CLINICAL COMMISSIONING GROUP BOARD MEETING TO BE HELD ON JULY 18TH 2012 AT 1.30PM
BOARD ROOM NEW CENTURY HOUSE DENTON
A G E N D A
Page 1. Apologies for Absence
2. Declarations of Interest
3. Chair’s Update
4. Minutes of the Meeting Held on June 20th 2012 p3-12
Matters Arising
5. - Transition Update – to follow Steve Allinson
- Public Health Transition update – verbal Elaine Michel
6. Collaborative Commissioning of Care Homes Michelle Rothwell p13-17
7. Safeguarding Children and Vulnerable Adults Gill Gibson p18-52
8. EDHR Strategy Julia Allen p53-101
9. Patient Transport Services – Re-Procurement Exercise Steve Allinson p102-106
Standing Items:-
10. Planning and Implementation and Quality Committee Clare Watson p107-114
11. Finance Report - to follow Kathy Roe
12. Performance Update Kathy Roe p115-143
13. Quality Committee Minutes Lynn Travis p144-151
14. Medicines Management Minutes John Doldon p152-156
15. GM Clinical Board – Summary Document Raj Patel p157-182
16. Any Other Business
17. Date and Time of Next Meeting – August 15th 2012 at 12.30pm
MINUTES OF THE CLINICAL COMMISSIONING BOARD MEETING HELD ON JUNE 20TH 2012
Present: Raj Patel Richard Bircher John Doldon Alan Dow Tina Greenhough Jo Rowell Phaninder Tatineni Guy Wilkinson Graham Curtis Lynn Travis Steve Allinson Kathy Roe Clare Symons
In attendance: John Boyington, Elaine Michel, Yvonne Pritchard, Dr. Vikram Tanna, Clare Watson, Dr. Andrew Hershon, Dr. Matthew Kinsey, Julie Bell
1. Apologies for Absence
None to record
2. Declarations of Interest
Dr. Tina Greenhough – Item 8. 111 Procurement Strategy
3. Chair’s Update
Steve Allinson (interim Chief Operating Officer) and Kathy Roe (interim Director of Finance) for the CCG
Raj Patel was pleased to announce that both Steve Allinson and Kathy Roe were successful in their assessments through the Assessment Centre and both had been deemed ready for appointment.
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3 Hyde Doctor Makes Top ‘Influential’ Listing – Manchester Evening News
It was noted that Dr. Raj Patel had been named as one of the most influential people in Greater Manchester, and had been placed in the top 250 in the region, on the Manchester Evening News published list. He is the only practicing doctor to be included in the list.
C. Diff
Elaine Michel informed the meeting that C. Diff figures were improving. The biggest reduction had been seen with Tameside FT. It was noted that the health economy had not been in this position for a long time.
Chlamydia Screening
Elaine Michel stated that the final confirmed 2011/12 Chlamydia Screening figures had just been published. Tameside and Glossop’s performance was 32.4%, which is the highest in Greater Manchester. In addition, when analysed against the new target for 2012/13 (i.e. diagnosis rate of between 2,400 and 3,000 or higher per 100,000) Tameside and Glossop also had the highest performance in Greater Manchester: 3,150.
Board conveyed their congratulations to all involved, noting that the PH team would be looking at actions for the forthcoming year at the next Chlamydia Screening Implementation Group meeting on the 10th July.
4. Minutes of the Meeting Held on May 16th 2012
The minutes were agreed as a correct record of the meeting.
Matters Arising
CCG Practice Dashboards
Clare Watson informed the meeting that there had been no further information on when to expect the National Scorecard.
E. Learning – Introducing Finance
Kathy Roe stated that she was currently analysing the most useful modules for CCG Board members. It is an aspiration to roll out the E.
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4 Learning tool to each GP practice (once more licenses were purchased through NHS GM).
Action: Kathy Roe
NWAS – Future of Ambulance Services
Steve Allinson and Kathy Roe were meeting with a representative from Blackpool. GM had also reiterated its intent for more traction with the Board of NWAS, to keep apprised of developments.
5. QIPP/Finance/Performance Presentation
The Board received an informative presentation from Kathy Roe. Board discussed at length, areas that required further attention:-
National Measures:
Referral to Treatment; A & E 4 hour target; Category A; stroke; HCAI.
Quality:
SHMI CQC Patient Experience/LINK report
Outcomes:
Life Expectancy Colorectal Cancer Survival rates Smoking Status at time of delivery Excess weight in 4 to 5 and 10 -11 year olds
Financial Risks:
Secondary care Continuing Care Prescribing Contingencies QIPP target
On a general note, Board outlined the sterling work of Dr. Andrew Hershon on the ICATS agenda, noting how a front line clinician, in leading and engaging colleagues, can make a positive difference in driving forward change.
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5 Michelle Rothwell and her team were also formally thanked for their exemplary work on the Continuing Care Panels, as was Yvonne Pritchard. It was noted that Board members had a ‘standing invite’ to attend the CCP’s.
It was noted that managers would ‘buddy up’ with CCG Board members (based on individual’s portfolios), to offer additional support in understanding more the organisations’ business.
6. Transition Update
Board received its monthly update from Steve Allinson, focussing on the good progress that is being made and the further work required to stay on track to apply for Authorisation.
The Board noted that it now had confirmation that Authorisation would be Wave 3 – September 2012.
The Board also received an update on the Constitution, which was being shared with all GP constituents via Locality Groups and the LMC.
The Board noted that further work on the Board composition would be necessary, and in short order, in terms of clarity around a deputy Chair; Chair’s appointment process; voting roles on Governing Body; co- option situation; Lay advisor; GP election process and committee structures, in preparation for a full elective Board by 1st September 2012.
Board received the transition update and supported the direction of travel.
6a. Public Health Transition and Memorandum of Understanding
The Board received its monthly update on the Public Health Transition and the Memorandum of Understanding (MOU).
The Board noted the key areas of progress made on the public health agenda in terms of:-
1. The PH Memorandum of Understanding
The Board noted that the purpose of the Memorandum of Understanding between NHS Tameside and Glossop, TMBC, Derbyshire CC and the CCG, was to establish the principles by which each party will work together to establish the principles and together deliver the Tameside and Glossop public health function during 2012/13 and to lay
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6 the foundations for the full service transfer of the public health function to Tameside MBC. It set out how organisations will work together to maintain and strengthen joint working relationships.
Board accepted the MOU.
2. An update on the PH workforce.
The Board noted that NHS Tameside and Glossop had the smallest Public Health team in the North West, this issue was being raised at a Greater Manchester level.
3. Contract Stock-take with the Local Authority
The Board noted that agreement had been reached with Tameside Local Authority to extend current Public Health contracts by 1 year to 2014, to allow a review and stock-take.
4. Transformation Change Programme with Tameside Local Authority
The Board noted that there was an invite to become involved in the above project, to help build a joint vision across the health economy. This would also align to the CCG’s Transition process.
Board noted the progress made on the Public Health Transition agenda.
7. Joint Strategic Needs Assessment Strategy
The Board received the Joint Strategic Needs Assessment 2011 -2012. This was one of a number of reports that form the basis of the on-going assessment of needs in terms of the populations’ wellbeing. The report has been led by the Public Health Department, and supported by staff from the NHS and the Local Authority.
The Board felt the JSNA was well constructed, with a good focus on vulnerable groups, however, they noted that the challenge would be to manage the strategy across both of our council boundaries.
The Board agreed the following:-
CCG Leads would review the outcomes in relation to their leadership roles
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7 CCG noted that a workshop would be arranged by the Public Health directorate to decide upon the priorities for investment, and to align to the Clinical Commissioning Strategy.
CCG Board agreed their on-going commitment to priority areas.
8. III Procurement
Clare Watson briefed the Board on the development of 111, a new national NHS service, which will provide a telephone advice line for patients with urgent health problems which require assessments but which are not so serious as to require a 999 call. The service will be available free to callers, 24 hours a day, 7 days a week, 365 days a year and intended to absorb most the calls going to NHS Direct and our GP out of hours services.
The Board noted the update and that the North West PCT Clusters have commenced a process to procure the 111 services that will commence by 21st March 2013 at the latest in line with the national deadline.
The Board acknowledged the financial implications (already aligned within Tameside and Glossop’s financial contingency plans).
The Board discussed some implications in relation to the new service. Tina Greenhough particularly raised some potential issues in relation to out of hours cover.
Board agreed to continue to support the 111 Programme in the North West through continued engagement with the Programme and through support for development of the infrastructure required to successfully deliver the required savings.
9. Any Qualified Provider Update
The Board received an update from Clare Watson, outlining that, following previous discussions, in Tameside & Glossop and at GM Cluster (GM Clinical Strategy Board) it was decided that the 3 pathways for AQP would be podiatry, adult hearing, and diagnostics (MRI – head & neck, and NOUS). The procurement of these services is being led by NHS Greater Manchester.
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8 The briefing had been prepared by NHS GM and circulated to all sCCGs.
It was noted that Tameside & Glossop commissioning leads for planned care and the Tameside and Glossop Community Health contract are ensuring all actions required of CCGs are taken forward in Tameside & Glossop.
The Board noted the progress to date with AQP, and approved the actions that were outlined in the document, including the actions which have been handed over to sCCGs by NHS Greater Manchester.
10. Finance Update
Board received the financial report, noting that the overall forecast surplus for the PCT was £1,000K by year end and £166k year to date, which is in line with the overall control total.
Board discussed the financial summary and CCG monthly summary reports in detail.
Kathy Roe stated that further work, through the Finance and QIPP Committee, would produce a far more centric finance report for CCG, going forwards. CCG Board members would contact Kathy Roe with comments on what specific information they would like to see in the report.
Board received the finance update.
10a. 11/12 Incentive Scheme Achievement
The 11/12 CCG Incentive scheme had previously been presented to CCG Board; the updated paper reported the achievement against the scheme.
The paper also illustrated the achievement by practice against the 1/12 incentive scheme and illustrated the utilisation of the available resource.
Board discussed the paper in detail and Kathy Roe’s department would now notify the practices in terms of their achievements.
Action: Kathy Roe’s Department to notify practices of their achievement
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11. Performance
The Board noted that the overall performance RAG risk rating remains the same for NHS T&G against the North of England key priority areas, with a RAG risk rating of RED.
The Board also noted that the April North of England report, showed that NHS T&G had achieved the following targets:
RTT admitted 95th percentile 62 day Cancer A&E 4 hour wait Mixed Sex Accommodation Health Visitors
The Board noted that the National Bowel Cancer awareness campaign had caused a rise in referrals for colonoscopy. Tameside FT are exploring options to secure additional diagnostic capacity to meet this demand, to ensure patients are seen within 2 weeks. Tameside FT anticipate that this may affect other areas of performance in April and May.
The Board noted that NHS T&G failed to achieve the following targets:
C.diff Stroke Cat A
T&G Health Economy are developing a strategic plan for HCAI reduction. CCG will be kept informed. NHS T&G anticipate achieving the monthly trajectory of 15 in April 2012.
The Stroke improvement plan will be refreshed to address the current performance issues; this will also address the flow of patients through the pathway. Discussions are ongoing, regarding an NHS GM solution to centralising Stroke services
NWAS have funded a rapid response vehicle in the Glossop Locality and are working with the NWAS Commissioning lead to discuss longer term solutions to address performance.
The Board discussed patient experience at length - (an indicator that provides an overview of Patient Perception feedback from the Adult Inpatient Survey). Raj Patel and Steve Allinson agreed to address some
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10 issues raised by the Board, with the local Foundation Trust, at their respective meetings.
CCG Board would further consider developing an Action Plan for expected outcomes on a number of areas of relating to ‘quality’, to be monitored through the Quality and Performance Committee.
Action: Raj Patel/Steve Allinson to raise Patient Experience Issus with Tameside FT at their respective meetings.
12. Audit and Risk Committee Minutes
The Board received the Audit and Risk Committee Minutes held on 28th March 2012.
The Board discussed the Corporate Risk Register Extracts in detail and requested to have an agenda item at a future Board meeting to further explore the risks; to understand how they are scored and how they are actioned.
Action: Graham Curtis/Mark Simon – Risk Register agenda item at a future CCG Board meeting
13. Medicines Management Committee Minutes
The Board received the MMC Minutes of 31st May 2012, noting the key areas of good practice across Tameside and Glossop.
14. GM Clinical Strategy Board – Summary Document
The Board received the Summary Report from the meeting held on June 12th 2012.
The Board particularly discussed the ‘’Improving Outcomes for People with Dementia’’, noting that this aligned to the work we are doing with the Local Authority and also linked to the acute care work.
The Board further noted that Greater Manchester Clinical Strategy Board was looking to identify CCG clinical leads to contribute and support the dementia agenda.
15. Any Other Business
There was no further business to discuss
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11 16. Date and Time of Next Meeting
July 18th at 1.30pm
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Clinical Commissioning Group Meeting
Collaborative Commissioning of care homes within Tameside
Paper prepared by: Tom Wilson
Date of paper: 03/07/2012
Subject: Procurement of Nursing Home Care in Tameside
History of paper: For 5 years NHS Tameside and Glossop have had a joint contract for care homes with nursing. This contract has been temporarily extended whilst a procurement exercise takes place.
Executive Summary:
NHS T&G has a long history of collaboration with TMBC regarding the commissioning and subsequent contract management of care home providers. For the last 5 years TMBC and Tameside and Glossop have had a joint contract for the provision of care within nursing homes. TMBC has also paid NHS T&G a sum of £30k a year to ensure there is nursing input to social care assessments and subsequent case management. This arrangement has created opportunities for efficiencies for both commissioning organisations and is favoured by providers of care homes keeping transaction costs low as they need effectively to only have to deal with one body. This positive working NHS T&G has a long history of collaboration with TMBC regarding the commissioning and subsequent contract management of care home providers. NHS Tameside and Glossop need to ensure proper governance arrangements are in place as the procurement process commences.
Outcome Required of CCG: CCG are asked to agree to put in place a s75 of the NHS Act 2006 with TMBC for the commissioning and contracting of care homes. This agreement be between Tameside & Glossop PCT initially transferring to Tameside & Glossop Clinical Commissioning Group in April 2013 and TMBC
1. Note the contents of the collaborative
13 agreement, as drafted by the PCT’s lawyers for negotiation with TMBC, are approved. 2. NHS T&G formally request that this agreement is ratified by the Board of NHS GM when it has been agreed with TMBC.
For Discussion or Approval: Approval
QIPP principles addressed by proposal: Quality
Direct questions to: Tom Wilson/Michelle Rothwell/ Ben Galbraith
14 Collaborative commissioning of care homes within Tameside.
Background
NHS T&G has a long history of collaboration with TMBC regarding the commissioning and subsequent contract management of care home providers. For the last 5 years TMBC and Tameside and Glossop have had a joint contract for the provision of care within nursing homes. TMBC has also paid NHS T&G a sum of £30k a year to ensure there is nursing input to social care assessments and subsequent case management.
This positive working arrangement has created opportunities for efficiencies for both commissioning organisations and is favoured by providers of care homes keeping transaction costs low as they need effectively to only deal with one body.
As PCTs wind down and CCGs become responsible commissioners it is essential that arrangements such as this are properly underpinned by appropriate governance regimes. There are three reasons for this: proper governance arrangements protect both the CCG and TMBC from any challenges should a contractual dispute with a provider arise; as CCGs confirm their ‘make/share/buy’ decisions it is important that appropriate governance arrangements are in place to demonstrate good partnership working for authorisation purposes as T&G CCG has chosen to share this role; lastly, as part of the DH contract transition work it is the responsibility of the current commissioner (formally the PCT) to hand over contracting regimes that are ‘fit for purpose’ to new commissioners (in this case the CCG). Currently no formal governance arrangements are in place.
The need to have proper governance arrangements is being emphasised at present because TMBC are about to start a formal procurement exercise for contracting with care home providers. This exercise is being undertaken with the full cooperation of NHS T&G but the intention is that, as now, TMBC will be the contracting authority and will use a local authority, rather than standard NHS contract.
This paper summarises legal opinion sought from Hempsons and lays out a proposed collaborative agreement between NHS T&G and TMBC. Once approved this will need to be ratified through the NHS GM Board (via a recommendation in the Chief Executive’s report) and will transfer to the CCG from 1st April 2013.
Summary of legal opinion
Hempsons were asked to give advice on two main areas: to give a view as to whether a formal s75 agreement was required and if so to provide such an agreement; to review the draft care homes contract suggested by TMBC to ensure it did not miss any key points that appear in the NHS standard contract.
The advice is clear regarding s75 arrangements:
A section 75 arrangement between an NHS body and local authority may be defined as: an agreement made under section 75 of National Health Services Act 2006 between a local authority and PCTs, NHS trusts or NHS foundation trusts in England, which can include arrangements for pooling resources and delegating certain NHS and local authority health-
15 related functions to the other partner(s) if it would lead to an improvement in the way those functions are exercised.
In the absence of such an agreement, if there is any delegation of prescribed functions, there is a risk of legal challenge if and to the extent that prescribed functions of NHS bodies are being exercised by TMBC and/or prescribed functions of the local authority are being exercised by the PCT without a prescribed section 75 agreement in place.
Neither the PCT nor TMBC has any desire to create an onerous partnership agreement: the current arrangements have worked excellently for several years and build on generally good relations between the PCT and local authority. Hempsons have therefore drafted a simple collaboration agreement that is attached at Appendix 1. This needs some detail to be finalised in discussions with TMBC but it is not expected that the changes will be material. Hempsons have commented that “the collaboration agreement will simply regulate the legal relationship between TMBC and the PCT and provides for succession further to the transfer of the PCT’s functions to the CCG.”
A draft care homes contract for use by TMBC and the PCT was reviewed by Hempsons. The material aspects of their advice is that:
The TMBC draft contract is balanced and there are no significant omissions such as would give rise to any high level legal risk The TMBC draft contract delivers a broadly comparable set of rights and obligations as the NHS Standard Care Homes contract; it is simpler, familiar and less onerous in terms of operation and management. There are a number of areas where the PCT/CCG should seek to make some amendments to the TMBC contract to cover off residual risk and these included ensuring that liability for breach of agreement is operative on both parties (currently drafted so that TMBC have no liability for PCT breach but does not offer the mirror agreement and ensure that the PCT/CCG has no liability for a TMBC breach); the notice period of three months may be considered to be too short to allow commissioners to find alternative providers and perhaps six months would be better; dispute resolution ends in arbitration with costs borne equally whereas the NHS contract ends in binding pendulum arbitration with the loser bearing all costs – the NHS terms are stronger and act as a deterrent to using formal dispute resolution in all but the most serious of cases.
It will be important that the CCG can fully implement any changes to nationally dictated CQUIN schemes within the contract. Strictly speaking as a local authority contract CQUIN rules do not apply. In the initial draft being considered all the aspects of the Safety Thermometer CQUIN are included within the quality provisions. It will be important that both the final commission contract and the collaborative agreement give the CCG the ability to ensure that due notice is given to DH Guidance in this area.
If approved the PCT Contracts Team will work with TMBC to finalise both the commissioning contract and the collaborative agreement to ensure that as far as is reasonably practicable all of Hempsons points are accounted for. The COG Commissioning Operations Group will oversee this
16 process and report back to CCG should there be any issues that cannot be resolved with TMBC that are deemed to present a risk to CCG.
Recommendations
1. CCG are asked to formally request that an agreement to satisfy s75 of the NHS Act 2006 is entered into with TMBC for the commissioning and contracting of care homes. This agreement will formally be between Tameside & Glossop PCT initially transferring to Tameside & Glossop Clinical Commissioning Group in April 2013. 2. The contents of the collaborative agreement, as drafted by the PCT’s lawyers for negotiation with TMBC, are approved. 3. NHS T&G formally request that this agreement is ratified by the Board of NHS GM when it has been agreed with TMBC.
Tom Wilson
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Clinical Commissioning Group Meeting
Safeguarding Children and Vulnerable Adults Board Report
Paper prepared by: Gill Gibson Date of paper: July 2012 Subject: Safeguarding Children and Vulnerable Adults Board Report
History of paper: This is the first integrated Board report on safeguarding children and vulnerable adults to be presented to the CCG . The PCT has in the past had separate reports on safeguarding.
Executive Summary: The purpose of the Annual report is to raise the awareness of the Clinical Commissioning Group and NHS Greater Manchester of its responsibility and the accountability it carries for protecting children, young people and vulnerable adults. The report provides an update on the current arrangements within the organisation, highlighting any gaps in service provision and delivery and inform commissioners of new legislation, the past years achievements and to present a plan for future development.
The Report outlines statutory responsibilities for safeguarding Children and young people and expected commissioning standards in regard to safeguarding vulnerable adults.
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Outcome Required of CCG: CCG are asked to accept the report and future plans
For Discussion or Approval: Approval
QIPP principles addressed by proposal: Quality and patient safety
Direct questions to: Gill Gibson
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SAFEGUARDING CHILDREN and VULNERABLE ADULTS
Report to the NHS Tameside & Glossop Board
1st April 2011-31st March 2012
NHS Tameside and Glossop Responsibilities
Version :1 22.5.11 Date of issue: Date for review: Status:
Prepared by:
Gill Gibson Designated Nurse Safeguarding Children and Vulnerable Adults
Dr M Khan Designated Doctor Safeguarding
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Executive Summary
This is the first safeguarding children and adults Annual report to NHS Tameside and Glossop Shadow Clinical Commissioning Group for April 1st 2011 to 31st March 2012.
Safeguarding, promoting and improving the health of Tameside and Glossop’s children and vulnerable adults are public health priorities and these are reflected in NHS Tameside and Glossop’s plans and those agreed with partners. NHS Tameside and Glossop play an active role in the work of the Children’s Safeguarding and Adults Boards in Tameside and Derbyshire.
Tameside and Glossop have high numbers of vulnerable adults, children and families faced with significant stressors that require additional and responsive support and interventions to keep them safe and promote their welfare and development.
Lessons from local serious case reviews reflect the findings both nationally and regionally. There is a requirement to focus on adult issues that may impact on the welfare of children and to focus on early years and neglect. There is a need to ensure that vulnerable adult’s health needs are met.
There is a requisite to “think family” and to identify need much earlier and the role of midwives, health visitors and general practitioners in this is critical.
The purpose of the Annual report is to raise the awareness of the Clinical Commissioning Group and NHS Greater Manchester of its responsibility and the accountability it carries for protecting children, young people and vulnerable adults. The report provides an update on the current arrangements within the organisation, highlighting any gaps in service provision and delivery and inform commissioners of new legislation, the past years achievements and to present a plan for future development.
NHS Tameside and Glossop has a strong underlying culture for the protection of children, young people and vulnerable adults, evidenced in its commitment to addressing the needs of those most at risk of abuse and neglect.
Prevention is the key to safeguarding children and adults and requires all organisations that come into contact with children, their parent’s vulnerable adults and carers, to contribute. NHS Tameside and Glossop are proactive, using robust supervision and training for all the key practitioners working with children and their families and robust training for those working with vulnerable adults. NHS Tameside and Glossop committed to rolling out Level 1 safeguarding children and adults training to the whole organisation, and expanding supervision to incorporate adult practitioners working in Child safeguarding situations. c:\documents and settings\jbell\local settings\temporary internet files\content.outlook\buhq96fi\safeguarding children and adults board report 2011-2012 (draft 3.docx 2 | P a g e
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Children die for various reasons; this report informs the board of the process for scrutiny of those deaths and gives assurance that all childhood deaths are analysed by both the Derbyshire and Tameside Local Safeguarding Board’s Child Death Overview Panel’s, taking appropriate action as required.
This report intends to assure the board that Safeguarding Children and vulnerable adults is at the forefront of service delivery, impacting on all services, and is the responsibility of every member of staff to be child and adult focused.
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CONTENTS Page
1. Purpose of Report 6
1.1 Definition 6 1.2 Service Aim 6-8
2. The Health Economy 8
2.1 NHS Tameside and Glossop Responsibilities 8-10 2.2 The Role of the Chief Executive 11 2.3 The Role of the Director for Safeguarding Children and Adults 11 2.4 The Role of The Locality Director for Safeguarding 11 2.5 Designated and Named Professionals Update 12 2.6 The Joint Health Child and Adult Protection Forums 12
2.7 Case Management Supervision 12-13 2.8 Training 13-14
3. Quality Assurance Areas 14
31. Quality Indicators/Care Quality Commission Standards 14-15 3.2 Safeguarding Policies and Procedures 15 3.3 Safeguarding Children Audits 16 3.4 Outcome of audit 16-17
4. Local Safeguarding Children and Adult Boards 17-18
5. Guidance for Safe Working Practice 18
6. Multi-agency Working 18
6.1 NHS Tameside & Glossop Commissioning 18 6.2 Child and Adult Protection Investigations 18-19 6.3 Sexual Abuse 19
7. Child Protection in Tameside 19
7.1 Recent Activity 19-20 7.2 Summary of progress on key priority areas in Tameside 20-22 7.3 Future key Priority areas in Tameside 22-23 8. Child Protection in Derbyshire High Peak and North Dales 23
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8.1 Recent Activity 23 8.2 Summary of progress on key priority areas in Derbyshire 23 8.3 Identified Goals for the coming year for Derbyshire 23-24
9. Safeguarding Adults in Tameside 24 9.1 Activity 24-25 9.2 Summary of Key Priority Areas for Tameside 25-26
10. Safeguarding Adults in Derbyshire 26 10.1 Activity 26 10.2 Summary of Key Priority Areas in Derbyshire 26
11. Childhood Deaths 27 11.1 Sudden Unexpected Death 27 11.2 Child Death Overview Panel (CDOP) 27 11.3 Achievements and Challenges 27-28
12. Progress on priorities for 2011/12 28-30
13. Conclusion 30
114. Priorities for 2012/13 30-32
15. References 33
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1. Purpose of the Report
1.1 Definition
Child Protection is part of safeguarding and promoting the welfare of children and refers to the activity which is undertaken to protect children who are suffering or likely to suffer significant harm (HM Government 2006, 2010), including:
Protecting children from maltreatment. Preventing impairment of children’s health or development. Ensuring that children are growing up in circumstances consistent with the provision of safe and effective care; and undertaking that role so as to enable those children to have optimum life chances and to enter adulthood successfully.
Each local authority with Children Social Care responsibility has a Local Safeguarding Children Board (LSCB). The PCT and CCG’s statutory duties include involvement in, and commitment to, the work of the LSCB in Tameside and Derbyshire (See diagram 2).
Safeguarding adults No Secrets (2000 Department of Health and Home Office), which is the main guidance document for safeguarding adults, in the opening pages informs the reader that the document:
Does not have the full force of statute but should be complied with unless local circumstances indicate exceptional reasons to justify a variation (section 1.4 page 6)
Despite the lack of statutory powers the intent of the guidance is clear. Statutory organisations need to cooperate and work together in protecting vulnerable adults from abuse.
1.2. Safeguarding Service Aim
The service aims, within the health economy, to ensure that all children and vulnerable adults in Tameside and Glossop are safeguarded and protected from harm in accordance with national legislation and guidance.
This is achieved by the following:
Ensuring that health organisations protect children by following national child safeguarding guidelines within the PCT activities and in their dealings with other organisations (Care Quality Commission Standard 7). c:\documents and settings\jbell\local settings\temporary internet files\content.outlook\buhq96fi\safeguarding children and adults board report 2011-2012 (draft 3.docx 6 | P a g e
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Ensuring that health organisations meet their duty under Section 11 of the Children Act 2004 to make arrangements to ensure that in discharging their functions, they have regard to the need to safeguard and promote the welfare of children and young people. Ensuring that health organisations in discharging their roles and responsibilities are compliant with the National Service Framework for Children, Young People and Maternity Services (NSF) in particular Standard 5 Safeguarding children is an integral part of the governance and audit arrangements of health organisations. Ensuring that health organisations are aware of their responsibilities for ensuring that their staff are competent and confident in carrying out their roles and responsibilities for safeguarding children. Ensuring that staff are offered safeguarding children training which meets the requirements of the Common Core Skills and Knowledge and meet the competencies identified in Safeguarding Children and Young people: Roles and Responsibilities for healthcare staff (Royal Colleges 2010). Ensuring that health organisations meet their duty to promote the health of children and young people who are looked after by the Local Authority (DOH 2002) Ensuring that health organisations meet their duty to notify the Local Authority of Private Fostering arrangements in line with Section 44 of the Children Act 2004, the Children (Private Arrangements for Fostering) Regulations and the National Minimum Standards for private fostering.
The ultimate aim is that all children have optimum life chances and are able to enter adulthood successfully.
The key legislative framework that underpins the safeguarding of children includes:
The National Service Framework for Children, Young People and Maternity Services 2004 The Children Act 1989,2004 Working Together to safeguard children 2010 The Sexual Offences Act 2006 Every Child Matters 2004 The Safeguarding Vulnerable Groups Act 2006 National domestic violence delivery Plan 2009 Care Quality Commission essential standards 2009 Improving the Health of Looked After Children 2002.
The Lead Agencies for the Safeguarding of Vulnerable Adults are Tameside MBC and Derbyshire CC. However, NHS Tameside and Glossop has a responsibility as a partner agency of the Tameside and Derbyshire
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Safeguarding Adults Partnerships and is required in the “No secrets“ guidance to contribute to developing and implementing multi-agency policies and procedures to:-
1. Protect Vulnerable Adults from abuse (DOH and Home Office 2000).
2. Co-operate with Tameside and Derbyshire in the operation of the Partnerships.
3. Share responsibility for the effective delivery of The Safeguarding Boards functions.
2. The Tameside and Glossop Health Economy
NHS Tameside and Glossop is required to ensure that all health staff across the entire health economy are alert to the need to safeguard and promote the welfare of children and vulnerable adults, and are required to satisfy themselves that all their contractors and the staff of commissioned services are also aware of this requirement.
2.1. NHS Tameside and Glossop Responsibilities
Working Together (DCSF 2010) provides statutory guidance, which places a clear responsibility on health organisations and professionals working within them. The CCG is under a duty to ensure that safeguarding and promoting the welfare of children and young people is a fundamental and core part of their functions.
The commitment must encompass both the commissioning and the operational aspects of the organisation’s functions.
To this effect, NHS Tameside and Glossop have clear lines of accountability for safeguarding, which are described in the following structure, (Diagram 1). Accountability frameworks for safeguarding adults is similar to the structures within the diagram, but there is no duty on provider organisations to have named professionals for adult safeguarding.
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Diagram 1 Individual accountability and responsibility arrangements
Mike Burrows CEO C&A
Hilary Garratt Director for Safeguarding C&A
Steve Allinson Int Dr Munera Khan Gill Gibson COO Safeguarding Designated Doctor C Designated Nurse C&A C&A
Doctor Named Nurse *Named Midwife Named Nurse NHS *Named Nurse Pennine CareC Named Doctor Named Doctor Acute Trust C Acute Trust C T&G CH C Pennine Care NHS T&G C Acute Trust C C
*These professionals will also have accountability arrangements in place within their employer organisation
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Diagram 2 – Multi-agency accountability & responsibility arrangements
PCT Board
PCT Quality Committee Derbyshire Tameside Safeguarding Safeguarding Children / adults Children / adults
Health Economy Child and adult safeguarding Forum’s
Tameside Hospital NHS Tameside & Glossop Foundation Trust Pennine Care Mental community health Health Trust
KEY- Minutes received C&A – children and adults
Minutes sent C -children
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Mike Burrows as Chief Executive NHS Greater Manchester has responsibility for ensuring that the health contribution to safeguarding and promoting the welfare of children and adults is discharged effectively across the whole health economy through commissioning arrangements. NHS Greater Manchester’s role is not just about specific clinical services, but also about exercising a public health responsibility for the whole population, with the key task being to ensure the health and wellbeing of children in need and adults at risk in their area.
2.3. The Role of the Director for Safeguarding Children and Adults The Director for Safeguarding children and adults in NHS Greater Manchester is Hilary Garratt, Director of Nursing and Quality. In her role as Director for Safeguarding children and adults, Hilary Garratt has executive responsibility for Safeguarding Children and adults as part of her portfolio of responsibilities. The Designated Nurse and the Designated Doctor are directly accountable to the Director who performance manages the roles and supervision is provided by The Associate Director of Safeguarding for NHS Greater Manchester Kay Welsh.
2.4 Locality Director of safeguarding
The Locality Director with responsibility for safeguarding within The Clinical Commissioning Group (CCG) Is Interim Chief Operating Office Steve Allinson. His role is to ensure NHS Tameside & Glossop CCG discharges its statutory functions within the locality on behalf of The Chief Executive of NHS Greater Manchester.
2.5. Designated and Named Professionals The Designated Nurse and the Designated Doctor for Safeguarding have a strategic role in safeguarding children across the whole health economy in Tameside and Glossop. Each provider within Tameside and Glossop has a named lead for safeguarding children.
Dr M Khan is the Designated Doctor and Mrs G Gibson is the Designated Nurse.
The Designated Nurse also has strategic responsibility for Safeguarding Vulnerable adults.
The guidance for the Roles and Responsibilities of the Designated Professionals are documented and are in place (Royal Colleges 2010). This has been updated to reflect Working Together 2010 requirements.
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2.6. The Joint Health Child Protection and adult protection Forums
The Forums meets every eight weeks and membership comprises of key professionals from NHS Tameside and Glossop, the Tameside Hospital Foundation Trust, Tameside & Glossop Community Health, Pennine Care Mental Health Trust and Go To Doc. These representatives are responsible for ensuring that health staff working in individual areas within the different organisations have the required knowledge and understanding, of local safeguarding procedures and are clear about how to contact the Named and Designated professionals. A member of the public health team sits on The Forum and ensures there is a commissioning oversight of all provider organisations. All health staff are required to be confident about what to do if they have concerns about a child or vulnerable adult, how to identify and assess children and adults who may be experiencing abuse or neglect, and how to access professionals trained in examining such children and adults. NHS Tameside and Glossop Community Health, Tameside Foundation Trust and the Pennine Care Mental Health Trust all have robust arrangements for staff supervision and support.
2.7. Case Management Supervision
A robust process for clinical supervision and staff support has been developed within NHS Tameside and Glossop Community Health Business Group through the Safeguarding Children’s Unit team. All practitioners who require mandatory safeguarding children supervision are required to comply with the Child Safeguarding Case Management policy for NHS Tameside and Glossop, which has been developed in line with nationally, approved standards. The policy has been updated to encompass all healthcare professionals working with children and families with child protection issues; to include adult health professionals when required. The policy has also increased the frequency of child protection supervision for health visitors and school nurses from three to four times per year. The new policy reflects the increased importance in Working Together 2010 on supervision. Supervision has also been developed with medical colleagues for supervision of doctors within primary care. A system of supervision is now in place for Consultant Paediatricians, Accident and Emergency and Paediatric staff. The Named Nurse for Tameside Foundation Trust has introduced child protection supervision within the organisation, which has been rolled out with the Children’s Community Nursing Team and in patient units, all now receiving regular supervision. The Named Nurse has introduced supervision training to increase capacity of supervisors. Supervision is also provided for any member of staff working within the child protection arena.
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Supervision of staff working in adult safeguarding is not a statutory requirement, but is to be a priority for health and multi-agency services in the coming year to develop a framework for adult protection supervision.
2.8 Training
NHS Tameside and Glossop have issued a Commissioning Training Strategy outlining what is expected of all health care providers who operate within their borders, this training strategy will be refreshed in 2012 to incorporate new commissioning structures.
A Training Policy is in place to ensure that all health staff within provider services and independent contractors have access to the relevant training for their needs, from in-house training programmes through to Local Safeguarding Children Board multi-agency programmes. All children’s services staff are compliant with basic training requirements action plans are in place to ensure relevant staff are compliant with level 2 and 3 training within major providers. Due to the report to the government by Professor Eileen Munroe on safeguarding arrangement for children. A new Working Together to safeguard children and NHS Safeguarding Assurance Framework are due, training policies will need to be further updated to ensure compliance in 2012. Designated Professionals and the TSCB will quality assure each training policy to ensure it is fit for purpose through its training sub group.
A further requirement of Working Together (2010) and the Care Quality Commission, is that an annual update on the national perspective of Safeguarding Children is given to all staff within the organisation. NHS Tameside and Glossop complied with this requirement and used the intranet and CCG newsletter to deliver the update. A New quarterly Safeguarding newsletter will be developed in 2012 to ensure all independent contractors are kept updated about safeguarding children and adults.
To ensure the Trust complies with Care Quality Commission requirements, the NHS E learning package on safeguarding children and adults, level one has been rolled out across all the directorates. The E learning package is linked to the electronic staff record enabling a complete audit of staff training to be available. NHS Tameside and Glossop is assured via the Health Economy Child and adult Protection Forum, that the Tameside Foundation Trust Community services and Pennine Care Mental Health Trust have substantial training packages in place which are quality assured by the Tameside Safeguarding Children Board training Department. All agencies comply with the requirement to provide level 1, level 2 and 3 training. Training requirements are also monitored through the safeguarding standards audit process.
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In addition, all staff work in accordance with the policies and legislation for safeguarding. They are aware of the competencies they need to demonstrate in relation to Safeguarding Children and adults. With the development of the National Learning Management System and E Learning from Royal College of Paediatricians, safeguarding training will become more accessible and cost effective for all health care staff level 2, E learning training is to become available soon. Providing training to GP’s practice staff and other independent practitioners continues to be a challenge. NHS Tameside and Glossop continued throughout the year to support training for GPs through TARGET and individual practice based sessions. This has resulted in a high percentage of staff compliant with requirements. Designated Professionals issued guidance to independent contractors of how their staff can access relevant Training. Raising awareness of Safeguarding adults amongst GPs is on the TARGET agenda in 2012.
Within the new architecture of the NHS there needs to be a robust strategy in place to ensure GPs and their staff are compliant with training requirements that take into consideration the reviewed level of training required for GPs from the Intercollegiate document (2010). The CCG and national Commissioning Board also need to consider how they will monitor this compliance with all independent contractors and providers. Designated professionals will continue to support all independent contractors with their training requirements and advise the CCG on training needs and compliance monitoring.
The child and adult protection forums monitor compliance of training on a quarterly basis by all providers, the safeguarding standards audit also requires an annual report of compliance.
3. Quality Assurance areas are as follows: 3.1 Quality Indicators / Care Quality Commission Standards
NHS Tameside and Glossop are compliant with The Care Quality Commissions 27 core standards. Compliance also applies to the providers we commission.
Care Quality Commission standard 7 provides the local framework for the quality of safeguarding. The 24 core standards represent a level of service that all service users should expect from the NHS including the Safeguarding Children Unit, which is required to risk assess and address risk management in line with policy and is compliant. Child Protection, and Domestic Abuse, are included as public health issues. The Safeguarding Children and adults Service is committed to meeting the standards within the framework to address the serious risk to children, young people and vulnerable adults through advice, support, training and supervision.
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In March 2012, Tameside received a safeguarding and looked after children’s inspection. Judgements for health were as follows, “outstanding contribution to safeguarding children” and a “good” judgement for the health of looked after children. The CQC report will be received in June 2012 and a priority will to be address any actions arising from the inspection.
The North West Strategic Health Authority issued a North West Safeguarding Policy which has been included in all major provider contracts and will be audited using the associated audit tool through the contracting and performance monitoring process. There are also audit tools for independent contractors and the voluntary and faith sector and new for 2012 funded nursing care. NHS Tameside and Glossop intend to encourage independent contractors to use the policy and audit tool in 2012-2013 and offer assistance for audit.
NHS Tameside and Glossop has published its safeguarding declaration on the web site, assuring the public of its compliance with safeguarding standards.
3.2 Safeguarding Policies and Procedures NHS Tameside and Glossop should ensure that providers, from whom they commission services, have comprehensive policies and procedures to safeguard and promote the welfare of children and vulnerable adults. The Designated Nurse is the chair of the Policy and Procedure sub group of the Tameside Safeguarding Children Board.
NHS Tameside and Glossop Community Health, Tameside Foundation Trust, Pennine Care Foundation Trust and Go To Doc have policies and procedures in place which are in line with, and informed by, Local Safeguarding Children and Adult Board procedures and which are easily accessible for all staff at all levels within each organisation.
As assurance to NHS Tameside and Glossop CCG of all providers commitment and compliance with safeguarding standards, a North West commissioning standards document has been included in all major contracts. The Commissioning Standards are planned to be audited on an annual basis, using the standardised audit tool.
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3.3 Safeguarding Children Audits Audits demonstrate that practitioners are working with all agencies to underpin Working Together (DOH 2006, 2010), enabling NHS Tameside and Glossop to meet its commitments to the Local Safeguarding Children’s Board’s and partner agencies by ensuring practice is focused on the child.
The Designated Professionals have developed an annual audit plan which is health economy wide and allows for internal assurance. This includes three individual audits from each of the three Trusts to address their recognised needs and three health economy audits to ensure the quality of provision of child protection across Tameside and Glossop. Results of these audits across the Health Economy are addressed through the Health Economy Child Protection Forum.
Audits carried out for 1st April, 11 to 31st March 2012 were:
Child Protection record keeping Multi Agency Practice audits. Health Visiting and Midwifery Handover Audit of multi-agency information sharing
Additional Multi agency audits have been carried out over 2011/12 on behalf of The LSCB arising from action plans from Serious Case Reviews. Focus groups with practitioners across all agencies including many groups of health professionals have taken place to inform the LSCB that learning from serious case reviews has been disseminated to practioners and that the work of the TSCB is understood at the front line. These focus groups also served to inform the board from practitioner level of the future priorities to safeguard children and young people. There will be further multi-agency audits in 2012/13. An audit group comprising of the Named and Designated professionals is established, with advice available from the Clinical Governance department to focus on the planning and delivery of all audits. New arrangements for audit will need to be established with the CCG in the coming year.
3.4 Outcomes of Audit
Child protection record Keeping
Training has been developed across all agencies to address issues that arose from the audit and new standards have been set within health visiting about how to keep a chronology, and types of information that should be recorded. This audit is required to be carried out on an annual basis.
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Multi agency Practice Audits Work around recording of assessment of risk needs to be improved and training and development of a risk assessment tool are being led by Tameside Safeguarding Children’s Board, training has been provided to key professionals and a strategy to roll out risk assessment training is being developed. Risk assessment tools will be available to all practitioners across Tameside & Glossop.
Health Visitor, Midwifery Handover A short life working group has been established to develop electronic solutions to birth notifications to speed up process, this work is on-going but significant improvements have been made.
Multi-Agency Information sharing A report on this audit is awaited, the particular focus is on the implementation of The Tameside agreement, an agreement between GPs and Health Visitors to have regular meetings to discuss children in need.
4. Local Safeguarding Children and Adult Boards NHS Tameside and Glossop have established good representation on both the Tameside Local Safeguarding Children and Adults Boards and the Derbyshire Local Safeguarding Children and Adult Boards, with increased commitment to the many sub and short life working groups. Members advise and support the Local Safeguarding Children and Adult Boards on a wide range of specialist health functions.
Safeguarding Children Boards have a specific purpose which includes the safeguarding of children and young people, and promoting the welfare of children in three broad areas:
Proactive work to protect and target those children deemed to be in need of protective services Reactive work to respond to the needs of those children who are suffering from any kind of abuse and those deemed to be at risk of significant harm and or neglect within families and the community. Protect children and young people from any activity that may prove harmful to children and cause impairment and development.
Lynne Jones is the independent Chair of the Tameside Safeguarding Children Board (TSCB). Andy Searle is the independent chair of the Safeguarding Adults Board.
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Guidance is awaited from the Munroe review of safeguarding Children on the role and function of LSCB’s and the Board will need to reflect this guidance in its strategic direction. Safeguarding adults boards are to become statutory it is expected at some time during 2012 and this will need to be reflected in the work of the partnership.
5. Guidance for Safe Working Practice for Adults who work with Children and Young People (October 2009)
This document has been produced in response to the Bichard Inquiry following the Soham Murders. The Children Act (2004) and through the Stay Safe outcome of the Every Child Matters (2006). This guidance supports employers in giving a clear message that unlawful or unsafe behaviour will not be tolerated and that appropriate, legal or disciplinary action is likely to follow. During 2010-2011 this guidance was reviewed and scaled back to “common sense levels”(Direct Gov 2011).The main revisions are to maintain a barring function, abolish registration and monitoring requirements, redefine the requirements of regulated activities and abolish controlled activities. The Criminal Records Bureau and The Independent Safeguarding Authority have merged to become one organisation to fulfil both functions. New Legislation will be introduced to amend The Safeguarding Vulnerable Groups Act (2006) to allow these changes. Until new legislation is implemented in 2012 existing law applies, new legislation is expected in 2012.
The Executive lead for safeguarding and Designated Nurse have the role of informing the Local Authority Designated officer (Lado) of any staff member who is accused of abuse.
6. Multi agency Working.
6.1 NHS Tameside and Glossop Commissioning.
NHS Tameside and Glossop are responsible with their Local Authority partners for commissioning integrated services to respond to the assessed needs of children, young people, vulnerable adults and their families, where a child or adult has been, or is at risk of, being abused or neglected.
6.2 Child and Adult Protection Investigations
Health professionals play a key role in child and adult safeguarding investigations and case conferences and are crucial to the implementation of child and adult protection plans.
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Since April 1st 2009, the child protection register is no longer part of the safeguarding children process. Children deemed to be at risk of abuse or neglect are to be identified by child protection plans being in place. Health professionals continue to be committed to, and involved in, multi-agency joint working. Within the last year, the Tameside and Glossop Health Economy have had one children’s Serious case review (SCR). The SCR submitted to OFSTED, was judged “good “and the commissioning health overview report was judged “good” and have met requirements of Working Together. Arising from the SCR was a comprehensive action plan with particular actions for health. The main themes of these actions were to work with GP colleagues and community health staff to strengthen information sharing around health and social situation of parents which may affect the wellbeing of their children. A Tameside agreement between GP’s and Health Visitors and School Nurses has been developed to strengthen these arrangements and has now been implemented and the outcome of an audit in 2011-2012 is awaited.
A pregnancy social risk assessment, a proforma for information sharing with child protection conference and use of read codes for child protection for GPs have all been agreed and are ready to be implemented during 2012. Improved pathways of working for all agencies with parents with a learning disability are nearing completion and will be implemented in 2012. Improved early intervention working with vulnerable parent’s pathway being developed and implemented during 2012-13.
6.3 Sexual Abuse NHS Tameside and Glossop are responsible for commissioning services in Sexual Assault Referral Centres (SARCS), for victims of rape and sexual assault including children and young people.
This service is commissioned from Greater Manchester Sexual Assault Referral Centre for Tameside residents, and provides a comprehensive package of forensic, medical and counselling services. The Glossop residents receive this service in Chesterfield.
7. Child Protection in Tameside
7.1 Recent activity
There were 237 Tameside children with Child Protection Plans in March 2011. There had been a fairly steady rate increase throughout the year from 181 in quarter one.
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Children and young Quarterly Yr 11/12 annual Qtr1 181 Qtr2 191 Qtr3 207 Qtr4 237 people who are the average subject of a child protection plan, in the following categories [number (percentage)]: Physical 148(18.5%) 33 (18%) 22(11.5%) 19 (9.18%) 28(11.8%) Abuse Emotional 371(46.3%) 86 (48%) 106(55.5%) 117 (56.5%) 125(52.7%) Abuse Neglect 248(31%) 58 (32%) 60 (31.4%) 65 (31.4%) 75(31.6%) Sexual Abuse 33(4.1%) 4 (2%) 3 (1.6%) 6 (2.9%) 9(3.8%)
Two thirds of plans are for 3-6 months: 11 % of children have been the subject of a plan for over two years, March 2011. Indicating that the majority of protection plans are effective and that intervention is provided to enable children and family situations to improve. Though Tameside has a higher than England and statistical neighbour average in plans lasting more than 2 year. This was picked up by the recent OFSTED/CQC inspection and considerable work is being undertaken by children’s social care to review all these plans.
The percentage of children who started a second or subsequent plan during 2011 is 15.7%,(cumulative figure) March, 2011, this percentage has risen over the last year from 9.8% , again an piece of work is being conducted by TSCB and children’s services to look at step down arrangements.
Emotional abuse and neglect are the most common category of abuse for children on a protection plan.
With the development of the LSCB performance report, we are better able to judge ourselves against statistical neighbours. Benchmarking shows that the o we are outliers is in the number of children referred to social care and continues to directly correspond to the low number of common assessments carried out.
7.2 Summary of progress on key priority areas in Tameside
Updated policies, procedures and guidance for safeguarding and promoting the welfare of children in Tameside have been produced including TSCB guidance on forced Marriage, Female Genital Mutilation and asylum seekers. TSCB have commissioned a company called Tri-X as part of arrangements across Greater Manchester to develop and update future policies. A multi-agency risk assessment for neglect “The Graded Care Profile” has been adopted from a recommendation of a serious
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case review, training and implementation are to be completed during 2012. A new focus on Child Sexual Exploitation has been developed and scheduled multi-Agency meetings to discuss young people at risk and develop appropriate interventions were initiated in 2011, Addressing Child Sexual Exploitation in Tameside is a priority for Tameside safeguarding Children’s Board in the coming year. Safe sleeping assessment and guidance has been adopted. Child protection supervision policies have been updated across health economy and will need to be updated in 2012 to reflect the new Working Together and NHS Safeguarding assurance framework. A multi-agency supervision framework has been developed. A rolling programme of multi-agency training ensuring that practitioners and managers are aware of their responsibilities to protect children by being able to recognise and respond to abuse and neglect. This also includes the training and development of the members of the Safeguarding Children Board. A Board development session has occurred, which helped the Board decide it’s priorities for the coming year and for members to explore their role within the board structure and efficacy of the board and formed part of the section 11 audit. DOH E Learning Safeguarding level one was approved by NHS Tameside and Glossop Executive Team and rolled out across all its directorates. E Learning is linked to Employee Management System so a comprehensive database of compliance of training is available. A database of GP and practice staff training has been established by the governance department and continues to be populated. Co-operation with neighbouring children’s services authorities and their Board partners includes use of Common Processes regional and national procedures and commitment to the Greater Manchester safeguarding Partnership and other Pan Manchester and Regional groups. All agencies are committed to the use of JASPER, the local Information sharing solution. Cross agency policy on the use of common processes developed to increase the use of Common Assessments and working group continues to drive up use of common processes. KPI’s inserted in to some health contracts to increase the use of common processes.
Monitoring and Evaluation of the effectiveness of safeguarding arrangements o Multi-agency practice audits carried out. o Audit of child protection case notes o Section 11 Audits
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o NHSNW Safeguarding Standards Audit
o CQC/Ofsted inspection
o Audit of Health Visiting, Midwifery handover
Key issues addressed from audits:
o Increasing use of common processes and role of lead professional. Common processes policy guidance, each organisation has set themselves targets for increase, included in some KPI’s.
o Increased emphasis in supervision on early intervention, decision making and challenge and measuring outcomes for children.
o Ongoing work on risk assessment tools in safeguarding focus on measuring risk and risk management in neglect.
o Ongoing work by children’s social care on thresholds for intervention and clarity for practitioners and the public. Social care is to re structure to provide a single access point for services to improve consistency across Tameside.
o Designated doctor and Named doctors introduction of case supervision for paediatricians.
o Action Plan to improve handover from midwife to health visitor, currently under development and to be implemented from June 2011 when Midwifery IT system in place improvements made, but actions on- going.
7.3 Future Key Priority areas in Tameside
Complete improvements required arising from OFSTED CQC inspection
Develop child sexual exploitation strategy and implement and monitor effectiveness
Seek assurance that children who are looked after are safe
To promote and raise awareness of the importance of safeguarding children and young people
Develop the participation of children and young people in the work of the Board
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Review the impact of multi-agency work around Domestic Violence, Child Sexual Exploitation, Looked After Children, Alcohol/Substance Misuse, and Neglect Seek assurances of agency capacity and workforce skills and knowledge to deliver comprehensive and effective risk assessment across the borough Seek assurances that partners continue to have the capacity to deliver effective services, including early intervention services, to safeguard children and young people
8. Child Protection in Derbyshire, High Peak and North Dales
8.1 Recent activity
There has been a slight increase in the number of children on a protection plan in High Peak and North Dales from 57 in March 2011 to 69 in Feb 2012, and is consistent with what would be expected for the demography.
8.2 Summary of Key Priority areas in Derbyshire
Suicide Prevention Strategy Published leaflets for the public and practitioners providing information on support for young people at risk of suicide or self-harm. Updated thresholds and referral process for multi-agency teams. Training Developed a comprehensive multi-agency training strategy. Inter-agency development implementation of child sexual exploitation action plan. Early Help development of a model of early intervention/early help/neglect and developing ways to work with troubled families. Monitoring professional practice and outcomes in relation to safeguarding children. Questionnaire on compliance with safeguarding procedures to staff Produced a strategy for dealing with neglect. Improving scrutiny of safeguarding outcomes for disabled children.
8.3 Identified goals for the coming year for Derbyshire
Development of an early identification and early help service for children and families Implementation of a single assessment tool for all agencies Work with adult service to promote the “Think Family” model Learning from the current serious case reviews Embedding of the strategy to reduce the incidence of suicide and self harm by children and young people
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Develop a process for identifying and supporting young people who are most at risk including risk due to sexual exploitation, running away and self-harm. Review and amend policies and procedures in light of the Munroe review and new Working Together.
9.Safeguarding Adults in Tameside 9.1 Activity Overall there has been an increase of 9.5 % of concerns reported and a 9% increase in investigations this year. This is a reduction in comparison to the increase last year. As the number of organisations reporting adult abuse is increasing, this is evidence that the work to raise awareness of adult abuse is successful and adult abuse is being prevented across Tameside. The outcomes of the majority of Safeguarding Adult investigations were founded. This confirms that the Safeguarding Adult concerns have been appropriately raised in the first instance. There is no significant trend to indicate that investigations that were unfounded were inappropriately raised. Performance Management Data indicates that adults, who are at risk of abuse or experienced abuse, appear to be more likely victims of neglect. One of the main reasons for this was due to changes in commissioning of services for home care and communication breakdowns resulted in missed calls. This was addressed by Adult Services and lessons have been learnt to avoid this situation happening again. Physical abuse is an easier form of abuse to detect, which is a possible reason why this abuse is documented as one of the more prevalent in Tameside. Intervention into these situations is addressed via the safeguarding adult process and protection plans applied to prevent abuse happening in the future. As in previous years and as would be expected due to the nature of the business, Adult Services have raised the majority of these concerns and led on the Safeguarding Adult Investigations. This organisation has raised 48% more concerns than last year and led on 8% more investigations. The increase in concerns was largely due to changes in commissioning of services for home care and communication breakdowns resulted in missed calls. As discussed earlier, Adult Services addressed this appropriately. PCT are also leading on more investigations in the independent sector, 16% of investigations during the year were led by continuing care staff. The decrease in investigations they have led on is minimal compared to last year’s figures and is due to the fact one residential home last year had a major investigation involving a number of residents. PCT led these investigations. During 2011/12, Tameside Hospital NHS Foundation Trust has led on 40% more safeguarding adult investigations than last year. This is evidence of the commitment of partnership working and that safeguarding adults is embedded in the Trust’s core business. c:\documents and settings\jbell\local settings\temporary internet files\content.outlook\buhq96fi\safeguarding children and adults board report 2011-2012 (draft 3.docx 26 | P a g e
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Tameside Hospital NHS Foundation Trust have been proactive in work undertaken by TASP to improve the process for recording safeguarding alerts for adults at risk of neglect resulting in developing pressure sores. In response to the work TASP have produced additional guidance regarding reporting of pressure sores as a safeguarding concern. The apparent decrease in safeguarding adult concerns raised by the Trust could demonstrate that this guidance is effective and provides clarity for staff and concerns are raised appropriately. Tameside and Glossop Pennine Care NHS Foundation Trust have also witnessed a 48% increase in concerns raised this financial year. This also suggests that training is effective.
9.2 Summary of key Priority areas for Tameside
World Elder Abuse Awareness Day is one of the main annual events for TASP. This day provides a platform for TASP to raise awareness of Adult Abuse across all communities. TASP chose Ashton Arcades to host an information stand. In excess 350 people visited the Information Stand. This forum was facilitated by TASP, Safeguarding Adult Team, Tameside Hate Incident Panel, Police and Patrollers. It was an enjoyable day and visitors went away with free bags, pens, panic alarms and lots of information regarding how to keep safe inside and outside the home.
Raising Awareness for Staff and Public with financial support made possible via Cllr Travis during 2011/12 TASP publicity campaign was launched. Consequently, new publicity materials were designed and distributed across Tameside. Posters documenting new strap lines such as ‘Break the silence’, ‘Abuse hurts at any age’ and ‘Safeguarding adults is everybody’s business’ can be seen in many Public buildings across Tameside. This information was also distributed to Banks, Building Societies, Supermarkets, Opticians, Dentists and GP Practices.TASP hosted numerous events across Tameside to raise awareness of Safeguarding Adults Agenda and what to do if you are aware of an adult at risk of abuse. Tameside Hospital NHS Foundation Trust hosted its 5th Patient Safety Day in November 2011. The purpose of the day was to promote and share lessons learned. Safeguarding Adults was included in the delivery of the content for the day. This was attended by over 100 members of staff. TASP have also introduced an e-brief for staff. This provides updates on a quarterly basis regarding safeguarding adult’s abuse. The work has been developed based on the Local Strategic Children’s Board Practice in Tameside. It is cost effective and demonstrates a shared learning approach. Training programmes for Safeguarding Adult Managers and Investigators have been revised this year to reflect recommendations from the TASP Serious Case Review. The training programme has
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refreshed the content regarding Equality and Human Rights and now includes guidance re. ASBRAC and MARAC. TASP have increased the delivery of Safeguarding Adult Managers, training this year to ensure that the additional 20 Safeguarding Adult Managers identified across Tameside have access to the relevant training.
2011/12 TASP have also been successful in engaging with GP’s, Dentists and Opticians, offering access to e-learning safeguarding adult packages.
To reflect the increase in partner organisations represented at TASP, the TASP Information Protocol has been refreshed
Analysis of data is core business for TASP. Trends illustrated in the performance management data are given an appropriate response. During 2011/12, this work has resulted in guidance introduced to support practitioners for the reporting of Pressure Sores and Violent Incidents as safeguarding alerts.
In response to the Serious Case Review, Adult A, lessons learnt, TASP refreshed the Serious Case Review Protocol. This guidance is for Practitioners and revised to give more clarity and support to ensure the process is applied as effectively as possible.
The British Medical Association (BMA) produced guidance for GP’s regarding responding to concerns if they consider adults to be at risk of abuse. TASP embraced this and devised a flowchart to be used locally by GP’s regarding reporting of Safeguarding Adult Concerns. This was delivered in conjunction with PCT and via the Clinical Commissioning Group.
10. Safeguarding adults in Derbyshire
10.1. Activity It is not possible to disaggregate activity for Glossop from general data for Derbyshire
10.2 Summary of Key Priority Areas for Derbyshire
To undertake an evaluation of IDVA services across the county To source funding to continue the Derbyshire SAM project To implement the Domestic Abuse Information Sharing System To identify funding to provide non mandated perpetrator programmes To work closely with service providers to ensure adequate outreach provision is available for low/medium risk victims To work with partners to address the recommendations arising from Tim c:\documents and settings\jbell\local settings\temporary internet files\content.outlook\buhq96fi\safeguarding children and adults board report 2011-2012 (draft 3.docx 28 | P a g e
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Courts report To develop partnership protocols with Safeguarding Adult Partnership and Children and Young Adults partnership
11.Childhood Deaths
There is a requirement that all child deaths are examined in some detail and are analysed annually and fed back centrally to look for areas where changes can lead to improvements in mortality and identify trends on a regional basis. There is also a requirement that all sudden unexpected deaths be looked at immediately by a specialised professional (SUDI Paediatrician in Manchester) with the police and an assessment made of the circumstances of those deaths.
Locally in Tameside this has been addressed on several levels:
11.1 Sudden Unexpected Death
We are part of the central Manchester Rapid SUDI (Sudden unexpected death in Infancy) rapid response team. The team provides a 24 hour, 7 day service over the whole of Greater Manchester. NHS Tameside and Glossop part fund this together with all other Manchester areas. The paediatricians attend sudden deaths when informed and home visit with the police. They collect information on the case, do an analysis of findings and provide a final report liaising with the coroner. Future funding has been secured to continue with these arrangements.
This service has been used within Tameside for several deaths over the past year and meetings have been held by the SUDI paediatrician to debrief staff involved, the service is evaluated well.
11.2 Child Death Overview Panel (CDOP)
All child deaths are reviewed the Tripartite CDOP, which collects information on all deaths from Stockport, Tameside and Trafford. There are several joint CDOP’s covering greater Manchester. This panel collects information, analyses it and produces recommendations for the Local Safeguarding Children’s Board (LSCB) who then decides actions. Tripartite CDOP, also analyses information statistically and liaises with the coroner, parents, other agencies and organisations to collect and share information. All Manchester CDOP chairs meet to combine information. Health has two representatives from Tameside on this panel.
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Tameside seems to not have any outliers in terms of deaths and causes or in any particular age group. Neonates continue to be the highest death group. The Child Death Overview Panel continues to examine the circumstances surrounding individual deaths to identify any patterns or trends.
11.3 Achievements/Challenges:
o CDOP has now appointed a single administrator leading to better communication with parents, coroner and specialist organisations. AGMA IT system is well embedded.
o There is still a challenge to receive health information for all children under 18 as most health information is for 16 and under. Work continues in this area. Information on children 16-18, is helped by better liaison with the coroner who is informed of all deaths.
o Information to parents has been difficult, as the death of a child is a very sensitive time. Work continues in this area.
At the time of this report, the CDOP annual report was not available, a separate summary of the report will be provided to the CCG by the Consultant in Public Health Medicine with responsibility in this area.
Working Together (2010) has provided important guidance on the response to and review of deaths in childhood. In response to baby P. Chapter 8 of the guidance includes a multi-agency overview of all deaths, a rapid response to Sudden Unexpected Death and a full Serious Case Review (SCR) for any death where abuse or neglect is known to be factors. Professor Eileen Munroe as part of her review of safeguarding is to make recommendations with regard to Child Death Overview Panels in 2011this is not yet available.
12. Progress on Priorities for 2011/12
The Board can be assured that new legislation and research evidence is used to support the work of the Local Safeguarding Children and Adults Boards and practitioners; not only to be reactive to child and adult abuse and neglect, but also proactive, to ultimately improve outcomes for children, young people and vulnerable adults in Tameside and Glossop. Learning from serious case reviews has resulted in new developments implemented within practice and new training courses to ensure lessons learned are disseminated. Some of these improvements have been the development of:
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o A framework for child protection supervision, which has been refreshed in 2011. o A multi-agency framework to improve quality of supervision and promote reflective practice has been developed and launched. o Ensure all safeguarding policies and procedures across the health economy are fit for purpose and reflect current legislation and guidance, reviews have taken place. o Ensure robust processes are in place to deliver training to independent contractors. Training has been delivered through Target and sessions within individual practices. E learning has been recommended to independent contractors and safeguarding training for GPs is monitored through the quality dashboard, ensuring independent practitioners comply with safeguarding standards. Needs to remain a high priority and comprehensive plans developed to ensure continuity in the new architecture of the NHS. o Ensure all actions plans arising from serious case reviews and domestic homicide reviews are developed and implemented. All commissioning health actions complete and evidence provided to TSCB. Health continues to collaborate with colleagues on some multi-agency actions. And some provider organisation plans are on-going but meeting time schedules. o Implement and audit commissioning standards with all provider organisations. NHS Tameside and Glossop implemented The North West Commissioning policy and standards into all main provider contracts. Pennine Care Foundation trust, Tameside Foundation Trust, Community Health Services and Go To Doc was audited and was mainly compliant with a few areas for action, such as statements in job descriptions for safeguarding, which have all now been addressed. Auditing of the standards remains a priority through 2012/13 and will be led by the contracting and performance process as per SHA guidelines. We will work with independent contractor’s nursing homes and voluntary organisations to encourage the adoption of the policy and audit and assist with implementation. o Designated Nurse role is firmly situated within Commissioning Division and now incorporates safeguarding vulnerable adults ensuring a joined up approach from commissioners on how safeguarding is managed strategically across the health economy. o Ensure business plan for Tameside Safeguarding Children’s Board is integral to plans across the health economy. Business plan objectives are reflected in health economy plans and have been reviewed through section 11 audits. o Implement a robust audit programme across the health economy and individual providers. Audit programme developed and implemented and findings have led to practice change. c:\documents and settings\jbell\local settings\temporary internet files\content.outlook\buhq96fi\safeguarding children and adults board report 2011-2012 (draft 3.docx 31 | P a g e
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o Ensure Care Quality Commission standards are met for safeguarding. CQC standards are met and a declaration on the web page displays compliance to the public and evidence continues to be developed. Recent CQC inspection affirms compliance.
o Increase use of common processes, NHS Tameside and Glossop monitor the use of common processes throughout the health economy and challenges providers to increase usage. Audit of child in need notes has highlighted need for further progress in this area and key performance indicators have been included in relevant provider contracts to monitor improvements.
o Provide an annual update to staff on national picture and legislation for safeguarding children, this has been completed.
13.Conclusion
The Health Economy has a strong culture addressing the protection of children and young people and vulnerable adults in Tameside and Glossop, underpinned by the support of the named professionals across the health economy. This is clearly demonstrated through the commitment to the Child and Adult Protection Forum’s form all health agencies and the commitment to Tameside and Derbyshire Safeguarding boards both in terms of representation and budgetary commitment. Operational Child Protection Groups are now in place in all major provider agencies and report to the Child Protection Forum, which is a vehicle for senior staff to develop policy, share good practice and implement action plans and share learning from serious case reviews.
The CCG can be assured that new legislation and research evidence is used to support the work of the Local Safeguarding Children Boards and practitioners; not only to be reactive to child and adult abuse and neglect, but also proactive, to ultimately improve outcomes for children, young people and vulnerable adults in Tameside and Glossop.
NHS Tameside and Glossop faces immense challenge over the coming year to ensure continuity in safeguarding arrangements and their obligations under section 11 of The Children’s Act (2004)are maintained during transition to new NHS arrangements and multi-agency service re design. This is reflected in the priorities for the coming year.
14. Priorities for 2012/13:
Priorities for the coming year are grouped into 2 main categories: a. Managing Safeguarding Risk during Transition:
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-Ensure all safeguarding policies and procedures across the health economy are fit for purpose and reflect current legislation and guidance and NHS architecture. Ensure policies reflect requirements of the new Working Together due autumn 2012 and The NHS Safeguarding Assurance Framework due May 2012.
-Respond to the changing agenda in Safeguarding adults with the expected statutory footing of adult safeguarding boards.
-Ensure Safeguarding commissioning arrangements transition to Clinical Commissioning Group and ensure requirements for authorisation are met. Continue to review LSCB and LASB membership and the roles and functions of senior officers are maintained.
-Work with public health to ensure safeguarding children and vulnerable adults is high priority in the work of the emerging Health and Wellbeing Board and integral to JSNA.
-Ensure robust processes are in place to deliver training to independent contractors. And that training plans reflect levels required in Working Together (2010) and roles and Competencies for Health Care Staff (2010). Work with The National Commissioning Board to ensure compliance in this area.
-Monitor emerging risks to safeguarding, from redesign of multi-agency services and highlight risks to The Board.
Work with NHS Greater Manchester to:
-Develop across Greater Manchester a sustainable Designated Nurse and Designated Doctor resource to ensure statutory functions and robust resilient safeguarding arrangements are maintained during and post NHS transition.
-Implement recommendations adopted by The Government in relation to The Munroe review of Safeguarding, Working Together and NHS Safeguarding Assurance Framework. b. Managing ongoing work streams for safeguarding in health economy.
-Complete Serious Case Review commissioned May 2012.
-Complete Domestic homicide review Commissioned April 2012
-Ensure all actions plans arising from emergent serious case review, Domestic Homicide review are developed and implemented.
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-Develop supervision for General Practitioners and further develop supervision for all health practitioners.
-Develop a job description and employ a named GP to work with independent contractors.
-Develop a safeguarding quarterly newsletter for independent contractors.
-Implement and audit commissioning standards with all provider organisations. Work with Independent Contractors and the Voluntary and Nursing Home sector to implement and audit policy and standards.
-Ensure business plan for Tameside Safeguarding Children’s Board is integral to plans across the health economy.
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15. References
Case Management Policy (2010), NHS Tameside and Glossop Community Health. Child Protection Guidelines (2010), Derbyshire Local Safeguarding Children Board. Safeguarding Children Framework (2010), Tameside Local Safeguarding Children Board. Department of Health (1989), The Children Act, Stationery Office, London. Department of Health (2000)No secrets : guidance on developing and implementing multi-agency policies and procedures to protect vulnerable adults from abuse, Stationary Office: London Department of Health (2004), Every Child Matters, Stationery Office, London. Department of Health (2004), The National Service Framework for Children, Young People and Maternity Services, Stationery Office, London. Department of Health (2005), What to do if you are worried a child is being abused, Stationery Office, London. Department of Health (2006), Working Together to Safeguard Children, Stationery Office, London. DCSF (2010) Working Together to Safeguard children (2010) Stationery Office, London Department of Health (2006), The Common Assessment Framework, Stationery Office, London. Department of Health (2008), Safeguarding Children, The third joint inspectors report on arrangements to safeguard children, OFSTED, London. Safeguarding Children Policy (2010), NHS Tameside and Glossop. Training Policy (2010), NHS Tameside and Glossop.
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Clinical Commissioning Group Meeting
EDHR Strategy
Julia Allen, Equality & Diversity Manager Paper prepared by: Date of paper: 5 July 2012 Subject: EDHR Strategy 2012-16 (Equality Diversity and Human Rights)
EDHR, CCG Authorisation and Beyond – What does good look like?
History of paper: EDHR Strategy 2012-16, presented to 24 May PIQ meeting for approval. Strategy was well received with only 2 changes proposed as below.
Changes then made to EDHR Strategy re Equality Data Framework (see CCG Paper Appendix 1, page 27 also Appendix 2 pages 3, 4 & 5) (Linked)Equality Objectives re: Equality Objective 3 (see CCG Paper Appendix 1 page 30 & 31 & Appendix 2, page 8)
Executive Summary: Request approval of EDHR 4 year Strategy, however suggest will require review after 12 months as each element addresses only the next 12 months.
EDHR assurances to CCG, are detailed below.
Outcome Required of CCG: Approve 4 year Equality Diversity and Human Rights Strategy 2012-16. Review by end June 2013.
For Discussion or Approval: Approval.
QIPP principles addressed All by proposal:
Direct questions to: Alan Dow Steve Allinson
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53 Our EDHR Strategy 2012-16 provides the following assurances to CCG:
Evidences how CCG are meeting responsibilities arising from the recent Equality Act 2010 and our new extended PSED (public sector equality duties)
Responds to findings from our Annual Equality Publication – which was legally required to be displayed on our website by 31 January 2012. This key document summarises what protected group data we hold for workforce, job applicants and service delivery. This document also sets out how we will address any significant data gaps over the next 4 years. This Annual Equality Publication has also recently been produced as an Easy Read (public) document to improve access to learning disability patients and people with literacy issues.
All public bodies were required by 6 April 2012 to consult with local interest groups and develop new Equality Objectives for delivery over the next 4 years. We have identified 4 priority Objectives to deliver.
Meeting our PSED: Our new Annual Equality Publication (Jan’12) has highlighted a number of significant gaps in our patient / carer equality data knowledge. Our agreed Equality Objectives focus on how we will address any significant shortfalls over the next 4 years.
Our EDHR strategy is a core document required for CCG Authorisation. (Equality Delivery System or EDS Action Plan is also required as a core equality document for CCG Authorisation.)
Meeting our Equality Objectives provides the following assurances to CCG:
Respond to findings from our Annual Equality Publication. This key document summarises what protected group data we hold for workforce, job applicants and service delivery. This document also sets out how we will address any significant data gaps over the next 4 years. This Annual Equality Publication has also recently been produced as an Easy Read (public) document to improve access to learning disability patients and people with literacy issues.
All public bodies were required by 6 April 2012 to consult with local interest groups and jointly develop new Equality Objectives for delivery over the next 4 years. We have identified 4 Objectives to deliver.
Meeting our PSED: Our new Annual Equality Publication (Jan’12) has highlighted a number of significant gaps in our patient / carer equality data knowledge. Our agreed Equality Objectives focus on how we will address (over the next 4 years) any significant equality data shortfalls.
Equality Objective 1 supports meeting our PSED re addressing any significant gaps in equality data. In addition, this provides challenging evidence for CCG Authorisation and consultation with local interest groups in terms of GPs’ dual role as providers and commissioners of services in the new NHS landscape.
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Equality Objective 2 supports meeting our PSED, in terms of improving access to information, services and premises for harder to reach more marginalised groups. This Objective also supports achieving CQC Registration for EDHR and essential links to patient safety being prioritising and assured specifically for local protected groups. EDS Outcome 1.4 is also evidenced (ie The safety of patients is prioritised and assured).
Equality Objective 3 supports GP / Dental Practices in preparing for CQC Registration for EDHR responsibilities, by March 2013. This involves practices self assessing their performance via a short optional questionnaire leading to a primary care public dashboard for equality awareness across T&G. Completion also offers a supporting ‘bridge’ to EDS compliance. (Joint product. Assurances to NCB with CCG providing support to primary care practices.)
Equality Objective 4 Inclusive leadership at all levels, supports Equality Delivery System (EDS) annual compliance and public grading by local interest groups. Leads to a public grading dashboard for all NHS organisations. EDS is the NHS equality performance framework launched by Sir David Nicholson November 2011.
History of Paper:
EDHR Strategy 2012-16, presented to 24 May 2012 PIQ meeting for approval.
Changes then made to EDHR Strategy re Equality Data Framework (see CCG Paper Appendix 1, page 27 also Appendix 2 pages 3, 4 & 5) (Linked)Equality Objectives re: Equality Objective 3 (see CCG Paper Appendix 1 page 30 & 31 & Appendix 2, page 8)
Summary of amendments made to EDHR Strategy:
CLICK Information Group and E&D Manager will make Equality Data Framework recommendations that CCG can consider. There is currently poor quality data to analyse service uptake across local protected characteristic groups.
Summary of amendments made to Equality Objectives:
Equality Objective 3 – seek clarity on outcomes through conversation with GP provider partners. Feedback requested from LMC Secretary Alan Dow. Document is being presented at 31 July Practice Managers’ Forum. Also new joint equality product drafted for CCG and NCB as a ‘bridge’ to Equality Delivery System, plus provides support for CQC Registration focusing on equality responsibilities for GP and Dental Practices.
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CCG EDHR Paper: Appendix 1
Tameside & Glossop CCG EDHR Strategy 2012-16
Equality, Diversity and Human Rights Clinical Commissioning Group Authorisation & Beyond - What does good look like?
Author:
Julia Allen
Equality & Diversity Manager
NHS Tameside with Glossop / sCCG
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1.0 Introduction:
This document has been drafted to support the Clinical Commissioning Group (CCG) as part of the authorisation process and beyond, during 2012-16. 2.0 Background:
The NHS Institute for Improvement and Innovation in their Preparing for Authorisation Workbook (2012) states that CCGs ‘must have meaningful engagement with patients, carers and their communities’1, this requirement clearly links to the 3 aims of the Equality Duty as set out in the Equality Act 2010 (EA2010). Meeting the public sector equality duties (PSED) as set out in the EA2010 is a statutory requirement for CCG’s as CCGs should ensure they have they take over the reins of commissioning local health robust Leadership and and wellbeing services. governance arrangements to avoid the pitfalls of other Public CCGs will ensure they meet the equality duties Sector organisations e.g. in 2011 through putting the patient at the heart of what they a number of Public Sector do e.g. through effective engagement and organisations were taken to judicial review and in all cases a involvement of local people in decision making, lack of robust governance buying health care to meet local needs, involving local arrangements and engagement people in recruiting CCG posts, showing improved led to the organisations losing health outcomes for those protected groups. Failure the legal action and over 200 to have in place sound governance arrangements to decisions being overturned. meet these duties can result in the CCG not obtaining authorisation (appendix 1).
This will also involve equality robust, specific and inclusive contracting and procurement processes being in place, with supporting monitoring arrangements – applying to all provider and commissioner partner organisations.
3.0 Public Sector Equality Duties (Equality Act 2010) The Clinical Commissioning Group (CCG) should ensure that all the key changes, policies and practices carried out in their CCG or on “We will make equality behalf of the CCG have made informed decisions based on equality analysis and core to our business assessment of impact (adverse and positive) that has identified if there are any effects on planning” people; specifically with protected characteristics; within our community who may use our services or on the people we employ in line with the EA2010.
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3.1 General Duty (appendix 2)
Aim 1: Eliminate unlawful discrimination, harassment and victimisation
. The CCG should develop a Governance structure for Equality, Diversity and Human Rights (EDHR) . All partnership arrangements are subject “We will use the NHS to EDS (or equivalent) annual compliance, as a framework for evidencing how Equality and Diversity organisations are meeting the public Competency Framework to sector equality duty (PSED) through recruit, develop and support contractual arrangements and SLAs. This includes all NHS and non NHS provider strategic leaders to advance and commissioner partners. equality outcomes” . CCG leads should be informed and involved to assure equality, diversity and human rights practices . CCG should ensure all staff undertake targeted equality and diversity training at a level and frequency pertinent to supporting them to carry out their role effectively . Equal opportunity related Policies and Guides (such as Reasonable Adjustments) are in place and reviewed in accordance with each organisation’s policy guidance and amended as new legislation and guidance requires . Human Resources (HR) policies including recruitment policies, exit interviews and restructures are fair and transparent and take account of reasonable adjustments and any adverse impacts upon local protected groups resulting from key changes or reviews. . Staff record any ‘Serious Untoward Incidents’ relating to the identified protected characteristic groups . Customer Satisfaction Monitoring based on comments, compliments, complaints and concerns is carried out, with periodic reporting within governance arrangements and contract requirements . Organisations carry out access audits to ensure services are accessible.
Aim 2: Advance equality of opportunity between different groups
. The CCG should have in place an ‘Analysis of the Effects on equality’ process which allows the CCG to identify potential risks and any adverse impacts to the outcomes of ‘We will promote patients as part of its decision making process. empowerment (i.e. . The commissioning process should include engagement, the need to undertake Analysis of the Effects involvement and choice) on equality (AoEs) with consultation with local for everyone to go hand in hand with responsibility EDHR Strategy 2012-2016 Tameside & Glossop sCCG – May 2012 and accountability.Page 3’
58 interest groups / patient reps from local protected groups. . The CCG should have an Engagement Strategy which aims to ensure that people of protected groups are engaged effectively see appendix - 3 . Human Resource Policies should be in place to promote, monitor and report on equality of opportunity outcomes for all staff at all levels . The CCG should demonstrate how it’s committed to: Promoting Staff Side activities Work with Partner agencies from public and voluntary sectors Work with the Job Centre Plus e.g. Two Ticks Employer award to evidence accessible employment for people with Disabilities. Putting in place reasonable adjustments for employees, for engagement with local communities, and require provider partners to raise awareness of reasonable adjustments for patients consistently in all primary and secondary care settings Have in place Language Support Services Consider the needs of local Carers and Military Veterans
Aim 3: Foster good relations between different groups ‘We will develop a workforce The CCG should aim to carry out: who feels valued, motivated, inspired with high morale. . Engagement with the workforce, partners and This will be by involvement, statutory partners . Engagement with patients, service users and carers engagement, empowerment . Monitoring options for local protected groups (both and accountability’ for patient records and anonymous satisfaction surveys)
3.2 Specific Duty
The Clinical Commissioning Group should meet the requirements of the Specific Duties of the Equality Act by publishing equality information (Appendix 2). . All partnership arrangements are subject to EDS (or equivalent) annual compliance, as a framework for evidencing how organisations are meeting the public sector equality duty (PSED) through contractual arrangements and SLAs. This includes all NHS and non NHS provider and commissioner partners.
4.0 Equality Delivery System
18 EDS Outcomes tell CCGs and patients whether patients, carers and staff are getting good services or not. Meaningful engagement with patients, carers and their communities is also an underpinning principle of the NHS Equality Delivery System which has four clear goals aimed at enabling local people to grade their NHS organisations in relation to their performance against these four goals which are:
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2. Improved patient access and experience
3. Empowered, engaged and included staff
4. Inclusive leadership at all levels
EDS is designed to support NHS commissioners and providers to deliver better outcomes for patients and communities and better working environments for staff. The EDS is all about making positive differences to healthy living and working lives.
The EDS is a tool for both current and emerging NHS organisations – in partnership with patients, the public, staff and staff-side organisations - to use to review their equality performance and to identify future priorities and actions. It offers local and national reporting and accountability mechanisms which involve all CCGs provider and commissioner partner organisations.
At the heart of the EDS is a set of 18 outcomes grouped into four goals. These outcomes focus on the issues of most concern to patients, carers, communities, NHS staff and Boards. It is against these outcomes that performance is analysed, publicly graded and action determined. The CCG should consider how it will embed EDS into its own governance arrangements and the performance and contract review processes for all its providers to enable the CCG to receive assurance and support the CCG to show its commitment to meeting the Equality Duties as required for authorisation (domains 1, 2, 3, 5, 6 & 7). 5.0 Human Rights Based Approach
The CCG should consider adopting a Human rights based approach as part of its overarching governance arrangements. Engaging with local people is a fundamental principle set out in the CCG Authorisation Workbook (Domain 2).
The implementation of a Human Rights based approach to decision making within the CCG will not only support the CCG through authorisation and beyond but will strengthen the evidence of its commitment to the three equality duties and the NHS Constitution 2009.
The World Health Organisation (WHO) state that ‘In relation to health, a rights-based approach means integrating human rights norms and principles in the design, implementation, monitoring, and evaluation of health-related policies and programmes. These include human dignity, attention to the needs and rights of vulnerable groups, and an emphasis on ensuring that health systems are made accessible to all. The principle of equality and freedom from discrimination is central, including discrimination on the basis of gender roles. Integrating human rights into development also means empowering poor people, ensuring their participation in decision-making processes which concern them and incorporating accountability mechanisms which they can access.’2 The NHS is founded on a common set of principles 5.1 What is a human rights based approach? and values that bind A human rights based approach is about putting together the communities the patient, their carers and families first and and people it serves – foremost in decision making, empowering people patients and public – and EDHR Strategy 2012-2016 Tameside & Glossop sCCG – May 2012 the staff who workPage for 5 it.
60 to know about and how to claim their rights and increasing the ability and accountability of individuals and institutions who are responsible for respecting, protecting and fulfilling rights.
A Human rights based approach is at the heart of the NHS Constitution brings together in one place details of what staff, patients and the public can expect from the National Health Service, it also sets out patient’s right’s which cover how patients access health services, the quality of care they will receive, the treatments and programmes available to them, confidentiality, information and their right to complain if things go wrong. A human rights based approach is about ensuring that both the standards and the principles of human rights are integrated into policymaking as well as the day to day running of organisations such as the CCG and its providers. CCGs that implement and embed a human rights based approach will provide greater evidence for authorisation that the CCG through effective engagement is providing people greater opportunities to participate in shaping the decisions that impact on their lives and their human rights (Domains 2 & 7).
5.2 Human rights Principles
CCGs in considering embedding a human rights based approach will need to think through what this means in practice. A guide to best practice is set out in appendix 4
PANEL Principles: FREDA Principles: are important in applying a human rights are invaluable for ensuring based approach in practice the project and any associated policies and procedures that are aligned with human rights values.
PARTICIPATION FAIRNESS ACCOUNTABILITY RESPECT NON-DISCRIMINATION AND EQUALITY EQUALITY DIGNITY EMPOWERMENT AUTONOMY LEGALITY
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PANEL Principles in practice Participation Everyone has the right to participate in decisions which affect their human rights. Participation must be active, free, meaningful and give attention to issues of accessibility, including access to information in a form and a language which can be understood. Accountability Accountability requires effective monitoring of human rights standards as well as effective remedies for human rights breaches. For accountability to be effective there must be appropriate laws, policies, institutions, administrative procedures and mechanisms of redress in order to secure human rights. Non- A human rights based approach means that all forms of discrimination in the discrimination realisation of rights must be prohibited, prevented and eliminated. It also and equality requires the prioritisation of those in the most marginalised situations who face the biggest barriers to realising their rights. Empowerment A human rights based approach means that individuals and communities of rights should know their rights. It also means that they should be fully supported to holders participate in the development of policy and practices which affect their lives and to claim rights where necessary. Legality of A human rights based approach requires the recognition of rights as legally rights enforceable entitlements and is linked in to national and international human rights law.
5.3 Astraea Protocol: Minimising or mitigating disadvantages suffered by people as a result of their protected characteristic(s)
In planning, drafting or deciding upon specific proposals for significant efficiencies, disinvestments, cuts and service re-designs to public services in NHS Tameside and Glossop, the following 6 issues should be addressed and answers to questions evidenced. This is also part of our EDHR risk management approach.
5.3.1. Identify Impacts
Issue: Any reduction in public service provision is likely to impact unequally on vulnerable communities and key protected characteristic groups who will depend on them most. Any decision made must be made in full knowledge of the likely consequences.
Question: Have the impacts on vulnerable communities and key protected characteristic groups been fully identified and quantified?
5.3.2. Mitigate Impacts
Issue: All significant efficiencies, disinvestments, cuts and service re-designs across the public services will have some impact across the whole population.
Question: Have the proposals identified mitigation strategies – especially for changes that impact specifically upon vulnerable communities and key protected characteristic groups?
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62
5.3.3. Strengthen Community Capacity
Issue: All significant efficiencies, disinvestments, cuts and service re-designs to public services may to some extent reduce public sector capacity to help vulnerable communities or protected characteristic groups.
Question: Have the proposals included specific measures to compensate for any reduction in the level of public sector service provision by identifying ways in which remaining public services can strengthen the community’s capacities and assets?
5.3.4. Maximise Opportunities
Issue: Many significant efficiencies, disinvestments, cuts and service re-designs may offer new opportunities to join up services in ways that reduce costs, improve citizen satisfaction and improve outcomes.
Question: Have all the potential opportunities arising from the proposed changes been fully identified and realised. Have the proposals identified ways in which these might be quantified and monitored?
5.3.5. Register and Review Whole System Impact
Issue: Whilst individual changes to public service provision may have minimal impacts in themselves, the sum total of impacts on specific groups may be very substantial.
Question: In your proposals, have you reviewed other significant efficiencies, disinvestments, cuts and service re-designs to public services registered locally and assessed the likely ‘whole system impacts’ of the changes proposed. Have you registered your change?
5.3.6. Register and Review VCS Impact
Issue: The Voluntary and Community (third) Sector is particularly vulnerable to both large and small scale changes to service contracts. Reductions in service contracts can mean that VCS organisations loose the core organisational infrastructure for delivery.
Question: If you are planning to disinvest from existing VCS contracts have you reviewed the existing VCS contract register to see what whole system effect your additional decision may have. Have you taken this impact fully into account and have you identified any mitigation strategy that will enable the VCS organisation to continue its work?
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63 5.4 Definitions
Vulnerable Communities - Those who are: workless, on low income, single parents, living in houses below ‘decent homes standard’, living in areas with high morbidity and mortality.
Protected characteristic groups - Those defined by the Equality Act 2010 with ‘protected characteristics’: disability, gender, pregnancy and maternity, race, religion or belief, gender variance (Trans), , marriage and civil partnership, sexual orientation, age). At NHS Tameside and Glossop we also include carers and military veterans as if protected groups.
Unfair - An act/decision/consequence is unfair if it arises as a result of an action not conforming to common standards of justice, honesty or ethics – particularly in that its effect is unequal or not ‘even handed’ across those affected.
Unjust - An act/decision/consequence is unjust if its predictable and attributable effect is marked by injustice or impartiality or if its impact is not equitable across those affected.
Avoidable - An act/decision/consequence is avoidable if its effects are predictable and its cause is attributable to a specific action.
Distributive Justice - refers to the distribution of goods (and services) across society and is concerned with ‘fair shares’ for each individual. A key issue is ‘whether and how’ fair shares are allocated. These require demonstrably ‘just processes’.
Astraea - In Greek mythology Astraea (Ancient Greek: Ἀστραῖα); was a daughter of Zeus and Themis or of Eos and Astraeus. She and her mother were both personifications of justice, though Astræa was also associated with innocence and purity. She is always associated with the Greek Goddess of justice, Dike, who used to live on Earth but then left it since she was sickened by human greed.
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64 6.0 Governance
The CCG will have ‘proper constitutional and governance arrangements, with the capacity to deliver on all their duties and responsibilities’3
The CCG needs to ensure that it has the support of people with the rights skills, competencies and capacity to ensure that the CCG can carry out all their corporate and commissioning responsibilities, including the delivery of statutory functions such as Equality, Diversity and protecting people’s Human Rights. (appendix 4)
The Governance Structure should be based on what Tameside and Glossop Clinical Commissioning Group decides to ‘Do’ themselves, ‘Buy’ from Commissioning Support Services (CSS) or other providers or ‘Share’ with other Clinical Commissioning Groups or Public Health/Local Authority (Domain 5). The governance structure below is a recommended structure for best practice (Domain 4,6 & 7).
The CCG needs to set out how it will do this e.g. We intend to do this by CCG Lead incorporating equality, diversity and human rights into its business plans, such as the Integrated Strategic Operational Plan (ISOP), Clear and Credible Plans CCG E&D (Domain 3) and Organisational Executive Lead Development Plan. ‘
The CCG needs to consider the development of any identified executive lead and CCG E&D specialist to ensure that they CSS E&D Lead(s) are developed or have been Specialist Support developed to the relevant standard required to function effectively in their role e.g. the NHS Equality and Diversity Competency Framework (NHS North West 2011) sets out clearly the competencies required for the relevant posts (domain 4 & 6).
See section eight for suggested best practice for CCGs EDHR governance arrangements for authorisation.
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65 7.0 Equality Objectives for T&G CCG - 2012-16 (links to the 4 EDS Goals & set by local interest groups)CCG Organisational Development Plan re ‘how CCG can help you as GP providers to be good c Develop simple guide. Include focus on using patient data for improvements.
1: Input into CCG 2. Review our Complaints process Organisational Development to ensure it is accessible for Plan re ‘how CCG can help you protected groups and is promoted as GP providers to be good widely to patients and carers commissioners’. Develop simple (including Easy Read version). Link guide. Include focus on using to patient safety being prioritising patient data for improvements. and assured specifically for protected groups. In particular monitor complaints and patient experience to evidence patients are free from abuse, harassment, bullying, violence from other patients and staff, with redress being open and fair to all.
3. Consumer Advisory Panel to 4. E&D Leadership consider what products GPs Competency Framework to be should engage with to evidence adopted initially by all CCG good inclusive practice? CAP to roles, through performance input into developing such review outcomes and products with Equality Lead. recruitment practices.
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66 The 4 year Equality Objectives developed for the CCG need to clearly link to the goals set out in the Equality Delivery System (EDS) which will provide a robust framework for the CCG to demonstrate its preparedness for Authorisation (Domain 7).
The objectives should be published separately to meet the Specific Equality Duty and should be woven into the Clear and Credible Plan (Domain 3) Integrated Strategic Operating Plans, Operational Development Plan and any future Strategic plans to ensure that EDHR is seen as a mainstream activity not a bolt on (Domain 7). (Appendix 5)
The CCG needs to consider how they will monitor, performance manage and report on the effectiveness of the equality objectives annually to meet the Specific Equality Duty (Domain 5 & 7).
Best practice suggestions:
Equality, Diversity and Human Rights as a standing agenda item at the CCG Board including performance of CCG against its equality objectives and EDS 18 Outcomes (Domain 7) Exception reports on CCG, CSS, Public Health and other provider performance should be standing items on the Quality/Governance Committees (Domain 7) Involving local people in scrutinising CCG and provider performance (Domain 2) Engagement outcomes on performance against the 4 goals of EDS and the Equality Objectives are sought annually and there is clear indicators to identify how this feedback is influencing decision making and performance management (Domain 2) Partnership approach to development and review of Equality Objectives across the health economy served. (Domain 5)
8.0 Questions for the CCG to consider for authorisation: 1. What governance arrangements is the CCG putting place to ensure that it meets all the duties set out in the Equality Act 2010? 2. How will it ensure any providers including the CSS, Public Health, primary and secondary care are doing the same? 3. How will the CCG ensure that all protected groups are engaged in decision making including those communities which are seldom heard or marginalised? 4. How will the CCG provide evidence that it has competent Equality, Diversity and Human Rights Leadership that can consistently deliver? 5. How will the CCG demonstrate fair and equitable recruitment and employee terms and conditions in line with the Equality Duties? 6. How will the CCG ensure that data gathering, analysis and reporting for local protected groups are being consistently improved across our health economy for the benefit of patients, carers and staff? 7. How will the CCG demonstrate an understanding of different health needs of local protected groups and how this links to health inequalities?
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67 Below are statutory requirements and best practice suggestions to support a CCG going forward through authorisation and beyond:
Question Statutory and Best Practice Suggestions Governance arrangements to meet Publish annual equality data and information Equality Duties e.g. annual EDHR report, workforce profile (Domain 7) Publish Equality Objectives and annually report on outcomes as a result of the objectives Implementing the Equality Delivery System and showing year on year improvement – minimum is ‘developing grade’, for full compliance (includes all our provider partners and commissioner partners) CCG Board receives quarterly reports on progress against 4 goals of EDS and the Equality Objectives The CCG puts in place a robust Analysis of the Effects on equality process which is carried out as part of the decision making process from the beginning and enables the CCG to have a full understanding of the equality risks to patients and staff of any decisions they make The CCG adopts a Human Rights based approach to governance arrangements The CCG should consider the board receiving EDHR Development to support their embedding a Human Rights approach to decision making as part of its authorisation and beyond. CCG develop a Risk Mapping Checklist to identify any significant EDHR risks as early as possible (NHS GM wide) as an integral part of the Risk Register process. How will the CCGs EDS Action Plan and EDHR Strategy document deliver on the NHS Outcomes Framework? NHS outcomes framework: The NHS outcomes framework contains a balanced set of national outcomes goals and supporting indicators which patients, the public and Parliament will be able to use to judge the overall progress of the NHS. The framework also provides a mechanism by which the Secretary of State for Health can hold the NHS Commissioning Board to account for the outcomes it is securing for patients through its role in allocating resources and overseeing the commissioning process that will be led locally by CCGs.
Performance of providers Equality Diversity and Human Rights (EDHR) (Domain 5&7) including the EDS is written into all provider
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68 contracts including any SLAs and Memorandum of Understanding (MOUs) with Commissioning Support Service (CSS), Public Health (PH), Local Authorities and other providers from community or private sector Primary care performance is given special support to reach required EDS gradings and with the help of eg nominated GP EDS Champions GP practices are also encouraged to attend Quality & Equality Workshops during 2012 and to complete a straightforward GP EDHR Accreditation for GP Practices (Bronze level)
Protected groups are engaged in . The CCG needs a clear understanding of the decision making including those demographics of the people they will be serving communities which are seldom identifying any groups which are marginalised or heard or marginalised? seldom involved in engagement e.g. Deaf (Domain 2) people, Blind people, Deaf /Blind people, those with Learning Disabilities, Asylum seeker and Refugees, Sex workers, Homeless people, young people, middle aged people, men, LGB & T especially older LGB and Transgendered people of all ages, some minority BME communities e.g. Gypsy/Roma/Travellers, Chinese, Polish, Somalian, Bengali and Bangladeshi Communities. . Local interests (local people) across all protected groups (appendix 3) / local interest groups are engaged and involved annually in grading the CCG and its providers against the 4 goals of EDS . The CCG has a robust engagement strategy which includes the provision of reasonable adjustments they will need to employ in engaging effectively e.g. range of formats of documents, ensuring interpreter support where required, times of engagement, paying expenses for people who they engage with especially if they have to access specialist transport etc.
Competent Equality, Diversity and . The CCG is supported by an EDHR Specialist Human Rights Leadership that can and the CCG EDHR Executive is supported to consistently deliver? develop in line with the NHS Equality & Diversity (Domain 4,6&7) Competency Framework . The CCG should consider the board receiving EDHR Development to support their embedding a Human Rights approach to decision making as part of its authorisation and beyond. . The EDHR Specialist should be able to support the CCG by providing strategic visioning and
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69 leadership and operational delivery competence e.g. a. Understand and be able to operate from a human rights , equality and inclusion perspective b. Be able to respond to diverse and changing community needs c. Apply robust equality analysis to service planning and improvement
Fair and equitable recruitment and . The CCG undertakes robust equality analysis employee terms and conditions in on transition plans line with the Equality Duties? . The CCG as an employer has built in to all (Domain 4) employees’ job descriptions EDHR using the NHS E&D Competency Framework to underpin competency development. . The CCG creates job descriptions and selection criteria appropriate to delivery expectations and available resources. . CCGs when going out to advert have considered the access needs of future employees through the recruitment/application process and on appointment . Putting in place reasonable adjustments for any disabled employees or future employees e.g. accessible IT equipment, recruitment procedures and policies, working arrangements . Assessing other staff who have identified workstation issues, for reasonable adjustments . All Human Resource policies have been assessed for their impact on protected groups . The CCG when workforce planning, assesses the overall capability and capacity within its existing workforce to deliver the EDHR outcomes set out in the authorisation workbook, EDS and the NHS Outcomes Framework.
The guidance given throughout this document is aimed at supporting a CCG to meet the Equality requirements set out in the Authorisation Documentation (appendix 1) and beyond. Also to allow the CCG to make a positive self-certification backed up by robust evidence of commitment and Governance.
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70 9.0 References
1. NHS Institute for Improvement and Innovation (2012) Preparing for Authorisation Workbook www.institute.nhs.uk/commissioning 2. NHS Equality and Diversity Council (2011) Equality Delivery System main text http://help.northwest.nhs.uk/library/item/1800 3. World Health Organisation – A Human Rights Based Approach to Health http://www.who.int/hhr/news/hrba_to_health2.pdf 4. Department of Health (2012) The NHS Constitution http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/document s/digitalasset/dh_132958.pdf 5. NHS North West (2011) Competency Framework for Equality and Diversity Leadership http://help.northwest.nhs.uk/storage/library/Competency_Framework_- _Resource_Pack_FINAL.pdf 6. EDS Good Engagement Practice for the NHS (May 2012) http://nww.tamesideandglossop.nhs.uk/contrib2/corp_gov_div/equalDiversity/docume nts/GoodengagementpracticefortheNHS1_000.pdf
7. Equality Objectives 2012-16 NHS Tameside and Glossop
8. NHS Commissioning Board - Clinical commissioning group authorisation: Draft guide for applicants (May 2012) See p 26 re EDS & p38 re EDGR Strategy requirements.
9. Information to support applicant CCGs in making declarations of compliance (May 2012) See information sheet 4 (p8): Public Sector Equality Duty .
10.0 Appendices
Appendix 1 – Clinical Commissioning Group Authorisation Plan
Appendix 2 – Equality Act 2010 Section 149 General/Specific Duties
Appendix 3 – The Public Sector Equality Duty – Protected Characteristics
Appendix 4 - Equality Delivery System March 2012 annual public grading NHS Tameside & Glossop / sCCG
Appendix 5 – Human Rights Based Approach Suggested Best Practice
5.3 Astraea Protocol: Minimising or mitigating disadvantages suffered by people as a result of their protected characteristic(s)
Appendix 6 – Suggested CCG Equality Action Plan
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71 Appendix 1
Clinical Commissioning Group Authorisation Plan (1-7)
Topic Statement
1 Clinical Focus Clinical leadership / change management: The emerging CCG has clinical and Added leaders that are able to influence and lead others to deliver on the emerging Value CCG's objectives of improving the health of the population and using the budget most wisely Population’s health and clinical needs: The emerging CCG has a comprehensive, up-to-date understanding of the needs of its population, now and over the next 5 years such that, if asked, the emerging CCG leadership and constituent practices could describe the main health issues facing their (respective) population. Understanding providers: The emerging CCG understands how healthcare services, and healthcare providers, can meet the needs of the population, and the constraints on this. Values and behaviours: are agreed by all the constituent practices of the emerging CCG. Through the way the emerging CCG works, behaviours that support its values are promoted and strengthened, whilst those behaviours that do not promote its values face sanctions. Continuous improvement: There is a conscious, and promoted, culture in the emerging CCG of systematically and continuously improving the quality of clinical care to improve health outcomes within the given budget.
2 Engagement Engagement with patients, the public and the population: Patient and public with Patients engagement is embedded into the organisation and the full commissioning and process. Communities Engaging with communities: To define, and deliver on its purpose, the emerging CCG has engaged with the different communities in the geographical area it covers.
3 Clear and Strategy development and implementation: There is a practical and Credible Plan implementable strategy, developed collaboratively, that clearly sets out the priorities for the emerging CCG and why those priorities are likely to lead to greatest health gain taking into account future changes. Getting best value out of the system: In order to achieve best outcomes for the population within the available resources the emerging CCG is equipped to ensure that the needs of the population are met by the providers of healthcare services. The emerging CCG has prioritised what it needs to do to achieve these outcomes within resources. Vision: There is a clear vision (narrative) of what the emerging CCG's purpose is and how it will achieve its purpose that is to achieve better patient outcomes within available resources, and discharge its statutory duties. The case for change: There are clear, consistent and communicated reasons for the things that the emerging CCG is going to do, and how success will be tracked. These reasons are understood and accepted by Practices and providers.
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72 4 Capacity and Structure and Culture of Change: Key elements of structural and Capability cultural change (transition) plans are in place, with the skills required to support this, including project management and monitoring success. Contracting/ Procurement: The emerging CCG has the clinical, commercial, legal and other skills and capacity to negotiate, write and manage contracts for the provision of health services Administrative functions: The necessary administrative functions are in place to run the organisation. Clinical elements of Governance: Systems are in place to effectively monitor and track quality and safety so the emerging CCG has early warning of problems and there are clear processes for acting when problems are detected. Emerging CCG structure and capability; Learning and Development: The emerging CCG has, or is able to assemble, the right commissioning skills and build the best operating model to most effectively commission services (in house, shared or bought in). Integration of governance: Integrated corporate governance systems of finance, probity, statutory duties and clinical quality, are in place. They go beyond being compliant with legal requirements, and identify and adopt good practice and innovation in the running of the organisation and fulfilling statutory duties. Financial management capacity/ capability: There is capacity and capability in the organisation for robust financial management of budgets. Financial planning controls : The emerging CCG has a financial planning process that allows prioritisation of resources for commissioning services and its population and is ensuring that the funds are spent only as intended. External financial control requirements: The emerging CCG can stand up to public scrutiny regarding its spending of public funds.
5 Collaborative Managing relationships: The emerging CCG has the skills to understand the Arrangements relationships they, as an organisation, need as good commissioners, and how to get the most out of these relationships. Engagement with other commissioners: The emerging CCG has arrangements to work collaboratively with other commissioners including the NHS Commissioning Board, other emerging CCGs, and Commissioning Support Services. Engagement with providers: There is access to the specialist skills and capacity to actively manage supplier relationships and clinical engagement. Existing relationships and processes: Recognising that at a time of change relationships can be lost; there is an excellent understanding of existing relationships and a robust handover mechanism. Engagement with Local Authorities and others: There are effective relationships with all the Local Authorities, district / borough councils and partnerships in the community.
6 Leadership Leading Change: Leadership motivates individuals within the organisation to Capacity and make changes in what they do. Capability Business Intelligence and Reporting: Reporting mechanisms exist so the emerging CCG leadership is aware of progress in delivering their strategy. The role of leadership in governance, including appropriate delegation: "The emerging CCG is clear about how it makes decisions. The delegation of
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73 functions, duties and actions, and of decision making is clear. There is an appropriate distribution of power, responsibility and accountability amongst practices." Leading a commissioning organisation: "There is a leadership team in place with sufficient knowledge of commissioning processes to be able to ensure effective delivery. This knowledge includes how and where to acquire additional knowledge and skills and to enable sufficient challenge advice provided, if required." Leadership roles: "The roles and responsibilities of the individual leaders, emerging CCG leadership, the emerging CCG, and the constituent practices are clear and aligned to the Vision, Values and Strategy”. Financial elements of governance: The Leadership of the emerging CCG is able to make transparent, defensible, informed, robust and sustainable decisions about the allocation of public funds on the basis of systems that are compliant with legal, statutory and regulatory requirements and national governance policies. Internal Engagement: Leadership understands how to involve those who will actually make things different, such that the success of the changes that are brought about is made most likely.
7 Governance Governance is about how the CCG makes robust, sustainable and defensible decisions. The making of robust, informed (including by the users of services) decisions, and ensuring that the right things are addressed. 1. Resources (including cost), 2. Quality of services 3. Balancing of demand & supply 4. Ensuring the CCG continuously improves.
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74 Appendix 2
Equality Act 2010 Section 149 General / Specific Duties (1-3) General Duties Due Regard
1 Eliminate discrimination, harassment, Remove or minimise disadvantages connected with a victimisation and any other conduct that is relevant protected characteristic (e.g. address the problems prohibited by or under the Equality Act that women have in accessing senior positions in the 2010 workplace) Take steps to meet the different needs of persons who share a relevant protected characteristic (e.g. ensure the particular needs of BME women fleeing domestic violence are met) Encourage persons who share a relevant protected characteristic to participate in public life or any other activity in which they are under-represented (e.g. take steps to encourage more disabled people to apply for senior posts).
2 Advance equality of opportunity between Tackle prejudice (e.g. tackle hate crime for people with persons who share a relevant protected protected characteristics) characteristic and persons who do not
share it
3 Foster good relations between persons Promote understanding (e.g. promote an understanding of who share a relevant protected different faiths). characteristic and persons who do not
share it.
NB Organisations that are not public authorities are also required to have due regard to the needs listed above whenever they carry out public functions. This could include, for example, a private company with a contract to provide certain public services.
Specific Duties
4 Publication of information Each public authority must publish information to show that it is complying with the s.149 duty by 31st January 2012 and at least on an annual basis after that. Significant gaps in data for protected groups should be highlighted with how Equality Objectives will address such gaps over the next 4 years. Authorities must include information about persons who share a protected characteristic who are its employees (if it has 150 or more employees) and its service users.
5 Equality objectives Each public authority must prepare and publish one or more objectives it thinks it should achieve to have due regard to the need to eliminate discrimination and harassment, to advance equality of opportunity or to foster good relations. Any objective must be specific and measurable. Authorities must publish their first objectives no later than 6 April 2012 and at least every four years after that.
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75 Appendix 3
The Public Sector Equality Duty 2010 (protected characteristics)
(1-8)
1 Age By being of a particular age / within a range of ages
2 Disability A physical or mental impairment which has a substantial and long term adverse effect on day to day activities.
3 Gender (sex) being a man or a woman
4 Gender Variance Transsexual people who propose to; are doing or have undergone a process of having their sex reassigned
5 Pregnancy and maternity If a woman is treated unfavourably because of her pregnancy, pregnancy related illness or related to maternity leave
6 Race Includes colour, nationality, ethnic origins and national origins.
7 Religion or belief The full diversity of religious and belief affiliations in the United Kingdom. / lack of belief
8 Sexual orientation A person’s sexual preference towards people of the same sex, opposite sex or both.
9 Marriage and Civil This is relevant in relation to employment and vocational training, the CCG Partnership will need to ensure that it considers this protected group in relation to employment of staff and their training.
* Carers Adopt across Tameside and Glossop as if protected groups.
* Military Veterans Adopt across Tameside and Glossop as if protected groups.
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76 Appendix 4 - EDS annual public grading 2012
NHS Tameside & Glossop Equality Delivery System Outcomes March 2012 EDS Submission 1.1 Services are commissioned, designed and procured to meet the Achieving health needs of local communities, promote well-being, and reduce health inequalities 1.2 Patients’ health needs are assessed, and resulting services Developing provided, in appropriate and effective ways 1.3 Changes across services are discussed with patients, and Developing transitions are made smoothly 1.4 The safety of patients is prioritised and assured Developing
1.5 Public health, vaccination and screening programmes reach and Achieving benefit all local communities and groups 2.1 Patients, carers and communities can readily access services, and Achieving should not be denied access on unreasonable grounds 2.2 Patients are informed and supported so that they can understand Achieving their diagnoses, consent to their treatments, and choose their places of treatment 2.3 Patients and carers report positive experiences of the NHS, where Achieving they are listened to and respected and their privacy and dignity is prioritised 2.4 Patients’ and carers’ complaints about services, and subsequent Developing claims for redress, should be handled respectfully and efficiently 3.1 Recruitment and selection processes are fair, inclusive and Developing transparent so that the workforce becomes as diverse as it can be within all occupations and grades. 3.2 Levels of pay and related terms and conditions are fairly Developing determined for all posts, with staff doing the same work in the same job being remunerated equally 3.3 Through support, training, personal development and performance Achieving appraisal, staff are confident and competent to do their work, so that services are commissioned or provided appropriately 3.4 Staff are free from abuse, harassment, bullying, violence from both Achieving patients and their relatives and colleagues, with redress being open and fair to all 3.5 Flexible working options are made available to all staff, consistent Achieving with the needs of patients, and the way that people lead their lives. 3.6 The workforce is supported to remain healthy, with a focus on Developing addressing major health and lifestyle issues that affect individual staff and the wider population. 4.1 Boards and senior leaders conduct and plan their business so that Excelling equality is advanced, and good relations fostered, within their organisations and beyond 4.2 Middle managers and other line managers support and motivate Achieving their staff to work in culturally competent ways within a work environment free from discrimination 4.3 The organisation uses the NHS Equality & Diversity Competency Developing Framework to recruit, develop and support strategic leaders to advance equality outcomes
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77 EDS public grading levels available each year on robust evidence being presented by NHS or their provider partners to a team of local interest groups who are trained to carry out EDS grading: Excelling Achieving Developing Underdeveloped
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78 Appendix 5 – Human Rights Based Approach Suggested Best Practice
PARTICIPATION ACCOUNTABILITY NON-DISCRIMINATION EMPOWERMENT LEGALITY in all AND EQUALITY decisions The CCG should consider how it CCG should consider: CCG should consider: A CCG should consider CCG should ensure it is will engage local people in Identifying an Taking a human rights taking a human rights compliant with: decision making e.g. Executive lead for based approach to ensure based approach which The Equality Act 2010 setting equality objectives EDHR that all forms of means that: Human Rights Act Involvement in selecting Specialist support to discrimination in the Individuals and 1998 and takes a CCG post holders operationalise EDHR realisation of rights must be communities should: human rights based Involvement in equality Astrea Protocol re prohibited, prevented and know their rights approach to its analysis and scrutiny for mitigation of adverse eliminated by the CCG. It should be fully decisions making, adverse impacts on impacts for protected also requires the supported to which requires the protected groups arising groups See 5.3 prioritisation of those in the participate in the recognition of rights from key changes Good governance most marginalised development of policy as legally enforceable Involvement in grading arrangements e.g. situations who face the and practices which entitlements and is CCG and contracted CSS no decisions biggest barriers to realising affect their lives and linked in to national against EDS Goals taken without their rights. to claim rights where and international Participation must be Equality analysis Work to recognise and necessary human rights law. active, free, meaningful & Human rights eliminate Health and give attention to screening inequalities in collaboration Active involvement of local issues of accessibility, EDHR is standing with the H&WB Board. people and or advocates in including access to agenda item at Meet the three aims of the decision making will information in a form and meetings General Equality Duty facilitate empowerment and a language which can be effective Meet the Specific Duties in links directly to the General understood. monitoring of publishing annually its Equality Duty Ensuring your contracted human rights equality information and providers/CSS also meet standards as well have published equality these standards as effective objectives. remedies for human rights breaches
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79
Appendix 6 – Suggested CCG Equality Strategy Plan 2012-16 * review May 2013
Equality & EDS EDS Measurable Actions Timescale Lead(s) Objectives Goals Outcomes 1. All 4 To develop EDS Annual EDS grading shows Year 1 - 4 CCG EDHR EDS: To show a Action Plan which details improvement across Executive Lead year on year milestones / steps for each the 18 outcomes of Supported by improvement EDS Outcome to progress to EDS at annual public EDHR Specialist against the 18 next grade or actively maintain grading by local outcomes of EDS current level. No action is not interest groups Alan Dow an option. Julia Allen To annually gather evidence of Commissioner outcomes against the 4 EDS Lead goals HR Shared To present the evidence to Service Lead – local interest groups annually Kate Calder for them to grade To tie in the 4 goals of EDS to Governance Clear and Credible Plans and Lead Integrated Strategic Operating Plans To ensure all provider Contracts Lead contracts include EDS and are E&D Lead monitored and graded Specialist annually by their local interest groups To ensure equality objectives E&D Lead pick up development areas Specialist EDHR Strategy 2012-2016 Tameside & Glossop sCCG – May 2012 Page 25
80 identified via EDS grading. 2. Goal 1 CAP members with sCCG Evidence taking ‘due Year 1 by E&D Lead Equality Objective (1.1) E&D Lead to develop simple regard’ of local April 2012 Specialist 1: Input into CCG Services guide ‘How CCG can help you protected groups in Organisational are as GP providers to be good how GP providers LMC Secretary Development Plan commissi commissioners’. commission services Alan Dow re ‘how CCG can Develop short 20 minute DVD which effectively help you as GP oned, highlighting vignettes of an reach all sections of providers to be good designed Inclusive Patient Journey with their community as commissioners’. & short examples from first GP well as recognising Develop simple procured contact, to referral at and addressing guide. Include focus to meet secondary care, to finally health inequalities for on using patient the exiting the service. CAP protected groups. data for members to help make the Targeted training Year 1 by improvements. health DVD. Funding requested from support tool (at Jan 2013 needs of GP Equality training delivered Induction for new local during 2011. DVD to be staff (primary & E&D Lead communi targeted at GPs and secondary care) to Specialist ties, Secondary care as a training raise awareness of promote resource for new staff at protected group Induction stage. Charge inclusion & improve well- nominal fee to recover some equitable access to being, & of the costs. Market to target information, services reduce audience. & premises for health protected groups. inequaliti Survey pilot areas to Start Sept E&D Lead es measure for 2012 and Specialist improved patient again Jan Patient Goal 1 experience 2013 Experience (1.2) Patients’ satisfaction levels. Manager
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81 health Consumer Advisory Panel Embed a consistent Year 1 – 4 sCCG Board needs patient reps recommend steps framework approach PIQ Committee are be agreed by sCCG which to data collection E&D Lead promote a consistent data across sCCG initially Specialist assessed collection and analysis and subsequently , & approach across NHSGM, for across GM footprint. resulting local protected groups. Analysis & reporting services Currently poor quality data to of data (by providers Year 1 S Allinson provided, analyse service take up & to commissioners) Nov 2012 in satisfaction levels across leads to improved Sue Gilks protected characteristic groups services & Data Standards appropria (PCGs). Can do this – should satisfaction levels, for Manager te & routinely offer the opportunity local protected Primary Care effective for patients to declare their groups. Computer ways protected characteristics when Services we are anonymously surveying for patient opinion let us ask as a standard question ‘what are your protected groups?’, rather than every time patients exit a service. CLICK is the Information group – practically what does that mean for us as a CCG? What are the next steps towards making this happen? By reference to CLICK together create a set of recommendations CCG can consider.
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82
EDHR Governance processes EDHR ‘Papers’ Year 1 E&D Lead to link into sCCG presented to COG June 2012 J Allen Organisational Development then CCG Board for Plan. approval.
Access to services for BAME Translation Fan Year 1 E&D Lead local communities is improved (MediBabel) piloted Dec 2012 Specialist through point of additional in 3 T&G GP J Allen contact translation services. Practices Jun – Sept’12. Project Plan developed with NHS BwD, Bury & E Lanc PCTs including pre & post questionnaires. 3. Goal 2 – Newly reviewed Comments, Evidence of Year 1 – 4 Complaints Equality Objective Improved Compliments and Complaints improvement in EDS Lead supported 2: Review our patient publications to be finalised by grading annually for by EDHR Lead Complaints process access and Complaints Manager (as part Outcome 2.4 re Year 1 Complaints experience. to ensure it is of merger with Complaints & Complaints being End Sept 2012 Lead 2.4 accessible for Patients’ PALS services): accessible for each EDHR Lead protected groups and carers’ Leaflets to be available in of the protected supported by and is promoted complaints Easy Read version for groups. Year 1 CCG Leads widely to patients about improved access for learning End Sept 2012 and carers services, disability patients and for (including Easy and those with literacy issues. Read version). Link subsequent Ensure availability of Link closely to pilot Year 1 to patient safety claims for complaints information for Translation Fan End March being prioritising redress, local BAME communities in project NHS T&G 2013 should be and assured 5 key local languages for Jun – Sept 2012. handled EDHR Strategy 2012-2016 Tameside & Glossop sCCG – May 2012 Page 28
83 specifically for respectfully Tameside and Glossop eg Develop a complaints protected groups. In and via website and link on Translation Fan? particular monitor efficiently leaflets to LIPS complaints and interpretation service. patient experience to evidence patients Complaints Manager to promote Widely promote Year 1 are free from abuse, Complaints service and improved accessibility & 31 March 2013 harassment, accessibility for local protected availability of bullying, violence groups. Complaints process from other patients in other formats for and staff, with local protected redress being open groups. Actively and fair to all. promote to staff and patients / carers plus provider partners.
A source of evidence for patient Continue to monitor Year 1 Complaints safety in terms of patients being all complaints & 30 June 2012 Lead free from abuse and PALS by protected 31 Dec 2012 discrimination. group and types of Reports due discrimination such as Hate Crime, Harassment. 6 monthly report to E&D Lead end June & Dec 2012.
Ensure provider partners adopt Service Year 1 E&D Lead similar standards for their own specifications and June 2012 Specialist Complaints processes and contracts for accessibility for protected groups. providers are to
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84 Urgent Action required June 2012 include explicit to embed into next contract requirements of review. providers to deliver on this standard.
Commissioners review through Quality accounts, CQUINs / KPIs and contract reviews – asking for evidence of outcome.
4. Develop simple guide for GPs Reference guide for Year 1 Equality Objective to include ‘What do ‘Good GPs offering a menu Feb 2013 3: Consumer Products’ Look Like for GP of good products in Advisory Panel to Providers to Evidence terms of inclusive consider what Commissioning Inclusive practice for local products GPs Services?’ protected groups. should engage with to evidence good Clarify outcomes via a Provides information inclusive practice? conversation with providers. Meet to patients on what CAP to input into with Laura Browse 25.6.12. good products look developing such Director Primary care like from GP products with Commissioning NCB. providers Equality Lead. commissioning inclusive services.
Develop & embed Year 1 Consumer Panel EDHR GP Practices Sept 2012 members / E&D Accreditation to Lead / LMC
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85 Scheme Bronze Nov 2012 Secretary Level 1 (2012) Laura Browse across at least 60% NBC of all T&G practices.
CCG understand Year 1 how EDHR risks are June 2012 being effectively E&D Lead managed. Specialist Develop EDHR Risk Exec EDHR Mapping Checklist & Lead Consider how should CCG risk supporting CCG COO assess for EDHR issues? information for all E&D Leads across NHSGM / all GM Governance Leads / Receiving organisations.
5. Goal 3 – To undertake an Equality No complaints. Year 1 – 4 EDHR Specialist Equality Objective empowere Analysis on the Transition plan Lead & 4: d, engaged for Human Resources to No appeals on Transition Team E&D Leadership and well ensure that the alignment of equality grounds. HR Shared Competency supported staff, recruitment and Service Framework to be staff redundancy processes are Recruitment and adopted initially by fair, equitable and free from selection to the CCG all CCG roles, discrimination. and the alignment of through To build in equality into all job staff as part of the CCG Chair
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86 performance review profiles and recruitment transition period is supported by outcomes and processes utilising the national inclusive and EDHR Specialist recruitment E&D competency framework transparent. Lead practices. To develop an equality Deliver Analysis of Year 1 EDHR Specialist development plan for all the Effects training to July 2012 Lead current and future employees. 11 HR Shared To build into contracts with Service Business providers including emerging Partners. Agree AoE Transition Team Commissioning Support process & training supported by Services the need for their content for all EDHR Specialist employees to have E&D NHSGM. Lead development / training NHSGM E&D Agree with all NHSGM E&D Effective compliance Leads Leads what EDHR training with public sector EDHR Exec should include & delivery equality duty which is Lead NHSGM format menu. This also applies proportionate to the to primary care GP Practices size of our resources. and Dentists.
6. Goal 4 – The CCG Board identifies an EDS grading by local Year 1 - 4 CCG Chair EDS: Ensure Inclusive Exec lead for EDHR people shows yearly supported by continuing senior Leadership The Executive Lead is improvement EDHR Specialist level commitment to at all levels developed in line with the Lead. this EDS E&D National NHS E&D Executive lead is Leadership Competency Framework actively engaged with Competency work The CCG Board receive the EDHR agenda annual EDHR development and promotes relevant to their role. equality at board EDHR exceptions go to the meetings Board quarterly EDHR annual report on
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87 Equality Delivery System Grading outcomes and CCG board meeting December Equality Objective Outcomes papers reflect the annually for prior to publication is received reporting publication by the board and signed off. January HR Shared Service senior annually. lead delivers annual workforce report with analysis / year on year comparison by 1 Annual Workforce 1 Nov annually HR Shared November 2012 and annually. Report displayed in a for publication Service Senior Ensure any figures of 10 or timely manner on Jan annually. Lead less are shown as # in final CCG website to meet public report to ensure legal compliance with anonymity with transparency. PSED.
7. Evidence how you meet PSED Annual Equality Legal E&D Lead EDHR & CCG Publication displayed requirement Specialist Authorisation (and Publish easily accessible on website as for this beyond) information to show how PCT / accessible to all. information to Business assurances to be CCG & all provider partners meet Details equality data be displayed Intelligence in place the PSED annually (Specific Duty) held, key gaps & how by 31 Jan Lead will be addressed 2012 & then over next 4 years. annually Evidence how you meet PSED Set new Equality Legally E&D Lead Objectives for next 4 required by 6 Specialist Set and publish equality years. Engage with April 2012 objectives, at least every four local interest groups Local interest years (Specific Duty) to set key priorities. group patient Suggest 1 to 4 reps from each SMART Objectives protected group be agreed.
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88 7.1 Develop an EDHR Strategy or Show what is Before 30 Jun E&D Lead EDHR & CCG Plan for your business for the required to achieve 2012 Specialist Authorisation (and next 1 to 4 years EDHR element of beyond) CCG Authorisation & By end Sept Engage with assurances to be how. Set our overall 2012 local in place overview for stakeholder inclusion, meeting groups PSED & taking ‘due regard’ of local protected groups in NHS & provider decision making & tendering re commissioning of services through contracts. 7.2 Implement Equality Delivery Use latest EDS Public grading EDHR & CCG System (EDS) equality Guide and Grading required Authorisation (and performance framework (or Manual. before 31 beyond) equivalent) across NHS & all See summary of March 2012, assurances to be providers in 2012. Show links EDS 18 required .by trained in place with CQC equality Outcomes local interest requirements. See EDS Guide groups Appendix D for details 7.3 Develop an EDS Action Plan Before 30 Sept All provider as above re delivery of the 18 required 2012 for partners via EDS Outcomes provider contract / EDHR partners Schedule 7.3.1 Develop an EDS Action Plan Before 30 Jun E&D Lead as above re delivery of the 18 required 2012 for PCT / Specialist EDS Outcomes CCG
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89 7.4 Must consider equality data – Equality Data Paper Before end E&D Lead as above collection, input & analysis for to PIQ Committee July 2012 Specialist improvement purposes May 2012, from CAP. Bus Intel to identify next steps. 7.5 Consider a clear approach to Develop RA Guide & Before end E&D Lead as above providing reasonable training for all T&G Sept 2012 Specialist adjustments to patients, carers staff. Offer free & staff in all settings. training to providers who attend Q&E Workshop training. 7.6 Analysis of Effects on equality Agree an NHSGM Before 20 Jun Amanda EDHR & CCG (AoE) programme and process process & training 2012 Rafferty (NHS Authorisation (and required to evidence taking material via GM E&D Salford) beyond) early stage ‘due regard’ of Leads group Julia Allen NHS assurances to be adverse & positive impacts on T&G in place local protected groups in our key changes arising from planning & decision making. Develop a 1 year Before 31 Aug E&D Lead AoE Rolling 2012 Specialist Programme to include QIPP Kate Calder Pathways, Corporate, HR Finance / QIPP Shared Service. Lead
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90 Acknowledgements: Thanks to the key author of original ‘What does good look like?’ document Julie Wall, NHS Blackburn with Darwen, also contributions from the Lancashire Equality Delivery Partnership, Dawn Clarke NHS Central Lancashire, NHS North West EDHR Team, Naheed Nazir NHS Bury, Julia Allen NHS Tameside and Glossop, and Dr Chris Clayton Blackburn with Darwen CCG Chair.
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91 CCG Board Paper Appendix 2
Equality Objectives 2012-16
Aim: Set new Equality Objectives by 6 April 2012 and for the next 4 years (PSED requirement). Consult with local interest groups and staff. Link with the 4 EDS Goals, and T&G CCG ‘Plan on a Page’ (Transforming Lives).
Equality Objectives:
1. Input into CCG Organisational Development Plan re ‘how CCG can help you as GP providers to be good commissioners’. Develop simple guide. Include focus on using patient data for improvements.
2. Review our Complaints process to ensure it is accessible for protected groups and is promoted widely to patients and carers (including Easy Read version). Link to patient safety being prioritising and assured specifically for protected groups. In particular monitor complaints and patient experience to evidence patients are free from abuse, harassment, bullying, violence from other patients and staff, with redress being open and fair to all.
3. Consumer Advisory Panel to consider what products GPs should engage with to evidence good inclusive practice? CAP to input into developing such products with Equality Lead.
4. E&D Leadership Competency Framework to be adopted initially by all CCG roles, through performance review outcomes and recruitment practices.
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21.3.12. Document updated for and approved by CCG Shadow Board and Executive team.
Objective 1: Better Health Outcomes for All
Context: All healthcare organisations are required to have in place programmes for health promotion and disease prevention for the whole community with regards to priority areas. For Tameside and Glossop the following areas are proposed within a new 5 year commissioning strategy, as existing QIPP priority areas: - Urgent care Planned care (& cancer) LTC Mental Health Children & Families.
CCGs National context The development and evolution of the shadow Clinical Commissioning Group is one part of a much wider picture of reform within the NHS. The Locality PCT is currently also overseeing the transition of the Public Health function to Local Authorities, Primary Care Management to a new and single service across Greater Manchester; and Commissioning Support services. In addition, nationally, plans are well underway to establish a National Commissioning Board that will provide national leadership for outcomes and standards.
Tameside and Glossop sCCG Vision: Your sCCG is led by local . By inspiring all NHS colleagues, and working closely with partners, we will ensure the development of excellent, compassionate, cost effective care, leading to longer, healthier lives.
Tameside and Glossop sCCG Principles: Listening to patients Developing innovative services closer to home Increasing taxpayer value for money Improving health indicators.
As part of the CCG authorisation process, Tameside and Glossop sCCG will develop a clear and credible 5 year commissioning strategy. The strategy will set out the sCCG’s ambitions for its service and improvement programme for the future, and demonstrate how it can work within the local and Greater Manchester programmes for system reform and improved health and wellbeing for the population. The process of developing the strategy will support the authorisation process through wide engagement with all key stakeholders, clinical leadership and a strategic coordination of the health and social care economy to improve health outcomes, reduce health inequalities and improve quality of care for the population
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93 of Tameside & Glossop. It will also aim to improve services, attract future personnel, promote excellence and improve the public perception of our heath service. The sCCG currently has 5 key QIPP areas, which it is proposed remain the service and redesign priority areas for the strategy: Urgent care; Planned care (& cancer); LTC Mental Health, and; Children & Families. It is proposed that the 5 QIPP priority areas are the key service and redesign areas for the above strategy. Equality Objective 1: Input into CCG Organisational Development Plan re ‘how CCG can help you as GP providers to be good commissioners’. Develop simple guide. Include focus on using patient data for improvements.
Measures: 1. CAP members with sCCG E&D Lead to develop simple guide ‘How CCG can help you as GP providers to be good commissioners’.
2. Develop short 20 minute DVD highlighting vignettes of an Inclusive Patient Journey from first GP contact, to referral at secondary care, to finally exiting the service. CAP members to help make the DVD. Funding from GP Equality training during 2011. Target GPs and Secondary care as a training resource for new staff at Induction stage. Charge nominal fee to recover some of costs. Develop a short patient questionnaire in targeted locations prior to DVD being used by new staff at Induction. Survey again after 6 months of DVD training support in same locations. Measure any improvement in patient experience in terms of inclusion for protected groups.
3. Consumer Advisory Panel patient reps recommend steps be agreed by sCCG which promote a consistent data collection and analysis approach across NHSGM, for local protected groups.
Prepare Paper to sCCG on Equality Data Framework April 2012 sCCG COO requires Paper to go before new PIQ initially CCG Board to consider two sets of key issues dropping down from this equality data priority (see summarised paper) and how this issue of developing a consistent Equality Data Framework can best be progressed through a stepped approach? Agree steps to achieve an Equality Data Framework for our CCG and then influence to include all CCGs across GM in this new approach. [Share joint approach for a new data framework with NHS Salford and to include CCGs engaging with their local protected groups, as one of NHSGM E&D Leads Group Key Objectives] Two sets of key issues drop down from this priority. 1. Provide patients / carers with the option to anonymously declare their protected characteristics at the point of exiting a service. The outcome is to be able to evidence differential patient satisfaction levels by protected group ie evidence that our disabled patients are at least as satisfied with the service as our non disabled patients. This patient satisfaction data should be routinely collected (via survey) each time a patient exits a service eg complaints, FOI
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94 requests; at Pathway design stage, or Strategy development engagement. 2. Provide patients / carers with the option to declare their own protected characteristics (including any agreed reasonable adjustments provision) in terms of their individual patient record. This data should be collected once only and then travel with the patient at the point of referral, as appropriate. Confidential data which is treated as personal and sensitive.
The data once declared and stored, should be proactively used for improvement purposes. Following completion of a new annual public grading in March 2012, at the patient level local interest groups for Tameside and Glossop (including the Consumer Advisory Panel or CAP) have requested the sCCG consider how this issue of developing a consistent Equality Data Framework can best be progressed through a stepped approach? Our new Annual Equality Publication has highlighted a number of gaps in our patient / carer equality data knowledge. Our agreed Equality Objectives focus on how we will address any significant shortfalls over the next 4 years.
Currently poor quality data to analyse service uptake across protected characteristic groups. CCG response 29 May 2012:
Part 1: OK can do this - should offer the opportunity for patients to declare their protected characteristics. When we are anonymously surveying for patient opinion let us ask as a standard question ‘what are your protected groups?’, rather than every time patients exit a service.
Part 2: CLICK is the Information group – practically what does that mean for us as a CCG? What are the next steps towards making this happen? By reference to CLICK together create a set of recommendations CCG can consider.
Steve added that he is responsible for collaborations across GM CCGs in terms of equality diversity and human rights (EDHR).
Equality Data Recommendations (draft for CLICK): Consistent Equality Data Framework for be developed by GP CCG Leads: Primary care GP practices to offer the following options for patients and carers to declare their protected characteristics, as a default position: When we are anonymously surveying for patient opinion let us ask as a standard question ‘what are your protected groups?’, rather than every time patients exit a service Include confidential equality monitoring form for patient’s completion in all New Patient Welcome Packs Send same patient record form out with central mailings for flu vaccination, routine screening appointments as appropriate Set ability on the patient record to flag where equality monitoring information still required as well as where declined to respond Where information is returned, input onto individual patient record and maintain under Data Protection Act standards
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95 System to have ability to report on individual patient records by protected groups Include any agreed reasonable adjustment information – actively try to ensure this information travels with the patient at referral points eg to secondary care for practical action and good patient experience.
4. EDHR Governance processes to link into sCCG Organisational Development Plan. Timescale: to be achieved by April 2013 Mainstreamed: Transparent Reporting: Report to sCCG quarterly on progress with first report due 1 June 2012.
Objective 2: Improved patient access and experience
Context: The new GP led Clinical Commissioning Group (CCG) for Tameside and Glossop want to be excellent at listening and responding to patients. So to do this we need to be able to establish what data and intelligence we currently gather, identify the gaps and establish how this information will shape decisions and improve access to services. At present the PCT are in the early stages of a large scoping exercise on gathering patient experience data across primary and secondary care. Patient feedback, PALs reports, PCT complaints etc will then help the CCG identify how services can be continually improved and access to those services can be enhanced to benefit patients, carers and communities from protected characteristic groups within the communities we serve.
The organisation is demonstrating improvements in handling patient and carer complaints about services, using Easy Read as a mainstream mechanism. Also Complaints reporting is firmly embedded within our scrutiny and recommendations meetings with patient reps from 7/9 of the protected groups. Recommendations from this patient rep Panel are made directly to sCCG for consideration.
Furthermore, through its engagement processes and its monitoring of provider patient surveys, the PCT can show that most protected groups report that their complaints are handled with just as much respect and efficiency as those complaints made by patients as a whole. The trust records the protected characteristics of patients exiting our complaints service. The PCT’s Equality & Diversity Manager works very closely with our Complaints Manager with reporting on complaints monitoring made 6 monthly via our consumer Advisory Panel and strategic monitoring group EDMA chaired by a NED. The current Strategic Business Plan for the trust does not give due regard to improving current performance in this area.
Our Complaints Manager attends our monthly Consumer Advisory Panel meeting and supports one of our learning disabled members through plain English. Our complaints process is currently being produced as an Easy Read version through
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96 joint working with People First a Tameside service user led organisation for learning disabled patients and their carers.
Equality Objective 2: Review our Complaints process to ensure it is accessible for protected groups and is promoted widely to patients and carers (including Easy Read version). Link to patient safety being prioritising and assured specifically for protected groups. In particular monitor complaints and patient experience to evidence patients are free from abuse, harassment, bullying, violence from other patients and staff, with redress being open and fair to all.
Measures: 1. Newly reviewed Comments, Compliments and Complaints publications to be finalised by Complaints Manager (part of merger with Complaints & PALS services); 2. Leaflets to be available in Easy Read version for improved access for learning disability patients and for those with literacy issues. 3. Ensure availability of complaints information in 5 key local languages for Tameside and Glossop eg via website and link on leaflets to LIPS interpretation service. 4. Complaints Manager to promote Complaints service and improved accessibility for local protected groups. Timescale: to be achieved by April 2013 Mainstreamed:
1. Easy Read version of Comments & Complaints leaflet produced by Complaints / PALS team in close working with Consumer Advisory Panel June 2012. 2. New Easy Read version of Annual Equality Publication developed by E&D Manager and People First Tameside (Voluntary sector learning disability support organisation). Public document to be displayed on our website for improved access to key documents for ppatients with learning disabilities / literacy issues.
Transparent Reporting:
Report to sCCG quarterly on progress with first report due 1 June 2012.
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Objective 3: Empowered, engaged and well-supported staff
Context: Mandatory Quality and Equality Workshops are currently available to all NHS Tameside and Glossop staff on a 2 yearly basis. These bespoke Workshops aim to provide assurance to sCCG of the level of awareness of all staff in terms of how we are required to meet the public sector equality duty (PSED) and how this can be achieved within our day to day practice. This level of training will support our sCCG through EDHR requirements within the Authorisation process.
Whilst many of the standard EDHR headlines are known, there have been many key changes to EDHR in the last 18 months. Our Workshops consider what those EDHR headlines mean in reality in terms of commissioning for CCGs. They take into account CCG Authorisation EDHR requirements and beyond and ask the question of delegates ‘How do commissioners evidence taking into consideration the range of differences for protected characteristic groups? How do staff know what to consider? What are the key things commissioners need to take ‘due regard’ of? Our aim is to try to ensure we provide services to patients and colleagues in a fair and equitable way to each of the protected groups, as well as carers and military veterans locally.
We expect our staff to understand how to identify and effectively address barriers to inclusion in health care inequalities and any form of prohibited discrimination in the workplace including eg Hate Crime.
Actions taken: 1. AoE training being delivered to 11 HR Shared Service Business Partners 15.8.12. NHSGM process has been developed and is now out to consultation with E&D Leads. 2. New Hate Crime policy developed and taken to Safeguarding meeting on 26.6.12. Awaiting TMBC reporting form then can embed into provider contracts at next update. 3. HR Advice Line With effect from the 3rd July 2012 a Central Employee Relations (ER) Advice Line will be open to enable managers and staff to seek answers to their HR queries. The line will be manned by a member of the Employee Relations Team and will be open from 9am – 5pm Monday – Friday. You can also email the HR advice line – this is our preferred method for you to contact us for straightforward ER queries.
Our aim is that this advice line will provide you with a quick response to your query and can provide you with general ER advice.
Examples of when you might call or email our Advice Line would include matters regarding Sickness Management, Performance Management, Grievance & Disciplinary issues, Terms and conditions of employment, Interpretation of HR policies and procedures and advice around drafting job descriptions in preparation for recruitment. Where further support is required we will assign you a named HR
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98 Advisor to provide you with support.
Equality Objective 3: Consumer Advisory Panel to consider what products GPs should engage with to evidence good inclusive practice? CAP to input into developing such products with Equality Lead. Measures:
1. Develop simple guide for GPs to include ‘What do ‘Good Products’ Look Like for GP Providers to Evidence Commissioning Inclusive Services?’
29.5.12. sCCG Steve Allinson suggested we be clear about Objective 3 via a conversation with provider partners.
Actions taken: A new EDHR Accreditation Scheme (Bronze Level 1 Award) has been developed as a joint product for CCG and NCB. A 3 page questionnaire is based on CQC Registration equality requirements for primary care and represents a ‘bridge’ to EDS (Equality Delivery System) intentions for GP and Dental Practices. This is being considered by CCG (4.7.12). NCB have supported this document (June 2012). E&D Manager met with Laura Browse 25.6.12 new Director of Commissioning Primary Care NCB to discuss joint products going forward via CSS? JA taking this product to GP Practice Managers’ Forum on 31.7.12. to seek support for completion. Also JA will take to LMC Secretary (Alan Dow) for feedback.
At 29.5.12. PIQ meeting, Steve Allinson added that he is responsible for collaborations across GM CCGs in terms of equality diversity and human rights (EDHR).
Timescale: to be achieved by April 2013 Mainstreamed:
Transparent Reporting:
Report to sCCG quarterly on progress with first report due 1 June 2012.
Objective 4: Inclusive leadership at all levels
Context: Competency Framework for Equality and Diversity Leadership (July 2011) This new framework must be adopted by NHS organisations in order to evidence our compliance with (Equality Delivery System) EDS Goal: 4 Inclusive Leadership at all levels (NHS organisations should ensure that equality is everyone's business and everyone is expected to take an active part, supported by the work of specialist equality leaders and champions.)
EDS Outcome 4.3 requires that: The organisation uses the 'Competency Framework
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99 for Equality and Diversity Leadership' to recruit, develop and support strategic leaders to advance equality outcomes.
The Equality Delivery System (EDS) was launched by Sir David Nicholson and his Equality Council in November 2011. This provides the first NHS wide Equality Performance framework which supports collection of equality outcomes for patients, carers and staff within each NHS organisation and their provider partners. Evidence is annually graded by local interest groups which is transparently available to the public. Gaps are identified with Action Plans to actively bring in improvements in time for the next annual public grading.
The Competency Framework for E&D Leadership is an essential tool to support evidence for EDS Outcome 4.3 (as above). Leadership for EDHR involves actively embedding this framework initially into the processes of (1) recruitment for all new posts at sCCG level in year 1, and (2) annual performance reviews.
Equality Objective 4: E&D Leadership Competency Framework to be adopted initially by all CCG roles, through performance review outcomes and recruitment practices.
1. Measures: 2. Evidence how CCG HR Shared Service have embedded this Framework into recruitment for all new posts at sCCG level in year 1. 3. Evidence how CCG HR Shared Service have embedded this Framework into annual performance reviews. 4. To undertake an Equality Analysis on the Transition plan for Human Resources to ensure that the alignment of staff, recruitment and redundancy processes are fair, equitable and free from discrimination. 5. To build in equality into all job profiles and recruitment processes utilising the national E&D competency framework 6. To develop an equality development plan for all current and future employees. 7. To build in to contracts with providers including emerging Commissioning Support Services the need for their employees to have E&D development / training 8. The CCG Board identifies an executive lead for EDHR 9. The Executive Lead is developed in line with the National NHS E&D Competency Framework 10. The CCG Board receive annual EDHR development relevant to their role. 11. EDHR exceptions go to the Board quarterly 12. EDHR annual report on Equality Delivery System Grading outcomes and Equality Objective Outcomes prior to publication is received by the board and signed off Timescale: to be achieved by April 2013 Mainstreamed:
Transparent Reporting:
Report to sCCG quarterly on progress with first report due 1 June 2012.
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100 Equality Objectives - Measures and Reporting details added 11.5.12. Julia Allen
Last updated content 5.7.12.
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Clinical Commissioning Group Meeting
Re: Patient Transport Service (PTS) Re-Procurement Exercise
Paper prepared by: NHS Blackpool
Date of paper: June 2012 Subject: Patient Transport Service (PTS) Re-Procurement Exercise
History of paper: NHS Blackpool Ambulance Commissioning Team are currently in the middle of an external procurement process for PTS services across the North West under a delegated process/powers, structured around health economy footprints (Cumbria, Lancashire, Greater Manchester, Cheshire & Merseyside) following an earlier referral to the Competition and Co-operation Panel.
Executive Summary: The letter outlines that the time window for Clusters and CCGs to review the procurement outcome recommendations is very tight, but it is necessary to ensure that a conclusion is reached and award a contract(s) capable of being successfully mobilised by the 1st April next year.
The letter suggests that where an organisation does not have a suitable Board or governing body meeting during this period that the decision as to whether or not to support the procurement recommendations is properly delegated to the likes of an executive meeting or Chair and accountable officer as appropriate.
It is noted that each health economy has a Cluster Lead to assist in any matters associated with the PTS procurement process of which they are a formal part
102 on our behalf. Their contact details are attached to the letter
Outcome Required of CCG: CCG to note the re-procurement process.
For Discussion or Approval: For discussion/information
QIPP principles addressed by proposal: Quality
Direct questions to: Steve Allinson
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Ambulance Commissioning Team Blackpool Stadium Seasider’s Way Cluster CEOs Blackpool CCG AOs Lancashire FY1 6JX Tel 01253 651261 Fax 01253 651268 E-mail [email protected] 21st June 2012
Dear Colleague,
Re: Patient Transport Service (PTS) Re-Procurement Exercise
As you will be aware we are currently in the middle of an external procurement process for PTS services across the North West under a delegated process/powers, structured around health economy footprints (Cumbria, Lancashire, Greater Manchester, Cheshire & Merseyside) following an earlier referral to the Competition and Co-operation Panel.
Following receipt of the tender bids, the deadline for which is the 22nd June, we will then carry out a detailed appraisal of the bidders submissions with involvement of CCG, acute trust, patient and PCT representatives, supported by specialist experts including financial assessors and a PTS Director from another regional ambulance service as ‘external’ adviser.
It is anticipated that the remote bidder evaluation, moderation and subsequent bidder interviews will have been completed by the 20th August, after which the procurement team will finalise the recommendations and complete their report for commissioners. This report will then need to be presented to CCGs for their support and the Clusters for formal approval. As a consequence of the tight timetable imposed upon us it will be necessary for these ‘approvals’ to have been achieved between the 31st August and the 10th September to allow the outcome to be presented to the PTS Programme Board when it meets in early September to confirm the preferred bidder(s) for the five health economy footprints.
I appreciate that the time window for Clusters and CCGs to review the procurement outcome recommendations is very tight, but this is necessary to ensure that we reach a conclusion and award a contract(s) that are capable of being successfully mobilised by the 1st April next year. It is therefore suggested that where an organisation does not have a suitable Board or governing body meeting during this period that the decision as to whether or not to support the procurement recommendations is properly delegated to the likes of an executive meeting or Chair and accountable officer as appropriate.
Your co-operation in ensuring this is achieved within the timescales would be very much appreciated. Failure to support the outcome of the procurement will put the affected footprint at risk of legal challenge or a second referral to the Competition and Co-operation Panel.
104 Furthermore, it will place at risk the area having a break in service delivery for patients as notice has been properly served with NWAS for the current service.
Each health economy has a Cluster Lead who is there to assist you and your colleagues in any matters associated with the PTS procurement process of which they are a formal part on your behalf. I have attached their contact details to this letter if you want to contact them directly for any further assistance. Myself and the NHS Blackpool ambulance commissioning team are also here should you have any queries about the approvals process or need any further help or information.
Once again many thanks for your assistance in this urgent matter.
Yours sincerely,
Allan Jude Director for Ambulance Commissioning NHS Blackpool PTS Programme Board Chair
Cc Cluster Ambulance Leads
105 Cluster Ambulance Leads
Cumbria Charles Welbourn [email protected] 07920 781886
Merseyside Ian Davies [email protected] 07803 886255
Gtr Warren Heppolette warrenheppolette.nhs.uk 07917 551247 Manchester or Steve Allinson [email protected] 07970 148830
Cheshire Joanne Forrest [email protected] 07834 047774
Lancashire Jane Higgs [email protected] 07825 319614
106
Clinical Commissioning Group Meeting
PIQ Committee Minutes
Paper prepared by: Clare Watson
Date of paper: 4th July 2012
Subject: PIQ Committee Minutes
History of paper: This is the first set of minutes for this new Committee.
Executive Summary: This Committee was brought together in order to discuss and make decisions on items prior to being presented to CCG.
The meeting considered the Committee’s Terms of Reference and core attendees as well as looking at workstreams. Key issues discussed were: ISCATS, clinical engagement, business cases, quality & assurance/clinical audit /quality improvement, hospital mortality report.
Outcome Required of CCG: CCG are asked to not the content of these minutes.
For Discussion or Approval: For approval.
QIPP principles addressed by proposal: All
Direct questions to: Clare Watson
107 NHS Tameside and Glossop Planning, Implementation and Quality (PIQ) Committee
24th May 2012, 1.30- 4.30
Boardroom, NCH
Attendees: Graham Curtis, (Chair) Clare Watson, Programme Director, NHS T&G Pam Watt (on behalf of Elaine Michel), NHS T&G Pat McKelvey, Head of Children’s service, NHS T&G Michelle Rothwell, Head of Individualised Commissioning, NHS T&G Elaine Richardson, Strategic Programmes Manager, NHS T&G Alison Lewin, Associate Director, NHS T&G Alan Dow, CCG Board Member, NHS T&G Kathy Roe, Director of Finance, NHS T&G Steve Allinson, Interim Chief Operating Officer, NHS T&G John Doldon, CCG Board Member, NHS T&G Simone Hall, PA, NHS T&G (minutes)
1. Apologies for absence Richard Bircher, Jo Rowell, Raj Patel, Sue Pitt, Peter Howarth, Clare Symons, Guy Wilkinson, Phaninder Tatineni, Elaine Michelle, Tom Wilson
The Chair welcomed everyone to the first PIQ Committee Meeting and explained that this meeting is the “workhouse” where decisions will be made before the item goes to CCG Board.
Clare explained who had been invited to attend, and that all the locality leads had been invited.
2. Draft TOR and Flow Diagram
Clare explained that the flow chart was added to the TOR as a way to describe relationships. She confirmed that this was the committee that commissioning, re-design, business cases etc items should go in advance of being presented at Board. Some may not go into Board.
It was agreed that the following should be standing items on the future agenda:- MMC Minutes Continuing Care
It was agreed to review the TOR again in 6 months
The group was not to be confused with Quality & Performance Committee.
108 Issues raised:-
Page 2 Pat McKelvey stated that clarity was needed around - Joint Commissioning/Health & Wellbeing. SA agreed that conversations were needed around how this would work jointly. PM also suggested that the words relating to “To promote health & wellbeing needed strengthening.
Page 4
Alan Dow added that Local Representative Committee needed to be added (he had seen a different version of this TOR) SA added that Ian short would like to be a member.
Action:- CW to check version of TOR and revise/update for circulation with agenda for the next meeting.
Quoracy
It was agreed that the quoracy should increase to at least 5 members, including Locality COO, Locality DOF (or representative) and three CCG members.
The group discussed if the chair should be a lay member or a clinical member. Concerns were raised re :- Conflicts of interest.
There was a long debate and it was agreed that a non exec member would act as a chair for the short term, until greater clarity regarding structures and wider governance.
Attendees
It was agreed that a representative from all three LA’s to be invited.
Action:- To have the Governance Group meetings before the next PIQ meeting- All
Action :- To attach the revised TOR with the minutes – CW/SH
3. Prioritisation and Clinical Engagement
All commissioning leads had been asked to identify where there were capacity pressures re:- their CCG programmes of work; and to submit a proforma detailing where additional support was needed.
It was agreed by the group that some changes were needed to the template. It was also agreed that ideally the Clinical Lead requesting additional support should present “the case” at PIQ meetings.
Action:- A box to be added to the template entitled “Risks”
Action:- End date to be added to the template
109 Action:- Revised template to go out with the next agenda.
Work stream Areas discussed:-
LTC
Sara Roscoe submitted the GP and/or PN input into Respiratory QIPP and SHMI programme including COPD and Pneumonia
AL explained that there is a NW Respiratory QIPP plan in place that we would be wise to implement locally.
Looking for a local GP for 6 months
Outcome was agreed
Action:-To report back on results
Urgent Care
Clare Watson explained that Sara Garratt has submitted the request for GP to input into the ongoing development of the SSIU ward.
Jo Rowell and Richard Bircher currently support this request, however additional Clinical support is required. A total of 6 x sessions are required to understand deaths on the ward, more work needs to be done on this. Support is required by the end June.
Action:- Outcome to be reported back to the September meeting.
Ophthalmology
Elaine Richardson explained that a request has been submitted for GP input into the Ophthalmology QIPP programme.
Working with local clinicians on the repatriation of eye surgery of eye surgery to TFT, the review of pathways and more services delivered in the community,
Action :- to check how a GP can be identified
Six sessions required to start at the end June/July
Action:- to report back at September meeting.
Sexual Health
Pam Watt explained that we are trying to get Clinical Support for Sexual Health.
GP support required for input into the strategy around contraception, LARC provision and Chlamydia screening.
110 Two sessions per week for 12 months are required.
In principal the request is agreed
Action:- SA/PW to discuss number of sessions required with Tina Greenough
Action :- To report back to the next meeting
ISCATS
Elaine Richardson explains that the locality GP has now stepped down from the role.
Trying to encourage the increase usage of the service to ensure return on spend.
A GP is required to support and build pathways with Tameside FT.
It was agreed to go out to all GPs
Action:- Feedback to October meeting – to be reviewed
Children & Families
Pat McKelvey explained that support is needed to provide 3 x elements around Safeguarding, Children & Families QIPP and clinical support around Asthma.
Two sessions per month are required in this financial year (totalling 20 sessions).
A named GP is required for Safeguarding as a priority.
Action: Conversation required with Pat, Steve Allinson and Tina Greenhough.
Action :- A further conversation is required with Tina Greenough re:- sexual health
Action :- The outcomes of the above meeting to be e-mailed out to everyone
Cancer- to be discussed at next meeting.
Quality & Assurance/Clinical Audit/Quality Improvement
Alan Dow explains that Heather Harrison submitted a request for an individual to look at what happens outside the hospital. The post requires regular sessions in support of the SMHI work.
Action:- to offer to all GPs
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Clinical Leadership – 12/13 Community Contract
Elaine Frew submitted a request for 2 x sessions per month (this has already been signed off).
The future process will be to provide written documentation (Clinical Engagement form).
4. Hospital Mortality Report
The report action plan was presented by Pam Watt on behalf of Elaine Michel.
The group felt that excellent progress had been made by developing a joint CCG/TFT plan.
The group agreed that the report should go to the Quality & Performance Committee in terms of ‘performance’, but should come to PIQ for commissioning solutions to support improvements.
Action :- Work to be done outside the meeting to ensure the loop is closed - PW
5. Investment Proposals
All the remaining business cases are due to come to the next PIQ meeting on 5th July. In light of if and when resources are identified to be spent, the NR monies and the need to ensure the CCG makes best use of the resources it was recommended that there needs to be some on the shelf , approved and ready to go.
DOCMAN
Alison Lewin presented the business case relating to the Docman electronic workflow for General Practice.
The business case was agreed with the caveat that the Finance was agreed with Kathy Roe.
Falls
Rachel Hinchliffe presented the business case. She explained that it had already been to CCG and that the Board support the Falls service.
If the funding is approved it will need to go to market for procurement.
The funding is non-recurrent for this year and cost neutral in 12 months as a 10% reduction in falls would pay for the service.
The business case was approved, however it needs to be reviewed with all the other business cases on 5th July and a final decision will then be made at that meeting.
112 Framework for LTC/Health Outcomes
Pam Watt explains that a number of initiatives to support the prevention, identification and management of Long Term Conditions.
The paper is setting framework to invest in health outcomes.
There are seven separate business cases to be presented at the next meeting.
The joint working between Public Health and Commissioning was commended.
Care Homes LES
The Care homes pilot started in January 2012. A request for a further 4 month extension to the pilot is being made to support the evaluation
The panel agreed to continue the pilot for a further 4 months, but with the additional activity lay practices, authorised by service and clinical lead . A report will be brought to October PIQ.
Action:- SG/RB
6. Proposed Tameside Children’s Trust Commissioning Priorities
Pat McKelvey presented the proposal.
The committee commented that operational governance needs to be set up so Pat does not feel unsupported.
Action :- Pat to draft a letter to send to Steve Allinson
7. Telehealth Update
Clare Watson explained that the additional funding for the service and outcomes had been improved. Individuals could now be tracked through the system to demonstrate they were using ‘out of hospital’ care.
The committee agreed that annual feedback was required.
Action:- QIPP plan – next stage of activity through Alan Dow/Ali Lewin to support
8. Nerve Conduction for Carpal Tunnel
Rachel Hinchliffe explained that the service was wider than Carpal Tunnel and that the service needs to be re-procured.
Rachel is seeking agreement for a new provider.
113 The committee were happy with the specification.
Action:- The title of the paper needs to be changed to Nerve Conduction Studies –RH
9. Equality & Diversity
Julia Allen presented the suggested equality action plan.
This is a one year strategy that would need to be reviewed in March 2013.
Action:- Julia to send out more detail re:- evidence
10. AOB
Future Agenda Items:-
Locality Issues
Membership – locality GPs – verbal update or written report, also need to check why they didn’t attend.
Graham Curtis gave his apologies for October meeting
Date of Next Meeting: Thursday 5th July 2012, 2-5pm in the Boardroom.
114 Clinical Commissioning Group Clinical Commissioning Group Meeting
Corporate Performance
Paper prepared The Corporate Performance Team by: Date of paper: 18.07.2012 Subject: Corporate Performance History of paper: Executive In 2012/13 the performance framework will incorporate: National Summary: Integrated performance measures; NHS Outcomes Framework; existing local commitments and selected measures from the Adult Social Care Outcomes framework and Public Health Outcomes framework.
This report provides an update on the assurances for NHS Tameside and Glossop Clinical Commissioning Group against the performance framework. The report highlights key points and actions against measures of high priority and or high risk. Consideration should be given to the following:
1. How can CCG ensure that the services delivered are of the highest quality (Patient safety, Patient Experience, Service Effectiveness and Health Outcomes) and that patient’s care is not compromised? Noting that any failure may affect the patient’s health or perception of the service provider. 2. What can we influence locally, regionally or nationally? 3. What are our local priorities? The overall performance RAG risk rating for NHS Tameside and Glossop against the NoE key priority areas is Amber (7 for local monitoring).
Outcome NHS Tameside and Glossop Clinical Commissioning Group and Required of CCG: commissioning leads will ensure appropriate steps are taken to maintain / improve performance. Clinical Commissioning Group are asked to:
a) Note the issues raised in relation to the quality of commissioned services b) Endorse the approach which is being taken to manage the issues raised For Discussion or Discussion Approval: QIPP principles Delivery of NHS T&G’s Operating Framework commitments for addressed by 2011/12; to include the three suites of measures Quality, proposal: Resources and Reform. Direct questions Kathy Roe to:
115 1.0 Introduction and Background
1.1 NHS Tameside and Glossop Clinical Commissioning Group (CCG) have developed a performance framework that includes integrated performance measures, underpinned by national and mandatory data collections for national oversight and additional areas of assurance. The framework covers the NHS Operating framework; NHS Outcomes Framework and selected measures from the Public Health Outcomes Framework and Adult Social Care Outcomes Framework.
1.2 The performance framework spans the following domains/overarching themes: Preventing people from dying prematurely Enhancing quality of life for people with long term conditions Helping people to recover from episodes of ill health or following injury Ensuring that people have a positive experience of care Treating and caring for people in a safe environment and protecting them from avoidable harm Public Health Resources (Finance, Capacity & Activity) Reform (Commissioner, Provider & building capability and partnership) Improving the wider determinants of health (Public Health) Health Improvement (Public Health) Health Protection (Public Health) Selected Measures the Adult Social Care Existing commitments from NHS Tameside and Glossop in 2011/12 for local monitoring
1.3 Quality and Performance Committee will review all Corporate Performance Measures known to be of high level risk to NHS Tameside and Glossop, as well as any additional areas of assurance. Measures, RAG risk rated as red are included on the Corporate Risk Register and will be discussed at the Locality Audit and Risk Group. This will be reviewed at the Locality Audit and Risk Group to allow triangulation of Quality, Finance and Performance.
1.4 All measures are mapped over to the quality domains of patient experience; patient safety; service effectiveness and health outcomes. They are also mapped to the QIPP work streams: children and families; CVD/Stroke/Long Term Conditions; End of Life; Long Term Conditions; Mental Health and Substance misuse; Planned Care and Surgical thresholds; Prescribing; Public Health; Urgent Care and Workforce.
1.5 On a monthly basis NHS NoE circulate a scorecard based on selected key priority areas. NHS Manchester has an overall RAG risk rating of RED and NHS Tameside and Glossop have an overall RAG risk rating of Amber, based on the NoE scorecard, produced in June 2012. NHS Tameside and Glossop CCG invested transitional funding worth up to £1.7million to support some of these priority areas
1
116 (refer to Finance committee minutes dated 28th March 2012) based on achievement of KPI’s.
2 Purpose
2.1 NHS Tameside and Glossop CCG Operating Framework, details how it will provide assurance that satisfactory performance will be maintained or provide recovery plans where appropriate. The Corporate Performance team, have developed a performance framework to incorporate all these measures. The Integrated performance measures are now aligned to the Quality and QIPP work streams. This means that the performance updates across these work streams, are all taken from the same source. These will then inform NHS Tameside and Glossop Clinical Commissioning Group.
2.2 Many of the indicators will require a clinical overview. Key performance measures will be presented to NHS Tameside and Glossop Clinical Commissioning Group on a monthly basis. Failure to reach any milestone or monthly target will require an exception report; detailing a remedial action plan.
2.3 NHS Tameside and Glossop Clinical Commissioning Group may request exception reports to be presented and will focus on a couple of selected measures per month. Alternatively sCCG may choose to focus on performance monitoring on particular work streams.
2.4 The report provides an update on assurances in relation of the quality of services commissioned and highlights any current issues and actions. This report provides statistical information along with a narrative regarding any issues or actions. Performance reports are updated on a monthly basis and include a high level action plan; these along with supporting information are available on request.
2.5 NHS Tameside and Glossop Clinical Commissioning Group needs to ensure that the services delivered are of the highest quality (Patient Safety, Patient Experience, Service Effectiveness and Health Outcomes) and that patient’s care is not compromised. Any failure may affect the patient’s health or perception of the service provider.
3 Exception Reports
3.1 The following exception reports were selected on the 29th June 2012; they are either high risk (RAG risk rated RED); high profile; not demonstrating significant progress against the action plan or NHS Tameside and Glossop CCG have requested an update.
2
117
NHS Operating Framework – RAG RATED RED
Link to Tameside Foundation Trust – Adult In patient survey. http://www.nhssurveys.org/Filestore/benchmark/ip11/IP11_RMP.pdf
3
118
4
119
5
120
Data available on request
6
121 NHS Outcomes Framework - RAG RATED RED
7
122
Insert graph here
8
123 Existing measure for local monitoring - RAG RATED RED
9
124 Public Health Outcomes Framework - RAG RATED RED
10
125
11
126
For smoking prevalence aged 15- we have to use Trading Standards North West Survey of people aged 14-17 done in September 2011- 12,388 young people across the NW completed questionnaires in school. We estimate from this that 16% of 15 year olds in NW smoke- not available by PCT level. Whilst this seems to have dropped from 2009- the confidence interval around these estimates is wide so we cannot say this represents a definite trend.
12
127
13
128
14
129 Additional High RAG Risk Assurances Focus areas Rating RTT admitted Green 1. Weekly local monitoring / conference calls with TFT 2. TFT closely monitoring and proactively discussing plans with NHS T&G to mitigate any risks, particularly around the issue of Orthopaedics. 3. Transitional monies available to TFT. 4. TFT produced action plan to ensure all specialties are brought into and remain within target. This includes sourcing additional capacity where required (for example Colonoscopy). Cancer 62 day Green 1. Weekly discussions and action plan in place. waits 2. TFT implemented a number of actions following local reviews including reducing time to initial appointment ( from 14 days to 7); introduced a Neck lump clinic. 3. Increased Capacity and Resources. 4. Transitional monies available to TFT HCAI Green 1. Working to one Whole Health Economy plan. 2. Antibiotic Stewardship, raising awareness, RCA and having firm governance plans in place. 4 hour wait in A&E Green 1. NHS T&G in daily discussions with TFT to negotiate how additional funding can be utilised to contribute towards improving performance. 2. Utilising Utilisation Management data to model daily A&E demand and workforce. 3. Funded a Short Stay Intervention Unit. 4. Assessing whether WIC can help provide any extra resource. 5. Confirmation from TFT they will achieve Q1. Action plan to achieve 95% in month of June. Mixed Sex Green 1. TFT are fully compliant. Accommodation. 2. TFT to ensure ongoing training, education and awareness programme. Cat A - NWAS Amber 1. Blackpool PCT are the lead commissioners for this. 2. Review required on developments of a local improvement plan. 3. Review required for NWAS-funded Rapid Response Vehicle in Glossop. 4. In discussions with Business Manager at NWAS regarding ambulance turnaround times between NWAS and TFT. NHS Health checks Green 1. Increase capacity for health trainers service to accept referrals for physical activity 2. Continue staffing support for primary care Health Visitors Green 1. Recruitment is dependent on new trainees and therefore growth will be staggered. 2. Volume of new trainees plus the requirement to mobilise the profession will have an impact on activity in the short term. 3.
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130 Ongoing co-operation between provider, CCG, LA, GM and AGMA is required to deliver the desired outcomes for children and families in T&G . Funding identified in CCG plans. IAPT Amber 1. Our IAPT service is having a service review later this month with the IAPT team. 2. In Tameside we are achieving the set 50% recovery rate and are on track to achieve the 10% prevalence rate of people accessing the service. 3. The challenges ahead are maintaining the 50% recovery rate and also the expectation to increase the prevalence rate to 15% by March 2014. These discussions will be on the agenda for the service review and will include the capacity of the team to meet these targets. Summary Care Green 1. GM wide action plan – RAG status green. National target of 75% of all practices to Record. have SCR; RAG risk rated RED 2. PIP commenced on 30th May 2012 (due to end at the end of August). 3. Progress reviewed and discussed at Clinical Links and Information Committee (CLIC) on a monthly basis. 4. IT infracture survey being reviewed by IT 5. Supporting Practices and responding to any issues or queries raised by the public. 6. IT infracture survey being reviewed by IT
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131 NHS North of England performance overview - June 2012 report
RTT A&E 4 Mixed Sex Health Health admitted 62 day C-diff hour wait accommodat Ambulance Checks Overall Visitors PCT Cluster 90% Cancer April QTD as at ion Cat A Q4 March 2012 March 2012 Q4 2011/12 2012 27-May-12 April 2012 April 2012 2011/12
Tees
South Yorkshire & Bassetlaw
South of Tyne & Wear
North of Tyne
County Durham & Darlington
Merseyside
Calderdale Kirklees & Wakefield
Humber
North Yorkshire & York
Lancashire
Manchester
Cumbria
Cheshire
Airedale Bradford & Leeds 132 NHS North of England performance overview - June 2012 report
RTT 62 day A&E 4 MixedMixed Sex Sex Health admittedRTT 62Cancer day C-diff A&Ehour 4 wait accommodatAmbulanceAmbulance Checks Overall C-diff accommod Stroke PCT admitted90% CancerQ4 April hourQTD wait as at ion Cat A Cat A Q4 March95th 2012% 2011/12 2012 27-May-12 ationApril 2012 April 2012 2011/12
133 NHS North of England performance overview - June 2012 report
RTT 62 day A&E 4 MixedMixed Sex Sex Health admittedRTT 62Cancer day C-diff A&Ehour 4 wait accommodatAmbulanceAmbulance Checks Overall C-diff accommod Stroke PCT admitted90% CancerQ4 April hourQTD wait as at ion Cat A Cat A Q4 March95th 2012% 2011/12 2012 27-May-12 ationApril 2012 April 2012 2011/12
134 NHS North of England performance overview - June 2012 report
RTT 62 day A&E 4 MixedMixed Sex Sex Health admittedRTT 62Cancer day C-diff A&Ehour 4 wait accommodatAmbulanceAmbulance Checks Overall C-diff accommod Stroke PCT admitted90% CancerQ4 April hourQTD wait as at ion Cat A Cat A Q4 March95th 2012% 2011/12 2012 27-May-12 ationApril 2012 April 2012 2011/12
135 Data thresholds and time periods
Upper threshold Lower threshold Indicator Data period (green) (Amber) Overall score RTT admitted patients seen within 18 Mar 2012 90% weeksEach Red = 0 Amber = 2 Green=3 62Score day cancer of >=20 waiting Green, times >=16 Amber,Q4 2011/12 <16 Red 85% C-diff infections 12/13 YTD at Apr 12 0 z-score 1 z-score Breach rate <1 Mixed Sex accommodation Apr 2012 0 breaches per 1000 FCEs 0 main provider Q1 to date at 27th trusts breaching A&E 4 hour wait May 2012 the 95% threshold Ambulance Cat A (8 mins) Apr 2012 75% 71% Health Checks – eligible patients 80% of plan Q4 2011/12 Meets plan offered an NHS health check level Within 2% of Health Visitors – number of WTE on Meets PCT Mar 2012 PCT cluster ESR cluster target target 136 Scoring
Overall score Each Red = 0 Amber = 2 Green=3
Score of >=20 Green, >=16 Amber, <16 Red
Note – The Health Visitor indicator is not included in the overall score.
137 NHS North of England provider performance overview – June 2012 report
A&E 4 hour 6-wk Rtt admitted 62 day Mixed Sex VTE C-diff wait diagnostic 90% cancer Accommodation assessments Provider Overall April-12 QTD as at 27- wait March-12 Q4 2011/12 April-12 April-12 May-12 March-12
138 NHS North of England provider performance overview – May 2012 report
A&E 4 hour 6-wk Rtt admitted 62 day Mixed Sex VTE C-diff wait diagnostic 90% cancer Accommodation assessments Provider Overall April-12 QTD as at 27- wait March-12 Q4 2011/12 April-12 April-12 May-12 March-12
139 NHS North of England provider performance overview – May 2012 report
A&E 4 hour 6-wk Rtt admitted 62 day Mixed Sex VTE C-diff wait diagnostic 90% cancer Accommodation assessments Provider Overall April-12 QTD as at 27- wait March-12 Q4 2011/12 April-12 April-12 May-12 March-12
140 NHS North of England provider performance overview – May 2012 report
A&E 4 hour 6-wk Rtt admitted 62 day Mixed Sex VTE C-diff wait diagnostic 90% cancer Accommodation assessments Provider Overall April-12 QTD as at 27- wait March-12 Q4 2011/12 April-12 April-12 May-12 March-12
141 Data thresholds and time periods
Upper threshold Lower threshold Indicator Data period (green) (Amber) RTT admitted patients seen within 18 Mar 2012 90% weeks 62 day cancer waiting times Q4 2011/12 85%* C-diff infections 12/13 YTD at Apr 12 0 z-score 1 z-score Breach rate <1 Mixed Sex accommodation Apr 2012 0 breaches per 1000 FCEs Q1 to date as at 27th A&E 4 hour wait 95% May 12 Proportion of adult admissions risk Apr 2012 90% 85% assessed for VTE Diagnostic 6-week waiting times Mar 2012 99% 97%
* The Clatterbridge Cancer Centre and The Christie, as specialist Cancer Service providers, are monitored against an agreed 79% standard, for 62 day cancer waiting times, by the Department of Health and Monitor.
142 Scoring
Overall score Each Red = 0 Amber = 2 Green = 3 White (denominator=0) = 3 RTT (where <50 patients) = 3 Cancer 62wk wait (where <10 patients) = 3
Score of >=20 Green, >=16 Amber, <16 Red
143
Clinical Commissioning Group Meeting Quality Committee Minutes
Paper prepared by: Lynn Travis
Date of paper: April 2012 Subject: Quality Committee Minutes History of paper: The Quality Committee meets regularly. The minutes attached are a summary of the key discussions held at April 5th meeting.
Executive Summary: CCG Board to note the key actions and discussions regarding the following key topics:-
Future of Task Groups Draft Terms of Reference Adult Safeguarding Report Pals update SHMI/HSMR/Link and Francis Report Delivering Dignity Health and Safety Report Quality Dashboards Report
Outcome Required of CCG: To receive the Quality Committee Minutes
For Discussion or Approval: To receive the Minutes
QIPP principles addressed by proposal: Quality
Direct questions to: Lynn Travis
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NHS Tameside & Glossop Draft Quality Committee Minutes
Thursday 5th April 2012
Present:- Lynn Travis (LT) Non-Executive Director (Chair) Naomi Duggan (ND) Director of Public Affairs (part) Peter Denton (PD) LINKS representative Tameside Alan Dow (AD) Quality Lead CCG Heather Harrisson (HH) Head of Quality Improvement Elaine Michel (EM) Interim Director of Public Health Mark Simon (MS) Head of Corporate Governances Louise Roberts (LR) Strategic Project Manager Steve Allinson (SA) Interim Chief Operation Officer (part)
Note taker:- Jayne Somerville (JS) PA, Executive Secretariat
1. Chairs Welcome, Introduction and Apologies
Apologies were received from:-
Graham Curtis, Non-Executive Director Raj Patel, Chair, Shadow Clinical Commissioning Group (RP) Tom Wilson, Locality Director of Commissioning (TW)
2. Minutes of meeting held on 2nd February 2012.
These were agreed as a correct record, subject to a typographical error on page 5 which should read:-
RTT On target for admitted and non-admitted patient care. However, incomplete pathway did not achieve against target.
3. Matters arising:-
Agenda item No.15 – Future of Task Groups HH reported that she had recently received communication from ReGroup, stating 3 proposals of where it might sit going forward. This is currently out for consultation and HH agreed to update as progress is made.
Agenda item No. 4 – Adult Safeguarding Report HH confirmed that the new pharmacy contract has now been received and that Safeguarding is written into one of the two mandatory audits. 1
145
Agenda item 6 – PALS LR had looked into the data as requested by PD. On investigation, it appeared that previously, contacts had been incorrectly presented.
MS updated colleagues that the PCT has taken over the PALS service for the Commissioner from 1st April 2012 and that calls are being redirect from TGH. Chair advised that CCG will continue to ask for complaints information from all its providers.
Agenda item 7 – SHMI/HSMR update EM reported that although an action plan from TFT has been received, she continues to work with them in producing a joint report. Work is ongoing.
Agenda item 8 – LINk Enter and View Once the report is published, a formal response will be sent to LINk.
Agenda item 10 – Francis Report Update HH reported that although a specific formal response had not been received from the SHA, feedback had been included within the CCG Bi-lateral feedback document, and which ranked T&G as “maturing”. It was noted that this is on the agenda for the next GM Quality meeting.
HH reported that the Mid Staffs report is expected May/June. This was raised by herself at the TFT Clinical Governance Accountability Committee meeting, where it was confirmed that on receipt, it will go to their Executive Team to determine what action is required.
HH thanked PD for providing her with a copy of the LINk action plan and his comments following the ‘Enter and View’ visits.
Agenda item 12(i) PD provided an overview following his attendance at the National Quality Board two- event in London. The scenario testing was on new guidance around quality surveillance, which will be published after the Francis Report. This will be aimed at GM level, rather than CCG.
4. Unannounced Commissioner Visit to TFT Report
Received: Unannounced Commissioner visit to TFT report, 26th January 2012
Members received the above report for information and noted its content. HH confirmed that the report had been sent to TFT for review and comments/changes were received. These were acknowledged, however, the report was not amended to incorporate these as they would have significantly changed the content of the report, and what was written was felt to be a true reflection of the visit. The report will shortly become a public document.
PD informed colleagues that the ‘Enter and View’ report, following the visits in January, is likely to be with Commissioners and TFT shortly. The report looks at last year’s
2
146 recommendations and ascertains whether these have been followed up. It was confirmed that the report should be sent to COO.
5. TFT Dear Sirsital
Subsequent to the meeting, an email to ND from a member of the public expressing his concern with TFT was circulated to all Quality Committee members for information, the content of which was noted.
6. TFT Risk Health and Safety Report
Received: TFT Risk Management and Health & Safety Report, Oct-Dec 2011 (Quarter 3)
Members received the above report and noted its content. MS provided an overview of the incidents and commented that it was encouraging that we are now receiving information on STEIS and SUI. He confirmed that SCRs are being reported at Audit and Risk Committee.
AD asked about the RED incidents and would welcome site of these. MS agreed to provide this information. Action: MS
Police incidents were also noted and members considered that more information around these would be helpful. MS confirmed that this information should be available as it will be graded for the National systems. PD commented on a large increase in assault to staff, and is currently keeping an eye on this. Should the figure increase further, he will make enquiries accordingly.
7. “Delivering Dignity” - draft report for consultation
Received: http://www.nhsconfed.org/Documents/dignity.pdf The above hyperlink had been circulated to members ahead of the meeting, in order for them to peruse the report and note its content.
HH reported that consultation commenced on 29/02/12 and finished on 27/03/12; the final document is expected to be published May/June. It was raised at the TFT Clinical Governance Accountability Committee meeting, and commissioners were assured that an action plan will be devised. In respect of nursing homes, it has also been raised with Michelle Rothwell. SA agreed to ensure that conversations are being held and that recommendations are being built within the nursing homes network around this. Action: SA
Chair agreed to ascertain if the document has been shared within Local Authority. Action: LT
8. Quality Dashboards Report
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Received: Quality Dashboard Report as at 16th March 2012.
LR provided a detailed interpretation of the full performance report provided.
Patient Safety
HCAI: MRSA – Exceeded trajectory: 4 Acute, 9 T&G. SHA has second highest number of cases YTD. NHS NW is above the England rate, with NW PCTs reporting 24 cases against a plan of 11 for January. Target for WHE is 8, with 10 cases recorded to date. Next year, it will be a challenging trajectory for TFT with 1 case per annum (and 5 WHE). AD asked how we compare to other areas and LR agreed to obtain benchmarking. Action: LR
C.Diff – In February, T&G were 51 over the YTD trajectory of 115 (79 Acute, 90 Non- acute) and are forecasting 184 (63 over) for year end. Forecasting 10 for April against a target of 15, bringing us back on trajectory. Weekly meetings taking place with regular reviews with the prescribing team being held. Two communication campaigns have now commenced. A lot of work is taking place within T&G, which has result in a great reduction in the number of cases. RCA process has been strengthened and GP practices are responding well. Lynda Lowe, Clinical Governance Manager, assisting with this. PD referred to the team commissioned by GM and reported that 3 sessions had been held on 9/5/12 which was to engage in patients’ lifestyle, interaction and antibiotic use and personal expectations of it. He felt that this would certainly aid the public mind set. EM had received no notification of this taking place and PD agreed to forward her the details. LT also asked how this had been communicated to the public, and whether it had been targeted at a particular area. LR confirmed that T&G campaigns are aimed at the older population and the prescribers. Action: PD
National Guidance has recently been published around 2-stage testing, and it was noted that this is fully implemented within T&G.
Patient Experience TFT have received the results of the adult inpatient survey and this will be published in April 2012.
RTT All targets achieved for this month. Focus needs to be on the Incomplete Pathway – currently under review. Winter access monies have been invested to ensure relevant targets are met. Orthopaedics was noted as a risk within GM.
PALS News Items: there has been an increase following the publication of the LINk report. However, generally, media attention is focused on GM issues. Access to patient card records: to be managed across GM.
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CQUINS Awaiting final figures. Two areas of concern at TFT: End of Life – uptake is not as high – under GP accessing training; Discharge Summaries: Formal monitoring process taking place in accordance with guidance.
Health Outcomes
Ambulance Cat A: North of England to be managed on a locality basis. LR reported that, following a meeting to discuss geographic location, it had been agreed to place a vehicle in Glossop. Target was therefore achieved last week for the first time. Work is taking place with the Community Team as to whether it will be viable to place a paramedic within a GP practice.
Cancer: Provisional figures indicate we will achieved quarter 4 (TFT) achieving 88%. Residents usually 2% lower. Patients are being seen within 7 days (14 day requirement). A lot of work is being undertaken with the introduction of a neck and lump clinic.
Stroke: Previously reports confirmed that we had achieved target in December, however this was as a result of a coding problem, which has been identified on Ward 5. Discussions are now being held as to whether funding will be withheld (£42K).
NHS NoE Key Priority areas It was noted that both Ambulance Cat A and Stroke are significant risks for T&G if we wish to improve performance overall. NHS GM present a monthly PCT scorecard: This is to include VTEs, however it is in early development. The level of risk is unknown as we cannot say if they are high until we receive all the data. EM confirmed that this is now part of JSNA which will provide and an overview of all the NHS public health outcomes. To look at trajectory and reasonable comparison, and to identify vulnerable groups.
Gap analysis – to develop strategy and CCG commissioning intentions. This will indicate where we are making progress and areas for development.
9. Any Other Business
(i) Terms of Reference
Received: Final Draft Terms of reference, April 2010
SA informed colleagues of plans that are underway to establish a Quality and Performance Committee, which will be a sub-committee of the CCG Board. Members were asked to review the Draft Terms of Reference, originally drafted in April 2010, and test that they are happy with the membership and the relationship between Quality and Performance.
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AD commented that reference is made to Quality within the draft Model Constitution, and it is also referred to within Health and Wellbeing; therefore it does have a pivotal role. SA advised that guidelines are expected around June, by which time, we need to be satisfied that we have a suitable document which clearly reflects the health outcomes framework.
Members to provide comments to SA ahead of the next Quality Committee meeting (7th June), in order for the document to be agreed at that meeting. Action: ALL
(ii) Greater Manchester Quality and Safety Committee
HH highlighted an item of note from the last meeting: all CCGs are to have a Quality Strategy. GM is to draft a template for use, which could include what we already have drafted.
(iii) Transfer of PALS
ND noted that the transfer of PALS to TFT has not taken place at the end of March as planned, despite one year’s notice having been given, 6 months of which was formal notice. All outstanding issues have been resolved, leaving the service in the best shape for transfer. It was recognised that the receiving manager of the service had been on leave from work, having only just returned. It was hoped therefore that the transfer may now be able to progress. An external reference group will ensure any amendments made will not be at the detriment of the patients.
ND provided an overview of the TUPE/TCS process and confirmed that providers have a statutory duty to provide a PALS service; however, Healthwatch is the Commissioner. She advised that signposting may be taken on by Healthwatch, but there remains uncertainty as to who will deal with any patient queries. Discussion ensued around the type of contacts to the PALS service. AD commented that some issues are often raised and resolved by PALS, therefore do not go on to be a formal complaint. In his opinion, these contacts should also be recorded. It was confirmed that the sharing of data is now built in as a contractual requirement.
LT asked if this would be a good role for the Scrutiny Panel to look at the adequacy of the complaint reporting and ND supported this view.
ND confirmed that legal advice has been sought and that discussions continue. ND agreed to keep Quality Committee updated accordingly. Action: ND
(iv) Safeguarding – Joint Ofsted CQC Inspection EM reported that, following the recent Joint Ofsted CQC inspection, feedback had been received which ranked the Health input into Safeguarding as “Outstanding”. Looked after children gained a score of “good”. It was also reported at the Children’s Trust Board and for both Learning Disabilities and the Family Health Sector overall, we again achieved “Outstanding”.
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Quality Committee commended Gill Gibson, Muneera Khan and all involved for this high achievement.
(v) Quality Accounts HH reported that both NHS Acute Trusts and Mental Health Trusts are formally required to have their Quality Accounts audited this year and, as commissioners, we have a responsibility to provide a formal response to the Quality Accounts. In view of this, HH has requested a draft Quality Account from TFT via Phil Dylak. Action: HH (vi) Action Plan in response to CQC visit ND reported that good input had been received and which has been fed back to TFT. She asked if it was appropriate to keep this item on the agenda for in the hope that we receive a more formal response, and AD agreed with this. Action: JS - For agenda
Subsequent to the meeting, it was agreed that a letter be sent to Christine Green confirming that we had failed as yet to receive a response to RP’s letter of 29th February, and that we would have to agree to differ regarding the content of the Action Plan. A formal response is still required.
10. Date and time of next meeting
The next meeting is scheduled for Thursday 7th June 2012 at 1pm.
The meeting closed at 2.35 pm
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Clinical Commissioning Group Meeting
(Medicines Management Committee Meeting Minutes)
Paper prepared by: Peter Howarth Head of Medicines Management Date of paper: 28th June 2012 (Final Version not ratified)
Subject: Medicines Management Committee
History of paper: This is an ongoing group previously a sub-group of PEC and now a subgroup of CCG
Executive Summary: To update board members on discussions / decisions made at the Medicines Management Committee meeting held on 28th June 2012
Outcome Required of CCG: Note the content of minutes and actions
For Discussion or Approval: Discussion
QIPP principles addressed Quality by proposal: Innovation Value for money Productivity
Direct questions to: Medicines Management Team
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MEDICINES MANAGEMENT COMMITTEE MEETING HELD 28th JUNE 2012 MEETING ROOM 1, NEW CENTURY HOUSE, DENTON
Present: Katie Heywood (KH) Medicines Management Technician Peter Howarth (PH) Prescribing Advisor, HoMM (Chair) Dorothy Cartwright (DC) Lay Member Mubasher Ali (MA) LPC Representative Jill Pinnington (JP) Strategic Pathway Partnership Lead- end of life/ long term conditions (Tameside and Glossop Community Health Care)
In Attendance: Kate Connor (KC) Medicines Management PA
1. Apologies & Welcome: Apologies for their absence were received from Clare Liptrott, Dr John Doldon, Tony Sivner, Graham Curtis, Lisa McManamon, Heather Palmer, Jane Gaunt, Hannah Simmons, Paul Johnston, Heather Palmer & Jo Kinsley.
2. Chairs Introduction – Peter Howarth PH opened the meeting stating that due to the amount of apologies received the meeting was not quorate and the minutes would be distributed for comments from the rest of the committee for consideration.
3. Declarations of Interest: No declarations of interest were noted.
4. Minutes from previous meeting (May 2012): Accuracy & Actions: The minutes from the previous meeting were accepted as a true recording of the meeting and all actions were carried out.
5. Matters Arising from previous meeting:
(a) Scriptswitch (update): KH updated on the May data noting savings of £33,462 an increase from £22k the previous month. KH said that there were notable savings from Ashton and Hyde. KH said that she had tried to be more specific about the increase but was having difficulties extracting this type of data due to the functioning of ScriptSwitch since the implementation of the new web based design. Concerns were noted about the system reporting inexplicable increases in savings and this will be raised with Scriptswitch at a meeting between them & KH & PH next week.
(b) HCAI (update): Antibiotic APP The new Antibiotic App was launched at TARGET and was received well by most GPs although there was slight criticism from a few GPs. PH said that overall the launch was successful and has brought antibiotic prescribing to the forefront for most prescribers.
PH said that he has received enquiries from the North East and SHA who are keen to learn more details about the App as they are interested in mirroring the work done in T&G.
1 153 Saarah Niazi-Ali has completed the entry form from the HSJ Innovation and Improvement in Healthcare Award, JP suggested that she should speak to Paul Armitage in Communications in connection with completing the form accurately.
C.Diff (update): JP said that the reduction in c.diff cases had been noted and singled out for praise at SHA level.
PH commented on the BBC interview with Dr Raj Patel which was to highlight C.Diff within GM, PH noted that the graphs which were used in the interview were 2 years old and since then current figures revealed that the PCT had reduced cases from 101 down to 45 per 1000 highlighting that a co-ordinated approach with key themes around antibiotic prescribing were beginning to bear fruit. PH said that T&G are below trajectory with predicted figures for June being only 6 cases. PH said that maintaining close monitoring and current programmes of activity is imperative if the PCT is to continue to stay below trajectory.
(c) Meds 6 + 10 GRASP Software & appropriate anticoagulation in AF: PH reported that the audit has been agreed and is not a duplication of QOF AF targets. The two indications set will look at diagnosed AF patients and potential AF patients. The target will go out next month (July) and the practices will have until March 2013 to complete it.
(c) Prescribing LES 2012/13: PH reported that after a few last minute changes the LES 2012/2013 has now been sent out to practices with the 2 antibiotic targets remaining. The LES will now be discussed at the Locality Workshops with the practices being shown the baseline figures.
(e) Guidelines for the Management of Lactose Intolerance & Cows Milk Protein / Allergy in Infants T &G: PH to email Rachel Lawson for an update on the Guidelines for the Management of Lactose Intolerance & Cows Milk Protein / Allergy in Infants Tameside and Glossop.
Action: PH: (f) Lay Membership KC reported that she had spoken to Tracey Turley regarding asking members of the patient participation groups if they would like to apply to become lay representatives at the Medicines Management Committee. Tracey agreed to put the message out at the PPGs (Patient Participation Groups) and feedback accordingly. KC to contact Tracey Turley for an update. Action: KC
(g) Implementing EU Directive on Prevention of Sharps Injuries in the Hospital and Healthcare Sector: Clare Liptrott reported that she has discussed the above with one of the GPs and it has been suggested that this be discussed further at LMC and CCG the briefing note has been forwarded on as appropriate. Following queries from T & G community healthcare Clare would like to reiterate that it is up to each employer to ensure implementation to protect their staff.
(h) Stock Piling Medicines: At the previous MMC JP raised the issue of stockpiling medicines in care homes stating that she had received a report that large quantities of meds were being stockpiled. PH emailed the contact he had been given and is still awaiting a response. 2 154
(i) Inhaler Technique Pharmacy Intervention Service: PH reported that Sara Roscoe attended a meeting to take this forward in a co- ordinated manner across GM. Five GM CCG areas have won £15,000 funding from the DH. Further to this GSK have agreed to support the project on an area wide basis. The project will provide support for correct inhaler technique training for Asthma & COPD patients.
GSK have said that they will fund provision of “Incheck” check device for each patient and to cover training events for pharmacists to carry out correct inhaler technique. The DH funding would cover audit trail and pharmacists carrying out an extra MUR. The MUR process would then be an initial MUR on each patient recruited followed by a 3 month MUR, funded from the £15,000, with a final MUR at the month follow up. The 3 MURs in 6 months are designed to ensure patients retain the learning on how to use their devices effectively. It is anticipated that the study will start early September 12.
6. Prescribing Budget Report: As there was no Finance representation at the meeting Paul Johnston sent an update to PH which reporting that the April budget was £3,097,967 and the April spend totalled at £3,142,128 noting an overspend £44k which Paul reported was not too bad a start to the year.
PH updated on Wolfsen unit data showing comparative figures noting that T & G remain 5th best on cost growth. However there is an increase on items prescribed per head which will need to be looked at. Cost per capita is down which is positive and data from the same time last year shows further reduction. Monitoring of 2 of the bigger spending practices show reduction in spends compared to last year Donneybrook down by 3% and Bedford 9%. PH said that he will have a truer comparison after collating 3months data from this year.
PH added that since Adrian Johnston had left the PCT the Monthly Prescribing Reports and Scorecards would no longer be available at the MMC however, the new Eclipse online system extracts data in a similar way which will be used as a reporting tool.
Donneybrook (update): PH updated on progress at Donneybrook Joanne Kinsley has been in to the practice and looked where improvements could be made. PH noted erratic prescribing of Pregabalin which had previously improved after face to face consultations with patients but this has slipped back. PH suggested that Joanne Kinsley looks into this. Although improvements have been made by the practice PH said that further monitoring around Clopidogrel and Prasugrel, and statins needs to take place. Action: JK:
7. New Agenda Items: 7.a. PIL -Awburn House: PH produced a copy of a new Patient Information Leaflet (PIL) developed by Awburn House Medical in an attempt to reduce their high prescribing of antibiotics. The leaflet explains to patients why it is not always necessary to prescribe antibiotics and if prescribed why shorter doses are given. They have also produced an action plan to be carried out by the practice which includes a survey and review of e-pact data. PH acknowledged that this was a good piece of work and was a positive step forward in their attempt to reduce antibiotic prescribing.
8. Interface Issues: 3 155
JMMC Meeting 15th June Cancelled: Deferred until after next JMMC meeting
9. NICE /NSF/NPSA/GMMMG: No issues were discussed
10. Any Other Business:
(a) Antibiotic Prescribing (Letter Waterloo Medical Practice) Dr Sadik from Waterloo Medical sent a letter to PH noting his intention to address antibiotic prescribing. He has said that he had discussed this with his salaried partner and intends to reduce the number of antibiotics by a more robust attitude to patients returning from the Walk-in Centre. Dr Sadik said that he intends to advertise a checklist of symptoms U.R.T.I. and the viral origin and suggest over the counter medicines before antibiotics are initiated. Dr Sadik said he hopes that this will result in a reduction in the statistics to a more acceptable level.
(b) Antibiotic Prescribing (Droylsden Medical Practice- Dr Butler): PH reported that after several attempts via phone, email and letter with no response PH attended the Droylsden practice in person to address the practice’s poor antibiotic prescribing, as a result Dr Butler has sent in an action plan he has put in place:- Run a search for all antibiotics prescribed over previous 3 months and ensure a reason for prescribing in patient records. Check the patients that are on long term antibiotics and that it should be noted in their records. Ensure all staff is aware that they are trying to reduce antibiotic prescribing and the reasoning behind it so that they are able to pass this on to patients. Patient education i.e. leaflets and general health advice, self help on minor ailments etc. Try to ensure it is an infection and if in doubt relevant lab investigations if relevant i.e. swabs, urine tests etc. If patients requested hospital prescriptions for antibiotics make sure it is recorded in the notes. Search for any patients that have a history of c.diff and check prescribing history and any relevant history i.e. hospital admissions. After a 3 month period re-run any searches and compare results. If prescribing remains high contact Medicines Management Team.
PH acknowledged that this was a positive step forward and that he was pleased with the response from the 6 poorer performing practices he had contacted. PH said that he will monitor the prescribing and in 2 months check to see if there has been improvements. Action:PH:
Meeting closed 3.00pm
Date of Next Meeting: Thursday 19th July 2012 1.15 p.m. – 3.15 pm Boardroom (Meeting room 3) Millennium House **Please note new change in time for future meetings**
4 156 Greater Manchester Clinical Strategy Board
Tuesday 3rd July 2012
Summary Briefing Paper
1. Introduction The purpose of this briefing paper is to outline the agenda items considered and key decisions taken by the GM Clinical Strategy Board at its meeting on Tuesday 3rd July 2012.
Attendance: Raj Patel (Chair) NHS GM/ T&G CCG Terry Atherton NHS GM Tim Dalton ALW CCG Jerry Martin Bury CCG Chris Duffy HMR CCG Mike Eeckelaers Central Manchester CCG Bill Tamkin South Manchester CCG Denis Gizzi Oldham CCG Hamish Stedman Salford CCG Gaynor Mullins Stockport CCG Nigel Guest Trafford CCG Steve Allinson T&G CCG Kate Ardern NHS ALW/DPHs Warren Heppolette NHS GM Leila Williams NHS GM Helen Stapleton NHS GM Anne Talbot NHS GM Jenny Scott Specialist Commissioning
1.1 Apologies: Stephen Liversedge Bolton CCG Martin Whiting North Manchester CCG Ian Wilkinson Oldham CCG Ash Patel Stockport CCG Hilary Garratt NHS GM Claire Yarwood NHS GM Phil Harris NHS GM
In attendance: Sue Gibson (PA to Chair - Minutes) Annette Johnson Salford CCG Jonathan Martin Children, Young People, Families Network Andrew White GMMMG Siobhan Fahey GM HCVS Sean Greer CMFT Dominic Arkwright Sound Doctor
1.2 Minutes and action log of the meeting held on 12 June 2012. The minutes of the Clinical Strategy Board held on 12 June 2012 were accepted as an accurate record.
Board noted that no response had been received to date from CMFT and Pennine Acute following their attendance at the June meeting.
1 157 The action log was reviewed and updated.
1.3 Clinical Strategy Board Forward plan
The Clinical Strategy Board noted the forward plan.
1.4 Matters arising a. Ratification of decision of the June CSB regarding the NWAS items: Summary of NHS 111 procurement strategy for Clusters/CCGs GM Out of Hours Patient Transport Service Proposal for the Future of Ambulance Commissioning The June Clinical Strategy Board considered the 3 items above, but was not quorate when the decisions were taken.
The July Clinical Strategy Board was asked to ratify the decisions taken.
The Clinical Strategy Board: (i) Approved the decision of the June Clinical Strategy Board on the 111 procurement strategy update.
(ii) Approved the decision of the June Clinical Strategy Board for NHS Blackpool to finalise the specification and procurement documentation for the GM Out of Hours patient transport service.
(iii) Approved the decision of the June Clinical Strategy Board on the arrangements for ambulance commissioning and noted that a Board to Board had been arranged between NWAS and NHS GM for week commencing 9 July 2012.
2 Policy and Strategy
2.1 Service Transformation - Work programme update
The Clinical Strategy Board received a paper updating on the progress of the work of the Service Transformation Directorate of NHS GM.
The Board currently receives a report on a monthly basis updating on progress and any issues to be discussed and/or resolved in respect of the following work programmes: Safe and Sustainable Making it Better Healthy Futures New Deal for Trafford Major Trauma QIPP
The Clinical Strategy Board: (i) Noted that the final case for change documentation will be presented to the September Clinical Strategy Board prior to the consideration by the Board of NHS Greater Manchester.
(ii) Noted the development of exemplar health and social care projects through the whole place budgets pilot, generating government interest in the GM reconfiguration agenda, which should help support a discussion with the public on the future of health and social care in GM.
2 158 (iii) Noted that the GM Cancer Summit will take place on 24 and 25 September (venue tbc) and that GM CCGs should be represented.
(iv) Recommended that work is undertaken to understand and clarify the revenue stream for service transformation post April 2013.
(v) Noted that the current understanding is that service transformation will be a function of the National Commissioning Board, but that consideration will need to be given as to how the outcomes of a public consultation on safe and sustainable will be implemented.
(vi) Noted the Service Transformation Portfolio Management Office is reporting monthly to the SHA on the progress of QIPP milestones and that CCGs will need to consider how this function is carried out in the future.
2.2 QIPP Update There was no detailed QIPP update to provide to Board and this item was replaced by a short presentation by Steve Allinson on the progress of the CCG-led work stream to determine the scope and scale, leadership and architecture for collaboration up to and beyond April 2013.
The Clinical Strategy Board noted that following the clarification of the role of the Local Area Teams, the relationship between CCGs and the NCB will become much clearer.
The Clinical Strategy Board: (i) Noted that the case for collaboration has been updated and shared with the GM GP Council.
(ii) Noted that the CCG Chief Operating Officers have mapped and shared the current areas of collaboration and that the next step will be to prioritise where collaboration would deliver the most benefit, and be sustainable, given NCB and CCG operating cost envelopes and then to identify CCG leadership support.
(iii) Agreed that the priority area for focus would be the collaborative contracts (district/tertiary cardiac, neurology, stroke, The Christie), but that it would also be important to review the networks, nascent NCB transformation programmes (S&S, and QIPP) and other strategic CCG alliances.
(iv) Approved the proposal to build the CCG governance framework from existing collaborative governance (building on the CSB partnership agreement)
(v) Approved the next steps to: - Develop the supporting workflow and operational arrangements and clarify what sits with and is funded by the NCB, and what sits with and is funded by CCGs (to be taken forward at weekly operations meeting on 6 July)
- Appraise and agree the preferred option for CCG arrangements for resourcing collaboration including a Portfolio Management Office (to be complete by 20 July)
- Develop a proposal to introduce shadow NCB and CCG operational arrangements as soon as possible (where 2012/13 arrangements are as closely aligned with proposed future arrangements as possible)
2.3 Scope of the Safe and Sustainable Project Board The Clinical Strategy Board received a paper proposing a revision to the scope of the Safe and Sustainable Project Board, which is accountable to the Clinical Strategy Board, 3 159 in order to bring coherence to the NHS GM portfolio of service transformation projects and programmes.
The Clinical Strategy Board: (i) Supported the proposal to revise the scope and function of the Safe and Sustainable Project Board, in order to ensure the coherence to the portfolio of GM service transformation.
(ii) Requested that a detailed governance proposal including Terms of Reference for the revised Board be brought back to the next CSB meeting.
2.4 Role of Networks and their alignment to the delivery of service transformation A verbal update was given to the Clinical Strategy Board on the role of the networks and their alignment to the delivery of service transformation.
The Clinical Strategy Board: (i) Noted that Janet Ratcliffe had been appointed as the Director of Clinical Networks.
(ii) Noted that Clinical Networks will be hosted by National Commissioning Board from April 2013, but that clarity was awaited on the number and type of Networks that would be hosted.
(iii) Noted that the geography for the Clinical Senates had been confirmed; that there would be two for the NW and that GM would be part of one of the Senates with Lancashire and South Cumbria.
2.5 Building a Case for Change – Liver Disease in Greater Manchester The Clinical Strategy Board received a paper describing the issues that are emerging regarding liver disease across GM and identifying the drivers for change. The paper described the processes that have started to build a case for change for the prevention, identification and management of liver disease, which are: building a case for change communicating the case for change.
An invitation was extended to the Clinical Strategy Board and CCG members to an event on 2 October 2nd where this work will be launched.
The Clinical Strategy Board: (i) Noted the case for change for prevention, identification and management of liver disease
(ii) Noted the formation of a Greater Manchester clinical group for Liver Disease
(iii) Supported the attendance of Clinical Strategy Board and CCG members to the event - Building a Case for Change (Liver Disease) on 2 October 2012
(iv) Noted the need to ensure that the work is aligned to local alcohol strategy developments.
2.6 Improved Patient Education for Long Term Conditions The Clinical Strategy Board received a presentation about a web-based application to improve self-care.
4 160 The Clinical Strategy Board: (i) Concluded that it was not the place of the Clinical Strategy Board to endorse a third party web application.
(ii) Noted the work taking place across the country to develop the application and establish the evidence base for the intervention provided.
(iii) Agreed that it is for individual CCGs to consider the application and its use and seek further information from the provider as required.
3 Performance
3.1 GM Contract Steering Group – Contract Review & Process 2012/13 The Clinical Strategy Board received a paper detailing the discussions of the June meeting of the GM Contract Steering Group.
The Clinical Strategy Board: (i) Noted and approved the contents of the paper.
(ii) Approved the work plan as attached at appendix one and noted the actions to be delivered by CCGs.
(iii) Noted the receipt of revised terms of reference for the Contract Steering Group and its subgroups to the August Board meeting.
(iv) Noted that a proposal would be presented to August Board to seek the views of the Board on GM CQUINS for 2013/14 as well as any KPIs that they would like to be included in all contracts 2013/14.
(v) Requested an update on the Christie 62-day KPI penalty proposal following consideration at the August Contract Steering Group and requested that it is made clear that commissioners expect providers to meet the performance standards as set out to ensure that the patient pathway and patient care is not compromised.
(vi) Requested that an update is provided to the August Clinical Strategy Board detailing the collaborative commissioning intentions that were negotiated into all 2012/13 contracts.
3.2 Update on transition of specialised services Jenny Scott provided a verbal update to Board on the transition of Specialised Commissioning.
It was agreed that the Specialised Commissioning Operational Group (SCOG) minutes would be circulated to Clinical Strategy Board for information.
It was noted that work had begun to align specialised commissioning QIPP work programmes with those of the GM Clinical Networks, with particular emphasis on neurosciences.
It has been confirmed that the Local Area Team of the NCB that will host Specialised Commissioning for the NW will be Cheshire, Wirral and Warrington.
5 161 4 Commissioning business
4.1 Financial Impact across Greater Manchester re: the Proposed Treatment of Hepatitis C Infection
A paper was presented to the February 2012 meeting of the GM Clinical Commissioning Board. The paper was presented jointly by GMMMG and the Hepatitis C Treatment Strategy Group, which considered the two newer agents for Hepatitis C which have recently been launched, to develop a coordinated approach to outline those patients that will benefit most. The costs of treatment with these newer agents may be high as they are in addition to current costs and the paper presented options to reduce costs.
The February Clinical Commissioning Board: (i) Approved the Hepatitis C recommendation and treatment pathway proposed in the paper. (ii) Approved the proposed next steps to follow a GM procurement process to ensure the ‘best deal’ on price for Greater Manchester, but requested additional financial scrutiny from Greater Manchester Directors of Finance on the Hepatitis C proposal before Board can endorse movement to procurement.
The paper presented updated Board on the recommendations of the locality Directors of Finance - in summary:
1. To enter into a GM wide drug procurement process to gain the best value for money for the local population in the use of these therapeutics. The GMHCVS will manage the procurement process on behalf of the GM health economy. Decision required regarding how to ensure savings are returned to commissioners and not retained by the Provider.
GM DoFs Response: on the basis that it is highly probable that NICE will approve these treatments, we support entering into a GM wide drug procurement process to gain best value for money for the local population. We would also request GM DoFs are represented on the group leading the procurement process. Effective communications need to be implemented to ensure patient numbers are identified by CCG to enable costs to be tracked appropriately.
2. Endorsement of decisions by GMHCVS and GMMMG is requested to allow early use of the new therapies prior to full endorsement by NICE in May/June 2012.
GM DoFs Response: In any business case presented such as this one , the GM DOFs would recommend that a cost benefits analysis be requested by the lead commissioner in putting forward any commissioning proposal to assess the potential impact, both on finances and service delivery across GM. This analysis would expect to include staff from all areas deemed appropriate including Finance, Business Intelligence, Commissioners, Prescribing, Public Health, and any other relevant functions. Only then can we be assured of a whole system review to anticipate the impact of changes across the whole system e.g. Implementation of new prescribing therapies such as the Hep C ones could lead to a reduction in expected hospital activity later on, both in volume and complexity. This impact needs to be modelled to ensure that informed decisions can be made when agreeing to cap activity etc. It may be worth trying to raise the cap if the future benefits of this proposal increase value for money, or improve quality or the patient experience. Without this information available we feel unable to recommend the early adoption of these therapies.
6 162 3. Decision sought on how the DoF group will be informed of future use of the new HCV therapies.
GM DoFs Response: could this be reported to CCGs and the Network by Acute Trusts in a process similar to the use of high cost PbR excluded drugs for which there is a commissioning minimum dataset included within the 12-13 NHS contract?
The Clinical Strategy Board: (i) Noted the paper
(ii) Approved the recommendation that the conversations to advance the GM wide drug procurement process to gain the best value for money for the local population in the use of these therapeutics should continue.
(iii) Considered recommendations 2 and 3 and were unable to fully endorse the decision taken by the GMHVCS strategy and requested further information in the form of a full commissioning case outlining the progress and next steps for the GM hepatitis C strategy to be presented to a future Board.
(iv) Requested a proposal is presented back to Board to outline how collaborative resources can be prioritised in a fair and effective manner, based on collaboratively agreed priorities.
5 Reports
Thresholds for recommendations from GMMMG to become GM Policy or Guidance: Omacor Challenge Following the presentation to the Clinical Commissioning Board in March, detailing scenarios where the need for a strong GM medicines management position to be agreed is necessary; a live issue has developed for which the view of the Clinical Strategy Board is sought, to inform future decisions on delegated authorities.
The need for GMMMG to make decisions in a timely fashion, while being aware of delegated authority is necessary. The Omacor case study will allow Board to recognise the levels of decision making GMMMG is comfortable with, to allow assurance of delegated limits.
The Clinical Strategy Board: (i) Considered the attached correspondence and supported the letter on Omacor to be sent to Abbott on the basis that this is advice from the GM Medicines Management Group at which all CCGs are represented.
(ii) Provisionally approved the recommendation to reduce inappropriate prescribing of Omacor. CCGs have been given an opportunity to test this recommendation with their local medical management advisors and Clinical Strategy Board will review feedback at the next meeting
(iii) Noted the need to clarify the future governance arrangements for medicines management and requested that this is considered as part of the collaborative work stream.
6. AOB There were no items of any other business tabled.
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The Clinical Strategy Board: (i) Considered the items that had been presented to Board and a number of issues arose that Board members agreed warranted further detailed discussion.
(ii) Agreed that one of the Clinical Strategy Board sessions would be extended to include a development session and Board members would be advised of the date as soon as possible.
Date and time of next meeting
Tuesday 7th August 2012, 9am -12:30pm.
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CLINICAL STRATEGY BOARD AGENDA ITEM NO
Meeting date: 3rd July 2012
REPORT OF: Greater Manchester Medicines Management Group
DATE OF PAPER: 03.07.12
Thresholds for recommendations from GMMMG to SUBJECT: become Greater Manchester Policy or Guidance. Follow up - Omacor Challenge
IN CASE OF QUERY, PLEASE CONTACT Andrew White
PURPOSE OF PAPER: Following the previous paper presented to the CSB in March, laying out scenarios where the need for a strong GM position to be agreed is necessary; a live issue has developed for which CSB’s views are sought, which will inform these decisions on delegated authorities.
The need for GMMMG to make decisions in a timely fashion, while being aware of delegated authority is necessary. This case study will allow CSB to recognise the levels of decision making GMMMG is comfortable with, to allow assurance of delegated limits.
The Clinical Strategy Board is asked to: Consider attached correspondence and agree the Omacor letter for distribution to Abbott. Recognise the need for delegated decision making at GMMMG and agreed suitable levels before reference to CSB, to ensure an appropriately governed GMMMG, with timely response.
Document History DATE VERSION CONSIDERED BY NOTES/DECISION 16/06/12 1 Andrew White
165 GMMMG – Thresholds for Policy and guidance – follow up
GMMMG - Thresholds for Policy and Guidance in Greater Manchester – follow up
Executive Summary
The purpose of this paper is to apprise CSB of a live issue which GMMMG is dealing with on behalf of all GM PCTs/CCGs, which has implications for delegated limits for the approval of: - Policies - Guidance Key to these agreements will be the implementation in localities.
This requires a clinically engaged CCG workforce at each locality, blending the practice, medicines management staff for best effect, lead and driven by strong clinical leadership from CCGs.
1 Background
1.1 The GMMMG though its main group and sub groups make decisions which have strategic impact on Greater Manchester. 1.2 Those recommendations with greatest potential impact are not currently consistently implemented by all localities. 2 Introduction
2.1 GMMMG has QIPP priorities which will be much more likely to be achieved if the GMMMG recommendations are agreed and implemented consistently. 2.2 If a consistent approach to decision making can be agreed this will reduce the risk or postcode prescribing accusations. 2.3 The GMMMG in conjunction with the GM&C Cardiac and Stroke Network has produced guidance on the usage of Omacor® capsules post MI and in Heart failure. The Drug Company marketing Omacor® (Abbott) has challenged the GM approach to post MI usage (see attached letter). 2.4 The revised wording of the IPNTS position statement that has been approved at GMMMG, as has a rebuttal letter to explain the situation (both attached). 2.5 GMMMG is comfortable to make this decision, but given the issues of delegated authority, this was a good opportunity to seek CSB approval and explanation of the issues dealt with at GMMMG. 3 NICE compliance regime
3.1 As CCGs and providers will be strongly monitored on compliance with NICE guidance, this GMMMG position statement is felt by GMMMG to be justifiable, but is felt to be contrary to NICE guidance by the drug company. 3.2 As explained in the rebuttal letter, NICE post MI guidance, in its ‘lifestyle changes’, not drug therapies section, approves of oily fish post MI within dietary intake, and if this is not possible for patients to consider prescribing the use or omega-3 esters fish oil (Omacor®) capsules. Recent high quality evidence, more contemporaneous with Greater Manchester practice is now available, which finds no value of omega-3 fish oil supplementation in reducing any of a number of pre-
166 GMMMG – Thresholds for Policy and guidance – follow up
specified major CV event outcomes (Sudden cardiac death, total mortality, major adverse cerebrovascular and cardiovascular events and revascularisation in survivors). 3.3 As this is argued to be contrary to NICE guidance the approval of CSB to send this statement and retain the revised position statement on the GMMMG website is sought. 6 Current GM usage of Omacor 4.1 Items for 2011/12 and associated costs. Prescriber Name Omacor Total Items 2011/12 Omacor Total Act Cost 2011/12 PCT ASHTON,LEIGH & WIGAN 10,926 £199,667 PCT BOLTON 11,349 £177,004 PCT BURY 5,997 £117,231 PCT HEYWOOD, MIDDLETON & ROCHDALE 9,045 £150,780 PCT MANCHESTER 14,842 £222,940 PCT OLDHAM 8,322 £148,592 PCT SALFORD 9,288 £93,467 PCT STOCKPORT 14,717 £187,701 PCT TAMESIDE & GLOSSOP 10,906 £154,088 PCT TRAFFORD 8,957 £111,606 TOTAL GM 104,349 £1,563,075 4.2 Trend of Omacor® items - 2 PCTs have actively reviewed and stopped patients. Others were awaiting this decsion before commencing clinical reviews. GM usage is above levels expected in NICE costing tools.
4 Implications for future decision making
4.1 The GMMMG is made up of senior pharmaceutical advisers, with currently limited GP input (max 3 attendees at any meeting). The new chair – Nigel Guest, will swell this number, but it is not uncommon for just one GP to attend. As Nigel is a CSB member, he will be able to apprise the CSB of GMMMG business and support items presented to ensure approval, and be able to communicate these back to GMMMG.
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4.2 With the changes to NHS structures and the advent of CCGs and CSS, many of the senior pharmaceutical advisers who currently attend GMMMG as decision makers, will likely be CSS employed from April 2013 and thus can only be able to advise the group, not take decisions. 4.3 There is a need for CCG decision makers to attend GMMMG regularly, having the trust and authority of all GM CCGs. They need to understand clearly the levels of delegated authority entrusted to the group and the thresholds for CSB referral. The need for regular GP attendance is imperative to ensure quorate decisions. 5 Next steps
5.1 To send rebuttal letter to Abbott without further delay. 5.2 To make any terms of reference changes required for GMMMG (or its subgroups) to allow delegated decision making at the appropriate level. 5.3 CSB& GMMMG locality members to consult/agree with CCGs to adopt policies or guidance from GM as CCG policy/guidance as agreed. 5.3 CCGs to agree methods for policies / guidance to go into CCG plans.
7 Recommendations
The Clinical Strategy Board is asked to: Agree the rebuttal letter to Abbott. CCGs to agree to reduce existing inappropriate usage of Omacor. Most new initiations will cease. Discuss policy and guideline thesholds for GM wide approval given this live case study. To ensure CCG representation on GMMMG is maintained and enhanced through the current NHS structural changes.
Andrew White Associate Director of Medicines Management NHS Greater Manchester 28/06/12
168 GMMMG – Thresholds for Policy and guidance – follow up
GREATER MANCHESTER MEDICINES MANAGEMENT GROUP AGENDA ITEM NO 12.3
Meeting date: 6th June 2012
REPORT OF: Interface Prescribing and New Therapies Subgroup
DATE OF PAPER: 6th June 2012
SUBJECT: Omacor® use post MI
IN CASE OF QUERY, PLEASE CONTACT Bhavana Reddy. PURPOSE OF PAPER:
A decision was taken at the Cardiac Formulary Joint Working Group (CFJWG) that Omacor® capsules would not be given to GM patients as other secondary prevention measures would be prioritised over Omacor®. It was noted that this decision was in spite of the recommendation in the NICE guidance that Omacor® may be considered for the post MI patient group.
The IPNTS recommendation on Omacor® was updated in light of the above and after approval at GMMMG was published on the website.
IPNTS has since received a letter from Abbott – Company that manufacturers Omacor® capsules. Attached is a copy of the letter received and the IPNTS response. It was felt that as this decision was taken by the CFJWG it should be co-signed. In addition IPNTS felt GMMMG sign off/approval of the response letter would be useful.
The GMMMG is asked to
Approve the attached response letter from IPNTS to Abbott. Approve the updated Omacor® recommendation
Document History DATE VERSION CONSIDERED BY NOTES/DECISION May 2012 Final IPNTS, Cardiac Network Approved at IPNTS 22.05.12
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Omacor Letter – Final Draft Contact: Bhavana Reddy, Professional Secretary to IPNTS
14th May 2012
Mr Chris Martin Head of Market access Abbott Healthcare Products Ltd Mansbridge Road West End Southampton Hampshire SO18 3JD
Position of Omacor® within the Greater Manchester Health economy
Dear Mr Martin
Thank you for your letter of 13th April 2012, which we received on the 17th of April. This has been shared with the groups mentioned in the letter to obtain their comments. On behalf of the Greater Manchester Medicines Management Group (GMMMG), Interface Prescribing and New Therapies Subgroup (IPNTS) and Greater Manchester and Cheshire Cardiac and stroke network (GMCCSN), please find below the response to your letter.
The treatment of preventable causes of mortality is a key priority for Greater Manchester and much work is ongoing to optimise the care of patients with long term conditions and to prevent the development and progression of these diseases. The work of the GMMMG and GMCCSN supports these aims and also the need to ensure up to date guidance for clinicians, mindful of the Quality, Innovation, Productivity and Prevention (QIPP) challenge.
NICE guidance ® The GMMMG guidance produced regarding Omacor capsules1,2 is clear about the low priority designation of Omega-3 Ethyl esters, given the weak evidence for use. We feel this is justifiable in light of the position of the treatment within the NICE post MI guidance3, given that it is not listed as a drug intervention, but within the section entitled ‘Lifestyle changes after a myocardial infarction (MI)’. It recommends (our highlighting): ‘Patients should be advised to consume at least 7 g of omega 3 fatty acids per week from two to four portions of oily fish. For patients who have had an MI within 3 months and who are not achieving 7 g of omega 3 fatty acids per week, consider providing at least 1
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g daily of omega-3-acid ethyl esters treatment licensed for secondary prevention post MI for up to 4 years.’
NICE does cast doubt on the ‘Clinical and cost effectiveness of omega-3-acid ethyl esters treatment in all patients after an MI’. It suggests that more research is necessary in this area, and highlights the GISSI-P trial4 from 1999, but points out that: ‘other secondary prevention treatment had not been optimised in this trial and the majority of patients had preserved left ventricular function. There is some uncertainty about how much additional benefit patients after acute MI optimally managed for secondary prevention, including those with left ventricular systolic dysfunction, will obtain from the addition of omega-3-acid ethyl esters treatment.’
SMC guidance While SMC guidance is not mandatory in England we do pay regard to it in the absence of NICE ® guidance. This statement5 reagarding Omacor from 2002 approved usage, but with caution to its priority within treatment.. ‘Whilst cost effectiveness appears to be within generally acceptable limits, NHS Boards will recognise that there are now a number of established interventions for this indication. The priority given to this agent needs to be considered alongside the implementation of other effective approaches to secondary prevention of cardiovascular disease, always keeping in mind alternative dietary methods of obtaining fish oil supplementation.’
Recent evidence The GISSI-P4 trial and JELIS6 trial have population characteristics dissimilar to the UK population. If however you ignore this important factor, the major issue remains that in GISSI-P trial’s population was not optimized on what would be considered contemporary secondary prevention therapy. While anti-platelet usage was around current 85% usage, ACE inhibitor (around 40%), beta blocker (around 40%) and cholesterol-lowering drugs (around 30%) and low revascularization rates (15-25%) are not consistent with current practice.
The OMEGA trial7, which was conducted recently in Germany, with a similar northern european population to Greater Manchester population, considered the benefit of DHA and EPA in vigorously treated patients (85% to 95% usage of aspirin, clopidogrel, statins, beta-blockers, and angiotensin-converting enzyme inhibitors). The study had a high level of coronary revascularisation - Acute coronary angiography (93.8%) and acute percutaneous coronary intervention (77.8%) of all patients, contemporaneous with local practice. The arrhythmia event and total mortality rates were only 0.7% and 3.7%, respectively, in the placebo group, indicating the baseline benefits of the vigorous treatment. This trial showed no benefit of EPA/DHA on any of the primary or secondary end points (Sudden cardiac death, total mortality, major adverse cerebrovascular and cardiovascular events and revascularisation in survivors). In conclusion the authors’ state: ‘The results of the OMEGA trial demonstrate a low rate of SCD, total mortality, and major adverse cerebrovascular and cardiovascular events within 1 year of follow-up after guideline-adjusted treatment and secondary prevention of acute myocardial infarction. A further reduction of these low event rates by supplementation with highly purified omega-3 fatty acids remains to be proven and is not supported by the present study’.
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The Circulation journal’s ‘Clinical perspective’ box at the bottom of the paper (i.e. should this change my clinical practice?) states (our highlighting): ‘The OMEGA study demonstrates that current guideline-adjusted therapy of acute myocardial infarction results in a low rate of mortality, nonfatal reinfarction, or stroke during 1 year of follow- up. This low rate of major clinical events appears to be difficult to improve further with additional therapeutic regimen. In particular, an additional beneficial effect of omega-3 fatty acids on mortality and recurrent nonfatal myocardial infarction during follow-up of patients surviving acute myocardial infarction remains to be proven and is not supported by the OMEGA study’.
It’s editorial8 was more candid about the lack of a place for omega-3 fatty acid in current post MI therapy. So where does the OMEGA Trial leave us? First, we should keep eating a heart-healthy diet enriched in fruits and vegetables, whole grains, and lean poultry and fish. We have no need for additional studies of low-dose omega-3 fatty acid therapy in the first few weeks to months after an AMI. If the safety of a higher-dose intervention, eg, 2 to 4 g DHA plus EPA can be demonstrated, such a trial could be informative. Until then, let us continue with the evidence-based risk management strategies on discharge such as statins, an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, aspirin with or without a second antiplatelet drug if indicated, and -blocker.
Cost effectiveness
When considering the place of a therapy the GM health economy must consider if the therapy is one of the best uses of our scarce resources. When all else is equal GM will strive for a given cost to maximise the number of quality adjusted life years gained for patients i.e. if two therapies exist for the same condition and one yields QALYs at a lower cost then that therapy would usually be favoured when considering priorities for spending. In this case other therapies for secondary prevention were prioritised over Omacor® for this patient group.
Specific wording within the recommendation Your comments regarding the specific wording used within the recommendation were noted and some adjustments will be made, however please note this will not change the overall message within the recommendation.
Dietary advice We hope Abbott realises that in the financially constrained environment in which the NHS finds itself, patients are increasingly being advised by the media and health professionals alike that they should take personal responsibility for their health. Lifestyle interventions are the most important changes they can make, which will have the greatest impact on their health, so it is not unreasonable to advise lifestyle changes, as we would do with smoking cessation advice. We do not advocate the use of OTC supplements in GM guidance, and take note of your advice regarding the potential for vitamin A excess consumption.
Omacor® usage in hypertriglyceridaemia We agree that usage is at the discretion of the lipid clinics managing patient with this condition and cessation of treatment should not occur. Hence, inclusion in the GM ‘Do Not Prescribe List’ was not felt to be appropriate due to the potentially small cohort of patients for whom this therapy may be a suitable option.
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Yours Sincerely
Sent electronically, not signed
Dr Julie Higgins Richard Popplewell Deputy Chief Executive & Chair, GMCCSN Director of Commissioning Development NHS Greater Manchester Cluster Chair, GMMMG
Dr Peter Budden Dr Farzin Fath-Ordoubadi, GP Prescribing Lead Consultant Cardiologist, NHS Salford & Chair of GMMMG Central Manchester NHS FT Interface Prescribing and Chair of the Cardiac Formulary Joint & New Therapies Subgroup Working Group.
On behalf of GMMMG and GMCCSN
References
1. GMMMG IPNTS; Omacor® for the secondary prevention of myocardial infarction, 24th January 2012. Accessed at http://www.nyrdtc.nhs.uk/GMMMG/ on 14/5/12. 2. GMMMG IPNTS; Omacor®▼(Omega-3 polyunsaturated fatty acids) in patients with Heart Failure, 27th July 2010. Accessed at http://www.nyrdtc.nhs.uk/GMMMG/ on 14/5/12. 3. NICE Post Myocardial Infarction: Secondary prevention in primary and secondary care for patients following a myocardial infarction Full guideline – Final Version May 2007. Accessed at www.nice.org.uk on 14/5/12. 4. GISSI-Prevenzione Investigators. Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial: Lancet 1999; 354: 447–55 5. Scottish Medicines Consortium. Omega-3-acid ethyl esters for secondary prevention of myocardial infarction. (Omacor). 28 November 2002 Accessed at www.scottishmedicines.org.uk on 14/5/12. 6. Yokoyama M et al, Effects of eicosapentaenoic acid on major coronary events in hypercholesterol-aemic patients (JELIS). Lancet 2007; 369, 1090 – 1098 7. Rauch et al; OMEGA, a Randomized, Placebo-Controlled Trial to Test the Effect of Highly Purified Omega-3 Fatty Acids on Top of Modern Guideline-Adjusted Therapy After Myocardial Infarction. Circulation 2010; 122(21)23: 2152-2159. 8. Eckel RH; The Fish Oil Story Remains Fishy. Circulation. 2010;122:2110-2112;
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24th January 2012 Omacor® capsules
The New Therapies Subgroup discussed the above drug at a meeting on the 24th January 2012 and 22nd May 2012 The recommendation of this subgroup is as follows:*
The New Therapies Subgroup of the GMMMG considered the therapeutic use of Omacor® for the secondary prevention of myocardial infarction.
The group does not recommend the use of Omacor® capsules for the above indication.
The group is aware of the NICE guidance that is available on the use of Omacor® post MI however after re-reviewing the data it was agreed at a joint GMCCSN and GMMMG meeting that Omacor® capsules will not be prioritised for use within Greater Manchester.
The evidence base supporting the recommendation in NICE CG 48 is derived from the GISSI Prevenzione study. The trial was published in 1999 and data collection took place in Italy during the mid to late 90s. During this period, the use of secondary prevention measures widely used today (e.g. statins, aspirin and beta-blockers) was much lower. The much lower use of these alternative secondary prevention measures is likely to have resulted in the trial overestimating the benefits of Omacor®. In addition the trial had very high dietary consumption of fish, fresh vegetables and olive oil, described by many as a ‘Mediterranean diet’ which may also have contributed to the beneficial effects and so transferability of the results to a Greater Manchester population are questionable.
The Joint working group therefore concluded that a diet high in omega-3 fatty acids should be encouraged however other secondary prevention measures would be prioritised over Omacor® for the Greater Manchester population.
Patients should be encouraged to achieve the required level of omega 3 fatty acids by dietary means.
According to set criteria Omacor® capsules was deemed to be a low priority for funding. Review Date July 2013
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* Unless superseded by NICE guidance or substantial and significant new evidence becomes available. ▼ Newly marketed drugs and vaccines are intensively monitored for a minimum of two years, in order to confirm the risk / benefit profile of the product. Healthcare professionals are encouraged to report all suspected adverse drug reactions regardless of the severity of the reaction.
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