARD ASSURANCE FRAMEWORK -BOARD CCGs CC/SaS
29/01/2016 29/01/2016 Last Review Date both both CCG
29/02/2016 29/02/2016 Date of Next Review
Assistant to Chief Executive Director of Primary Care Exec Lead Item: 11 Enc: 07
REPORT TO: The Clinical Commissioning Group Governing Body Meeting TO BE HELD ON: Thursday 4th February 2016
Subject: Finance Report Month 9 (1st April 2015 to 31st December 2015) Board Lead: Paul Simpson, Director of Finance and Deputy Chief Executive Officer Lead: Vicky Hilpert For For For For Recommendation: Approval Ratification Discussion Information
PURPOSE OF THE REPORT:
This paper provides the Governing Body with the financial position of Cannock Chase CCG as at the end of November, and to advise of any other financial issues that are likely to impact during 2015/16.
KEY POINTS: This report sets out the outturn financial position at Month 9. This shows; the planned in-year deficit for 2015/16 for Cannock Chase CCG is £6.377 m. the identification of significant savings from across the contracting portfolio and other areas of expenditure, continue to be pursued via the Executive Management Team and CCG Committee structure the summary financial statement shows the month 9 planned revenue position was a year to date deficit of £7,889m and the CCG has underspent against its plan by £14k. The CCG also remains on target to deliver its agreed deficit control total of £6.377m by the end of the financial year.
RELEVANCE TO KEY GOALS To reduce health inequalities across Cannock Chase through targeted interventions. To identify and support patients with Long Term Conditions to ensure care delivery closer to home. Finance Plan supports delivery of key goals To improve and increase overall life expectancy.
To develop integrated services with simple, easy access.
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Item: 11 Enc: 07 IMPLICATIONS Legal and/or Risk Report contains assessment of financial risk CQC None Patient Safety None Patient Engagement None Financial Year to date underspend. Forecast achievement of annual targets for revenue control total, cash management and QIPP delivery for 2015-16 Sustainability Supports financial sustainability and best value commissioning. Workforce / Training None
RECOMMENDATIONS / ACTION REQUIRED: The CCG Governing Body is asked; To note that the reported £7.889m deficit at Month 9 of the financial year is slightly under plan. To note that the CCG is forecasting to deliver the deficit control total of £6.377m set by NHS England. There are however a range of potential risks to this position that will require ongoing management throughout the remainder of the financial year. To note that QIPP delivery remains a challenge.
Not KEY REQUIREMENTS Yes No Applicable Has a quality impact assessment been undertaken? Has an equality impact assessment been undertaken? Has a privacy impact assessment been completed? Have partners / public been involved in design? Are partners / public involved in implementation? Are partners / public involved in evaluation?
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CANNOCK CHASE CCG
Report To: Governing Body Report From: Paul Simpson, Director of Finance and Deputy Chief Executive Report Author: Yasmin Ahmed, Interim Deputy Director of Finance Title: Finance Report Month 9 (1st April 2015 to 31st December 2015)
1.0 Introduction
1.1 The purpose of this report is to inform Governing Body Members of the CCG’s financial position as at the end of November, and to advise of any other financial issues that are likely to impact during 2015/16.
2.0 Planned in-year deficit
2.1 The planned in-year deficit for 2015/16 for Cannock Chase CCG is £6.377m. The CCG is however aiming to eliminate as much as possible of this deficit in year, as this will support the delivery of the requirement for the CCG to be in recurrent balance in 2016/17 and to enable the CCG to begin to repay historically accumulated deficits.
2.2 This ambition will require the identification of significant savings from across the contracting portfolio and other areas of expenditure and these continue to be pursued via the Executive Management Team and CCG Committee structure.
2.3 The summary financial statement at Table 1 shows the month 9 planned revenue position was a year to date deficit of £7.889m and the CCG has underspent against its plan by £14k. The CCG also remains on target to deliver its agreed deficit control total of £6.377m by the end of the financial year.
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3.0 Financial position to Month 9
3.1 Income and Expenditure by Services commissioned is shown in Table 1 with the detailed position provided in the Appendices.
Table 1 - Cannock Chase CCG Annual Year to Date Annual Forecast Outturn Summary Financial Statement as at 31st December 2015 Budget Budget Actual Variance Budget Actual Variance £000 £000 £000 £000 £000 £000 £000
Acute Services 87,399 65,806 65,290 (516) 87,399 86,531 (868) Mental Health Services 14,436 10,678 10,772 94 14,436 14,495 60 Community Services 21,108 15,855 16,264 409 21,108 21,526 418 Continuing Healthcare Services 16,730 12,678 13,385 707 16,730 18,059 1,329 Primary Care Services 25,339 18,829 18,847 18 25,339 25,091 (248) Other Programme Services 1,384 1,044 1,160 117 1,384 1,507 123 Reserves 1,104 817 0 (817) 1,104 290 (813) Corporate Running Costs 2,940 2,226 2,202 (25) 2,940 2,940 0
CCG Total Expenditure 170,438 127,933 127,919 (14) 170,438 170,438 0
Revenue Resource Limit prior to repaying previous year deficit (164,061) (120,030) (120,030) 0 (164,061) (164,061) 0
In Year Position (Surplus)/Deficit 6,377 7,903 7,889 (14) 6,377 6,377 0
Repayment of previous year deficit 18,124 10,572 10,572 0 18,124 18,124 0
Cumulative Position (Surplus)/Deficit 24,501 18,475 18,461 (14) 24,501 24,501 0
3.2 Acute, Mental Health and Community Services contracts are showing a year to date underspend of £13k and a forecast outturn underspend of £390k. The position is based on initial contracting information to the end of November (Month 8) for the majority of contracts. In addition, the position includes anticipated QIPP targets that had not been included in the agreed baseline contracts but are still being pursued and some of the additional costs relating to 14/15 activity that had not been provided for in full.
3.3 Continuing Healthcare is showing a significant overspend of £707k and the current forecast is an overspend £1.3m. This is mainly due to growth in additional placements compared to the planned growth levels.
3.4 Primary Care Services are showing a small overerspend of £18k to the end of November and the current forecast is an underspend of £248k. The forecast underspend mainly relates to prescribing (£106k), and Local Enhanced Services (£92k). The prescribing position is based on October PPA (Prescription Pricing Authority) data. The PPA forecast overspend for prescribing is £0.3m and the medicines management team have identified opportunities/initiatives of £0.4m to improve the financial position reported in month 9.
3.5 Other programme services are showing an overspend year to date of £117k and forecast overspend of £123k. This is mainly due to the provision of patient transport services and discussions with the service provider are continuing to identify opportunities to limit the current forecast overspend position.
3.6 The underspend on reserves year to date of £817k and forecast underspend of £813k relates to the contingency budget that was created by the CCG, in accordance with NHSE business rules, at the start of the year to mitigate against in year overspends. This has moved by £274k in M9 due to the receipt of the quality premium income.
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3.7 The CCG corporate running costs are monitored separately within the Revenue Resource Limit. The position to date is a small underspend of £25k. It is anticipated that the running cost budget will revert to plan by the year-end.
4.0 Risks and mitigations
4.1 At this stage in the financial year, there are a number of financial risks that will need to be managed to ensure that the reported position can be achieved. Although acute contracts overall are underperforming there remains a risk that activity may increase due to additional capacity being opened by providers and final contract reconciliations may reduce the under- performance reported. The monthly contract meetings continue to monitor the contracts and regular meetings with budget holders/providers are in place to resolve issues.
4.2 In particular, significant cost pressures in GP prescribing, CHC and the requirement for additional QIPP in acute contracts needs to be urgently addressed.
4.3 Delivery of projected savings from the QIPP programme remains a risk and performance is being monitored through the PMO and Finance, Performance and Contracts Committee.
4.4 The CCG continues to forecast achievement of its control total for 2015-16 and there are now weekly reviews of the forecast position through the Executive Management team. Recent discussions with Senior officials in NHSE have reinforced the CCG’s direction of travel in terms of achieving financial balance in 2016/17. It is clear that there is no flexibility in the timescale to achieve a recurrent balanced position and therefore the CCG must continue to pursue its “ambition” plan for 15/16 as well as urgently progressing plans for releasing further significant costs savings going into the new financial year. This will necessitate difficult decisions having to be made in terms of service provision.
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5.0 Allocations
5.1 In month 9, the CCG received an additional allocation of £402k, £274k is the awarded Quality Premium uplift, £28k is to commission additional Psychiatric Liaison within Acute hospitals and £100k relates to Vanguard Pioneer Staffordshire. Table 2 below provides the details of the CCG’s current allocation.
Table 2 Revenue Resource Limit as at 31st December 2015 £000
BCF 2,521 Initial CCG Programme Allocation 157,219 Initial CCG Running Cost Allocation 2,940 ETO/DTR Funding 422 GP IT Funding 411 Health & Justice Secondary Care Funding 232 Mid Staffs. Dissolution Transfer (479) Waiting list validation and improving operational processes 4 Eating Disorders 71 Mental Health Assessments 74 Tier 3 Neurology 2 Tier 3 Specialist Wheelchairs 36 Mental Health Liaison Psychiatry 28 CAMHs Transformational Funding 178 Liaison Psychiatry 28 14-15 Quality Premium award 274 Vanguard: Pioneer - Staffordshire 100 Revenue Resource Limit prior to repaying previous year 164,061 deficit Brought Forward surplus/(deficit) (18,124) Total Resource Limit - Programme & Admin 145,937
Contracting position at month 8
5.1 The position is based on initial contracting information to the end of November (Month 8) for the majority of contracts.
5.2 The UHNM contract is significantly underspent year to date by £10.7m and Royal Wolverhampton Trust is £7.1m overspent year to date. The contract values agreed with both providers included a level of estimation for the County and Cannock Hospitals following the dissolution of Mid Staffordshire Hospitals NHS Trust (MSFT). These estimates did not fully take account of the impact of certain service transfers and work is ongoing to understand revised baselines for the 2016/17 contracts.
5.3 Acute contracts overspending include Walsall Healthcare Trust (£175k) mainly due to increased non elective and maternity admissions; Dudley Group of Hospitals (£159k) due to increased non elective and critical care admissions; Shrewsbury and Telford Hospitals (£93k) due to increased non elective and critical care admissions; Derby FT (£59k) due to increased day case and non elective admissions and University Hospital of Birmingham (£13k) related to increased non elective admissions.
5.4 Mental health contracts overspending year to date include Staffordshire and Shropshire NHS FT (£106k) mainly relating to the cost and volume elements of the contract for the psychiatry intensive care unit and case management.
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5.5 Community contracts are showing an overspend of £409k mainly relating to some of the additional costs relating to 14/15 activity that had not been provided for in full.
5.6 Table 3 provides an analysis of contracted activity based on Month 8 draft submissions from Providers.
Table 3 Annual YTD Plan YTD YTD YTD % Plan Actual Variance Variance Activity
Daycase 16,760 11,213 10,442 (771) (6.9%) Elective 2,804 2,521 2,629 108 4.3 % Non Elective 15,837 10,268 9,567 (701) (6.8%) Critical Care 2,315 1,524 1,096 (428) (28.1%) OP First 39,370 26,285 26,258 (27) (0.1%) OP Follow Up 94,345 63,989 64,570 581 0.9 % OP Procedure 16,312 10,425 9,287 (1,138) (10.9%) OP Diagnostic 18,438 12,529 12,379 (150) (1.2%) A&E 31,861 21,473 23,051 1,578 7.3 % Drugs 4,388 2,948 1,186 (1,762) (59.8%) Maternity 2,562 1,707 2,143 436 25.5 % Direct Access 828,314 487,288 366,724 (120,564) (24.7%) Other 20,051 13,319 13,062 (257) (1.9%) Total 1,093,358 665,488 542,394 (123,095)
6.0 QIPP 6.1 The QIPP target for the year contained within the NHS England Assured plan is £4.3m but recognising the CCGs ambition to improve its recurrent financial position it has set an internal target of £5.6m. Approximately £3.9m of this has been formally included into the relevant provider contracts and Continuing Healthcare and Prescribing budgets; therefore the CCG is confident of achieving the NHSE agreed levels and the remaining targeted savings continue to be progressed to ensure full delivery of the overall programme. The Month 9 QIPP position indicates a £83k year to date over achievement against plan and forecast under achievement of £213k. The detailed QIPP programme is shown in Appendix 5.
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7.0 Balance Sheet, Better Payment Policy Compliance, Cash
7.1 The Summary balance sheet (Statement of Financial Position) confirming the position at the end of the previous financial year and the most recent three months of the current financial year is included in Table 4.
31st 31st 30th 31st Table 4 March October November December Summary Statement of Financial Position 2015 2015 2015 2015 £000 £000 £000 £000
Current assets: Trade and other receivables 7,353 2,483 2,688 2,880 Cash and cash equivalents 83 27 125 53
Total current assets 7,436 2,510 2,813 2,932
Current liabilities Trade and other payables (11,047) (8,244) (8,241) (9,014)
Total Assets Employed (3,611) (5,734) (5,428) (6,081)
Financed by Taxpayers’ Equity General fund (3,611) (5,734) (5,428) (6,081)
Total Taxpayers Equity (3,611) (5,734) (5,428) (6,081)
7.2 Performance against the Better Payment Practice Code (BPPC) for April to November is shown below:
BPPC Compliance 2015/16 NHS 100.0 99.0 98.0 97.0 % 96.0 Number 95.0 94.0 Value 93.0 92.0 APR MAY JUNE JULY AUG SEPT OCT NOV DEC Months
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BPPC Compliance 2015/16 Non NHS
97.5 97.0 96.5 96.0 95.5 % 95.0 Number 94.5 Value 94.0 93.5 93.0 92.5 APR MAY JUNE JULY AUG SEPT OCT NOV DEC Months
7.3 The Better Payment Practice Code requires organisations to pay suppliers within thirty days, unless other terms are specified.
7.4 For cash management purposes, CCGs are set a maximum cash draw down (MCD) which is effectively a cash limit. The CCG has been notified that its MCD has been set at £169.8m which is broadly consistent with its planned expenditure and therefore the CCG does not envisage any cash management issues in year.
8.0 Recommendations
8.1 The Governing Body is asked;
To note that the reported £7.889m deficit at Month 9 of the financial year is slightly under plan. To note that the CCG is forecasting to deliver the deficit control total of £6.377m set by NHS England. There are however a range of potential risks to this position that will require ongoing management throughout the remainder of the financial year. To note that QIPP delivery remains a challenge.
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Appendix 1 – Acute Services
Cannock Chase CCG Financial Year 2015-16 In Month - Month 9 Year to Date - Month 9 31st December 2015Annual Forecast Outturn Budget Actual Variance Budget Actual Variance Budget Actual Variance £000 £000 £000 £000 £000 £000 £000 £000 £000 Acute Services NHS Contracts University Hospital North Midlands NHS Trust 2,898 713 (2,184) 26,078 15,355 (10,723) 34,771 20,473 (14,298) Royal Wolverhampton Hospital Trust 2,301 3,683 1,382 20,709 27,850 7,141 27,612 37,134 9,522 Walsall Manor Hospital Trust 813 818 5 7,320 7,495 175 9,760 9,992 232 Burton Hospitals FT 322 335 13 2,894 2,858 (37) 3,859 3,810 (50) University Hospitals of Birmingham 82 57 (26) 741 753 13 987 1,004 17 Heart of England FT 81 36 (45) 732 530 (202) 976 707 (269) Robert Jones & Agnes Hunt 50 24 (26) 451 413 (39) 602 550 (52) Royal Orthopaedic Hospital NHST 34 22 (12) 305 313 7 407 418 10 Birmingham Childrens Hospital NHS FT 31 18 (14) 282 251 (31) 376 335 (41) Sandwell & West Birmingham NHS Trust 30 29 (1) 274 258 (16) 365 344 (22) Dudley Group of Hospitals FT 30 55 25 271 430 159 361 573 212 Derby FT 24 40 16 212 271 59 283 362 79 Birmingham Womens NHS FT 85(4) 76 49 (28) 102 65 (37) Shrewsbury & Telford Hospitals 8 28 19 76 169 93 101 226 125 Contract Exclusions 12 12 0 109 106 (3) 182 182 0 Prior Year - Under / Over accrued 0 0 0 0 463 463 0 463 463 NHS Contract Variation Orders pending (216) 528 744 (2,044) 528 2,572 (3,104) 311 3,415 Total NHS Contracts 6,510 6,401 (109) 58,487 58,091 (396) 77,640 76,946 (693) Non NHS Contracts Rowley Hall 179 179 (0) 1,611 1,611 0 2,148 2,147 (0) Spire Healthcare 49 31 (17) 438 421 (17) 583 561 (22) British Pregnancy Advisory Service 17 20 3 155 146 (9) 207 195 (11) Alliance Medical 13 40 27 118 141 23 157 187 30 Nuffield Health 10 10 0 86 86 0 115 115 0 Ramsay Healthcare - West Midlands Hospital 6 (26) (32) 54 22 (32) 72 30 (42) Midland Fertility Services 66 0 5151068680 Brewood Vasectomies 00 0 0 0 0 00 0 Fertility Treatment 4 4 0 36 36 0 48 48 (0) Prior Year - Under / Over accrued 00 0 0 787807878 Total Non NHS Contracts 283 264 (19) 2,549 2,592 43 3,398 3,430 31
West Midlands Ambulance 385 368 (17) 3,466 3,336 (129) 4,621 4,450 (172) West Midlands Ambulance - Prior Year 0 0 0 0 (34) (34) 0 (34) (34)
NCA's 76 76 0 681 681 (0) 909 909 0
Winter Pressures 69 69 (0) 623 623 (0) 831 831 0
Acute Services 7,323 7,178 (146) 65,806 65,290 (516) 87,399 86,531 (868)
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Appendix 2 – Mental Health & Community Services
Cannock Chase CCG Financial Year 2015-16 In Month - Month 9 Year to Date - Month 9 31st December 2015Annual Forecast Outturn Budget Actual Variance Budget Actual Variance Budget Actual Variance £000 £000 £000 £000 £000 £000 £000 £000 £000 Mental Health Services NHS Contracts Staffordshire & Shropshire NHS FT 1,022 1,017 (5) 8,886 8,992 106 11,848 11,989 141 Dudley & Walsall MH Partnership Trust 11 11 (0) 95 95 (0) 126 126 0 Black County Partnership NHS FT (29) (30) (0) 19 19 0 26 26 0 Derby Healthcare NHS FT 55 04747063630 North Staffs Combined HC Trust 55 04242057570 Birmingham & Solihull NHS FT 33 02626035350 Contract Exclusions 10 6 (4) 91 65 (27) 122 89 (33) Prior Year - Under / Over accrued 0 0 0 0 16 16 0 16 16 Total NHS Contracts 1,026 1,016 (10) 9,206 9,302 96 12,276 12,401 124 Other Provider Contracts - Non NHS Starfish Mental Health Services 58 58 (0) 518 518 (0) 691 691 0 Staffordshire County Council 29 29 (0) 258 258 0 344 344 0 Midland Psychology 21 20 (0) 187 183 (4) 250 244 (6) Mental Health Assessments 6 10 4 55 55 0 74 74 0 Eating Disorders/Mental Health Liaison Psychiatry 6 6 0 53 53 0 127 127 0 CAMHS 0 0 0 0 0 0 178 178 0 Alzheimers Association 33 02525034340 Approach 00 0 4 4 0 66 0 ASD 00 0 0 0 04011 (29) Prior Year - Under / Over accrued 0 0 0 0 32 32 0 32 32 Total Non NHS Contracts 122 126 3 1,102 1,130 28 1,743 1,741 (2)
Learning Disabilities North Staffs Combined 0 0 0 118 118 0 118 118 0 Placements - Danshell 0 0 0 59 103 44 59 103 44 Stoke Housing Association 2 (2) (4) 20 16 (4) 26 20 (6) Staffordshire County Council Income (28) (28) 0 (252) (252) 0 (336) (336) 0
Section 117's 18 97 79 159 189 30 212 253 40
Complex Placements 24 10 (13) 266 165 (101) 337 196 (140)
Cannock Chase CCG Financial Year 2015-16 In Month - Month 9 Year to Date - Month 9 31st December 2015Annual Forecast Outturn Budget Actual Variance Budget Actual Variance Budget Actual Variance £000 £000 £000 £000 £000 £000 £000 £000 £000 Community Health Services NHS Contracts Staffordshire & SOT Partnership Trust 1,002 998 (4) 9,059 9,059 0 12,065 12,065 0 Walsall Manor Hospital Trust 75 75 0 672 672 0 895 895 0 Royal Wolverhampton Hospital Trust 39 32 (7) 349 338 (11) 466 451 (15) Contract Exclusions 33 15 (18) 297 286 (11) 396 382 (14) Burton Hospitals 92 92 0 828 828 0 1,104 1,104 0 Prior Year - Under / Over accrued 00 0 0111101111 Total NHS Contracts 1,240 1,212 (28) 11,204 11,194 (11) 14,926 14,908 (18) Other Provider Contracts - Non NHS Methodist Homes for the Aged 4 3 (0) 87 87 0 98 98 0 Community Beds 30 67 37 270 270 (0) 360 360 0 Nursing Homes 00 0 0 0 0 00 0 Better Care Fund 304 304 0 2,737 2,737 0 3,650 3,650 0 Marie Curie 3 3 0 31 31 (0) 41 41 0 Equipment Loan Store 59 59 0 529 529 0 705 705 0 Staffs CC - Carers 11 11 (0) 100 100 (0) 134 134 (0) Brewood Dermatology 1 (1) (1) 55 077 0 Brewood Vasectomies 3 3 0 30 30 0 40 40 0 Dr Gupta - ENT Service 15 15 0 131 131 0 175 175 0 Staffs County Council Pooled Budgets 7 7 0 60 60 0 80 80 0 Prior Year - Under / Over accrued 0 34 34 0 354 354 0 354 354 Total Non NHS Contracts 436 505 69 3,981 4,335 354 5,290 5,644 354 Hospices Compton Hall 5 5 0 41 41 0 55 55 0 Katharine House 28 36 8 255 266 10 341 355 14 St Giles 40 45 4 362 399 37 482 531 49 Donna Louise 1 1 (0) 11 11 (0) 15 15 0 Prior Year - Under / Over accrued 00 0 0181801818 Total Hospices 74 87 12 669 735 66 892 974 81
Community Health Services 1,751 1,804 53 15,855 16,264 409 21,108 21,526 418
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Appendix 3 – CHC, Primary Care and Other Programme Services
Cannock Chase CCG Financial Year 2015-16 In Month - Month 9 Year to Date - Month 9 31st December 2015Annual Forecast Outturn Budget Actual Variance Budget Actual Variance Budget Actual Variance £000 £000 £000 £000 £000 £000 £000 £000 £000 Continuing Care Services Continuing Care 1,109 1,564 455 9,661 10,866 1,205 12,978 14,914 1,936 CHC Risk 0 0 0 883 883 0 883 883 0 Funded Nursing Care 203 167 (37) 1,757 1,397 (360) 2,365 1,842 (523) CSU Staff Charge 42 (96) (138) 378 239 (138) 504 419 (85)
Continuing Care Services 1,354 1,634 280 12,678 13,385 707 16,730 18,059 1,329
Cannock Chase CCG Financial Year 2015-16 In Month - Month 9 Year to Date - Month 9 31st December 2015Annual Forecast Outturn Budget Actual Variance Budget Actual Variance Budget Actual Variance £000 £000 £000 £000 £000 £000 £000 £000 £000 Primary Care Services Prescribing GP Prescribing 1,831 1,908 77 16,478 16,732 254 21,970 22,034 64 GP Prescribing Recharges / Rebates 0 0 0 0 (65) (65) 0 (90) (90) Central Topslice 51 55 4 463 488 25 618 618 0 Medicines Management Team 24 (8) (32) 220 195 (25) 293 293 0 Prescribing Other 11 0 (11) 47 0 (47) 80 0 (80) Total Prescribing 1,918 1,955 38 17,209 17,350 141 22,961 22,855 (106)
Local Enhanced GP Services 31 22 (9) 286 218 (68) 489 397 (92) Local Enhanced GP Services - Prior Year 00 0 0(31) (31) 0 (31) (31) Practice Training 2 2 0 18 18 0 24 24 0 Home Oxygen 31 31 0 279 235 (44) 372 313 (59) Out of Hours 40 40 (1) 363 358 (5) 484 484 0 Map of Medicines 3 (0) (3) 25 22 (3) 33 33 0 Excess Treatment Costs 1 1 0 7 8 0 10 10 0 GP IT 41 41 (0) 368 368 0 490 490 0 149 137 (13) 1,346 1,196 (150) 1,902 1,720 (182) Commissioning Schemes Calprotectin 2 9 7 19 25 6 25 38 13 Hearing AQP 25 24 (1) 225 186 (39) 300 206 (94) Non Obstetric Ultrasound AQP 0 8 8 0 60 60 0 106 106 Glaucoma Referral Scheme 1 (0) (1) 10 (0) (11) 14 14 0 Cataract Referral Scheme 1 (1) (2) 73(4) 10 10 0 Primary Eye Assessment & Treatment 3 12 9 27 24 (3) 36 32 (4) Acute Visiting Service 17 1 (15) 150 150 0 249 249 0 Mediaburst - Flo Meters 0 0 0 0 13 13 0 15 15 Cannock Headache Clinic 2 2 (0) 18 18 (0) 24 24 0 NHSE Winter Funding (183) (183) 0 (183) (183) 0 (183) (183) (0) Prior Year - Under / Over accrued 0 0 0 0 4 4 0 4 4 Total Commissioning Schemes (132) (127) 5 274 301 26 475 515 40
Primary Care Services 1,935 1,965 30 18,829 18,847 18 25,339 25,091 (248)
Cannock Chase CCG Financial Year 2015-16 In Month - Month 9 Year to Date - Month 9 31st December 2015Annual Forecast Outturn Budget Actual Variance Budget Actual Variance Budget Actual Variance £000 £000 £000 £000 £000 £000 £000 £000 £000 Other Programme Services Patient Transport Services - NSL 45 68 23 409 649 239 546 795 249 Patient Transport Services - WMAS 3 0 (3) 30 0 (30) 40 37 (3) Patient Transport Services - Other NHS 0 0 0 0 (0) (0) 03 3 Patient Transport Services - Prior Year 0 (1) (1) 0 (75) (75) 0 (75) (75)
NHS 111 38 71 34 341 324 (17) 455 404 (51)
Safeguarding 4 15 11 34 34 0 45 45 0
MacMillan Procurement 81 28 (53) 154 154 0 198 198 0
NHS Property Services 8 8 0 75 75 0 100 100 0
Other Programme Services 180 189 9 1,044 1,160 117 1,384 1,507 123
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Appendix 4 – Reserves and Corporate Running Costs
Cannock Chase CCG Financial Year 2015-16 In Month - Month 9 Year to Date - Month 9 31st December 2015Annual Forecast Outturn Budget Actual Variance Budget Actual Variance Budget Actual Variance £000 £000 £000 £000 £000 £000 £000 £000 £000 Reserves / QIPP Contingency Reserve 68 0 (68) 610 0 (610) 813 0 (813) QIPP Reinvestments 0 0 0 0 0 0 15 15 0 Commissioning Reserve 203 0 (203) 207 0 (207) 276 275 (0) Reserves / QIPP 271 0 (271) 817 0 (817) 1,104 290 (813)
Cannock Chase CCG Financial Year 2015-16 Including MacMillan In Month - Month 9 Year to Date - Month 9 31st December 2015Annual Forecast Outturn Budget Actual Variance Budget Actual Variance Budget Actual Variance £000 £000 £000 £000 £000 £000 £000 £000 £000 Corporate Costs Running Costs Pay Costs 119 104 (16) 1,145 1,355 210 1,504 1,504 0 Non Pay Costs 31 168 137 295 672 378 388 388 0 CSU Costs 87 86 (1) 786 690 (97) 1,049 1,049 0 Income 0 (134) (134) 0 (515) (515) 00 0
Corporate Costs 238 223 (15) 2,226 2,202 (25) 2,940 2,940 0
Cannock Chase CCG Financial Year 2015-16 Excluding MacMillan In Month - Month 9 Year to Date - Month 9 31st December 2015Annual Forecast Outturn Budget Actual Variance Budget Actual Variance Budget Actual Variance £000 £000 £000 £000 £000 £000 £000 £000 £000 Corporate Costs Running Costs Pay Costs 119 75 (44) 1,145 1,110 (36) 1,504 1,504 0 Non Pay Costs 31 64 33 295 421 127 388 388 0 CSU Costs 87 86 (1) 786 690 (97) 1,049 1,049 0 Income 0 (3) (3) 0 (19) (19) 00 0
Corporate Costs 238 223 (15) 2,226 2,202 (25) 2,940 2,940 0
Cannock Chase CCG Financial Year 2015-16 MacMillan In Month - Month 9 Year to Date - Month 9 31st December 2015Annual Forecast Outturn Budget Actual Variance Budget Actual Variance Budget Actual Variance £000 £000 £000 £000 £000 £000 £000 £000 £000 Corporate Costs Running Costs Pay Costs 0 29 29 0 245 245 0 0 0 Non Pay Costs 0 103 103 0 251 251 0 0 0 CSU Costs 0 0 0 0 0 0 0 0 0 Income 0 (132) (132) 0 (496) (496) 00 0
MacMillan Costs 0 0 0 0 0 0 0 0 0
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Appendix 5
QIPP Programme – Cannock Chase CCG
2015/16 QIPP Performance Report - Finance Month 9 - December
Scheme Current Month PMO Report Previous Month PMO In Month In Month Annual Forecast Forecast Movement In Month YTD Target YTD Actual Forecast Out ID Scheme Description Lead Phasing Target Actual YTD Variance Planned Out Turn Out Turn in Forecast Variance Savings Savings Turn Variance Savings Savings Savings Savings Savings Out Turn Planned Care 1 First to follow up Mel Mahon M3-M12 (103,491) (23,312) 80,179 (728,274) (491,198) 237,075 (1,038,747) (573,838) 464,909 (665,317) 91,479 2 PLCV Mel Mahon M1-M12 (55,104) (106,801) (51,697) (403,916) (1,243,552) (839,635) (569,229) (1,654,916) (1,085,687) (1,891,080) 236,164 3 Referral Demand Management Mel Mahon M4-M12 (30,145) 52,623 82,768 (144,035) (127,360) 16,675 (234,469) (69,362) 165,107 (159,849) 90,487 4 Daycase to outpatient Mel Mahon M4-M12 (25,980) 55,053 81,033 (155,881) (240,960) (85,079) (233,821) (262,264) (28,443) (392,901) 130,636 5 Excess bed days Mel Mahon M1-M12 (10,004) - 10,004 (90,035) - 90,035 (120,046) - 120,046 - 0 Planned Care Total (224,724) (22,436) 202,288 (1,522,141) (2,103,070) (580,930) (2,196,313) (2,560,380) (364,067) (3,109,146) 548,766 Unplanned Care 6 Admission avoidance Rob Lusuardi M1-M12 (114,651) (21,856) 92,795 (831,310) (152,992) 678,318 (1,189,410) (218,560) 970,850 (218,560) 0 7 A&E attendances Rob Lusuardi M1-M12 (13,871) - 13,871 (102,170) - 102,170 (145,494) - 145,494 - 0 Unplanned Care Total (128,522) (21,856) 106,666 (933,480) (152,992) 780,488 (1,334,904) (218,560) 1,116,344 (218,560) - Other 8 Continuing healthcare Rob Lusardi M1-M12 (92,970) (190,978) (98,008) (814,855) (726,923) 87,932 (1,163,714) (1,243,081) (79,366) (1,077,648) (165,433) 9 Pharmacy Lynn Millar M1-M12 (34,994) (40,000) (5,006) (403,588) (637,107) (233,519) (493,796) (816,504) (322,708) (677,060) (139,444) Other Total (127,964) (230,978) (103,014) (1,218,443) (1,364,030) (145,587) (1,657,511) (2,059,585) (402,074) (1,754,708) (304,877) 14/15 Full Year Effect 10 MSK Mel Mahon M1-M6 - 3,260 3,260 (187,737) (324,546) (136,809) (187,737) (324,546) (136,809) (327,806) 3,260 11 MIU Jonathan Bletcher M1-M8 - - 0 (145,457) (145,457) (0) (145,457) (145,457) 0 (145,457) 0 12 Healthnet Jonathan Bletcher M1-M4 - - 0 (61,415) (61,415) 0 (61,415) (61,415) 0 (61,415) 0 13 Section 256 Mel Mahon M1-M12 (2,118) (2,118) 0 (18,787) (18,787) 0 (22,104) (22,104) 0 (22,104) 0 14 Voluntary Sector Grants Mel Mahon M1-M12 (258) (258) 0 (2,288) (2,288) (0) (3,036) (3,036) 0 (3,036) 0 14/15 Full Year Effect Total (2,376) 884 3,260 (415,683) (552,492) (136,809) (419,748) (556,558) (136,809) (559,818) 3,260 Grand Total (483,586) (274,386) 209,200 (4,089,747) (4,172,584) (82,837) (5,608,475) (5,395,082) 213,393 (5,642,232) 247,149 Key Variance 10% adverse or greater 11 FOT has worsened relative to FOT in previous month Variance between breakeven and 10% adverse 0 FOT has remained the same as FOT in previous month Variance breakeven or favourable - 2 FOT has improved relative to FOT in previous month
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Item: 12 Enc: 08
REPORT TO: The Clinical Commissioning Group Governing Body Meeting TO BE HELD ON: Thursday 4th February 2016
Subject: Medicines Optimisation 2016/17 QiPP Schemes Overview Board Lead: Lynn Millar Officer Lead: Sharuna Reddy For For For For Recommendation: Approval Ratification Discussion Information
PURPOSE OF THE REPORT:
NHS Cannock Chase CCG has recently been identifying the QiPP schemes for 2016/17 in collaboration with NHS Stafford and Surrounds and NHS South East Staffordshire and Seisdon CCG’s.
This report is to give the Governing Body a brief overview of the Medicines Optimisation QiPP schemes planned for 2016-17.
KEY POINTS:
The overall medicines management QiPP plan across the 3 CCG’s is expected to deliver >£2.4million pounds of QiPP efficiencies in 6 key work streams: 1. Nursing Home Medication Reviews 2. PbR excluded drug recharges 3. COPD / Asthma Medication Reviews 4. DROP-List (drugs to review for optimised prescribing) / OTC prescribing 5. Gluten Free Prescribing 6. Third Party Ordering
These streams will aim to increase the efficiencies within prescribing to ensure that safe, cost-effective and quality prescribing is achieved within the CCG.
For some of the schemes there will be considerable communication and planning required with stakeholders, including GP practices, community pharmacy and patient representation groups to ensure that the plans are implemented as efficiently as possible.
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Item: 12 Enc: 08
RELEVANCE TO KEY GOALS To reduce health inequalities across Cannock Chase through targeted interventions.
To identify and support patients with Long Term Conditions to ensure care delivery closer to home. N/A To improve and increase overall life expectancy. To develop integrated services with simple, easy access.
IMPLICATIONS Legal and/or Risk N/A CQC N/A All schemes are based on clinical evidence to ensure cost-effective, safe Patient Safety and quality prescribing. As there will be implications to patients, by stopping low clinical value medication prescribing or by changing the current processes of Patient Engagement obtaining/ordering medication there will need to be patient engagement in the planning process. Potential QiPP savings of £2.4million over the 3 CCG’s – estimated Financial £700,000 for NHS Cannock Chase CCG. Sustainability N/A Workforce / Training N/A
RECOMMENDATIONS / ACTION REQUIRED: The SAS CCG Governing Body is asked to: Acknowledge the planned medicines optimisation QiPP schemes for 2016/17
Not KEY REQUIREMENTS Yes No Applicable Has a quality impact assessment been undertaken?* Has an equality impact assessment been undertaken?* Has a privacy impact assessment been completed?* Have partners / public been involved in design? Are partners / public involved in implementation? Are partners / public involved in evaluation? * The quality, equality and privacy impact assessments will be completed as part of the project planning process.
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Item: 12 Enc: 08
Medicines Optimisation QiPP plans 2016/17
1. Nursing Home Medication Reviews Continuation of current QiPP scheme. Review patients in nursing home to ensure medicines are optimised using nationally recognised tools such as START/ STOPP. Undertake medication switches where suitable. Review ordering processes in homes where waste seems to be an issue. Reconcile medication changes in practice and care home setting.
2. PbR excluded drug recharges Drugs which are not included in the tariff and are subject to a NICE Technology appraisal are treated as pass through costs and therefore are recharged back to CCGs. During 2015/16 there has been considerable growth and to date there is significant over performance against plan – predicted £3.1m across the 3 CCG’s. Plan to have medicines optimisation teams validate the drug invoicing to ensure costs are appropriate. Impact on the acute contract budgets NOT primary care prescribing.
3. COPD / Asthma Medication Reviews Medicines optimisation teams to undertake work in practice to identify optimisation opportunities for COPD and Asthma patients. For COPD - identify patients on triple therapy, who are classed as mild/ moderate or who have not had an exacerbation in the last 12 months. These patients should be reviewed towards formulary products in line with GOLD standards for COPD. For Asthma - identify patients on high dose combination therapy, who have not had an exacerbation in the previous 6 months or score 0 on the RCP- 3 questions. These patients should be stepped down and reviewed towards formulary products in line with BTS guidelines for Asthma.
4. DROP-List (drugs to review for optimised prescribing) / OTC prescribing PrescQiPP publish a DROP-list of medications which are considered as low priority, poor value for money, or where there are safer alternatives. Some of these drugs are NICE ‘do not prescribe’ recommendations (see Appendix 1). The list also includes drugs which could potentially be provided as self-care with advice and support from community pharmacies. There is considerable prescribing of the majority of items on the PrescQiPP DROP list in all 3 CCG's. The DROP-list has been reviewed and split into 2 categories: 1) drugs which the CCG should consider low priority/low clinical value for prescribing and decommission the prescribing of these and 2) drugs which should not be used a first-line choice and prescribing should be reviewed and reduced.
Item: 12 Enc: 08
5. Gluten Free Prescribing In 2001 a paper published by the Cabinet Office Regulatory Impact Unit, recommended that GPs should no longer issue prescriptions for gluten free foods and that instead these items should be supplied by community pharmacies. It is estimated that if this approach, using a pharmacy led service, was adapted nationally the NHS could save between £5-£11 million (between 10-20% of current costs). Several CCGs have set up pharmacy led schemes to decrease the administrative workload for GPs and increasing convenience of supply of these products to the patients, whilst also monitoring that these items are not being over ordered. Plan to review gluten free prescribing to one of two options: o Move supply to Community Pharmacy with a supply against a restricted list – approach taken by many others o Stop prescribing of all gluten free products on prescription. Patients to purchase all products – approach taken by only one other CCG.
6. Third Party Ordering During 2015/16 the Medicines Optimisation teams have seen a large growth in prescription items. Based on soft intelligence from general practice it is suspected third party ordering i.e. medication ordered on behalf of a patient, may have led to an increase in prescription requests. In 2015/16 Luton CCG noticed a similar issue and after auditing, they implemented a ban on third party ordering – leading to one of the lowest growths in prescribing cost across England. Undertake a similar exercise to Luton CCG, however to also encourage pharmacies/practices to identify patients suitable for repeat dispensing. Significant patient and partner engagement will be required but this ties in with the reducing medicine waste agenda. In summary: The overall medicines management QiPP plan across the 3 CCG’s is expected to deliver >£2.4million pounds. To underpin these schemes there will be continuation of the current Scriptswitch and rebate schemes work.
Item: 12 Enc: 08
Appendix 1: DROP-List (drugs to review for optimised prescribing) / OTC prescribing
List a – plan to decommission the prescribing of the following medications (aim to reduce current prescribing by >80%):
Medication Notes Antifungal nail paint Available OTC Cannabis sativa Already a commissioning policy to not prescribe but some small amounts of prescribing Complementary therapies Available OTC Cough and cold remedies Available OTC Dental products on FP10 Should be prescribed by dentists or available OTC Glucosamine Commissioning statement already agreed to not prescribe but some prescribing remains - available OTC. NICE states do not use in management of osteoarthiritis. Haemorrhoid treatments (excl. Available OTC POM) Colief, simeticone and gripe water Available OTC Lutein and antioxidant vitamins (for Commissioning statement already agreed to not prescribe but age-related macular degeneration) some prescribing remains - available OTC Omega-3 and other fish oils Not recommended by NICE - available OTC Probiotics Available OTC Rubefacients Available OTC. No evidence to support the use of topical rubefacients in acute or chronic musculoskeletal pain. Eflornithine cream (vaniqua) for POM medication therefore to be provided via private hirsutism prescription. Vitamins and minerals Available OTC Travel vaccines not prescribable To be provided through private services on NHS
List b – plan to reduce the prescribing of the following medications (by >15%):
Medication Notes Aliskiren (Rasilez®) Not recommended for routine use as NICE state there is insufficient evidence of its effectiveness to determine its suitability for use in resistant hypertension. Amiodarone No longer recommended by NICE for long-term rate control due to potentially fatal, long-term side-effects. Digoxin is equally effective. OTC antihistamines/nasal sprays Available OTC – costs are now significantly lower following for hayfever patent expiries and hayfever should be self-managed. Tadalafil (cialis once-a-day) Not recommended as not cost-effective in most patients. Other local CCG’s have reviewed and removed from formulary. Co-proxamol Unlicensed products which is markedly more toxic in overdose than paracetamol. Withdrawn from market in 2005 due to safety concerns. Coversyl® arginine and branded No evidence of any benefit over generic perindopril erbumine Coversyl® yet more costly.
Item: 12 Enc: 08
Dosulepin NICE recommends no new initiations on dosulepin due to potential side-effects. Doxazosin MR No evidence of additional benefit over normal release doxazosin but considerable additional cost. Fentanyl immediate release Fentanyl is considerably more expensive than morphine and formulations there are potential safety problems with these products which provide relatively high doses of a potent opiod and are associated with complicated titration and maintenance instructions. Lidocaine patch (versatis, NICE guidance on neuropathic pain does not recommend the lidoderm) use if lidocaine patches as a treatment option due to limited clinical evidence. Liothyronine No robust evidence on the use of liothyronine either alone or in combination with thyroxine and it is not licensed for long- term use. Minocycline for acne Increased risk of side-effects and not considered first-line tetracycline for acne. Oxycodone/naloxone (Targinact®) Non-formulary yet considerable prescribing. Poor-cost effectiveness and lack of robust data to show efficacy over other strong opioids with regular laxatives. Tramacet (combination product No more effective than established analgesics in acute or paracetamol with tramadol) chronic pain and contains sub-therapeutic doses of paracetamol and tramadol.
Item: 13 Enc: 09
REPORT TO THE Clinical Commissioning Group Governing Body Meeting TO BE HELD ON: Thursday 4th February 2016
Subject: Joint Communications & Engagement Strategy Board Lead: Sally Young Officer Lead: Adele Edmondson For For For For Recommendation: Approval Ratification Discussion Information PURPOSE OF THE REPORT:
To present the Joint Communications & Engagement Strategy to the Governing Body for ratification.
KEY POINTS: The Communications and Engagement Strategy has been developed with the support and input of the Communications and Engagement Committee. A workshop was held in the summer with the Executive Management Team, Lay Members and the CSU Communications and Engagement Team to develop the priorities for the strategy and how we align the work of the CSU team to CCG priorities.
This Communications and Engagement Strategy seeks to raise the profile of both Clinical Commissioning Groups (CCGs) and to develop their reputations as caring, transparent organisations that deliver high quality healthcare.
This strategy will inform how these CCGs communicate and engage with their: Population and Patients Member Practices Stakeholders and Partners Staff
The strategy provides a framework to support the delivery of the CCGs’ priorities. This will be done through effective, open and transparent communications and engagement mechanisms.
In addition to supporting the delivery of the CCGs’ priorities, this strategy will support the CCGs’ delivery of their Operational Plans and the emerging Quality, Innovation, Productivity and Prevention (QIPP) schemes.
On a Staffordshire-wide scale this strategy will ensure that both the Cannock Chase CCG and Stafford and Surrounds CCG are delivering communications and engagement that align with the Staffordshire and Stoke on Trent Five Year Plan and the emerging “We’re Better Together” transformation programme.
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Item: 13 Enc: 09 The strategy is being presented to the Governing Body for ratification and discussion. The strategy will be supported by an action plan which will be updated annually and will be the detailed work programme for communication and engagement for both CCGs. The action plan will be developed and agreed at the next meeting of the Communications and Engagement Committee in February.
RELEVANCE TO KEY GOALS To reduce health inequalities across Cannock Chase through targeted interventions.
To identify and support patients with Long The strategy provides a framework to support Term Conditions to ensure care delivery the delivery of the CCGs’ key goals and closer to home. priorities. This will be done through effective, To improve and increase overall life open and transparent communications and engagement mechanisms. expectancy. To develop integrated services with simple, easy access.
IMPLICATIONS Legal and/or Risk The CCG has a statutory duty to engage with its population. CQC N/A Patient Safety Patient experience helps inform the quality and safety of the CCG. Patient Engagement The CCG needs to ensure it has robust systems in place to engage with the public and involve them in the decision making processes of the CCG. Financial N/A Sustainability N/A Workforce/Training The CSU Communications and Engagement Team will work the management team to develop the skills and knowledge to ensure we engage effectively.
RECOMMENDATIONS/ACTION REQUIRED:
The Governing Body is asked to: Ratify the Joint Communications & Engagement Strategy
Not KEY REQUIREMENTS Yes No Applicable Has a quality impact assessment been undertaken? Has an equality impact assessment been undertaken? Has a privacy impact assessment been completed? Have partners/public been involved in design? Are partners/public involved in implementation? Are partners/public involved in evaluation?
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Cannock Chase CCG and Stafford & Surrounds CCG Communications and Engagement Strategy 2015/2018
Listening to and learning from our patients and partners
Table of Contents 1. Foreword ...... 3 2. Introduction ...... 4 3. Communications and engagement aims and objectives ...... 5 Aims ...... 6 Objectives ...... 6 4. Our duties and constitutions ...... 6 Duties ...... 6 Constitutions ...... 6 5. Our commitment to equality and diversity ...... 7 The Equality Act 2010 ...... 7 6. Practice Engagement Cannock Chase CCG ...... 8 7. Practice Engagement Safford and Surrounds CCG ...... 9 8. Patient and public engagement ...... 10 The Engagement Cycle ...... 10 Patient Groups ...... 11 Patient Insight ...... 11 Hard-to-Reach Groups (not engaged through traditional methods) ...... 12 Public Involvement Forums ...... 12 9. Communications and engagement methods ...... 12 Patients and the public ...... 12 Corporate stakeholders ...... 12 Councillors and committees ...... 12 Health and Wellbeing Board ...... 12 Healthwatch ...... 12 Local Authorities ...... 13 Local MPs ...... 13 Voluntary Sector, diverse groups and community groups & networks ...... 13 Appendix 1A: – Stakeholder Map ...... 14 Appendix 1B: Key External Stakeholder Analysis ...... 15 Appendix 2: – Action Plan ...... 18 Appendix 3: How we engage with the Patients and the public ...... 19 Appendix 4: Equality Delivery System 2 ...... 20 The Goals and Outcomes of EDS2 ...... 20 Appendix 5: Mosaic Profiles ...... 22
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1. Foreword Cannock Chase Clinical Commissioning Group (CCG) and Stafford and Surrounds Clinical Commissioning Group believe that engaging local patients and partners effectively is key to achieving our ambitions.
In common with the wider NHS, our areas face significant financial challenges. To address these challenges, services need to be transformed. We need to move from the current position, where care is predominantly hospital based to one with more emphasis on self- care, community care and primary care.
This transformation must be driven by clinicians and provide high quality alternatives to the current provision. To do this, we need to talk to our patients and local residents to understand how these changes will affect them and then work with them to come up with high quality, clinically appropriate solutions.
To support this, we will aim to share information in a timely way and establish channels so that the populations we serve can offer comments and feedback. We have already been involved in engaging patients, both locally and across the wider Staffordshire region, and will build upon this knowledge and experience. Recent examples include the Transforming Cancer and End of Life Care Programme and the framework for the Cannock Minor Injuries Unit. These have both helped to provide us with a foundation, on which we can build in the future.
The established framework of Public Engagement Networks in Cannock Chase and Stafford and Surrounds provides an invaluable basis for us to continue our information sharing. Where we need to engage with patients based on a specific health condition or characteristic, including for example where they live, we will work directly with relevant groups, such as the Long Term Conditions patient group. We will also use technology to reach out to the wider population and look for innovative means to engage those who may not be willing or able to engage through traditional methods.
As we embark on the challenge of transforming the services we provide, our priority remains patient safety and a high quality patient experience. We believe that the best way to achieve this is by listening to and learning from our patients and partners.
Dr Mo Huda Dr Paddy Hannigan Chair Chair Cannock Chase CCG Stafford and Surrounds CCG
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2. Introduction
Cannock Chase CCG and Stafford and Surrounds CCG are the clinically-led NHS organisations that buy and manage the quality of (or “commission”) health services for the residents within these areas. Together, the CCGs represent 40 GP practices and serve a resident population of approximately 276,000 people. Led by local GPs, they commission local health services, including mental health services, provided in hospitals, the community and some voluntary and third sector services.
The contracts and funding for primary care services are currently held by NHS England; however, the NHS Five Year Forward View invited CCGs to take on an increased role in the commissioning of primary care services. Cannock Chase and Stafford and Surrounds CCGs applied for and were both granted level 2 co-commissioning, which enables them to jointly commission general practice services with NHS England through a joint committee.
This Communications and Engagement Strategy seeks to raise the profile of both Clinical Commissioning Groups (CCGs) and to develop their reputations as caring, transparent organisations that deliver high quality healthcare by involving the patient at every step of the journey
This strategy will inform how these CCGs communicate and engage with their: Population and Patients Member Practices Stakeholders and Partners Staff
The strategy also provides a framework to support the delivery of the CCGs’ priorities listed below. This will be done through effective, open and transparent communications and engagement mechanisms. These priorities are based on the health needs of the respective populations in Cannock Chase and Stafford and Surrounds.
The five joint priorities shared by both CCGs are:
Priority
Decommissioning and disinvesting from interventions and services of limited clinical value
Reducing inappropriate elective referrals
Reducing avoidable emergency admissions
Improving care for dementia patients and the frail elderly with complex needs
Developing the capacity and capability of Primary Care
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The priorities specific to the individual CCGs are:
Cannock Chase CCG
Priority
Developing a safe and sustainable model of care following the Mid Staffordshire Trust dissolution
Implementing the CCG’s Long Term Conditions Strategy
Stafford and Surrounds CCG
Priority
Continued re-procurement and re-commissioning of key aspects of secondary care to drive improvements in efficiency
Transforming services for Long Term Conditions improving quality, coordination of care and efficiency
Operational Plan: Key Areas of Focus
In addition to supporting the delivery of the CCGs’ priorities, this strategy will support the CCGs’ delivery of their Operational Plans. The areas of focus that have been identified are:
Priority
Balancing prioritised healthcare needs with limited financial resources
Maintaining quality and sustainability
Delivery of the NHS constitution
On a Staffordshire-wide scale this strategy will ensure that both the Cannock Chase CCG and Stafford and Surrounds CCG are delivering communications and engagement that align with the Staffordshire and Stoke on Trent Five Year Plan and the emerging “We’re Better Together” transformation programme.
3. Communications and engagement aims and objectives
We recognise that for communications and engagement to be truly effective, we need to take a coordinated, organisation-wide approach that reflects the vision and values of the two Clinical Commissioning Groups (CCGs). In turn, this will help to influence the actions of our
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organisations and behaviours of our staff and member practices. The key aims and objectives of the CCGs’ strategy are listed below:
Aims 1. To establish open and honest two-way communication with our patients, the wider public and all stakeholders 2. To provide opportunities for patients and the public to be properly informed about the role, responsibilities and vision of the CCGs 3. To encourage and provide opportunities for patients and the public to engage actively with the CCGs 4. To ensure that staff, the membership and other stakeholders are fully informed and engaged with the values and vision of the CCGs.
Objectives 1. To ensure that all information is readily accessible to different population groups, including protected and disadvantaged groups 2. To undertake regular proactive, as well as reactive, communications about the CCGs 3. To establish and publicise mechanisms by which patients and the public can be engaged and feel assured that their views are taken into account 4. To establish and publicise mechanisms for effective feedback from patients, the public and stakeholders 5. To ensure that, where feedback has been received, it is responded to promptly 6. To ensure that staff, members and Governing Body members are fully informed and engaged 7. To ensure that communications and engagement are recognised as part of the responsibilities of all staff of the CCG
4. Our duties and constitutions
Duties As responsible NHS organisations, Cannock Chase CCG and Stafford and Surrounds CCG will: Involve the public in the planning and development of services Involve the public in any changes that affect patient services, not just those with a “significant” impact Set out in our commissioning plans how we intend to involve patients and the public in our commissioning decisions Engage the public in annual commissioning plans to ensure proper opportunities for public input Report on involvement in our Annual Report Have lay members on our Governing Body Have due regard to the findings from HealthWatch Staffordshire and Healthwatch Stoke on Trent Consult NHSE and local authorities about substantial service change Have regard to the NHS Constitution in carrying out our functions Promote choice
Constitutions We have made a clear commitment to securing public involvement in our respective CCG constitutions. These documents bring together the national requirements for all CCGs as well as setting out how we will approach clinical commissioning locally. Putting patients and the public at the heart of clinical commissioning is not just about making decisions that reflect the needs, priorities and aspirations of the local population; it is also a legal requirement.
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Section 242 of the NHS Act (2006) places a legal responsibility on commissioners to ensure that patients and the public are informed, involved and consulted in the following areas:
In planning the provision of services In the development and consideration of proposals to change the way services are provided, and In decisions to be made affecting the operation of services
The duty applies if implementation of the proposal or a decision would have an impact on the manner in which services are delivered or the range of services available.
Section 234 of the Local Government and Public Involvement in Health Act (2007) adds an additional responsibility for commissioners to report on consultations carried out prior to making commissioning decisions and also on the influence that any feedback from consultations has had on those decisions.
The duty to involve patients and the public in the planning, development and delivery of local services is one of our core values and is also one of the pledges made in the NHS Constitution (2012). The NHS Constitution sets out the principles, rights and values of the NHS in England and emphasises one of the key aims of the Health and Social Care Act (2012) where there is “No decision about me, without me”. Other pledges made by the NHS Constitution relating to the duty to engage include:
to make decisions in a clear and transparent way so that people can understand how services are planned and delivered (in line with the CCGS’ values of openness and honesty) to inform people about healthcare services available locally and nationally to provide easily accessible, reliable and relevant information to support patient choice and the right for people to be involved in decisions about their care
5. Our commitment to equality and diversity
Promoting equality and equity are at the heart of our values – ensuring that we exercise fairness in all that we do and that no community or group is left behind in the improvements that will be made to health outcomes across the Clinical Commissioning Groups.
The Equality Act 2010
The Clinical Commissioning Groups (CCGs) have a legal duty under the Equality Act (2010) and the Public Sector Equality Duty (2011) to eliminate inequality and discrimination in relation to the nine recognised groups with protected characteristics. These include age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief (including lack of belief), sex and sexual orientation. The CCGs are also committed to reducing demographic or economic inequalities and this duty needs to be reflected in the way we communicate and engage with our local population. We also want to engage all staff with the Personal, Fair and Diverse Campaign (NHS Confederation) to embed equality and diversity in everything we do.
This Communication and Engagement Strategy encourages the use of a wide range of methods to share information and will ensure the engagement process is open, inclusive and accessible to all.
In relation to all of our communications and engagement activities, we aim to:
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Reach a representative cross section of our population when engaging on commissioning intentions, including people with a disability, minority groups and those not traditionally engaged with NHS services Hold our meetings and events in accessible venues that comply with the requirements of the Equality Act 2010, particularly with respect to disability access Consider provision of materials in alternative formats where a specific need is identified Test the accessibility of our materials through engagement with groups who share protected characteristics
In paying due regard to equality under our public sector duties, we will ensure that feedback from people who share protected characteristics, or those representing them, will form part of the decision making and equality analysis process, which is embedded in the governance of our organisation. In November 2014, there was a refreshed Equality Delivery System (EDS2) for the NHS. Each CCG needed to produce an Equality and Inclusion Annual Report and publish this on their website. Further details can be found in Appendix 4
6. Practice Engagement Cannock Chase CCG Cannock Chase CCG has a relatively large number of GP practices with a mixture of small and multi-partner practices. This can create particular challenges in terms of communication and engagement, however practice engagement and the role of clinical leaders remains a priority focus for the CCG.
All 26 member practices that make up Cannock Chase CCG meet monthly at the Membership Board. Meetings are scheduled to coincide with the educational Protected Learning Time (PLT) sessions and a GP from each practice is represented. A Practice Managers meeting is also held at the same time as the PLT sessions to support engagement and networking between the different practices.
Once a quarter, the Membership Board meeting is dedicated to supporting three Clinical Network meetings. The Clinical Networks have been established to support practices in providing responsive, population based care on a locality basis across Cannock Town, Rugeley, Great Wyrley and Cheslyn Hay.
The purpose of each Network is to encourage a closer supportive relationship between its Practices and to a have a collective approach to improving patient care through joint working and mutual support. Each Network has a committee with representation from each practice and is chaired by a GP, with a named Practice Manager and a CCG Manager to provide support.
Each network has a business plan, developed in partnership with patients and the public, to outline the group’s proposals and to monitor any progress against the priorities identified for that locality. This business plans link into the key goals and objectives of the Cannock Chase Primary Care Strategy with the aim of delivering some of the key objectives.
Specifically, practices engage in core strategic activities and plans for service redesign on subjects such as Long Term Conditions. The CCG also engages with member practices on specific issues or areas that the practices would like to look at in more depth. A clinical lead is sought and assigned for either short term or longer term periods to oversee the development of these and other projects.
A Clinical Leads meeting has been established to enable clinical leads that may not sit on the CCG Governing Body to meet and to network. The meetings provide an opportunity to keep the clinical leads engaged and informed about corporate objectives
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outside their own area of expertise. In Cannock Chase, the Clinical Leads meeting has been extended to the Clinical Network leads to provide an opportunity to update colleagues on locality priorities and to support collaborative working and peer support.
The CCG has a Membership Agreement which aims to work with practices to support clinically led commissioning and the delivery of the Primary Care Strategy in maintaining and improving provision of effective, efficient and accessible primary care services. The investment is shared across 3 delivery areas: Clinical Commissioning Quality Locality Networks
7. Stafford and Surrounds CCG
All 14 member practices that make up Stafford and Surrounds CCG meet monthly at the Membership Board, which is chaired by the CCG clinical chair. Each member practice is represented by a GP and a Practice Manager and this is the main vehicle to communicate and engage with practices at grass roots level. The meeting is divided up with clinicians and practice managers meeting separately for the first hour to discuss pertinent areas/ issues before coming back together for the formal Membership Board session.
Specifically, practices engage in core strategic activities and plans for service redesign on subjects such as Long Term Conditions. The CCG also engages with member practices on specific issues or areas that the practices would like to look at in more depth. A clinical lead is sought and assigned for either short term or longer term periods to oversee the development of these and other projects.
A Clinical Leads meeting has been established to enable clinical leads that may not sit on the CCG Governing Body to meet and to network. The meetings provide an opportunity to keep the clinical leads engaged and informed about corporate objectives outside their own area of expertise.
The CCG has a Membership Agreement which aims to work with practices to support clinically led commissioning and the delivery of the Primary Care Strategy in maintaining and improving the provision of effective, efficient and accessible primary care services. The investment is shared across 4 delivery areas:
Clinical Commissioning Innovation Quality – Reducing Unwarranted Variation Medicines Optimisation
The CCG has also developed with practices an Innovation Facilitators Forum which meets bimonthly. The forum includes a range of practice staff including assistant practice managers, secretaries and reception staff. The Innovation Leads identified for each practice are responsible for disseminating innovation and best practice within each practice and to consider how practices might support Plan on a Page priorities. The meetings are also used to share any current issues and an opportunity for the CCG to share advance notice of training events.
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8. Patient and public engagement
As the local commissioner of health services, it is our role to ensure that we fully engage our communities in the decisions we make. Involving people in developing and evaluating health services is at the heart of everything we do and we believe it is integral to making sure local services meet everyone’s needs.
Over the past two years, we have established firm relationships with our communities, partners, patients and carers. This strategy will help us to build on those foundations over the coming years.
We are committed to using a wide variety of methods to ensure people can contribute to decisions at all stages of our work.
The Engagement Cycle
The Engagement Cycle is a useful tool that can help us to understand what we need to do, in order to engage communities, patients and the public at each stage of commissioning. This model identifies five different stages when patients and the public can and should be engaged in commissioning decisions:
1. Community engagement to identify needs and aspirations. 2. Public engagement to develop priorities, strategies and plans. 3. Patient and carer engagement to improve services. 4. Patient, carer and public engagement to procure services. 5. Patient and carer engagement to monitor services.
The Engagement Cycle
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In the planning stages we will: Engage communities in identifying health needs and aspirations Involve the public in decisions about our priorities Gather information from service users and carers to inform planning
When specifying outcomes we will: Involve patients in service redesign and feedback Embed an open and transparent process for service redesign and procurement
Patient Groups
Both Clinical Commissioning Groups (CCGs) have built a robust network of people with a particular interest in local health services.
In the Stafford and Surrounds CCG area, we have an established patient and public involvement structure based on a foundation of practice-based Patient Participation Groups. Each practice group has nominated representatives on a district-wide Public Engagement Network providing them with direct access to the CCG as part of our two-way model of engagement. In Cannock Chase, we have three Public Engagement Networks covering the Cannock Town, Rugeley and Great Wyrley and surrounds localities. The networks bring together a range of individuals and organisations that are able to represent the views and health needs of patients and people living within each locality. They aim to provide a geographical community reference group for the network practices in each area. This will help to develop a two-way flow of information between the practices and their registered patients, including those who may not engage through traditional methods. In this way we can capture patient feedback on their experience of local services and report back to the CCG.
We currently have around 120 members on the Networks and through them access to the members of the various groups and organisations that are represented. It is our ambition to grow and develop the networks over the coming months and to increase the use of technology designed to access those who may not be willing or able to attend groups in person. We will continue to promote the networks at events we attend and by encouraging existing members to help us to spread the word. We will also continue to contact local community groups and ask for their support and representation.
Patient Insight
Feedback from patients, or patient insight, is central throughout the Engagement Cycle and we aim to make the best use of any information that is available, either real time or secondary. Real-time information could be feedback given to the CCGs’ quality team on visits to hospital wards or information gathered from existing patients through mechanisms such as focus groups. Secondary data could include patient experience feedback that is captured from the services provided, national or local surveys, previous engagement projects, complaints, compliments or suggestions.
All feedback received is collated by six domains of patient experience and reported back to the CCGS’ Joint Quality Committee through regular reports identifying potential themes and trends. The six domains of patient experience are:
- Safe, high quality, coordinated care - Clean, friendly comfortable place to be - Building closer relationships - Better information, more choice - Access and waiting - Other issues
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Hard-to-Reach Groups (not engaged through traditional methods)
We will make particular efforts to identify hard-to-reach, disadvantaged groups and individuals who may not engage through traditional methods to ensure that we develop services in response to their specific needs. We will continue to develop our database of the main patient groups and their characteristics to avoid excluding or under-representing certain people, particularly people who have a number of different needs and patients whose views are rarely heard.
Communications and information will be relevant and accessible and we will consider the language that we use, its format, and availability. We are extending our network of contacts in the community, voluntary and faith sectors to signpost us to hard-to-reach or vulnerable groups or to act as advocates on their behalf.
Public Involvement Forums
We will hold a Patient and Public Involvement Forum or Conference once a year to give us an opportunity to meet our local communities and gather feedback on key pieces of work.
9. Communications and engagement methods
Patients and the public We will use a variety of communications channels to share information and to let people know about opportunities to get involved, and how their feedback has been used. Mosaic Profiles have been developed for each area (see appendix 5) and these will help to advise the CCGs on the appropriate method of communication channel to use, depending on the target audience.
The range of methods currently used by the CCGs includes digital and social media, websites, newsletters and publications and face to face communications. A full list of the methods already identified can be found at Appendix 3. We will constantly look for fresh new methods of communicating to reach a wide range of people .
Corporate stakeholders We need to work closely with our corporate stakeholders to achieve our organisational ambitions. This includes our local authorities, elected councillors and MPs, HealthWatch organisations and other networks.
Councillors and committees We will maintain our positive working relationship with the Healthy Staffordshire Select Committee. We will continue to attend meetings at county, district and borough local authority level to discuss service proposals and engagement activities, to brief members on our plans and activity.
Health and Wellbeing Board As active members of the Staffordshire Health and Wellbeing Board, our CCGs work closely with local authority representatives to address local health needs and inequalities, and improve health and social care services.
HealthWatch HealthWatch Staffordshire supports people across Staffordshire to: have a say in how health and social care services are provided find out about health and social care services make a formal complaint about NHS services
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We will work in partnership with HealthWatch Staffordshire to support their work and drive engagement with members of the public. We will ensure that the insight we receive from HealthWatch about services we commission helps us to continually improve healthcare provision across the area covered by the two CCGs.
Local Authorities We will build on our relationships with county, district and borough councils. Given the national drive towards integration of health and social care services, our local authority partners are a key corporate stakeholder.
Local MPs We will continue to meet with local MPs on a regular basis and will continue to proactively brief and involve MPs on developments as well as receive feedback from their constituents about local health services.
Voluntary Sector, diverse groups and community groups & networks We will extend our proactive engagement with voluntary and community partners, both as providers of services and as parties with an interest and influence in local health care.
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Appendix 1A – Stakeholder Map
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Appendix 1B: Key External Stakeholder Analysis Stakeholder Group Characteristics Needs and Interest Potential Risk Risk mitigation Patients and Public Central to everything we are Appropriate and timely To share good Impact of complaints and Proactive promotion Including carers and about. information to make experiences and be negative feedback of good news and support workers Taxpayers and citizens. informed decisions ambassadors for what through press and local best practice about their health. works well. politicians. Recipients of good quality Ensure engagement NHS provision. Knowledge and To provide valued and Cynicism and negative is led by clinicians education about self- on-going feedback. responses to proposed and based on an Engaged and knowledgeable care and prevention changes to status quo. open and transparent on NHS issues. To be co-producers of approach Knowledge on where to quality services. Misinterpretation of key Lack of understanding of get help and messages. Ensure messaging is new system. information. To use first hand clear and tested with experiences to shape Balancing the views of appropriate patient Guidance on how to future services. often heard voices groups make comments or against those seldom take forward concerns asked Reach out to seldom if things do not go well. heard groups as relevant to topics Voluntary, community Have influence and To have confidence in To have confidence in Ensuring that a broad As above and faith sector groups understanding. local services through local services through range of views are Communities of interest good experiences and good experiences and secured. (older people, children Some groups small in number good customer service. good customer service. and young people, BME and not well established. Significant groups Aim for early groups, people with Able to feedback, Able to feedback, overlooked. engagement as soon disabilities, mental Not a comprehensive influence and shape influence and shape as commissioning health service users, coverage or co-ordinated services. services. Speed of change activity under review lesbian, gay, bisexual voice negates genuine and transgender, Listened to and treated Listened to and treated involvement. travellers and homeless) Established communication with dignity and with dignity and respect channels with their own respect. – a trusted source members
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Stakeholder Group Characteristics Needs and Interest Potential Risk Risk mitigation HealthWatch Maturing organisation with Need to establish Able to influence Polarisation of existing Work constructively statutory powers covering themselves as positively and publicly- networks. with the chief officer health and social care. influencers on quality, champion local health and share this future need and issues. Over-representation of strategy for Membership mixture of new performance. members for particular discussion regarding and old local activists. Champion whole health areas, age groups etc. partnership working economy i.e. adult on delivery. social care Plan engagement to Act as a conduit to reach specific groups further understand who will be most patient/carer impacted. experiences and need. MPs High level of interest due to Regular and timely Able to influence High profile and Continue proactive 1. Stafford historic/legacy issues. information to positively and publicly- influential. approach to Jeremy Lefroy MP understand and be champion local health engaging MPs early 2. Cannock Chase kept informed on local issues. Credibility with local in discussions via Amanda Milling MP issues: media. Accountable Officer 3. Stone Champion health and GP Chairs William (Bill) Cash MP Understanding the economy wide issues. Party politicisation of strategic direction, health issues. political context and Positive support for ‘behind the headlines’. local health care facilities. Campaigning for local services and Champion key public constituent concerns. health messages. Local democratic Influential and visible political To be seen as local Champion whole High profile and Continue to work representatives/ political leaders. leaders; system issues; influential; positively with leaders Credibility with local political leaders at all High profile allegiance to Regular information to Influence local health media; levels across the Health and Wellbeing existing NHS provision. understand & be kept issues; Party politicisation of health economy. Board informed on local issues; Active role on HWB issues; to be maintained. Page | 16
Stakeholder Group Characteristics Needs and Interest Potential Risk Risk mitigation Staffordshire County Local leaders for community Understanding the Provide independence Politicisation of a single As above Council voices. strategic direction, (i.e. chairing public patient issue; political context and meetings); Part of three-tier Local ‘behind the headlines’; Cannock Chase District Government with limited joint Source of contacts and Opposition to service Council services/structures Campaigning for local influence within other change. (unitary/county/district/ services; organisations; Stafford Borough Council borough/town and parish council structures). Active partners in Political influence at South Staffordshire delivery and locality, sub -regional District Council Active partners on strategic commissioning of and regional level; planning. services; Conduit into communities, local knowledge and empowerment. Scrutiny of Health Statutory authority; Regular contact and Able to influence High profile and As above Committee briefing; positively and publicly- influential; Active and engaged in local champion local health Primarily Staffordshire health issues; Regular attendance at issues; Credibility with media; County Council, Cannock public committees; Chase District Council Provide real challenge on all Local leaders on NHS Champion health Can refer service change and Stafford Borough service change proposals; issues; economy wide issues; process to Secretary of council scrutiny State. committees for local Strong political leadership; High levels of interest Positive support for NHS. in the NHS and NHS local health care Hold NHS organisations to services; facilities & campaigns; account; Need clear, concise Provide guidance on Make regular enquiries. and timely information levels of engagement about NHS services. for projects.
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Appendix 2 – Action Plan
The Action Plan is being developed and will be presented to the Communications and Engagement Committee in February to enable us to capture the detail in the Operational Plan.
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Appendix 3: How we engage with the Patients and the public
Method Description CCG websites This will be the primary source of public information where we will publish news, reports, Governing Body papers and other statutory pieces of information.
News media News media, particularly the local press and radio, will scrutinise our work and hold us to account. We will work with local news media outlets to promote understanding, raise our reputation and demonstrate clinical leadership. Newsletters, We will publish a quarterly newsletter through our networks and on our website. We will also seek to publications and contribute to newsletters and publications published by partners, providers and third sector organisations, external websites including content on external websites. Digital media (including We will continue to use Twitter as our primary means of communicating through social media, to individuals social media) and organisations that follow our CCG. We will monitor the reach of our key messages to track both how effective our social media activity is and ways in which we can drive progress. Public events and We are represented at a number of public events and meetings throughout the year, including our own public meetings Governing Body meetings, Health and Wellbeing Board, Overview and Scrutiny Committee, etc. These will provide good opportunities to discuss plans in public and receive feedback, as well as show that engagement with the local community and health economy is at the heart of our organisation. Direct We will endeavour to communicate promptly and professionally with the public and with stakeholders who correspondence contact us directly asking for specific information i.e. Freedom of Information requests, letters from elected representatives Corporate We have an established Publications Scheme and readily publish information following that process. Publications We will capture and feedback our work in an annual report which will be published each year following the approval of our accounts.
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Appendix 4 Equality Delivery System 2 In November 2014, there was a refreshed Equality Delivery System (EDS2) for the NHS. Each CCG needed to produce an Equality and Inclusion Annual Report and publish this on their website.
EDS2 is a tool designed for both commissioners and providers. It is a performance management (grading) tool with 18 outcomes, which are grouped into four goals:
1. Better health outcomes 2. Improved patient access and experience 3. A representative and supported workforce 4. Inclusive leadership.
The CCGs will develop an implementation plan for Equality and Inclusion support. This will ensure our organisations support us to meet our statutory obligations as set out in: the Equality Act 2010, Health and Social Care Act 2012, Human Rights Act 1998 and the NHS constitution. It will also enable us to meet NHS England’s CCG gateway requirements by for example completing an annual EDS2 grading. The grading is initially a self-assessment which is tested with both the public and the staff. The Goals and Outcomes of EDS2 These outcomes relate to issues that matter to people who use, and work in, the NHS.
Objective Narrative Outcome 1. Better health The NHS 1.1 Services are commissioned, procured, outcomes should achieve designed and delivered to meet the health needs of improvements in local communities patient health, 1.2 Individual people’s health needs are assessed public health and met in appropriate and effective ways and patient 1.3 Transitions from one service to another, for safety for all, people on care pathways, are made smoothly with based on everyone well-informed comprehensive 1.4 When people use NHS service their safety is evidence of prioritised and they are free from mistakes, needs and mistreatment and abuse results 1.5 Screening, vaccination and other health promotion services reach and benefit all local communities
2. Improved The NHS should 2.1 People, carers and communities can readily patient access improve access hospital, community health or primary care and accessibility and services and should not be denied access on experience information, and unreasonable grounds deliver the right 2.2 People are informed and supported to be as services that are involved as they wish to be in decisions about their targeted, useful, care useable and 2.3 People report positive experiences of the NHS used in order to 2.4 People’s complaints about services are handled improve patient respectfully and efficiently experience 3. A The NHS should 3.1 Fair NHS recruitment and selection processes representative increase the lead to a more representative workforce at all levels
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and supported diversity and 3.2 The NHS is committed to equal pay for work of workforce quality of the equal value and expects employers to use equal working lives of pay audits to help fulfil their legal obligations the paid and 3.3 Training and development opportunities are non-paid taken up and positively evaluated by all staff workforce, 3.4 When at work, staff are free from abuse, supporting all harassment, bullying and violence from any source staff to better 3.5 Flexible working options are available to all respond to staff consistent with the needs of the service and patients’ and the way people lead their lives communities’ 3.6 Staff report positive experiences of their needs membership of the workforce 4. Inclusive NHS 4.1 Boards and senior leaders routinely leadership organisations demonstrate their commitment to promoting equality should ensure within and beyond their organisations that equality is 4.2 Papers that come before the Board and other everyone’s major Committees identify equality-related impacts business, and including risks, and say how these risks are everyone is managed expected to take 4.3 Middle managers and other line managers an active part, support their staff to work in culturally competent supported by ways within a work environment free from the work of discrimination specialist equality leaders and champions
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Appendix 5 Mosaic Profiles
Staffordshire Joint Strategic Needs Assessment
HEALTH AND WELLBEING PROFILE 2015 FOR CANNOCK CHASE
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Document details
Title Health and wellbeing profile for Cannock Chase Date created April 2015 The purpose of this profile is to support commissioners and others by providing robust intelligence about health and wellbeing priorities in their area based on the analysis
of data from numerous sources. Description
It aims to support enhanced joint strategic needs assessments (EJSNAs) and complements other profiles and resources produced by Staffordshire Observatory. Staffordshire JSNA, Staffordshire Health and Wellbeing Key links Strategy, Staffordshire districts/boroughs, Locality commissioning Matthew Bentley, Public Health Analyst, Insight Team [email protected] 01785 854885 Contacts Phil Steventon, Public Health Analyst, Insight Team [email protected] 01785 276529 Divya Patel (Insight Team)
Daniel Shrimpton (Public Health Staffordshire) Contributions Martin Dudgon (Public Health Staffordshire) Rachel Caswell (Insight Team) Geographical coverage Cannock Chase Time period covered Various (depending on indicator and availability of data) Frequency of profile update Annual Frequency of intelligence update As and when new data is published Word and pdf Formats and access Available via the Staffordshire Observatory website If you wish to reproduce this document either in whole, or Usage statement in part, please acknowledge the source and the author(s). This product includes mapping data licensed from Ordnance Survey with the permission of the Controller of Maps Her Majesty's Stationery Office. © Crown copyright and / or database right 2014. All rights reserved. Licence Number 100019422. Staffordshire County Council, while believing the information in this publication to be correct, does not
guarantee its accuracy nor does the County Council Copyright and disclaimer accept any liability for any direct or indirect loss or damage or other consequences, however arising from the use of such information supplied.
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Contents
Document details ...... 2
Glossary of terms ...... 6 1 Introduction ...... 7
1.1 Purpose of the profile ...... 7
1.2 Format of the profile ...... 7 1.3 How to use this profile ...... 8
1.4 Further information and support ...... 8
2 The population of Cannock Chase...... 9 2.1 Population age structure ...... 9
2.2 Population projections ...... 10
2.3 Rurality ...... 11 2.4 Ethnicity ...... 12
2.5 Deprivation ...... 12
2.6 Geodemographic profile ...... 13 3 Start well ...... 15
3.1 Child poverty ...... 15 3.2 Infant mortality...... 15
3.3 Smoking in pregnancy...... 15
3.4 Breastfeeding ...... 15 3.5 Immunisation...... 16
3.6 Dental health ...... 16
3.7 School readiness...... 16 4 Grow well ...... 17
4.1 GCSE attainment ...... 17
4.2 Young people not in education, employment or training (NEETs) ...... 17 4.3 Children with special educational needs ...... 17
4.4 Vulnerable children ...... 18
4.5 Children with a limited long-term disability ...... 18 4.6 Lifestyles ...... 18
4.7 Teenage pregnancy ...... 19
4.8 Chlamydia ...... 22 4.9 Hospital admissions ...... 22
5 Live well ...... 23
5.1 Employment and income...... 23 5.2 Education ...... 23
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5.3 The living environment ...... 24 5.4 Crime ...... 24 5.5 NHS health checks...... 25 5.6 Adult lifestyles ...... 25 5.7 Mental health...... 27 5.8 People with learning disabilities ...... 27 5.9 Sexual health ...... 28 6 Age well ...... 29 6.1 Demography and deprivation ...... 29 6.2 Disability free life expectancy ...... 29 6.3 Adult immunisation ...... 29 6.4 Long-term conditions...... 30 6.5 Dementia...... 32 6.6 Utilisation of health and social care ...... 32 6.7 Carers ...... 33 6.8 Accidents ...... 34 6.9 Excess winter deaths ...... 34
7 Die well ...... 35 7.1 Life expectancy ...... 35 7.2 Main causes of death ...... 37 7.3 Preventable mortality ...... 37 7.4 End of life ...... 39 8 Indicator matrix by ward...... 40
9 Indicator matrix by district ...... 45
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Health and wellbeing profile for Cannock Chase
April 2015
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Glossary of terms Definitions of some terminology that is used within the profile are described below.
. Age-standardised rate (ASR) These are used in sections of the profile to allow direct and fair comparisons of disease or mortality to be made between different areas or groups which may have very different age structures. The method adjusts the crude rate by eliminating the effect of differences in age structure. Throughout the profile, age-specific rates of the local population are applied to a standard population. The overall rate provides a summary rate of what would occur in the local population if it had the standard population’s age structure.
. Confidence intervals and statistical significance The profile uses upper and lower limits to indicate the uncertainty or variability of the value and also for comparison purposes. The upper and lower limits have been calculated to a 95% confidence level. Therefore when a value has lower and upper limits, we can be 95% sure that the value will be within this range.
Throughout this profile, confidence intervals are used to compare different values so it is possible to compare a local value to a national one to see if it is statistically similar, lower or higher. These confidence intervals are displayed on some of the charts at the end of the bar to illustrate the possible variability of the value. If the confidence interval overlaps the England (or other comparator) interval, the difference is not statistically significant. If it does not overlap the difference is statistically significant.
. Emergency hospital admissions An unplanned hospital admission is known as an emergency admission of a patient to hospital.
. Incidence Incidence quantifies the number of new cases of disease that develop in a population of individuals at risk during a specified time period.
. Prevalence Prevalence is a snapshot of the proportion of individuals in a population who have a disease or condition at a particular point in time.
. Synthetic estimates Synthetic estimates give the expected prevalence of a behaviour for an area (e.g. local authority), given the demographic and social characteristics of that area based on national prevalence data from national surveys (e.g. Health Survey for England).
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1 Introduction
1.1 Purpose of the profile The purpose of the profile is to provide commissioners with an evidence base across a range of health and wellbeing issues to help formulate district enhanced JSNAs and identify areas to prioritise.
It includes a range of indicators from numerous sources of data that each gives some information about an aspect of public health or the factors that influence health, the wider determinants. Most of the indicators are included in the national outcomes frameworks for public health, National Health Service and adult social care.
The profile should be used alongside the suite of profiles and other resources produced by the Staffordshire Observatory which collectively support the joint strategic needs assessment process in Staffordshire.
1.2 Format of the profile The format is similar to last year’s health and wellbeing profile. It highlights some of the key health and wellbeing issues facing each district and contains a wider range of information in the indicator matrices towards the end of the profiles at district level and/or ward level where information is available.
It is important to remember that a green box may still indicate an important health and wellbeing problem, for example rates of teenage conceptions are already high across England so even if an area does not have a significantly high rate this does not mean that it is not a public health issue.
Information presented for smaller areas allows a greater understanding of the particular characteristics of different communities and of the variations in and between different populations. Ward level data is sometimes presented for different time periods than the district level data – often older and / or pooled over several years. This is because data at lower geographies is often published later than the higher level information but it is also to make sure that the statistics relating to the smaller areas are robust. Some indicators values may therefore be different for these reasons: a) to show the latest information available at district level and b) to show robust statistics at ward level. Most of the information presented is published data but some indicators have been derived locally.
Both the district and ward indicator matrix will be updated as and when new information is released and this will be made available as a ‘live’ resource on the Staffordshire Observatory website.
The indicators are grouped under life course stages: start well, grow well, live well, , age well and die well along with a section on demographics.
Where appropriate the information is colour coded adopting a similar approach to that used in the Public Health Outcomes Framework tool (http://www.phoutcomes.info/)
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1.3 How to use this profile Health and social needs are complex and it is unlikely that there will be a single factor which is responsible for the particular situation in each local area. Therefore, it is important that no single item of information is treated in isolation. Instead the various pieces of data and evidence should be used as pieces of a jigsaw which, when linked together, give a picture of the needs of the local community. This should also include, where possible, insight into the perceptions of the people who live in the area.
As with all data and intelligence, it is important to ‘sense check’ the findings and compare it with local knowledge. Is the picture given by the data what you would expect? If it is not then it is important to understand the reasons why it is different.
1.4 Further information and support
Further information is available on the Staffordshire Observatory website: http://www.staffordshireobservatory.org.uk/publications/healthandwellbeing/yourhealt hinstaffordshire.aspx
This profile gives a snapshot of health and wellbeing in each area. For more advice or more in-depth profiling and assessment in any particular area please contact a member of the Insight Team: [email protected] or [email protected]
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2 The population of Cannock Chase
2.1 Population age structure
. The 2013 mid-year population estimate for Cannock Chase was 98,100. It has a slightly different age profile compared with England - there are lower proportions of children under five, adults aged 20-39 years and aged 80 and over. There are however more adults aged 40-74 in Cannock Chase compared to average
Figure 1: Population structure of Cannock Chase, 2013
Source: 2013-mid-year population projections, Office for National Statistics, Crown copyright
. At ward level the population age structure also differs across the district. Cannock North, Hagley and Hawks Green wards have high proportions of children under 16 compared with England whilst Brereton and Ravenhill, Cannock East, Cannock West, Etching Hill and The Heath, Norton Canes and Western Springs have high proportions of older people aged 65 and over. Cannock West and Western Springs also have higher proportions of people aged 85 or over.
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2.2 Population projections
. The overall population for Cannock Chase is projected to increase by 4% between 2013 and 2023. The population is projected to see significant growth in people aged 65 and over (26%) and in particular those aged 85 and over (58%) (Figure 3). The rate of increase in the number of older people in Cannock Chase is faster than the England average and equates to 3,600 additional residents aged 75 and over by 2023.
Figure 2: Population projections for Cannock Chase, 2013-2033
Source: 2012-based population projections, Office for National Statistics, Crown copyright
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Figure 3: Projected population change between 2013 and 2023
Source: 2012-based population projections, Office for National Statistics, Crown copyright
2.3 Rurality Living in a rural area has a positive association with people’s satisfaction. However it can also present difficulties in accessing services. In addition the structural demographic change towards an older population is the single most significant factor in an increasing prevalence of rural isolation.
. Based on the 2011 Rural and Urban Classification almost all of Cannock Chase’s population live in an urban area (91%) compared with 83% nationally (Table 1).
. More urban populations tend to have a higher population density – Cannock Chase has 1,244 people per square kilometre compared with 413 for England as a whole.
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Table 1: Rural and urban populations in Staffordshire, 2013
Urban Rural Rural Rural Urban Urban city Urban 2013 town and village and Rural total conurbation and town total population fringe dispersed 62,400 26,600 89,000 7,400 1,700 9,100 98,100 Cannock Chase (64%) (27%) (91%) (8%) (2%) (9%) (100%) 0 89,800 89,800 12,200 13,000 25,200 114,900 East Staffordshire (0%) (78%) (78%) (11%) (11%) (22%) (100%) 28,900 42,900 71,800 18,500 11,500 30,000 101,800 Lichfield (28%) (42%) (71%) (18%) (11%) (29%) (100%) 0 99,700 99,700 11,500 14,100 25,600 125,200 Newcastle-under-Lyme (0%) (80%) (80%) (9%) (11%) (20%) (100%) 64,700 1,500 66,300 32,700 11,300 44,000 110,300 South Staffordshire (59%) (1%) (60%) (30%) (10%) (40%) (100%) 0 90,000 90,000 17,700 24,400 42,100 132,100 Stafford (0%) (68%) (68%) (13%) (18%) (32%) (100%) 0 67,900 67,900 6,600 22,900 29,600 97,400 Staffordshire Moorlands (0%) (70%) (70%) (7%) (24%) (30%) (100%) 0 77,200 77,200 0 0 0 77,200 Tamworth (0%) (100%) (100%) (0%) (0%) (0%) (100%) 156,000 495,500 651,500 106,700 98,700 205,500 857,000 Staffordshire (18%) (58%) (76%) (12%) (12%) (24%) (100%) 2,604,000 2,233,100 4,837,100 379,300 458,300 837,600 5,674,700 West Midlands (46%) (39%) (85%) (7%) (8%) (15%) (100%) 21,159,400 23,499,900 44,659,400 4,970,200 4,236,200 9,206,500 53,865,800 England (39%) (44%) (83%) (9%) (8%) (17%) (100%)
Note: Numbers may not add up due to rounding
Source: The Rural and Urban Classification 2011, Office for National Statistics, Crown copyright and 2013 mid- year population estimates, Office for National Statistics, Crown copyright
2.4 Ethnicity
. The proportion of people from minority ethnic groups within Cannock Chase is lower than the national average (3.5%, or 3,240 people, compared with 20.2%).
2.5 Deprivation
. The Index of Multiple Deprivation 2010 (IMD 2010) is a way of identifying deprived areas. There are eight lower super output areas (LSOAs) that fall within the most deprived national quintile in Cannock Chase, making up 12% of the total population (11,500 people). These areas fall within Cannock East, Cannock North, Brereton and Ravenhill, Cannock South, Etching Hill and The Heath and Hednesford North.
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2.6 Geodemographic profile Mosaic Public Sector 6, released in 2014, is a way of analysing people by where they live in terms of an individual’s demographics, lifestyles and behaviours. This allows interventions to be targeted more effectively in an appropriate style and language which is suited to the different lifestyle groups.
The most common groups across Cannock Chase making up 70% of the population fall within five Mosaic groups:
. H Aspiring Homemakers (20.5%) . M Family Basics (13.8%) . K Modest Traditions (12.5%) . E Suburban Stability (12.4%) . D Domestic Success (10.4%)
Some wards have high proportions of their populations in a single segmentation group, for example, one in two residents who live in Hednesford Green Heath are in the “Aspiring Homemakers” group.
Table 2: Mosaic lifestyle groups in Cannock Chase
Mosaic group Cannock Chase Staffordshire West Midlands England A Country Living 0.7% 9.3% 6.8% 5.9% B Prestige Positions 3.7% 8.6% 6.9% 7.6% C City Prosperity 0.0% 0.0% 0.3% 4.5% D Domestic Success 10.4% 10.1% 6.8% 9.0% E Suburban Stability 12.4% 10.9% 7.1% 6.2% F Senior Security 7.3% 9.8% 8.7% 7.8% G Rural Reality 1.4% 5.8% 3.6% 5.3% H Aspiring Homemakers 20.5% 12.8% 11.1% 10.0% I Urban Cohesion 0.0% 0.6% 8.0% 6.7% J Rental Hubs 1.7% 2.0% 4.3% 6.9% K Modest Traditions 12.5% 7.1% 6.4% 4.3% L Transient Renters 6.4% 6.4% 7.1% 6.0% M Family Basics 13.8% 8.5% 11.6% 8.8% N Vintage Value 6.5% 4.7% 6.5% 4.7% O Municipal Challenge 2.5% 2.5% 4.2% 5.5% U Unclassified 0.2% 0.8% 0.5% 0.6% Total population 100.0% 100.0% 100.0% 100.0%
Key: Highlights top five groups
Source: Experian Public © 2014 Experian. All rights reserved
Key features for the 15 groups are shown in Table 3.
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Table 3: Key features of Mosaic groups
Mosaic group Key features Rural locations, well-off homeowners, attractive detached homes, higher self- A Country Living employment, high car ownership, high use of internet High value detached homes, married couples, managerial and senior positions, B Prestige Positions supporting students and older children, high assets and investments, online shopping and banking High value properties, central city areas, high status jobs, low car ownership, high C City Prosperity mobile phone spend, high internet use Families with children, upmarket suburban homes, owned with a mortgage, three or D Domestic Success four bedrooms, high internet use, own new technology Older families, some adult children at home, suburban mid-range homes, three E Suburban Stability bedrooms, have lived at same address some years, research on internet Elderly singles and couples, homeowners, comfortable homes, additional pensions F Senior Security above state, don't like new technology, low mileage drivers Rural locations, village and outlying houses, agricultural employment, most are G Rural Reality homeowners, affordable value homes, slow internet speeds Younger households, full-time employment, private suburbs, affordable housing H Aspiring Homemakers costs, starter salaries, buy and sell on eBay Mature age, homeowners, affordable housing, kids are grown up, suburban I Urban Cohesion locations, modest income Elderly, living alone, low income, small houses and flats, need support, low J Rental Hubs technology use Aged 18-35, private renting, singles and sharers, urban locations, young K Modest Traditions neighbourhoods, high use of smartphones Settled extended families, city suburbs, multicultural, own three bedroom homes, L Transient Renters sense of community, younger generation love technology Social renters, low cost housing, challenged neighbourhoods, few employment M Family Basics options, low income, mobile phones Families with children, aged 25 to 40, limited resources, some own low cost homes, N Vintage Value some rent from social landlords, squeezed budgets Private renters, low length of residence, low cost housing, singles and sharers, older O Municipal Challenge terraces, few landline telephones
Source: Experian Public © 2014 Experian. All rights reserved
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3 Start well
3.1 Child poverty Children living in low-income families are defined as the number of children under 16 living in families in receipt of out of work benefits or tax credits where their reported income is less than 60% median income.
. In 2012, 18% of children (3,205) in Cannock Chase were defined as living in poverty, lower than the national average (19%).
. Data from the 2011 Census highlights that in Cannock Chase there are almost 1,700 (4%) of households with children where there are no adults in employment. This is a similar rate to the national average.
3.2 Infant mortality
. Between 1999-2001 and 2011-2013, infant mortality rates in Cannock Chase have fluctuated due to small numbers; however rates in Cannock Chase have remained similar to the England average throughout this period.
3.3 Smoking in pregnancy
. The rate of women who smoked during pregnancy in Cannock Chase increased from 12.2% in 2007/08 to 15.1% in 2012/13 (around 170 women), although has reduced from the peak in 2009/10 when 15.9% of pregnant women smoked. The prevalence in 2012/13 was higher than the national average (12.7%).
3.4 Breastfeeding
. Breastfeeding initiation rates in Cannock Chase have increased slightly over the last five years from 66% in 2009/10 to 68% in 2013/14. Despite this small increase rates remain lower than the England rate (74%).
. The proportion of mothers in Cannock Chase who continue to breastfeed at six to eight weeks in 2013/14 was 26%, considerably below both regional (39%) and national average (46%).
Note: Data for 2013/14 suggests that the initiation and prevalence of breastfeeding fall significantly below minimum data quality standards and should therefore be used with caution.
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3.5 Immunisation
. The immunisation of children is the single most cost-effective form of prevention and protects children against serious diseases. Uptake rates for Cannock Chase in 2013/14 show that overall levels at 12 and 24 months are higher than the England average. However, for some diseases e.g. measles, mumps and rubella, coverage rates for children reaching their fifth birthday did not reach the 95% optimum protective target set by the World Health Organisation (WHO).
3.6 Dental health Tooth decay is particularly high amongst children who have poor weaning practices, poor diet (high or frequent uptake of food containing sugar) and inadequate use of fluoride toothpaste.
. The 2011/12 survey for five year olds found that tooth decay in this age group in Cannock Chase was 26%, similar to both the regional and national average.
3.7 School readiness Children are assessed through the Early Years Foundation Stage Profile (EYFSP) by a teacher in the year in which they turn five. Children are defined as having reached a good level of development if they achieve expected levels in the early learning goals in the prime areas of learning (personal, social and emotional development, physical development, and communication and language) and in the specific areas of literacy and mathematics.
Children from poorer backgrounds are more at risk of poorer development and evidence suggests that differences by social background emerge early in life.
. In 2014, the proportion of children in Cannock Chase who had reached a good level of development was 64%, which is higher than the England average of 60% and similar to the Staffordshire average of 64%.
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4 Grow well
4.1 GCSE attainment
. In 2013, 46% of Cannock Chase pupils achieved five or more A*-C grades at GCSE level including English and Maths. This is lower than the England average.
. In addition there are inequalities within the district with achievement ranging from 31% in Hednesford North ward to 65% in Hawks Green ward.
. Cannock Chase also has a higher proportion of children who are absent from school compared with the average.
4.2 Young people not in education, employment or training (NEETs) Being NEET between the ages of 16-19 is seen as a major predictor of later unemployment, low income, depression, involvement in crime and poor physical and mental health.
. The proportion of young people who were NEET at the start of January 2015 for Cannock Chase was 5% (around 190 young people). This is higher than the Staffordshire average.
. Four wards in Cannock Chase have particularly high levels of young people who are NEET: Cannock East, Cannock North, Cannock South and Hednesford North.
4.3 Children with special educational needs Some children need extra help during their time at school. In most cases, staff in mainstream schools can help children overcome difficulties quickly and easily. They do this through providing a teaching programme suitable for each child's needs and level of ability. However, a few children will have difficulties that require help in addition to this. These children are said to have special educational needs and may have difficulties with things like literacy, Mathematics or understanding information, expressing themselves or understanding others, making friends or relating to others, a hearing or visual impairment, or a physical or medical condition.
. Data from the January 2014 School Census found that 19% (around 2,700) of Cannock Chase pupils had special educational needs (SEN), which is higher than the England average (18%).
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4.4 Vulnerable children Children and young people in care are among the most socially excluded in children in England. There are significant inequalities in health and wellbeing outcomes compared with all children, which contribute to poorer health and wellbeing outcomes later in life.
. During 2013/14, there were 1,600 children in Cannock Chase identified as being ‘in need’ with rates being higher than the national average.
. As at the end of March 2014, there were around 130 looked after children in Cannock Chase with the rate being similar to the England average.
. The number of children in Cannock Chase requiring child protection plans during 2013/14 was however higher than the national average.
4.5 Children with a limited long-term disability
. The 2011 Census found that 4.5% of under 16s (around 830 children) had a limiting long-term illness in Cannock Chase which is higher than the England average of 3.7%.
. Five wards in Cannock Chase are particularly higher than the England average: Cannock North, Cannock South, Hagley, Hednesford North and Norton Canes.
4.6 Lifestyles
4.6.1 Smoking The Department of Health’s Tobacco Control Plan for England sets out to reduce rates of regular smoking among 15 year olds to 12% or less by the end of 2015. A target for reducing smoking prevalence in this age group is also included in the Public Health Outcomes Framework. Synthetic estimates for 2009-2012 suggest:
. The prevalence of regular smokers among 11-15 year olds in Cannock Chase is 3.7% which is similar to the national average of 3.1%.
. The prevalence of regular smokers among 15 year olds in Cannock Chase is 10.1%, with rates again being similar to the national average (8.7%).
4.6.2 Alcohol
. Over a three year period (2010/11-2012/13) there were around 60 alcohol- related admissions in children and young people under 18 in Cannock Chase, with rates being higher than the England average.
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4.6.3 Excess weight
. The proportion of children in Reception (aged four to five) with excess weight (overweight or obese) in Cannock Chase came down from 27.3% in 2012/13 to 24.5% in 2013/14 with rates being similar to England (Figure 4). The proportion of children aged 10-11 (Year 6) with excess weight reduced from 36.4% in 2012/13 to 34.6% in 2013/14. Rates are also similar to England.
. The prevalence of children who are either overweight or obese in Reception is higher in five wards: Brereton & Ravenhill, Cannock North, Cannock East, Hagley and Norton Canes. The prevalence of children who are either overweight or obese in Year 6 is higher in four wards: Cannock North, Etching Hill & the Heath, Hednesford North and Norton Canes.
Figure 4: Trends in children who are overweight and obese
Source: National Child Measurement Programme (NCMP) Local Authority Profile, Public Health England
4.7 Teenage pregnancy Being a teenage parent can have adverse effects on an individual’s life chances, for example, teenage mothers often have poor educational attainment and reduced employment opportunities. Being a teenage mother also has an additional risk of increased mortality and morbidity for both mother and infant.
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Risky behaviours such as early onset of sexual activity, poor or no use of contraception, alcohol and substance misuse, teenage motherhood and repeat abortions are often associated with areas of high teenage pregnancy. Teenage pregnancy is associated with deprivation and young people from lower socio- economic groups tend to have higher levels of teenage pregnancy.
. During 2013 there were around 70 teenage pregnancies in Cannock Chase. Between 1998 and 2013 under-18 conception rates in Cannock Chase have reduced by 28% compared with a 33% reduction in Staffordshire and a 48% reduction in England (Figure 5). However following a downward trend between 2008 and 2012 teenage pregnancy rates in Cannock Chase during 2013 appear to have increased and are now higher than England and amongst the worst in the Country (Figure 6).
. Under-16 conceptions make up around one in six under-18 pregnancies in Cannock Chase with rates being similar to England (Figure 7).
. Teenage pregnancy rates are particularly high in Cannock South, Cannock North and Hednesford North wards
Figure 5: Teenage pregnancy trends: under-18 conception rates
Source: Office for National Statistics
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Figure 6: Teenage pregnancy trends: under-18 conception rates, 2013
Source: Office for National Statistics
Figure 7: Teenage pregnancy: under-16 conception rates, 2011-2013
Source: Office for National Statistics
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4.8 Chlamydia Chlamydia infection remains the most commonly diagnosed sexually transmitted disease (STI) both in England and in local Staffordshire clinics. Young people under 25 make up almost three quarters of all chlamydia cases.
Chlamydia is often asymptomatic so a large proportion of cases remain undiagnosed. The National Chlamydia Screening Programme (NCSP) was set up to control and prevent the spread of chlamydia, targeting the high risk group, i.e. young people aged under 25 who are sexually active.
. Data from 2013 shows that 30% (around 3,700) young people aged 15-24 in Cannock Chase were screened for chlamydia which is higher than the England average (25%).
. However the diagnosis rate for this age group falls below the Public Health Outcomes Framework (PHOF) recommendation of at least 2,300 per 100,000 aged 15-24 years. This may indicate that Cannock Chase has lower levels of chlamydia prevalence as the target has not been adjusted for different prevalence across different geographical areas and / or that young people who are at higher risk of chlamydia are not being targeted appropriately for testing.
4.9 Hospital admissions Unintentional and deliberate injuries are the leading cause of admissions for children and are often higher for children from more deprived areas. They are also one of the main causes of death in children and young people.
. Around 140 children aged under five in Cannock Chase were admitted to hospital due to unintentional and deliberate injuries during 2012/13, with rates being higher than the England average.
. During 2012/13 around 270 children under 15 were admitted for unintentional and deliberate injuries. Between 2011/12 and 2012/13 hospital admissions caused by unintentional and deliberate injuries in children under 15 in Cannock Chase decreased by 11% compared with 12% for England. However rates in Cannock Chase remain higher than England.
Long-term conditions such as asthma, diabetes, epilepsy and other lower respiratory tract infections also make up significant numbers of unplanned hospital admissions in under 19s.
. During 2013/14 there were 90 hospital admissions caused by asthma, diabetes or epilepsy in children under 19 in Cannock Chase with rates remaining higher than the England average.
. During the same period around 70 Cannock Chase children under 19 were admitted to hospital due to a lower respiratory tract infection with rates being similar to the national average.
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5 Live well
5.1 Employment and income There is a key relationship between work, health and wellbeing - having a job is better for health than no job. As well as the obvious links to low income and worklessness, detachment from the labour market can lead to a number of social and psychological disadvantages. People who are unemployed tend to have higher levels of premature mortality and poorer general health than those who work. People who have been unemployed for a long duration also tend to visit their GP more frequently and have higher hospital admission rates.
. Data from the 2013/14 annual population survey found that similar proportions of people aged 16-64 in Cannock Chase were in employment compared to the England average (69% compared with 72%). However some vulnerable groups are less likely to be employed, for example during 2013/14:
o only 4% of people with learning disabilities in Cannock Chase were in paid employment; this is similar to the 7% average for England o employment for people with long-term conditions in Cannock Chase was over 13 percentage points lower than that of the working age population as a whole
. Unemployment in Cannock Chase (as at Feb 2015) was lower, at 1.4% or around 910 claimants than England (2%). However there are two wards (Cannock North and Cannock South) with high unemployment levels.
. Youth unemployment in Cannock Chase (3.2% or around 265 claimants) is similar to England (3.1%).
. The average household income for Cannock Chase was £35,200 which is less than the Great Britain average (£40,000). Cannock Chase also has a higher than average proportion of households with an average income of under £20,000.
. The percentage of people claiming disability living allowance is higher than average in Cannock Chase (6.6% or around 6,435 people) compared with England (4.9%).
5.2 Education Areas of low educational attainment and skills are often associated with high levels of worklessness, deprivation and poor health.
. 11% of people aged 16-64 have no qualifications in Cannock Chase which is similar to the England average of 9%.
. The percentage of working age adults with NVQ1 or above in Cannock Chase (84%) is similar to England (85%).
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5.3 The living environment The relationship between health and housing is well documented and the environment we live in can be an important influence on the demand for health and social care.
Certain characteristics, such as overcrowding, sanitation and poor heating can have adverse effects on an individual’s health. Overcrowding is linked to a number of health problems including TB, dysentery, heart attacks, chest problems and poor mental health conditions. Damp and cold homes are linked to asthma, wheezing, chest infections and hypothermia and are also one of the major causes for excess winter deaths in the older population.
. Estimates from a 2009 study on housing suggest that around three in ten private sector households would not meet the decent homes standard in Cannock Chase which is lower than the England estimate of 36%.
. Households that are accepted as being homeless or are in temporary accommodation often have greater health needs than the average population. Statutory homelessness is one of the key public health outcomes indicators. During 2013/14, 40 households in Cannock Chase were accepted as being homeless which is lower than average.
. Around 4,400 households in Cannock Chase are thought to be in fuel poverty, the rate being higher than the England average (11% compared with 10%). About half of Cannock Chase electoral wards also experience high fuel poverty.
. Based on data from the Feeling the Difference survey, 93% of Cannock Chase residents were satisfied with their area as a place to live, which is similar to the overall Staffordshire average (also 93%).
5.4 Crime Crime can have a direct impact on health, e.g. through violence and injury to an individual, and may also be alcohol or drug-related. Furthermore it has an effect on wellbeing, e.g. domestic violence or feeling socially isolated due to fear of crime.
. During 2013/14 there were around 1,230 recorded incidents of violent crime with rates in Cannock Chase being higher than the England average. In addition there are five wards with particularly high rates of violent crime: Cannock East, Cannock South, Cannock West, Hednesford North and Western Springs.
. There were around 2,790 reported incidents of anti-social behaviour during 2013/14 with rates being lower than the England average. However Cannock South, Hednesford North and Western Springs wards have significantly high rates of anti-social behaviour.
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. The percentage of juvenile re-offenders in Cannock Chase was 45%, similar to the national average. The re-offending rate for adults is lower at 21%, which is lower than the England average.
. Based on data from the Feeling the Difference survey, 10% of Cannock Chase respondents thought that they were likely to be a victim of crime. However, only 7% of the Cannock Chase respondents had experienced crime (either as a victim or a witness to a crime). These figures are similar to the Staffordshire average.
5.5 NHS health checks The NHS health check programme is key in reducing health inequalities and increasing life expectancy from preventable cardiovascular (CVD) conditions. It aims to help prevent CVD by offering everyone between the ages of 40 and 74 a health check that assesses their risk of heart disease, stroke, kidney disease, diabetes and dementia and gives them support and advice to reduce that risk.
. In Cannock Chase there are 30,100 patients who are eligible to be invited for an NHS health check over a five year period (around 70% of the population aged 40-74). Between April 2013 and March 2014, almost 6,000 invites were sent to Cannock Chase residents, which is around a fifth of the eligible population and higher than the national average of 18%. During this period around 3,300 patients received a NHS health check which is an uptake rate of 54% also higher than the national average of 49%.
5.6 Adult lifestyles People’s lifestyle choices can have a profound impact on their health. Smoking for example is the biggest preventable cause of disease and death in England and remains a key health and wellbeing challenge. The misuse of alcohol has been shown to contribute to a number of health problems and is also linked to social problems such as anti-social behaviour, crime and domestic violence. Being obese increases the risk of diseases such as diabetes, hypertension (high blood pressure), cancer and heart disease, and can lead to social and psychological problems. A healthy diet can help reduce the risk of developing heart disease, some cancers, reduce the risk of diabetes, high cholesterol and blood pressure levels and also reduce excess weight. People who have a physically active lifestyle reduce the risk of cardiovascular disease, some cancers and diabetes. Being active can also improve musculoskeletal conditions, reduce excess weight and improve an individual’s wellbeing.
. Based on data from the 2013 Integrated Household Survey smoking prevalence for adults aged 18 and over in Cannock Chase was 20% (around 15,500 people and similar to the national average of 18%. GP recorded data suggests that smoking prevalence in persons aged 15 years or over is slightly higher for Cannock Chase (24% or around 19,400 people) than England (23%).
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. Around one in five deaths in Cannock Chase are due to a smoking related disease (equivalent to 170 deaths). In addition there are around 1,200 admissions to hospital due to smoking. Both smoking-attributable mortality and admissions in Cannock Chase are higher than the England average.
. During 2013/14 around 1,280 Cannock Chase smokers accessed stop smoking services of which 56% were quit at four weeks. Both access rates to stop smoking services per 1,000 smokers and conversion rates, i.e. number of four week quitters as a proportion of those who set a quit date are higher than average.
. During 2013/14 there were 700 alcohol-related admissions in Cannock Chase with rates being higher than average. Provisional rates for 2013/14 show a slight increase from the previous year (Figure 8).
Figure 8: Trends in alcohol related admissions
Source: Local Alcohol Profiles for England, Public Health England
. Around six in ten adults have excess weight (either obese or overweight). The proportion of people who are obese in Cannock Chase is higher than the England average (30% compared with 23% nationally).
. Data from the latest National Diet and Nutrition Survey (NDNS) shows that overall the population is still consuming too much saturated fat, added sugars and salt and not enough fruit, vegetables, oily fish and fibre.
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. Estimates suggest that the proportion of people in Cannock Chase eating five or more portions of fruit and vegetables daily (23%) is lower than England (29%).
. The Chief Medical Officer recommended that adults undertake 150 minutes of moderate intensity activity over a week in bouts of 10 minutes or more. Only 49% of Cannock Chase adults met the recommended levels of physical activity in 2013 which is lower than the England average of 56%.
. Around three in ten Cannock Chase adults are inactive, similar to the England average (equating to around 23,980 people).
5.7 Mental health People with mental ill-health are a marginalised and vulnerable group that can experience considerable barriers when accessing health services and suffer from poorer health outcomes than the general population. At least one in four people will experience a mental health problem at some point in their life and one in six adults have a mental health problem at any one time.
. The estimated number of people suffering mental ill-health in the community is between 20,800 and 24,800 people.
. In Cannock Chase, around 7% of adults aged 18 and over were on GP depression registers in 2013/14 which is slightly higher than the national average.
. In terms of severe mental health conditions (schizophrenia, bipolar disorder or other psychoses), the recorded prevalence in Cannock Chase was 0.6% in 2013/14 which is lower than the England average of 0.9%.
. In Cannock Chase there are around nine suicides every year accounting for about 1% of deaths with rates being similar to the national average. Self- harm is often an expression of personal distress and there is a significant and persistent risk of future suicide following an episode of self-harm. During 2012/13 there were around 170 hospital admissions due to self-harm in Cannock Chase with rates being similar to the England average.
5.8 People with learning disabilities Learning disability is one of the most common forms of disability and is a lifelong condition. It is acquired before, during or soon after birth and affects an individual’s ability to learn. Similar to people suffering from mental ill health, people with learning disabilities also face challenges and prejudice every day, for example the proportion who were in paid employment is lower than average.
. Around 46% of Cannock Chase adults with learning disabilities live in their own home or with their family which is lower than the national average.
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. The number of people recorded on a disease register (QOF register) as having a learning disability was around 410 in 2013/14. The recorded prevalence (0.5%) is similar to the national average (also 0.5%). The expected prevalence of learning disability however suggests that there are significant numbers of people undiagnosed or unrecorded on GP disease registers.
5.9 Sexual health
. In 2013 there were around 670 acute sexually transmitted infections (STIs) diagnosed at GUM clinics for residents of Cannock Chase, a reduction of 13% since 2012. This compares with a 1% increase across Staffordshire and very little change seen nationally across England.
. Overall rates of STIs in Cannock Chase are lower than average. However rates of Cannock Chase women admitted to hospital with pelvic inflammatory disease (PID) during 2012/13 were higher than the national average.
. The proportion of new patients attending GUM who were offered a HIV test in Cannock Chase is similar to the national average. However uptake, i.e. new GUM patients who received a HIV test is higher than England. The prevalence of HIV in Cannock Chase is lower than average.
. People who have experienced sexual assault have multiple on-going sexual health needs including addressing pregnancy risk, risks of infection and psychosocial impacts. During 2013/14 there were around 100 sexual offences reported to the police in Cannock Chase with rates being similar to the national average.
Insight and Intelligence, Staffordshire County Council Page 28
6 Age well
6.1 Demography and deprivation The dependency ratio for older people measures the number of people aged over 65 who depend on people of working age (16-64) and gives an indication of both the economic and social responsibility of those of working age for older people.
. There are around 17,000 people aged 65 and over living in Cannock Chase. The dependency ratio for older people in Cannock Chase, based on mid-year 2013 population estimates, was 27 older people for every 100 people of working age which is similar to England. However there are six wards in Cannock Chase who have a higher dependency ratio than the national average for older people. These are: Brereton and Ravenhill, Cannock East, Cannock West, Etching Hill and The Heath, Norton Canes and Western Springs.
. Around 4,700 (21%) people aged 60 and over in Cannock Chase are deemed to be living in income deprived households. This is higher than the England average (18%).
. The proportion of older people living alone in Cannock Chase is 11% (4,600 people). This is lower than the national average of 12%.
. Four wards in Cannock Chase have higher proportions of households with lone pensioners: Cannock North, Cannock South, Cannock West and Western Springs.
6.2 Disability free life expectancy
. Based on data for 2007-2009, men in Cannock Chase at the age of 16 can expect to have 46 additional years of disability-free life expectancy (DFLE) and women 47 years. These are similar to the national average.
. At the age of 65 men and women in Cannock Chase can expect to have nine and 10 additional years of DFLE respectively. Again these are similar to the England average.
6.3 Adult immunisation
. The proportion of people aged 65 and over who have been vaccinated against flu in 2013/14 was 68%. This is lower than the England average of 73%.
. Pneumococcal vaccine coverage in Cannock Chase was 63%, which is lower than the England average of 69%.
Insight and Intelligence, Staffordshire County Council Page 29
6.4 Long-term conditions
. The 2011 Census found that 20.7% (20,200 people) had a limiting long-term illness (LLTI) in Cannock Chase. This is higher than the England average of 17.6%. The proportion of people who have a LLTI also increases with age: around 61% of people with 65 and over and 77% of people aged 75 and over have a LLTI, both higher than the national averages.
. In Cannock Chase 12 of 15 wards also have higher proportions of people with LLTI than the England average.
. The prevalence of long-term conditions is projected to increase given the ageing population and increase in unhealthier lifestyles placing an increased burden on future health and social care resources.
. GP disease registers show that the long-term conditions with the highest prevalence in Cannock Chase are hypertension (15%), obesity (14% of people aged 16 and over), depression (7% of people aged 18 and over), diabetes (7% of people aged 17 and over), and asthma (6%).
. The numbers of patients recorded on general practice disease registers when compared with the expected numbers of people on registers with specific conditions shows that there are potentially large numbers of undiagnosed or unrecorded cases for osteoporosis, learning disabilities, peripheral arterial disease, palliative care conditions, dementia and heart failure.
. Higher numbers of cases on the registers than would be expected are recorded for cancer, hypothyroidism and severe mental health problems. Some of these differences may be due to the model used for expected numbers, particularly in cases such as the cancer and hypothyroidism which are noted as underestimating the true prevalence.
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Table 4: Summary of actual and expected prevalence for selected long-term conditions in Cannock Chase, 2013/14
Recorded Expected Estimated under prevalence prevalence recording (QOF 2013/14) (2013/14) (percentage) 5,804 8,967 Asthma 35% (5.9%) (9.2%) 1,631 1,957 Atrial fibrillation 17% (1.7%) (2.0%) 2,296 789 Cancer -191% (2.3%) (0.8%) 3,156 4,939 Chronic kidney disease (age 18+) 36% (4.1%) (6.4%) 2,180 2,689 Chronic obstructive pulmonary disease 19% (2.2%) (2.7%) 3,997 4,577 Coronary heart disease 13% (4.1%) (4.7%) 540 1,075 Dementia 50% (0.6%) (1.1%) 5,477 6,468 Depression (age 18+) 15% (7.0%) (8.3%) 5,433 4,853 Diabetes (age 17+) -12% (6.9%) (6.2%) 805 684 Epilepsy (age 18+) -18% (1.0%) (0.9%) 801 1,471 Heart failure 46% (0.8%) (1.5%) 14,656 24,410 Hypertension 40% (14.9%) (24.9%) 3,996 2,042 Hypothyroidism -96% (4.1%) (2.1%) 409 1,648 Learning disabilities (age 18+) 75% (0.5%) (2.1%) 586 393 Mental health -49% (0.6%) (0.4%) 10,925 18,444 Obesity (age 16+) 41% (13.6%) (23.0%) 118 1,006 Osteoporosis (age 50+) 88% (0.3%) (2.8%) 302 639 Palliative care 53% (0.3%) (0.7%) 661 2,631 Peripheral arterial disease 75% (0.7%) (2.7%) 841 646 Rheumatoid arthritis (16+) -30% (1.0%) (0.8%) 1,839 1,936 Stroke 5% (1.9%) (2.0%)
Source: Quality and Outcomes Framework (QOF) for April 2013 - March 2014, GPES and CQRS database - 2013/14 data as at end of June 2014, Copyright © 2014, Health and Social Care Information Centre. All rights reserved, NHS Comparators, NHS Doncaster QOF Benchmarking Tool, Public Health England, 2014 dementia calculator, Primary Care Web Tool and GP registered populations, Midlands and Lancashire Commissioning Support Unit (CSU)
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6.5 Dementia
. Around 540 people in Cannock Chase had a recorded diagnosis of dementia on GP registers during 2013/14.
. A new dementia prevalence calculator was published in 2014. As well as the age-sex structure of the population, this takes into account the higher proportion of dementia cases found for care home residents. Using this tool, only one in two Cannock Chase residents with dementia are diagnosed (similar to the national average of 54%).
6.6 Utilisation of health and social care By the time people reach 65 most will have developed at least one chronic (long- term) condition and large proportions will also have developed two or three conditions. Whilst most of this care will occur in primary and community settings, a high proportion occurs in more costly hospital settings.
. During 2013/14 older people made up around 45% of all emergency (unplanned) admissions, 70% of unplanned hospital bed days and 60% of costs despite making up only 20% of the population in Staffordshire.
. Acute and chronic conditions that can be managed effectively in primary care or outpatient settings are known as ambulatory care sensitive (ACS) conditions. These measure emergency admissions for conditions that should not usually require hospital admission.
. In Cannock Chase in 2013/14, there were about 1,300 admissions classed as acute ACS conditions and about 800 classed as chronic ACS conditions. Trends show rates in Cannock Chase for both acute and chronic conditions are increasing more rapidly than average although there were signs of reductions during 2013/14. The admission rate for acute ACS conditions remains higher than England whilst the rate of chronic ACS conditions is now similar to the national average.
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Figure 9: Trends in unplanned admissions from ACS conditions
Source: Compendium of Population Health Indicators (www.indicators.ic.nhs.uk or nww.indicators.ic.nhs.uk), The NHS Information Centre for health and social care. Crown copyright
. During 2013/14 there were around 125 permanent admissions to people aged 65 and over to residential and nursing care homes, the rate being similar to the national average.
. In 2013/14 the percentage of older people (aged 65 and over) who were discharged from hospital to reablement services and as a consequence were still at home after 91 days was 85%, similar to the national figure of 83%.
6.7 Carers
. Based on data from the 2011 Census, 12% of Cannock Chase residents provide unpaid care which is higher than the England average of 10%. This equates to around 11,800 people.
. In Cannock Chase, 16% (2,500 people) of residents aged 65 and over provide unpaid care which is again higher than the England average of 14%.
Insight and Intelligence, Staffordshire County Council Page 33
6.8 Accidents
. Around 310 Cannock Chase residents aged 65 and over were admitted to hospital for a fall-related injury during 2012/13, with rates being similar to the England average.
. National research indicates that only one in three people who have a hip fracture return to their former level of independence and one in three have to leave their own home and move to long-term care (resulting in social care costs).
. During 2012/13 there were 110 hip fracture admissions to people aged 65 and over in Cannock Chase, again rates are similar to the England average.
. Accidental deaths account for around 20 deaths per year in Cannock Chase with rates being similar to the England average. Common causes of accidental mortality are falls (49%) and road traffic accidents (13%). Accidental death rates in older people aged 65 and over and from accidental falls are however higher than England.
6.9 Excess winter deaths There is some evidence to suggest that some deaths that occur during the winter months are preventable. National research shows that winter deaths increase more in England compared to other European countries with colder climates. This suggests that it is more than just lower temperatures that are responsible for the excess mortality. The excess winter deaths index (EWD index) indicates whether there are higher than expected deaths in the winter compared to the rest of the year.
. There were around 70 excess winter deaths between August 2012 and July 2013 in Cannock Chase mainly amongst older people. During this period the EWD index in Cannock Chase was similar to England.
Insight and Intelligence, Staffordshire County Council Page 34
7 Die well
7.1 Life expectancy
. Overall life expectancy at birth continues to increase both nationally and locally (Figure 10). Overall life expectancy at birth in Cannock Chase is 79 years for men and 83 years for women, both similar to the national average. However men and women living in the most deprived areas of Cannock Chase live seven and five years less than those living in less deprived areas.
. Map 1 shows there are also marked gaps in life expectancy between different communities at ward level for both men and women:
o For men the difference in life expectancy between the ward with the lowest life expectancy and the ward with the highest life expectancy in the district is seven years (varying between 76 years in Cannock South and 83 years in Hednesford South).
o For women the difference in life expectancy between the ward with the lowest life expectancy and the ward with the highest life expectancy in the district is 11 years (varying between 79 years in Hawks Green and 90 years in Hednesford Green Heath).
Figure 10: Trends in life expectancy at birth
Source: Office for National Statistics, Crown Copyright
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Map 1: Life expectancy at birth for men (left) and women (right), 2009-2013
Source: Primary Care Mortality Database and Death extracts, Office for National Statistics, Mid-year population estimates, Office for National Statistics, Crown copyright and Vital statistics Table 3, Office for National Statistics, Crown copyright
This product includes mapping data licensed from Ordnance Survey with the permission of the Controller of Her Majesty's Stationery Office. © Crown copyright and / or database right 2014. All rights reserved. Licence Number 100019422
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7.2 Main causes of death
. Around 810 Cannock Chase residents die every year with the most common causes of death being cancer (240 deaths, 30%), circulatory disease (230 deaths, 29%) and respiratory disease (110 deaths, 14%) (Figure 11).
Figure 11: Common causes of deaths in Cannock Chase, 2011-2013
Source: Public Health Mortality Files and Death extracts, Office for National Statistics
7.3 Preventable mortality The major causes of preventable deaths can be attributed to the roots of ill-health, for example education, employment and housing as well as lifestyle risk factors such as smoking, drinking too much alcohol, unhealthy diets, physical inactivity and poor emotional well-being.
. Around 22% of Cannock Chase residents die from causes that are largely thought to be preventable, equating to around 180 deaths every year with overall rates being similar to the national average.
. The numbers of people dying from preventable deaths across the district have reduced significantly by 28% between 2001-2003 and 2011-2013 compared with 26% for England (Figure 12). Two wards (Cannock North and Heath Hayes East and Wimblebury) have higher preventable mortality rates than England.
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Figure 12: Mortality rates from causes considered preventable
Source: Public Health Outcome Framework, Public Health England, http://www.phoutcomes.info/
. Cancer - Every year around 130 Cannock Chase residents die prematurely (i.e. before 75) from cancer, accounting for 42% of all premature deaths. Rates in Cannock Chase have been falling at a faster rate than England and in 2011-2013 were similar to the England average
. Circulatory disease - Every year around 70 Cannock Chase residents die prematurely from circulatory diseases making up 24% of all premature deaths. Premature mortality from circulatory diseases have fallen by 44% between 2001-2003 and 2011-2013 which is similar to England (also 44%) with Cannock Chase rates being similar to England. However the rate of premature death from circulatory disease in Cannock North ward is higher than the England average.
. Respiratory disease - Respiratory disease is the third biggest cause of death and about 20 people die prematurely in Cannock Chase every year making up around 7% of all premature deaths. Rates in Cannock Chase have been decreasing and are similar to England.
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Liver disease - Around 20 Cannock Chase residents die from liver disease every year, accounting for 2% of all deaths. Around 80% of these deaths occur to people who are under 75 with almost half of these due to alcoholic liver disease. Unlike the reductions seen in under 75 mortality from cancer and cardiovascular disease, rates of people dying early as a result of liver disease have increased by 49% between 2001-2003 (28 deaths) and 2011- 2013 (48 deaths). This may be a result of increased alcohol consumption and consequently increased alcohol-related harm within the district.
. Communicable diseases - Around 40 Cannock Chase residents die from a communicable disease every year with rates being similar to average.
7.4 End of life Research by the End of Life Care Intelligence Network (now Public Health England) suggests that on average a quarter of all deaths are unexpected. Death in hospital is considered the least likely place that people in general would choose to die compared with home, hospices and care homes. Therefore ensuring peoples’ preferences are met involves working to reduce the number of deaths in hospital. This improves quality of care at end of life for the patients and also reduces hospital costs on unnecessary admissions.
. During 2013/14 there were around 300 people on palliative care registers across Cannock Chase making up 0.3% of the population. It remains significantly lower than the expected number of people on registers (0.7%). This indicates that people who may have palliative care needs are not being identified prior to their death.
. During 2013 around one in two Cannock Chase residents died in hospital whilst 43% died at home (or their usual place of residence), both similar to the England average.
. People with an underlying cause of death recorded as cardiovascular disease or respiratory disease were more likely to die in hospital than those who have cancer.
Insight and Intelligence, Staffordshire County Council Page 39
8 Indicator matrix by ward The information in the following matrix is mainly benchmarked against England and colour coded using a similar approach to that used in the Public Health Outcomes Framework tool (http://www.phoutcomes.info/).
It is important to remember that a green box may still indicate an important health and wellbeing problem, for example rates of teenage conceptions are already high across England so even if an area does not have a significantly high rate this does not mean that it is not a public health issue.
Compared to England: Better Similar Worse Lower Similar Higher Suppressed / not tested / not available
Heath Hagley England Ravenhill Rawnsley The Heath Brereton and Staffordshire Hawks Green Norton Canes Cannock East Cannock West Cannock North Cannock South Cannock Etching Hill and Hill Etching Cannock Chase and Wimblebury Western Springs Western Heath HayesEastHeath Hednesford North Hednesford Green Hednesford South Hednesford
Demographics Mid-year population estimate (000s), 2013 6.7 6.9 7.5 7.9 7.0 6.7 4.7 7.8 6.4 5.0 7.1 5.3 7.4 5.0 6.9 98.1 857 53.9m % under five, 2013 7 6 7 7 5 5 7 7 5 5 6 5 5 6 6 6 5 6 % under 16, 2013 19 17 21 18 14 17 21 22 19 17 18 18 18 17 17 18 17 19 % aged 16-64, 2013 61 63 63 65 60 64 65 71 66 67 66 65 63 66 61 64 63 64 % aged 65 and over, 2013 20 20 16 17 25 19 14 7 15 16 16 18 19 17 21 17 20 17 % aged 75 and over, 2013 9 8 8 8 12 6 6 3 6 6 7 7 7 8 10 7 9 8 % aged 85 and over, 2013 2 2 2 2 4 1 1 1 2 1 2 2 1 3 3 2 2 2 Dependency ratio per 100 working age population, 2013 64 59 59 55 66 57 53 41 51 49 52 55 59 52 63 56 60 57 Dependency ratio of children per 100 working age population, 32 27 33 28 24 27 32 31 28 25 28 27 29 26 28 29 28 30 2013 Dependency ratio of older people per 100 working age 32 32 25 27 42 30 22 10 23 24 24 27 30 26 35 27 32 27 population, 2013 Minority ethnic groups, 2011 (%) 3 3 4 6 4 3 4 5 3 3 3 3 3 2 3 4 6 20 Index of multiple deprivation (IMD) 2010 weighted score, 2010 23 30 35 31 14 18 23 7 14 13 26 13 21 17 18 21 16 22
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Compared to England:
Heath Hagley England Ravenhill Rawnsley The Heath Brereton and Staffordshire Hawks Green Norton Canes Cannock East Cannock West Cannock North Cannock Cannock South Cannock Etching Hill and Hill Etching Cannock Chase and Wimblebury Western Springs Heath Hayes East HayesHeath Hednesford North Hednesford Green Hednesford South
% in most deprived IMD 2010 national quintile, 2013 26 42 38 20 0 19 0 0 0 0 16 0 0 0 0 12 9 20 % in second most deprived IMD 2010 national quintile, 2013 26 39 62 80 31 0 49 0 24 0 61 0 37 0 22 30 17 20 Child Wellbeing Index (CWI) 2009 weighted score, 2009 150 179 234 182 102 151 172 82 106 94 167 78 159 122 115 143 114 159 % in most deprived CWI 2009 national quintile, 2013 0 24 23 0 0 26 0 0 0 0 0 0 0 0 0 5 8 24 % in second most deprived CWI 2009 national quintile, 2013 32 23 59 70 0 27 51 0 20 0 62 0 50 38 0 31 16 20 Mosaic profile - most common group, 2014 M M M M B H M D H H K E E G H H H H Mosaic profile - % in the most common group, 2013 21 21 44 26 29 26 26 47 25 50 27 28 28 23 25 21 13 10 Start well Children under 16 in low-income families, 2012 (%) 23 24 34 28 12 16 19 7 12 13 22 7 18 13 17 18 14 19 Lone parent households, 2011 (%) 12 13 14 12 8 10 12 9 8 8 11 7 10 7 9 10 9 11 General fertility rate per 1,000 women aged 15-44, 2011-2013 65 68 66 68 57 56 59 59 56 44 72 52 58 56 65 61 58 64 Low birthweight babies (under 2,500 grams), 2011-2013 (%) 8 8 9 6 9 7 9 5 7 9 8 6 6 7 6 7 7 7 Breastfeeding prevalence rates at six to eight weeks, 2012/13 21 17 18 20 32 18 19 32 24 31 22 24 20 34 24 23 33 47 (%) School readiness (Early Years Foundation Stage), 2014 (%) 60 57 63 56 74 76 53 68 59 82 62 68 53 65 79 64 64 60 Grow well Pupil absence, 2014 (%) 5 5 6 5 4 4 5 4 5 5 6 4 5 5 4 5 5 5 Children who claim free school meals, 2014 (%) 20 20 28 23 7 13 20 6 10 6 17 6 14 10 12 14 12 16 KS2 results - Level 4 or above in reading, writing and 74 75 61 72 82 81 80 80 82 69 73 82 73 87 86 77 77 79 mathematics, 2014 (%) GCSE attainment (five or more A*-C GCSEs including English 55 44 31 33 46 64 44 65 55 56 31 44 44 36 60 46 55 53 and mathematics), 2014 (%) Young people not in education, employment or training Jan 6 7 9 9 3 5 6 3 4 S 8 3 4 5 4 5 4 n/a 2015 (%) (compared to Staffordshire)
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Compared to England: Better Similar Worse Lower Similar Higher Suppressed / not tested / not available
Heath Hagley England Ravenhill Rawnsley The Heath Brereton and Staffordshire Hawks Green Norton Canes Cannock East Cannock West Cannock North Cannock Cannock South Cannock Etching Hill and Hill Etching Cannock Chase and Wimblebury Western Springs Heath Hayes East HayesHeath Hednesford North Hednesford Green Hednesford South
Excess weight (children aged four to five), 2010/11 to 2012/13 31 30 31 27 25 26 30 24 22 26 26 23 29 29 26 27 23 22 (%) Excess weight (children aged 10-11), 2010/11 to 2012/13 (%) 37 37 42 36 29 43 34 30 32 41 42 32 45 29 37 37 34 34 Obesity (children aged four to five), 2010/11 to 2012/13 (%) 13 13 16 9 12 12 9 8 11 12 10 8 16 9 13 11 9 9 Obesity (children aged 10-11), 2010/11 to 2012/13 (%) 21 20 26 23 17 24 19 13 16 18 25 18 26 13 25 20 19 19 Children aged 15 who have never smoked, 2009-2012 (% 74 70 70 70 77 77 75 78 75 77 72 78 76 75 75 75 76 77 estimates) Children aged 15 who are regular smokers, 2009-2012 (% 10 13 13 13 9 9 10 8 10 8 12 8 9 10 10 10 9 9 estimates) Children aged 15 who are occasional smokers, 2009-2012 (% 4 5 4 5 5 4 4 5 5 4 5 4 4 5 5 4 4 4 estimates) Under-18 conception rates per 1,000 girls aged 15-17, 2010- 33 49 59 62 18 40 28 35 46 39 57 29 30 31 27 40 32 31 2012 Limiting long-term illness (under 16), 2011 (%) 4 4 6 5 4 5 5 2 4 5 6 4 5 5 4 5 4 4 Limiting long-term illness (16-24), 2011 (%) 5 6 7 8 6 6 7 5 4 5 6 5 4 6 4 5 5 5 Unpaid care (under 16), 2011 (%) 1 1 1 2 2 1 1 1 1 1 2 2 1 1 1 1 1 1 Unpaid care (16-24), 2011 (%) 6 5 8 7 4 6 7 4 5 6 8 6 6 6 3 6 5 5 Live well Unemployment (claimant counts), Feb 2015 (%) 1 2 3 2 1 1 1 1 1 1 2 1 1 1 1 1 1 2 Disability Living Allowance claimants, Aug 2014 (%) 7 9 10 8 6 6 7 3 6 5 9 4 7 6 6 7 5 5 Average household income (£000s), 2012 32 28 25 28 46 37 39 50 38 37 29 40 36 39 35 35 39 40 Households with an income under £20K, 2012 (%) (compared to 42 46 51 48 26 30 36 10 31 26 43 27 34 29 35 35 33 35 Great Britain) Owner occupied households, 2011 (%) 70 57 54 54 78 80 71 82 72 81 59 84 75 74 71 70 73 64 Privately rented households, 2011 (%) 11 13 9 15 11 9 17 13 13 12 15 9 9 10 16 12 11 17 Socially rented households, 2011 (%) 18 29 35 30 10 10 11 5 14 6 24 6 15 15 12 17 15 18
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Compared to England: Better Similar Worse Lower Similar Higher Suppressed / not tested / not available
Heath Hagley England Ravenhill Rawnsley The Heath Brereton and Staffordshire Hawks Green Norton Canes Cannock East Cannock West Cannock North Cannock Cannock South Cannock Etching Hill and Hill Etching Cannock Chase and Wimblebury Western Springs Heath Hayes East HayesHeath Hednesford North Hednesford Green Hednesford South
Living rent free households, 2011 (%) 1 1 2 2 1 1 1 0 1 1 2 1 1 1 1 1 1 1 Households with no central heating, 2011 (%) 1 1 1 2 1 1 1 3 1 1 2 3 2 2 2 2 2 3 Overcrowded households, 2011 (%) 2 5 5 5 2 2 3 1 3 3 4 2 3 3 2 3 2 5 Estimated private sector households failing to meet decent 32 32 33 37 31 27 30 13 25 26 33 26 36 32 31 30 34 36 homes standard, 2009 (%) Households with no cars or vans, 2011 (%) 23 30 32 31 17 15 22 5 17 12 24 11 16 12 24 20 18 26 Total recorded crime (rate per 1,000), 2013/14 25 57 39 110 48 26 42 19 37 23 57 35 44 34 69 49 45 61 Violent crime (rate per 1,000), 2013/14 7 17 13 32 15 8 13 5 8 7 15 8 13 8 21 13 11 11 Violent crime with injury (rate per 1,000), 2013/14 3 7 6 15 8 3 5 2 2 3 7 4 6 5 11 6 5 6 Antisocial behaviour (rate per 1,000), 2013/14 19 32 32 58 31 21 28 12 19 10 49 16 23 16 42 28 23 37 Domestic abuse (rate per 1,000), 2013/14 (compared to 2 6 5 8 3 4 4 2 3 1 5 2 3 4 5 4 4 n/a Staffordshire) Limiting long-term illness, 2011 (%) 23 24 25 24 21 19 20 10 19 19 24 19 21 19 22 21 19 18 Age well Older people aged 60 and over living in income-deprived 19 25 30 28 12 16 17 17 26 21 27 16 21 20 18 21 15 18 households, 2013 (%) Fuel poverty, 2012 (%) 12 13 16 14 11 11 12 4 10 9 12 9 11 10 12 11 12 10 Lone pensioner households, 2011 (%) 13 13 14 14 14 9 10 3 10 9 12 10 11 9 15 11 13 12 Limiting long-term illness in people aged 65 and over, 2011 (%) 62 64 71 67 53 50 67 50 63 60 69 59 60 52 60 61 53 52 Limiting long-term illness in people aged 75 and over, 2011 (%) 78 80 79 84 73 71 78 73 78 77 79 77 78 73 75 77 69 67 Unpaid care, 2011 (%) 12 12 12 12 13 13 12 9 11 14 14 13 13 13 11 12 12 10 Unpaid care by people aged 65 and over, 2011 (%) 16 17 14 16 17 17 14 13 15 20 15 19 17 15 14 16 15 14 Excess winter mortality, Aug 2008-July 2013 (%) 2 2 14 18 4 1 20 10 16 4 18 -9 -2 28 19 10 19 19
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Compared to England: Better Similar Worse Lower Similar Higher Suppressed / not tested / not available
Heath Hagley England Ravenhill Rawnsley The Heath Brereton and Staffordshire Hawks Green Norton Canes Cannock East Cannock West Cannock North Cannock Cannock South Cannock Etching Hill and Hill Etching Cannock Chase and Wimblebury Western Springs Western Heath HayesEastHeath Hednesford North Hednesford Green Hednesford South
Die well Life expectancy at birth - males (years), 2009-2013 79 79 78 76 81 81 79 77 77 82 77 83 79 79 81 79 79 79 Life expectancy at birth - females (years), 2009-2013 84 83 83 83 86 84 84 79 80 90 83 85 84 82 82 83 83 83 All-age, all-cause mortality (ASR per 100,000), 2009-2013 916 965 1,006 1,063 763 874 948 1,850 1,332 699 1,034 842 912 1,242 1,067 1,006 988 980 Under 75 mortality rate from all causes (ASR per 100,000), 410 422 464 430 286 325 425 363 483 286 408 283 370 314 316 368 330 351 2009-2013 Mortality from causes considered preventable (various ages) 216 206 270 229 148 209 250 156 272 138 209 184 200 194 179 202 179 184 (ASR per 100,000), 2009-2013 Under 75 mortality rate from cancer (ASR per 100,000), 2009- 146 190 172 175 124 138 212 120 186 108 172 127 163 121 147 154 140 146 2013 Under 75 mortality rate from all cardiovascular diseases (ASR 94 99 126 105 59 73 84 78 119 68 107 58 112 84 73 89 76 83 per 100,000), 2009-2013 Under 75 mortality rate from respiratory disease (ASR per 50 16 45 32 18 23 40 52 34 19 31 9 15 28 40 28 28 33 100,000), 2009-2013 Under 75 mortality rate from liver disease (ASR per 100,000), 31 17 34 25 18 6 18 7 28 15 24 8 15 12 17 18 16 18 2009-2013 Mortality from communicable diseases (ASR per 100,000), 40 29 53 50 35 53 44 128 74 97 56 41 50 69 41 51 58 62 2009-2013
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9 Indicator matrix by district The information in the following matrix is mainly benchmarked against England and colour coded using a similar approach to that used in the Public Health Outcomes Framework tool (http://www.phoutcomes.info/).
It is important to remember that a green box may still indicate an important health and wellbeing problem, for example rates of teenage conceptions are already high across England so even if an area does not have a significantly high rate this does not mean that it is not a public health issue.
Compared to England: Better Similar Worse Lower Similar Higher Suppressed / not tested / not available
Newcastle- Cannock East South Staffordshire West Time period Lichfield under- Stafford Tamworth Staffordshire England Chase Staffordshire Staffordshire Moorlands Midlands Lyme Demographics Mid-year population estimate 2013 98,119 114,922 101,768 125,239 110,295 132,092 97,415 77,157 857,007 5,674,712 53,865,817 Percentage under five 2013 5.9% 6.4% 5.1% 5.1% 4.5% 5.1% 4.8% 6.5% 5.4% 6.4% 6.3% Percentage under 16 2013 18.4% 19.2% 17.3% 16.7% 15.8% 16.8% 16.3% 19.8% 17.4% 19.5% 19.0% Percentage aged 16-64 2013 64.3% 62.8% 60.6% 63.9% 62.0% 62.5% 60.9% 64.1% 62.6% 62.7% 63.8% Percentage aged 65 and over 2013 17.3% 18.0% 22.1% 19.3% 22.1% 20.7% 22.8% 16.2% 19.9% 17.7% 17.3% Percentage aged 85 and over 2013 2.1% 2.3% 2.6% 2.5% 2.7% 2.7% 2.8% 1.7% 2.4% 2.3% 2.3% Dependency ratio per 100 working age 2013 55.6 59.1 64.9 56.4 61.2 60.0 64.3 56.1 59.7 59.4 56.8 population Dependency ratio of children per 100 2013 28.6 30.5 28.5 26.2 25.5 26.9 26.8 30.8 27.8 31.1 29.7 working age population Dependency ratio of older people per 2013 27.0 28.6 36.5 30.3 35.7 33.1 37.5 25.3 31.8 28.3 27.1 100 working age population Population change between 2013 and 2013-2023 3.5% 6.7% 5.2% 2.4% 2.1% 3.9% 1.7% 4.2% 3.7% 5.6% 7.2% 2023 Population change between 2013 and 2013-2023 -4.8% -0.7% -2.2% -1.7% 0.6% -3.4% -6.0% -5.1% -2.8% 1.6% 2.0% 2023 - under five Population change between 2013 and 2013-2023 -0.4% 6.4% 1.4% 2.5% 0.7% 0.2% 0.6% 1.7% 1.8% 6.9% 9.1% 2023 - under 16s Population change between 2013 and 2013-2023 -1.4% 1.3% -0.7% -2.7% -5.3% -1.7% -5.7% -2.6% -2.3% 1.2% 2.7% 2023 - ages 16-64 Population change between 2013 and 2013-2023 26.0% 25.6% 24.4% 18.9% 23.5% 23.6% 22.0% 34.0% 24.0% 19.5% 21.7% 2023 - 65 and over
Insight and Intelligence, Staffordshire County Council Page 45
Compared to England: Better Similar Worse Lower Similar Higher Suppressed / not tested / not available
Newcastle- Cannock East South Staffordshire West Time period Lichfield under- Stafford Tamworth Staffordshire England Chase Staffordshire Staffordshire Moorlands Midlands Lyme Population change between 2013 and 2013-2023 57.9% 55.9% 69.2% 38.3% 67.4% 52.2% 55.2% 63.2% 56.5% 43.2% 41.0% 2023 - 85 and over Proportion of population living in rural 2013 9.3% 21.9% 29.5% 20.4% 39.9% 31.9% 30.3% 0.0% 24.0% 14.8% 17.1% areas Population density (people per square 2013 1,244 297 307 594 271 221 169 2,501 327 437 413 km) Proportion of population from minority 2011 3.5% 13.8% 5.4% 6.7% 5.4% 7.4% 2.5% 5.0% 6.4% 20.8% 20.2% ethnic groups National insurance number 2013/14 0.8 8.3 3.4 2.6 0.6 6.8 0.7 2.6 3.4 7.0 10.1 registrations (rate per 1,000) Flag 4 GP patient registrations (rate 2012/13 1.1 8.2 2.1 5.6 1.0 3.5 1.1 2.0 3.3 8.4 10.9 per 1,000) Index of multiple deprivation (IMD) 2010 20.6 19.1 12.7 18.9 11.9 13.1 16.0 19.7 16.4 25.0 21.5 2010 weighted score Percentage in most deprived IMD 2013 11.7% 20.4% 3.7% 15.0% 0.0% 6.0% 4.5% 13.7% 9.4% 28.9% 20.4% 2010 quintile Percentage in second most deprived 2013 30.5% 18.7% 7.9% 23.7% 13.1% 10.5% 16.6% 19.1% 17.3% 18.8% 20.2% IMD 2010 quintile Child Wellbeing Index (CWI) 2009 2009 143 133 92 114 81 111 88 150 114 180 159 weighted score Percentage in most deprived CWI 2013 5.2% 19.4% 0.0% 7.8% 2.1% 7.7% 0.0% 18.4% 7.8% 33.6% 24.4% 2009 national quintile Percentage in second most deprived 2013 30.5% 23.3% 9.1% 18.1% 5.2% 11.5% 13.2% 16.6% 16.1% 19.3% 20.4% CWI 2009 national quintile Mosaic profile - most common 2014 H L B F B A A H H M H geodemographic group Mosaic profile - percentage of 2013 20.5% 12.6% 17.5% 13.0% 15.6% 15.1% 16.5% 23.4% 12.8% 11.6% 10.0% population in the most common group Start well Child poverty: children under 16 in 2012 18.1% 15.1% 12.3% 16.6% 11.8% 11.5% 11.1% 18.6% 14.4% 21.9% 19.2% low-income families Households with children where there 2011 4.1% 3.4% 2.6% 3.2% 2.3% 2.4% 2.3% 4.7% 3.1% 4.8% 4.2% are no adults in employment Lone parent households 2011 10.1% 9.7% 8.2% 9.6% 8.3% 8.4% 8.4% 11.6% 9.2% 11.3% 10.6% General fertility rates per 1,000 2013 62.2 65.8 55.3 49.3 53.1 54.7 51.4 61.2 56.5 64.9 62.4 women aged 15-44 Access to maternity services 2012/13 Q1-Q2 90% 90% 95% 91% 90% 92% 94% 95% 91% 90% 87% Stillbirth rate per 1,000 total births 2011-2013 5.4 4.1 4.1 3.0 5.3 4.7 3.8 5.8 4.5 4.8 4.9
Insight and Intelligence, Staffordshire County Council Page 46
Compared to England: Better Similar Worse Lower Similar Higher Suppressed / not tested / not available
Newcastle- Cannock East South Staffordshire West Time period Lichfield under- Stafford Tamworth Staffordshire England Chase Staffordshire Staffordshire Moorlands Midlands Lyme Perinatal mortality rate per 1,000 total 2011-2013 8.3 7.7 6.5 7.0 6.7 7.8 6.5 7.5 7.3 8.0 7.1 births Early neonatal mortality rate per 1,000 2011-2013 2.9 3.7 2.4 4.0 1.4 3.1 2.7 1.7 2.9 3.3 2.2 live births Neonatal mortality rate per 1,000 live 2011-2013 3.5 4.6 2.7 4.8 2.9 3.7 2.7 2.4 3.5 4.1 2.9 births Infant mortality rate per 1,000 live 2011-2013 4.9 5.2 3.8 6.2 3.2 6.0 3.9 5.8 5.0 5.6 4.1 births Smoking in pregnancy 2012/13 15.1% 15.1% 15.1% 15.3% 15.1% 15.1% 15.6% 15.1% 15.2% 14.2% 12.7% Low birthweight babies (under 2,500 2011-2013 7.2% 8.3% 8.2% 7.7% 5.8% 6.3% 6.7% 8.0% 7.3% 8.3% 7.4% grams) Low birthweight babies - full term 2012 2.7% 3.1% 2.3% 3.7% 2.2% 2.6% 2.0% 3.3% 2.8% 3.2% 2.8% babies (under 2,500 grams) Breastfeeding initiation rates 2013/14 67.7% 72.1% 76.5% 44.0% 69.0% 52.5% 50.1% 65.6% 62.5% 66.6% 73.9% Breastfeeding prevalence rates at six 2013/14 26.3% 31.6% 38.3% 30.4% 32.0% 38.6% 31.6% 25.3% 31.5% 39.4% 45.8% to eight weeks Diphtheria, tetanus, polio, pertussis, haemophilus influenza type b (Hib) at 2013/14 96.8% 96.8% 98.1% 99.4% 97.1% 97.5% 99.6% 97.1% 97.7% 95.2% 94.3% 12 months Measles, mumps and rubella at 24 2013/14 98.2% 96.6% 98.1% 99.1% 96.8% 97.2% 99.3% 97.5% 97.8% 93.6% 92.7% months Measles, mumps and rubella (first and 2013/14 88.5% 90.2% 91.5% 96.9% 88.5% 88.0% 96.0% 91.6% 91.3% 90.1% 88.3% second doses) at five years Children aged three with tooth decay 2012/13 S 11.4% 0.0% 2.2% 2.3% 9.0% 4.8% 0.0% 4.0% 10.1% 11.7% Children aged five with tooth decay 2011/12 26.2% 21.8% 18.0% 29.0% 13.7% 25.5% 17.1% 19.7% 21.6% 26.0% 27.9% School readiness (Early Years 2014 64.2% 58.7% 64.5% 60.8% 70.8% 70.3% 61.0% 65.1% 64.2% 58.4% 60.4% Foundation Stage) Grow well Pupil absence 2014 4.8% 4.5% 4.2% 4.7% 4.7% 4.5% 4.5% 4.4% 4.5% 4.5% 4.5% Children with special educational 2014 18.8% 16.6% 15.2% 16.1% 16.0% 16.0% 12.7% 19.2% 16.3% 18.6% 17.9% needs Children who claim free school meals 2014 14.5% 12.1% 9.2% 15.1% 8.9% 9.8% 9.5% 15.5% 11.8% 19.0% 16.3% KS2 results - Level 4 or above in 2014 76.5% 71.9% 82.2% 79.7% 76.0% 76.5% 76.9% 73.7% 76.7% 76.9% 78.8% reading, writing and mathematics GCSE attainment (five or more A*-C 2014 GCSEs including English and 46.5% 58.9% 62.8% 50.8% 58.2% 58.8% 57.8% 43.0% 54.9% 54.9% 53.4% provisional mathematics)
Insight and Intelligence, Staffordshire County Council Page 47
Compared to England: Better Similar Worse Lower Similar Higher Suppressed / not tested / not available
Newcastle- Cannock East South Staffordshire West Time period Lichfield under- Stafford Tamworth Staffordshire England Chase Staffordshire Staffordshire Moorlands Midlands Lyme Young people not in education, employment or training (NEET) 2014 5.5% 3.8% 3.3% 5.3% 3.5% 3.5% 2.5% 4.5% 4.0% n/a n/a (compared to Staffordshire) Unplanned hospital admissions due to 2010/11- alcohol-specific conditions (under 18) 100.8 38.9 48.1 32.0 37.5 73.9 50.8 57.6 54.7 45.4 44.9 2012/13 (rate per 100,000) Children in need (rate per 1,000 2013/14 77.8 80.7 53.0 62.5 45.3 65.7 39.2 85.9 66.8 71.1 67.9 children aged under 18) Looked after children (rate per 1,000 2013/14 6.2 3.8 4.1 6.9 2.0 5.7 4.4 3.9 5.6 7.3 6.0 children aged under 18) Child protection plans (rate per 1,000 2013/14 8.0 3.2 2.3 4.7 1.2 2.9 2.5 7.1 4.7 5.5 5.2 children aged under 18) Excess weight (children aged four to 2013/14 24.5% 25.0% 22.3% 22.6% 24.4% 21.4% 25.2% 24.5% 23.6% 23.5% 22.5% five) Excess weight (children aged 10-11) 2013/14 34.6% 33.0% 30.0% 34.8% 32.6% 29.5% 32.9% 36.1% 32.8% 35.8% 33.5% Obesity (children aged four to five) 2013/14 10.2% 9.5% 9.7% 9.5% 10.0% 7.2% 10.4% 11.1% 9.6% 10.5% 9.5% Obesity (children aged 10-11) 2013/14 20.2% 19.1% 15.1% 18.7% 19.1% 15.2% 18.7% 18.5% 18.0% 21.0% 19.1% Physical activity in children (participation in at least three hours 2009/10 53.1% 63.1% 54.2% 44.7% 57.4% 50.5% 63.9% 61.2% 55.9% 53.0% 55.1% sport / PE) Modelled prevalence of children aged 2009-2012 74.5% 76.8% 76.4% 75.3% 76.6% 76.0% 76.9% 74.2% 75.9% n/a 76.6% 15 who have never smoked Modelled prevalence of children aged 2009-2012 10.1% 8.5% 9.0% 9.5% 8.7% 9.1% 8.7% 10.3% 9.2% n/a 8.7% 15 who are regular smokers Modelled prevalence of children aged 2009-2012 4.4% 4.1% 4.6% 4.3% 4.6% 4.6% 4.2% 4.5% 4.4% n/a 4.0% 15 who are occasional smokers Under-18 conception rates per 1,000 2013 37.4 28.8 31.5 29.5 17.6 26.6 21.1 44.0 29.1 28.9 24.3 girls aged 15-17 Under-16 conception rates per 1,000 2011-2013 6.1 6.9 6.4 6.4 4.0 3.5 5.6 9.5 5.9 6.3 5.5 girls aged 13-15 Chlamydia screening rates (15-24 2013 30.2% 25.1% 31.6% 28.9% 19.7% 25.4% 27.8% 29.9% 27.2% 22.0% 24.9% years) Chlamydia diagnosis (15-24 years) 2013 2,139 1,718 1,945 1,502 1,613 1,438 1,303 2,207 1,699 1,921 2,030 (rate per 100,000) Hospital admissions caused by unintentional and deliberate injuries in 2012/13 248 170 131 132 135 259 106 110 166 144 135 children under five (rate per 10,000)
Insight and Intelligence, Staffordshire County Council Page 48
Compared to England: Better Similar Worse Lower Similar Higher Suppressed / not tested / not available
Newcastle- Cannock East South Staffordshire West Time period Lichfield under- Stafford Tamworth Staffordshire England Chase Staffordshire Staffordshire Moorlands Midlands Lyme Hospital admissions caused by unintentional and deliberate injuries in 2012/13 158 109 103 106 91 162 89 84 115 106 104 children under 15 (rate per 10,000) Hospital admissions caused by unintentional and deliberate injuries in 2012/13 123 162 134 110 107 143 156 106 130 124 131 young people aged 15-24 (rate per 10,000) Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s 2013/14 417 573 247 492 448 372 397 245 408 394 313 (ASR per 100,000) Hospital admissions - lower respiratory 2013/14 342 348 338 653 387 452 374 308 405 411 356 tract in under 19s (ASR per 100,000) Children with a limiting long-term 2011 4.5% 3.4% 3.6% 3.6% 3.5% 3.8% 3.5% 4.4% 3.8% 4.0% 3.7% illness (under 16) Young people with a limiting long-term 2011 5.4% 5.2% 5.0% 5.1% 4.6% 5.5% 4.8% 6.0% 5.2% 5.4% 5.2% illness (16-24) Under 15 childhood mortality rates 2011-2013 34.6 38.7 40.7 50.6 26.3 46.8 32.5 43.2 39.9 45.8 35.9 (ASR per 100,000) Live well Adults with NVQ level 1 or above (16- 2013 84.4% 81.0% 83.8% 82.7% 90.1% 85.7% 82.0% 76.8% 83.6% 79.2% 84.5% 64) Adults with no qualifications (16-64) 2013 10.9% 9.5% 10.6% 9.9% 4.9% 9.1% 11.1% 17.7% 10.1% 13.6% 9.2% People in employment (aged 16-64) 2013/14 69.3% 82.6% 73.5% 71.8% 73.9% 76.5% 70.5% 71.8% 74.0% 69.2% 71.7% Unemployment (16-64 year olds Feb-15 1.4% 1.3% 0.8% 1.4% 1.2% 0.8% 0.9% 0.7% 1.1% 2.5% 2.0% claiming jobseekers allowance) Youth unemployment (16-24 year olds Feb-15 3.2% 2.6% 1.7% 1.8% 2.6% 1.5% 1.9% 1.8% 2.1% 4.0% 3.1% claiming jobseekers allowance) Gap in the employment rate between those with a long-term health condition 2013/14 13.2% 8.2% 3.7% 8.1% -0.5% 7.4% 13.7% 43.5% 11.7% 9.6% 8.7% and the overall employment rate Proportion of adults with learning 2013/14 4.3% 2.2% 5.7% 4.6% 4.6% 8.0% 4.5% 4.2% 5.2% 4.9% 6.7% disabilities in paid employment People with a learning disability who live in stable and appropriate 2013/14 46.5% 54.6% 88.0% 34.0% 90.7% 65.8% 75.7% 54.0% 72.7% 68.9% 74.9% accommodation Sickness absence - employees who had at least one day off in the previous 2010-2012 1.0% 1.6% 0.7% 2.1% 3.6% 1.4% 3.4% 0.5% 1.9% 2.3% 2.5% week
Insight and Intelligence, Staffordshire County Council Page 49
Compared to England: Better Similar Worse Lower Similar Higher Suppressed / not tested / not available
Newcastle- Cannock East South Staffordshire West Time period Lichfield under- Stafford Tamworth Staffordshire England Chase Staffordshire Staffordshire Moorlands Midlands Lyme Sickness absence - working days lost 2010-2012 1.0% 1.4% 0.7% 1.8% 2.6% 0.8% 2.8% 0.5% 1.5% 1.5% 1.6% due to sickness absence Average household income 2012 £35,200 £37,800 £45,900 £34,600 £43,300 £41,700 £36,200 £36,800 £39,000 £35,600 £40,000 Households with an income under 2012 35.4% 35.7% 26.7% 39.3% 28.4% 30.9% 35.8% 32.7% 33.2% 38.6% 34.6% £20K (compared to Great Britain) Owner occupied households 2011 69.7% 70.1% 76.2% 69.5% 76.3% 72.1% 80.0% 68.7% 72.8% 65.6% 64.1% Privately rented households 2011 12.1% 15.1% 9.5% 10.5% 8.5% 12.9% 9.8% 11.0% 11.3% 14.0% 16.8% Socially rented households 2011 16.9% 13.5% 13.2% 18.7% 13.9% 13.7% 8.9% 19.3% 14.7% 19.0% 17.7% Living rent free households 2011 1.2% 1.3% 1.1% 1.3% 1.3% 1.3% 1.3% 0.9% 1.2% 1.5% 1.3% Households with no central heating 2011 1.6% 3.9% 1.6% 1.8% 1.9% 1.9% 2.4% 1.9% 2.1% 2.9% 2.7% Overcrowded households 2011 3.0% 3.1% 2.4% 2.7% 2.2% 1.9% 1.9% 2.7% 2.5% 4.5% 4.6% Estimated private sector households 2009 29.6% 38.7% 31.6% 35.9% 32.2% 33.0% 41.5% 25.9% 34.1% 36.7% 36.0% failing to meet decent homes standard Fuel poverty 2012 11.1% 14.6% 10.9% 13.4% 10.5% 12.4% 13.5% 10.1% 12.2% 15.1% 10.4% Statutory homelessness - homelessness acceptances per 1,000 2013/14 1.0 1.6 1.5 0.3 0.6 0.9 1.6 2.1 1.1 3.4 2.3 households Statutory homelessness - households in temporary accommodation per 2013/14 0.1 0.2 0.5 0.1 0.1 0.1 0.4 0.2 0.2 0.7 2.6 1,000 households Access to private transport - 2011 20.2% 21.4% 13.6% 22.1% 13.2% 17.5% 14.8% 20.6% 18.0% 24.7% 25.8% households with no cars or vans Satisfied with area as a place to live October 2013- 93.1% 93.6% 85.8% 93.8% 94.6% 92.9% 96.4% 94.4% 93.1% n/a n/a (compared to Staffordshire) October 2014 Residents who felt fearful of being a October 2013- victim of crime (compared to 9.6% 12.4% 25.4% 10.8% 9.2% 10.6% 5.5% 18.7% 12.8% n/a n/a October 2014 Staffordshire) People who have experienced crime October 2013- 7.3% 7.3% 13.9% 11.1% 9.2% 11.3% 9.9% 10.2% 10.0% n/a n/a (compared to Staffordshire) October 2014 Total recorded crime (rate per 1,000) 2013/14 49 48 35 52 36 42 38 57 45 56 61 Violent crime (rate per 1,000) 2013/14 12.5 12.4 7.4 13.5 7.1 9.8 10.8 13.6 10.8 11.1 11.0 Violent crime with injury (rate per 2013/14 6.2 6.4 3.6 6.8 3.5 4.7 5.8 7.0 5.5 6.2 5.6 1,000) Antisocial behaviour (rate per 1,000) 2013/14 28 25 19 30 17 23 20 25 23 30 37
Insight and Intelligence, Staffordshire County Council Page 50
Compared to England: Better Similar Worse Lower Similar Higher Suppressed / not tested / not available
Newcastle- Cannock East South Staffordshire West Time period Lichfield under- Stafford Tamworth Staffordshire England Chase Staffordshire Staffordshire Moorlands Midlands Lyme Alcohol-related crime (rate per 1,000) 2012/13 5.3 5.3 3.3 5.1 3.4 4.0 3.7 5.9 4.5 5.6 5.7 Domestic abuse (rate per 1,000) 2013/14 4.2 3.8 2.3 4.6 2.3 3.2 3.3 4.5 3.5 n/a n/a (compared to Staffordshire) Re-offending levels (adults) 2012/13 21.3% 23.2% 18.0% 23.5% 20.4% 22.8% 19.1% 21.7% 21.7% 23.6% 24.8% Re-offending levels (juveniles) 2012/13 44.8% 38.2% 29.5% 31.8% 42.2% 40.8% 38.7% 50.0% 39.6% 31.8% 36.0% Breast cancer screening 2014 78.3% 78.2% 79.1% 80.6% 79.7% 80.3% 81.8% 75.3% 79.4% 76.5% 75.9% Cervical screening 2014 74.4% 74.1% 77.3% 75.7% 77.8% 75.3% 77.2% 76.9% 76.0% 73.0% 74.2% Bowel cancer screening 2013 58.5% 59.6% 63.7% 60.5% 64.3% 62.2% 65.5% 60.6% 61.9% 58.5% 58.8% NHS health checks offered (as a 2013/14 19.8% 17.6% 22.4% 19.8% 12.1% 14.6% 25.0% 38.0% 21.1% 22.1% 18.5% proportion of those eligible) NHS health checks received (as a 2013/14 54.5% 51.1% 44.4% 46.2% 52.5% 32.6% 41.3% 18.8% 41.3% 44.7% 49.0% proportion of those offered) NHS health checks received (as a 2013/14 10.8% 9.0% 9.9% 9.1% 6.3% 4.8% 10.3% 7.1% 8.7% 9.9% 9.0% proportion of those eligible) Depression prevalence (ages 18+) 2013/14 7.0% 6.0% 5.8% 7.6% 5.0% 6.3% 6.8% 8.4% 6.6% 6.7% 6.5% Mental health prevalence 2013/14 0.6% 0.6% 0.7% 0.7% 0.5% 0.7% 0.8% 0.7% 0.6% 0.8% 0.9% Suicides and injuries undetermined 2011-2013 11.7 9.6 10.7 12.6 9.6 13.3 9.9 8.2 10.8 9.9 10.4 (ages 15+) (ASR per 100,000) Self-harm admissions (ASR per 2012/13 166.4 211.0 147.6 262.6 110.5 215.9 200.2 169.9 187.4 199.8 188.0 100,000) Learning disabilities prevalence (ages 2013/14 0.5% 0.5% 0.4% 0.4% 0.3% 0.3% 0.5% 0.5% 0.4% 0.5% 0.5% 18+) Proportion of disability living allowance Aug-14 6.6% 4.3% 4.5% 5.7% 4.4% 4.3% 5.1% 6.1% 5.0% 5.5% 4.9% claimants Limiting long-term illness 2011 20.7% 17.7% 18.1% 20.8% 18.7% 18.2% 21.1% 17.9% 19.2% 19.0% 17.6% Smoking prevalence (18+) 2013 20.0% 16.9% 15.7% 21.1% 17.3% 13.3% 9.5% 10.0% 15.8% 17.8% 18.4% Smoking prevalence in manual 2013 22.2% 20.3% 28.3% 31.4% 21.9% 26.5% 6.6% 15.1% 22.1% 26.4% 28.6% workers (18+) Smoking prevalence (15+) (QOF 2013/14 23.7% 23.1% 19.9% 22.9% 17.5% 19.5% 19.9% 25.1% 21.4% 22.7% 22.3% registers) Smoking attributable mortality (ASR 2011-2013 346 277 229 324 251 242 253 273 272 283 289 per 100,000) Smoking-attributable admissions (ASR 2012/13 2,331 1,818 1,654 2,073 1,437 1,665 1,442 1,826 1,762 1,725 1,688 per 100,000)
Insight and Intelligence, Staffordshire County Council Page 51
Compared to England: Better Similar Worse Lower Similar Higher Suppressed / not tested / not available
Newcastle- Cannock East South Staffordshire West Time period Lichfield under- Stafford Tamworth Staffordshire England Chase Staffordshire Staffordshire Moorlands Midlands Lyme Access to stop smoking services (rate 2013/14 82.2 101.5 68.3 47.6 70.6 110.5 86.9 172.2 87.3 86.5 75.0 per 1,000 smokers) Smoking quit rates at four weeks 2013/14 56.1% 56.2% 60.0% 61.7% 46.6% 52.1% 56.7% 54.7% 55.4% 52.6% 51.3% Binge drinking (synthetic estimates) 2007-2008 20.4% 18.9% 19.1% 21.8% 20.0% 21.4% 20.5% 22.3% 20.5% 18.8% 20.1% Alcohol-related admissions (narrow 2013/14 704 716 602 901 650 699 657 590 697 669 634 definition) (ASR per 100,000) provisional Alcohol-related admissions (broad 2013/14 2,125 1,974 1,773 2,254 1,888 1,851 1,755 1,928 1,943 2,108 2,073 definition) (ASR per 100,000) provisional Alcohol-specific mortality - men (ASR 2010-2012 17.8 16.6 10.2 17.4 16.1 11.3 9.7 17.9 n/a 17.7 14.6 per 100,000) Alcohol-specific mortality - women 2010-2012 8.6 7.2 6.5 16.8 7.3 7.6 10.0 5.1 n/a 8.7 6.8 (ASR per 100,000) Estimated problem drug users (PDUs) using crack and/or opiates (rate per 2010/11 8.7 7.8 3.1 6.6 2.6 3.9 5.4 5.9 5.5 9.6 8.6 1,000) Number of PDUs in effective treatment 2013/14 53.9% 62.3% 77.3% 72.0% 58.4% 71.7% 63.6% 60.4% 64.3% 61.1% 60.9% Adults who are overweight or obese 2012 62.5% 71.6% 66.7% 63.4% 69.5% 69.6% 70.0% 70.7% 67.9% 65.7% 63.8% (excess weight) Adults who are obese 2012 30.3% 31.0% 23.5% 18.0% 23.2% 21.4% 24.1% 27.4% 24.4% 24.5% 23.0% Healthy eating - 5-a-Day (synthetic 2006-2008 22.5% 27.1% 28.4% 25.5% 26.7% 29.1% 25.5% 21.9% 26.1% 25.7% 28.7% estimates) Physical activity in adults 2013 49.2% 55.7% 58.7% 58.4% 61.6% 56.2% 52.7% 52.3% 55.9% 53.9% 56.0% Physical inactivity in adults 2013 29.9% 29.1% 24.1% 28.1% 26.1% 26.2% 25.1% 33.7% 27.6% 30.5% 28.3% All acute sexually transmitted 2013 687 707 546 473 486 544 328 675 552 724 805 infections (rate per 100,000) Pelvic inflammatory disease (PID) admissions rate (rate per 100,000 2012/13 417 208 146 220 270 321 274 162 255 239 228 women aged 15-44) Offered HIV test - GUM attendees 2013 85.2% 86.4% 76.3% 92.9% 70.3% 84.9% 92.0% 76.2% 82.4% 87.6% 86.1% Received HIV test - GUM attendees 2013 77.5% 77.6% 68.8% 81.1% 56.4% 79.0% 79.8% 65.9% 72.9% 73.9% 71.0% HIV prevalence in people aged 15-59 2013 0.55 0.94 0.64 0.73 0.64 0.62 0.56 0.55 0.66 1.54 2.14 (rate per 1,000) Late HIV diagnosis 2011-2013 S 33% 50% 75% 83% 64% S 67% 60% 54% 45% Sexual violence (rate per 1,000) 2013/14 1.0 1.3 0.7 1.3 0.7 1.1 0.9 1.3 1.0 1.0 1.0
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Compared to England: Better Similar Worse Lower Similar Higher Suppressed / not tested / not available
Newcastle- Cannock East South Staffordshire West Time period Lichfield under- Stafford Tamworth Staffordshire England Chase Staffordshire Staffordshire Moorlands Midlands Lyme Age well Disability free life expectancy - males 2007-2009 46.1 46.4 52.2 45.8 52.2 50.5 47.8 46.7 n/a 48.4 49.1 at 16 (years) Disability free life expectancy - 2007-2009 47.0 50.7 51.5 46.3 51.1 53.2 50.1 45.3 n/a 49.6 50.1 females at 16 (years) Disability free life expectancy - males 2007-2009 9.0 8.1 12.1 8.7 10.9 11.3 10.8 6.6 n/a 9.9 10.2 at 65 (years) Disability free life expectancy - 2007-2009 10.2 11.4 11.1 7.7 11.1 13.4 11.9 7.7 n/a 10.7 10.9 females at 65 (years) Older people aged 60 and over living 2013 20.8% 14.7% 12.8% 15.7% 14.7% 11.4% 13.8% 20.8% 15.0% 20.6% 18.0% in income-deprived households People aged 65 and over in 2013/14 S 6.7% 14.1% 10.5% 13.1% 12.3% 9.0% 11.1% 9.9% 9.6% 9.9% employment Lone pensioner households 2011 11.4% 12.4% 12.2% 13.5% 13.3% 12.8% 13.5% 10.9% 12.6% 12.6% 12.4% Older people feeling safe at night October 2013- (people aged 65 and over) (compared 92.5% 77.1% 66.7% 81.8% 79.5% 84.1% 81.5% 77.1% 79.4% n/a n/a October 2014 to Staffordshire) Seasonal flu - people aged 65 and 2013/14 68.1% 70.8% 69.7% 73.7% 71.3% 69.3% 70.1% 73.8% 70.8% 72.4% 73.2% over Seasonal flu - people aged under 65 2013/14 48.3% 49.9% 48.1% 55.1% 50.7% 46.7% 52.8% 50.9% 50.4% 52.8% 52.3% at risk Pneumococcal vaccine in people aged 2013/14 63.2% 67.3% 69.8% 62.6% 63.1% 64.4% 60.4% 72.1% 65.1% 68.1% 69.1% 65 and over Limiting long-term illness in people 2011 60.9% 51.4% 48.2% 57.4% 49.4% 48.5% 53.3% 55.8% 52.6% 54.1% 51.5% aged 65 and over Limiting long-term illness in people 2011 77.4% 67.8% 67.1% 72.4% 66.4% 65.9% 70.2% 71.1% 69.4% 69.5% 66.6% aged 75 and over Asthma prevalence 2013/14 5.9% 5.9% 5.9% 6.2% 5.8% 5.7% 6.5% 6.3% 6.0% 6.1% 5.9% Atrial fibrillation prevalence 2013/14 1.7% 1.6% 1.8% 1.9% 2.0% 1.9% 2.2% 1.5% 1.8% 1.6% 1.6% Cancer prevalence 2013/14 2.3% 2.4% 2.5% 2.3% 2.7% 2.7% 2.5% 2.4% 2.5% 2.1% 2.1% Chronic kidney disease prevalence 2013/14 4.1% 4.5% 3.6% 4.0% 4.6% 4.0% 4.4% 3.7% 4.1% 4.6% 4.0% (ages 18+) Chronic obstructive pulmonary 2013/14 2.2% 1.7% 1.7% 2.3% 1.5% 1.4% 1.9% 2.0% 1.8% 1.8% 1.8% disease prevalence Coronary heart disease prevalence 2013/14 4.1% 3.3% 3.8% 3.8% 3.9% 3.7% 4.3% 3.4% 3.8% 3.4% 3.3% Diabetes prevalence (ages 17+) 2013/14 6.9% 6.6% 6.5% 7.0% 6.6% 6.2% 7.2% 6.6% 6.7% 7.1% 6.2%
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Compared to England: Better Similar Worse Lower Similar Higher Suppressed / not tested / not available
Newcastle- Cannock East South Staffordshire West Time period Lichfield under- Stafford Tamworth Staffordshire England Chase Staffordshire Staffordshire Moorlands Midlands Lyme Epilepsy prevalence (ages 18+) 2013/14 1.0% 0.9% 0.8% 0.9% 0.8% 0.9% 0.9% 0.8% 0.9% 0.9% 0.8% Heart failure prevalence 2013/14 0.8% 0.8% 0.8% 0.8% 0.8% 0.7% 0.8% 0.7% 0.8% 0.8% 0.7% Hypertension prevalence 2013/14 14.9% 13.9% 15.3% 15.8% 16.7% 15.2% 18.3% 13.6% 15.4% 14.8% 13.7% Hypothyroidism prevalence 2013/14 4.1% 3.6% 3.6% 3.1% 3.9% 3.9% 3.6% 3.3% 3.6% 3.4% 3.3% Obesity prevalence (ages 16+) 2013/14 13.6% 10.5% 10.5% 10.8% 9.5% 8.6% 11.4% 12.4% 10.8% 10.3% 9.4% Osteoporosis prevalence 2013/14 0.3% 0.5% 0.3% 0.4% 0.3% 0.4% 0.4% 0.3% 0.4% 0.4% 0.4% Palliative care prevalence 2013/14 0.7% 0.6% 0.7% 0.7% 0.6% 0.7% 0.7% 0.6% 0.7% 0.7% 0.6% Peripheral arterial disease prevalence 2013/14 0.3% 0.1% 0.2% 0.3% 0.2% 0.2% 0.3% 0.2% 0.2% 0.3% 0.3% Rheumatoid arthritis prevalence (ages 2013/14 1.0% 0.8% 0.9% 0.8% 1.0% 0.9% 0.9% 0.9% 0.9% 0.8% 0.7% 16+) Stroke or transient ischaemic attacks 2013/14 1.9% 1.7% 1.9% 2.3% 2.0% 2.0% 2.5% 1.8% 2.0% 1.8% 1.7% prevalence Dementia prevalence 2013/14 0.6% 0.6% 0.5% 0.8% 0.6% 0.6% 0.6% 0.5% 0.6% 0.6% 0.6% Estimated dementia diagnosis rate 2013/14 50.2% 51.2% 40.6% 50.8% 42.9% 47.0% 38.6% 48.1% 46.4% 50.6% 51.9% (recorded / expected) Acute ambulatory care sensitive (ACS) 2013/14 1,373 1,211 1,108 1,608 1,235 1,342 1,250 1,335 1,313 1,360 1,196 conditions (ASR per 100,000) Chronic ambulatory care sensitive 2013/14 846 947 755 924 624 632 705 887 780 872 800 (ACS) conditions (ASR per 100,000) People receiving social care who 2013/14 24.7% 18.8% 24.7% 21.7% 24.1% 22.0% 26.9% 23.9% 26.2% 51.1% 61.9% receive self-directed support Proportion of people using social care 2013/14 9.3% 10.3% 8.5% 8.4% 10.5% 14.2% 12.5% 10.9% 10.6% 16.8% 19.1% who receive direct payments Permanent admissions to residential and nursing care homes for people 2013/14 734 591 440 755 536 783 630 697 655 663 651 aged 65 and over (rate per 100,000) People aged 65 and over who were still at home 91 days after discharge 2013/14 85.2% 82.5% 84.9% 92.9% 90.0% 80.0% 91.3% 92.5% 86.3% 82.4% 82.5% from hospital into reablement / rehabilitation services Provision of unpaid care 2011 12.1% 10.1% 11.5% 11.9% 12.5% 11.5% 12.9% 10.6% 11.6% 11.0% 10.2% Provision of unpaid care by people 2011 16.1% 13.3% 15.4% 15.0% 15.3% 14.7% 15.3% 14.8% 15.0% 14.5% 13.8% aged 65 and over Falls admissions in people aged 65 2012/13 1,868 2,330 2,095 2,304 1,747 2,012 1,959 2,417 2,071 1,951 2,011 and over (ASR per 100,000)
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Better Similar Worse Lower Similar Higher Suppressed / not tested / not available Compared to England:
Newcastle- Cannock East South Staffordshire West Time period Lichfield under- Stafford Tamworth Staffordshire England Chase Staffordshire Staffordshire Moorlands Midlands Lyme Hip fractures in people aged 65 and 2012/13 637 622 591 625 586 658 547 680 613 588 568 over (ASR per 100,000) Accidental mortality (ASR per 2011-2013 27.7 32.8 28.8 32.8 21.7 24.0 24.4 33.7 27.7 24.2 21.5 100,000) Accidental mortality in people aged 65 2011-2013 102.1 113.3 106.4 115.5 77.8 85.8 89.9 134.7 100.2 81.1 69.1 and over (ASR per 100,000) Mortality from accidental falls (ASR 2011-2013 14.5 17.0 15.2 19.0 10.4 13.4 14.1 22.6 15.3 10.5 7.7 per 100,000) August 2012 to Excess winter mortality 25.6% 27.9% 19.9% 34.2% 25.8% 21.3% 31.0% 14.8% 25.7% 21.6% 20.1% July 2013 Excess winter mortality in people aged August 2012 to 16.7% 63.9% 47.8% 40.5% 18.0% 5.5% 43.4% 7.0% 29.8% 27.8% 28.2% 85 and over July 2013 Die well Life expectancy at birth - males 2011-2013 79.2 79.2 80.0 78.6 80.4 80.4 79.9 79.8 79.7 78.8 79.4 (years) Life expectancy at birth - females 2011-2013 83.2 82.6 83.5 82.6 83.3 83.5 83.2 82.6 83.1 82.8 83.1 (years) Inequalities in life expectancy - males 2011-2013 6.8 6.6 5.2 8.8 5.0 6.5 4.1 7.0 6.6 9.2 9.1 (slope index of inequality) (years) Inequalities in life expectancy - females (slope index of inequality) 2011-2013 4.9 6.7 10.0 6.7 7.7 7.5 3.5 6.8 6.3 6.8 6.9 (years) All-age, all-cause mortality (ASR per 2011-2013 993 1,017 965 1,056 967 924 976 1,003 986 1,001 978 100,000) Under 75 mortality rate from all causes 2011-2013 359 342 298 347 292 293 315 330 320 359 342 (ASR per 100,000) Mortality from causes considered preventable (various ages) (ASR per 2011-2013 194 190 168 194 159 152 169 190 175 192 184 100,000) Under 75 mortality rate from cancer 2011-2013 152 149 127 130 143 127 134 140 137 148 144 (ASR per 100,000) Under 75 mortality rate from all cardiovascular diseases (ASR per 2011-2013 86 77 66 83 56 64 71 68 71 82 78 100,000) Under 75 mortality rate from 2011-2013 26.8 27.5 21.8 37.7 23.0 23.7 27.7 31.2 27.2 34.1 33.2 respiratory disease (ASR per 100,000) Under 75 mortality rate from liver 2011-2013 18.7 15.7 13.5 17.6 14.4 14.1 13.8 20.2 15.8 19.1 17.9 disease (ASR per 100,000) Mortality from communicable diseases 2011-2013 51.8 55.6 49.2 80.7 46.9 52.7 66.4 62.6 58.2 60.7 62.2 (ASR per 100,000)
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Compared to England:
Better Similar Worse Lower Similar Higher Suppressed / not tested / not available
Newcastle- Cannock East South Staffordshire West Time period Lichfield under- Stafford Tamworth Staffordshire England Chase Staffordshire Staffordshire Moorlands Midlands Lyme End of life: proportion dying at home 2013 42.6% 38.8% 45.9% 42.6% 43.8% 45.2% 44.4% 39.4% 43.1% 39.5% 41.3% or usual place of residence End of life: proportion dying at hospital 2013 50.3% 56.2% 46.9% 49.4% 48.9% 46.8% 47.4% 53.8% 49.6% 53.2% 50.9% End of life: proportion dying at hospice 2013 5.8% 3.3% 4.9% 6.2% 5.8% 7.0% 6.5% 5.5% 5.7% 5.4% 5.6% End of life: proportion dying in other 2013 1.4% 1.7% 2.3% 1.8% 1.5% 0.9% 1.7% 1.3% 1.6% 1.9% 2.1% settings
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Staffordshire Joint Strategic Needs Assessment
HEALTH AND WELLBEING PROFILE 2015 FOR STAFFORD
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Document details
Title Health and wellbeing profile for Stafford Date created April 2015 The purpose of this profile is to support commissioners and others by providing robust intelligence about health and wellbeing priorities in their area based on the analysis
of data from numerous sources. Description
It aims to support enhanced joint strategic needs assessments (EJSNAs) and complements other profiles and resources produced by Staffordshire Observatory. Staffordshire JSNA, Staffordshire Health and Wellbeing Key links Strategy, Staffordshire districts/boroughs, Locality commissioning Matthew Bentley, Public Health Analyst, Insight Team [email protected] 01785 854885 Contacts Phil Steventon, Public Health Analyst, Insight Team [email protected] 01785 276529 Divya Patel (Insight Team)
Daniel Shrimpton (Public Health Staffordshire) Contributions Martin Dudgon (Public Health Staffordshire) Rachel Caswell (Insight Team) Geographical coverage Stafford Time period covered Various (depending on indicator and availability of data) Frequency of profile update Annual Frequency of intelligence update As and when new data is published Word and pdf Formats and access Available via the Staffordshire Observatory website If you wish to reproduce this document either in whole, or Usage statement in part, please acknowledge the source and the author(s). This product includes mapping data licensed from Ordnance Survey with the permission of the Controller of Maps Her Majesty's Stationery Office. © Crown copyright and / or database right 2014. All rights reserved. Licence Number 100019422. Staffordshire County Council, while believing the information in this publication to be correct, does not
guarantee its accuracy nor does the County Council Copyright and disclaimer accept any liability for any direct or indirect loss or damage or other consequences, however arising from the use of such information supplied.
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Contents
Document details ...... 2
Glossary of terms ...... 6 1 Introduction ...... 7
1.1 Purpose of the profile ...... 7
1.2 Format of the profile ...... 7 1.3 How to use this profile ...... 8
1.4 Further information and support ...... 8
2 The population of Stafford ...... 9 2.1 Population age structure ...... 9
2.2 Population projections ...... 10
2.3 Rurality ...... 11 2.4 Ethnicity ...... 12
2.5 Deprivation ...... 12
2.6 Geodemographic profile ...... 13 3 Start well ...... 15
3.1 Child poverty ...... 15 3.2 Infant mortality...... 15
3.3 Smoking in pregnancy...... 15
3.4 Breastfeeding ...... 15 3.5 Immunisation...... 16
3.6 Dental health ...... 16
3.7 School readiness...... 16 4 Grow well ...... 17
4.1 GCSE attainment ...... 17
4.2 Young people not in education, employment or training (NEETs) ...... 17 4.3 Children with special educational needs ...... 17
4.4 Vulnerable children ...... 17
4.5 Children with a limited long-term disability ...... 18 4.6 Lifestyles ...... 18
4.7 Teenage pregnancy ...... 19
4.8 Chlamydia ...... 22 4.9 Hospital admissions ...... 22
5 Live well ...... 23
5.1 Employment and income...... 23 5.2 Education ...... 23
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5.3 The living environment ...... 24 5.4 Crime ...... 24 5.5 NHS health checks...... 25 5.6 Adult lifestyles ...... 25 5.7 Mental health...... 27 5.8 People with learning disabilities ...... 27 5.9 Sexual health ...... 28 6 Age well ...... 29 6.1 Demography and deprivation ...... 29 6.2 Disability free life expectancy ...... 29 6.3 Adult immunisation ...... 29 6.4 Long-term conditions...... 30 6.5 Dementia...... 32 6.6 Utilisation of health and social care ...... 32 6.7 Carers ...... 33 6.8 Accidents ...... 34 6.9 Excess winter deaths ...... 34
7 Die well ...... 35 7.1 Life expectancy ...... 35 7.2 Main causes of death ...... 37 7.3 Preventable mortality ...... 37 7.4 End of life ...... 39 8 Indicator matrix by ward...... 40
9 Indicator matrix by district ...... 46
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Health and wellbeing profile for Stafford
April 2015
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Glossary of terms Definitions of some terminology that is used within the profile are described below.
. Age-standardised rate (ASR) These are used in sections of the profile to allow direct and fair comparisons of disease or mortality to be made between different areas or groups which may have very different age structures. The method adjusts the crude rate by eliminating the effect of differences in age structure. Throughout the profile, age-specific rates of the local population are applied to a standard population. The overall rate provides a summary rate of what would occur in the local population if it had the standard population’s age structure.
. Confidence intervals and statistical significance The profile uses upper and lower limits to indicate the uncertainty or variability of the value and also for comparison purposes. The upper and lower limits have been calculated to a 95% confidence level. Therefore when a value has lower and upper limits, we can be 95% sure that the value will be within this range.
Throughout this profile, confidence intervals are used to compare different values so it is possible to compare a local value to a national one to see if it is statistically similar, lower or higher. These confidence intervals are displayed on some of the charts at the end of the bar to illustrate the possible variability of the value. If the confidence interval overlaps the England (or other comparator) interval, the difference is not statistically significant. If it does not overlap the difference is statistically significant.
. Emergency hospital admissions An unplanned hospital admission is known as an emergency admission of a patient to hospital.
. Incidence Incidence quantifies the number of new cases of disease that develop in a population of individuals at risk during a specified time period.
. Prevalence Prevalence is a snapshot of the proportion of individuals in a population who have a disease or condition at a particular point in time.
. Synthetic estimates Synthetic estimates give the expected prevalence of a behaviour for an area (e.g. local authority), given the demographic and social characteristics of that area based on national prevalence data from national surveys (e.g. Health Survey for England).
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1 Introduction
1.1 Purpose of the profile The purpose of the profile is to provide commissioners with an evidence base across a range of health and wellbeing issues to help formulate district enhanced JSNAs and identify areas to prioritise.
It includes a range of indicators from numerous sources of data that each gives some information about an aspect of public health or the factors that influence health, the wider determinants. Most of the indicators are included in the national outcomes frameworks for public health, National Health Service and adult social care.
The profile should be used alongside the suite of profiles and other resources produced by the Staffordshire Observatory which collectively support the joint strategic needs assessment process in Staffordshire.
1.2 Format of the profile The format is similar to last year’s health and wellbeing profile. It highlights some of the key health and wellbeing issues facing each district and contains a wider range of information in the indicator matrices towards the end of the profiles at district level and/or ward level where information is available.
It is important to remember that a green box may still indicate an important health and wellbeing problem, for example rates of teenage conceptions are already high across England so even if an area does not have a significantly high rate this does not mean that it is not a public health issue.
Information presented for smaller areas allows a greater understanding of the particular characteristics of different communities and of the variations in and between different populations. Ward level data is sometimes presented for different time periods than the district level data – often older and / or pooled over several years. This is because data at lower geographies is often published later than the higher level information but it is also to make sure that the statistics relating to the smaller areas are robust. Some indicators values may therefore be different for these reasons: a) to show the latest information available at district level and b) to show robust statistics at ward level. Most of the information presented is published data but some indicators have been derived locally.
Both the district and ward indicator matrix will be updated as and when new information is released and this will be made available as a ‘live’ resource on the Staffordshire Observatory website.
The indicators are grouped under life course stages: start well, grow well, live well, , age well and die well along with a section on demographics.
Where appropriate the information is colour coded adopting a similar approach to that used in the Public Health Outcomes Framework tool (http://www.phoutcomes.info/)
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1.3 How to use this profile Health and social needs are complex and it is unlikely that there will be a single factor which is responsible for the particular situation in each local area. Therefore, it is important that no single item of information is treated in isolation. Instead the various pieces of data and evidence should be used as pieces of a jigsaw which, when linked together, give a picture of the needs of the local community. This should also include, where possible, insight into the perceptions of the people who live in the area.
As with all data and intelligence, it is important to ‘sense check’ the findings and compare it with local knowledge. Is the picture given by the data what you would expect? If it is not then it is important to understand the reasons why it is different.
1.4 Further information and support
Further information is available on the Staffordshire Observatory website: http://www.staffordshireobservatory.org.uk/publications/healthandwellbeing/yourhealt hinstaffordshire.aspx
This profile gives a snapshot of health and wellbeing in each area. For more advice or more in-depth profiling and assessment in any particular area please contact a member of the Insight Team: [email protected] or [email protected]
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2 The population of Stafford
2.1 Population age structure
. The 2013 mid-year population estimate for Stafford was 132,100. It has a slightly different age profile compared with England – overall there are lower proportions of children and adults aged under 40 years, although there are more young men in the 20-24 age group which is likely to reflect military, prison and university populations. There are also more adults aged over 45 in Stafford compared to average.
Figure 1: Population structure of Stafford, 2013
Source: 2013-mid-year population projections, Office for National Statistics, Crown copyright
. At ward level the majority of wards (19 out of 26) have higher proportions of older people aged 65+. Barlaston and Oulton, Baswich, Eccleshall, Fulford, Milwich, Rowley, Seighford, Stonefield and Christchurch and Walton also have higher proportions of people aged 85 or over. Only four wards, Coton, Penkside, St. Michael's and Tillington have a higher proportion of children under 16.
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2.2 Population projections
. The overall population for Stafford is projected to increase by 4% between 2013 and 2023. The population is projected to see significant growth in people aged 65 and over (24%) and in particular those aged 85 and over (52%) (Figure 3). The rate of increase in the number of older people in Stafford is faster than the England average and equates to 5,900 additional residents aged 75 and over by 2023.
Figure 2: Population projections for Stafford, 2013-2033
Source: 2012-based population projections, Office for National Statistics, Crown copyright
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Figure 3: Projected population change between 2013 and 2023
Source: 2012-based population projections, Office for National Statistics, Crown copyright
2.3 Rurality Living in a rural area has a positive association with people’s satisfaction. However it can also present difficulties in accessing services. In addition the structural demographic change towards an older population is the single most significant factor in an increasing prevalence of rural isolation.
. Based on the 2011 Rural and Urban Classification most of Stafford’s population live in a rural area (32%) compared with 17% nationally (Table 1).
. More rural populations tend to have a lower population density – Stafford has 221 people per square kilometre compared with 413 for England as a whole.
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Table 1: Rural and urban populations in Staffordshire, 2013
Urban Rural Rural Rural Urban Urban city Urban 2013 town and village and Rural total conurbation and town total population fringe dispersed 62,400 26,600 89,000 7,400 1,700 9,100 98,100 Cannock Chase (64%) (27%) (91%) (8%) (2%) (9%) (100%) 0 89,800 89,800 12,200 13,000 25,200 114,900 East Staffordshire (0%) (78%) (78%) (11%) (11%) (22%) (100%) 28,900 42,900 71,800 18,500 11,500 30,000 101,800 Lichfield (28%) (42%) (71%) (18%) (11%) (29%) (100%) 0 99,700 99,700 11,500 14,100 25,600 125,200 Newcastle-under-Lyme (0%) (80%) (80%) (9%) (11%) (20%) (100%) 64,700 1,500 66,300 32,700 11,300 44,000 110,300 South Staffordshire (59%) (1%) (60%) (30%) (10%) (40%) (100%) 0 90,000 90,000 17,700 24,400 42,100 132,100 Stafford (0%) (68%) (68%) (13%) (18%) (32%) (100%) 0 67,900 67,900 6,600 22,900 29,600 97,400 Staffordshire Moorlands (0%) (70%) (70%) (7%) (24%) (30%) (100%) 0 77,200 77,200 0 0 0 77,200 Tamworth (0%) (100%) (100%) (0%) (0%) (0%) (100%) 156,000 495,500 651,500 106,700 98,700 205,500 857,000 Staffordshire (18%) (58%) (76%) (12%) (12%) (24%) (100%) 2,604,000 2,233,100 4,837,100 379,300 458,300 837,600 5,674,700 West Midlands (46%) (39%) (85%) (7%) (8%) (15%) (100%) 21,159,400 23,499,900 44,659,400 4,970,200 4,236,200 9,206,500 53,865,800 England (39%) (44%) (83%) (9%) (8%) (17%) (100%)
Note: Numbers may not add up due to rounding
Source: The Rural and Urban Classification 2011, Office for National Statistics, Crown copyright and 2013 mid- year population estimates, Office for National Statistics, Crown copyright
2.4 Ethnicity
. The proportion of people from minority ethnic groups within Stafford is lower than the national average (7.4%, or 9,709 people, compared with 20.2%).
2.5 Deprivation
. The Index of Multiple Deprivation 2010 (IMD 2010) is a way of identifying deprived areas. There are 4 lower super output areas (LSOAs) that fall within the most deprived national quintile in Stafford, making up 6% of the total population (8,000 people). These areas fall within Highfields and Western Downs, Littleworth, Manor and Penkside.
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2.6 Geodemographic profile Mosaic Public Sector 6, released in 2014, is a way of analysing people by where they live in terms of an individual’s demographics, lifestyles and behaviours. This allows interventions to be targeted more effectively in an appropriate style and language which is suited to the different lifestyle groups.
The most common groups across Stafford making up 56% of the population fall within five Mosaic groups:
. A Country Living (15.1%) . B Prestige Positions (10.7%) . F Senior Security (10.5%) . D Domestic Success (10.4%) . H Aspiring Homemakers (9.7%)
Some wards have high proportions of their populations in a single segmentation group, for example, most of the residents who live in Chartley, Church Eaton, Eccleshall, Gnosall and Woodseaves, Milwich and Seighford wards are in the “Country Living” group.
Table 2: Mosaic lifestyle groups in Stafford
Mosaic group Stafford Staffordshire West Midlands England A Country Living 15.1% 9.3% 6.8% 5.9% B Prestige Positions 10.7% 8.6% 6.9% 7.6% C City Prosperity 0.0% 0.0% 0.3% 4.5% D Domestic Success 10.4% 10.1% 6.8% 9.0% E Suburban Stability 8.6% 10.9% 7.1% 6.2% F Senior Security 10.5% 9.8% 8.7% 7.8% G Rural Reality 7.9% 5.8% 3.6% 5.3% H Aspiring Homemakers 9.7% 12.8% 11.1% 10.0% I Urban Cohesion 0.1% 0.6% 8.0% 6.7% J Rental Hubs 3.5% 2.0% 4.3% 6.9% K Modest Traditions 4.1% 7.1% 6.4% 4.3% L Transient Renters 6.6% 6.4% 7.1% 6.0% M Family Basics 5.4% 8.5% 11.6% 8.8% N Vintage Value 4.1% 4.7% 6.5% 4.7% O Municipal Challenge 1.6% 2.5% 4.2% 5.5% U Unclassified 1.8% 0.8% 0.5% 0.6% Total population 100.0% 100.0% 100.0% 100.0%
Key: Highlights top five groups
Source: Experian Public © 2014 Experian. All rights reserved
Key features for the 15 groups are shown in Table 3.
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Table 3: Key features of Mosaic groups
Mosaic group Key features Rural locations, well-off homeowners, attractive detached homes, higher self- A Country Living employment, high car ownership, high use of internet High value detached homes, married couples, managerial and senior positions, B Prestige Positions supporting students and older children, high assets and investments, online shopping and banking High value properties, central city areas, high status jobs, low car ownership, high C City Prosperity mobile phone spend, high internet use Families with children, upmarket suburban homes, owned with a mortgage, three or D Domestic Success four bedrooms, high internet use, own new technology Older families, some adult children at home, suburban mid-range homes, three E Suburban Stability bedrooms, have lived at same address some years, research on internet Elderly singles and couples, homeowners, comfortable homes, additional pensions F Senior Security above state, don't like new technology, low mileage drivers Rural locations, village and outlying houses, agricultural employment, most are G Rural Reality homeowners, affordable value homes, slow internet speeds Younger households, full-time employment, private suburbs, affordable housing H Aspiring Homemakers costs, starter salaries, buy and sell on eBay Mature age, homeowners, affordable housing, kids are grown up, suburban I Urban Cohesion locations, modest income Elderly, living alone, low income, small houses and flats, need support, low J Rental Hubs technology use Aged 18-35, private renting, singles and sharers, urban locations, young K Modest Traditions neighbourhoods, high use of smartphones Settled extended families, city suburbs, multicultural, own three bedroom homes, L Transient Renters sense of community, younger generation love technology Social renters, low cost housing, challenged neighbourhoods, few employment M Family Basics options, low income, mobile phones Families with children, aged 25 to 40, limited resources, some own low cost homes, N Vintage Value some rent from social landlords, squeezed budgets Private renters, low length of residence, low cost housing, singles and sharers, older O Municipal Challenge terraces, few landline telephones
Source: Experian Public © 2014 Experian. All rights reserved
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3 Start well
3.1 Child poverty Children living in low-income families are defined as the number of children under 16 living in families in receipt of out of work benefits or tax credits where their reported income is less than 60% median income.
. In 2012, 12% of children (2,410) in Stafford were defined as living in poverty, lower than the national average (19%).
. Data from the 2011 Census highlights that in Stafford there are around 1,300 (2%) of households with children where there are no adults in employment. This is a lower rate than the national average.
3.2 Infant mortality
. Between 1999-2001 and 2011-2013, infant mortality rates in Stafford have fluctuated due to small numbers; however rates in Stafford have remained similar to the England average throughout this period.
3.3 Smoking in pregnancy
. The rate of women who smoked during pregnancy in Stafford increased from 12.2% in 2007/08 to 15.1% in 2012/13 (around 190 women), although this has reduced from the peak in 2009/10 when 15.9% of pregnant women smoked. The prevalence in 2012/13 was higher than the national average (12.7%).
3.4 Breastfeeding
. Breastfeeding initiation rates in Stafford have fluctuated slightly over the last five years rising from 67% in 2009/10 to 69% in 2012/13 but falling to 53% in 2013/14. Rates in Stafford are now lower than the England rate (74%).
. The proportion of mothers in Stafford who continue to breastfeed at six to eight weeks in 2013/14 was 39%, below both regional (39%) and national average (46%).
Note: Data for 2013/14 suggests that the initiation and prevalence of breastfeeding fall significantly below minimum data quality standards and should therefore be used with caution.
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3.5 Immunisation
. The immunisation of children is the single most cost-effective form of prevention and protects children against serious diseases. Uptake rates for Stafford in 2013/14 show that overall levels at 12 months are higher than the England average. However, for some diseases e.g. meningitis C at 24 months and measles, mumps and rubella for children reaching their fifth birthday, coverage rates do not reach the 95% optimum protective target set by the World Health Organisation (WHO).
3.6 Dental health Tooth decay is particularly high amongst children who have poor weaning practices, poor diet (high or frequent uptake of food containing sugar) and inadequate use of fluoride toothpaste.
. The 2012/13 survey for three year olds found that tooth decay in this age group in Stafford was 9%, similar to both the regional and national averages.
. The 2011/12 survey for five year olds found that tooth decay in this age group in Stafford was 26%, similar to both the regional and national averages.
The figures from the two samples whilst not strictly comparable do indicate that tooth decay in children increases significantly between the ages of three and five.
3.7 School readiness Children are assessed through the Early Years Foundation Stage Profile (EYFSP) by a teacher in the year in which they turn five. Children are defined as having reached a good level of development if they achieve expected levels in the early learning goals in the prime areas of learning (personal, social and emotional development, physical development, and communication and language) and in the specific areas of literacy and mathematics.
Children from poorer backgrounds are more at risk of poorer development and evidence suggests that differences by social background emerge early in life.
. In 2014, the proportion of children in Stafford who had reached a good level of development was 69%, which is higher than both the England and Staffordshire averages (60% and 64% respectively).
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4 Grow well
4.1 GCSE attainment
. In 2013, 59% of Stafford pupils achieved five or more A*-C grades at GCSE level including English and Maths. This is higher than the England average.
. However there are inequalities within the district with achievement ranging from 35% in Manor ward to 88% in Milwich ward.
4.2 Young people not in education, employment or training (NEETs) Being NEET between the ages of 16-19 is seen as a major predictor of later unemployment, low income, depression, involvement in crime and poor physical and mental health.
. The proportion of young people who were NEET at the start of January 2015 for Stafford was 4% (around 140 young people). This is similar to the Staffordshire average.
. Two wards in Stafford do however have high levels of young people who are NEET: Manor and Penkside.
4.3 Children with special educational needs Some children need extra help during their time at school. In most cases, staff in mainstream schools can help children overcome difficulties quickly and easily. They do this through providing a teaching programme suitable for each child's needs and level of ability. However, a few children will have difficulties that require help in addition to this. These children are said to have special educational needs and may have difficulties with things like literacy, Mathematics or understanding information, expressing themselves or understanding others, making friends or relating to others, a hearing or visual impairment, or a physical or medical condition.
. Data from the January 2014 School Census found that 16% (around 2,500) of Stafford pupils had special educational needs (SEN), which is lower than the England average (18%).
4.4 Vulnerable children Children and young people in care are among the most socially excluded in children in England. There are significant inequalities in health and wellbeing outcomes compared with all children, which contribute to poorer health and wellbeing outcomes later in life.
. During 2013/14, there were 1,700 children in Stafford identified as being ‘in need’ with rates being similar to the national average.
. As at the end of March 2014, there were around 140 looked after children in Stafford with the rate being similar to the England average.
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. The number of children in Stafford requiring child protection plans during 2013/14 was lower than the national average.
4.5 Children with a limited long-term disability
. The 2011 Census found that 3.8% of under 16s (around 860 children) had a limiting long-term illness in Stafford which is similar to the England average of 3.7%.
. Highfields and Western Downs and Penkside wards however have higher than average rates of children with limiting long-term illness.
4.6 Lifestyles
4.6.1 Smoking The Department of Health’s Tobacco Control Plan for England sets out to reduce rates of regular smoking among 15 year olds to 12% or less by the end of 2015. A target for reducing smoking prevalence in this age group is also included in the Public Health Outcomes Framework. Synthetic estimates for 2009-2012 suggest:
. The prevalence of regular smokers among 11-15 year olds in Stafford is 3.3% which is similar to the national average of 3.1%.
. The prevalence of regular smokers among 15 year olds in Stafford is 9.1%, with rates again being similar to the national average (8.7%).
4.6.2 Alcohol
. Over a three year period (2010/11-2012/13) there were around 60 alcohol- related admissions in children and young people under 18 in Stafford, with rates being higher than the England average.
4.6.3 Excess weight
. For Stafford children aged four or five (Reception) the proportion of those who were overweight or obese decreased from 22.6% in 2012/13 to 21.4% in 2013/14 with rates remaining similar to England. For children aged ten to eleven (Year 6) the proportion of those who were overweight or obese also decreased from 32.6% in 2012/13 to 29.5% in 2013/14 and rates in Stafford are now lower than the England average (Figure 4).
. The prevalence of children who are either overweight or obese in Reception is higher than the national average in Coton and Haywood and Nixon wards.
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Figure 4: Trends in children who are overweight and obese
Source: National Child Measurement Programme (NCMP) Local Authority Profile, Public Health England
4.7 Teenage pregnancy Being a teenage parent can have adverse effects on an individual’s life chances, for example, teenage mothers often have poor educational attainment and reduced employment opportunities. Being a teenage mother also has an additional risk of increased mortality and morbidity for both mother and infant.
Risky behaviours such as early onset of sexual activity, poor or no use of contraception, alcohol and substance misuse, teenage motherhood and repeat abortions are often associated with areas of high teenage pregnancy. Teenage pregnancy is associated with deprivation and young people from lower socio- economic groups tend to have higher levels of teenage pregnancy.
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During 2013 there were around 60 teenage pregnancies in Stafford with rates being similar to the national average. Between 1998 and 2013 under-18 conception rates in Stafford have reduced by 25% compared with a 33% reduction in Staffordshire and 48% in England (Figure 5). During 2013 teenage pregnancy rates in Stafford fell amongst the worst third of areas nationally (Figure 6).
. Under-16 conceptions make up around one in eight under-18 pregnancies in Stafford with rates being lower than England (Figure 7).
. Ward level analysis suggests there are two wards in Stafford where teenage pregnancy rates are particularly high compared to England: Highfields and Western Downs and Penkside.
Figure 5: Teenage pregnancy trends: under-18 conception rates
Source: Office for National Statistics
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Figure 6: Teenage pregnancy trends: under-18 conception rates, 2013
Source: Office for National Statistics
Figure 7: Teenage pregnancy: under-16 conception rates, 2011-2013
Source: Office for National Statistics
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4.8 Chlamydia Chlamydia infection remains the most commonly diagnosed sexually transmitted disease (STI) both in England and in local Staffordshire clinics. Young people under 25 make up almost three quarters of all chlamydia cases.
Chlamydia is often asymptomatic so a large proportion of cases remain undiagnosed. The National Chlamydia Screening Programme (NCSP) was set up to control and prevent the spread of chlamydia, targeting the high risk group, i.e. young people aged under 25 who are sexually active.
. Data from 2013 for 15-24 year olds shows that 25% (around 4,100) of young people in Stafford were screened for chlamydia which is similar to the England average (also 25%).
. The diagnosis rate for this age group however falls below the Public Health Outcomes Framework (PHOF) recommendation of at least 2,300 per 100,000 aged 15-24 years. This may indicate that Stafford has lower levels of chlamydia prevalence as the target has not been adjusted for different prevalence across different geographical areas and / or that young people who are at higher risk of chlamydia are not being targeted appropriately for testing.
4.9 Hospital admissions Unintentional and deliberate injuries are the leading cause of admissions for children and are often higher for children from more deprived areas. They are also one of the main causes of death in children and young people.
. Around 180 children aged under five in Stafford were admitted to hospital due to unintentional and deliberate injuries during 2012/13, with rates being higher than the England average.
. During 2012/13 around 340 children under 15 were admitted for unintentional and deliberate injuries. Between 2011/12 and 2012/13 hospital admissions caused by unintentional and deliberate injuries in children under 15 in Stafford decreased by 21% compared with 12% for England. However rates in Stafford remain higher than England.
Long-term conditions such as asthma, diabetes, epilepsy and other lower respiratory tract infections also make up significant numbers of unplanned hospital admissions in under 19s.
. During 2013/14 there were 100 hospital admissions caused by asthma, diabetes or epilepsy in children under 19 in Stafford with rates similar to the England average.
. During the same period around 110 Stafford children under 19 were admitted to hospital due to a lower respiratory tract infection with rates being higher than the national average.
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5 Live well
5.1 Employment and income There is a key relationship between work, health and wellbeing - having a job is better for health than no job. As well as the obvious links to low income and worklessness, detachment from the labour market can lead to a number of social and psychological disadvantages. People who are unemployed tend to have higher levels of premature mortality and poorer general health than those who work. People who have been unemployed for a long duration also tend to visit their GP more frequently and have higher hospital admission rates.
. Data from the 2013/14 annual population survey found that similar proportions of people aged 16-64 in Stafford were in employment compared to the England average (77% compared to 72%). However some vulnerable groups are less likely to be employed, for example during 2013/14:
o only 8% of people with learning disabilities in Stafford were in paid employment; this is similar to the 7% average for England o employment for people with long-term conditions in Stafford was about seven percentage points lower than that of the working age population as a whole
. Unemployment in Stafford (as at Feb 2015) was lower, at 0.8% or around 650 claimants than England (2%).
. Youth unemployment in Stafford (1.5% or around 170 claimants) is also lower than England (3.1%).
. The average household income for Stafford was £41,700 which is more than the Great Britain average (£40,000). Stafford also has a lower than average proportion of households with an average income of under £20,000.
. The percentage of people claiming disability living allowance is lower than average in Stafford (4.3% or around 5,650 people) compared with England (4.9%).
5.2 Education Areas of low educational attainment and skills are often associated with high levels of worklessness, deprivation and poor health.
. 9% of people aged 16-64 have no qualifications in Stafford which is similar to the England average (also 9%).
. The percentage of working age adults with NVQ1 or above in Stafford (86%) is similar to England (85%).
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5.3 The living environment The relationship between health and housing is well documented and the environment we live in can be an important influence on the demand for health and social care.
Certain characteristics, such as overcrowding, sanitation and poor heating can have adverse effects on an individual’s health. Overcrowding is linked to a number of health problems including TB, dysentery, heart attacks, chest problems and poor mental health conditions. Damp and cold homes are linked to asthma, wheezing, chest infections and hypothermia and are also one of the major causes for excess winter deaths in the older population.
. Estimates from a 2009 study on housing suggest that around a third of private sector households would not meet the decent homes standard in Stafford which is lower than the England estimate of 36%.
. Households that are accepted as being homeless or are in temporary accommodation often have greater health needs than the average population. Statutory homelessness is one of the key public health outcomes indicators. During 2013/14, 50 households in Stafford were accepted as being homeless which is lower than average.
. Around 6,800 households in Stafford are thought to be in fuel poverty, the rate being higher than the England average (12% compared with 10%). Of the 26 wards in Stafford 16 experience high fuel poverty.
. Based on data from the Feeling the Difference survey, 93% of Stafford residents were satisfied with their area as a place to live, which is similar to the overall Staffordshire average (also 93%).
5.4 Crime Crime can have a direct impact on health, e.g. through violence and injury to an individual, and may also be alcohol or drug-related. Furthermore it has an effect on wellbeing, e.g. domestic violence or feeling socially isolated due to fear of crime.
. During 2013/14 there were around 1,300 recorded incidents of violent crime with rates in Stafford being lower than the England average. In addition there are five wards with significantly high rates of violent crime: Common, Forebridge, Highfields and Western Downs, Penkside and Rowley.
. There were around 2,980 reported incidents of anti-social behaviour during 2013/14 with rates being lower than the England average. However Forebridge and Manor wards have significantly high rates of anti-social behaviour.
. The percentage of juvenile re-offenders in Stafford was 41%, similar to the national average. The re-offending rate for adults is lower at 23%, and also similar to the England average.
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. Based on data from the Feeling the Difference survey, 11% of Stafford respondents thought that they were likely to be a victim of crime. The same percentage (11%) of Stafford respondents had experiences crime (either as a victim or a witness to a crime). These figures are similar to the Staffordshire average.
5.5 NHS health checks The NHS health check programme is key in reducing health inequalities and increasing life expectancy from preventable cardiovascular (CVD) conditions. It aims to help prevent CVD by offering everyone between the ages of 40 and 74 a health check that assesses their risk of heart disease, stroke, kidney disease, diabetes and dementia and gives them support and advice to reduce that risk.
. In Stafford there are 42,400 patients who are eligible to be invited for an NHS health check over a five year period (around 70% of the population aged 40- 74). Between April 2013 and March 2014, about 6,200 invites were sent to Stafford residents, which is 15% of the eligible population and lower than the national average of 18%. During this period around 2,000 patients received an NHS health check which is an uptake rate of 33%, lower than the national average of 49%.
5.6 Adult lifestyles People’s lifestyle choices can have a profound impact on their health. Smoking for example is the biggest preventable cause of disease and death in England and remains a key health and wellbeing challenge. The misuse of alcohol has been shown to contribute to a number of health problems and is also linked to social problems such as anti-social behaviour, crime and domestic violence. Being obese increases the risk of diseases such as diabetes, hypertension (high blood pressure), cancer and heart disease, and can lead to social and psychological problems. A healthy diet can help reduce the risk of developing heart disease, some cancers, reduce the risk of diabetes, high cholesterol and blood pressure levels and also reduce excess weight. People who have a physically active lifestyle reduce the risk of cardiovascular disease, some cancers and diabetes. Being active can also improve musculoskeletal conditions, reduce excess weight and improve an individual’s wellbeing.
. Based on data from the 2013 Integrated Household Survey smoking prevalence for adults aged 18 and over in Stafford was 13% (around 14,200 people and lower than the national average of 18%). GP recorded data suggests that smoking prevalence in persons aged 15 years or over is higher for Stafford (19% or around 20,700 people).
. Around one in six deaths in Stafford are due to a smoking related disease (equivalent to 190 deaths), at a lower rate than England. In addition there are around 1,300 admissions to hospital due to smoking, similar to the England average.
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. During 2013/14 around 1,570 Stafford smokers accessed stop smoking services of which 52% were quit at four weeks. Access rates to stop smoking services per 1,000 smokers are higher than the average whilst conversion rates, i.e. number of four week quitters as a proportion of those who set a quit date are similar to average.
. During 2013/14 there were over 900 alcohol-related admissions in Stafford with rates being higher than average. Provisional rates for 2013/14 have remained similar to the previous year (Figure 8).
Figure 8: Trends in alcohol related admissions
Source: Local Alcohol Profiles for England, Public Health England
. Around seven in ten Stafford adults have excess weight (either obese or overweight), higher than the England average. The proportion of people who are obese in Stafford is similar to the England average (21% compared with 23% nationally).
. Data from the latest National Diet and Nutrition Survey (NDNS) shows that overall the population is still consuming too much saturated fat, added sugars and salt and not enough fruit, vegetables, oily fish and fibre.
. Estimates suggest that only three in ten people in Stafford eat five or more portions of fruit and vegetables daily, similar to England.
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. The Chief Medical Officer recommended that adults undertake 150 minutes of moderate intensity activity over a week in bouts of 10 minutes or more. Around 56% of Stafford adults met recommended levels of physical activity in 2013, the same percentage as the England average (also 56%).
. About a quarter of Stafford adults are inactive (28,830 people), similar to the England average.
5.7 Mental health People with mental ill-health are a marginalised and vulnerable group that can experience considerable barriers when accessing health services and suffer from poorer health outcomes than the general population. At least one in four people will experience a mental health problem at some point in their life and one in six adults have a mental health problem at any one time.
. The estimated number of people suffering mental ill-health in the community is between 28,600 and 34,100 people.
. In Stafford around 6% of adults aged 18 and over were on GP depression registers in 2013/14 which is slightly lower than the national average.
. In terms of severe mental health conditions (schizophrenia, bipolar disorder or other psychoses), the recorded prevalence in Stafford was 0.7% in 2013/14 which is lower than the England average of 0.9%.
. In Stafford there are around 14 suicides every year accounting for about 1% of deaths with rates being similar to the national average. Self-harm is often an expression of personal distress and there is a significant and persistent risk of future suicide following an episode of self-harm. During 2012/13 there were around 280 hospital admissions due to self-harm in Stafford with rates being higher than the England average.
5.8 People with learning disabilities Learning disability is one of the most common forms of disability and is a lifelong condition. It is acquired before, during or soon after birth and affects an individual’s ability to learn. Similar to people suffering from mental ill health, people with learning disabilities also face challenges and prejudice every day, for example the proportion who were in paid employment is lower than average.
. Around 66% of Stafford adults with learning disabilities live in their own home or with their family which is lower than the national average.
. The number of people recorded on a disease register (QOF register) as having a learning disability was around 350 in 2013/14. The recorded prevalence (0.3%) is lower than the national average. The expected prevalence of learning disability suggests that there are significant numbers of people undiagnosed or unrecorded on GP disease registers.
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5.9 Sexual health
. In 2013 there were around 720 acute sexually transmitted infections (STIs) diagnosed at GUM clinics for residents of Stafford, a reduction of 8% since 2012. This compares with a 1% increase across Staffordshire and very little change seen nationally across England.
. Overall rates of STIs in Stafford are lower than average. However rates of Stafford women admitted to hospital with pelvic inflammatory disease (PID) during 2012/13 were higher than the national average.
. The proportion of new patients attending GUM who were offered a HIV test in Stafford is similar to the national average. However uptake, i.e. new GUM patients who received a HIV test is higher than England. The prevalence of HIV in Stafford is lower than average.
. People who have experienced sexual assault have multiple on-going sexual health needs including addressing pregnancy risk, risks of infection and psychosocial impacts. During 2013/14 there were around 150 sexual offences reported to the police in Stafford with rates being similar to the national average.
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6 Age well
6.1 Demography and deprivation The dependency ratio for older people measures the number of people aged over 65 who depend on people of working age (16-64) and gives an indication of both the economic and social responsibility of those of working age for older people.
. There are around 27,300 people aged 65 and over living in Stafford. The dependency ratio for older people in Stafford, based on mid-year 2013 population estimates, was 33 older people for every 100 people of working age. This is higher than England. In Stafford 18 of 26 wards also have high dependency ratios for older people.
. Around 4,100 (11%) people aged 60 and over in Stafford are deemed to be living in income deprived households which is lower than the England average (18%).
. The proportion of older people living alone in Stafford is 13% (7,100 people). This is higher than the national average of 12%.
. Nine wards in Stafford have higher proportions of households with lone pensioners: Barlaston and Oulton, Baswich, Eccleshall, Fulford, Holmcroft, Manor, Stonefield and Christchurch, Walton and Weeping Cross.
6.2 Disability free life expectancy
. Based on data for 2007-2009, men in Stafford at the age of 16 can expect to have 50 additional years of disability-free life expectancy (DFLE) and women 53 years. For men this is similar the national average; for women this is higher than the England average.
. At the age of 65 men and women in Stafford can expect to have 11 and 13 additional years of DFLE respectively. For women this is higher than the England average.
6.3 Adult immunisation
. The proportion of people aged 65 and over who have been vaccinated against flu in 2013/14 was 69%. This is lower than the England average of 73%.
. Pneumococcal vaccine coverage in Stafford was 64%, which is lower than the England average of 69%.
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6.4 Long-term conditions
. The 2011 Census found that 18.2% (23,800 people) had a limiting long-term illness (LLTI) in Stafford. This is higher than the England average of 17.6%. The proportion of people who have a LLTI also increases with age: around 49% of people with 65 and over and 66% of people aged 75 and over have a LLTI.
. Nine wards have higher proportions of people with LLTI than the England average: Barlaston and Oulton, Fulford, Highfields and Western Downs, Holmcroft, Manor, Rowley, Seighford, Stonefield and Christchurch and Walton.
. The prevalence of long-term conditions is projected to increase given the ageing population and increase in unhealthier lifestyles placing an increased burden on future health and social care resources.
. GP disease registers show that the long term conditions with the highest prevalence in Stafford are hypertension (15%), obesity (9% of people aged 16 and over), depression (6% of people aged 18 and over), diabetes (6% of people aged 17 and over) and asthma (6%).
. The numbers of patients recorded on general practice disease registers when compared with the expected numbers of people on registers with specific conditions shows that there are potentially large numbers of undiagnosed or unrecorded cases for osteoporosis, learning disabilities, peripheral arterial disease, palliative care conditions, heart failure, chronic obstructive pulmonary disease, dementia, chronic kidney disease and hypertension.
. Higher numbers of cases on the registers than would be expected are recorded for cancer, hypothyroidism and severe mental conditions. Some of these differences may be due to the model used for expected numbers, particularly in cases such as the cancer and hypothyroidism which are noted as underestimating the true prevalence.
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Table 4: Summary of actual and expected prevalence for selected long-term conditions in Stafford, 2013/14
Recorded Expected Estimated under prevalence prevalence recording (QOF 2013/14) (2013/14) (percentage) 7,101 11,465 Asthma 38% (5.7%) (9.2%) 2,434 2,501 Atrial fibrillation 3% (1.9%) (2.0%) 3,387 1,098 Cancer -208% (2.7%) (0.9%) 4,055 7,250 Chronic kidney disease (age 18+) 44% (4.0%) (7.1%) 1,761 3,761 Chronic obstructive pulmonary disease 53% (1.4%) (3.0%) 4,668 6,643 Coronary heart disease 30% (3.7%) (5.3%) 774 1,646 Dementia 53% (0.6%) (1.3%) 6,475 8,280 Depression (age 18+) 22% (6.3%) (8.1%) 6,365 6,789 Diabetes (age 17+) 6% (6.2%) (6.6%) 966 910 Epilepsy (age 18+) -6% (0.9%) (0.9%) 924 2,242 Heart failure 59% (0.7%) (1.8%) 19,041 33,848 Hypertension 44% (15.2%) (27.1%) 4,859 2,784 Hypothyroidism -75% (3.9%) (2.2%) 347 2,148 Learning disabilities (age 18+) 84% (0.3%) (2.1%) 827 506 Mental health -63% (0.7%) (0.4%) 9,048 24,315 Obesity (age 16+) 63% (8.6%) (23.2%) 194 1,417 Osteoporosis (age 50+) 86% (0.4%) (2.8%) 274 874 Palliative care 69% (0.2%) (0.7%) 855 3,854 Peripheral arterial disease 78% (0.7%) (3.1%) 940 835 Rheumatoid arthritis (16+) -13% (0.9%) (0.8%) 2,559 2,837 Stroke 10% (2.0%) (2.3%)
Source: Quality and Outcomes Framework (QOF) for April 2013 - March 2014, GPES and CQRS database - 2013/14 data as at end of June 2014, Copyright © 2014, Health and Social Care Information Centre. All rights reserved, NHS Comparators, NHS Doncaster QOF Benchmarking Tool, Public Health England, 2014 dementia calculator, Primary Care Web Tool and GP registered populations, Midlands and Lancashire Commissioning Support Unit (CSU)
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6.5 Dementia
. Around 770 people in Stafford had a recorded diagnosis of dementia on GP registers during 2013/14.
. A new dementia prevalence calculator was published in 2014. As well as the age-sex structure of the population, this takes into account the higher proportion of dementia cases found for care home residents. Using this tool only 47% of Stafford residents with dementia are diagnosed which is lower than the national average of 54%.
6.6 Utilisation of health and social care By the time people reach 65 most will have developed at least one chronic (long- term) condition and large proportions will also have developed two or three conditions. Whilst most of this care will occur in primary and community settings, a high proportion occurs in more costly hospital settings.
. During 2013/14 older people made up around 45% of all emergency (unplanned) admissions, 70% of unplanned hospital bed days and 60% of costs despite making up only 20% of the population in Staffordshire.
. Acute and chronic conditions that can be managed effectively in primary care or outpatient settings are known as ambulatory care sensitive (ACS) conditions. These measure emergency admissions for conditions that should not usually require hospital admission.
. In Stafford in 2013/14, there were about 1,800 admissions classed as acute ACS conditions and about 900 classed as chronic ACS conditions. Trends show rates in Stafford for both acute and chronic conditions are increasing more rapidly than average although there were signs of reductions during 2013/14. The rate of acute ACS conditions is higher than England whilst the rate of chronic ACS conditions is lower than average.
Insight and Intelligence, Staffordshire County Council Page 32
Figure 9: Trends in unplanned admissions from ACS conditions
Source: Compendium of Population Health Indicators (www.indicators.ic.nhs.uk or nww.indicators.ic.nhs.uk), The NHS Information Centre for health and social care. Crown copyright
. During 2013/14 there were around 215 permanent admissions to people aged 65 and over to residential and nursing care homes, the rate being higher than the national average.
. In 2013/14 the percentage of older people (aged 65 and over) who were discharged from hospital to reablement services and as a consequence were still at home after 91 days was 80%, similar to the national figure of 83%.
6.7 Carers
. Based on data from the 2011 Census, 11% of Stafford residents provide unpaid care which is higher than the England average of 10%. This equates to around 15,000 people.
. In Stafford, 15% (3,700 people) of residents aged 65 and over provide unpaid care which is again higher than the England average of 14%.
Insight and Intelligence, Staffordshire County Council Page 33
6.8 Accidents
. Around 560 Stafford residents aged 65 and over were admitted to hospital for a fall-related injury during 2012/13, with rates being similar to the England average.
. National research indicates that only one in three people who have a hip fracture return to their former level of independence and one in three have to leave their own home and move to long-term care (resulting in social care costs).
. During 2012/13 there were 170 hip fracture admissions to people aged 65 and over in Stafford, with rates being similar to the England average.
. Accidental deaths account for around 30 deaths per year in Stafford with rates being similar to the England average. Common causes of accidental mortality are falls (56%) and road traffic accidents (13%). Death rates from accidental falls are however higher than average.
6.9 Excess winter deaths There is some evidence to suggest that some deaths that occur during the winter months are preventable. National research shows that winter deaths increase more in England compared to other European countries with colder climates. This suggests that it is more than just lower temperatures that are responsible for the excess mortality. The excess winter deaths index (EWD index) indicates whether there are higher than expected deaths in the winter compared to the rest of the year.
. There were around 90 excess winter deaths between August 2012 and July 2013 in Stafford mainly amongst older people, with the rate being similar to average. During this period the EWD index for people aged 85 and over in Stafford was lower than average.
Insight and Intelligence, Staffordshire County Council Page 34
7 Die well
7.1 Life expectancy
. Life expectancy at birth continues to increase both nationally and locally for males (Figure 10). Overall life expectancy at birth is 80 years for men, higher than the national average and almost 84 years for women, similar to the national average. However, men and women living in the most deprived areas of Stafford live seven and eight years less than those living in less deprived areas.
. Map 1 shows there are also marked gaps in life expectancy between different communities at ward level for both men and women:
o For men the difference in life expectancy between the ward with the lowest life expectancy and the ward with the highest life expectancy in the district is nine years (varying between 76 years in Rowley and 85 years in Baswich).
o For women the difference in life expectancy between the ward with the lowest life expectancy and the ward with the highest life expectancy in the district is also nine years (varying between 81 years in Barlaston and Oulton and 90 years in Baswich).
Figure 10: Trends in life expectancy at birth
Source: Office for National Statistics, Crown Copyright
Insight and Intelligence, Staffordshire County Council Page 35
Map 1: Life expectancy at birth for men (left) and women (right), 2009-2013
Source: Primary Care Mortality Database and Death extracts, Office for National Statistics, Mid-year population estimates, Office for National Statistics, Crown copyright and Vital statistics Table 3, Office for National Statistics, Crown copyright
This product includes mapping data licensed from Ordnance Survey with the permission of the Controller of Her Majesty's Stationery Office. © Crown copyright and / or database right 2014. All rights reserved. Licence Number 100019422
Insight and Intelligence, Staffordshire County Council Page 36
7.2 Main causes of death
. Around 1,230 Stafford residents die every year with the most common causes of death being circulatory disease (360 deaths, 29%), cancer (350 deaths, 29%) and respiratory disease (160 deaths, 13%) (Figure 11).
Figure 11: Common causes of deaths in Stafford, 2011-2013
Source: Public Health Mortality Files and Death extracts, Office for National Statistics
7.3 Preventable mortality The major causes of preventable deaths can be attributed to the roots of ill-health, for example education, employment and housing as well as lifestyle risk factors such as smoking, drinking too much alcohol, unhealthy diets, physical inactivity and poor emotional well-being.
. Around 17% of Stafford residents die from causes that are largely thought to be preventable, equating to around 210 deaths every year with overall rates being lower than the national average.
. The numbers of people dying from preventable deaths across the district have reduced significantly by 31% between 2001-2003 and 2011-2013 compared with 26% for England (Figure 12). Despite this two wards (Forebridge and Highfields and Western Downs) have higher preventable mortality rates than England.
Insight and Intelligence, Staffordshire County Council Page 37
Figure 12: Mortality rates from causes considered preventable
Source: Public Health Outcome Framework, Public Health England, http://www.phoutcomes.info/
. Cancer - Every year around 160 Stafford residents die prematurely (i.e. before 75) from cancer, accounting for 44% of all premature deaths. Rates of premature mortality from cancer have fallen by 20% between 2001-2003 and 2011-2013 which is faster than England (15%) with the Stafford rate being similar to England.
. Circulatory disease - Every year around 80 Stafford residents die prematurely (i.e. before 75) from circulatory disease, accounting for 22% of all premature deaths. Rates of premature mortality from circulatory disease have fallen by 45% between 2001-2003 and 2011-2013 which is similar to England (44%) with the Stafford rate being similar to England. However the rate of premature death from circulatory disease in Forebridge and Highfields and Western Downs wards are higher than the England rate.
. Respiratory disease - Respiratory disease is the third biggest cause of death and about 30 people die prematurely in Stafford every year making up around 8% of all premature deaths. The rate of people dying early from respiratory disease in Stafford has stayed around the same since whilst national rates have decreased by 18% over the same period. Rates in Stafford are however lower than average
Insight and Intelligence, Staffordshire County Council Page 38
. Liver disease - Around 30 Stafford residents die from liver disease every year, accounting for 2% of all deaths. Around two thirds of these deaths occur to people who are under 75 with over half of these due to alcoholic liver disease. Unlike the reductions seen in under 75 mortality from cancer and cardiovascular disease, rates of people dying early as a result of liver disease have increased by 17% between 2001-2003 (39 deaths) and 2011-2013 (52 deaths). This may be a result of increased alcohol consumption and consequently increased alcohol-related harm within the district.
. Communicable diseases - Around 70 Stafford residents die from a communicable disease every year with rates being lower than average.
7.4 End of life Research by the End of Life Care Intelligence Network (now Public Health England) suggests that on average a quarter of all deaths are unexpected. Death in hospital is considered the least likely place that people in general would choose to die compared with home, hospices and care homes. Therefore ensuring peoples’ preferences are met involves working to reduce the number of deaths in hospital. This improves quality of care at end of life for the patients and also reduces hospital costs on unnecessary admissions.
. During 2013/14 there were around 270 people on palliative care registers across Stafford making up 0.2% of the population. It remains significantly lower than the expected number of people on registers (0.7%). This indicates that people who may have palliative care needs are not being identified prior to their death.
. During 2013 a lower proportion of Stafford residents died in hospital (47%) than the England average and a higher proration died at home (45%) (or their usual place of residence).
. People with an underlying cause of death recorded as cardiovascular disease or respiratory disease were more likely to die in hospital than those who have cancer.
Insight and Intelligence, Staffordshire County Council Page 39
8 Indicator matrix by ward The information in the following matrix is mainly benchmarked against England and colour coded using a similar approach to that used in the Public Health Outcomes Framework tool (http://www.phoutcomes.info/).
It is important to remember that a green box may still indicate an important health and wellbeing problem, for example rates of teenage conceptions are already high across England so even if an area does not have a significantly high rate this does not mean that it is not a public health issue.
Compared to England:
and and
Hixon Coton Manor Oulton Walton Milford Fulford Rowley Milwich Stafford England Chartley Baswich Common Penkside Tillington Seighford Holmcroft Eccleshall Littleworth Forebridge Gnosall and Swynnerton St. Michael's St. Woodseaves Christchurch Staffordshire Haywood Barlaston Barlaston Church Eaton Stonefield and Highfields and Weeping Cross Western Downs
Demographics Mid-year population 4.2 4.4 2.0 2.4 4.5 4.7 6.7 5.3 5.9 6.5 6.4 6.6 6.8 7.4 6.4 5.5 2.0 4.6 4.5 5.0 3.5 5.7 4.5 4.7 5.9 6.4 132.1 857 53.9m estimate (000s), 2013 % under five, 2013 5 5 5 4 5 9 4 6 4 5 4 6 6 4 6 4 4 8 5 6 4 6 4 7 5 5 5 5 6
% under 16, 2013 16 18 15 15 14 21 14 14 15 16 16 20 18 13 19 14 16 23 16 20 12 18 15 21 16 18 17 17 19
% aged 16-64, 2013 57 57 59 61 71 70 60 72 57 61 61 66 61 71 61 67 59 64 63 64 57 61 62 59 59 58 63 63 64
% aged 65 and over, 2013 27 25 26 24 14 8 25 14 27 23 23 14 21 16 20 19 25 13 21 16 31 21 23 20 25 25 21 20 17
% aged 75 and over, 2013 13 12 10 9 7 4 11 7 12 9 8 6 10 7 9 9 11 5 11 7 14 10 9 8 11 10 9 9 8
% aged 85 and over, 2013 5 3 1 2 2 1 3 3 3 2 2 1 2 2 2 2 4 2 5 2 4 4 2 2 3 3 3 2 2 Dependency ratio per 100 working age population, 75 75 70 65 40 42 65 40 74 63 65 52 65 42 63 49 68 57 58 57 76 63 62 69 70 74 60 60 57 2013 Dependency ratio of children per 100 working 28 31 25 25 20 31 23 20 27 26 27 30 30 19 31 21 26 36 26 32 22 29 25 36 26 31 27 28 30 age population, 2013 Dependency ratio of older people per 100 working age 46 43 45 40 20 11 42 20 47 37 38 22 35 23 32 28 42 21 32 25 55 34 37 33 43 43 33 32 27 population, 2013 Minority ethnic groups, 2011 4 7 3 4 12 25 5 16 4 2 3 8 8 13 7 9 3 9 9 3 5 5 4 8 4 7 7 6 20 (%)
Insight and Intelligence, Staffordshire County Council Page 40
Compared to England:
and and
Hixon Coton Manor Oulton Milford Walton Fulford Rowley Milwich Stafford England Chartley Baswich Common Penkside Tillington Seighford Holmcroft Eccleshall Littleworth Forebridge Gnosall and Gnosall Swynnerton St. Michael's St. Woodseaves Staffordshire Christchurch Haywood Barlaston Barlaston Church Eaton Highfields and Highfields Stonefield and Weeping Cross Western Downs
Index of multiple deprivation (IMD) 2010 weighted score, 15 4 8 7 19 16 11 16 13 10 8 26 15 14 22 7 15 25 10 9 11 13 9 19 12 3 13 16 22 2010 % in most deprived IMD 0 0 0 0 0 0 0 0 0 0 0 27 0 33 24 0 0 49 0 0 0 0 0 0 0 0 6 9 20 2010 national quintile, 2013 % in second most deprived IMD 2010 national quintile, 29 0 0 0 29 34 0 38 0 0 0 49 24 0 26 0 0 0 0 0 0 0 0 28 0 0 11 17 20 2013 Child Wellbeing Index (CWI) 97 46 117 114 115 157 118 108 81 100 90 200 145 105 132 73 118 226 51 74 93 75 69 194 87 48 111 114 159 2009 weighted score, 2009 % in most deprived CWI 0 0 0 0 0 0 0 0 0 0 0 33 32 0 0 0 0 55 0 0 0 0 0 32 0 0 8 8 24 2009 national quintile, 2013 % in second most deprived CWI 2009 national quintile, 0 0 0 0 23 73 0 32 0 0 0 47 0 0 27 0 0 45 0 0 0 0 0 0 0 0 11 16 20 2013 Mosaic profile - most A D A A L H A L A A G M H E K B A M B D A D B H F B A H H common group, 2014 Mosaic profile - % in the 32 31 71 86 44 23 58 35 21 50 36 29 20 17 21 31 95 22 26 32 54 17 29 21 29 32 15 13 10 most common group, 2013 Start well Children under 16 in low- 16 2 2 4 8 13 7 10 8 6 7 27 15 8 22 4 3 25 8 11 6 10 4 24 8 5 12 14 19 income families, 2012 (%) Lone parent households, 7 6 4 5 8 9 6 8 6 6 7 15 10 9 11 7 6 14 7 9 5 8 7 13 6 8 8 9 11 2011 (%) General fertility rate per 1,000 women aged 15-44, 61 48 60 40 63 82 38 55 48 51 46 69 59 46 66 43 41 78 53 56 46 56 42 64 64 42 56 58 64 2011-2013 Low birthweight babies (under 2,500 grams), 2011- 5 3 8 S 8 7 10 8 3 8 6 8 5 6 6 4 S 7 9 6 5 7 S 7 7 3 6 7 7 2013 (%) Breastfeeding prevalence rates at six to eight weeks, 46 47 61 69 39 34 36 42 S 25 49 24 31 48 27 63 40 24 45 51 36 43 33 30 35 45 36 33 47 2012/13 (%) School readiness (Early Years Foundation Stage), 65 92 75 86 52 68 67 73 64 74 73 53 68 71 59 72 88 48 85 72 75 72 75 78 84 87 70 64 60 2014 (%) Grow well
Pupil absence, 2014 (%) 4 4 3 5 4 5 4 5 4 4 4 6 4 4 5 4 4 6 4 5 4 3 4 5 5 4 5 5 5
Insight and Intelligence, Staffordshire County Council Page 41
Compared to England:
and and
Hixon Coton Manor Oulton Milford Walton Fulford Rowley Milwich Stafford England Chartley Baswich Common Penkside Tillington Seighford Holmcroft Eccleshall Littleworth Forebridge Gnosall and Gnosall Swynnerton St. Michael's St. Woodseaves Staffordshire Christchurch Haywood Barlaston Barlaston Church Eaton Highfields and Highfields Stonefield and Weeping Cross Western Downs
Children who claim free 15 2 S 6 10 12 5 6 7 4 6 25 13 7 19 1 3 21 8 7 3 11 4 21 5 3 10 12 16 school meals, 2014 (%) KS2 results - Level 4 or above in reading, writing 73 95 93 80 86 60 68 69 81 80 87 42 81 83 70 79 94 66 55 81 85 76 73 72 83 91 77 77 79 and mathematics, 2014 (%) GCSE attainment (five or more A*-C GCSEs including 58 78 54 53 48 38 62 53 67 56 69 37 63 56 35 72 88 40 65 64 52 60 77 54 69 75 59 55 53 English and mathematics), 2014 (%) Young people not in education, employment or 5 S S S 7 6 S 6 S S 3 5 6 S 7 S S 9 S S S 5 S 4 3 S 4 4 n/a training Jan 2015 (%) (compared to Staffordshire) Excess weight (children aged four to five), 2010/11 26 19 S S 29 30 14 24 20 23 29 25 25 21 27 19 S 27 18 14 22 11 12 26 15 20 22 23 22 to 2012/13 (%) Excess weight (children aged 10-11), 2010/11 to 34 17 S 29 38 38 30 35 31 29 33 33 40 26 36 25 S 34 31 29 27 31 31 38 26 28 32 34 34 2012/13 (%) Obesity (children aged four to five), 2010/11 to 2012/13 9 7 S S 10 15 S 8 8 13 9 7 11 10 10 S S 11 9 7 10 6 S 10 7 4 8 9 9 (%) Obesity (children aged 10- 20 7 S 12 16 24 15 18 21 15 15 19 22 18 24 11 S 21 15 17 11 15 17 28 10 12 17 19 19 11), 2010/11 to 2012/13 (%) Children aged 15 who have never smoked, 2009-2012 75 81 77 76 73 73 76 73 78 77 78 72 76 77 76 80 75 72 75 76 79 73 78 75 77 81 76 76 77 (% estimates) Children aged 15 who are regular smokers, 2009-2012 10 7 9 9 11 10 9 11 8 9 8 12 9 9 9 7 10 11 9 9 8 11 8 10 8 6 9 9 9 (% estimates) Children aged 15 who are occasional smokers, 2009- 5 4 5 5 5 5 5 5 4 5 5 5 5 4 5 4 5 5 3 5 4 6 5 4 5 4 5 4 4 2012 (% estimates) Under-18 conception rates per 1,000 girls aged 15-17, 28 S S S 42 37 23 S 27 15 37 51 26 30 52 S S 95 22 15 S 18 21 40 24 19 29 32 31 2010-2012 Limiting long-term illness 4 4 2 4 3 4 3 3 4 3 4 6 5 4 4 2 4 5 2 3 3 4 2 5 5 3 4 4 4 (under 16), 2011 (%) Limiting long-term illness 5 7 4 5 4 5 3 6 6 4 5 7 7 5 6 5 6 7 8 6 5 5 5 4 4 5 5 5 5 (16-24), 2011 (%)
Insight and Intelligence, Staffordshire County Council Page 42
Compared to England:
and and
Hixon Coton Manor Oulton Milford Walton Fulford Rowley Milwich Stafford England Chartley Baswich Common Penkside Tillington Seighford Holmcroft Eccleshall Littleworth Forebridge Gnosall and Gnosall Swynnerton St. Michael's St. Woodseaves Staffordshire Christchurch Haywood Barlaston Barlaston Church Eaton Highfields and Highfields Stonefield and Weeping Cross Western Downs
Unpaid care (under 16), 1 1 1 2 1 1 1 1 1 1 2 1 1 1 2 1 0 2 1 1 0 1 0 1 2 1 1 1 1 2011 (%) Unpaid care (16-24), 2011 7 5 4 4 3 2 4 2 6 4 4 4 5 3 7 2 3 5 4 3 2 3 5 5 5 3 4 5 5 (%) Live well Unemployment (claimant 1 1 0 0 1 1 0 1 1 0 0 1 1 1 2 0 0 2 1 1 0 1 1 1 1 0 1 1 2 counts), Feb 2015 (%) Disability Living Allowance 5 3 3 4 4 4 3 4 6 4 4 7 4 4 7 2 3 6 4 4 4 5 4 5 5 3 4 5 5 claimants, Aug 2014 (%) Average household income 46 44 55 52 30 30 48 36 45 46 46 30 34 33 31 59 63 39 51 51 49 46 54 34 33 44 42 39 40 (£000s), 2012 Households with an income under £20K, 2012 28 28 19 21 40 42 27 39 26 26 24 44 38 39 43 15 17 35 20 21 26 30 19 37 39 23 31 33 35 (%)(compared to Great Britain) Owner occupied 72 92 81 81 55 41 76 52 83 80 84 56 72 67 59 85 75 56 81 77 85 64 83 67 80 93 72 73 64 households, 2011 (%) Privately rented households, 9 7 13 9 28 38 13 32 6 9 7 8 10 18 9 11 15 10 10 10 9 19 9 9 11 6 13 11 17 2011 (%) Socially rented households, 16 0 4 8 15 20 9 15 9 9 8 35 17 14 31 3 7 33 8 12 4 15 6 23 8 0 14 15 18 2011 (%) Living rent free households, 2 1 2 2 1 1 2 1 1 2 1 1 1 1 2 1 4 1 1 1 1 1 2 1 1 1 1 1 1 2011 (%) Households with no central 1 1 1 1 4 3 2 5 0 2 1 1 2 2 2 2 4 2 2 2 1 2 1 2 3 1 2 2 3 heating, 2011 (%) Overcrowded households, 2 1 1 1 3 4 1 3 1 2 1 3 3 2 3 1 1 4 2 1 2 2 1 2 1 0 2 2 5 2011 (%) Estimated private sector households failing to meet 53 27 43 52 41 29 45 44 34 39 30 20 27 27 26 40 61 26 27 13 42 44 37 23 28 21 33 34 36 decent homes standard, 2009 (%) Households with no cars or 12 12 6 6 30 31 10 33 12 10 8 29 20 25 28 7 5 26 14 13 7 22 7 21 16 10 17 18 26 vans, 2011 (%) Total recorded crime (rate 27 11 7 15 59 36 29 220 22 19 18 40 39 40 56 25 29 54 55 13 24 50 26 32 23 13 42 45 61 per 1,000), 2013/14 Violent crime (rate per 6 4 S 3 17 10 6 54 8 5 5 14 14 13 13 5 3 19 14 4 6 13 4 11 7 4 10 11 11 1,000), 2013/14 Violent crime with injury 3 1 S S 7 4 2 22 4 3 2 7 5 6 5 2 S 6 5 2 3 6 S 5 3 1 5 5 6 (rate per 1,000), 2013/14
Insight and Intelligence, Staffordshire County Council Page 43
Compared to England:
and and
Hixon Coton Manor Oulton Milford Walton Fulford Rowley Milwich Stafford England Chartley Baswich Common Penkside Tillington Seighford Holmcroft Eccleshall Littleworth Forebridge Gnosall and Gnosall Swynnerton St. Michael's St. Woodseaves Staffordshire Christchurch Haywood Barlaston Barlaston Church Eaton Highfields and Highfields Stonefield and Weeping Cross Western Downs
Antisocial behaviour (rate 14 8 5 6 43 22 10 93 17 14 8 27 23 18 42 9 6 35 29 9 6 36 16 33 17 9 23 23 37 per 1,000), 2013/14 Domestic abuse (rate per 1,000), 2013/14 (compared 2 2 S S 5 3 1 5 2 2 2 6 5 4 4 1 S 11 3 2 2 3 S 4 2 2 3 4 n/a to Staffordshire) Limiting long-term illness, 23 17 17 16 18 13 18 17 22 16 18 20 19 18 22 14 19 18 19 14 20 19 17 18 21 16 18 19 18 2011 (%) Age well Older people aged 60 and over living in income- 9 7 6 7 22 23 10 20 10 11 11 18 14 16 18 5 11 20 11 12 6 13 6 11 9 5 11 15 18 deprived households, 2013 (%) Fuel poverty, 2012 (%) 14 9 14 14 15 15 15 21 11 13 9 10 12 14 11 13 20 14 12 7 12 14 12 10 10 9 12 12 10 Lone pensioner households, 16 16 12 12 12 7 14 13 14 13 12 11 14 13 15 10 12 10 10 10 13 15 13 13 14 14 13 13 12 2011 (%) Limiting long-term illness in people aged 65 and over, 50 45 43 41 58 62 42 61 51 44 45 55 51 51 57 43 38 55 47 49 45 52 45 47 49 44 49 53 52 2011 (%) Limiting long-term illness in people aged 75 and over, 69 61 57 58 76 76 64 76 69 61 68 68 67 69 69 59 52 73 62 67 64 69 62 64 68 62 66 69 67 2011 (%) Unpaid care, 2011 (%) 14 12 13 13 8 7 12 8 15 12 13 10 11 10 12 11 13 11 12 10 14 10 15 12 12 13 11 12 10 Unpaid care by people aged 14 16 14 17 11 13 13 10 18 16 16 14 13 11 15 16 14 14 14 13 16 13 20 14 14 17 15 15 14 65 and over, 2011 (%) Excess winter mortality, Aug -5 16 14 51 -2 14 38 22 25 8 18 -9 33 1 25 26 24 34 42 31 33 22 20 49 39 27 22 19 19 2008-July 2013 (%) Die well Life expectancy at birth - 81 85 85 81 80 78 80 76 82 81 82 77 79 80 80 84 80 79 76 81 80 79 81 81 81 83 80 79 79 males (years), 2009-2013 Life expectancy at birth - 81 90 86 87 81 86 84 82 83 89 82 86 82 82 84 85 84 86 81 88 84 85 87 84 82 88 84 83 83 females (years), 2009-2013 All-age, all-cause mortality (ASR per 100,000), 2009- 1,137 620 644 797 1,006 938 946 1,177 985 718 988 927 1,031 985 862 786 1,030 868 1,336 776 911 905 807 782 973 721 923 988 980 2013 Under 75 mortality rate from all causes (ASR per 304 187 260 271 357 407 299 463 284 241 253 398 350 337 357 196 273 362 323 228 310 376 228 292 321 213 296 330 351 100,000), 2009-2013
Insight and Intelligence, Staffordshire County Council Page 44
Compared to England:
and and
Hixon Coton Manor Oulton Milford Walton Fulford Rowley Milwich Stafford England Chartley Baswich Common Penkside Tillington Seighford Holmcroft Eccleshall Littleworth Forebridge Gnosall and Gnosall Swynnerton St. Michael's St. Woodseaves Staffordshire Christchurch Haywood Barlaston Barlaston Church Eaton Highfields and Highfields Stonefield and Weeping Cross Western Downs
Mortality from causes considered preventable 158 111 169 191 232 194 151 262 184 105 123 247 205 187 152 114 120 185 146 125 130 173 161 137 162 112 158 179 184 (various ages) (ASR per 100,000), 2009-2013 Under 75 mortality rate from cancer (ASR per 100,000), 131 111 132 108 133 148 153 165 141 136 107 159 147 100 134 78 104 153 129 93 131 153 107 131 157 94 127 140 146 2009-2013 Under 75 mortality rate from all cardiovascular diseases 70 35 17 82 56 137 42 161 53 37 50 129 95 85 70 43 28 99 54 58 53 96 29 60 56 46 64 76 83 (ASR per 100,000), 2009- 2013 Under 75 mortality rate from respiratory disease (ASR 18 8 9 24 51 28 20 34 25 17 16 25 23 34 58 21 21 33 28 16 18 27 19 47 33 16 25 28 33 per 100,000), 2009-2013 Under 75 mortality rate from liver disease (ASR per 9 18 15 20 21 17 12 28 16 8 14 19 14 16 10 0 12 11 13 0 17 22 12 11 10 12 13 16 18 100,000), 2009-2013 Mortality from communicable diseases 43 27 43 29 35 73 76 43 101 40 36 40 54 46 51 27 84 51 70 39 44 64 51 38 40 45 51 58 62 (ASR per 100,000), 2009- 2013
Insight and Intelligence, Staffordshire County Council Page 45
9 Indicator matrix by district The information in the following matrix is mainly benchmarked against England and colour coded using a similar approach to that used in the Public Health Outcomes Framework tool (http://www.phoutcomes.info/).
It is important to remember that a green box may still indicate an important health and wellbeing problem, for example rates of teenage conceptions are already high across England so even if an area does not have a significantly high rate this does not mean that it is not a public health issue.
Compared to England:
Newcastle- Cannock East South Staffordshire West Time period Lichfield under- Stafford Tamworth Staffordshire England Chase Staffordshire Staffordshire Moorlands Midlands Lyme Demographics Mid-year population estimate 2013 98,119 114,922 101,768 125,239 110,295 132,092 97,415 77,157 857,007 5,674,712 53,865,817 Percentage under five 2013 5.9% 6.4% 5.1% 5.1% 4.5% 5.1% 4.8% 6.5% 5.4% 6.4% 6.3% Percentage under 16 2013 18.4% 19.2% 17.3% 16.7% 15.8% 16.8% 16.3% 19.8% 17.4% 19.5% 19.0% Percentage aged 16-64 2013 64.3% 62.8% 60.6% 63.9% 62.0% 62.5% 60.9% 64.1% 62.6% 62.7% 63.8% Percentage aged 65 and over 2013 17.3% 18.0% 22.1% 19.3% 22.1% 20.7% 22.8% 16.2% 19.9% 17.7% 17.3% Percentage aged 85 and over 2013 2.1% 2.3% 2.6% 2.5% 2.7% 2.7% 2.8% 1.7% 2.4% 2.3% 2.3% Dependency ratio per 100 working age 2013 55.6 59.1 64.9 56.4 61.2 60.0 64.3 56.1 59.7 59.4 56.8 population Dependency ratio of children per 100 2013 28.6 30.5 28.5 26.2 25.5 26.9 26.8 30.8 27.8 31.1 29.7 working age population Dependency ratio of older people per 2013 27.0 28.6 36.5 30.3 35.7 33.1 37.5 25.3 31.8 28.3 27.1 100 working age population Population change between 2013 and 2013-2023 3.5% 6.7% 5.2% 2.4% 2.1% 3.9% 1.7% 4.2% 3.7% 5.6% 7.2% 2023 Population change between 2013 and 2013-2023 -4.8% -0.7% -2.2% -1.7% 0.6% -3.4% -6.0% -5.1% -2.8% 1.6% 2.0% 2023 - under five Population change between 2013 and 2013-2023 -0.4% 6.4% 1.4% 2.5% 0.7% 0.2% 0.6% 1.7% 1.8% 6.9% 9.1% 2023 - under 16s Population change between 2013 and 2013-2023 -1.4% 1.3% -0.7% -2.7% -5.3% -1.7% -5.7% -2.6% -2.3% 1.2% 2.7% 2023 - ages 16-64 Population change between 2013 and 2013-2023 26.0% 25.6% 24.4% 18.9% 23.5% 23.6% 22.0% 34.0% 24.0% 19.5% 21.7% 2023 - 65 and over
Insight and Intelligence, Staffordshire County Council Page 46
Compared to England:
Newcastle- Cannock East South Staffordshire West Time period Lichfield under- Stafford Tamworth Staffordshire England Chase Staffordshire Staffordshire Moorlands Midlands Lyme Population change between 2013 and 2013-2023 57.9% 55.9% 69.2% 38.3% 67.4% 52.2% 55.2% 63.2% 56.5% 43.2% 41.0% 2023 - 85 and over Proportion of population living in rural 2013 9.3% 21.9% 29.5% 20.4% 39.9% 31.9% 30.3% 0.0% 24.0% 14.8% 17.1% areas Population density (people per square 2013 1,244 297 307 594 271 221 169 2,501 327 437 413 km) Proportion of population from minority 2011 3.5% 13.8% 5.4% 6.7% 5.4% 7.4% 2.5% 5.0% 6.4% 20.8% 20.2% ethnic groups National insurance number 2013/14 0.8 8.3 3.4 2.6 0.6 6.8 0.7 2.6 3.4 7.0 10.1 registrations (rate per 1,000) Flag 4 GP patient registrations (rate 2012/13 1.1 8.2 2.1 5.6 1.0 3.5 1.1 2.0 3.3 8.4 10.9 per 1,000) Index of multiple deprivation (IMD) 2010 20.6 19.1 12.7 18.9 11.9 13.1 16.0 19.7 16.4 25.0 21.5 2010 weighted score Percentage in most deprived IMD 2013 11.7% 20.4% 3.7% 15.0% 0.0% 6.0% 4.5% 13.7% 9.4% 28.9% 20.4% 2010 quintile Percentage in second most deprived 2013 30.5% 18.7% 7.9% 23.7% 13.1% 10.5% 16.6% 19.1% 17.3% 18.8% 20.2% IMD 2010 quintile Child Wellbeing Index (CWI) 2009 2009 143 133 92 114 81 111 88 150 114 180 159 weighted score Percentage in most deprived CWI 2013 5.2% 19.4% 0.0% 7.8% 2.1% 7.7% 0.0% 18.4% 7.8% 33.6% 24.4% 2009 national quintile Percentage in second most deprived 2013 30.5% 23.3% 9.1% 18.1% 5.2% 11.5% 13.2% 16.6% 16.1% 19.3% 20.4% CWI 2009 national quintile Mosaic profile - most common 2014 H L B F B A A H H M H geodemographic group Mosaic profile - percentage of 2013 20.5% 12.6% 17.5% 13.0% 15.6% 15.1% 16.5% 23.4% 12.8% 11.6% 10.0% population in the most common group Start well Child poverty: children under 16 in 2012 18.1% 15.1% 12.3% 16.6% 11.8% 11.5% 11.1% 18.6% 14.4% 21.9% 19.2% low-income families Households with children where there 2011 4.1% 3.4% 2.6% 3.2% 2.3% 2.4% 2.3% 4.7% 3.1% 4.8% 4.2% are no adults in employment Lone parent households 2011 10.1% 9.7% 8.2% 9.6% 8.3% 8.4% 8.4% 11.6% 9.2% 11.3% 10.6% General fertility rates per 1,000 2013 62.2 65.8 55.3 49.3 53.1 54.7 51.4 61.2 56.5 64.9 62.4 women aged 15-44 Access to maternity services 2012/13 Q1-Q2 90% 90% 95% 91% 90% 92% 94% 95% 91% 90% 87% Stillbirth rate per 1,000 total births 2011-2013 5.4 4.1 4.1 3.0 5.3 4.7 3.8 5.8 4.5 4.8 4.9
Insight and Intelligence, Staffordshire County Council Page 47
Compared to England:
Newcastle- Cannock East South Staffordshire West Time period Lichfield under- Stafford Tamworth Staffordshire England Chase Staffordshire Staffordshire Moorlands Midlands Lyme Perinatal mortality rate per 1,000 total 2011-2013 8.3 7.7 6.5 7.0 6.7 7.8 6.5 7.5 7.3 8.0 7.1 births Early neonatal mortality rate per 1,000 2011-2013 2.9 3.7 2.4 4.0 1.4 3.1 2.7 1.7 2.9 3.3 2.2 live births Neonatal mortality rate per 1,000 live 2011-2013 3.5 4.6 2.7 4.8 2.9 3.7 2.7 2.4 3.5 4.1 2.9 births Infant mortality rate per 1,000 live 2011-2013 4.9 5.2 3.8 6.2 3.2 6.0 3.9 5.8 5.0 5.6 4.1 births Smoking in pregnancy 2012/13 15.1% 15.1% 15.1% 15.3% 15.1% 15.1% 15.6% 15.1% 15.2% 14.2% 12.7% Low birthweight babies (under 2,500 2011-2013 7.2% 8.3% 8.2% 7.7% 5.8% 6.3% 6.7% 8.0% 7.3% 8.3% 7.4% grams) Low birthweight babies - full term 2012 2.7% 3.1% 2.3% 3.7% 2.2% 2.6% 2.0% 3.3% 2.8% 3.2% 2.8% babies (under 2,500 grams) Breastfeeding initiation rates 2013/14 67.7% 72.1% 76.5% 44.0% 69.0% 52.5% 50.1% 65.6% 62.5% 66.6% 73.9% Breastfeeding prevalence rates at six 2013/14 26.3% 31.6% 38.3% 30.4% 32.0% 38.6% 31.6% 25.3% 31.5% 39.4% 45.8% to eight weeks Diphtheria, tetanus, polio, pertussis, haemophilus influenza type b (Hib) at 2013/14 96.8% 96.8% 98.1% 99.4% 97.1% 97.5% 99.6% 97.1% 97.7% 95.2% 94.3% 12 months Measles, mumps and rubella at 24 2013/14 98.2% 96.6% 98.1% 99.1% 96.8% 97.2% 99.3% 97.5% 97.8% 93.6% 92.7% months Measles, mumps and rubella (first and 2013/14 88.5% 90.2% 91.5% 96.9% 88.5% 88.0% 96.0% 91.6% 91.3% 90.1% 88.3% second doses) at five years Children aged three with tooth decay 2012/13 S 11.4% 0.0% 2.2% 2.3% 9.0% 4.8% 0.0% 4.0% 10.1% 11.7% Children aged five with tooth decay 2011/12 26.2% 21.8% 18.0% 29.0% 13.7% 25.5% 17.1% 19.7% 21.6% 26.0% 27.9% School readiness (Early Years 2014 64.2% 58.7% 64.5% 60.8% 70.8% 70.3% 61.0% 65.1% 64.2% 58.4% 60.4% Foundation Stage) Grow well Pupil absence 2014 4.8% 4.5% 4.2% 4.7% 4.7% 4.5% 4.5% 4.4% 4.5% 4.5% 4.5% Children with special educational 2014 18.8% 16.6% 15.2% 16.1% 16.0% 16.0% 12.7% 19.2% 16.3% 18.6% 17.9% needs Children who claim free school meals 2014 14.5% 12.1% 9.2% 15.1% 8.9% 9.8% 9.5% 15.5% 11.8% 19.0% 16.3% KS2 results - Level 4 or above in 2014 76.5% 71.9% 82.2% 79.7% 76.0% 76.5% 76.9% 73.7% 76.7% 76.9% 78.8% reading, writing and mathematics GCSE attainment (five or more A*-C 2014 GCSEs including English and 46.5% 58.9% 62.8% 50.8% 58.2% 58.8% 57.8% 43.0% 54.9% 54.9% 53.4% provisional mathematics)
Insight and Intelligence, Staffordshire County Council Page 48
Compared to England:
Newcastle- Cannock East South Staffordshire West Time period Lichfield under- Stafford Tamworth Staffordshire England Chase Staffordshire Staffordshire Moorlands Midlands Lyme Young people not in education, employment or training (NEET) 2014 5.5% 3.8% 3.3% 5.3% 3.5% 3.5% 2.5% 4.5% 4.0% n/a n/a (compared to Staffordshire) Unplanned hospital admissions due to 2010/11- alcohol-specific conditions (under 18) 100.8 38.9 48.1 32.0 37.5 73.9 50.8 57.6 54.7 45.4 44.9 2012/13 (rate per 100,000) Children in need (rate per 1,000 2013/14 77.8 80.7 53.0 62.5 45.3 65.7 39.2 85.9 66.8 71.1 67.9 children aged under 18) Looked after children (rate per 1,000 2013/14 6.2 3.8 4.1 6.9 2.0 5.7 4.4 3.9 5.6 7.3 6.0 children aged under 18) Child protection plans (rate per 1,000 2013/14 8.0 3.2 2.3 4.7 1.2 2.9 2.5 7.1 4.7 5.5 5.2 children aged under 18) Excess weight (children aged four to 2013/14 24.5% 25.0% 22.3% 22.6% 24.4% 21.4% 25.2% 24.5% 23.6% 23.5% 22.5% five) Excess weight (children aged 10-11) 2013/14 34.6% 33.0% 30.0% 34.8% 32.6% 29.5% 32.9% 36.1% 32.8% 35.8% 33.5% Obesity (children aged four to five) 2013/14 10.2% 9.5% 9.7% 9.5% 10.0% 7.2% 10.4% 11.1% 9.6% 10.5% 9.5% Obesity (children aged 10-11) 2013/14 20.2% 19.1% 15.1% 18.7% 19.1% 15.2% 18.7% 18.5% 18.0% 21.0% 19.1% Physical activity in children (participation in at least three hours 2009/10 53.1% 63.1% 54.2% 44.7% 57.4% 50.5% 63.9% 61.2% 55.9% 53.0% 55.1% sport / PE) Modelled prevalence of children aged 2009-2012 74.5% 76.8% 76.4% 75.3% 76.6% 76.0% 76.9% 74.2% 75.9% n/a 76.6% 15 who have never smoked Modelled prevalence of children aged 2009-2012 10.1% 8.5% 9.0% 9.5% 8.7% 9.1% 8.7% 10.3% 9.2% n/a 8.7% 15 who are regular smokers Modelled prevalence of children aged 2009-2012 4.4% 4.1% 4.6% 4.3% 4.6% 4.6% 4.2% 4.5% 4.4% n/a 4.0% 15 who are occasional smokers Under-18 conception rates per 1,000 2013 37.4 28.8 31.5 29.5 17.6 26.6 21.1 44.0 29.1 28.9 24.3 girls aged 15-17 Under-16 conception rates per 1,000 2011-2013 6.1 6.9 6.4 6.4 4.0 3.5 5.6 9.5 5.9 6.3 5.5 girls aged 13-15 Chlamydia screening rates (15-24 2013 30.2% 25.1% 31.6% 28.9% 19.7% 25.4% 27.8% 29.9% 27.2% 22.0% 24.9% years) Chlamydia diagnosis (15-24 years) 2013 2,139 1,718 1,945 1,502 1,613 1,438 1,303 2,207 1,699 1,921 2,030 (rate per 100,000) Hospital admissions caused by unintentional and deliberate injuries in 2012/13 248 170 131 132 135 259 106 110 166 144 135 children under five (rate per 10,000)
Insight and Intelligence, Staffordshire County Council Page 49
Compared to England:
Newcastle- Cannock East South Staffordshire West Time period Lichfield under- Stafford Tamworth Staffordshire England Chase Staffordshire Staffordshire Moorlands Midlands Lyme Hospital admissions caused by unintentional and deliberate injuries in 2012/13 158 109 103 106 91 162 89 84 115 106 104 children under 15 (rate per 10,000) Hospital admissions caused by unintentional and deliberate injuries in 2012/13 123 162 134 110 107 143 156 106 130 124 131 young people aged 15-24 (rate per 10,000) Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s 2013/14 417 573 247 492 448 372 397 245 408 394 313 (ASR per 100,000) Hospital admissions - lower respiratory 2013/14 342 348 338 653 387 452 374 308 405 411 356 tract in under 19s (ASR per 100,000) Children with a limiting long-term 2011 4.5% 3.4% 3.6% 3.6% 3.5% 3.8% 3.5% 4.4% 3.8% 4.0% 3.7% illness (under 16) Young people with a limiting long-term 2011 5.4% 5.2% 5.0% 5.1% 4.6% 5.5% 4.8% 6.0% 5.2% 5.4% 5.2% illness (16-24) Under 15 childhood mortality rates 2011-2013 34.6 38.7 40.7 50.6 26.3 46.8 32.5 43.2 39.9 45.8 35.9 (ASR per 100,000) Live well Adults with NVQ level 1 or above (16- 2013 84.4% 81.0% 83.8% 82.7% 90.1% 85.7% 82.0% 76.8% 83.6% 79.2% 84.5% 64) Adults with no qualifications (16-64) 2013 10.9% 9.5% 10.6% 9.9% 4.9% 9.1% 11.1% 17.7% 10.1% 13.6% 9.2% People in employment (aged 16-64) 2013/14 69.3% 82.6% 73.5% 71.8% 73.9% 76.5% 70.5% 71.8% 74.0% 69.2% 71.7% Unemployment (16-64 year olds Feb-15 1.4% 1.3% 0.8% 1.4% 1.2% 0.8% 0.9% 0.7% 1.1% 2.5% 2.0% claiming jobseekers allowance) Youth unemployment (16-24 year olds Feb-15 3.2% 2.6% 1.7% 1.8% 2.6% 1.5% 1.9% 1.8% 2.1% 4.0% 3.1% claiming jobseekers allowance) Gap in the employment rate between those with a long-term health condition 2013/14 13.2% 8.2% 3.7% 8.1% -0.5% 7.4% 13.7% 43.5% 11.7% 9.6% 8.7% and the overall employment rate Proportion of adults with learning 2013/14 4.3% 2.2% 5.7% 4.6% 4.6% 8.0% 4.5% 4.2% 5.2% 4.9% 6.7% disabilities in paid employment People with a learning disability who live in stable and appropriate 2013/14 46.5% 54.6% 88.0% 34.0% 90.7% 65.8% 75.7% 54.0% 72.7% 68.9% 74.9% accommodation Sickness absence - employees who had at least one day off in the previous 2010-2012 1.0% 1.6% 0.7% 2.1% 3.6% 1.4% 3.4% 0.5% 1.9% 2.3% 2.5% week
Insight and Intelligence, Staffordshire County Council Page 50
Compared to England:
Newcastle- Cannock East South Staffordshire West Time period Lichfield under- Stafford Tamworth Staffordshire England Chase Staffordshire Staffordshire Moorlands Midlands Lyme Sickness absence - working days lost 2010-2012 1.0% 1.4% 0.7% 1.8% 2.6% 0.8% 2.8% 0.5% 1.5% 1.5% 1.6% due to sickness absence Average household income 2012 £35,200 £37,800 £45,900 £34,600 £43,300 £41,700 £36,200 £36,800 £39,000 £35,600 £40,000 Households with an income under 2012 35.4% 35.7% 26.7% 39.3% 28.4% 30.9% 35.8% 32.7% 33.2% 38.6% 34.6% £20K (compared to Great Britain) Owner occupied households 2011 69.7% 70.1% 76.2% 69.5% 76.3% 72.1% 80.0% 68.7% 72.8% 65.6% 64.1% Privately rented households 2011 12.1% 15.1% 9.5% 10.5% 8.5% 12.9% 9.8% 11.0% 11.3% 14.0% 16.8% Socially rented households 2011 16.9% 13.5% 13.2% 18.7% 13.9% 13.7% 8.9% 19.3% 14.7% 19.0% 17.7% Living rent free households 2011 1.2% 1.3% 1.1% 1.3% 1.3% 1.3% 1.3% 0.9% 1.2% 1.5% 1.3% Households with no central heating 2011 1.6% 3.9% 1.6% 1.8% 1.9% 1.9% 2.4% 1.9% 2.1% 2.9% 2.7% Overcrowded households 2011 3.0% 3.1% 2.4% 2.7% 2.2% 1.9% 1.9% 2.7% 2.5% 4.5% 4.6% Estimated private sector households 2009 29.6% 38.7% 31.6% 35.9% 32.2% 33.0% 41.5% 25.9% 34.1% 36.7% 36.0% failing to meet decent homes standard Fuel poverty 2012 11.1% 14.6% 10.9% 13.4% 10.5% 12.4% 13.5% 10.1% 12.2% 15.1% 10.4% Statutory homelessness - homelessness acceptances per 1,000 2013/14 1.0 1.6 1.5 0.3 0.6 0.9 1.6 2.1 1.1 3.4 2.3 households Statutory homelessness - households in temporary accommodation per 2013/14 0.1 0.2 0.5 0.1 0.1 0.1 0.4 0.2 0.2 0.7 2.6 1,000 households Access to private transport - 2011 20.2% 21.4% 13.6% 22.1% 13.2% 17.5% 14.8% 20.6% 18.0% 24.7% 25.8% households with no cars or vans Satisfied with area as a place to live October 2013- 93.1% 93.6% 85.8% 93.8% 94.6% 92.9% 96.4% 94.4% 93.1% n/a n/a (compared to Staffordshire) October 2014 Residents who felt fearful of being a October 2013- victim of crime (compared to 9.6% 12.4% 25.4% 10.8% 9.2% 10.6% 5.5% 18.7% 12.8% n/a n/a October 2014 Staffordshire) People who have experienced crime October 2013- 7.3% 7.3% 13.9% 11.1% 9.2% 11.3% 9.9% 10.2% 10.0% n/a n/a (compared to Staffordshire) October 2014 Total recorded crime (rate per 1,000) 2013/14 49 48 35 52 36 42 38 57 45 56 61 Violent crime (rate per 1,000) 2013/14 12.5 12.4 7.4 13.5 7.1 9.8 10.8 13.6 10.8 11.1 11.0 Violent crime with injury (rate per 2013/14 6.2 6.4 3.6 6.8 3.5 4.7 5.8 7.0 5.5 6.2 5.6 1,000) Antisocial behaviour (rate per 1,000) 2013/14 28 25 19 30 17 23 20 25 23 30 37
Insight and Intelligence, Staffordshire County Council Page 51
Compared to England:
Newcastle- Cannock East South Staffordshire West Time period Lichfield under- Stafford Tamworth Staffordshire England Chase Staffordshire Staffordshire Moorlands Midlands Lyme Alcohol-related crime (rate per 1,000) 2012/13 5.3 5.3 3.3 5.1 3.4 4.0 3.7 5.9 4.5 5.6 5.7 Domestic abuse (rate per 1,000) 2013/14 4.2 3.8 2.3 4.6 2.3 3.2 3.3 4.5 3.5 n/a n/a (compared to Staffordshire) Re-offending levels (adults) 2012/13 21.3% 23.2% 18.0% 23.5% 20.4% 22.8% 19.1% 21.7% 21.7% 23.6% 24.8% Re-offending levels (juveniles) 2012/13 44.8% 38.2% 29.5% 31.8% 42.2% 40.8% 38.7% 50.0% 39.6% 31.8% 36.0% Breast cancer screening 2014 78.3% 78.2% 79.1% 80.6% 79.7% 80.3% 81.8% 75.3% 79.4% 76.5% 75.9% Cervical screening 2014 74.4% 74.1% 77.3% 75.7% 77.8% 75.3% 77.2% 76.9% 76.0% 73.0% 74.2% Bowel cancer screening 2013 58.5% 59.6% 63.7% 60.5% 64.3% 62.2% 65.5% 60.6% 61.9% 58.5% 58.8% NHS health checks offered (as a 2013/14 19.8% 17.6% 22.4% 19.8% 12.1% 14.6% 25.0% 38.0% 21.1% 22.1% 18.5% proportion of those eligible) NHS health checks received (as a 2013/14 54.5% 51.1% 44.4% 46.2% 52.5% 32.6% 41.3% 18.8% 41.3% 44.7% 49.0% proportion of those offered) NHS health checks received (as a 2013/14 10.8% 9.0% 9.9% 9.1% 6.3% 4.8% 10.3% 7.1% 8.7% 9.9% 9.0% proportion of those eligible) Depression prevalence (ages 18+) 2013/14 7.0% 6.0% 5.8% 7.6% 5.0% 6.3% 6.8% 8.4% 6.6% 6.7% 6.5% Mental health prevalence 2013/14 0.6% 0.6% 0.7% 0.7% 0.5% 0.7% 0.8% 0.7% 0.6% 0.8% 0.9% Suicides and injuries undetermined 2011-2013 11.7 9.6 10.7 12.6 9.6 13.3 9.9 8.2 10.8 9.9 10.4 (ages 15+) (ASR per 100,000) Self-harm admissions (ASR per 2012/13 166.4 211.0 147.6 262.6 110.5 215.9 200.2 169.9 187.4 199.8 188.0 100,000) Learning disabilities prevalence (ages 2013/14 0.5% 0.5% 0.4% 0.4% 0.3% 0.3% 0.5% 0.5% 0.4% 0.5% 0.5% 18+) Proportion of disability living allowance Aug-14 6.6% 4.3% 4.5% 5.7% 4.4% 4.3% 5.1% 6.1% 5.0% 5.5% 4.9% claimants Limiting long-term illness 2011 20.7% 17.7% 18.1% 20.8% 18.7% 18.2% 21.1% 17.9% 19.2% 19.0% 17.6% Smoking prevalence (18+) 2013 20.0% 16.9% 15.7% 21.1% 17.3% 13.3% 9.5% 10.0% 15.8% 17.8% 18.4% Smoking prevalence in manual 2013 22.2% 20.3% 28.3% 31.4% 21.9% 26.5% 6.6% 15.1% 22.1% 26.4% 28.6% workers (18+) Smoking prevalence (15+) (QOF 2013/14 23.7% 23.1% 19.9% 22.9% 17.5% 19.5% 19.9% 25.1% 21.4% 22.7% 22.3% registers) Smoking attributable mortality (ASR 2011-2013 346 277 229 324 251 242 253 273 272 283 289 per 100,000) Smoking-attributable admissions (ASR 2012/13 2,331 1,818 1,654 2,073 1,437 1,665 1,442 1,826 1,762 1,725 1,688 per 100,000)
Insight and Intelligence, Staffordshire County Council Page 52
Compared to England:
Newcastle- Cannock East South Staffordshire West Time period Lichfield under- Stafford Tamworth Staffordshire England Chase Staffordshire Staffordshire Moorlands Midlands Lyme Access to stop smoking services (rate 2013/14 82.2 101.5 68.3 47.6 70.6 110.5 86.9 172.2 87.3 86.5 75.0 per 1,000 smokers) Smoking quit rates at four weeks 2013/14 56.1% 56.2% 60.0% 61.7% 46.6% 52.1% 56.7% 54.7% 55.4% 52.6% 51.3% Binge drinking (synthetic estimates) 2007-2008 20.4% 18.9% 19.1% 21.8% 20.0% 21.4% 20.5% 22.3% 20.5% 18.8% 20.1% Alcohol-related admissions (narrow 2013/14 704 716 602 901 650 699 657 590 697 669 634 definition) (ASR per 100,000) provisional Alcohol-related admissions (broad 2013/14 2,125 1,974 1,773 2,254 1,888 1,851 1,755 1,928 1,943 2,108 2,073 definition) (ASR per 100,000) provisional Alcohol-specific mortality - men (ASR 2010-2012 17.8 16.6 10.2 17.4 16.1 11.3 9.7 17.9 n/a 17.7 14.6 per 100,000) Alcohol-specific mortality - women 2010-2012 8.6 7.2 6.5 16.8 7.3 7.6 10.0 5.1 n/a 8.7 6.8 (ASR per 100,000) Estimated problem drug users (PDUs) using crack and/or opiates (rate per 2010/11 8.7 7.8 3.1 6.6 2.6 3.9 5.4 5.9 5.5 9.6 8.6 1,000) Number of PDUs in effective treatment 2013/14 53.9% 62.3% 77.3% 72.0% 58.4% 71.7% 63.6% 60.4% 64.3% 61.1% 60.9% Adults who are overweight or obese 2012 62.5% 71.6% 66.7% 63.4% 69.5% 69.6% 70.0% 70.7% 67.9% 65.7% 63.8% (excess weight) Adults who are obese 2012 30.3% 31.0% 23.5% 18.0% 23.2% 21.4% 24.1% 27.4% 24.4% 24.5% 23.0% Healthy eating - 5-a-Day (synthetic 2006-2008 22.5% 27.1% 28.4% 25.5% 26.7% 29.1% 25.5% 21.9% 26.1% 25.7% 28.7% estimates) Physical activity in adults 2013 49.2% 55.7% 58.7% 58.4% 61.6% 56.2% 52.7% 52.3% 55.9% 53.9% 56.0% Physical inactivity in adults 2013 29.9% 29.1% 24.1% 28.1% 26.1% 26.2% 25.1% 33.7% 27.6% 30.5% 28.3% All acute sexually transmitted 2013 687 707 546 473 486 544 328 675 552 724 805 infections (rate per 100,000) Pelvic inflammatory disease (PID) admissions rate (rate per 100,000 2012/13 417 208 146 220 270 321 274 162 255 239 228 women aged 15-44) Offered HIV test - GUM attendees 2013 85.2% 86.4% 76.3% 92.9% 70.3% 84.9% 92.0% 76.2% 82.4% 87.6% 86.1% Received HIV test - GUM attendees 2013 77.5% 77.6% 68.8% 81.1% 56.4% 79.0% 79.8% 65.9% 72.9% 73.9% 71.0% HIV prevalence in people aged 15-59 2013 0.55 0.94 0.64 0.73 0.64 0.62 0.56 0.55 0.66 1.54 2.14 (rate per 1,000) Late HIV diagnosis 2011-2013 S 33% 50% 75% 83% 64% S 67% 60% 54% 45% Sexual violence (rate per 1,000) 2013/14 1.0 1.3 0.7 1.3 0.7 1.1 0.9 1.3 1.0 1.0 1.0
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Compared to England:
Newcastle- Cannock East South Staffordshire West Time period Lichfield under- Stafford Tamworth Staffordshire England Chase Staffordshire Staffordshire Moorlands Midlands Lyme Age well Disability free life expectancy - males 2007-2009 46.1 46.4 52.2 45.8 52.2 50.5 47.8 46.7 n/a 48.4 49.1 at 16 (years) Disability free life expectancy - 2007-2009 47.0 50.7 51.5 46.3 51.1 53.2 50.1 45.3 n/a 49.6 50.1 females at 16 (years) Disability free life expectancy - males 2007-2009 9.0 8.1 12.1 8.7 10.9 11.3 10.8 6.6 n/a 9.9 10.2 at 65 (years) Disability free life expectancy - 2007-2009 10.2 11.4 11.1 7.7 11.1 13.4 11.9 7.7 n/a 10.7 10.9 females at 65 (years) Older people aged 60 and over living 2013 20.8% 14.7% 12.8% 15.7% 14.7% 11.4% 13.8% 20.8% 15.0% 20.6% 18.0% in income-deprived households People aged 65 and over in 2013/14 S 6.7% 14.1% 10.5% 13.1% 12.3% 9.0% 11.1% 9.9% 9.6% 9.9% employment Lone pensioner households 2011 11.4% 12.4% 12.2% 13.5% 13.3% 12.8% 13.5% 10.9% 12.6% 12.6% 12.4% Older people feeling safe at night October 2013- (people aged 65 and over) (compared 92.5% 77.1% 66.7% 81.8% 79.5% 84.1% 81.5% 77.1% 79.4% n/a n/a October 2014 to Staffordshire) Seasonal flu - people aged 65 and 2013/14 68.1% 70.8% 69.7% 73.7% 71.3% 69.3% 70.1% 73.8% 70.8% 72.4% 73.2% over Seasonal flu - people aged under 65 2013/14 48.3% 49.9% 48.1% 55.1% 50.7% 46.7% 52.8% 50.9% 50.4% 52.8% 52.3% at risk Pneumococcal vaccine in people aged 2013/14 63.2% 67.3% 69.8% 62.6% 63.1% 64.4% 60.4% 72.1% 65.1% 68.1% 69.1% 65 and over Limiting long-term illness in people 2011 60.9% 51.4% 48.2% 57.4% 49.4% 48.5% 53.3% 55.8% 52.6% 54.1% 51.5% aged 65 and over Limiting long-term illness in people 2011 77.4% 67.8% 67.1% 72.4% 66.4% 65.9% 70.2% 71.1% 69.4% 69.5% 66.6% aged 75 and over Asthma prevalence 2013/14 5.9% 5.9% 5.9% 6.2% 5.8% 5.7% 6.5% 6.3% 6.0% 6.1% 5.9% Atrial fibrillation prevalence 2013/14 1.7% 1.6% 1.8% 1.9% 2.0% 1.9% 2.2% 1.5% 1.8% 1.6% 1.6% Cancer prevalence 2013/14 2.3% 2.4% 2.5% 2.3% 2.7% 2.7% 2.5% 2.4% 2.5% 2.1% 2.1% Chronic kidney disease prevalence 2013/14 4.1% 4.5% 3.6% 4.0% 4.6% 4.0% 4.4% 3.7% 4.1% 4.6% 4.0% (ages 18+) Chronic obstructive pulmonary 2013/14 2.2% 1.7% 1.7% 2.3% 1.5% 1.4% 1.9% 2.0% 1.8% 1.8% 1.8% disease prevalence Coronary heart disease prevalence 2013/14 4.1% 3.3% 3.8% 3.8% 3.9% 3.7% 4.3% 3.4% 3.8% 3.4% 3.3% Diabetes prevalence (ages 17+) 2013/14 6.9% 6.6% 6.5% 7.0% 6.6% 6.2% 7.2% 6.6% 6.7% 7.1% 6.2%
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Compared to England:
Newcastle- Cannock East South Staffordshire West Time period Lichfield under- Stafford Tamworth Staffordshire England Chase Staffordshire Staffordshire Moorlands Midlands Lyme Epilepsy prevalence (ages 18+) 2013/14 1.0% 0.9% 0.8% 0.9% 0.8% 0.9% 0.9% 0.8% 0.9% 0.9% 0.8% Heart failure prevalence 2013/14 0.8% 0.8% 0.8% 0.8% 0.8% 0.7% 0.8% 0.7% 0.8% 0.8% 0.7% Hypertension prevalence 2013/14 14.9% 13.9% 15.3% 15.8% 16.7% 15.2% 18.3% 13.6% 15.4% 14.8% 13.7% Hypothyroidism prevalence 2013/14 4.1% 3.6% 3.6% 3.1% 3.9% 3.9% 3.6% 3.3% 3.6% 3.4% 3.3% Obesity prevalence (ages 16+) 2013/14 13.6% 10.5% 10.5% 10.8% 9.5% 8.6% 11.4% 12.4% 10.8% 10.3% 9.4% Osteoporosis prevalence 2013/14 0.3% 0.5% 0.3% 0.4% 0.3% 0.4% 0.4% 0.3% 0.4% 0.4% 0.4% Palliative care prevalence 2013/14 0.7% 0.6% 0.7% 0.7% 0.6% 0.7% 0.7% 0.6% 0.7% 0.7% 0.6% Peripheral arterial disease prevalence 2013/14 0.3% 0.1% 0.2% 0.3% 0.2% 0.2% 0.3% 0.2% 0.2% 0.3% 0.3% Rheumatoid arthritis prevalence (ages 2013/14 1.0% 0.8% 0.9% 0.8% 1.0% 0.9% 0.9% 0.9% 0.9% 0.8% 0.7% 16+) Stroke or transient ischaemic attacks 2013/14 1.9% 1.7% 1.9% 2.3% 2.0% 2.0% 2.5% 1.8% 2.0% 1.8% 1.7% prevalence Dementia prevalence 2013/14 0.6% 0.6% 0.5% 0.8% 0.6% 0.6% 0.6% 0.5% 0.6% 0.6% 0.6% Estimated dementia diagnosis rate 2013/14 50.2% 51.2% 40.6% 50.8% 42.9% 47.0% 38.6% 48.1% 46.4% 50.6% 51.9% (recorded / expected) Acute ambulatory care sensitive (ACS) 2013/14 1,373 1,211 1,108 1,608 1,235 1,342 1,250 1,335 1,313 1,360 1,196 conditions (ASR per 100,000) Chronic ambulatory care sensitive 2013/14 846 947 755 924 624 632 705 887 780 872 800 (ACS) conditions (ASR per 100,000) People receiving social care who 2013/14 24.7% 18.8% 24.7% 21.7% 24.1% 22.0% 26.9% 23.9% 26.2% 51.1% 61.9% receive self-directed support Proportion of people using social care 2013/14 9.3% 10.3% 8.5% 8.4% 10.5% 14.2% 12.5% 10.9% 10.6% 16.8% 19.1% who receive direct payments Permanent admissions to residential and nursing care homes for people 2013/14 734 591 440 755 536 783 630 697 655 663 651 aged 65 and over (rate per 100,000) People aged 65 and over who were still at home 91 days after discharge 2013/14 85.2% 82.5% 84.9% 92.9% 90.0% 80.0% 91.3% 92.5% 86.3% 82.4% 82.5% from hospital into reablement / rehabilitation services Provision of unpaid care 2011 12.1% 10.1% 11.5% 11.9% 12.5% 11.5% 12.9% 10.6% 11.6% 11.0% 10.2% Provision of unpaid care by people 2011 16.1% 13.3% 15.4% 15.0% 15.3% 14.7% 15.3% 14.8% 15.0% 14.5% 13.8% aged 65 and over Falls admissions in people aged 65 2012/13 1,868 2,330 2,095 2,304 1,747 2,012 1,959 2,417 2,071 1,951 2,011 and over (ASR per 100,000)
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Compared to England:
Newcastle- Cannock East South Staffordshire West Time period Lichfield under- Stafford Tamworth Staffordshire England Chase Staffordshire Staffordshire Moorlands Midlands Lyme Hip fractures in people aged 65 and 2012/13 637 622 591 625 586 658 547 680 613 588 568 over (ASR per 100,000) Accidental mortality (ASR per 2011-2013 27.7 32.8 28.8 32.8 21.7 24.0 24.4 33.7 27.7 24.2 21.5 100,000) Accidental mortality in people aged 65 2011-2013 102.1 113.3 106.4 115.5 77.8 85.8 89.9 134.7 100.2 81.1 69.1 and over (ASR per 100,000) Mortality from accidental falls (ASR 2011-2013 14.5 17.0 15.2 19.0 10.4 13.4 14.1 22.6 15.3 10.5 7.7 per 100,000) August 2012 to Excess winter mortality 25.6% 27.9% 19.9% 34.2% 25.8% 21.3% 31.0% 14.8% 25.7% 21.6% 20.1% July 2013 Excess winter mortality in people aged August 2012 to 16.7% 63.9% 47.8% 40.5% 18.0% 5.5% 43.4% 7.0% 29.8% 27.8% 28.2% 85 and over July 2013 Die well Life expectancy at birth - males 2011-2013 79.2 79.2 80.0 78.6 80.4 80.4 79.9 79.8 79.7 78.8 79.4 (years) Life expectancy at birth - females 2011-2013 83.2 82.6 83.5 82.6 83.3 83.5 83.2 82.6 83.1 82.8 83.1 (years) Inequalities in life expectancy - males 2011-2013 6.8 6.6 5.2 8.8 5.0 6.5 4.1 7.0 6.6 9.2 9.1 (slope index of inequality) (years) Inequalities in life expectancy - females (slope index of inequality) 2011-2013 4.9 6.7 10.0 6.7 7.7 7.5 3.5 6.8 6.3 6.8 6.9 (years) All-age, all-cause mortality (ASR per 2011-2013 993 1,017 965 1,056 967 924 976 1,003 986 1,001 978 100,000) Under 75 mortality rate from all causes 2011-2013 359 342 298 347 292 293 315 330 320 359 342 (ASR per 100,000) Mortality from causes considered preventable (various ages) (ASR per 2011-2013 194 190 168 194 159 152 169 190 175 192 184 100,000) Under 75 mortality rate from cancer 2011-2013 152 149 127 130 143 127 134 140 137 148 144 (ASR per 100,000) Under 75 mortality rate from all cardiovascular diseases (ASR per 2011-2013 86 77 66 83 56 64 71 68 71 82 78 100,000) Under 75 mortality rate from 2011-2013 26.8 27.5 21.8 37.7 23.0 23.7 27.7 31.2 27.2 34.1 33.2 respiratory disease (ASR per 100,000) Under 75 mortality rate from liver 2011-2013 18.7 15.7 13.5 17.6 14.4 14.1 13.8 20.2 15.8 19.1 17.9 disease (ASR per 100,000) Mortality from communicable diseases 2011-2013 51.8 55.6 49.2 80.7 46.9 52.7 66.4 62.6 58.2 60.7 62.2 (ASR per 100,000)
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Compared to England:
Newcastle- Cannock East South Staffordshire West Time period Lichfield under- Stafford Tamworth Staffordshire England Chase Staffordshire Staffordshire Moorlands Midlands Lyme End of life: proportion dying at home 2013 42.6% 38.8% 45.9% 42.6% 43.8% 45.2% 44.4% 39.4% 43.1% 39.5% 41.3% or usual place of residence End of life: proportion dying at hospital 2013 50.3% 56.2% 46.9% 49.4% 48.9% 46.8% 47.4% 53.8% 49.6% 53.2% 50.9% End of life: proportion dying at hospice 2013 5.8% 3.3% 4.9% 6.2% 5.8% 7.0% 6.5% 5.5% 5.7% 5.4% 5.6% End of life: proportion dying in other 2013 1.4% 1.7% 2.3% 1.8% 1.5% 0.9% 1.7% 1.3% 1.6% 1.9% 2.1% settings
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Item: 14 Enc: 10
REPORT TO THE Clinical Commissioning Group Governing Body Meeting TO BE HELD ON: Thursday 4th February 2016
Subject: Commissioning Support Services – Lead Provider Framework Board Lead: Andrew Donald Officer Lead: Paul Simpson For For For For Recommendation: Approval Ratification Discussion Information
PURPOSE OF THE REPORT: The Governing Body is aware that, Cannock Chase, South East Staffordshire & Seisdon Peninsula and Stafford & Surrounds CCGs (the CCGs) currently procure a range of “back office” services from Midlands and Lancashire Commissioning Support Unit (MLCSU). These services are provided under a Service Level Agreement. The services are common across the 3 CCG’s, albeit there are some shared arrangements amongst SES&SP CCG and East Staffordshire CCG. Whilst there is no definitive “drop off date” for when these services must be subject to a procurement process, the risk of legal challenge to our existing arrangements, along with NHSE expectations that good progress will be made over the next 12-18 months, suggests that it would be advisable for the CCG to have commenced this process in 2016, with a target contract start date of April 2017. By that point, a procurement process, which complies with EU procurement law, will need to have been undertaken which demonstrates the commissioning of quality support services which meet the needs of the organisation and which demonstrate value for money. CCGs nationally are at various stages in this process; some have already re-procured a provider, others are in a similar position to the Staffordshire CCGs. The CCGs may also consider whether any of the existing services could be provided “internally” rather than out-sourced. Any such proposals would be subject to the approval of a separate Business Case by NHS England.
KEY POINTS: 1. Background 1.1. The CCGs currently have a service level agreement in place with Midlands and Lancashire Commissioning Support Unit (MLCSU) for the delivery of a number of support services, on our behalf. The value of the service level agreement that is in place for Cannock Chase CCG in 2015/2016 is £1.603m. 1.2. In accordance with best practice, the CCGs will need to have undertaken a review of all support services received and have new contracts in place with either one or a number of support service suppliers over the course of the next 12-18 months. The process for doing this is by means of a procurement, which tests the market and allows the CCGs to compare and contrast service offers from a number of providers be they private or public sector.
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1.3. In order to facilitate this process, during 2014/2015, NHS England undertook a piece of work to establish a Lead Provider Framework (LPF), the results of which were announced at the end of January 2015. The successful organisations appointed to the LPF consist of both existing NHS commissioning support units and private sector providers. 1.4. A LPF enables CCGs to call-off any or all-commissioning support services through a process of mini-procurements from a list of suppliers who have successfully been through the first stages of a full procurement process and have been robustly quality assured to ensure that they are excellent and affordable providers. 1.5. Appointment as a lead provider is via a formal, open, transparent OJEU procurement and appointment to the framework is based on the quality of services delivered and the prices submitted for services to be delivered. Having said that, the use of the LPF is voluntary for CCGs, but should the CCG not decide to use the framework agreement in place, it will need to undertake a full EU procurement law compliant, OJEU procurement process for which we will need to secure external support. Due to a conflict of interest, we would not be able to utilise the support provided by MLCSU. 2. Current Services Procured from the CSU to Stafford & Surrounds CCG Service Line
Business Intelligence Communications & Engagement Finance Governance & Legal Human Resources Employment Services Contract Management Quality & Performance Procurement IT Support
3. Benefits of using the Commissioning Support Service Lead Provider Framework 3.1. By using the LPF, the CCGs can undertake the process safe in the knowledge that the EU procurement law has been fully complied with. As such, a significant amount of time and expense incurred during procurement has already been expended. The CCGs are able to run a mini-procurement process limited to those organisations appointed to the framework, safe in the knowledge that they have already been robustly quality assured for the services they deliver and the prices they are offering. 3.2. Entering into a full procurement would mean repeating all the work that has already been undertaken by NHS England in establishing the LPF, which could take up to 12-months to complete, as opposed to the timeframe for a mini-procurement of 4-6 months. 3.3. As part of the framework agreement, NHS England have been able to negotiate volume based discounts which will only be available to those organisations who use the LPF. They have also commissioned independent support services (legal and procurement) for CCGs to access at no charge in order to undertake mini-procurements. 4. Approved Suppliers on the Lead Provider Framework 4.1. The services available under the LPF are grouped into lots: Lot 1 (end to end commissioning
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support), Lot 2A (medicines management) and Lot 2b (supporting Continuing Healthcare and Individual Funding Requests). 4.2. There are 10 organisations who have been accredited to provide commissioning support services in Lot 1 (the Lot containing the most common grouping of services procured by CCGs): Capita MBED (Mouchel, BDO, Engine, Dr Foster) NHS Arden-GEM Partnership (AGP) NHS Central Southern CSU* NHS Midlands and Lancashire CSU NHS North East London CSU NHS North of England CSU (NECS) NHS South and West Commissioning Support Alliance (SaWCS)* NHS South East CSU Optum
4.3. Since the accreditation process, there has been a merger between Central Southern CSU and South and West Commissioning Support Alliance to create South Central and West CSU. Therefore, there are now 9 organisations on the framework. It is likely that geography will play a part in determining which organisations bid for services. 5. Process 5.1. The process to be followed is a mini-competition, also called Invitation to Tender or Call-off which usually takes between 2-3 months depending on complexity, see below.
6. Further Considerations 6.1. NHS England request that CCGs consider and identify with their neighbouring CCGs where it makes sense for organisations to buy together, or release their tenders at the same time in order to make best use of the volume based discounts on offer. As CC, SES&SP and S&S CCGs now have a shared management structure, it is assumed that the 3 will work together on this process. The CCGs therefore need to consider whether they should look to collaborate
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with the remaining other Staffordshire/Stoke CCGs. 6.2. There are benefits to working with other organisations and two approaches are recommended: COLLABORATIVE Single set of tender documents Single specification or separate schedules for each CCG Single provider awarded contract 1 CCG signs on behalf of others OR all CCGs party to the agreement (underpinned where necessary by ‘collaboration agreement’) – agreeing the manage the contract either collectively or through lead CCG
COORDINATED Each CCG has set of tender documents submitted to framework bidders in parallel Each CCG evaluates and appoints preferred provider Each CCG manages own contract
6.3. The collaborative approach will deliver greater savings because service providers will deliver the same product to all customers and manage to one set of contract terms. On this basis, we have agreed to work collaboratively with East Staffordshire, North Staffordshire and Stoke-on- Trent CCGs to re-procure services and a formal collaborative agreement is in development. This process is being coordinated by the respective CFO’s and NHSE have provided a Project Manager, who has supported a similar process in the North West, and will lead on the development of a project plan. 6.4. The other primary consideration is the specification itself i.e. the actual services that the CCGs are looking to procure. Currently, a significant proportion of back-office services are effectively outsourced to the CSU. There is the option for the CCGs to bring back in-house a range of services (some such as elements of Business Intelligence, have to remain “out-sourced” due to issues of scale/volume). These considerations will be built into the planning process but any proposal to bring in-house services currently provided by the CSU would be subject to a separate Business Case, which requires sign-off by NHS England. This decision would clearly need to be made, and endorsed, before the final specification for services to be procured through the LPF was agreed (albeit it could be left sufficiently flexible to allow services to be added in/taken out). 6.5. As the lead officer for this piece of work, it is suggested that the GB delegate to the Director of Finance, the authority to agree the exact content of the specification, subject to appropriate consultation with senior CCG staff and other key stakeholders e.g. the Chair of Finance, Performance & Contracts Committee. 7. Timetable 7.1. The outline timetable for the LPF procurement process (which is indicative at this time) is set out below: Procurement Stage Date (these dates are indicative at this stage)
Pre-procurement/ preparation of tender documents Complete by May 2016 Issue Invitation to Tender documents to NHSE for Early/Mid-July 2016 review/sign off Joint Bidder Briefing Session End of August 2016 Return of Tenders End Sept 2016 Page | 4
Item: 14 Enc: 10
Evaluation Process Completed by Nov 2016 Prepare Contract Award Recommendation papers By mid-end Nov 2016 Governing Body Approval Process Complete end Nov/early Dec Contract Mobilisation Phase From mid Dec 2016 8. Risks 8.1. The risks identified fall into a range of categories: 1. Timetabling risks – associated with developing suitable service specifications and KPIs and other procurement documentation, and the time allocated for mobilisation as detailed above. Also risk to the 2017/18 planning process if timetable not adhered to. 2. Collaborative working – risks associated with working with other CCGs and the requirement to reach agreement on a range of issues from service specifications to savings within the contract term. 3. Internal capacity – for the CCG to participate fully within the process and safeguard our interests. 4. Financial – associated with the potential for bidders to fail to provide services within the agreed financial envelope or meet any savings requirements throughout the life of the contract. Appropriate steps will be taken to ensure that the CCG’s can mitigate these risks
8.2. With these risks in mind, it is suggested that the Governing Body request that an update is provided to a future GB meeting, to ensure that the process is delivering against the anticipated timescales and project plan. 9. Conclusion 9.1. In order to comply with best practice and to avoid any legal challenges to the CCG’s, associated with potential non-compliance with EU Procurement law the CCGs need to undertake a procurement exercise for the delivery of commissioning support services. The CCGs are utilising the commissioning support service LPF to run a mini-tender exercise, in conjunction with the other Staffordshire CCGs, with the aim of having a new contract in place by 1 April 2017.
RECOMMENDATIONS/ACTION REQUIRED: The CCG Governing Body is asked to: Note the contents of this report Endorse the decision to use the Commissioning Support Service Lead Provider Framework to run a mini-procurement exercise to award a commissioning support service contract from 01 April 2017. Endorse the proposal for the CCGs to work in collaboration with the other Staffordshire CCGs on a joint procurement process. Delegate to the Director of Finance the decision as to which services to include in the specification, subject to appropriate consultation with key staff and other stakeholders. Request an update on the process is bought back to the GB at an appropriate time.
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RELEVANCE TO KEY GOALS To reduce health inequalities across Cannock Chase through targeted interventions. To identify and support patients with Long Term Conditions to ensure care delivery N/A closer to home. To improve and increase overall life expectancy. To develop integrated services with simple, easy access.
IMPLICATIONS Establishing a new contract by 1 April 2017, would avoid any potential Legal and/or Risk legal challenge for non-compliance with EU Procurement Law. CQC N/A Patient Safety N/A Patient Engagement N/A The costs of re-procurement should be minimised through use of the LPF Process. The costs of the contract itself will be determined by the scope of the services being procured, but with the reduction in running costs, Financial CCGs will be expecting to deliver the support services within existing resources, and potentially the procurement should deliver some cost reductions. Sustainability N/A Workforce/Training N/A
KEY REQUIREMENTS Yes No Not Applicable All key requirements will Has a quality impact assessment been undertaken? be addressed as part of the procurement process. Has an equality impact assessment been undertaken? Has a privacy impact assessment been completed? Have partners/public been involved in design? Are partners/public involved in implementation? Are partners/public involved in evaluation?
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Enc 11-1
FINANCE, PERFORMANCE AND CONTRACTS (FPC) COMMITTEE
Tuesday 22 September 2015 2.00 pm – 5.00 pm Dining Room, County Buildings, Martin Street, Stafford ST16 2LH
MINUTES
Members: 20/08/15 20/08/15 20/11/14 18/12/14 22/01/15 19/02/15 19/03/15 23/04/15 21/05/15 25/06/15 21/07/15 22/09/15 20/10/15 19/11/15 Cancelled Cancelled Quoracy Quoracy ‘P’ = Partial Attendance Paul Woodhead (PW) x Chair – Lay Member Dr Gary Free (GF) P x P P P Clinical Lead Dr Paddy Hannigan (PH) x x x x x x GP Chair/Clinical Lead Dr Mohammed Huda (MH) x x x x GP Chair/Clinical Lead Rob Lusuardi (RL) x x x x x x x x x x Director of Operations Lynn Millar (LM) x x x x x x P x x Director of Primary Care of Finance Diana Smith (DS) P x Lay Member
Colin Groom (CG) x x x x x x P Deputy Director of Finance Paul Simpson (PS) Half members plus DirectorDeputy or Director x P x P Director of Finance
In attendance: Alex Bennett (AB) x x x x x x x Director of Performance Michael Brookes (MB) x P Head of Contracts, CSU Samantha Buckingham (SB) P P X Medicines Management Tracey Cox (TC) Senior Primary Care P Development Manager Shirley Goodchild (SG) P P x x x x x x Commissioning Manager Dr Marianne Holmes (MH) Clinical Lead Tammy Lott (TL) Head of Collaborative P x x Commissioning Mel Mahon (Savage) (MM) x x x x x P x x x Senior Commissioning Manager Claire McHugh – Minutes (CLM) x x Executive Assistant
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Members: 20/08/15 20/11/14 18/12/14 22/01/15 19/02/15 19/03/15 23/04/15 21/05/15 25/06/15 21/07/15 22/09/15 20/10/15 19/11/15 Cancelled Cancelled Quoracy ‘P’ = Partial Attendance Sarah Turner (ST) x P x x x x x Senior Information Analyst Dawn Wickham (DW) P CSU Service Manager
Action
1. Welcome by the Chairman
PW raised the issue of quoracy and the need for clinicians to be represented at Committee. CLM reported that Dr Paddy Hannigan has also raised the issue and it will be discussed at the next Clinical Leads Meeting.
The issue of late despatch of papers was also raised, two enclosures had only been distributed the day before the FPC. PS explained that there has been a clash with the NHSE Quarter 1 Assurance meeting and the new framework is much more labour intensive. The CCGs are required to provide assurance against 5 Domains for the 3 CCGs ie, Cannock Chase (CC); South East Staffs and Seisdon Peninsular (SESSP); and Stafford & Surrounds (S&S). PS explained that now the template is available, future Assurance self-assessment should be less intensive.
14:08 Dr Gary Free and Dr Marianne Holmes joined the meeting
2. Apologies
Paddy Hannigan – represented by Marianne Holmes Mo Huda Rob Lusuardi Lynn Millar – represented by Tracey Cox
For the purpose of the minutes, the meeting was quorate due to the attendance of TC and MH as delegated representatives.
3. Minutes of Previous Meeting – 21 July 2015
3.1 MH noted that Diana Smith’s initials were not identified within the table of attendees.
The minutes were approved as a true and accurate record of the meeting with the appropriate amendment.
3.2 Action Log
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Action 3.2.1 Risk 104 – Risk Register Review - MICAT In the absence of AB, MH confirmed that this matter is ongoing.
4. Conflicts of Interest
DS stated that whilst she is a Labour Party Member, she would not describe herself as an ‘active’ member.
Action: CLM to request that Tracey Revill update the Declarations of CLM Interest to reflect that DS is not an ‘active’ member of the Labour Party
GF/MH declared an interest the Prime Minister’s Challenge Fund.
MB identified that his wife is a provider of services to SSOTP, Combined Healthcare, Burton Hospitals, SSSFT. MB is the contract manager for SSOTP.
5. Continuing Healthcare (CHC) Costs and Boundaries
CG shared a graph to assist Members in their understanding and presented the paper that was initially produced by Matt Sanzeri, CSU. CG highlighted the figures in Table 1 to demonstrate the risk share and the growth in risk share for Cannock identified in the front cover of the report.
The rules are clear that if a patient elects to move, then the responsibility for cost of escalating needs in the future, is not with the CCG of origin. There is a significant east to west migration issue.
The paper suggests where the risk share should be discussed, approaches have been made from the east to consider how this can be done. CG explained that unless there is a process to transfer risk with the patient, then the problem will remain.
The options are: - Continue the risk share and review annually; - Continue the risk share, review and recommend that the funding across CCGs is aligned to mirror actual trends of expenditure.
Discussion followed regarding patient choice and planning policies. PS identified that the paper raises a number of questions, particularly regarding the high volume of nursing homes in CC and S&S and he expressed concern about how the risk share issue can be addressed.
DW talked about stimulating the market and explained that some years ago, there was discussion about utilising empty hospital premises in Burton. DW asked if there is merit in having discussions with the Local Authorities.
MB raised the risk share and asked what the impact would be for all 4 CCGs if discussion was prompted regarding risk share, ie, what other areas would be raised if this discussion took place.
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Action
CHC for CC and S&S represents 10% of the budget and this will continue to grow.
PW suggested that although discussion is taking place about distributing the funding, there is a discussion that should involve local authorities, district and borough councils. CG suggested that a starting point would be through the Better Care Fund (BCF).
PS asked what interest there is for funding transfers with CCG colleagues and CG explained that East Staffs would not benefit from a transfer and reminded Members that there is a greater impact to other budget areas including: primary care; medicines management ie, prescribing costs; A&E admissions etc.
DS identified additional impacts such as staffing and suggested that there needs to be an understanding, across the County, that local authorities should be willing to fund services that their resources cannot accommodate within their own area.
PW agreed with PS that the changing allocations need to be addressed but that this should be a starting point and other areas need to be investigated. There is particular pressures for Cannock Chase with the high number of homes within the geographical area.
PS asked what the Committee would like to recommend and PW responded: 1. The CHC issue needs highlighting at a cross organisation level including input from planning and other NHS partners; 2. In the short term, consider the option of moving the budgets appropriate to the individuals.
PW would like PS to report back on the above two steps.
Action: PS to highlight the issue of CHC risk share at a cross PS organisation level PS to consider the option of moving the budgets PS appropriately
14:57 CG left the meeting
6. Prime Ministers Challenge Fund (PMCF)
TC reported to the Committee and identified that LM will be presenting a paper to FPC at a future meeting. TC shared some figures and reported media activity, PW confirmed that local press has reported the ‘additional surgery’.
GF identified that it is early to identify how to manage whether appointments are urgent or not. There are some IT technical issues which need to be addressed at the GP Suite at Cannock Hospital.
TC reported that Cannock PMCF has progressed further than the Stafford PMCF which still requires some work.
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Action
Action: LM to present paper at October FPC LM
15:02 TC left the meeting
7. CSU Service Review
DW presented her paper to the Committee. Committee agreed that this should be presented every 6 months.
Forward Plan: CSU Service Review – Every 6 months
Each month, the CCG completes a Customer Review Sheet which is presented to NHSE and drives discussion, in particular, regarding improvements. Services receiving low scores included Communications and Business Intelligence but this changes regularly.
DW has been working hard to recruit to vacancies within the Teams and posts have now been filled. DW believes that this will ensure a better service to CCG. DW identified that resilience is an area of interest to her and discussed the importance of investing in people to develop them and demonstrate that the CSU is a quality employer.
DW has recently introduced a ‘professional lead’ for the embedded finance team within the CCG. DW highlighted that there are ongoing problems with recruiting to vacant positions and it is important that the CSU make themselves more attractive. The CSU have recruited Hayes to support ongoing recruitment.
Business Intelligence (BI) has been the most problematic with regard to continuity of support. The BI Team are working with Hayes and BI are starting a trainee scheme and have recruited to all positions as ‘Trainee Analyst’. They will have a 6 month induction programme, working with each of the teams. There is still a reliance on some interim staff and this is currently the case with support being provided to Rebecca Berrisford.
Work is being done on the CFO Report and it is hoped that improvements provided at South East Staffordshire and Seisdon Peninsular (SESS&P) will be mirrored for CC and S&S.
CSU are currently working with CHC to bring in dynamic charging system. Steps are being taken to improve systems and procedures within CHC. DW highlighted the risk regarding pressure on existing workloads identified within the report.
DW summarised by saying that the areas for particular focus now are Business Intelligence and Contract Management. DW shared key contacts for Committee and asked if this would be helpful.
PW identified that staffing and resilience appears to be the ongoing challenge. DW confirmed the importance of recruiting immediately a vacancy arises, and that the CSU should be marketed as desirable employer and that Staffordshire is
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Action a challenging, but interesting place to work.
PW identified that there is inconsistent information provided to the public eg, S&S twitter feed is active but CC appears less so. DW identified that it is difficult to balance resources.
GF asked whether GPs have the opportunity to score CSU, particularly with reference to HIS support. MH identified that this is discussed, frequently at S&S Membership Board. DW reported that she has not been made aware of issues. GF identified that practices are still using XP and he is not aware whether updating IT is the responsibility of HIS or CCG.
Discussion followed regarding IM&T Committee. DW will establish more information and asked Members to keep her informed of any issues that are brought to their attention.
Action: DW to share contacts list with CLM for distribution within DW/CLM CCGs
PS informed Committee that there is a meeting on Friday 25/09/2015 to discuss CSU.
8. Medium Term Financial Recovery Plan (MTFRP) Plan
PS presented his report identifying that this is the latest version of the Financial Recovery Plan (FRP). The template is based on a set of financial assumptions that NHSE have asked the CCG to report on. PS explained some of the background to the figures.
Discussion followed regarding the impact of successfully repaying legacy debt and the danger of future budgets being cut because of the perceived capacity to repay legacy debt.
GF reiterated the need to look at larger targets for QIPP, and not just small scale savings proposals.
9. Financial Governance Checklist
PS presented the paper and discussion followed regarding the scoring. This paper will also be submitted to Audit Committee.
16:02 DW left the meeting
10. Business Report
10.1 Finance PS explained that at the AGM (22/09/2015), he will be highlighting the financial position and that NHSE instructed the CCG not to amend the Financial Plan. There is a required level of QIPP to ensure that the control total is met for
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Action 2015/16.
The plans have been discussed with Area Team and they asked for confirmation that the Governing Bodies are aware of the situation.
GF asked how activity levels are determined for each of the Acute Trusts. PS explained that there is a significant underperformance at UHNM for Stafford, but an over performance at RWT. This could be for a variety of reasons eg, - the estimate of activity was incorrect originally; - the Trusts may have a general under performance. Discussion followed regarding activity and examples of difficulties and current practice at both Trusts; - a Contract Variation Order (CVO) would be put in place that would address a significant amount of this discrepancy.
PS informed the Committee that at an earlier meeting, it was reported that GP referrals have increased by 10% and GF/MH explained that it would be valuable to have a breakdown of the referrals to identify if there is a particular trend.
PW asked about the move to have a 24 hour County Hospital A&E. A meeting took place recently and Ministers stated that any move to have a 24 hour A&E at County Hospital would have to be paid for by the CCG. Information provided by the Trust states that the A&E is Category 3 (not Category 1) and that this confirms that it should be funded at a much lower level. PW identified that a 24 hour A&E needs the infrastructure to support that and County Hospital no longer has the capacity to accommodate a 24 hour A&E. The commissioning intentions state that it is expected that the cost of A&E will be reduced by £1.5m in 2016/17.
There are risks associated with meeting the control total but these are being closely monitored.
PS explained that whilst there are risks, there are potential mitigations. MB concurred and said that Quarter 1 has performed better than expected.
PW asked about any risk associated with the prescribing costs. PS confirmed that there does appear to be a problem across the NHS, and that only an element of the projected overspend could be attributed to the shortfall in the prescribing budget for S&S. GF identified that a large risk is the new anti- coagulant medications which do not require weekly blood tests required for patients on Warfarin.
GF highlighted the problem of pharmacies over ordering prescriptions which patients do not require and/or no longer use. MH explained that part of the problem is the services provided by pharmacies where they agree to collect and deliver patients prescriptions monthly, regardless of whether they are required or not.
Action: Medicines Management to consider the issue of pharmacies Meds automated service to patients where excess medication may Manage- be delivered to patients. ment
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Action
11. Risk Register Review
11.1 Risk 188 – BAF - The CCGs fail to deliver 2015/16 Control Total It was agreed that this Risk will be discussed more fully at the next update.
11.2 Risk 141 – Continuing Health Care This risk needs to be updated.
11.3 Additional Risk It was agreed that a QIPP risk needs to be included on the Risk Register, particularly with regard to prescribing.
12. Forward Plan
CSU Service Review – Every 6 months
13. Any Other Business
13.1 FPC Terms of Reference (ToR) ToR audit amendment was agreed and noted. However, the members element is not clear, and CLM agreed to re-word the section appropriately.
Action: CLM to revise the ToR and submit to Governance for CLM records.
14. Next Meeting
Date: Tuesday 20 October 2015 Time: 2.00 pm – 5.00 pm Venue: Dining Room, County Buildings, Martin Street, Stafford ST16 2LH
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FINANCE, PERFORMANCE AND CONTRACTS (FPC) COMMITTEE
Tuesday 20 October 2015 2.00 pm – 5.00 pm Ivanovo Room, County Buildings, Martin Street, Stafford ST16 2LH
MINUTES
Members: 20/08/15 20/08/15 20/11/14 18/12/14 22/01/15 19/02/15 19/03/15 23/04/15 21/05/15 25/06/15 21/07/15 22/09/15 20/10/15 19/11/15 Cancelled Cancelled Quoracy Quoracy ‘P’ = Partial Attendance Paul Woodhead (PW) x Chair – Lay Member Dr Gary Free (GF) P x P P P P Clinical Lead Dr Paddy Hannigan (PH) x x x x x x x GP Chair/Clinical Lead Dr Mohammed Huda (MH) x x x x x GP Chair/Clinical Lead Rob Lusuardi (RL) x x x x x x x x x x x Director of Operations Lynn Millar (LM) x x x x x x P x x x Director of Primary Care of Finance Diana Smith (DS) P x x Lay Member
Colin Groom (CG) x x x x x x P x Deputy Director of Finance Paul Simpson (PS) Half members plus DirectorDeputy or Director x P x P P Director of Finance
In attendance: Alex Bennett (AB) x x x x x x x x Director of Performance Chris Bird (CB) Director of Performance, South East Staffordshire and Seisdon Peninsular (SESSP) Michael Brookes (MB) x P Head of Contracts, CSU Samantha Buckingham (SB) P P x x Medicines Management Tracey Cox (TC) Senior Primary Care P x Development Manager Dr Marianne Holmes (MH) P Clinical Lead Harry Ireland (HI) Lay Member S&S Tammy Lott (TL) Head of Collaborative P x x x Commissioning
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Members: 20/08/15 20/11/14 18/12/14 22/01/15 19/02/15 19/03/15 23/04/15 21/05/15 25/06/15 21/07/15 22/09/15 20/10/15 19/11/15 Cancelled Cancelled Quoracy ‘P’ = Partial Attendance Mel Mahon (Savage) (MM) x x x x x P x x x x Senior Commissioning Manager Claire McHugh – Minutes (CLM) x x Executive Assistant Sarah Turner (ST) x P x x x x x x Senior Information Analyst Dawn Wickham (DW) P x CSU Service Manager
Action
1. Welcome by the Chairman
Discussion took place regarding membership and attendance. Attendance has been problematic and key people have regular meeting clashes. Consideration may be given to have a combined meeting with South East Staffordshire and Seisdon Peninsular CCG.
Brief introductions took place.
2. Apologies
Paddy Hannigan – Marianne Holmes attended to represent Paddy. Rob Lusuardi – Chris Bird attended to represent Rob. Lynn Millar
The Committee moved to Item 4 – Conflicts of Interest
4. Conflicts of Interest
CCG colleagues identified that they are now required to work across the 3 CCGs ie, Cannock Chase (CC), Stafford & Surrounds (S&S) and South East Staffordshire and Seisdon Peninsular (SESSP).
The Committee moved to Item 5 – Stafford & Surrounds and Cannock Chase Deep Dive
5. Stafford & Surrounds and Cannock Chase – Financial Deep Dive
PS presented the report to the Committee and reminded them of the meeting that he and Colin Groom attended. The letter provides feedback from the meeting.
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Action 14:20 Gary Free/Marianne Holmes joined the Committee
PW asked if there was any challenge regarding the negative reserve and PS confirmed that the impact of this would be negated by the additional activity that had been commissioned (at NHSE’s request). A further review will take place over the winter period.
The Committee noted the contents of the report for information.
The Committee is now quorate.
The Committee moved to Item 3 – Minutes of Previous Meeting – 22 September 2015
3. Minutes of Previous Meeting – 22 September 2015
3.1 The minutes were approved as a true and accurate record of the meeting.
GF identified that in the month since the last meeting, IT provision has not improved. XP upgrades need to take place by December 2015 and this is unlikely to be completed. This presents a risk to GP clinical systems from 01/12/2015.
PS reported that LM has discussed concerns with Dawn Wickham. PS and CB met with CSU on 19/10/2015 and IT issues were raised and PS has discussed concerns with Derek Kitchen, Head of CSU, and awaits his response.
GF asked what is included in the contract that the CCG pay for, including the provision of updates. GF has no confidence in the level of support, however, it may be that the financial budget is not sufficient for the requirements.
Action: Invite CSU to attend FPC to discuss the terms of the contract for IT systems to GPs PS Identify what the CCGs expectations are for the contract DW PS, SIRO, to request appropriate arrangements with EMIS to ensure smooth transition following upgrade PS
3.2 Action Log
3.2.1 Action 111 – FPC – Terms of Reference (ToR) The ToR have been updated and shared with Information Governance. This action is now complete.
3.2.2 Action 110 – Medicines Management There is concern that the pharmacies may not be monitored regarding their adherence to SOP. The SOP states that the pharmacy should check with patients to check what medication they require on their prescription and it is thought that this does not take place consistently.
Action: MH to e-mail PS with concerns regarding Medicines MH Management
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Action Upon receipt of the note from Medicines Management, PS to PS/LM raise concerns with LM and invite representation to next FPC if appropriate
HI asked if the pharmacy contracts have clauses regarding over-prescribing but GF explained that pharmacy contracts are with NHS England (NHSE). MH explained that the pharmacies get paid for everything they prescribe.
It is not clear if patient ordering through EMIS on-line does has the same difficulties.
3.2.3 Action 108 – Prime Ministers Challenge Fund (PMCF) LM has agreed to present PMCF at future meeting.
3.2.4 Action 109 – CSU Service Review CLM to ask DW to present the contact list in its current state and redistribute as appropriate.
3.2.5 Action 107/106 – Continuing Healthcare (CHC) – Costs and Boundaries This action is ongoing but will be marked as complete and identified on the Forward Plan.
Forward Plan: February 2016
3.2.6 Action 104 – Risk Register Review MICAT A meeting will take place regarding MICAT w/c 27/10/2015. CB will take this action forward. CB identified that the MICAT QIPP is forecast to underachieve and discussed the risk of a reduction not being achieved and/or sustained. Mel Action: Sarah Carter to be invited to MICAT meeting by Mel Mahon Mahon
3.2.7 Action 94 – FPC Business Report This action is now complete.
6. Business Report
PS introduced the background to this report, explaining it was hoped that the Business Report would provide information that would be suitable for a number of audiences eg, NHSE Assurance meetings. CB will be working to improve the format further and he will be leading with future Assurance meetings.
PS reviewed the financial element of the report and there is confidence that control totals will be met for both CCGs. There are some challenges including, medicines management, QIPP and Map of Medicine. There have been some additional costs associated with premises including some dilapidation costs incurred from Greyfriars (the previous CCG premises). The dilapidation costs will be paid over a phased period which reduces the pressure.
GF asked for clarity regarding the performance of UHNM and RWT and PS explained that when the CVO is in place, it will be easier to ascertain the true performance.
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Action
GF advised that there is already an increase in emergency admissions, which is an indication that Winter Pressures are commencing.
CB explained that the report highlights problems and does not identify solutions which he will look to address in future reports. He will also present the report with regard to patient numbers to assist in Committees’ understanding of the figures. There are 3 RTT targets but two cannot be used as part of the contract sanctions to providers. The data is still produced but it is not possible to hold providers to account.
Cancer 14 Day Breast Symptom is failing nationally, however, all were seen within 28 days for CC and S&S. PW asked if there is any indication of whether the delay has impacted the outcome for patients and GF explained that it is difficult to confirm this with the two week wait; it is the longer waits that will highlight any impact to outcome. CB identified that RWT are achieving their 14 day target as a Trust, but not for CC and S&S.
CB informed the Committee that NHSE previously wrote to all CCGs and identified providers that they had no confidence in. RWT was one of the Trusts with regard to Cancer 62 Day Waits and RWT remain on the radar for NHSE.
CB confirmed to GF that all local Trusts are failing local patients for Cancer Wait times.
15:37 PS left the meeting
CB talked about the Ambulance Red 1 failure which is also a problem for SES. The Ambulance service is provided for 19 CCGs and whilst they are achieving their targets overall, targets for more rural areas are not achieved.
15:40 PS returned to the meeting
Discussion followed regarding reporting from Walsall and their failure to report has been ongoing. CB explained that in future reports, he will provide data regarding backlog. PS informed the Committee that RTT backlog is identified within budget planning.
GF shared some insight regarding perceptions of performance.
The information relating to the number of cancelled operations needs more context eg, is the figure high? How many operations were not cancelled etc.
PS presented the financial element of the QIPP slides. There are still risks but some areas provide more assurance now, such as Continuing Healthcare (CHC).
CB identified 3 areas: - Harmonisation – QIPP reports will need to be considered for all 3 CCGs. The report needs to identify what the reporting should be. - Activity - it needs to be clear what the relationships are - What assumptions underpin over/underperformance
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Action
PS talked about the processes around QIPP. If these savings are not delivered, then this creates a continued problem for 2016/17. Another request has been received from NHSE to provide more data/assurance.
It has been agreed at EMT that a ‘star chamber’ will be created for QIPP and PW may be asked to attend.
HI asked for assurance from the CCG that the right systems/procedures are in place to achieve QIPP.
7. Risk Register Review
7.1 Risk 146 – Better Care Fund PS recently attended a County Council meeting regarding the BCF. In 2015/16, the CCGs in Staffordshire have agreed to make a one off contribution of £5m which will come from existing NHS budgets and reserves.
The BCF will now form part of the overall savings for the Transformation Programme.
A baseline piece of work will be carried out by a recently recruited contractor employed by CSU. A business case will be submitted to NHSE by the end of the financial year. This will identify what the problems are for Staffordshire and what needs to be done.
The Transformation Programme has agreed that BCF will be managed by them from January 2016.
8. Forward Plan
Continuing Healthcare Costs and Boundaries – February 2016 Medicines Management IT
9. Any Other Business
9.1 Colin Groom Colin leaves the CCG on 23/10/2015 as Deputy Director of Finance. The Committee recorded their thanks for Colin.
Yasmin Ahmed has been appointed as Interim Deputy Director of Finance. Gill Gardiner will join the CCGs in December 2015 as the permanent Deputy Director of Finance.
9.2 Finance Team Structure Ian Baines, Director of Finance – SESSP, is in discussion with PS regarding the structure of the Finance Team across the 3 CCGs.
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Action 9.3 Meeting Dates CLM will need to consider scheduling meetings for 2016/17 and asked the Committee if Tuesdays/Thursdays are still the preferred option. However, discussions are loosely taking place regarding combining the FPC for CC, S&S and SESSP.
An extra-ordinary meeting may be required to bring all clinical leads and lay members together. Further discussion will need to take place before any further decisions can be made.
14. Next Meeting
Date: Thursday 19 November 2015 Time: 2.00 pm – 5.00 pm Venue: Rudyard, Ground Floor, Number 1, Staffordshire Place, Stafford ST16 2LP
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Enclosure 12 Acronyms
1. A&E Accident & Emergency 2. ADNS Advanced Diploma in Nursing Studies (UK) 3. ADP Accelerated Development Programme 4. AED Automated External Defibrillator 5. AHP Allied Health Professional 6. ALAN Adult Literacy and Numeracy 7. ALE Auditors Local Evaluation 8. ALOS Average Length of Stay 9. ANNP Advanced Neonatal Nurse Practitioner 10. AO Accountable Officer 11. APMS Alternative Provider Medical Services 12. AQP Any Qualified Provider 13. ASD Autism Spectrum Disorder 14. AVS Acute Visiting Service 15. BADGER Birmingham and District General Emergency Rooms 16. BAF Board Assurance Framework 17. BCF Better Care Fund 18. BCHFT Birmingham Children’s Hospital NHS Foundation Trust 19. BEN Birmingham East and North PCT 20. BHFT Burton Hospital NHS Foundation Trust 21. BNP Brain Natriuretic Peptide 22. BOTOX Botulinum Toxin Type A 23. BPAS British Pregnancy Advisory Service 24. C&E Communications & Engagement 25. CAG Commissioning Advisory Group 26. CAMHS Children and Adolescent Mental Health Service 27. CAS Clinical Assessment Service 28. CB Commissioning Board 29. CBSA Commissioning Business Support Agency 30. CC Cannock Chase 31. CCG Clinical Commissioning Group 32. Cdiff Clostridium Difficile Infection 33. CEO Chief Executive Officer 34. CGA Comprehensive Geriatric Assessment 35. CHAI No longer in existence 36. CHC Continuing Health Care 37. CHI No longer in existence 38. CHKS Leading provider of healthcare intelligence and quality improvement services 39. CHPP Children’s Health Promotion Programme 40. CHRT Crisis Home Resolution Team 41. CIAMs Commissioning Investment Asset Management Strategy 42. CIG Clinical Informatics Group 43. CIP Cost Improvement Programme 44. CMT Contract Management Team 45. CNST Clinical Negligence Scheme for Trusts 46. CoE Care of the Elderly 47. COG Clinical Oversight Group 48. COPD Chronic Obstructive Pulmonary Disease 49. CPAG Clinical Policies Advisory Group 50. CPN Community Psychiatrist Nurse 51. CQC Care Quality Commission 52. CQINS Cancer Quality Improvement Network System 53. CQRM Clinical Quality Review Meetings 54. CQUIN Commissioning for Quality and Innovation 55. CRL Capital Resource Limit 56. CRT Crisis Response Team 57. CSIP Clinical Services Improvement Programme 58. CSU Commissioning Support Unit
Enclosure 12 59. CSW Clinical Support Worker 60. CWG Clinical Working Group 61. D&V Diarrhoea & Vomiting 62. DC Day Care 63. DCC Direct Clinical Care 64. DES Direct Enhanced Service 65. DIPC Director of Infection Prevention & Control 66. DN District Nurse 67. DoH Department of Health 68. DOLS Deprivation of Liberty Standards 69. DPA Data Protection Act 70. DPD Dental Practice Division 71. DPP Developing Patient Partnerships 72. DQF Data Quality Facilitator 73. DRS Dental Reference Service 74. DTC Delayed Transfer of Care 75. EAU Emergency Admissions Unit 76. ECDL European Computer Driving Licence 77. ECIST Emergency Care Intensive Support Team 78. ED Emergency Department 79. EDD Expected Discharge Date 80. EDS Equality Delivery System 81. EL Elective 82. EMS Escalation Management System 83. EMSA Eliminating Mixed Single Sex Accommodation 84. EMT Executive Management Team 85. ENT Ear Nose Throat 86. EOL End of Life 87. EPO Emergency Planning Officers 88. EPR Electronic Patient Record 89. ESR Electronic Staff Record 90. EWISS Emotional Well Being in Stafford & Surrounds 91. EWTD European Working Time Directive 92. F&P Finance and Performance 93. FE Frail Elderly 94. FET Funding Exceptional Treatment 95. FFT Friends and Family Test 96. FIG Financial Improvement Group 97. FIMS Financial Information Management System 98. FIT Funding Individual Treatment – now FET 99. FNOF Fractured Neck of Femur 100. FOI Freedom of Information 101. FPC Finance Performance & Contract Committee 102. FRP Financial Recovery Plan 103. GAAP Generally Accepted Accounting Principles 104. GB Governing Body 105. GDC General Dental Council 106. GDS General Dental Services 107. GMS General Medical Services (Practice) 108. GP General Practitioner 109. GPWSI GP with special interest 110. GSF Gold Standard Framework 111. HALO Hospital Ambulance Liaison Officer 112. HCAI Healthcare Associated Infections 113. HCC No longer in existence 114. HEFCE Higher Education Funding Council for England 115. HEFT Heart of England Foundation NHS Trust 116. HFMA Healthcare Financial Management Association 117. HIS Health Informatics Service 118. HOT Heads of Terms
Enclosure 12 119. HPS Health promoting Schools 120. HPSS Health promoting Schools Scheme 121. HR Human Resources 122. HRG4 Healthcare Resource Group 4 123. HROD Human Resources Organisational Development 124. HSJ Health Service Journal 125. IAPT Improving Access to Psychological Therapies 126. ICG Infection Control Group 127. ICSI Intracytoplasmic Sperm Injection 128. IFR Independent Funding Request 129. IFRS International Financial Reporting Systems 130. IG Information Governance 131. IM&T Information Management and Technology 132. IP Inpatients 133. IPC Infection Prevention & Control 134. IPR Individual Performance Review 135. IQT Improving Quality Team 136. ISA Intermediate Support Assistant 137. ISFE Integrated Single Financial Environment 138. ITT Invite to Tender 139. IV Intravenous Therapy 140. IVF Intravenous Fertilisation 141. IWL Improving Working Lives 142. JCI Joint Clinical Investigation 143. JCU Joint Commissioning Unit (SCC) 144. JSNA Joint Strategic Needs Assessment 145. JSP Joint Staff Partnership 146. KPI(s) Key Performance Indicator(s) 147. KPMG Global Network of Profession Firms providing audit, tax and advisory services 148. LAA Local Area Agreement 149. LCCB Local Collaborative Commissioning Boards 150. LCP Liverpool Care Pathway 151. LDD Learning Disability and/or Difficulty 152. LDP Local Delivery Plan 153. LES Local Enhanced Service 154. LETB Local Education and Training Board 155. LH Local Hospital 156. LHE Local Health Economy 157. LIN Local Intelligence Network 158. LMC Local Medical Council 159. LMS Local Medical Services 160. LOC Local ophthalmic Committee 161. LQR Local Quality Indicator 162. LSP Local Strategic Partnership 163. LTB Local Transition Board 164. LTC Long Term Conditions 165. LTFM Long Term Financial Model 166. M&L CSU Midlands & Lancashire Commissioning Support Unit 167. MAT Maternity 168. MAU Medical Assessment Unit 169. MB Membership Board 170. MCA Mental Capacity Act 171. MCD Maximum Cash Drawdown 172. MDT Multidisciplinary Team 173. MFCA Multi Factorial Comprehensive Assessment 174. MHRA Medicines & Healthcare products Regulatory Agency 175. MICATS Musculoskeletal Integrated Clinical Assessment & Treatment Service 176. MICOT Minor Injuries Community Outreach Team 177. MIU Minor Injuries Unit 178. MLU Midwife-led Unit
Enclosure 12 179. MOI Memorandum of Information 180. MORI (Market & Opinion Research International) 181. MOU Memorandum of Understanding 182. MPIG Medical Practice Income Guarantee 183. MRSA Meticillin-Resistant Staphylococcus Aureusis Infection 184. MSFT Mid Staffordshire NHS Foundation Trust (now part of UHNM as County Hospital) 185. MSK Musculoskeletal 186. MUR Medicine Use Review 187. NCAS National Clinical Assessment Service 188. NCB National Commissioning Board (now known as NHS England) 189. NCT National Childbirth Trust 190. NEDs None Executive Directors 191. NEL Non-Elective 192. NES National Enhanced Service 193. NHQAC Nursing Home Quality Assurance Group 194. NHS National Health Service 195. NHSE NHS England 196. NHSU NHS University 197. NICE National Institute for Clinical Excellence 198. NICU Neonatal Intensive Care Unit 199. NMC Nursing and Midwifery Council 200. NRPSI National Register of Public Service Interpreters 201. NSL Non Urgent Patient Transport Provider 202. NTDA NHS Trust Development Authority 203. OBD Occupied Bed Days 204. OD Organisational Development 205. OFSTED Officer for Standards in Education, Children’s Services & Skills 206. OOH Out of Hours, also Out of Hospital 207. OP (D) Outpatients (Department) 208. OT Occupational Therapist 209. PA Programmed Activities 210. PAED Paediatrics 211. PALS Patient Advice and Liaison Service 212. PASS Professional Advice and Support Service 213. PAU Paediatric Assessment Unit 214. PBC Practice Based Commissioning 215. PBR Payment By Results 216. PC Planned Care 217. PCR Patient Charge Revenue 218. PCT Primary Care Trust 219. PCTDS PCT Dental Service 220. PEAT Patient Environment Action Team (now known as Place) 221. PEC Professional Executive Committee 222. PHSO Public Health Service Ombudsman 223. PID Project Initiation Document 224. PII Period of Increased Incidence 225. PiP Partners in Paediatrics 226. PIS Prescribing Incentive Scheme 227. PLCV Procedures of Limited Clinical Value 228. PLT Protected Learning Time 229. PM Practice Manager 230. PMO Programme Management Office 231. PMS Personal Medical Services 232. POPP Partnerships for Older People Projects 233. PPG Patient Participation Group 234. PPI Patient and Public Involvement 235. PPI (prescribing) Proton Pump Inhibitors 236. PPV Post Payment Verification 237. PQQ Pre Qualifying Questionnaire 238. PRF Patient Report Form
Enclosure 12 239. PRISM Personnel Resource Information System for Management 240. PROMs Patient Related Outcome Measures 241. PT Physical Therapist 242. PTL Patient Target List 243. PU Pressure Ulcer 244. PWSI Pharmacist with Special Interest 245. QIA Quality Impact Assessment 246. QIF Quality Improvement Framework 247. QIL Quality Improvement Lead 248. QIP Quality Improvement Programme 249. QIPP Quality, innovation, productivity and prevention. 250. QOF Quality and Outcomes Framework 251. QSG Quality Surveillance Group 252. QSISM Quality and Safeguarding Information Sharing Group 253. RAG Red Amber Green 254. RAP Remedial Action Plan 255. RCA Root Cause Analysis 256. RIA Risk Impact Assessment 257. RIO Electronic Care System 258. RRL Revenue Resource Limit 259. RSUH Royal Stoke University Hospital 260. RTT Referral to Treatment 261. RWT Royal Wolverhampton Hospital Trust 262. SALT Speech & Language Therapist 263. SARC Sexual Assaults Referrals Centre 264. SAS Stafford and Surrounds 265. SCBU Special Care Baby Unit 266. SCC Staffordshire County Council 267. SCIO Staffordshire Consortium of Infrastructure Organisations 268. SCR Strategic Change Reserve 269. SCWP Social Care Workforce Planning 270. SDB Service Delivery Board 271. SDIP Service Delivery Improvement Plan 272. SI Serious Incident 273. SIB Service Improvement Board 274. SIC Statement of Internal Control 275. SIRO Senior Information Risk Officer 276. SLAM Service Level Agreement Model 277. SPA Supporting Programmed Activities 278. SPEC Strategic Public Engagement Committee 279. SSHLF South Staffordshire Health Libraries Federation 280. SSOTP Staffordshire & Stoke on Trent Partnership Trust 281. SSPAU Short Stay Paediatric Assessment Unit 282. SSSFT South Staffordshire & Shropshire Foundation Trust 283. SSSHFT South Staffs & Shropshire Healthcare Foundation Trust 284. SUI Serious Untoward Incident(now known as SI’s) 285. SUS Secondary User Services 286. TDA Trust Development Authority 287. TOR Terms of Reference 288. TSA Trust Special Administrator 289. TV Team Tissue Viability Team 290. UCC Urgent Care Centre 291. UDA Units of Dental Activity 292. UHB University Hospital Birmingham 293. UHNM University Hospitals of North Midlands NHS Trust 294. UHNS University Hospital North Staffordshire 295. UOA Units of Orthodontic Activity 296. VAT Value Added Tax 297. VFM Value for Money 298. VO Variation Order
Enclosure 12 299. VT Vocational Trainee 300. WCC World Class Commissioning 301. WHT Walsall Hospitals Trust 302. WIC Walk in Centre 303. WMAS West Midlands Ambulance Service 304. WMQRS West Midlands Quality Review Service 305. WMSCG West Midlands Strategic Commissioning Group 306. WRES Workforce Race Equality Standard 307. WTE Whole Time Equivalent 308. WUCTAS Wolverhampton Urgent Care Triage Access Service 309. YTD Year to Date