NSCCG GOVERNING BOARD – PUBLIC SESSION
Meeting to be held on the 1st July 2015 from 2.00pm until 5.15pm
Council Chambers, Merrial Street, Newcastle, Staffordshire
AGENDA
NO AGENDA ITEM PURPOSE LEAD/S ENC TIME
PROCEDURAL ITEMS 1 Chairs welcome and to receive apologies Dr M Shapley Verbal
2 New Conflicts of interest (available on website) Additions/ Dr M Shapley Verbal Amendments If any member of the Governing Board has any pecuniary interest, in any contract, proposed contract or other matter under consideration at this meeting he/she shall disclose the fact to the Chairman and shall not take part in the consideration or discussion of the matter or vote on any question with respect to it 3 Minutes of the meeting held on Wednesday Approve Dr M Shapley Enclosed 2.00pm th 6 May 4 Matters arising Update Dr M Shapley Enclosed
5 Matters discussed within the Closed Information Dr M Shapley Verbal session 6 Clinical Accountable Officers Report Information Dr J Oxtoby Enclosed 2.10pm
7 EPRR Assurance Mr M Warnes Verbal 2.20pm
8 Equality and Inclusion Assurance Mr M Warnes Verbal 2.30pm
QUALITY AND SAFETY 9 Quality Report Assurance Mrs S Parkin Enclosed 2.40pm
10 Patient Congress Information Prof N Chambers Verbal 3.00pm
STRATEGIC 11 IFR Annual Report Information Mr M Warnes Enclosed 3.10pm
12 Primary Care Research Consortium Annual Information Mrs S Parkin Verbal 3.20pm Report
COMFORT BREAK
PERFORMANCE 13 Integrated Performance and Finance Information Mr I Stoddart/ Enclosed 3.45pm Report Mr M Warnes PARTNER ISSUES 14 Local Authority Information Mr M Samuels Enclosed 4.05pm
GOVERNANCE 15 Audit Committee Report Update Mr N McFadden Enclosed 4.15pm
16 Audit Committee Annual Report Information Mr N McFadden Enclosed 4.25pm
17 Policies for Approval Approve Mrs A Palethorpe Enclosed 4.35pm
18 Terms of Reference Commissioning, Approve Mrs A Palethorpe Enclosed 4.40pm Finance and Performance Committee
QUESTIONS FROM THE PUBLIC 19 Questions from the public --- Dr M Shapley --- 4.45pm
DATE AND TIME OF NEXT MEETING 20 Wednesday 2nd September, Churnet Room, Moorlands House, Stockwell Street, Leek, Staffordshire
Note
The Clinical Chair and Members of the Governing Board will be glad to meet with members of the public and representatives of the press following the meeting to discuss and comment on any agenda items, or other issues which may be of current interest.
Members of the press/media are asked to contact the Communications and Marketing Department, tel: 01782 401048, with any requests for further information and comment
NORTH STAFFORDSHIRE CLINICAL COMMISSIONING GROUP
GOVERNING BOARD - PUBLIC SECTION
Minutes of the meeting held on Wednesday 6th May 2015 Seminar Rooms 2 – 5, Medical Institute, Harsthill, Newcastle, Staffordshire Commencing at 2.00pm
Present: Dr M Shapley Clinical Chair (CHAIR) (MSh) Dr A Bradley Non Executive GP Board Member (ABr) Prof N Chambers Lay Member, Patient Experience (NC) Dr L Hussain Non Executive GP Board Member (LH) Mr J Leslie Interim Director of Finance (Joint) (JL) Mr N McFadden Lay Member, Governance (NMcF) Dr R Page Non Executive GP Board Member (RP) Dr J Oxtoby Clinical Accountable Officer (JO) Dr D Robertson Secondary Care Board Member (DR) Dr E Sutton Clinical Director (ES) Mrs R Trainor Interim Nurse Board Member (RT) Mr M Warnes Chief Operating Officer (MW)
In Attendance: Ms A Dale Communications Team (AD) Mrs L Ellis Board and Committee Manager (LE) Mr L George Head of Quality (representing S Parkin) (LG) Mrs A Palethorpe Head of Governance (AP) Mr R Scott Communications Team (RS) Mr I Stoddart Chief Finance Officer Fylde Wyre CCG (observing) (IS)
Nye Bevan Programme (Board observation) Ms D Bolger Head of Equality & Organisational Development Birmingham Community Health NHS Trust Mr P Winter Head of Performance & Governance, East Staffordshire CCG Mrs L Taylor Quality & Governance Manager, Stoke on Trent CCG
Observers Mrs T Cork Local Pharmaceutical Representative (left at 3.45pm) (TC Mr D Hardy Patient Representative (DH) Dr P Scott LMC Representative (PS) Mr M Samuels Commissioner for Care (arrived at 3.45pm) (MSa)
15 members of the public (13 signed in)
2015.040 Chairs welcome and apologies for absence ACTION MSh welcomed members of the Governing Board and members of the public to the CCG Governing Board meeting, held in public.
MSh welcomed Mrs Rosie Trainor to her first Governing Board meeting, in her capacity as Interim Nurse Board member. He also welcomed Mr Iain Stoddart, new Joint Chief Finance Officer, who will commence in post on the 1st June 2015.
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MSh announced with great sadness that Mr John Leslie will be leaving the CCG at the end of May and thanked him for his excellent work and wished him well for the future. He also announced that Mrs Jan Warren has retired from her position as Nurse Board member and thanked her for her excellent work over the years and wished her well for her retirement.
MSh welcomed colleagues undertaking board observation in relation to the Ney Bevan Programme.
Apologies for absence were received from:
Ms K Owen Senior Planning and Development Manager (KO) Mrs S Parkin Clinical Director (SP) Dr P Unyolo Clinical Director (PU) Dr C Weiner Consultant in Public Health (CW)
A quorum of the Board was present and members had been given formal written notice of this meeting in accordance with the CCG’s constitution.
2015.041 Conflicts of Interest
No additional conflicts of interest were received.
2015.042 Minutes of the last meeting held on the 4th March 2015
The minutes from the meeting held on the 4th March, were approved as an accurate record of the meeting.
2015.043 Matters Arising
In addition to the actions noted on the action tracker, the following progress reports were noted.
Clinical Accountable Officers Report – Integrated Performance/Finance Report
At previous meetings, NC requested that waiting times, which are not part of the constitutional requirements, are included in the Integrated Report. It was confirmed that information is included in the Performance Report, presented at today’s meeting.
Quality Report – Nursing Home Quality Assurance
At the last meeting, member of the media, David Blackhurst referred to the number of 12-hour trolley breaches and asked how long patients had been waiting in the extreme cases. MW confirmed that information was provided and a further update will be provided at today’s meeting.
Public Health
At the last meeting SP referred to the commissioning cycle and requested patient involvement is undertaken where necessary and stated that the CCG would be supportive. In the absence of CW it was agreed to keep this issue on the action CW tracker and request an update at the next meeting.
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Local Authority
At the last meeting, member of the public, Bas Pickering expressed concern regarding the lack of information in relation to care in the community and requested regular update reports are presented within the Local Authority report. It was confirmed that regular updates will be provided within the Local Authority report.
Public Health
Member of the public, Trudie McGuiness referred to early intervention and asked what plans are in place for teenagers. Prior to the meeting CW advised that he has tried to make contact with Trudie McGuiness, with no success and agreed to CW continue to make contact.
2015.044 Matters Discussed within the Closed Session
MSh advised that the Governing Board in closed session discussed the financial position, quality and safety, cancer and end of life.
2015.045 Clinical Accountable Officers Report
JO presented the Clinical Accountable Officers report and advised that there are ongoing pressures within the urgent care system. She added that progress has been made within the current contracting round and announced that the contract for Combined Healthcare NHS Trust (CHC) and Staffordshire and Stoke on Trent Partnership Trust (SSOTP) have both being signed and it is anticipated that the contract for the University Hospital of North Midlands (UHNM) will be signed by the end of this week.
JO advised that the financial position remains challenging and advised that the CCG is intending to declare an in-year deficit and stated that JL will provide an update later in the meeting. She welcomed IS, who will commence in post as from the 1st June as the Joint Chief Finance Officer and thanked JL for his hard work in leading the CCG’s financial management and wished him well.
JO took the opportunity to thank front line staff in primary, community and hospital settings for their continued dedication and hard work. She advised that the local health economy continues to experience significant pressure in Accident and Emergency (A&E) and as a result the health economy continues to fail to achieve the 4 hour wait time in A&E. She advised that there were four 12 hour trolley breaches at the end of April, with a further two reported as of today (6th May). Root cause analyses (RCA’s) are being undertaken and performance continues to be a major priority for the CCG.
JO advised that both North Staffordshire and Stoke on Trent CCG continue to work collaboratively with UHNM and SSOTP to ensure that the service improvements which are commissioned continue to improve.
JO advised that the CCGs submission for delegated authority for primary care co- commissioning was not supported, however the CCG is proceeding to joint co- commissioning with NHS England as from June and work is being undertaken, led by ES with general practices to explore new models of care.
JO stated that collaborative working with Stoke on Trent CCG continues, in addition strong links have been made with the other CCGs in Staffordshire and Pan Staffordshire working continues and a Joint Transformation Board
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has been established, as there are many services which can be commissioned collaboratively across Staffordshire.
It was noted that the CCG continues to work closely with Staffordshire County Council’s Public Health team and discussions continue regarding future arrangements, cover and support.
JO welcomed Mrs Rosie Trainor, Interim Nurse Board member, who has replaced Mrs Jan Warren and advised that the CCG has successfully recruited a full time Director of Nursing, who will work across both CCGs.
JO announced that she has taken the decision to resign and step down from the CCG to peruse her career in general practice.
On behalf of the LMC, PS expressed sadness for the resignation of JO and wished her well.
PS referred to joint commissioning and asked if both CCGs are applying for level 2 and asked how confident are the CCGs in gaining level 2. JO stated that both CCGs have received assurance from NHS England that both applications will be welcomed and ES confirmed that the CCGs are in the process of completing the applications. She advised that a Commissioning Board has been established with representatives from all CCGs and it is intended that North Staffordshire and Stoke on Trent CCG’s will have membership on this Board.
Member of the public Wenslie Naylon asked how she would come across the better care fund (BCF) and what does it mean to the general public. MW stated that the BCF is about integrating health and social care services, with the aim to reduce the number of admissions to hospital. He advised that all CCGs within Staffordshire have signed up to the BCF and a proposal has been approved and work continues with the Local Authority. It was noted that a whole range of services are included, with the intention to keep patients at home and includes domiciliary care, as evidence highlights that patients recover quicker at home.
MSh stated that he was sad to receive the resignation of JO and on behalf of the Governing Board expressed thanks for her continued commitment to the CCG and to the population of North Staffordshire, her continued support during the winter period and in reaching financial balance.
Members of the Governing Board received and noted the report.
2015.046 Emergency, Preparedness, Resilience and Response (EPRR)
MW advised that there is no further update since the last meeting and assured the Governing Board the CCG continues to achieve all core competencies.
Members of the Governing Board noted the update.
2015.047 Quality Report
In the absence of SP, ES presented the Quality Report and advised that a Joint Quality Committee has been established with Stoke-on-Trent CCG which met for the first time in April. It was noted that North Staffordshire CCG’s Quality Committee Annual Report 2014/15 was presented to the Audit Committee to provide assurance that it has fulfilled its delegated responsibilities.
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ES provided assurance that the Clinical Quality Review Meetings are held with all main providers, with representation from both CCGs and stated that the meetings provide challenge and seek assurance from providers regarding the quality of services commissioned by the CCGs.
ES advised that the CCG had breached it 2014/15 annual tolerance for C-Difficile, 70 cases reported against a cumulative tolerance of 55, and 1 MRSA against a tolerance of zero (stated as 2 MRSA cases in the Integrated Performance Report, which is incorrect).
It was noted that the CCGs annual C-Difficile objective for 2015/16 has been set at 61 by NHS England.
NMcF noted that of the C-Difficile cases, 40 were community acquired cases, 17 have been identified as unavoidable and the remaining cases are still under investigation and asked why there is a delay. LG provided assurance that each case is investigated and advised that although the cases are being investigated as they occur they have not yet have been formally signed off or challenged by the CCG’s Infection Prevention & Control Group which meets on a quarterly basis. MSh expressed disappointment that the target was not achieved and asked what GPs can do to reduce the number of cases. ES stated that discussions have taken place with the Lead Nurse – Infection Prevention & Control and Medicines Optimisation team to look at possible interventions and the use of antibiotics is also been discussed. RT stated that in relation to C-Difficile, basic hand hygiene is the best preventable measure. She referred to the one MRSA case which was deemed avoidable and stated that it is essential to ensure that improvements are being made. LG referred to the CCG’s Infection Prevention & Control Group and stated that there is wide representation, including both CCGs, Public Health, Medicines Optimisation and provider representation. The group explores lessons which can be learnt from across the whole health economy and added that resources for 2015/16 will focus on preventative measure, in addition a strategy is being developed.
NC stated that behind the Quality Report, there is a whole amount of work being undertaken and assured members that the Quality Committee receives all the detail SP in full, applying challenge and scrutiny where necessary. She added that the report presented today, focuses on two of the three dimensions of quality and does not include any reference regarding clinical effectiveness and requested that this is included in the next report.
Member of the public, Ian Syme referred to the Friends and Family Test (FFT) in which it highlights the high number of staff within SSOTP who would not recommend working there and asked what dialogue the CCG has with SSOPT and highlighted there are issues in relation to staff morale. LG stated that the information reported in quarter three has been taken from the NHS Staff Survey 2014 results which provides national comparable data against peer Trusts which highlights that SSOTP are around the average for community trusts. He added that it is important to use multiple sources and listen directly to staff and there are ongoing discussions with colleagues from SSOTP and a report will be presented to the next Joint Quality Committee and the next Governing Board. He added that data for quarter four has not been published by NHS England, so cannot advise if there has been any improvement.
Member of the public, Ian Syme raised concern regarding community staffing, in particular staff morale. MSh stated that the CCG has the same concerns and advised that concerns have been raised with the provider organisation.
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Member of the public Wenslie Naylon referred to medical students wearing uniforms outside of the clinical setting, for example travelling on public transport and asked what the CCGs observation is. RT stated that the issue is more in relation to public perception and added that all organisations have robust policies in place, many of which have changed and for many this has created a number of logistic issues, for example providing adequate changing and laundry facilities.
Member of the public, Joan Buck referred to the FFT for UHNM in which it highlights 61% would recommend it as a place of work and asked how many people participated in the survey. LG stated that the process of the staff FFT is undertaken throughout the year and is reported alphabetically. Joan Buck voiced her concern regarding anonymity for staff. DR stated in Birmingham and Sandwell, the survey is divided into clinical group and all the information is held by a third party company and assured members that personal information is not shared.
Members of the Governing Board received and noted the report.
2015.048 Patient Congress
NC provided a verbal update following the last meeting of the Patient Congress. She advised that the Patient Congress Brand is currently under development in preparation for the forthcoming North Staffordshire Annual General Meeting, which is scheduled for the 24th June 2015.
It was noted that members of the Congress provided updates from their local PPG groups and it was highlighted that Biddulph Valley Practice now has an established PPG.
NC advised that PU attended the meeting and informed members that the diagnosis rate of dementia in primary care has increased to 62% and GP practices continue to improve their knowledge of dementia, diagnosis and treatment.
NC announced that there will be a Joint Patient Congress at the beginning of July with both North Staffordshire and Stoke CCGs.
NC presented the Citizens Jury Report, which focuses on diabetes and stated that the CCG endorsed an approach to establish a Citizens Jury, with the aim to make recommendations in relation to the commissioning of services. She added that nine members of the congress were involved and either had diabetes themselves or had an interest in diabetes. She also advised that the recommendations have been arrived at from a lay perspective, following the collation of evidence, discussions with patients and healthcare professionals and have not been tested for viability or costed, or compliance against NICE guidelines.
It was noted that 15 recommendations have been made, one of which relates to the provision of insulin pumps for type one diabetes and if the appropriate level of pumps is being commissioned. One of the recommendations is to raise public awareness of the diabetes and work will be undertaken with PPGs to promote the symptoms. Other recommendations include the need to establish a formal relationship between primary care and secondary care diabetes specialists.
NC stated that the Jury were delighted with the level of support from the CCG and healthcare professions. She added that members of the Jury are now empowered and have requested that the recommendations are received and actioned upon and it was noted that a meeting has been arranged, in which MW has been invited.
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MSh congratulated the Jury and asked NC if there are any barriers to prevent the recommendations being implemented. NC advised that the Jury have a realistic view regarding what can be afforded and the feasibility. She added that the Jury has capacity to follow through on the recommendations.
JO thanked members of the Jury and stated that the recommendations will be reviewed and will follow due process. She added that there are some “quick wins” and feedback will be part of the contracting process, as there is a need to establish how secondary care supports the recommendations.
ABr stated that a small survey sample size has been used and asked if there would be an opportunity to roll out the survey to gain the views of a bigger sample size. NC agreed that the sample size was small and stated that Diabetes UK was also undertaking a survey at the same time.
MSh stated there are other long term conditions, for example COPD (chronic obstructive pulmonary disease) which may benefit from a citizen led inquiry. NC stated that members of the Patient Congress have reviewed the report and have suggested that the model of care is used for other conditions and the Patient Congress will consider this. She added that the Director of Patient Experience for NHS England was in attendance at the Patient Congress meeting, in which this was discussed.
PS praised members of the Jury, however, stated that there was scope to be more ambitious and stated that there are additional models of care available, for example, GP Federation. He added that many recommendations require interface and investment.
MW congratulated the Jury on an excellent piece of work and stated that the recommendations will be included to shape the commissioning intentions. However, he stated that there are resource implications. He added that he met with the Director of Patient Experience and discussed orthotics and it was noted that nationally North Staffordshire has been identified as an area of good practice.
LH asked if the Jury just concentrated on North Staffordshire or did it include Stoke. NC confirmed it was North Staffordshire specific, however there are two members of the Jury who are members of the Stoke CCG Patient Congress.
LH requested that the recommendations are shared with the Diabetes Clinical Network. NC advised that colleagues from Diabetes Clinical Network have been involved, however advised that the report has not been shared with them.
DR declared an interest, as he is a secondary care diabetes specialist in another health economy and stated that undertaking projects of this nature is a good opportunity to link in with health economies to establish what other pieces of work have been undertaken.
MSh asked if all GP practices in North Staffordshire have a PPG. DH stated that not all practices haven an active PPG, however, stated that assistance has been offered to practices. NC confirmed that this has been noted and additional focus will be given. ES stated that having a PPG is part of the GP contract, however, some groups are more active than others.
Member of the public, Alice Pritchard referred to page five of the report, in particular recommendation one, to raise public awareness and stated that inviting speakers is not reaching out to the general population and suggested getting the local
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Universities involved, as they have an active volunteering section of younger people, a group that is often difficult to engage with on health issues. NC requested to NC speak to Alice Pritchard during the comfort break and agreed that it is essential to involve the generation of the future.
Members of the Governing Board received and noted the report and noted the recommendations contained with the report.
2015.049 ISOP Annual Review
MW presented the Integrated Strategy and Operating Plan (ISOP) and advised that the ISOP contains four goals and 18 outcomes. He added that the CCG set an ambitious target to be achieved by 2015/16 and advised that good progress has been made for the majority of targets, however, in some areas progress has been out of the immediate control of the CCG and in some cases the CCG has not been able to influence.
It was noted that the CCG has reduced the rate of infant mortality for the past three years.
NC noted that the CCG has achieved the overall increase in healthy life expectancy and asked if this is in line with the national picture or is it due to the quality of health care and asked if the CCG is an outlier. MW advised that there is a downward trajectory and confirmed that the CCG is delivering on the target and stated that the CCG are in the top performers nationally.
MSh stated that increased longevity may result in an increase in long term conditions. LH stated that there is a suggestion that this is the case. DR stated that there is a need to recognise the frail and elder population, which may not sit in a specific area.
LH referred to smoking cessation, which is an essential service and lies with public health and asked what is Public Health doing as there are different services being provided and stated that he believed the service should be provided within all GP practices. He referred to the difficulty being experienced in relation to trying to engage with public health colleagues. JO acknowledged the differences between practices and stated that practices wishing to offer the services are supported.
PS stated that the smoking cessation service is to be de-commissioned as from the 1st June and the service will be pharmacy based. He expressed his disappointment in relation to the lack of engagement of public health colleagues. IS stated that the CCG has entered a memorandum of understanding with Public Health, via the Better Care Fund. JO advised that she is in discussion with Public Health colleagues and JO agreed to raise this issue.
ABr asked when the strategies will be reviewed again. MW stated that this will be undertaken over the next few months and added that all targets will be refreshed.
Members of the Governing Board received and noted the report and noted the progress over the last 12 month against the 18 outcomes set out in the ISOP.
2015.050 Financial Outturn Position 2014/15
JL presented the report and advised that the CCG has improved its final outturn position for 2014/15 to £1.326 million surplus, which is £23,000 above the original planned control total surplus, which is a significant improvement from the reported
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outturn position at month 11. He thanked staff for their hard work and assistance in achieving financial balance at year end.
It was noted that the CCG will benefit from the surplus for 2015/16 which will be built upon.
LH referred to the past challenges with UHNM and asked if there will be future challenges. JL advised that the current challenges are in relation to the number of patients waiting outside the 18 week target. He added that colleagues are working with UHNM, as this has created financial difficulties.
Member of public, Ian Symes stated that he is aware that some of the penalties have been waved for some providers and stated that in 2015/16 it will become mandatory to apply penalties where necessary. He stated that UHNM have set funding aside and he understood that the CCG will have no authority not to implement penalties. JL confirmed that this will form part of the standard NHS contract for 2015/16 and stated that CCGs have no flexibility, national guidance will be followed and penalties will be applied where appropriate and re-invested.
Members of the Governing Board received and noted the report.
2015.051 Financial plan 2015/16
JL provided a verbal update, apologising of there not being a paper, but advised that there is an ever changing position and colleagues are in the process of implementing a significant transformation programme, which includes the step up/step down initiative.
JL advised that a financial plan was submitted on the 7th April, in which a number of cost pressures were highlighted, following submission colleagues have been working hard to review the cost profiles to achieve a break even position. However it has been identified that the CCG will not achieve a break even position and referred to the NHS Financial Targets, one of which is to create a surplus and for North Staffordshire this would be in the region of £2-3 million and this would not be likely to be achieved.
JL advised that there are a number of pressures facing the CCG and colleagues may have to approach NHS England to seek approve to operate with a deficit plan, as the cost pressures are significant and this would require formal approval, following which a final financial plan would be required to be submitted on the 14th May.
PS asked where the surplus has gone from the past two years. JL advised that they have been reinvested back into the CCG.
Member of the public, Joan Buck referred to the provider organisations and penalties and referred to the out of hours service, which is not performing and asked if any penalties are being applied. JL advised that the current contract is activity based, therefore they are only paid for the activity they undertake, therefore penalties cannot be applied
The Governing Board discussed the plan and whilst acknowledging the final submission date of the 14th May it was agreed that the Governing Board should have final sight of the plan for approval, prior to its submission and an extraordinary Board meeting to be convened on the 12th May 2015 for approval of plan.
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Members of the Governing Board noted the update and the requirement for an Extra-Ordinary Governing Board meeting to be held.
2015.052 Planning Submission 2015/16
MW presented the report and advised that as part of the planning round for 2015/16, CCGs were asked to provide an operating plan, which would confirm the CCGs approach to the delivery of the NHS Constitution and the NHS Mandate. He added that a “plan on a page” has been developed and the final plan will be signed off and submitted by the 14th May.
NC asked how the CCG can work more collaboratively with the voluntary sector. MW stated that the CCG has signed up to the Staffordshire Compact, however, there are limited resources and colleagues are in the process of reviewing third sector contracts and this will be undertaken on a Staffordshire wide basis. He added that one of the areas colleagues are focusing on is the role of the third sector and links with the Local Authority.
NMcF referred to the report, in particular the A&E target and raised concern regarding the continued underachievement. MW stated that 95% is the constitutional target and it’s the CCGs ambition to achieve this.
MSh referred to the report, in particular the prioritisation work and asked if there is a timetable and asked how the CCG is progressing. MW stated that a Steering Group has been established and added that all CCGs are supported by the Commissioning Support Unit (CSU). He advised that colleagues have taken the Oregon methodology, which is evidence based. Colleagues are looking at a number of areas which will inform commissioning intentions and will be presented to a future Commissioning, Finance and Performance Committee, and then presented to the Governing Board. It was noted that areas will be reviewed in June and will be presented to the Clinical Priorities Advisory Group (CPAG) if it is anticipated that there will be a major service change.
IS stated that evaluating health plans, provides an early insight as to where funding should be re-invested.
NC referred to the robust engagement and highlighted the value of undertaking engagement. MW stated that service users are welcomed and stated that this will be undertaken on a Staffordshire wide basis. DR added that CPAG has lay representation.
DH referred to the patient and public engagement and stated that the report highlights that there are 31 out of 33 practices that have an active PPG, which is incorrect. MW stated that the information was taken from the ISOP and stated that it MW&DH would be helpful to have the correct information. DH and MW agreed to liaise outside of the meeting.
Member of the public, Joan Buck asked if there is patient representation on CPAG and does this cover the whole of the area. DR confirmed that CPAG has geographical coverage. RP confirmed that there adequate representation, including Healthwatch representation.
Members of the Governing Board received the report and noted the key themes from the “five year forward view” planning guidance and approved the Operating Plan for 2015/16.
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2015.053 Integrated Performance Report
MW presented the integrated Performance Report and advised that the CCG failed the 18 weeks RTT admitted targets in February and are expecting to fail during March and April. He added that February performance stands at 84.4% and admitted targets across all specialties have been impacted by the significant number of cancelled operations in January and the rise in the inpatient backlog. In addition, incomplete pathways performance has been affected by the rising backlog and North Staffordshire CCG achieved 90.0% against the 92% target in February.
MW advised that diagnostic wait targets are below trajectory, mainly due to the delay in undertaking diagnostic tests, particularly MRI appointments.
It was noted that the CCG and UHMN have failed the A&E waiting time indicator throughout the financial year and there have been a significant number of 12 hour trolley breaches.
MW referred to the cancer waits, in particular 31 day wait and advised that a small number of procedures have been cancelled, however it was noted that performance year to date remains on target. He referred to 62 day wait and stated that performance continues to be below target and an action plan has been developed and plans are in place to penalise UHNM via the contracting route.
JO presented the Ambulance performance against Red 1 and 2 targets which has not met NHS Constitution standards and advised that a remedial action plan is to be agreed for Staffordshire.
JO advised that the outpatient backlog continues to increase and the CCG is working with UHNM and funding has been established to improve the position. MW added that there is a contract to clear the backlog.
NC referred to the shift in activity from see and convey to see and treat of 2% and asked how high can this go. JO stated that the CCG has been benchmarked against this and stated that there are other ambulance trusts across the country who are higher and added that the CCG continues to work with colleagues from WMAS in reviewing the metric.
NC referred to the backlog position and stated that this is not acceptable and advised that at the Board to Board meeting with UNHM, ABr offered to be involved in supporting them to work on the resolution of the backlog and offered to link with clinical teams. ABr confirmed that as of to date no contact has been made from UHNM. JO agreed to speak to colleagues are UHNM.
ABr stated that the data highlights that the capacity hub is still not fully performing to capacity and asked what measures are in place to get providers to use the facility. MW stated that it was intended that the hub took calls from UHNM, GPs, WMAS and reported that GP calls are below plan and stated that there is an ongoing communication with GPs.
MSh stated that there is a need to communicate the most appropriate mechanisms to GPs. ES confirmed that communications have been sent to all GPs. She advised that the team are currently looking at better ways of communicating with GPs.
MSh referred to the 62 day cancer target and asked where are the blocks in the system and asked if there is an action plan in place.
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MW stated that there is an issue with capacity in the system, especially imaging and histology. He added that UHNM are trying to minimise this.
MSh requested that the Integrated Performance Report is aligned with the Financial Plan.
LH noted the delays in diagnostics and asked if this is secondary care or GPs. MW confirmed that it is all providers and progress is being made.
LH referred to the outpatient backlog and noted that additional funding has been allocated and asked if UHNM will be paid twice. MW assured members that they will be paid once and it is non-recurrent activity to clear the backlog.
RP referred to the big ticket initiatives, in particular urgent care and asked why some areas are highlighted as zero. MW stated that there is an issue with regard to data collection and reporting of the data and added that issues have been raised and challenged, as there is a need to demonstrate the impact of the big tickets.
PS referred to the ambulance performance and stated that it is the default of paramedics to leave patients at home, requesting that they seek assistance from their GP and stated that colleagues should consider the impact of this and the impact on secondary care, which is already under resourced.
LH stated that patients can remain at home and be referred into the capacity hub, as it has been highlighted that this service is being underutilised. JO agreed to look into JO the issue raised.
Members of the Governing Board received and noted the report.
2015.054 Local Authority
MSa presented the report and referred to the Dementia Centres of Excellence and advised that the contract has been signed and services have transferred over to the new provider. He added that work is underway focusing on the new facilities that will replace exiting sites. He stated that activity has commenced at the Kniveden Hall site in Leek and colleagues are engaging with the District Council and progress is being made.
MSa referred to the integrated carers hub and stated that colleagues are working with the CCGs to modernise the care. The procurement exercise has commenced and it is anticipated that a final decision will be made in June with the new scheme becoming operational from October.
MSa advised that the City Council are working with SSOTP and have reached a three year agreement (section75) and stated that the first three years will focus on the structural process and will form the basis for service integration. He added that plans will be aligned to the better care fund, which aims to provide protection for adult social care. MSa advised that data is being collected from various sources to enable a clear picture in relation to the adult social care system. MSh asked if the plans will identify any trends or triggers in relation to the data. MSa stated that targets are being negotiated with CCGs. MSh requested that non-elective admissions for North Staffordshire are included. MSa agreed. JO advised that the data is also presented at the System Resilience Group.
NSCCG - Board - PUBLIC 6th May 2015 Page 12 of 14 Approval of minutes - Initital of Chair - ……………. ACTION
ABr referred to performance indicators and asked if there are any national benchmarks. MSa stated that there are for some indicators and stated that as part of the process colleagues will look to ensure that all indicators are benchmarked.
MSh advised that the CCG have had discussions with SSOTP regarding the step up/step down initiative and the ability to deliver, as one of the main areas of concern is domiciliary care. It was noted there are ongoing discussions regarding domiciliary care and the links to the better care fund.
Member of the public, Joan Buck referred to the signed contract with SSOTP and the three year agreement and raised concerns that they are not being achieved in all areas. MSa stated that the three year contract is part of the overall 10 year contract, which has a three year break clause and stated that the funding of nursing is the responsibility of the CCG, not the responsibility of the local authority. Joan Buck asked if there will be penalties. MSa confirmed that there are levers in place.
Members of the Governing Board received and noted the update.
2015.055 Audit Committee Report
NMcF presented the Audit Committee report, which highlights the matters discussed at the Audit Committee held on the 22nd April. Key highlights included the receiving of the SIRO report and head of internal audit opinion.
Members of the Governing Board noted the update.
2015.056 Policies for approval
AP presented the report and advised that the Risk Stratification Policy was received by the Commissioning, Finance and Performance Committee and requested formal approval from the Governing Board. She also requested that the Governing Board formally approve the Safeguarding Policy and Managing Allegations against Staff Policy, which has been approved at the Quality Committee.
Members of the Governing Board approved both policies.
2015.057 Any Other Business
No issues raised.
2015.058 To receive additional questions from the members of the public
MSh read out a written question from PPG Chair Ian Robbins:
“When will the funding for phlebotomy services in The Staffordshire Moorlands, that existed prior to the inception of this C.C.G., be restored in order that patients living in this mainly rural area will not continue to be disadvantaged?”
JO advised that there was a review of the phlebotomy services and agreed to JO establish the details and provide a response to Ian Robbins.
Dave Blackhurst referred to the step up programme and in particular engagement, and asked what the time table for public consultation is. MW advised that there have been a number of public consultation events. He added that phase one is focusing on the implementation of the model of care, which has not yet been concluded.
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Dave Blackhurst asked if there will be a consultation document. MW stated that formal consultation has been undertaken and stated if the Overview and Scrutiny Committee requested that formal consultation is required, this will be undertaken.
Ian Symes stated of the 600 services (Oregon), the CCG is reviewing 110 and noted discussions regarding Pan Staffordshire and asked does this include Stoke. MW stated that 110 is the threshold and work is being undertaken on a Pan Staffordshire wide basis, to avoid duplication, which does include Stoke.
Ian Symes noted the potential change in community hospitals and the potential for provider trusts and asked if it will affect more than SSOTP. JO stated that there is a system working group, which will ensure public consultation is undertaken where necessary and will include all providers, not just SSOTP.
Ian Symes referred to the report published by CQC on SSOTP in November and asked if the report has been shared with the CCG and what action has been taken. LG stated that the CQC did not share the report with the CCG, but the relevant trust has and confirmed that there is an action plan in place, which has been shared with all relevant parties.
Joan Buck referred to the integrated carers hub and asked if it is going to be 24/7 and also asked if there is advocacy service provided within the hub. MSa stated that he does not have the detail and stated that the service specification has been developed and the service is currently out to tender and is available in the public domain.
2015.059 Date and time of next meeting
The next meeting will take place on Wednesday 1st July, Council Chambers, Newcastle Borough Council, Merrial Street, Newcastle, Staffordshire
All parties should note that the minutes of the meeting are for record purposes only. Any action required should be noted by the parties concerned during the course of the meeting and action carried out promptly without waiting for the issue of the minutes
These minutes are signed as being a true record of the meeting
Signed:………………………………………………………………
Position:……………………………… Date:……………………
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Meeting Action Tracker - CCG Board – HELD IN PUBLIC
Actions from the meeting held on the 6th May, update to be provided at the meeting scheduled on the 1st July
Item Action Lead Progress
Matters Arising Public Health
At the last meeting SP referred to the CW commissioning cycle and requested patient involvement is undertaken where necessary and stated that the CCG would be supportive. In the absence of CW it was agreed to keep this issue on the action tracker and request an update at the next meeting.
Member of the public, Trudie McGuiness CW referred to early intervention and asked what plans are in place for teenagers. Prior to the meeting CW advised that he has tried to make contact with Trudie McGuiness, with no success and agreed to continue to make contact.
Quality Report The report presented, focuses on two of the SP three dimensions of quality, NC requested that reference is made regarding clinical effectiveness and requested that this is included in the next report.
Patient Congress Member of the public, Alice Pritchard referred NC to public awareness and NC requested to speak to Alice Pritchard outside of the meeting
ISOP Annual Review PS stated that the smoking cessation service is JO Communication sent to Public Health by JO on the 8th to be de-commissioned as from the 1st June May and the service will be pharmacy based. JO advised that she is in discussion with Public There are a number of Public Health programmes of Health colleagues and agreed to raise this activity that are being commissioned and smoking is issue. one of them. Formal response awaited.
Planning Submission DH referred to the patient and public DH&MW 2015/16 engagement and stated that the report highlights that there are 31 out of 33 practices that have an active PPG, which is incorrect. MW stated that the information was taken from the ISOP and stated that it would be helpful to have the correct information. DH and MW agreed to liaise outside of the meeting.
Integrated LH stated that patients can remain at home JO This is being picked up by the commissioning team Performance Report and be referred into the capacity hub, as it has and forms part of the step up specification and is being been highlighted that this service is being further developed and contracted within this work . underutilised. JO agreed to look into the issue raised.
NC referred to the backlog position and stated Communication sent to UHNM by JO on the 8th May, that this is not acceptable and advised that at JO Helen Lingham has responded and Alison Bradley and the Board to Board meeting with UNHM, ABR Steve Fawcett will work with UHNM on this issue. offered to be involved in supporting them to work on the resolution of the backlog and offered to link with clinical teams. ABr confirmed that as of to date no contact has been made from UHNM. JO agreed to speak to colleagues are UHNM. To receive additional Written question from a member of the public JO Response provided questions from the (not in attendance) regarding phlebotomy members of the public services in the Staffordshire Moorlands
ENCLOSURE: 6
AUTHOR REPORTING OFFICER /DIRECTOR
Name David Rogers Name Dr Julie Oxtoby Title Senior Partner Title Clinical Accountable Officer
REPORT TO North Staffordshire CCG Governing Body
TITLE OF REPORT Clinical Accountable Officers Report
DATE OF THE MEETING Wednesday 1st July 2015
WHAT OTHER CCG COMMITTEE/GROUP/INDIVIDUALHASCONSIDERED THIS REPORT? None.
COMMITTEE/GROUP INDIVIDUAL
ACTION REQUIRED FROM Approve Assurance Discussion For noting X COMMITTEE/GROUP/ GOVERNING BOARD (please identify all applicable and provide details below) RECOMMENDATION
1) That members receive and note this update.
STRATEGIC GOALS SUPPORTED BY THIS PAPER (identify appropriate goals) YES NO 1. Increase life expectancy and reduce inequality X
2. Improve prevention, early detection and effective management of those X at increased risk
3. Enhance quality of life and improve health outcomes for people with X LTCs
4. Ensure people receive the right care in the right place X
PURPOSE OF THE REPORT, KEY POINTS, OUTCOMES, EXECUTIVE SUMMARY (supporting information to be included, if applicable)
In this report I provide some context about the environment we have been operating in over the last month as well as describe progress with regard to A&E Performance, Financial Recovery and Primary Care.
I provide an update about the Step Up, Step Down engagement process, the commissioning of hearing aids, as well as matters of national interest from NHS England. In addition I describe how we are progressing with collaborative working.
I am pleased to report on recent executive appointments, and the Annual Report and recent Annual General Meeting.
SUMMARY OF RISKS RELATING TO THE PROPOSAL
None.
ANY STATUTORY / REGULATORY / LEGAL / NHS CONSTITUTION/ASSURANCE / GOVERNANCE / PRESCRIBING IMPLICATIONS
None.
QUALITY IMPACT ASSESSMENT AND/OR EQUALITY IMPACT ASSESSMENT
ANY RELATED WORK WITH STAKEHOLDERS/PRACTICES/PUBLIC AND PATIENT ENGAGEMENT
None.
ACRONYMS
CCG Clinical Commissioning Group
1. Introduction
1.1 I would like to acknowledge the outstanding efforts across the CCG and in collaboration with our partners. It has been another really challenging month and as such has been consistently both busy and challenging for the CCG as we continued to respond to the pressures on urgent care, the contracting round, our financial position, and our financial recovery plan. These continue to be our key priorities, with reports for information and discussion within this board meeting.
1.2 We continue to work with our neighbouring CCGs, notably NHS Stoke-on-Trent CCG, and our secondary care providers in a collaborative and supportive way to respond to the challenges that we collectively have been experiencing.
1.3 I am grateful, as ever to the hard work and dedication of front line staff in primary, community and hospital settings. I would like to thank everyone for their professionalism and for the support that is being offered to colleagues; it makes me really proud to be a member of this CCG.
1.4 We have submitted and have had approved our financial and activity plans for the financial year ahead, and we have also published our annual report. When one considers the challenges that we experienced in 2014/15, it is heartening to read the Annual Report and note the steady list of achievements that we have been responsible for, and that have clearly contributed to improvements in local health services. We received good feedback at the recent NHSE assurance review meeting and are working closely with NHSE to ensure we continue to focus sustained delivery this year.
2. A&E Performance
2.1 In terms of national performance metrics, the urgent care system continues to be a red flag with targets not being met, and a continued high level of demand on A&E and for urgent care services in the area. The health economy has continued to fail to achieve the 4 hour target for waiting times in A&E. We continue to investigate this as it is clear that there has been no significant rise in attendances in A&E by our patient population and a slight reduction in none elective admissions over the last 12 months. However our system wide urgent care system remains under extreme pressure.
2.2 Clearly with the system experiencing such high levels of demand, patients rightfully ask us about the quality and safety of urgent care. I am pleased to report that Sally Parkin, Director of Quality, Partnerships and Engagement led an unannounced visit to A&E on the 1st June in response to the high level of trolley breaches and the overall high level of demand. The headline from this visit was that we can be reassured that staffing levels are as planned, and adequate, and the unit can be considered to be clinically safe. Patients told the CCG that they were comfortable, receiving drinks and pain control and they were being regularly monitored. What is clear from this unannounced visit is that although the system may be experiencing a high level of demand – staff are responding professionally, and the patient experience is very good.
2.3 Everyone needs to play their part in using our acute services appropriately. We recognise the need to have a clear communication strategy to enable those in need of services to access the most appropriate care. Many problems can be managed effectively through self-care or a visit to the pharmacy or the GP. If in doubt, patients should ring the 111 service.
3. Financial Recovery
3.1 The CCG closed the end of the 2014/15 financial year and produced its annual accounts at the end of May. The financial year-end position was that we achieved a surplus of £1.326m. This was a massive improvement on the position forecast earlier on in the financial year, but unfortunately it still fell short of reaching the NHS England planning requirements of delivering a 1% surplus [£2.68m].
3.2 The financial plan for the current financial year (2015/16) shows the anticipated receipt of £273m of allocations. Unfortunately the anticipated expenditure requirements amount to £275m which has resulted in the CCG having a financial plan that is in deficit from the outset. This is against a backdrop of increasing demands and requirements on commissioned services, and as such it is clear that we need to consider more financially sustainable models of care. It is therefore, important for us and our partners to continue to develop new models of care that have a dual purpose – to increase the quality of care provided to our population at the levels of demand we anticipate, but to do so in a way that makes better use of new ways of working that are more affordable. In that way we can ensure that our scarce resources are best applied to meet the needs of all of our patients on an on-going basis.
3.3 It is important to note that because we have a deficit plan, we are subject to much more scrutiny by NHS England, but also by the public who rightly expect us to balance the books as we are in effect stewards of tax payers money. We will have to assess how we fare as a CCG in terms of the capacity to deliver this financial agenda and also if we need to enhance some of our team capabilities to deliver in areas where we may have gaps in experience. Some of this is likely to involve a general tightening up of financial controls in areas such as contracts and business cases. Equally we will need to focus on methods of co-production (working with others) to drive out efficiencies. NHS England have assured our financial plans and we will be focussing on ensuring that we deliver our plans. It is clear that this will be another challenging financial year, but the plans can be realistically achieved with the right degree of focus and approach.
4. Primary Care
4.1 A Primary Care Strategy event is to be held for North Staffs and Stoke CCG primary care teams on Thursday 25th June with a view to agreeing some shared values and a shared vision for primary care over the next 5 years. The event will include breakout sessions to cover specific strategy areas such as primary care access, primary care urgent care, links with community services, IT and future developments, workforce development and estates and infrastructure. The outcomes of this event will be shared with the joint patient congress in early July and all the resultant feedback will help drive the primary care strategy.
4.2 The CCG has not only rebadged it’s practice engagement scheme for 2015/6 – now called the GP membership participation, development and transformation scheme, but has relaunched it too. The scheme will support our GP member practices to participate, develop and transform primary care to help ensure that it is fit for the future. While over 90% of patient contact in the NHS is with our membership practices, the funding and infrastructure to support them deliver this transformation needs careful consideration. We know that there is a recruitment and retention challenge in primary care, and as such our GP member practices are the best equipped to understand these challenges, identify solutions, and help us realise the opportunities for creating a primary care that can meet the needs of the population, and that is sustainable. We have been heartened by the response to the challenges ahead from our membership practices who are proactively working together and with our teams to enable federation and interpractice working. 4.3 As members will be aware, our submission to receive delegated authority for primary care co- commissioning was not supported by NHS England, due to the need for us and Stoke CCG to focus on improving the financial challenges and the response to pressures on A&E.
4.1 As previously reported, as we move to co-commissioning responsibilities, we have been invited to join the Staffordshire-wide Primary Care Committee from this month onwards. A delivery group will be established for Stoke-on-Trent and North Staffordshire, but the planning footprint for primary care will be Staffordshire-wide to benefit from the increased capacity and shared learning that this will bring.
5. Step Up, Step down services
5.1 Members may recall that earlier this year we sought the views and experiences of patients and the public about our proposals for Step Up and Step Down services, as well as their experiences of hospital discharge and rehabilitation. Our engagement on the proposals certainly sparked a lively debate. It was clear that many people felt that the proposals would impact on the future of the community hospitals. Since we have engaged on this matter, I feel that we have been able to allay peoples’ concerns, as we believe that the community hospitals play a significant role in community service provision.
5.2 The CCGs have been investing in and will continue to invest in community based patient centred services such as district nurses, intermediate care teams and specialist nursing teams. These services can offer care closer to home and avoiding admission to hospital where it is safe to do so. However, in order to better meet the needs of patients the CCGs are working collaboratively with Primary Care, the University Hospitals of North Midlands NHS Trust (UHNM) and Staffordshire and Stoke on Trent Partnership NHS Trust (SSOTP) to develop community services to support patients in their own homes and closer to home.
5.3 What is clear is that the use of the hospitals may need to change to meet the evolving needs of our communities and patients. Following the engagement, we will work with our partners and the hospital provider trusts to consider a range of options for the community hospital sites. Collectively we all recognise that community services and facilities are an important part of the health system.
5.4 We promised to continue to engage with patients and the public as an ongoing commitment, following the initial engagement work. I am delighted to inform members that we have, with patients and patient groups, created a Step Up Step Down group as part of this. The following groups are represented on this engagement group and I am sure we will hear more about the work of the group in due course. I would like to extend my thanks to everyone who has committed their time and expertise to help us as we progress this exciting but challenging transformation of community services.
Age Uk Arch Aspire Housing Breathe Easy (North Staffs0 Brighter Futures Campaigns Manager SSOTP Changes Combined Healthcare Stoke-on-Trent Staffordshire and Stoke-on-Trent Partnership Crossroads Carers (North Staffordshire) Deaflinks Healthwatch Staffordshire Healthwatch Stoke-on-Trent Local Authority North Staffs Carers North Staffs Patient Congress Patient locality representative for Cheadle/Alton/Waterhouses/Werrington GP practices Scrutiny Officer Stoke on Trent City Council Stoke Patient Congress Diabetes UK liaison University Hospitals of North Midlands VAST WMAS
6. Collaborative Working
6.1 Collaborative working between us and NHS Stoke-on-Trent CCG continues. At our last informal Governing Board meeting in June, the Governing Board approved our continued plan to work more closely with NHS Stoke-on-Trent CCG and to merge more of the the workforce of both CCGs. This will enable us to move forward at a faster, yet more efficient pace on the delivery plans mentioned above, and also will enable us to remain focused on the financial challenges we collectively face.
6.2 For staff who are at the level of NHS Band 8a and below we will start the process of bringing together roles and functions. Staff above this grade will need to go through a management of change process. All staff have been briefed regarding this and we are absolutely clear that the process will be transparent and fair. We are also meeting as joint North Staffs and Stoke boards to work through how we further align the executive functions whilst maintaining our sovereign CCGs and will continue to keep you updated.
6.3 There are real benefits in this, not least in that we can work together effectively to free up capacity and capability, which in turn will enable us to jointly deliver our commissioning intentions and meet our priorities. We have always been clear that by combining as we are beginning to do will enable us to be less stretched and to deliver on the important matters that we need to. This is particularly vital given the challenges that the health economy has faced recently. Collaborative working with NHS Stoke-on-Trent CCG will also be more efficient in that it will help us avoid unnecessary duplication and reduce the additional workload that we have been shouldering.
6.4 Both CCGs are absolutely clear that this represents strong and effective collaboration, and not a merger of organisations, rather of workforce, to better support the two respective CCGs. We will continue to work to our respective organisations and constitutions and for our respective GP member practices ensuring that local determination and sovereignty is paramount.
7. Update on Executive Staffing
7.1 I am delighted to welcome Mr Iain Stoddart, who began working for us last month as substantive Chief Financial Officer for NHS North Staffordshire and NHS Stoke-on-Trent CCG. Mr Stoddart joins us at a most challenging time but has already begun to help us respond to the challenges.
7.2 I am also delighted to announce that we have successfully appointed Jayne Downey to the substantive role of Director of Nursing and Quality. We look forward to seeing Jayne when she starts in November.
7.3 In the meantime, I am very grateful that we have appointed Rosie Trainor as our interim Director of Nursing. Rosie started with us in May and is with us for a period of six months. Rosie is a registered district nurse with more than 34 years experience working across health and care services, of which 15 years have been in executive nurse leadership positions. She is an experienced interim executive recently undertaking the role of Director of Quality and Nursing for Wessex CCG. She is the independent nurse member of Nottingham City CCG’s Governing Body and works part-time as an independent clinical advisor to a national care home organisation. She also works in a voluntary capacity as the chair trustee for a domestic violence charity and provides progression mentorship to young people through the Prince’s Trust. The post is a shared post between NHS North Staffordshire, and NHS Stoke-on-Trent CCGs and Rosie will be with us 2/3 days per week.
7.5 Finally, members will recall that earlier this year, I was sorry to announce that I had taken the decision to step down from my role as Clinical Accountable Officer from September this year. This was an incredibly difficult decision for me to take. Members will be pleased to know that we have recently gone out to advert for an interim Accountable Officer. This post has been advertised on a part-time basis and the CCG is open to either a clinical or managerial candidate. The CCG is now also going out to advert for the substantive Accountable Officer post.
7.6 Either Dr Shapley or myself will keep members updated on progress.
8. Hearing Aids
8.1 Members will recall that following an extensive engagement exercise last year, and a thorough review of the evidence and the issues, including presentations to stakeholders, and Overview and Scrutiny Committees, the CCG Governing Board formally ratified the commissioning policy and eligibility criteria for provision of hearing aids for mild to moderate adult-onset hearing loss. 8.2 In June, the CCG was asked to present to the Staffordshire Health Select Committee concerning the commissioning policy and eligibility criteria. Mr Marcus Warne our Chief Operating Officer presented the position on behalf of the CCG. After a detailed and comprehensive discussion of the matter, the committee called a vote either in support of the policy, or not. The motion was passed for the CCG to continue with the policy with a majority of 9/8. While there is undoubtedly a lot to learn from our experiences regarding the commissioning of hearing aids, and we recognise that as a CCG we do occasionally need to make difficult and unpopular decisions, we can be confident that we followed a robust and fair process for decision-making.
9. Flu Plan: Winter 2015-216
9.1 The Department of Health, Public Health England and NHS England have published the Annual Flu Plan and Letter. The Flu Plan sets out a coordinated and evidence-based approach to planning for, and responding to, the demands of influenza across England. The Flu Plan will aid the development of strong and flexible operational plans by local organisations and emergency planners within the NHS and Local Government. It provides the public and healthcare professionals with an overview of the coordination and the preparation for the flu season, and signposting to further guidance and information.
9.2 The Flu Plan includes details about the extension of the flu vaccination programme to children, which is being implemented gradually due to the scale of the programme and this coming season will include all those in their first two years of primary school.
9.3 It may seem to be the wrong time to be talking about winter flu at the height of summer. However the planning for winter flu has to start earlier, and as a commissioner of health services it is vital that we start planning for the winter pressures as early as possible to ensure everything is in place as we move into the Autumn. For those patients who are ‘at risk’ or who are vulnerable to flu, the flu vaccination can be a life-saver. As well as this by having the flu jab they can prevent its further spread, and reduce the pressure on A&E and urgent care services. As we know, each winter, A&E experiences a spike of demand not solely due to flu, but certainly in response to patients presenting with flu-like symptoms. Having the flu jab will help yourself, help others and help valuable NHS services.
10. Improving Mental Health Services for Young People
10.1 The Department of Health has published the Future in Mind report, which outlines a blueprint for improving Child and Adolescent Mental Health Services. The report builds on work that is already underway including delivering access and waiting times for eating disorders; improving access to evidence-based and outcome-focused treatments; and supporting commissioners on developing local capacity and capability. ‘Future in mind – promoting, protecting and improving our children and young people’s mental health and wellbeing’ makes a number of proposals the Government wishes to see by 2020. These include:
Promoting resilience, prevention and early intervention Improving access to effective support – a system without tiers Care for the most vulnerable Accountability and transparency Developing the workforce
10.2 The report sets out how much of this can be achieved through better working between the NHS, Local Authorities, voluntary and community services, schools and other local services. It also makes it clear that many of these changes can be achieved by working differently, rather than needing significant investment. It is worth noting that as a CCG, in partnership with SSOTP and our neighbouring CCGs and local authorities we have been able to sign up to a mental health crisis concordat in Staffordshire. I referred to this successful innovation in my last report. We have also invested heavily in improving access to psychological therapies for those who need them. There is much to do, but we are well on the way.
11. Mental Health Taskforce launched
11.1 Still on the theme of mental health, it is important that everyone is aware that NHS England has launched a Mental Health Taskforce bringing together leaders and experts, including service users, from across the health and care system to collaborate on the best ways to design and deliver mental health services in England. The taskforce will develop a five year National Strategy for Mental Health covering services for all ages. This will be the first time there has been a strategic approach to designing mental health services spanning all settings, providers and ages.
11.2 Over 20,000 people have taken part in a recently launched online survey, aimed at gathering the views and expertise of families and professionals on mental health provision. The information gathered by the Mental Health Taskforce will be used to contribute to, and develop the national five year strategy for mental health.
12. National Maternity Review
12.1 NHS England has announced that Baroness Julia Cumberlege will lead a major review of Maternity Services which is set to modernise care for women and babies across the country. The programme of work will assess current maternity care provision and consider how services should be developed to meet the changing needs of women and babies.
12.2 The review was promised in the NHS Five Year Forward View and its Terms of Reference were published just after the report into maternity care at University Hospitals of Morecambe Bay NHS Foundation Trust was published. Baroness Cumberlege brings a wealth of experience in healthcare leadership. She will work closely with other members of the review team and provide independent leadership for its overall work, which will include:
reviewing the UK and international evidence and making recommendations on safe and efficient models of maternity services, including midwife-led units; ensuring that the NHS supports and enables women to make safe and appropriate choices of maternity care for them and their babies; and supporting NHS staff, including midwives to provide responsive care.
12.3 The review team will establish a number of advisory groups covering the healthcare system, the voluntary sector and international models of care. They will also engage with NHS Citizen Networks on the ideas and solutions they have for improving maternity care. The review team will report its findings by the end of the year.
13. Be Clear on Cancer - Breast Cancer in women over 70
13.1 A national reminder campaign to raise awareness of breast cancer in women over 70 will run from 13 July to 6 September 2015.
13.2 Advertising will run across England from 13 July to 6 September 2015. The campaign will include TV, press, and pharmacy advertising.
13.3 The key message promoted on TV will be: ‘One in three women who get breast cancer are over 70, so don’t assume you’re past it.’ The advert also reinforces the message that finding breast cancer early makes it more treatable.
A second message, promoted more prominently in other campaign materials, will be: ‘A lump isn’t the only sign of breast cancer. If you’re worried about any changes to your breasts, tell your doctor straight away.’
13.4 The aim is to encourage more women aged 70 and over with unusual breast symptoms to go and see their GP. By targeting this age group, Public Health England, the Department of Health and NHS England aim to focus the campaign on those with the greatest risk of developing the disease. Regardless of age, if a woman has an unusual or persistent change to their breasts, they should contact their GP.
14. Annual Report and Annual General Meeting (AGM)
14.1 We opened our doors to the public on the 24th June for our annual general meeting (AGM). The event was held at The Moat House Hotel at Etruria Hall on Festival Way. Holding an AGM is a statutory duty for the CCG. It’s where we present our final accounts and explain about the services we have commissioned or developed, and it is where we are held to account for our use of taxpayer’s funds.
14.2 The meeting offered opportunities for the public to meet CCG staff, as well as a variety of providers and voluntary groups who were on hand at the event manning exhibition stands.
14.3 On the day the public heard a number of talks from senior members of the CCG covering the highlights and achievements of the previous year, the annual reports and accounts, the patient congress and the work of the Citizens Jury, and finally the challenges the future is likely to bring.
14.4 I, and my Governing Board colleagues always like to engage in dialogue with members of the public. As practising GPs we see patients and the public everyday, and we hear about their personal experiences of health services. We use this information to improve services where improvements are clearly needed. The AGM offers us another forum to not only learn abou the issues with healthcare, but also to celebrate health services locally, and the NHS more generally. There is also much to be celebrated about our NHS locally and regardless of the challenges, it is clear that everyone holds the NHS in high regard as a much loved local and beneficial resource. This is true of the Governing Board, as it is, I know, for frontline staff and of course our patients.
ENCLOSURE: 9
AUTHOR REPORTING OFFICER Name Lee George Name Sally Parkin Title Head of Quality Title Clinical Director for Quality, Partnerships & Engagement
REPORT TO North Staffordshire (NS) Clinical Commissioning Group (CCG) Governing Board
TITLE OF REPORT Quality Report
DATE OF THE MEETING Wednesday 1st July 2015
WHAT OTHER CCG COMMITTEE OR Record which groups/committee have already seen this GROUP HAS CONSIDERED THIS report, the date and comments (for example agreed this REPORT? report should go to the governing board for approval) N/A
ACTION REQUIRED FROM COMMITTEE/GROUP/ Approve Assurance Discussion Information GOVERNING BOARD (PLEASE TICK) The CCG Governing Board is asked to: o Note the key quality and safety matters reported to provider’s Clinical Quality Review Groups and the CCG’s Quality Committee and actions taken in response.
STRATEGIC GOALS SUPPORTED BY THIS PAPER (tick appropriate goal) 1. Increase life expectancy and reduce inequality 2. Improve prevention, early detection and effective management of those at increased risk 3. Enhance quality of life and improve health outcomes for people with LTCs 4. Ensure people receive the right care in the right place PURPOSE OF THE REPORT/SUPPORTING INFORMATION (if applicable) This report aims to provide North Staffordshire CCG Governing Board assurance that structures and processes are in place to promote, monitor and ensure safe, high quality health services for the people of North Staffordshire.
Care Quality Commission inspection reports are published on the following website: www.cqc.org.uk
KEY POINTS/EXECUTIVE SUMMARY o The Quality Committee received the CCG’s Annual Complaints Report for 2014/15 and has published the report on the CCG’s website. o North Staffordshire CCG responded to a public consultation regarding the Freedom to Speak Up Report – A review of Whistleblowing in the NHS which has now closed and we await a report of the consultation findings. o Clinical Quality Review Meetings are held with all main providers with representation from both North Staffordshire and Stoke on Trent CCGs. These meetings provide challenge to and seek assurance from providers about the quality of services commissioned by the CCGs and review findings from internal and external quality visits. o North Staffordshire CCG is over trajectory at Month 2 for C-difficile; 29 cases against a tolerance of 10. Further, a MRSA bacteraemia has been apportioned against the CCG.
Risks relating to the proposals in this paper N/A
1 Summary of any finance/resource/medicines management /workforce implications N/A
Any statutory/regulatory/legal/NHS Constitution/Assurance/Governance implications N/A
Equality Impact Assessment (Are there any direct or indirect implications) N/A
Any related work with stakeholders/practices/public and patient engagement N/A
Quality implications Within the body of the report.
Acronyms Explained within the body of the report.
1. Developing CCG Capacity & Capability for Quality Improvement 1.1 Since the last Governing Board meeting the Quality Committee (joint meeting with Stoke-on- Trent CCG) met on the 13th May and 10th June. The Committee received reports outlining the quality assurances for the CCG’s main providers and updates from its subgroups; Infection Prevention & Control Group, Safeguarding Group and Primary Care Subcommittee
1.2 The Quality Committee discussed the Insight (Patient Experience) Feedback Report 2014/15 Quarter 4 (January – March) for North Staffordshire CCG. There were 147 feedback contacts by the following methods: PALS (67), Soft Intelligence – patient based (63), Media (7), MP Letters (5), Complaints (4), and Compliments (1).
North Staffordshire CCG directly received 4 complaints; two of the four complaints relate to ‘clinical care/treatment’, the others relate to ‘attitude’ and ‘failure to follow procedure’. The CCG are not aware of any complainants in the last quarter contacting the Parliamentary and Health Service Ombudsmen requesting an independent review of their complaints.
Work continues to strengthen the ‘lessons learned’ section of the report with greater emphasis on individual action plans for complaints. The Quality Committee was pleased to note that a quality control checklist, based on the Patient Association’s criteria is now applied to all complaint responses.
1.3 In addition the Quality Committee received the Annual Complaints Report for NHS North Staffordshire CCG for the period 1st April 2014 – 31st March 2015. There were 35 complaints made during 2014/15 of which 30 have been concluded; an increase of 29 received in 2013/14. The number of complaints raised per month in 2014/15 was evenly spread and no obvious trend could be spotted. For complainants who remain unhappy with the outcome of their complaint, they have the right to ask the Parliamentary & Health Service Ombudsman to consider undertaking a review of their complaint. We have not been made aware of any cases that have been sent to the Ombudsman’s Office for review. However, the number of Patient Advice & Liaison Service (PALS) enquiries dropped significantly from 210 in 2013/14 to 160 in 2014/15. The Committee discussed public awareness of and confidence in PALS. The Complaints & PALS Assurance Group will now focus on improving information available to the public about PALS.
North Staffordshire CCG’s Annual Complaints Report can be accessed here: http://www.northstaffsccg.nhs.uk/annual-reports
1.4 The Quality Committee received a briefing from the Clinical Director for Quality, Partnerships & Engagement regarding the Freedom to Speak Up Report – A review of Whistleblowing in the NHS. The report recognises that while the culture of reporting has improved there are still staff 2 members experiencing poor treatment from NHS colleagues when concerns are raised and that this is a barrier to patient safety. The evidence suggests that there are some groups of staff who are more vulnerable than others when they raise a concern. These include agency and locum staff, students and trainees and staff working in Primary Care. North Staffordshire CCG responded to a public consultation which has now closed and we await a report of the consultation findings. We are considering the implications of the freedom to speak up review for our CCG as part of a wider review of our culture, which is currently underway. We will report back to the governing Board in August.
1.5 In March 2015 the Governing Board agreed to extend the review date of the CCG’s Serious Incident Reporting & Management Policy & Procedure. The Quality Committee received a briefing on the Serious Incident (SI) Framework 2015: Supporting Learning to Prevent Recurrence issued by NHS England on the 27th March 2015. Members noted that the revised Serious Incident Framework has made a number of changes effective from the 1st April 2015.
The new framework describes SIs as: Serious Incidents are adverse incidents, where the consequences to patients, families and carers, staff or organisations are so significant or the potential for learning is so great that a heightened level of response is justified.
As a result of the simplified classification we anticipate that there will be a reduction in the number of serious incidents recorded on the national reporting system in the following areas: Maternity Service incidents, where there has been no act or omission on the part of staff; unexpected deaths where it is due to natural causes; pressure ulcer grade 3 or 4 where there has been no service / care delivery failure or act or omission by staff i.e. unavoidable / unattributable; child deaths; deaths in custody; under 18 admissions to adult health wards; safeguarding issues.
The full revised Serious Incident Framework can be accessed here: www.england.nhs.uk/ourwork/patientsafety/serious-incident
1.6 In addition the Quality Committee received a briefing on the revised Never Events List 2015/16 issued by NHS England on the 27th March 2015. In respect of Never Events, there is now a reduction in categories from 25 to 14 and serious harm or death is not required to have occurred in order to be categorised as a Never Event. The rationale behind a type of serious incident being included on the Never Events list is that there are barriers to prevent it from occurring and guidance is in place to ensure it should never happen. Members noted these changes and the need for the CCGs to review its local Serious Incident Reporting & Management Policy & Procedure in light of this new framework. In addition these changes will need to be operationalised with Providers, noting the significant changes and potential training need for staff to understand the new framework and changes in reporting.
The full revised Never Events Policy and Framework can be accessed here: https://www.england.nhs.uk/ourwork/patientsafety/never-events
1.7 The Quality Committee received a briefing note from the Lead Nurse Adult Safeguarding regarding the Care and Support Statutory Guidance (Section 14) Safeguarding issued under the Care Act 2014 and relates to adult safeguarding. The Act supersedes previous No Secrets Guidance (DH 2000) and sets out a clear legal framework for how local authorities and other partners should protect adults experiencing, or at risk of abuse and neglect. Members noted additional abuse categories relating to self-neglect, modern slavery along with changes to the definition of domestic abuse by the Home Office.
1.8 The CCG was invited to make a commissioner statement in respect of the Quality Account 2014/15 by our main NHS provider trusts; North Staffordshire Combined Healthcare NHS Trust, Staffordshire & Stoke-on-Trent Partnership Trust and University Hospital of North Staffordshire NHS Trust. North Staffordshire CCG agreed to work closely with colleagues in Stoke-on-Trent CCG to provide a statement on behalf the two CCGs. The Quality Committee were briefed on the process that North Staffordshire CCG and Stoke-on-Trent CCG would use to contribute a commissioner statement for inclusion verbatim in the individual provider Quality Accounts.
3 Comments were coordinated from the Clinical Accountable Officer, Clinical Director for Quality, Partnerships and Engagement, Board Nurse, Chief Operating Officer, Head of Medicines Management, Lead Nurse Adult Safeguarding, Designated Nurse Child Protection, Head of Infection Prevention & Control, Clinical Director(s) and Head(s) of Commissioning – relevant to contract. Commissioner Statements were submitted to all main providers. The providers have to make their Quality Accounts publically available on the NHS Choices website (http://www.nhs.uk/) by 30th June 2015.
2. Quality Monitoring of Main Providers of Clinical Services A. North Staffordshire Combined Healthcare NHS Trust (NSCHT) 2.1 NSCHT has reported 12 serious incidents during April and May 2015; 8 of these were within the ‘unexpected death’ and ‘suspected suicide’ categories. All serious incidents are investigated in accordance with the National Framework and using National Patient Safety Agency best practice guidance. The CCG has an opportunity to challenge the provider’s investigation findings at the monthly Serious Incident Subgroup.
2.2 No Eliminating Mixed Sex Accommodation breaches have been reported during the period April 2015 to May 2015.
2.3 The Friends and Family Test (FFT) is a simple, comparable test which, when combined with follow-up questions, provides a mechanism to identify both good and bad performance and encourage staff to make improvements where services do not live up to expectations. The FFT asks the following standardised question: “How likely are you to recommend our ward/A&E department to friends and family if they needed similar care or treatment?” Patients will use a descriptive six-point response scale to answer the question with the following response categories: Extremely Likely, Likely, Neither Likely Nor Unlikely, Unlikely, Extremely Unlikely, and Don’t know.
The latest Friends and Family Test results highlight that 87% of inpatients would recommend NSCHT, 89% of community patients would recommend NSCHT, 69% of staff would recommend NSCHT as a place to receive care and 49% of staff would recommend NSCHT as a place to work. The FFT results are broken down below:
Inpatients 14/15 Q1 14/15 Q2 14/15 Q3 14/15 Q4 Recommend 83% 87% 90% 87% Not Recommend 5% 3% 4% 4% Total Responses 99 103 100 123 Response Rate 28% 29% 30%
Community 14/15 Q1 14/15 Q2 14/15 Q3 14/15 Q4 Recommend 87% 89% Not Recommend 3% 0% Not Applicable Total Responses 61 38 Response Rate Not Available
Staff 14/15 Q1 14/15 Q2 14/15 Q3 * 14/15 Q4 Recommend – Care 69% 68% 50% 69% Recommend – Work 50% 48% 43% 49% Not Recommend – Care 7% 14% 15% Not Not Recommend – Work 22% 22% 32% Applicable Total Responses 145 139 100
* During Q3 (October to December) the Staff FFT is asked through the NHS Staff Survey therefore the results are slightly different. The results for the extent to which staff would recommend NSCHT to others as a place to work and would be happy with the standard of care provided by the Trust if a friend or relative needed treatment are given above. In addition a composite key finding – staff recommendation of the trust as a place to work or receive treatment – is published within the NHS Staff Survey results.
4 In 2014 this did not change for NSCHT (3.30) which is within the lowest (worst) 20% of all mental health trusts surveyed.
2.4 The NHS Safety Thermometer has been designed to be used by frontline healthcare professionals to measure a snapshot of harm once a month from pressure ulcers, falls, urinary infection in patients with catheters and treatment for venous thromboembolism (VTE). The Safety Thermometer ‘harm free care’ rate for May 2015 is 98.57% and 98.57% had no new harms recorded. This is based upon 70 patients surveyed. The highest rate of harm over the twelve month period is falls and the next highest rate of harm is pressure ulcers. Although the numbers are small there has been an increase since January 2015 in all types of harm collected using the NHS Safety Thermometer. Of these harms 7 have been detected on Ward 4 (2 falls with harm, 2 catheters with UTI, 2 existing pressure ulcers & 1 new VTE); Ward 4 changed in January 2015 to a dual care environment for patients whom are medically fit for discharge from UHNM and awaiting appropriate care package. The rest of the harms (6) were detected on Ward 7 (4 existing pressure ulcers, 1 new pressure ulcer & 1 new VTE).
The rolling twelve month performance at NSCHT is:
2014 2015 Indicator Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May No Harms (%) 95.95 97.26 97.06 98.28 100 97.4 94.52 95 98.48 93.67 97.22 98.57 No New Harms (%) 97.3 100 97.06 98.28 100 98.7 94.52 98.33 100 97.47 98.61 98.57 Patients 74 73 68 58 65 77 73 60 66 79 72 70
The Quality Committee has noted that Healthwatch Stoke-on-Trent undertook an ‘Enter and View’ Visit to Ward 4 at the Harplands Hospital on the 18th March 2015. The CQRM were advised that this was a positive assurance report and the Trust has responded to Healthwatch and that they are satisfied with the response received. Discussions have taken place at CQRM about how the Trust ensures compliance with physical healthcare best practice. It has been agreed that an action plan will be monitored at CQRM and Commissioners/NSCHT would scope the inclusion of a West Midlands Quality Review Service peer review for physical healthcare within Mental Health Services.
2.5 Quality Committee members noted that long waits are being experienced within the CAMHS Service and CQRM has sought assurance as to how NSCHT manages the potential risk to patients who are waiting for care. CQRM was advised that patients are risk assessed and prioritised on first assessment and contact details are provided for the patient / carer to contact if concerned. Work is ongoing to address the capacity issues.
2.6 CQRM is seeking assurance from the Trust on how in the absence of a recognised national suitable tool the Trust is assuring themselves on the safe staffing of community services. NSCHT advised that they are involved in the pilot work within the West Midlands that will inform the national methodology via NICE. CQRM has requested a progress update to the next meeting noting the intention to report vacancies and assurances from the review of incidents, complaints, caseloads etc at Board.
B. Staffordshire and Stoke on Trent Partnership NHS Trust (SSOTP) 2.7 SSOTP has reported 46 serious incidents during April and May 2015; of these 35 were within the ‘pressure ulcers’ category. All pressure ulcer serious incidents are reviewed, challenged and scrutinised at the Tissue Viability Panel, chaired by SSOTP’s Director of Nursing & Quality and attended by the CCG’s Quality Manager, a decision is made whether the pressure ulcer was avoidable/unavoidable and any learning identified.
The number of serious incidents reported as pressure ulcers increased quarterly throughout 2014/15. The number of pressure ulcers reported in community services increased though contact activity in the community remained constant. Overall during
5 2014/15 SSOTP reported 31 avoidable pressure ulcers within community services which is a slight increase on 2013/14 (29 avoidable pressure ulcers).
SSOTP have extended the reducing avoidable pressure ulcers quality priority into 2015/16 and there is a focus on reducing harm from pressure ulcers within the Trust’s Sign up to Safety Improvement plan. Further, SSOTP’s Director of Nursing & Quality has implemented a review of the role and effectiveness of the Tissue Viability Scrutiny Panels. SSOTP’s Quality & Governance Committee have agreed a ‘deep dive’ into pressure ulcers at a future meeting following which it has been agreed that it will be shared with commissioners at the pan-Staffordshire CQRM in August.
2.8 No Eliminating Mixed Sex Accommodation breaches have been reported during the period April 2015 to May 2015.
2.9 The latest Friends and Family Test results highlight that 97% of patients would recommend SSOTP, 64% of staff would recommend SSOTP as a place to receive care and 50% of staff would recommend SSOTP as a place to work. The FFT results are broken down below:
2014 2015 Patients Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Recommend 97% 97% 95% 97% 98% 96% 95% 96% 98% 97% 97% 97% Not Recommend 1% 0.4% 1% 0.4% 1% 1% 1% 1% 1% 1% 1% 1% Total Responses 2106 1976 2115 2695 1739 1818 1705 1491 1621 1779 1467 1613
2014 2015 Staff Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Recommend – Care 77% 75% 64% * Recommend – Work 56% 55% 50% * Not Recommend – Care 5% 5% Not Available Not Recommend – Work 21% 21% Not Applicable Total Responses 1888 1885
* During Q3 (October to December) the Staff FFT is asked through the NHS Staff Survey therefore the results are slightly different. The results for the extent to which staff would recommend SSOTP to others as a place to work and would be happy with the standard of care provided by the Trust if a friend or relative needed treatment are given above. In addition a composite key finding – staff recommendation of the trust as a place to work or receive treatment – is published within the NHS Staff Survey results. In 2014 this remained the same for SSOTP (3.57) which is below (worse than) average of all community trusts surveyed.
2.10 The Safety Thermometer ‘harm free care’ rate for May 2015 is 92.76% and 97.7% had no new harms recorded. This is based upon 2170 patients surveyed. The highest rate of harm over the twelve months is pressure ulcers and the majority of these are existing Grade 2 pressure ulcers. The number of new harm pressure ulcers remains constant between a high of 1.87% in December 2014 and a low of 1.2% in May 2015. The rolling twelve month performance at SSOTP is:
2014 2015 Indicator Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May No Harms (%) 90.67 91.65 89.55 91.63 91.89 92.41 92.15 92.71 92.66 91.76 90.92 92.76 No New Harms (%) 96.25 96.96 96.34 97.26 97.34 97.69 97.08 97.07 97.28 97.28 96.42 97.7 Patients 2187 2275 2106 2044 2145 2253 2089 2182 2058 2172 2148 2170
2.11 The Quality Committee received an update regarding nurse staffing levels in SSOTP. Within the community hospitals there are systems and processes in place to cover staffing 6 requirements and this information is shared with the CCG. In the community staffing remains below commissioned levels. Committee members noted that the shortfall now affects North Staffordshire predominantly, where previously it was Stoke-on-Trent. There remains a gap in the information and assurance received at CQRM which is of concern to the Quality Committee. The Interim Board Nurse is meeting with SSOTP's Director of Nursing and Quality to address this as a priority and a further Board to Board meeting has been agreed.
Commissioners are aware of the efforts being made but also the challenges being faced by SSOTP in recruiting and retaining qualified nurses into the District Nursing teams. This was reflected in staff feedback and the CQC unannounced inspection reports.
We recognise the importance of listening and responding to staff. Therefore in June 2015, in order to gain a broader insight into the service, we undertook six focus groups with District Nursing Teams, two in each of the Moorlands, Newcastle and Stoke areas. A summary report will be shared with SSOTP's Directors of Operations and Nursing and Quality to develop, in partnership, an action plan that will support closer working relationships and delivery of the improvement and transformation required.
C. University Hospital North Midlands NHS Trust (UHNM) 2.12 UHNM has reported 40 serious incidents during April and May 2015; of these 15 were within the ‘pressure ulcers’ categories. All pressure ulcer serious incidents are reviewed, challenged and scrutinised at the Tissue Viability Panel, chaired by UHNM’s Director of Nursing and attended by the CCG’s Quality Manager, a decision is made whether the pressure ulcer was avoidable/unavoidable and any learning identified.
During 2014/15 UHNM reported 86 avoidable pressure ulcers; 22 at County Hospital and 64 at Royal Stoke University Hospital. At Royal Stoke University Hospital this is an increase from 53 during 2013/14. UHNM are focusing on ensuring that their staff complete the pressure area risk assessments to allow robust review of the causes of pressure ulcers and to determine whether the pressure ulcers are avoidable or unavoidable.
2.13 No Eliminating Mixed Sex Accommodation breaches have been reported during the period April 2015 to May 2015.
2.14 The latest Friends and Family Test results highlight that 97% of inpatients would recommend UHNM, 86% of A&E attenders would recommend UHNM, 69% of staff would recommend UHNM as a place to receive care and 57% of staff would recommend UHNM as a place to work. The FFT results are broken down below:
2014 2015 Inpatients Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Recommend 96% 97% 92% 94% 96% 96% 96% 96% 95% 96% 96% 97% Not Recommend 0.3% 1% 2% 1% 1% 2% 1% 1% 2% 1% 2% 1% Total Responses 640 635 715 792 662 602 994 1202 1038 1214 1559 1530 Response Rate 20% 19% 22% 24% 21% 20% 30% 31% 26% 33% 45% 40%
2014 2015 A&E Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Recommend 91% 82% 78% 82% 82% 82% 85% 86% 84% 83% 84% 86% Not Recommend 3% 11% 10% 6% 7% 7% 6% 5% 6% 6% 6% 5% Total Responses 235 76 167 1335 1185 1042 1143 937 1218 964 2482 Response Rate 3.7% 1.1% 2.5% 19% 18% 19% 17% 15% 13% 18% 15% 33%
2014 2015 Staff Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Recommend – Care 86% 83% 69% * Recommend – Work 65% 61% 57% * Not Available Not Recommend – Care 4% 6% Not Applicable 7 Not Recommend – Work 17% 18% Total Responses 880 1109
* During Q3 (October to December) the Staff FFT is asked through the NHS Staff Survey therefore the results are slightly different. The results for the extent to which staff would recommend UHNM to others as a place to work and would be happy with the standard of care provided by the Trust if a friend or relative needed treatment are given above. In addition a composite key finding – staff recommendation of the trust as a place to work or receive treatment – is published within the NHS Staff Survey results. In 2014 this remained the same for UHNM (3.66) which is average of all acute trusts surveyed.
2.15 The Safety Thermometer ‘harm free care’ rate for May 2015 is 89.66% and 97.79% had no new harms recorded. This is based upon 1132 patients surveyed. The highest rate of harm over the twelve months is pressure ulcers and the majority of these are existing Grade 2 pressure ulcers. The number of new harm pressure ulcers has been slightly over the past seven months. Further analysis shows a decreasing trend of grade 3 new harm pressure ulcers from a high of 0.33% in February 2015 to a low of 0.09% in May 2015. However, there is an increasing trend grade 3 new harm pressure ulcers from a low of 0.24% in November 2014 to a high of 1.31% in April 2015.
The rolling twelve month performance at UHNM is:
2014 2015 Indicator Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May No Harms (%) 90.72 89.46 88.03 89.92 89.33 89.78 90.47 88.65 90.71 87.78 87.98 89.66 No New Harms (%) 97.15 96.55 96.58 95.95 97.57 97.07 97.8 97.59 97.66 97.01 97.6 97.79 Patients 981 1015 994 1012 947 1262 1270 1286 1195 1170 1123 1132
2.16 The Quality Committee received UHNM’s staffing data for the month of March 2015 achieving the 96.1% of its planned hours for all shifts for both registered nurses and nursing assistants. A number of actions were reported which the Committee noted, and in particular concerns were raised regarding the gaps in the medical workforce which are being filled with medium and short term agency locums. Many of the gaps are in ‘hard to recruit to’ specialities, including Trauma & Orthopaedic, Emergency Medicine, Heart & Lung, Elderly Care, Radiologists and Ophthalmologists. A discussion took place regarding what proportion of vacancies are filled by locums in comparison with other Trusts across the country. Whilst it was noted that this was difficult to determine and UHNM are actively continuing to try to recruit in all disciplines, it was agreed that the Joint Quality Committee would write to the LETB and LETC to enquire further in this area.
2.17 UHNM continue to experience pressures in the urgent care system which has resulted in sustained 4 hour waiting breaches and 12 hour trolley breaches in Accident & Emergency (A&E). The CCGs Quality Manager now attends UHNM’s internal RCA review panel and advised the Quality Committee of investigation findings related to insufficient capacity and flow across the organisation; continued infection control restrictions on a number of wards affecting flow and capacity and demand for medical capacity exceeded the medical capacity across the Trust. A number of unannounced quality visits to A&E have been undertaken during the past six months, most recently on 1st June, to ascertain if patients have had a poor experience or sustained harm. The outcome of these visits has on the whole provided a positive assurance whilst identifying minor areas for improvement.
D. Staffordshire Doctors Urgent Care (SDUC) 2.18 Since April 2015 the CQRM for SDUC has met monthly and includes a patient story/case study at every meeting. The scope of the discussion has also been expanded to include the Urgent Care Centre provided by SDUC in addition to GP Out of Hours for Northern (Lot 1) &
8 Eastern (Lot 2) Staffordshire. However, the CQRM does not cover NHS 111 or GP Out of Hours for Stafford however discussions are ongoing to create a pan-Staffordshire CQRM.
2.19 Regional clinical governance structures are being put in place to deliver more governance structures at a local level and a new Regional Manager and Clinical Support Manager have been appointed.
2.20 The Quality Committee were given assurances that reporting is much improved since April 2015 providing more transparency and detail, however, more progress is required particularly in Front of House / Urgent Care reporting. Members noted that the CQRM has requested assurance on actions being taken to mitigate the risks to patients potentially waiting longer than one or two hours for telephone and face-to-face contacts at peak times.
E. Non-Urgent Patient Transport (NSL) 2.21 The Quality Committee were advised of the ongoing contractual and operational discussions to manage and resolve current performance issues following a clearly defined national process. Members of the Committee were pleased to note the additional 19 crews and the quality visits undertaken by the CCGs with areas of positive and negative feedback received.
F. Nursing Home Quality Assurance 2.22 North Staffordshire CCG reported 1 pressure ulcer serious incidents on behalf of a care home during April and May 2015. Pressure ulcer management in care homes that provide nursing care is the responsibility of registered nurses employed by the home. Pressure ulcers in care homes that provide only residential care are managed by the community district nursing team with support from the Tissue Viability Nurses.
There are 79 care homes within North Staffordshire CCG of which 17 are homes in which Continuing Healthcare funds beds. The number of beds within a single care home within North Staffordshire ranges from 2 to 171 beds.
The CCG Pressure Ulcer Panel has not met since the last Governing Board meeting. However, the two open serious incidents remain under investigation and either within the nationally defined investigation timescale or ongoing and under review due to safeguarding processes.
2.23 The Quality Committee received a final draft of the joint North Staffordshire CCG & Stoke-on- Trent CCG Care Homes Strategy which will be presented to both Governing Boards for approval at a future meeting.
3. Improving the Quality of Primary Care 3.1 Since the last Governing Board meeting the Primary Care Sub-Committee has not met. The next meeting will take place on the 8th July 2015.
3.2 Under the Care Quality Commission’s (CQC) new programme of inspections, all of England’s GP practices are being given a rating according to whether they are safe, effective, caring, responsive and well led. Thirteen randomly chosen North Staffordshire practices have recently undergone a CQC inspection. Five reports have been published so far with four receiving an overall rating of ‘Good’ and one receiving an overall rating of ‘Outstanding’. The CCG are currently asking practices to share their experience and lessons learned with those practices so that these can be shared with those practices which are yet to receive a visit to support the next round of visits which are taking place in July and August.
3.3 North Staffordshire practices have been carrying out peer reviews over the last twelve months as part of the practice engagement scheme. The aim of the reviews is to look at areas in which practices or localities are outliers in activity or cost for A&E attendances, non-elective admissions and outpatient referrals. The reviews are facilitated by a GP Clinical Associate who supports the practices.
9 4. Infection Prevention & Control (IPC) 4.1 Since the last Governing Board meeting the Infection Prevention & Control Group (joint meeting with Stoke-on-Trent CCG) has not met. The next meeting will take place on the 16th July 2015.
4.2 NHS England has set a challenging trajectory for Clostridium Difficile Infections (CDI) and a zero tolerance approach to avoidable Methicillin-Resistant Staphylococcus Aureus (MRSA) blood stream infections (BSI) for 2015/16.
4.3 The Month 2 (April 2015 – May 2015) performance data for the CCG and our main providers is included below:
North Staffordshire Combined North Staffordshire CCG Healthcare NHS Trust Year Year YTD Annual YTD Annual to to target tolerance target tolerance date date CDI 29 10 61 CDI 1 0 0 MRSA 1 0 0 MRSA 0 0 0
Staffordshire & Stoke-on-Trent University Hospital of Partnership NHS Trust North Midlands NHS Trust Year Year YTD Annual YTD Annual to to target tolerance target tolerance date date CDI 5 3 10 CDI 25 16 74 MRSA 0 0 0 MRSA 2 0 0
4.4 North Staffordshire CCG is over trajectory at Month 2 with 29 CDI cases reported against a cumulative tolerance of 10. Of the 29 CDI cases, 8 occurred within an acute setting and 21 in a non-acute setting (e.g. sample sent from a Nursing Home, General Practice or within 48 hours of admission to an acute or bedded community facility other than a Care Home).
A refreshed IPC strategy is currently undergoing review prior to ratification by all CCGs across the County. In addition to the provider IPC work plans, the Head of Infection Prevention and Control has developed a Commissioning IPC work plan in response to the results of the extensive RCA work undertaken during 2014/15. This focuses on the following areas: IPC service provision in Care Homes IPC service provision in NHS provider settings Antimicrobial resistance and prescribing
4.5 The CCG’s Head of Infection Prevention & Control convened a health economy short life working group to address the local incidence of CDI. The first meeting place on Monday 15th June and an action plan is currently being generated as a result of the discussions that took place. The attendees comprised of the Heads of IPC (commissioner and providers), Medicines Optimisations teams, clinicians from provider trusts, Public Health England and NHS England North Midlands. A list of areas were agreed including enhanced cleaning of the Royal Stoke University Hospital, engagement with medicines optimisations teams to implement the UK 5 year antimicrobial resistance strategy and associated antibiotic stewardship competencies, reconvening of Health Economy IPC and antimicrobial prescribing forums, review of the local protocols around diagnosis and treatment of UTI, reintroduction of the CDI card and the introduction of a weekly conference call to discuss all cases and actions in real time.
4.6 The Post Infection Review for the MRSA BSI apportioned to North Staffordshire CCG is scheduled to be held on 22nd June.
10 5. Safeguarding Adults, Children & Young People 5.1 Since the last Governing Board meeting the Safeguarding Group (joint meeting with Stoke- on-Trent CCG) met on the 19th June 2015.
5.2 The Department for Education published Working together to safeguard children: A guide to inter-agency working to safeguard and promote the welfare of children on 26th March 2015. Updating and replacing the statutory guidance published in 2013. The revisions include changes to the referral of allegations against those who work with children, notifiable incidents involving the care of a child and the definition of serious harm for the purposes of serious case reviews.
5.3 The Local Authority’s procurement exercise for School Nursing continues. Due to the uncertainty of whether the changes will impact upon safeguarding arrangements a series of safeguarding workshops were held in May and June. This concern has been logged onto the CCG’s risk register as a low level (risk score 6) risk.
11
ENCLOSURE: 11
AUTHOR REPORTING OFFICER
Name Stacey Thursfield Name Marcus Warnes
Title Executive Assistant Title Chief Operating Officer (IFR Coordinator)
REPORT TO North Staffordshire CCG Governing Board
TITLE OF REPORT Individual Funding Request (IFR) Annual Report 2014-15
DATE OF THE MEETING Wednesday 1st July 2014
WHAT OTHER CCG COMMITTEE Record which groups/committee have already seen OR GROUP HAS CONSIDERED this report, the date and comments (for example THIS REPORT? agreed this report should go to the governing board for approval)
IFR Policy Review Group Annual Report noted and discussed by the IFR Policy Review Group on Wednesday 10th June 2015
ACTION REQUIRED FROM Approve Assurance Discussion Information COMMITTEE/GROUP/ GOVERNING BOARD (PLEASE TICK) RECOMMENDATION
The North Staffordshire CCG Governing Board is requested to:
Note the contents of the IFR Annual Report 2014-2015
STRATEGIC GOALS SUPPORTED BY THIS PAPER (tick appropriate goal) 1. Increase life expectancy and reduce inequality 2. Improve prevention, early detection and effective management of those at increased risk 3. Enhance quality of life and improve health outcomes for people with LTCs 4. Ensure people receive the right care in the right place PURPOSE OF THE REPORT/SUPPORTING INFORMATION (if applicable)
The purpose of the report is to inform the Governing Board of IFR activity for the year 2014-2015
KEY POINTS/EXECUTIVE SUMMARY
During 2014/15, there were a total of 42 funding requests received by the IFR Team. Of the 42, 338 were processed as IFRs, 4 were initial requests where completed IFR forms were never returned. One of these was carried over from 2013/14 Overall activity has decreased significantly from previous years 0 cases were approved funding by the IFR Panel as exceptional cases. The most commonly requested treatments are still surgery and in particular, cosmetic procedures GPs are the most common referral types There have been no formal complaints during the year 2014/15
Risks relating to the proposals in this paper
None arising directly from the IFR Annual Report. There is always the risk that decisions made by IFR panels can be legally challenged if the applicant is not satisfied with the outcome and has exhausted the appeals process.
Summary of any finance/resource/medicines management /workforce implications
None arising directly from the IFR Annual Report. Successful IFR applications have financial implications as they are for treatments and procedures not routinely commissioned or contracted. This is set out in the report.
Any statutory/regulatory/legal/NHS Constitution/Assurance/Governance implications
None arising directly from the IFR Annual Report. The IFR Policy and process complies with the relevant statutory and legal guidance.
Equality Impact Assessment (Are there any direct or indirect implications)
None related to the IFR Annual Report. The IFR Policy and process was subject to an EIA during its development.
Any related work with stakeholders/practices/public and patient engagement
Public and patient representatives are members of the IFR Review Group.
Quality implications
None arising directly from the IFR Annual Report. Quality is a key consideration when the CCG determines its commissioning priorities, policies and decisions.
Acronyms
IFR – Individual Funding Request CCG – Clinical Commissioning Group
Individual Funding Request Annual Report 2014-2015
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Contents
Aim of the Report ...... 3 Executive Summary ...... 3 Introduction ...... 3 1 Number of IFRs ...... 3 1.1 Requests that were referred to IFR Panel...... 3 1.2 Other requests ...... 3 1.3 Comparsions with previous years ...... 4 1.4 Improvements ...... 4 2 Cases considered by the IFR Panel ...... 5 2.1 Comparison of Outcomes from IFR Panel……………………………………..5
3 Cases not considered by the IFR Panel ...... 5 3.1 Status of the new cases not considered by IFR Panel ...... 5 3.2 Treatment Type ...... 6 3.3 Type of Requester ...... 6 4 Changes to IFR Policy ...... 6 5 IFR Policy Review Group ...... 7
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Aim of the Report
The aim of this report is to provide an overview of the activity within the Individual Funding Request (IFR) team for April 2014 – March 2015.
The report will provide:
Details of the numbers of requests received and comparisons with previous years. Details of the requests approved as exceptional cases, including referral details and cost of treatments. A summary of requests that are not progressed to IFR panel, including details into treatment and referral details. A summary of the changes to the IFR Policy and any changes to the process as a result. Details of the activity undertaken by the IFR Policy Review Group.
Executive Summary
During 2014/15, there were a total of 42 funding requests received by the IFR Team. Of the 42, 38 were processed as IFRs, 4 were initial requests where completed IFR forms were never returned. One of these was carried over from 2013/14 Overall activity has decreased significantly from previous years 0 cases were approved funding by the IFR Panel as exceptional cases. The most commonly requested treatments are still surgery and in particular, cosmetic procedures GPs are the most common source of referral There have been no formal complaints during the year 2014/15
Introduction
The responsibility of the IFR process transferred from the Commissioning Support Unit (CSU) to the Clinical Commissioning Group (CCG) in July 2012. The CCG continued to follow the Staffordshire Cluster of PCTs IFR Policy up until authorisation in April 2013. Since then, North Staffordshire CCG has operated its own IFR Policy.
IFRs remain a priority for the CCG and continue to support the prioritisation process. There has been even closer integration of the IFR process with the Clinical Priorities Advisory Group (CPAG), which also transferred to the CCG. The two processes sit together and actively feed into each other.
1 Number of IFRs
1.1 Requests that were Referred to IFR Panel.
During 2014 / 2015, 3 different cases were referred to IFR panel over 4 panels. One case was referred twice and one was a case carried over from 2013 / 14. None of these cases were funded as IFRs however one was seen as a service development and has since been funded having gone through the CCG governance processes and a new pathway is in place.
1.2 Other Requests
A number of other cases were received by the IFR team which did not reach IFR panel.
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Status 2014 - 2015 Approved at Panel 0 Declined at panel 3 Declined at review 33 Prior Approval 2 Prior Approval at Panel Stage 0 Initial Request 4 Total 42
1.3 Comparisons with Previous Years
The table below shows the total number of active cases (includes new and reactivated cases) and the number approved funding.
Considered at Year Total Requests IFR Panel Approved Percentage (IFRs) 2008 / 2009 140 NA 7 NA 2009 / 2010 165 56* 11 20% Policy Change 2010 / 2011 163 22 8 36% 2011 / 2012 144 15 12 80% 2012 / 2013 105 11 10 91% 2013 / 2014 92 5 4 80% 2014 / 2015 42 3 0 0% *includes mini-panels for requests under £10,000. 56 requests were referred to panel but some went to panel more than once – meaning the figure is actually 69 – giving an approval rate of 15%
In 2009 / 2010, 2 cases reached panel and were decided to be prior approvals. They were then funded through another route. A further 11 cases went to one panel but were postponed or cancelled due to lack of information. They were then heard at a second panel.
In 2013 / 2014, 1 case reached panel which was then agreed as a prior approval and funded via another route.
In 2014 / 2015, 1 case reached panel where it was agreed the treatment was a service development and was later approved following the agreement of a new pathway via the CCG governance processes.
1.4 Improvements
There has been a decrease in activity this year including the number of cases progressed to panel. Any prior approvals are identified by commissioners during the screening or through the stage 1 review by Public Health colleagues. This shows that there has been an improvement in the IFR process in the following areas:
Higher quality of requests Better understanding of the IFR process by local clincians A more efficent screening process by commissioners A more robust stage 1 review by Public Health colleagues Better understanding and management of cases by IFR panel
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The first two factors are probably the main influence on the improvement in the process.
The benefits to this are:
Patient expectations managed Smoother and less drawn out process for patients, their families and referrers More efficient use of panel member time Less complaints Less appeals
Ultimately, all the above are efficiency savings which will reduce costs for the CCG
2 Cases Considered by the IFR Panel
2.1 Comparison of Outcomes from IFR Panel
The table and graph below highlight the improvement made in the IFR process. There has been a reduction in the overall number of cases that are heard at IFR Panel. Fewer cases are referred to second panels or cancelled at late stages. As well as this, for the previous three years most prior approvals have been successfully screened at the early stages on the process. In the past, cases have been considered at panel when they in fact, could have been granted funding much earlier in the process.
Year on year there has been a marked decrease in the number of cases that are declined, which means less distress to the patient and their families.
Post Approved Approved Cancelled Declined Total Poned (Non-IFR) 2009 / 2010 11 1 45 10 2 691 2010 / 2011 8 2 13 0 0 23 2011 / 2012 12 0 4 0 0 162 2012 / 2013 10 0 1 0 0 113 2013 / 2014 4 0 0 0 1 5 2014 / 2015 0 0 0 0 0 0 Change -6 0 -1 0 1 -5 1. Although this figures reads 69, many of these were cases postpone etc meaning 56 requests were referred to IFR panel, many more than once. 2. One case was declined at the IFR Panel, but following more evidence was approved at a different IFR Panel - so there were 15 cases to IFR Panel 3. One case was declined at the IFR Panel, but following more evidence was approved at a different IFR Panel - so there were 11 cases to IFR Panel
3 Cases Not Considered by the IFR Panel
3.1 Status of the New Cases Not Considered by IFR Panel
As highlighted earlier, a number of new requests were not considered by the IFR Panel, as demonstrated by the table below.
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Status 2014 - 2015 Percentage Declined at review 33 85% Prior Approval 2 5% Requested completed form 4 10% Total 39 100%
3.2 Treatment Type
Surgery is the most frequently requested of these cases, accounting for over half of the requests.
The most frequently requested surgery types remains as Cosmetic Surgery i.e breast surgery and abdominoplasty.
This year has seen an increase in the number of requests for fertility treatment
Treatment Type for Cases Not Considered at Panel
6% 3% 8% 3% 3% Dermatology Diabetes Diagnostics 14% ENT Fertility Opthalmology 6% Orthopaedic 54% Plastics 3% Vascular
3.3 Type of Requester
GPs remain the most frequent type of requester. However, a number of completed forms were consultant driven. Soft intelligence suggests that more may be driven by consultants, who advise the patient of possible treatment and refer back to primary care for funding.
4 Changes to IFR Policy
During 2012 / 2013 the IFR Team continued to follow the Staffordshire Cluster of PCTs wide IFR Policy. The IFR process for North Staffordshire transferred to the Clinical Commissioning
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Group in July 2012 and CCG continued to use the Cluster wide policy up until authorisation in April 2013.
From April 2013 the CCG has operated a North Staffordshire Clinical Commissioning Group Policy which was agreed by the IFR Policy Review Group in March 2013 in preparation for the CCG becoming statutory in April and ratified in June 2013 by the North Staffordshire CCG Governing Board. The main changes were to the quoracy of the Stage 2 Panel and the Appeals Panel.
The IFR Policy Review Group developed a robust process for the processing of request received into the CCG that ensures medicines management are involved in the initial determination stage of all IFRs.
5 IFR Policy Review Group
The IFR Policy Review Group has continued with the induction of the CCG Policy. It continues to monitor the activity of the IFR team, ensuring that the process is effective. It was agreed in 2014 that the meeting would meet every six months rather than quarterly going forward.
During 2014 / 2015, patient representation continues within the group and into 2015 / 2016. There is both representation from LINKs (Healthwatch from 1st April 2013) and from the patient membership group.
During 2014 / 2015, the group has:
Continued to monitor the TOR in line with changing NHS structure and induction of CCG policy Reviewed all activity through the IFR process including cases approved at IFR Panel Supported the process of a CCG policy and assured itself that the process remains robust and equitable Reviewed changing NHS structure and discussed ways to work collaboratively in the future with Public Health colleagues and Stoke on Trent CCG Ensured Medicines Management colleagues were formally involved in the process, both at the screening process and following through the review and Panel.
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ENCLOSURE: 12
AUTHOR REPORTING OFFICER /DIRECTOR
Name Rhian Hughes/Helen Duffy Name Sally Parkin Title Honorary Associate Director of Title Clinical Director for Quality, Partnerships Research and Development, NSCCG; & Engagement Director Primary Care Research Consortium/NHS Partnerships Manager
REPORT TO North Staffordshire (NS) Clinical Commissioning Group (CCG) Governing Board
TITLE OF REPORT Primary Care Research Consortium Annual Report 2014/15
DATE OF THE MEETING 1st July 2015
WHAT OTHER CCG COMMITTEE/GROUP/INDIVIDUALHASCONSIDERED THIS REPORT? N/A
COMMITTEE/GROUP INDIVIDUAL n/a
ACTION REQUIRED FROM COMMITTEE/GROUP/ Approve Assurance Discussion For noting GOVERNING BOARD RECOMMENDATION
The CCG Governing Board is asked to note the contents of the report, note the progress made in developing a research culture in North Staffordshire and to approve the plans for 2015/16.
STRATEGIC GOALS SUPPORTED BY THIS PAPER (identify appropriate goals) YES NO 1. Increase life expectancy and reduce inequality
2. Improve prevention, early detection and effective management of those at increased risk
3. Enhance quality of life and improve health outcomes for people with LTCs
4. Ensure people receive the right care in the right place
PURPOSE OF THE REPORT, KEY POINTS, OUTCOMES, EXECUTIVE SUMMARY
This report provides a summary of the Primary Care Research Consortium annual report for 2014. There is a strong record of primary care research in North Staffordshire delivered by the partnership between Keele University and the local NHS and operationalised through the Primary Care Research Consortium. North Staffordshire CCG are the lead partner and host of the Primary Care Research Consortium. This partnership delivers an extensive research programme and continues to support the further development of clinical academic research locally, ensuring the commissioning and provision of evidence based clinical care to local residents. Through this partnership approach the Consortium has: delivered a programme of research over the last five years totalling £31 million. secured research income in 2014 totalling £9.2 million. achieved national recognition of its research programme: - with 91% of research judged as world leading or internationally excellent in Universities UK’s most recent national assessment of research quality – the Research Excellence Framework (REF) 2014. - judged to be 3rd in the UK out of 32 submissions for overall profile in Public Health, Health Services and Primary Care Unit of assessment (REF 2014). - assessed as 1st in the UK for research impact and environment profiles on basis of world leading or internally excellent research (REF 2014). supported North Staffordshire & Stoke on Trent CCGs to be the highest performing (1st and 3rd) CCGs in terms of recruiting patients to national research studies in 2014/15. developed research capacity in General Practice in North Staffordshire / Stoke through: Professor Christian Mallen’s national appointment to lead NIHR research training for GPs. Professor Christian Mallen’s personal success in gaining an NIHR Professorship in General Practice Research supporting 8 general practitioners to achieve National Institute of Health Research (NIHR) in- practice research fellowships; 3 within 2014 supporting a strong NIHR academic training programme for GPs, through competitive appointment of 26 NIHR clinical fellows/clinical lecturers –with 12 currently in training, ensuring that North Staffordshire retains the highest quality GP trainees to become local practitioners. developed research capacity in Nursing and Allied Health Professionals (AHP) in North Staffordshire / Stoke through supporting 8 nurses and physiotherapists to gain NIHR research fellowships, and developing an innovative local scheme where clinical academic AHPs work in joint posts across Keele University and local Trusts supported 2 evidence based practice groups for general practitioners and allied health professionals – 8 meetings per annum, >40 clinicians involved – producing 42 new guides to support local implementation of evidence-based practice. secured funding to establish a new evidence based practice group for practice nurses. secured £1.2 million income to support the implementation of published research undertaken by the Consortium partnership into practice - particularly STarT Back secured clinical research network (CRN) primary care funding totalling £1.5 million in 2014 to support general practices/primary care organisations to participate in research. 49 practices in North Staffordshire and Stoke are research active, with 6649 patients engaged in 94 primary care studies, with a further 1854 patients being identified by primary care for 74 secondary care studies (Clinical Research Network West Midlands). secured active clinician and patient engagement in the design, delivery and implementation of research studies. supported patient involvement and engagement at a national level via ARMA, Arthritis Care etc.
SUMMARY OF RISKS RELATING TO THE PROPOSAL
N/A
ANY STATUTORY / REGULATORY / LEGAL / NHS CONSTITUTION/ASSURANCE / GOVERNANCE / PRESCRIBING IMPLICATIONS
North Staffordshire CCG hosts the Primary Care Research Consortium and a service level agreement is in place setting out the roles and responsibilities of the parties to this agreement.
QUALITY IMPACT ASSESSMENT AND/OR EQUALITY IMPACT ASSESSMENT
N/A
ANY RELATED WORK WITH STAKEHOLDERS/PRACTICES/PUBLIC AND PATIENT ENGAGEMENT
Annual report will be presented to Primary Care Research Consortium Board in July 2015
ACRONYMS NIHR: National Institute of Health Research; CLAHRC WM – Collaboration for Leadership in Applied Health Research and Care, West Midlands; WM AHSN – West Midlands Academic Health Science Network, CRN Clinical Research Network, ARMA – Arthritis and Musculoskeletal Alliance
Primary Care Research Consortium – Summary Annual Report 2014/15
Paper prepared for NHS North Staffordshire Clinical Commissioning Group Board Meeting, July 2015 Submitted by: Rhian Hughes#1, Director, Primary Care Research Consortium/Honorary Associate Director of Research and Development, North Staffordshire CCG; Elaine Hay#1, Academic Director, Primary Care Research Consortium; Christian Mallen#1, NIHR Professor of General Practice Research, Primary Care Research Consortium; Helen Duffy#1, NHS Partnerships & Engagement Manager; Sally Parkin#2, Clinical Director for Quality, Partnerships and Engagement
#1: Research Institute for Primary Care and Health Sciences, Keele University #2: NHS North Staffordshire Clinical Commissioning Group
1. Annual Report Summary
1.1 The strong record of primary care research in Stoke on Trent, North Staffordshire and Cheshire delivered by the partnership between the local NHS and Keele University, and operationalised through the Primary Care Research Consortium, has continued to flourish in 2014/15. The Consortium delivers an extensive primary care research strategy through its largest research group, the Arthritis Research UK Centre of Excellence, as well as an expanded portfolio of studies through membership of the NIHR School of Primary Care Research and Collaborations for Applied Health Research and Care West Midlands (CLARHRC WM).
1.2 The Primary Care Research Consortium’s remit is to: i) ensure full engagement of primary care clinicians and patients in the development and delivery of a shared Keele / NHS research strategy; ii) develop the capacity for research across the Keele/NHS interface; iii) support the dissemination and implementation of research outputs across the NHS.
1.3 The Consortium supports a programme of research totalling £31 million pounds, of which £10,609,008 were directly managed by North Staffs CCG via the Consortium Service Level Agreement. In 2014 new funding totalling £9.2 million was secured for research. Members of the Consortium continue to take leadership roles to drive forward primary care research, education and training and implementation of research at a national/international level, and represent the Consortium’s research partnership both nationally and internationally.
1.4 The Primary Care Research Consortium’s five year research strategy aligns closely to the priorities within NHS Outcomes Framework for 2014/15 and beyond “enhancing the quality of life for people with Long Term Conditions” (domains 2, 4 and 5); to the Health and Well Being Strategy priority aim to “improve quality and safety in Primary Care”; as well as to the strategic aims of its local partners (references: 1. Integrated Strategy and Operation Plan for North Staffordshire Clinical Commissioning Group for 2012 – 15; 2. Clear Credible Plan for Stoke CCG for 2012 – 15; 3. Staffordshire and Stoke on Trent Five Year Strategic Plan 2014-19) – see full report www.keele.ac.uk/pchs
1.5 Key to the success of the Consortium’s research strategy are the multi-disciplinary teams that support engagement with primary care clinicians and patients as well as the development and delivery of the research programmes themselves. This report summarises the Consortium’s ongoing commitment to research capacity development and engagement with clinical services. The Consortium’s approach to patient and public involvement means that all studies have strong engagement with patient/users of services in the design, delivery and dissemination of studies.
Appendix 1 below summarises the Consortium’s progress against its key strategic aims:
2. Consortium Research Strategy
2.1 The Consortiums’ research strategy continues to build upon its strength to undertake research to improve the quality of care and outcomes of patients suffering with MSK conditions. Musculoskeletal (MSK) conditions are the most common cause of severe long term pain and disability in the UK and globally, and lead to significant UK healthcare and social support costs. As a major cause of work absence and incapacity they have a significant economic cost through lost productivity time of work. Musculoskeletal conditions are predominantly managed within the primary care setting, representing the 2nd most common reason to consult with a general practitioner in the UK. In terms of years lived with a disability (YLDs) the top five leading causes of YLDs in the United Kingdom are low back pain, falls, major depressive disorder, neck pain and other musculoskeletal disorders (see appendix 2).
2.2 The Consortium’s research strategy has further expanded to address the impact and management of pain within the complex context of managing long term conditions, recognising that pain will often prevent an individual from being able to adopt strategies to manage their condition (regardless of their ‘diagnosis’).
2.3 The Consortium’s research strategy is delivered through a number of research groups within the Institute of Primary Care and Health Sciences, Keele University, the largest of which is the Arthritis Research UK Centre of Excellence which leads an extensive programme of primary care Musculoskeletal Research. In addition to established programmes in spinal pain and osteoarthritis, the consortium’s programme of research has expanded to include a focus on inflammatory conditions – gout/Polymyalgia Rheumatica and Rheumatoid Arthritis. In addition the core research programmes have expanded to look at those conditions that commonly co-exist with musculoskeletal disorders, in particular common mental health issues such as anxiety and depression which have a significant impact on the way in which patients cope with and manage their long term conditions - an under researched area in primary care.
2.4 The Consortium has also expanded its research portfolio through membership of:
i) the National School of Primary Care Research – which expands the research portfolio through collaborations with the other ‘national schools’; and ii) the Collaborations for Applied Health Research and Care West Midlands (CLAHRC WM) – which continues the strong MSK flavour but also examines the impact of common mental health issues on patients with long term conditions.
The Consortium’s overarching research mission is to reduce the impact of chronic musculoskeletal pain in individuals and the population, by improving the content and delivery of primary care. We aim to do this by undertaking research which can: 1. Improve the understanding of the causes, course and impact of musculoskeletal pain and long term conditions in primary care 2. Identify predictors of poor outcomes to develop models of stratified care, to target treatment according to prognostic risk factors 3. Design new co-ordinated treatments and care pathways to improve patient outcomes and deliver more efficient primary care 4. Support dissemination of our research
2.5 Delivery of the partnership’s large research programme has secured additional funding from the NIHR Clinical Research Network (Primary care) that supports an infrastructure to facilitate delivery of the Consortium’s research which includes GP/Physiotherapy Research Facilitator posts working across primary care locally in General Practice, and community physiotherapy teams (within SSOTP).
3. Delivery against Consortium’s Research Strategy 2014/15
During 2014 the research partnership has delivered a number of key successes:
3.1 Outstanding performance in the Higher Education Funding Council’s national assessment of the quality of research undertaken in UK Universities – the Research Excellence Framework – with 91% of the Consortium’s research classified as world leading or internationally excellent and the impact case studies ranked as world leading (Unit of Assessment 2 – Primary Care). Keele was ranked 3rd out of 32 universities in terms of our high quality research outputs (3* and 4*) and 6th as measured by overall grade point average. In addition the Consortium’s research was submitted under the Allied Health Professional unit (UoA3) with 90% of the research judged as world leading or internationally excellent. 3.2 Award of NIHR Professorship in General Practice Research to Professor Christian Mallen 3.3 Award of competitive NIHR grants to support local GPs to take up clinical academic posts and funded research fellowships: Dr Adrian Chudyk; Dr Lorna Clarson, Dr Lizzie Cottrell, Dr Clare Burton, Dr Emma Clarke, Dr Catherine Hyde, Dr Toby Helliwell, Dr Victoria Welsh, Ms Kay Stevenson, Dr Kika Konstantinou. 3.4 Established new collaborations as part of West Midlands Collaboration for Applied Health Research and Care (WM CLAHRC) – leading integrated care theme (Mallen). 3.5 Renewal of membership of the NIHR School for Primary Care Research (SPCR) in open competition. Professor Mallen has been reappointed as national lead for the School’s Training and Capacity Building Programme. 3.6 Grant income and publications remain strong – highlights include award of a Health Technology Assessment (HTA) funded trial of stratified care for sciatica (Foster); HTA funded trial of anti-TNF for Sciatica (led by Bangor with Foster, Hay as co-applicants); Arthritis Research UK funded trial to promote walking in older people (McBeth); Research for Patient Benefit Trial of Injections for Hip OA (Mallen). 3.7 Development of a core team to drive implementation of research into practice – resulting in a new partnership with the Academic Health Sciences Network and funding of over £1 million to support the roll out of stratified care for low back pain across the West Midlands, and new ways of supporting self- management for osteoarthritis. These workstreams are further supported by two Knowledge Mobilisation Fellowships (Stevenson, Dziedzic). 3.8 Continued development of evidence based practice groups including a new group for practice nurses – addressing clinical questions from front-line staff, and developing a ‘clinical bottom line’ for clinicians in practice. 3.9 Senior academic staff have been awarded a number of personal accolades including NIHR Research Professorship (Mallen); NIHR Knowledge Mobilisation Research Fellowship (Dziedzic); NIHR Senior Investigator (Hay); Fellowship of the Chartered Society for Physiotherapy (Foster); Promotion to Professor of Biostatistics (Jordan). Keele is the only Primary Care Department to host two NIHR Research Professorships (Foster and Mallen). 3.10 The outputs from the Consortium’s research programme continue to have a transformative effect in shaping services and improving patient outcomes at a local, regional, national and international level. In 2014/15 the Consortium developed a strong framework for coordinating and supporting the implementation of research into clinical practice supported by the Impact working group (made up of representatives from the NHS and Keele). Working with North Staffordshire CCG the STarT Back project has facilitated a new partnership with and funding from WM AHSN and led to innovations with industry. The Osteoarthritis Project has been shortlisted for the NICE Shared Learning Awards.
4. Challenges and Plans for 2015/16
4.1 Challenges facing the Consortium in 2015/16 include: Securing ongoing support from the Clinical Research Network West Midlands (CRN WM) to ensure that GP Practices continue to receive service support costs and infrastructure support to enable them to remain research active and to deliver Consortium research projects; Securing new grants at a national level to support the Consortium’s programme of research; Creating the capacity (time and resources) for research at a time when general practice is experiencing such extreme pressures.
4.2 Plans to address these challenges include: continuing to strengthen engagement with CCGs, primary care clinicians and patients, at the point of design of research as well as delivery, so that our research remains important and relevant to patients and the NHS ensuring succession plans for clinical and academic leadership of the Consortium are in place to support the partnership going forward; launch practice nurse evidence based practice group; ensuring that the outputs from the consortium’s research programmes bring tangible benefits to patients and NHS partners, demonstrating the impact of the research at local organisational as well as national levels – seeking opportunities to support these activities from national bodies such as WM AHSN, Regional Innovation Funding, NICE, etc.. developing clinical research proposals for funding from a wider range of national grant funding organisations; working with the Cross Staffordshire and Shropshire Research, Development, Evaluation and Innovation group to secure systems and processes to support the further development of research and innovation locally (e.g. through joint systems for excess treatment costs, research capability funding etc). continue to ensure influence at a national level to ensure that the research outputs from Consortium’s programme influences national policy.
Appendix 1: Summary of Consortium Activities 2014/15
Strategic aim Progress 2014/15 Benefit to Consortium Partners Flourishing research £9.2 million new Grant Income Improving outcomes for patients with partnership Secured Clinical Research Network musculoskeletal and long term funding £1.5 million for primary care – conditions 49 practices are research in North Promoting research culture in line with Staffordshire and Stoke on Trent NHS outcomes framework Proactive research active Developing capacity for research physiotherapy teams Evidence based commissioning/ WM CLAHRC – lead for Integrated provision of services Care (Mallen) Strong Long Term Conditions Renewed membership of NIHR research portfolio National School of Primary Care Expanded range of research Arthritis Research UK Centre of opportunities Excellence Promoting profile of NHS in North Collaboration with Public Health Staffordshire at a national level– NICE England ‘Making every contact count’ Shared Learning Awards, WM AHSN for low back pain funding, Health Service Journal British Society for Rheumatology Gout Awards Guidelines (Mallen, Roddy) Secured £1.5million clinical research European (EULAR) Guidelines: OA, network funding to support primary Gout, PMR, Multi-Morbidity (Mallen) care research delivery. 94 primary care NIHR portfolio studies and 74 studies supporting secondary care (CRN West Midlands) in 2014
Implementation Secured £1.2 million implementation STarT Back template integrated within Partnership grant funding LBP pathway within EMIS system WM AHSN Funding support roll out of Training in evidence based clinical STarT Back – EMIS collaboration with pathways North Staffordshire Practices – Physiotherapy services with strong presented at national and evidence based culture international conferences (BSR, Raised profile nationally for EULAR, CSP) supporting evidence based culture; 2 evidence based practice groups for development of national/international GPs/AHPs – 3 meetings per year >40 guidelines clinical topics with evidence based >30 GPs and AHPs attend hub recommendations reviewed evidence based practice group with 3 Newly established Practice nurse spoke groups established EBP North Staffordshire CCG– Developing evidence base practice for commencing 2015 (Finney/Johnson) Practice Nursing National Guideline Group NICE Fellowships – OA (Dziedzic), membership: NICE GDG – LBP Low Back Pain (Sowden) (Somerville), OA (Dziedzic), Multi- NIHR Knowledge Mobilisation morbidity (Chew-Graham);; Working Fellowships (Stevenson, Dziedzic) group member for Rheumatoid Chartered Society of Physiotherapy Arthritis QOF (Mallen); Healthcare Fellowship (Foster), Distinguished Quality Improvement Partnership Service Award (Stevenson) (HQIP), rheumatoid arthritis national Shortlisted for NICE Shared Learning audit (Mallen) Awards 2015 for Osteoarthrits work Training Partnership Keele lead the only academic Building the capacity for clinical Vocational Training Scheme in UK – academics in the undergraduate Strong programme of intercalating curriculum. medical students linked to Keele Strong GP component to medical school (9) undergraduate curriculum 8 NIHR In-practice doctoral National recognition for quality of fellowships; 3 in 2014 training 4 NIHR SPRCR Research Career Retention of high quality trainee Progression Fellowship medical staff trained in North National lead for GP academic Staffordshire and practice locally. training (Mallen) Recruitment of clinical staff to Contribute to national MSK education innovative joint clinical academic staff – e.g. BMJ/NB Update incorporating High quality, nationally recognised, latest evidence base (including education available at a local level via Consortium’s research) PLT events/Best Practice RCGP on line MSK modules Days/Masterclasses BMJ/SAPC/RCGP masterclasses led by Consortium members at annual conferences (Porcheret, Mallen, Roddy) Established programmes of Best Practice Days for Allied Health Professionals/CAT in a Day training day Series of local masterclasses/PLT education events throughout the year Capacity Supported strong programme of North Staffs/Stoke highest performing Development academic clinical fellows and CCGs in 2014 for Research Capability clinical lecturers in General Funding Practice – 26 in total; 12 currently Supporting recruitment and retention in post locally, in 2014: Supported academic AHP – Dr T Helliwell - NSPCR GP career development through research progression (Kingsbridge Health training awards x 8 (nursing and Centre) physiotherapy) - Dr C Burton (Wolstanton), Dr E National Training and Capacity Clarke (Wolstanton), Dr E Cottrell Lead – NIHR School Primary (Trentham), Dr C Hyde (Hanley) - Care Research (Mallen) – over 70 NIHR GP In practice Fellowships trainees nationally - Dr A Chudyk (Leek), Dr L Clarson Secretary and Treasurer for (Kingsbridge), Dr M Artus (Derby) - Society of Academic Primary NIHR Clinical lectureships Care (Mallen/Protheroe) - Dr V Welsh (NIHR Doctoral Secretary to the General Practice Fellowship) Heads of University Departments Joint academic/clinical posts in: Group (Mallen) General Practice (Mallen, Porcheret, National lead for GP Academic Bedson, Edwards, Hayward); Clinical Fellowship scheme Rheumatology (Hay, Roddy, Hider, (Mallen) Paskins - SSOTP); Physiotherapy Support 2 academic trainees per (Sowden, Konstantinou, Thomas); annum with high PhD success Sonographer (Hall) rate HEFCE Senior Lectureship award – British Society of Rheumatology Konstantinou Heberden – (Roddy) NIHR Senior Investigator Award – British Health Professionals in Hay Rheumatology (Holden) Patient and Public Patients involved in developing 6649 patients engaged in CRN Involvement & research studies – 58 members of primary care studies in 2014, with a Engagement research user group further 1854 patients identified by Lead role in WM PILAR, links to WM primary care for secondary care CLAHRC, WM AHSN PPI groups studies PPI post funded as part of NIHR Research programme directed by Knowledge Mobilisation Fellowship service and users’ needs ARMA Gout Standards of Care National/international recognition (Mallen, Roddy); Arthritis Care Gout relating to the PPIE within research Report (Mallen, Roddy) Research outputs disseminated via Leadership of West Midlands RDS patient groups PPI (Blackburn) Contribute to national patient groups – PMR UK (Information officer – Muller); Arthritis Care, ARMA, OMERACT PMR Group (1st GP Omeract Fellow - Helliwell)
Appendix 2:
ENCLOSURE: 13
AUTHOR REPORTING OFFICER /DIRECTOR
Name Various Name Cheryl Hardisty
Title Clinical Directors – Heads of Title Deputy COO Commissioning
REPORT TO Governing Board
TITLE OF REPORT Integrated Finance and Performance Report
DATE OF THE MEETING 1st July 2015
WHAT OTHER CCG COMMITTEE/GROUP/INDIVIDUALHASCONSIDERED THIS REPORT?
COMMITTEE/GROUP INDIVIDUAL
ACTION REQUIRED FROM COMMITTEE/GROUP/ Approve Assurance Y Discussion Y For noting Y GOVERNING BOARD (please identify all applicable and provide details below) RECOMMENDATION
Members are asked to :-
1. Note the CCG performance against the NHS Constitution waiting time targets 2. Note the update on the LHE system resilience plan and performance against the Smart Plan 3. Note the update on Community services in relation to ILCT performance and Long Term Conditions 4. Note the Big ticket performance dashboard 5. Note the CCG performance against the dementia, IAPT and Care programme approach targets 6. Note the CCG performance against the local CCG priority of reducing alcohol related admissions.
STRATEGIC GOALS SUPPORTED BY THIS PAPER (identify appropriate goals) YES NO 1. Increase life expectancy and reduce inequality
2. Improve prevention, early detection and effective management of those at increased risk
3. Enhance quality of life and improve health outcomes for people with LTCs
4. Ensure people receive the right care in the right place
PURPOSE OF THE REPORT, KEY POINTS, EXECUTIVE SUMMARY
To provide an update to the committee about the CCG performance against the NHS constitution waiting list targets, the LHE system resilience activities and delivery against the Smart plan, update on the key community and mental health performance targets.
Finally there is an update on the 2015/16 finance recovery plan/ QIPP projects.
SUMMARY OF RISKS RELATING TO THE PROPOSAL
This report highlights issues with: Urgent Care 18 weeks Ambulance Planned Care Cancer
ANY STATUTORY / REGULATORY / LEGAL / NHS CONSTITUTION/ASSURANCE / GOVERNANCE / PRESCRIBING IMPLICATIONS
None
QUALITY IMPACT ASSESSMENT AND/OR EQUALITY IMPACT ASSESSMENT
None
ANY RELATED WORK WITH STAKEHOLDERS/PRACTICES/PUBLIC AND PATIENT ENGAGEMENT
None ACRONYMS
CQRM – Contract Quality Review Meeting CV – Contract Variation ED – Emergency Department FOH – Front of House IAPT – Improving Access to psychological therapies ILCT – Integrated Local Care Teams LHE – Local Health Economy OOH – Out of Hours PMO – Programme Management Office QIPP – Quality, Innovation, productivity and prevention QOF – Quality Outcomes Framework RAP – Remedial Action Plan RTT – Referral To Treatment SLA – Service Level Agreement SRG – System Resilience Group TDA – Trust Development Authority UCC – Urgent Care Centre UHNM – University Hospital of North Midlands WM – West Midlands WMAS – West Midlands Ambulance Service
North Staffordshire Clinical Commissioning Group Integrated Performance and Finance Report Governing Board July 2015 NHS North Staffordshire CCG - Constitution Report Referral to Treatment pathways RTT 18 weeks admitted adjusted Standard 90%
The percentage of admitted pathways Current 78.1% within 18 weeks for admitted patients YTD whose clocks stopped during the period 78.1% 69% 90% 111% 18 months annualised trend on an adjusted basis. (E.B.1) Month Apr-15 92 90 93 95 93 93 94 92 95 95 84 79 78 n/a A M J J A S O N D J F M A P to Mar-15 RTT Incomplete Standard 92% performa… The percentage of incomplete pathways Current 89.8% within 18 weeks for patients on YTD incomplete pathways at the end of the 89.8% 78% 92% 106% 18 months annualised trend period. (E.B.3) Month Apr-15 95 96 97 96 96 96 96 95 94 93 91 91 90 n/a A M J J A S O N D J F M A P to Mar-15 Commentary: The CCG is likely to fail the admitted and incomplete targets up until August 2015 although we are awaiting national guidance as to when the admitted and non admitted targets will be abolished centrally. Actions: Monthly monitoring in place through the Contract Review Board. Monthly Planned Care Operational Group set up. System Resilience Group overview. performance noticed has been raised. Assurance: Performance reported monthly to the Commissioning, Finance and Performance Committee (North Staffordshire) and then reported as part of the respective CCGs
Diagnostic test waiting times Diagnostic Wait Standard 99% Current The percentage of patients waiting 6 98.0% weeks or more for a diagnostic test. YTD 98.0% 90% 99% 108% (E.B.4) 18 months annualised trend Month Apr-15 98 98 98 99 100 100 98 99 98 98 98 98 98 n/a A M J J A S O N D J F M A P to Mar-15
Commentary: There remains significant issues with MRI, Children’s sleep studies and Endoscopy waiting times. Provider has informed the CCGs that performance will be back on line from June 2015. Actions: Monthly monitoring in place through the Contract Review Board and a performance notice has been raised. Monthly Planned Care Operational Group has been set up Assurance: Performance reported monthly to the Commissioning, Finance and Performance Committee (North Staffordshire) and then reported as part of the respective CCGs Governing Body monthly assurance reports.
1 of 16 NHS North Staffordshire CCG - Constitution Report A&E waiting time - total time in the A&E department Four hour wait Standard 95% Current 83.5% Percentage of patients who spent 4 YTD hours or less in A&E. (E.B.5) 82.1% 72% 95% 118% 18 months annualised trend Month May-15 89 90 89 89 87 85 84 78 80 81 80 81 84 n/a M J J A S O N D J F M A M #VALUE! to Mar-15 Commentary: UHNM and both CCGs have failed the waiting time indicator throughout the financial year: Highest performing day for Type 1 in Royal Stoke 91.27% 21st May (378 attendances overall), Highest performing day overall UHNM 94.54% 21st May. Lowest performing day for Type 1 in Royal Stoke 45.79% 12th April (321 attendances overall) Lowest performing day overall UHNM 66.89% 21st May. Actions: Due to variance against contracted levels, formal performance notices have been submitted for the four hour (95%) target FOH - Senior leaders within the CCG and SDUC are still trying to progress discussions to expand the clinical model but nothing agreed. Activity in May has increased by 17% compared with April taking the service to 28% diversion rate of those streamed at the front door which is only 2% less than the 30% aim. Attendances in May increased by 22% since February and were at the highest level since the service opened in October.
WMAS Additional diverts recovery action plan developed to increase net diversions to target levels. A WMAS programme is being developed to support the requirements of the SRP, to stretch existing targets, report more accurately the whole picture and bring together existing schemes to streamline actions and focus on priorities using best practices models Assurance: There is a bi weekly System wide System Resilience Group (including clinical quality sub group) and Urgent Care Business Meeting to review system resilience and performance of delivery against the whole system plan. There NHS England escalation meetings and ministerial briefings and TDA Exception Reporting.
2 of 16 NHS North Staffordshire CCG - Constitution Report Cancer waits - 2 week waits Breast Symptoms Referrals Standard 93% performa… Percentage of patients seen within two Current 67.6% weeks of an urgent referral for breast YTD symptoms where cancer was not 67.6% 71% 93% 115% 95 93 95 97 98 99 97 97 98 96 96 100 68 n/a 18 months annualised trend initially suspected. (E.B.7) Month Apr-15 A M J J A S O N D J F M A P to Mar-15 Cancer waits - 31 days Subsequent surgery Standard 94% performa… Percentage of patients receiving Current 88.9% subsequent treatment for cancer within YTD 31-days, where that treatment is 88.9% 77% 94% 111% 100 100 100 100 91 100 100 100 95 100 82 94 89 n/a 18 months annualised trend Surgery. (E.B.9) Month Apr-15 A M J J A S O N D J F M A P to Mar-15 Radiotherapy Treatments Standard 94% performa… Percentage of patients receiving Current 93.5% subsequent treatment for cancer within 31-days, where that treatment is a YTD 93.5% 85% 94% 103% Radiotherapy Treatment Course. 100 100 96 95 100 100 98 100 100 95 100 98 94 n/a 18 months annualised trend (E.B.11) Month Apr-15 A M J J A S O N D J F M A P to Mar-15 Commentary: 94.2% March 5 out of 86 patients were treated after 31 days. All of the breaches occurred at University Hospitals of North Midlands (1 x Lower GI; 2 x Lung; 1 x Head and Neck, 1x gynae). Achieved 2014/15 – slightly lower than national performance
3 of 16 NHS North Staffordshire CCG - Constitution Report Cancer waits - 62 days
Urgent GP referral Standard 85%
Current Percentage of patients receiving first 68.9% definitive treatment for cancer within YTD two months (62 days) of an urgent GP 68.9% 70% 85% 100% referral for suspected cancer. (E.B.12) 93 77 90 81 83 84 85 83 86 76 67 67 69 n/a 18 months annualised trend Month Apr-15 A M J J A S O N D J F M A P to Mar-15 Commentary: Demand is a key pressure on the pathway with an 11% increase overall in 2 week wait referrals in the last 4 months (200 per month). Significant demand peaks were experienced in April and into May with increases in: Head and Neck (64%), Urology (6%), UGI (8%), Dermatology (56%) and Breast (42%), although the Trust hasperforma continued to … achieve the 2ww 14 day standard. Drivers for demand are: health profile of the Staffordshire population, national cancer campaigns, social media, emergency pressures since January 2015 have impacted on elective and cancer pathways. Actions: UHNM agreed with the NTDA to deliver the 62 day standard from the end of May and is currently predicting delivery of the 85% standard in June.
UHNM is focused on the delivery of a number of internal standards within the cancer diagnostic phase of the pathway, and ensuring services have sufficient capacity in place across the whole pathway to meet growing demand levels. The Trust should deliver the standard from 31st May 2015. The remedial action plans that are in place are: A demand and capacity tool for two week wait referrals, in line with IMAS best practice principles, and used on a routine basis to highlight and respond to shifts is demand patterns. Demand and capacity planning in response to national and annual cancer campaigns. Escalated performance management arrangements to ensure patients progress through the pathway in a timely manner. Robust performance information to support operational delivery of the cancer pathway and to ensure visibility and oversight of performance by the Executive Team. Oversight of cancer performance and of delivery of actions through the weekly governance structure for access within divisions, in addition weekly oversight by the COO and Divisional Associate Directors (ADs).
To support sustainable achievement of the target from May 2015 onwards the Trust is taking further action, including: The Surgical Divisional Team and the Cancer Services Team have met with all cancer clinical leads during March/April 2015 to ensure full clinical ownership of cancer performance and to change systems to ensure that improvement against the standards continue are embedded in the MDT process. A Cancer Clinical Lead Forum has been established and will take place on a monthly basis from May 2015 onwards. This is chaired by the Clinical Director for Cancer Services and the Chief Operating Officer to ensure that agreed improvements are driven forward. An overview performance report has been developed for each cancer site, with the expectation that this is presented and discussed at weekly MDTs. Weekly meetings between directorate team, clinical lead, CNS and cancer co-ordinator to review the forecast position and identify pathway delays. Capacity constraints remain a challenge however, in two key pathways – lung and urology. Specific actions plans have been developed for these. The Cancer team is relocating to sit within the Surgical Division to improve communication and allow further embedding within Clinical forums. IST support (with a focus on reviewing Urology and Lung pathway
4 of 16 NHS North Staffordshire CCG - Constitution Report Ambulance clinical quality Ambulance Red 2 Standard 75% performa… Category A calls resulting in an Current 73.1% emergency response arriving within 8 minutes - Red 2 incidents: life YTD 73.4% 65% 75% 85% threatening but less time critical than 72 73 76 75 73 72 73 69 69 72 73 74 73 n/a 18 months annualised trend benchmarking based on current Red 1. (E.B.15.ii) Month May-15 M J J A S O N D J F M A M #VALUE! to Mar-15 month Commentary: NS CCG – performed above target for Red 1 and Red 19 but below target for Red 2 performa…
Attempting to align all current contract obligations with the aims of the local LHE. This will include all known initiatives including pathfinder and additional PGD’s with existing local improvement targets including the additional diverts to give a real view of what is realistic, enforceable via the contract and joint improvement ambition. Its intended that the metrics will be part of the whole system plan and the implementation plan will be held within the SOT commissioning team to drive forward.
5 of 16 Big Ticket Metrics for Big Tickets and Winter Pressures monitoring
June July August September October November December January February March April May YTD
Rolling 12 Scheme Provider How often Metric Target (month) months data Big Tickets - Admission avoidance Numbers going through Step up Intermediate Care Intermediate Care SSOTP Weekly 169 89 125 105 112 98 169 136 157 121 146 160 150 1568 services – assumed avoided UHNS admissions
District Nursing SSOTP Weekly Outcome Tracker – assumed UHNS avoided admissions 200 0 0 0 0 0 0 0 0 0 0 0 0
ILCT’s SSOTP Weekly Outcome Tracker – assumed UHNS avoided admissions 50 0 0 0 0 0 0 0 0 0 0 0
Nursing Home Support CCG’s Weekly SUS data – assumed UHNS avoided admissions 25 3 1 0 0 0 0 0 0 0 0 26 20 50
Number of Patients stepping – assumed UHNS avoided Community Hospital Step Up SSOTP Weekly 20 68 82 69 66 25 18 87 23 34 12 25 19 528 admissions Stoke City Number of Patients using these services - assumed Falls Responder Service Weekly 0 59 72 75 83 53 0 0 0 0 0 0 342 Council UHNS avoided admissions Total Big Ticket Avoided 464 219 280 249 260 176 187 223 180 155 158 2537 Admissions Numbers of Community / Primary care phone calls Hub SSOTP Weekly 678 798 848 789 959 736 776 724 643 854 7805 through the hub Capacity Numbers of attendances avoided from Primary Care / GP 108 373 484 489 408 485 367 446 411 407 558 4428 calls referrals Numbers of WMAS phone calls through the hub 492 598 102 73 135 114 142 99 146 170 2071
Numbers of A&E attendances avoided from WMAS calls 481 586 97 64 119 98 119 85 133 161 1943
Commentary: Intermediate care New step up patient referrals into Intermediate care have increased since the contractual dispute – pre dispute average 100 – post dispute 150. This is still below the target of 169 per month. In terms of the % split with step up - step down – the average split is 70:30 in favour of step up intermediate care.
District Nursing and ILCT’s The evaluation of whether the increased investment into District Nursing and ILCT’s has been impossible with the data sources we currently receive from both Providers. Hence, this is why the data is shown as zero across the year. The CCG’s are working on a project to receive a single patient record (joined up pseudonomised data across the providers), this though this still some months away from completion.
Nursing Home Support The Intermediate Care Nursing Home Support which started in February 2015 has had an impact in April 2015. Reducing non-elective admissions by 20 on the baseline period of April 2013.
Community Hospital Step Up There has always been an element of step up hospital admissions into community hospital. The step ups in this data represent the additional patients treated in step up beds after more beds were made available for this service. The community Hospital step ups have performed to target in May 2015.
Falls Responder Service This service has been consistent in terms of activity through the year. We are struggling to capture the data from the provider for November and December, but we are working to get this data.
Hub Hub data was not available from April to Mid May - we are receiving data again now.
6 of 16 On Call
Overnight on call summary to 22 June 2015
Total Time each patient was waiting for over 8 hours
Patient Handover
Month >8 >9 >10 >11 >12 Month Total Total
April 2014 2
May 2014 0
June 2014 0
July 2014 0
August 2014 2
September 2014 14
October 2014 48
November 2014 20
December 2014 15 19 19 54 90 197
January 2015 70 124 112 273 448 1027
February 2015 59 85 122 245 100 611
March 2015 119 118 142 191 7 577
April 2015 86 86 108 163 4 447
May 2015 104 139 124 308 6 681
June 2015 16 21 25 51 15 128 7 of 16 IAPT Recovery
The Improving Access to Psychological Services, (IAPT), has been delivered in North Staffordshire since 2009 and is known as the North Staffordshire Wellbeing Service. Initially the service adhered strictly to IAPT services only but following consultation with GP’s was retendered in 2011 to deliver a Primary Care Mental Health service with IAPT at the core.
The service is led by South Staffordshire and Shropshire NHS Foundation Trust provides NICE approved psychological therapies for patients with mild to moderate depression or anxiety disorders and to increase choice for patients now provides counselling services. Additionally the service has 10 Community Psychiatric Nurses, (CPN), who will respond to primary care crisis and provide primary care mental health assessments. The CPN will deliver interventions that enable patients with more complex or co morbid mental health disorders to be held at a primary care level with the opportunity to receive psychological therapies at a later time.
Since 2011 the service has seen an increase in referrals from 3900 in 2010/11 to 4650 in 2014/15. The increased demand brought pressures to the service that resulted in excessive waiting times well above the national target of 28 days though the rate of patients moving to recovery remained above the national target of 50%. Additional investment by the CCG in late 2012 coupled with a service redesign has had a significant effect on waiting times with the service now offering waiting times below national targets and increasing the percentage of people receiving therapies. The tables below demonstrate this.
The total number of people who have entered psychological therapies. Full National Target Q1 Q2 Q3 Q4 Year (15%)
2013/14 815 728 760 914 3217 16 2014/15 833 935 933 768 3469 17.3 Proportion of referrals offered an assessment within 14 days Average waiting time to start High Intensity treatment (Days). Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 2013/14 78% 71% 69% 76% 2013/14 115 118 94 63 2014/15 82% 83% 87% 85% 2014/15 34 32 26 26 Average waiting time to start Low Intensity treatment (Days). Q1 Q2 Q3 Q4 2013/14 33 35 30 27 2014/15 27 34 25 22
Commentary: The service is now achieving performance levels above national target levels. Additionally the number of active referrals who have waited more than 28 days from referral to 1st treatment has reduced from 1238 at the end of April 2014 to 338 by the end of March 2015. The CCG continues to see waiting times reduce in 2015/16.
During 2014/15, in partnership with Healthy Minds the Stoke CCG IAPT service, service leads have delivered mental health awareness training to district and community nurses from SSOTP to enable holistic assessments of patients with long term conditions. This has been successful and was delivered as a CQUIN for SSOTP which was achieved. Referrals to the service identified as having a long term condition are between 25% to 29% and the work undertaken with SSOTP including links between ILCT’s and senior therapists enable interventions at the earliest opportunity and provides parity of esteem across physical and mental health.
8 of 16 Quality CCG
CCG Governance Q1 Q2 Q3 Q4 Clinical Governance - has the CCG self assessed and identified any risks associated with the following: Concerns about quality issues being discussed regularly by the CCG No governing body? Concerns about the arrangements in place to proactively identify No early warnings of a failing service?
Concerns around the arrangements in place to deal with and learn No from serious untoward incidents and never events? Concerns around being an active participant in its Quality Surveillance No Group? EPRR:
If there was an emergency event in the last quarter, has the CCG self assessed and identified any areas of concern on the arrangements in No place for dealing with such an event? Winterbourne View: Has the CCG self assessed and identified any risk to progress against No its Winterbourne View action plan?
9 of 16 Finance Summary
This first update report for the 2015/16 financial year covers the 2 month period to 31st May 2015. The financial position set out within this report is based on external information provided to the CCG, e.g. Acute activity initial month 1 data and in future will incorporate Prescribing data. The report also sets out the final agreed Financial Plan position for 2015/16 following the latest submission to NHS England at the end of May.
At the end of month 2 the CCG Financial Plan baseline resource level stood at £273.058m. This is built up of £268.363m for Programme expenditure, £4.695m allocation to meet Running costs and £1.326m return non recurrently of the prior year’s surplus.
Initial month 1 data received from UHNM indicates that in April activity and costs appear to be under the contracted levels and would give an underspend of £378k against plan. This data is currently being validated and is subject to the application of data queries, penalties and Marginal rate Emergency Threshold. At this very early stage in the year it is too early to use this data as a basis upon which to build a forecast position, the assumption being made is that activity and finance will return to planned years at year end.
Initial month 1 data has also been received from West Midlands Ambulance Trust and this also indicates April’s activity to be under plan at this early stage in the year, in line with assumptions being made with Acute data it is anticipated these levels would return to plan by year end.
As stated above we have not yet received reporting information for Prescribing so the assumptions made within the month 2 and forecast reporting is that spend is currently at planned levels and the QIPP programme will be delivered in full.
Continuing Care information has now been received for expenditure up to May this indicates that costs are currently under plan including accommodating the ‘Top Slice’ expected from NHS England of £1.2m relating to the payment of retrospective claims from pre April 2013. Early reports indicate the Continuing Healthcare QIPP programme over achieved its April savings target by £100k. Again the assumption has been made when forecasting that spend would return to planned levels by year end.
The CCG has continued to see a rise in the costs relating to a number of individual patients being placed in out of area settings with either other NHS or Private sector providers mainly relating to Mental Health cases. At month 2 these costs were £58k above plan with the expectation within the forecast that the proposed QIPP scheme would return spend to planned levels.
The CCG set a QIPP programme for 2015/16 of £7.66m (net) with the majority of the savings profiled to be achieved in the latter part of the year. Performance to month 2 is slightly behind trajectory but monitoring information suggests this slippage will be recovered in year. The QIPP programme continues to be monitored bi-weekly through the Finance Recovery Group.
In summary whilst the CCG has only received to date month 1 Acute monitoring data (which remains subject to validation), there is early indication that activity and costs are below planned levels. The current assumption is however that we do not anticipate that to continue and spend and activity would return to those planned within the current forecast position.
The CCG is reporting a month 2 position of £148k surplus year to date and a forecast outturn position of £2m deficit, the year to date being an improvement on the planned year to date position by £602k. The forecast position being in line with plan. The CCG will however continue to work in year to try and achieve a final year end position closer to or achieving break even as currently it is in breach of its statutory duties. The CCG is also reporting an underlying deficit position of £608k (-0.22%) when removing non recurrent resource allocation and spend.
10 of 16 Finance Month 2 Position
CCG Current Position CCG Forecast Annual North Staffordshire CCG YTD Budget YTD Actual YTD Variance Forecast Variance budget £000 £000 £000 £000 £000 £000 Acute 20,623 20,212 -411 122,768 122,768 0 Mental Health 4,436 4,495 58 26,616 26,616 0 Continuing Care 3,641 3,391 -250 21,846 21,846 0 Community 7,908 7,908 0 42,802 42,802 0 Primary care 6,711 6,711 0 40,267 40,267 0 Other 1,575 1,575 0 9,452 9,452 0 TOTAL PROGRAMME 44,895 44,292 -602 263,751 263,751 0 Running Costs 782 782 0 4,695 4,695 0 Reserves (incl Contingency) 287 287 0 6,612 6,612 0 TOTAL SPEND 45,964 45,361 -602 275,058 275,058 0
Surplus -454 0 454 -2,000 0 2,000
TOTAL 45,510 45,361 -148 273,058 275,058 2,000
11 of 16 Finance Month 2 - SLA
Summary by Point of Delivery NHS NORTH STAFFORDSHIRE CCG Month: April 2015 Point of Delivery SLA Activity Finance Plan Actual Plan Actual Var % Vol Plan Actual Var % Price AandE 38110 £4,180,196 3176 3242 66 2% £348,340 £348,544 £204 0%
Day Case 17406 £11,242,208 1439 1488 49 3% £907,819 £1,016,683 £108,864 12% Elective 3177 £9,026,756 268 232 -36 -13% £751,870 £632,534 -£119,336 -16% Regular Day Attenders 1742 £623,760 145 4 -141 -97% £52,192 £842 -£51,350 -98%
Emergency 20703 £32,151,501 1739 1526 -213 -12% £2,735,209 £2,451,389 -£283,820 -10% Non Emergency 5597 £4,270,290 471 477 6 1% £359,433 £355,331 -£4,102 -1%
Elective XBD 1254 £293,211 102 165 63 62% £23,973 £37,636 £13,663 57% Emergency XBD 9738 £2,181,301 808 279 -529 -65% £181,253 £61,944 -£119,309 -66% Non Emergency XBD 212 £73,499 20 12 -8 -40% £6,881 £4,242 -£2,639 -38%
Outpatient First 53695 £6,347,054 4476 3889 -587 -13% £528,873 £460,729 -£68,145 -13% Outpatient Follow Up 92513 £6,343,526 7705 7288 -417 -5% £528,010 £512,417 -£15,593 -3% Outpatient Procedure 16510 £2,899,557 1373 1575 202 15% £241,149 £283,292 £42,143 17%
Block £2,559,771 £207,419 £207,419 £0 0% Non FCE £15,496,223 £1,301,362 £1,422,547 £121,185 9%
Total £97,688,852 £8,173,785 £7,795,548 -£378,237 -5%
The agreed contract value for UHNM stands at £97.7m following the protracted negotiation round earlier in 2015. The contract was set on a full Payment by Results (PbR) cost and volume basis where any activity carried out was paid for at tariff and the full National contract rules are applied.
At the time of finalising the Month 2 financial position the CCG was in receipt of the initial month 1 Service Level Agreement Monitoring (SLAM) information, this is shown within the table above and indicates activity levels in A&E, Non Elective (NEL), Outpatient Procedures and Outpatient First Appointment points of delivery over-performing along with costs associated with ‘Pass Through Drugs’, Critical Care and Unbundled Imaging. The SLAM report highlights under-performance at £378k for month 2 before data challenges, penalties and other adjustments are applied.
Key variations A& E attendances 66 above plan (2%) and £204 over Elective / Daycases 13 above plan (0.7%) and £10.4k under (0.6%) Non Elective admissions 213 below plan (12%) and £283k under (10%) Out Patient First appointments 587 below plan (13%) and £68k under (13%) Out Patient Follow Up appointments 417 below plan (5%) and £16k under (3%)
12 of 16 Finance Month 2 - SLA
Significant validation work continues following receipt of the data to ensure the activity is valid, the A&E activity information will reduce once the validated adjustment is made for activity seen through the Front of House service and the contract will be subject to a variation agreement that will increase the annual A&E plan by 1,718 attendances and £181k following the final CCG activity plan sign off by NHS England at the end of May. This work also includes validating performance against contract penalties and the Marginal rate Emergency tariff and consequences of failure would then be applied. The CCG’s also anticipate further contract variations being enacted to contract for the delivery of the QIPP schemes relating to the Step up model and Planned care initiatives which would result in reduced activity and costs within the UHNM contract.
The month 1 (April) data is very early in the year and does not give enough assurance of any continued trends upon which to base robust forecasts, our current assumption is that activity and costs will return to planned levels at year end.
The CCG also spends £0.5m with UHNM on services outside the main Acute contract at month 2 these are at planned levels.
OTHER MAIN CONTRACTS (2014/15)
Staffordshire and Stoke on Trent Partnership Trust (SSOTP) The final contract value for SSOTP is £40.5m. The contract operates predominantly on a block basis with cost and volume arrangements relating to PbR activity for Rheumatology and Anti TnF drugs costs. Monitoring information for month 1 has been received from SSOTP current indications suggest activity in line with plan. Work continues to ensure the investment made in previous years within Community services delivers the expected and contracted outcomes. It is anticipated once agreement has been reached with providers to contract for the Step Up and Step Down service models built into the CCG QIPP programme, contract variations will be processed in the latter part of the year.
Combined Healthcare (CHC) The contract value with CHC is £22.1m and operates on a ‘block contract’ basis. Work continues with Combined Healthcare to deliver activity reporting on a ‘Cluster’ basis. Month 2 and forecast positions both reflect spend at planned levels .
West Midlands Ambulance (WMAS) The contract value with WMAS for the Emergency Ambulance service is £6.27m. This operates predominantly on a cost and volume tariff basis, each Ambulance journey has a cost of £162, with some elements of the contract relating wider West Midlands programmes being funded on a block basis. At the time of finalising the month 2 position activity reporting up to month 1 has been received from the Provider, this indicates activity to be 202 journeys below plan (6.97%) this has been built in at month 2 as £33k below planned expenditure levels with activity assumed to return to plan in the forecast position in line with assumptions made throughout the month 2 report.
13 of 16 Finance - QIPP
The final Financial Plan detailed a required QIPP programme of £7.6m net of investment (£8m gross) which is equivalent to 2.8% of the resource allocation.
The QIPP programme has a phased delivery with several of the larger schemes scheduled to deliver in the latter part of the year. The table below highlights the key assumptions being made in the month 2 report against the areas of focus for the 2015/16 QIPP programme. Plan at Month Actual North Staffs Annual Plan 2 Delivered Forecast £000 £000 £000 £000 Comments Acute Step Up 2.99 0 0 2.99 delivery of savings from October Planned Care 1.00 0.09 0.09 1.00 UHNM month 1 planned care under plan phased delivery Emergency Activity 0.65 0.11 0.11 0.65 UHNM month 1 planned care under plan local data collected re schemes per FRG Other Acute 0.09 0.01 0.01 0.09 WMAS under plan month 1
Mental health OOA 0.25 0.04 0 0.25 savings rephased per workbook scheme being signed off by CCG
Community Step Down 0.59 0 0 0.59 delivery of savings from October Pathways 0.55 0 0 0.55 delivery of savings from October
Continuing Care 0.79 0.13 0.23 0.79 April over delivered re profile Prescribing 0.76 0.14 0.03 0.76 proposed re profile of delivery from Meds Opt
Total 7.66 0.52 0.47 7.66
The Month 2 savings target was £520k actual reported delivery was £470k (90%), £50k under plan. This is as a result of revised profiles for delivery of Mental Health and Prescribing savings being received after the plan had been submitted and the full savings now expected to be delivered later in the year. The Continuing Healthcare scheme has reported delivery of savings in excess of the target level for April of £100k.
Of the £7.66m program £5m is scheduled to be delivered from October onwards, assumptions within the forecasts being made are this level of savings will be achieved and the ongoing monitoring and assurance of this programme takes place through the Finance recovery Group which continues to meet on a fortnightly basis.
14 of 16 Finance - Cash Flow
The CCG plan for 2015/16 is £275.058m of cash for the period April to March including the requirements notified from the business service authority. As in previous years, by agreement, UHNM were advanced the March 2016 payment, resulting in the cash profile for the CCG being front loaded.
Details as follows:
CASH DRAWINGS Cumulative % Variance Draw dow n to Cumulative BSA Cumulative Cash & % Draw ings to Cumulative Variance from Plan Month Plan Date Monthly BSA Cas h BSA Date from Plan (cumulative) £000 £000 £000 % £000 % April 25,262 25,140 2,771 2,771 27,911 10.1% 2,649 10.49% May 22,921 41,590 2,926 5,697 47,287 17.2% -896 -1.86% June 22,921 July 22,921 August 22,921 September 22,921 October 22,921 November 22,921 December 22,921 January 22,921 February 22,921 Mar c h 20,586
March Supplementary
CHC Ris k Pool Cont 00 00 00 0 Total 275,058 207,503 36,197 36,197 243,699 88.6% 223,113 1083.81%
15 of 16 Finance - Better Payments
The CCG is expected to comply with the CBI Prompt Payment Code. This requires the CCG to pay 95% of valid invoices within 30 days of receipt. CCG performance up to 31st May stood at 93.9% based on count for non NHS payables (88.4% by value) and 92.4% based on count for NHS payables (94% by value).
Statistics to the end of May are as follows:
NHS Invoices Paid Percentage Compliance Within Limit Outside Limit Total Paid This Month Year to Date Number Value Number Value Number Value Number Value Number Value APR 229 24,722,122 12 31,104 241 24,753,226 95.0 99.9 95.0 99.9 MAY 133 14,111,672 11 906,104 144 15,017,776 92.4 94.0 94.0 97.6 JUN 0 0 JUL 0 0 AUG 0 0 SEP 0 0 OCT 0 0 NOV 0 0 DEC 0 0 JAN 0 0 FEB 0 0 MAR 0 0 TOTAL 362 38,833,793 23 937,208 385 39,771,002
NON NHS Invoices Paid Percentage Compliance Within Limit Outside Limit Total Paid This Month Year to Date Number Value Number Value Number Value Number Value Number Value APR 421 1,078,956 19 42,908 440 1,121,864 95.7 96.2 95.7 96.2 MAY 445 1,428,300 29 187,338 474 1,615,637 93.9 88.4 94.7 91.6 JUN 0 0 JUL 0 0 AUG 0 0 SEP 0 0 OCT 0 0 NOV 0 0 DEC 0 0 JAN 0 0 FEB 0 0 MAR 0 0 TOTAL 866 2,507,255 48 230,246 914 2,737,501 2507.25528 230.24577 2737.50105 1,228 41,341,049 71 1,167,454 1,299 42,508,503 94.5 97.3
16 of 16
ENCLOSURE: 14
AUTHOR REPORTING OFFICER /DIRECTOR
Name Martin Samuels Name Martin Samuels Title Commissioner for Care Title Commissioner for Care
REPORT TO Public Meeting of the North Staffordshire Governing Body
TITLE OF REPORT Staffordshire County Council (Care) update
DATE OF THE MEETING 1st July 2015
WHAT OTHER CCG COMMITTEE/GROUP/INDIVIDUALHASCONSIDERED THIS REPORT?
COMMITTEE/GROUP INDIVIDUAL Record which committee/group have already seen this Please indicate name of individual and date report, note date and comments (if applicable) agreed/approved (as necessary), for example HR, Finance, Quality, Medicines Optimisation or other
ACTION REQUIRED FROM COMMITTEE/GROUP/ Approve Assurance Discussion For noting GOVERNING BOARD (please identify all applicable and provide details below) RECOMMENDATION
The Board are asked to:
Note the progress made on the Staffordshire County Council (Care) Work Programme in Northern Staffordshire.
STRATEGIC GOALS SUPPORTED BY THIS PAPER (identify appropriate goals) YES NO 1. Increase life expectancy and reduce inequality
2. Improve prevention, early detection and effective management of those at increased risk
3. Enhance quality of life and improve health outcomes for people with LTCs
4. Ensure people receive the right care in the right place
PURPOSE OF THE REPORT, KEY POINTS, EXECUTIVE SUMMARY (supporting information to be included, if applicable) To update and inform the Clinical Commissioning Group Governing Body on the key areas of the Staffordshire County Council (Care) work programme
1. Dementia Centres of Excellence
As of 1st May 2015, Bracken House in Burntwood, Hillfield House in Burton and Meadowythe House in Tamworth, were transferred from Staffordshire County Council to Accord as part of the first phase of the Dementia Centres of Excellence project. All three homes are now being managed and operated by Accord, and all staff have successfully transferred across under TUPE in order to ensure continuity of care. Now that the service transfer has successfully taken place, commissioners are continuing to work with the Symphony Consortium (Accord and Keepmoat) in order to focus on the development of the two new Centres of Excellence in Burton and Lichfield.
Acquisition of the new sites for the two new homes is also progressing. Currently, the preferred sites are Outwoods (owned by Burton Hospital Foundation Trust) and the Circus fields site on Limburg avenue in Lichfield.
Work is also continuing in relation to the potential development of Dementia Centre of Excellence in North Staffordshire on the existing Kniveden Hall site. Conversations are taking place with District planners, as well as the local District Commissioning lead, Gail Edwards.
2. Learning Disabilities
Integrated Commissioning
Governance arrangements have been established for integrated commissioning across Staffordshire CCG’s and Staffordshire County Council. Andy Donald is leading on this for Staffordshire CCG’s county wide having been given this authority for North Staffordshire from Marcus Warnes.
Work is continuing with financial and contractual mapping of the services in scope for Integrated Commissioning across Staffordshire.
The Integrated Commissioning Board have provisionally agreed six priority commissioning Intentions which will form the work over the next 6 months. These are:
1. Reduce dependence upon residential & nursing care and increase the range of supported living options - April 2015-summer 2016 2. Develop & implement new model of Intensive Support in partnership with NHS/CCG - September 2015 3. Develop joint pathways across Health & Social Care to better meet the needs of adults with complex needs/highly challenging behaviours - April 2016 4. Fully implement joint strategy and care pathways in line with the requirements of the National Autism Strategy – May 2015 - April 2016 5. Act on the recommendations of the Winterbourne View Inquiry - commission approaches and a framework of local Community Support that will enable people placed in Independent Hospitals to return to Staffordshire to be supported in their local community - ongoing April 2015 onwards 6. Extend the range of community opportunities, ‘connect’ and brokerage services to ensure high quality options are available for people with complex needs
Specialist Health Inpatient Provision
The provision of bed based specialist health services is being reviewed. A Task and Finish group to oversee this work has been formed and a Project group which will form the working group. Terms of Reference and Governance for the group have been agreed.
The group is currently looking at the needs of people with learning disabilities in Stoke and North Staffordshire to inform the development of a future support model to meet these needs.
Market Development
A procurement exercise is about to be commenced to appoint providers to a framework contract to provide services to people with a learning disability, challenging behaviour and complex needs from North Staffordshire and Stoke on Trent.
As part of this process a Provider Engagement Event is being held to engage with Providers, prior to a procurement exercise. The event is being planned with Stoke on Trent CCG and Stoke City Council.
The event will take place on June 25 2015, 1.30 – 4.30 at Longton Rugby Club.
3. Social Care Performance Data 2014/15
(a) Integrated Access to Care: Maximising Independence & Self Help
Ref Indicator Rationale Metric Staffs North County Staffs (14/15 (14/15 Outturn) Outturn) 1a Initial contacts to A significant proportion of Deflections as Staffordshire initial contacts passed % of total calls This metric will require Cares deflected through to SSoTP are received the capturing of to primary and marked as No Further contacts that require no secondary Action following a more further action and are prevention detailed consideration of not recorded on the their situation. Earlier CareDirector system. deflection into non- Operational Intelligence statutory community and Performance Team capacity would promote liaising with the contact independence and reduce centre to establish a pressure on social work methodology. assessment capacity
(b) Integrated Local Community Teams: Managing Dependency on Services
Ref Indicator Rationale Metric Staffs County (14/15 Outturn)
2a Time from referral to Delays in completion of % of assessments completion of assessments can result completed within 1 assessment of new in deterioration of the day of referral clients where the route client’s circumstances, 38.2% of access was increasing the potential community need for hospital admission 2b Time from assessment Delays in start of % of service completion to service provision can result in packages starting provision start for new deterioration of the within 1 day clients where the route client’s circumstances, following 49.8% of access was increasing the potential completion of community need for hospital assessment admission 2c Clients receiving long- Regular reviews facilitate % of clients who term support services the proactive have been 41.2% for more 12 months or identification of receiving services more reviewed in the deterioration in the for 12 months or financial year client’s circumstances more who have and/or increased risk been reviewed within the past 12 months
(c) Integrated Local Community Teams: Managing Safe Return to Steady State
Ref Indicator Rationale Metric Staffs North Staffs North County Staffs County Staffs (14/15 (14/15 May May Outturn) Outturn) 2015 2015 (YTD) (YTD) 3a Time from Delays in % of referral to completion of assessments completion of assessments completed assessment can result in within 3 of new delayed calendar days clients where transfers of of s2 the route of care and notification 44.7% 49.4% 37.5% 47.2% access was hence being issued discharge inappropriate from use of NHS hospital (s2: bed capacity expected date of discharge) 3b Time from Delays in % of people referral to starts of care discharged discharge of packages can within 1 new clients result in calendar day where the delayed of s5 route of transfers of notification 59.0% 35.6% 43.8% 45.0% access was care and date (where discharge hence s5 not from inappropriate withdrawn) hospital (s5: use of NHS fit for bed capacity discharge) 3c Social Care Delays in # of delayed and Joint completion of people on the 18.0 Delayed assessments, monthly 14.8 n/a n/a (Apr 15) Transfers of resulting in snapshot date Care where delayed (validated) 3d the reason transfers of # of delayed was care, days on the completion represent monthly of inappropriate snapshot assessment use of NHS (validated) (ASCOF 2C) bed capacity. 552.0 301.3 n/a n/a A combination (Apr 15) of cases and days lost provides a balanced picture. 3e Social Care Delays in # of delayed and Joint starts of care people on the 23.0 Delayed packages, monthly 29.6 n/a n/a (Apr 15) Transfers of resulting in snapshot date Care where delayed (validated) 3f the reason transfers of # of delayed was waiting care, days on the for start or represent monthly re-start of a inappropriate snapshot care use of NHS (validated) package, or bed capacity. waiting for A combination residential of cases and 674.0 790.6 n/a n/a or nursing days lost (Apr 15) home place provides a (ASCOF 2C) balanced picture. This provides a measure of market capacity. 3g Eligible Reablement is % of eligible clients designed to clients receiving support reablement recovery and a in the year, return to where the steady state. outcome was Success is 78.9% 62.5% 70.4% 63.2% no long-term demonstrated support by service services users having (ASCOF 2D) no ongoing need for care and remaining out of hospital. 3h Older People Reablement is % of clients still at home designed to discharged 91 days after support discharge recovery and a from hospital return to into steady state. reablement Success is 87.9% 88.1% 85.7% 89.9% (ASCOF 2B) demonstrated by service users having no ongoing need for care and remaining out of hospital.
SUMMARY OF RISKS RELATING TO THE PROPOSAL Highlight any implications, including finance, quality, reputation, governance, strategic workforce, clinical, medicines optimisation or other
ANY STATUTORY / REGULATORY / LEGAL / NHS CONSTITUTION/ASSURANCE / GOVERNANCE / PRESCRIBING IMPLICATIONS
QUALITY IMPACT ASSESSMENT AND/OR EQUALITY IMPACT ASSESSMENT Date completed, please highlight any direct or indirect implications
ANY RELATED WORK WITH STAKEHOLDERS/PRACTICES/PUBLIC AND PATIENT ENGAGEMENT Provide further information, including dates if applicable
ACRONYMS If not listed in the report, please list
ENCLOSURE: 15
AUTHOR REPORTING OFFICER /DIRECTOR
Name Alex Palethorpe Name Neil McFadden Title Head of Governance Title Lay Member Governance/Audit Committee Chair
REPORT TO Governing Board
TITLE OF REPORT Annual Audit Committee Report
DATE OF THE MEETING 1 July 2015
WHAT OTHER CCG COMMITTEE/GROUP/INDIVIDUALHASCONSIDERED THIS REPORT?
COMMITTEE/GROUP INDIVIDUAL Record which committee/group have already seen this Please indicate name of individual and date report, note date and comments (if applicable) agreed/approved (as necessary), for example HR, Finance, Quality, Medicines Optimisation or other
Audit Committee 28/5/15
ACTION REQUIRED FROM COMMITTEE/GROUP/ Approve X Assurance Discussion X For noting GOVERNING BOARD X (please identify all applicable and provide details below) RECOMMENDATION The governing Board are asked to :
1) Receive the attached Audit Committee Annual Report which reflects the work undertaken by the Committee during the year and demonstrates how the Committee has fulfilled its delegated responsibly on behalf of the Board
STRATEGIC GOALS SUPPORTED BY THIS PAPER (identify appropriate goals) YES NO 1. Increase life expectancy and reduce inequality
2. Improve prevention, early detection and effective management of those at increased risk
3. Enhance quality of life and improve health outcomes for people with LTCs
4. Ensure people receive the right care in the right place
PURPOSE OF THE REPORT, KEY POINTS, EXECUTIVE SUMMARY (supporting information to be included, if applicable)
The purpose of this annual report is to provide assurance to the Governing Board that the Audit Committee has fulfilled its delegated responsibility in accordance with its terms of reference during the period 1 April 2014- 31 March 2015.
The Audit Committee agreed at its meeting on the 28th May 2015 that the report was to be shared with the Governing Board and that it provides written assurance of the activity undertaken by the committee during 2014-15 and covers the following areas:-
The Audit Committee can confirm from evidence provided throughout the year end and in this report that the Governing Board can be assured that an appropriate system of internal control is in place to ensure that: Business is conducted in accordance with the law and proper standards Financial statements are prepared in a timely fashion, and give an true and fair view of the financial positon of North Staffordshire CCG for the period in question; Affairs are managed to secure economic, efficient and effective use of resources Reasonable steps are taken to prevent and detect fraud and other irregularities
SUMMARY OF RISKS RELATING TO THE PROPOSAL Highlight any implications, including finance, quality, reputation, governance, strategic workforce, clinical, medicines optimisation or other
None.
ANY STATUTORY / REGULATORY / LEGAL / NHS CONSTITUTION/ASSURANCE / GOVERNANCE / PRESCRIBING IMPLICATIONS
HFMA Audit Committee Handbook best practice
QUALITY IMPACT ASSESSMENT AND/OR EQUALITY IMPACT ASSESSMENT Date completed, please highlight any direct or indirect implications
Not applicable
ANY RELATED WORK WITH STAKEHOLDERS/PRACTICES/PUBLIC AND PATIENT ENGAGEMENT Provide further information, including dates if applicable
Not applicable
ACRONYMS If not listed in the report, please list
Annual Audit Committee Report 2014/15 and 2015/16 work plan
Presented by the Chair of Audit Committee to Governing Board 1 July 2015
1. Introduction
1.1 The purpose of this report is to formally report to the Governing Board on the work of the Audit Committee during 2014/15 and indicate its work plan for the financial year 2015/16. The report ensures that the CCG conforms to best practice as recommended in the (NHS Audit Committee Handbook (HFMA 2014).
1.2 The Audit Committee reviewed and approved its Terms of Reference in January 2014 for 2014/15 (approved Governing Board March 2014) and February 2015 which were received and approved by the Governing Board in March 2015 for adoption from 1 April 2015.
2 Meetings
2.1 During 2014/15 the Audit Committee met on 4 occasions. All meetings were quorate.
2.2 Attendance by Audit Committee Members The quorum shall not be less than two of the three members.
Meeting Date Audit Committee Members Neil McFadden Latif Hussain Doug Robertson Lay Member Governance (Non‐ Executive GP board (Secondary Care Consultant (Chair) Member Board member)
30/05/2014 Apologies 31/7/2014 Apologies 27/11/2014 Apologies 26/2/2015 Apologies
It is worth noting that if a planned Committee meeting cannot take place as it would not be quorate, any of the following members may be called upon to attend that meeting of the Committee to bring the meeting up to quoracy and enable the business of the Committee to be transacted. lay member for patient and public engagement non‐executive GP board member
2.3 The following routinely attended the Audit committee meetings during 2014/15:
NSCCG: Chief Finance Officer, Head of Governance
Baker Tilly (Internal Audit): Head of Internal Audit, Manager
CW Audit Services (Local Counter Fraud Service): Head of Counter Fraud, Deputy Head ‐ Counter Fraud( As required)
Grant Thornton (External Audit):Director, Audit Manager
2.4 The Audit Committee’s minutes are submitted to the Governing Board, supported by a written or verbal report given by the Committee Chair.
3. Work undertaken during 2014/15
The Committee dealt with the following matters:‐
External Audit Annual report and Accounts and letter of representation (May 2014) Annual audit letter & delivery value report (July 2014) Progress report (November 2014 & February 2015) External audit plan 2014/15 and VFM approach 14/15 received and approved (February2015) Process and timetable for approval of annual report and accounts (February 2015)
Internal Audit Internal audit annual report including the Head of Internal audit opinion received and noted. The report found significant assurance on the CCG’s system of internal controls (May 2014) Internal audit progress reports received and noted (all meetings except May 2014)
Local Counter Fraud Specialist (LCFS) Local Counter Fraud Specialist (LCFS) progress reports received and noted (all meetings except May 2014, 2013/2014 Annual fraud report (May 2014) Anti‐fraud work plan 2014‐15 (May 2014)
Information Governance Progress reports Information governance progress reports received and noted (all meetings ); Freedom of Information progress reports received and noted (all meetings except July 2014) FOI Annual report (May 2014) Caldicott reports received and noted (all meetings except (May 2014)
Other matters addressed by the Committee
Single Tender waivers received and noted (February 2015) Board Assurance Framework Risk Register received and noted (at all meetings expect May 2014) Audit Committee Annual Performance Report (July 2014), Terms of Reference reviewed and approved (February 2015), Committee self‐assessment (February 2015) Register of Hospitality and gifts received (July2014) CSU Service auditors reports (February 20 15) Approval of polices which include anti‐fraud bribery and response policy, anti‐bribery policy (gifts and hospitality), raising concerns at work – whistleblowing policy and a suite of finance policies NSL contract update Approval of the Annual report and accounts 2014‐15
4. 2015/16 work plan
The work plan for 2015‐16 is detailed in Appendix 1. Meeting dates for 2015‐16 have not yet been agreed for the whole year.
5. Audit Committee Effectiveness 6. The committee review the terms of reference on an annual basis. This exercise was undertaken in February 2015 along with a self‐assessment on the Committees effectiveness.
Neil McFadden Lay Member Governance & Chair of Audit Committee 28 May 2015 Appendix 1 Work plan 2015‐16
This assumes the committee will meet a 1 2 3 4 minimum of 4 times each year and gives an Feb/Mar Apr/ July/Aug Nov indication of when key items are likely to May appear on the agenda
Agenda Item Issue Governance Review the Assurance framework X X X X Review the risk management system X Note business of other committees and X review relationships i.e. quality committee, Review draft annual governance statement X Review other sources of assurance i.e. FOI (Including Annual report) X X X X Information Governance X X X X including IG toolkit submission Review annual report and accounts X Review whistleblowing arrangements X X Review other reports & policies as X X X X appropriate i.e. IG policies, finance etc Review Hospitality register X
Financial Focus Review draft budgets X Agree final accounts timetable and plans X Review annual accounts progress X Review of audited annual accounts and X financial management (INCLUDING THE EXTERNAL AUDIT OPINION) * Review changes to PFPI’s and changes to X accounting policies Review of losses and special payments X X X X Review risks and controls around financial X X management
Internal Audit Review and approve annual internal audit X plan Review and approve internal audit terms of X reference Annual review of the effectiveness of X internal audit Review internal audit progress reports X X X X Receive annual internal audit report and X associated opinions
External Audit This assumes the committee will meet a 1 2 3 4 minimum of 4 times each year and gives an Feb/Mar Apr/ July/Aug Nov indication of when key items are likely to May appear on the agenda
Agree external audit plans and fees X X Review external audit progress reports (OR X X AS AND WHEN RECEIVED ) Review the effectiveness of external audit X Review the external audit’s report to those X charged with governance Receive/consider the external auditor’s X annual audit letter
Counter Fraud Review and approve the annual work plan X for counter fraud and security activity
Review counter fraud and security progress X X X X reports *or as required
Review the organisation’s annual self‐ X assessment against NHS Protect’s standards
Review effectiveness of those carrying out X counter fraud and security activity Receive the annual report on Counter Fraud X and security activity
Other Activities Plan how to discharge the committee’s X duties Self‐assessment the committee’s X effectiveness Review Committee’s terms of reference X Produce annual audit committee report X Private discussions with internal and X external audit Briefing/update sessions X X *AN ADDITONAL MEETING IN JUNE MAY NEED TO BE ARRANGED TO DISCHARGE THIS DUTY
ENCLOSURE: 16
AUTHOR REPORTING OFFICER /DIRECTOR
Name Alex Palethorpe Name Neil McFadden Title Head of Governance Title Lay Member Governance/Audit Committee Chair
REPORT TO Governing Board
TITLE OF REPORT Audit Committee Report
DATE OF THE MEETING 1 July 2015
WHAT OTHER CCG COMMITTEE/GROUP/INDIVIDUALHASCONSIDERED THIS REPORT?
COMMITTEE/GROUP INDIVIDUAL Record which committee/group have already seen this Please indicate name of individual and date report, note date and comments (if applicable) agreed/approved (as necessary), for example HR, Finance, Quality, Medicines Optimisation or other
N/A N/A
ACTION REQUIRED FROM COMMITTEE/GROUP/ Approve Assurance X Discussion For noting X GOVERNING BOARD (please identify all applicable and provide details below) RECOMMENDATION
The Board are asked to be assured that the Audit Committee have discharged its duties and in line with the powers delegated to it by the Governing Board note the Audit Committee approved the submission of the final annual report and accounts 2014/15 .
STRATEGIC GOALS SUPPORTED BY THIS PAPER (identify appropriate goals) YES NO 1. Increase life expectancy and reduce inequality
2. Improve prevention, early detection and effective management of those at increased risk
3. Enhance quality of life and improve health outcomes for people with LTCs
4. Ensure people receive the right care in the right place
PURPOSE OF THE REPORT, KEY POINTS, EXECUTIVE SUMMARY (supporting information to be included, if applicable)
This paper presents an update on key matters discussed at the Audit Committee on the 28th May 2015 . The Committee received the following:‐
Internal Audit Annual report – including the Head of Audit Opinion Quality Committee Annual Report Final Annual Reports and Accounts 2014/15 in relation to 2014/15 in respect of: Information Governance Annual Report 2014/15 (including the Senior Information Responsible Officer Report) External Audit Progress Paper and Audit Fee for 2015/16
The Committee on behalf of the Board reviewed the final annual report and accounts and approved their submission.
SUMMARY OF RISKS RELATING TO THE PROPOSAL Highlight any implications, including finance, quality, reputation, governance, strategic workforce, clinical, medicines optimisation or other
Audit committee informing the governing Board of its activities and how discharged its duties
ANY STATUTORY / REGULATORY / LEGAL / NHS CONSTITUTION/ASSURANCE / GOVERNANCE / PRESCRIBING IMPLICATIONS
None,
QUALITY IMPACT ASSESSMENT AND/OR EQUALITY IMPACT ASSESSMENT Date completed, please highlight any direct or indirect implications not applicable
ANY RELATED WORK WITH STAKEHOLDERS/PRACTICES/PUBLIC AND PATIENT ENGAGEMENT Provide further information, including dates if applicable
not applicable
ACRONYMS If not listed in the report, please list
SIRO – Senior Information responsible Officer
Audit Committee Report Presented by the Chair of Audit Committee
Introduction
1. This report summarises the key issues discussed at the Audit Committee on 28 May 2015 and aims to provide the Governing Board with formal assurance on the CCGs systems/processes reviewed by the Audit Committee in accordance with the Committee’s annual business cycle, to highlight any areas of concern and support the preparation of the CCG’s Annual Governance Statement for inclusion in the annual accounts 2015‐16.
2. The Audit Committee is authorised to review the establishment and maintenance of a system of internal control and risk management and may investigate any activity of the CCG with assistance from internal and/or external audit to establish the systems’ robustness and effectiveness.
3 The key headlines from the May meeting to which the Committee wish to draw the Governing Board’s attention are as follows:
3.1 CW Audit Annual report Caine Black presented an overview of the annual report and the counter Fraud plan 2015/16 . Key headlines from each document:‐ Annual report Joint working has been undertaken with SOT CCG as well as other Staffordshire CCGs to ensure that tasks are done once. Practices have not taken up fraud awareness training. It is the responsibility of CW Audit to protect the CCG from fraud in areas such as prescribing, however NHSE have direct responsibility for practices. A formal HR protocol has not yet been agreed with the CSU and it was confirmed that this will be formalised during the next year.
The committee discussed the number of days utilised by CW Audit and the under utilisation of 13.6 days and a refund is due to the CCG.
The annual report was a very clear and balanced report.
Counter Fraud work plan 2015/16.
The work plan for the forthcoming year has been developed against the recently published NHS Protect Standards for Commissioners. The work is based on generic areas set by NHS Protect. Contingency days have been built into the plan to account for any additional work necessary around governance, due to the inclusion of the requirement to oversee anti‐fraud arrangements with providers. NHS Protect are due to issue the self‐review toolkits in July which will be reviewed against the standards. Counter fraud was expected to move to a direct contract between CW audit and the CCG from 1 April as part of the CSU Business Case proposal. This has been delayed until 1 July to allow contracts and year end to take place and on that basis there may have to be a split arrangement regarding counter fraud as well.
The Committee approved the work plan for 2015/16
3.2 Governance
Information Governance progress report inc. Caldicott / SIRO log
An overview of the progress report including the Caldicott issues log, the SIRO report and IG update was provided to the Committee. Iain Stoddart, CFO will complete SIRO training in September. There has been one IG breach reported on 1 April since the report was issued. It was noted that in order to remain compliant with the IG toolkit all staff must complete IG training annually.
Assurance framework The Committee was informed that as part of the collaborative working with SOT CCG, work is progressing towards producing a joint risk register. The Committee reiterated the importance of having Executive review of the document and noted the progress made to date.
FOI annual report The Committee received and noted the FOI report. It was noted that the majority of requests were commercial e.g. requests for data from suppliers. The CCG attempts to publish as much information as possible in the public domain to alleviate the demand for FOI information.
Audit Committee annual report The Committee reviewed and approved the annual report which demonstrates that the committee has fulfilled its delegated responsibility on behalf of the board. It was noted that following a recommendation by external audit, the non‐executive committee membership will be reviewed.
Recommendation tracking report The Committee received a progress report which details the progress made with regard to agreed actions from internal audit reports. In respect to the CSU Payroll monthly exception reports it was agreed by members that the CSU response was not satisfactory and further clarification is needed.
Annual hospitality register The Committee noted and formally received the hospitality register.
Scheme of Delegation The Committee noted and approved the Scheme of Delegation for a further 12 month period.
3.3 External Audit Grant Thornton presented their report to the Committee and highlighted the following:‐
There were a number of changes to the accounts mainly due to difficulties with the templates issued by NHSE. An exceptions report has been referred to the Secretary of State under Section 19 of the Audit Commission Action as a formality. There was a £2000 additional cost associated with the production of this. A clear opinion was given with regard to the remuneration report and regularity on expenditure. Reference was made to variances identified in the agreement of balances and it was confirmed that satisfactory explanations had been accepted Particular attention was drawn to control issues identified with the CSU as identified by Deloittes as well as some IT weaknesses noted.
The Clinical Accountable Officer and the Chair of the Audit Committee approved and signed the letter of representation.
3.4 Financial Focus
Annual Accounts
The Interim Chief Finance Officer presented the accounts highlighting that the final submitted position remained at £1.3M surplus and that a clean audit position has been provided. Attention was drawn to the turnaround from the initial reported deficit position earlier in the year. It was confirmed that the draft annual report had been approved at the last audit committee and members should assume that all necessary amendments have been made prior to final signature. A discussion took place with regard to the accounts being prepared on a going concern basis. It was confirmed that the CCG would be able to manage financially for the next financial year and that the deficit position is recoverable over a maximum two year period.
The Committee approved the annual report and accounts and these were signed by the Clinical Accountable Officer prior to submission.
CSU phase 2 report / Update on service audit on Midlands and Lancashire CSU
Tony Matthews provided an overview of the supporting document of the phase 2 reports. It was confirmed that there were 7 areas tested and out of the 148 controls, there are 7 exception process improvements required. It was confirmed that the action plan with recommendations will cover all areas including e.g. IT weaknesses around disaster recovery and will be regularly received by the Committee to monitor progress.
Single Tender Actions – for approval
The Committee approved the request for single tender action (STA) in relation to the Prioritisation Programme and the extension of contract with John Harvey in order to provide continued expertise for the programme.
Items for inclusion in the risk register
This is a standing agenda item. The Committee have identified no new risks to go onto the Board Assurance Framework Risk Register.
Neil McFadden Lay Member Governance & Chair of Audit Committee May 2015
ENCLOSURE: 17
AUTHOR REPORTING OFFICER /DIRECTOR
Name Alex Palethorpe Name Alex Palethorpe Title Head of Governance Title Head of Governance
REPORT TO Governing Board
TITLE OF REPORT Approval of policies
DATE OF THE MEETING 1 July 2015
WHAT OTHER CCG COMMITTEE/GROUP/INDIVIDUALHASCONSIDERED THIS REPORT?
COMMITTEE/GROUP INDIVIDUAL
Organisational Development Committee 9 June 2015 Joint Quality Committee – 10 June 2015
ACTION REQUIRED FROM COMMITTEE/GROUP/ Approve X Assurance Discussion For noting GOVERNING BOARD RECOMMENDATION The Board are asked to formally ratify the policies listed below.
Maternity policy Special leave policy Shared parental leave policy Complaints and Concerns Policy
STRATEGIC GOALS SUPPORTED BY THIS PAPER (identify appropriate goals) YES NO 1. Increase life expectancy and reduce inequality
2. Improve prevention, early detection and effective management of those at increased risk
3. Enhance quality of life and improve health outcomes for people with LTCs
4. Ensure people receive the right care in the right place
PURPOSE OF THE REPORT, KEY POINTS, EXECUTIVE SUMMARY
Organisational Development Committee The following policies were received at the Organisational Development Committee on the 9 June 2015.
Maternity policy Special leave policy Shared parental leave policy The Maternity Policy and Special leave policy are existing polices within the CCG. The policies have been reviewed and updated to reflect legislative changes that came into effect on 1 October 2014 and 5 April 2015.
The Shared Parental Leave Policy is a new policy.
The Committee supported the recommendation to ask the Governing Board to formally ratify the above policies.
Complaints and Concerns Policy The policy was reviewed by the Joint Quality Committee on the 10th June 2015.
Members will be aware that the Complaints and Concerns Policy for both Stoke‐on‐Trent and North Staffordshire CCGs was due for review earlier this year, and each CCG extended the review period of its original policy whilst this policy was reviewed and updated to be common across both CCGs.
This revised policy has been considered and scrutinised by the North Staffordshire and Stoke‐on‐Trent Complaints and PALS Assurance Group along with patient representatives, and Healthwatch Stoke‐on‐Trent and Healthwatch Staffordshire. The main feedback from patient representatives was the need for this policy to be written in plain English. In addition, the ‘principles’ section has been rewritten and updated to include the most recent good practice guidance from the Ombudsman. This section now sets out a framework for how complaints should be handled which will make sense to patients, their families and carers.
This policy will be monitored by the Complaints and PALS Assurance Group and subject to minor amendments and the completion of an Equality Impact Assessment the Joint Quality Committee approved the policy at its meeting held on the 10th June 2015 and recommended this to Governing Board for ratification. Once ratified, the policy will be circulated to all staff and included on the CCG website, along with further public facing information and links to supporting advocacy services. The policy has a 3 year review period set, unless there are any changes in legislation before this time.
The Committee supported the recommendation to ask the Governing Board to formally ratify the following policy.
SUMMARY OF RISKS RELATING TO THE PROPOSAL
It is not envisaged that there will be any risk to the CCG from the implementation of this legislation
ANY STATUTORY / REGULATORY / LEGAL / NHS CONSTITUTION/ASSURANCE / GOVERNANCE / PRESCRIBING IMPLICATIONS
QUALITY IMPACT ASSESSMENT AND/OR EQUALITY IMPACT ASSESSMENT
EIA applicable to all.
ANY RELATED WORK WITH STAKEHOLDERS/PRACTICES/PUBLIC AND PATIENT ENGAGEMENT n/a
ACRONYMS
ENCLOSURE: 18
AUTHOR REPORTING OFFICER /DIRECTOR
Name Alex Palethorpe Name Alex Palethorpe Title Head of Governance Title Head of Governance
REPORT TO Governing Board
TITLE OF REPORT Updated Terms of Reference for Commissioning Finance and Performance Committee
DATE OF THE MEETING 1 July 2015
WHAT OTHER CCG COMMITTEE/GROUP/INDIVIDUALHASCONSIDERED THIS REPORT?
COMMITTEE/GROUP INDIVIDUAL CFP 15 June 2015 N/a
ACTION REQUIRED FROM COMMITTEE/GROUP/ Approve X Assurance Discussion For noting GOVERNING BOARD RECOMMENDATION The Board are asked to ratify: i) the proposed changes to the CFP Terms of Reference, and
ii) Where the clinical accountable officer is recorded in committees terms of reference, this is replaced with the generic term ‘Accountable Officer ‘.
STRATEGIC GOALS SUPPORTED BY THIS PAPER (identify appropriate goals) YES NO 1. Increase life expectancy and reduce inequality
2. Improve prevention, early detection and effective management of those at increased risk
3. Enhance quality of life and improve health outcomes for people with LTCs
4. Ensure people receive the right care in the right place
PURPOSE OF THE REPORT, KEY POINTS, EXECUTIVE SUMMARY (supporting information to be included, if applicable)
1. The Term s of reference for the Commissioning, Finance and Performance (CFP) Committee were reviewed and agreed by CFP at its meeting on the 15 June 2015. Changes have been made to reflect changes in membership, quoracy and the nomination of a vice chair at meetings. A copy of the revised terms of reference are attached. Changes summarised as follows:-
- Job titles have been updated - If the Chair is conflicted and the Vice Chair is not at the meeting, members will nominate a vice chair from the remaining non GP executive board members. - Quoracy has been changed from no less than half the membership to four of the non GP board members being present (one of who must be a lay member)
2. It was also agreed at the meeting that terms of reference for all committees should have ‘Clinical Accountable Officer’ replaced with the generic term ‘Accountable Officer’.
The committee agreed to ask the board to ratify both of the above proposals
SUMMARY OF RISKS RELATING TO THE PROPOSAL Highlight any implications, including finance, quality, reputation, governance, strategic workforce, clinical, medicines optimisation or other No risks – this will enable the committee to discharge its duties.
ANY STATUTORY / REGULATORY / LEGAL / NHS CONSTITUTION/ASSURANCE / GOVERNANCE / PRESCRIBING IMPLICATIONS Committee is a formal subcommittee of the Board
QUALITY IMPACT ASSESSMENT AND/OR EQUALITY IMPACT ASSESSMENT Date completed, please highlight any direct or indirect implications
Not applicable
ANY RELATED WORK WITH STAKEHOLDERS/PRACTICES/PUBLIC AND PATIENT ENGAGEMENT Provide further information, including dates if applicable
Not applicable
ACRONYMS If not listed in the report, please list
Not applicable
North Staffordshire CCG Commissioning, Finance & Performance Committee Terms of Reference
Terms of Reference - Summary Accountability The Commissioning, Finance & Performance Committee arrangements (CF&P) is established in accordance with North Staffordshire Clinical Commissioning Group’s (CCG) constitution, prime financial policies and scheme of delegation.
The CF&P Committee is a sub-committee of the North Staffordshire CCG Governing Board and has no executive powers other than those specifically delegated in these Terms of Reference.
The CF&P Committee is authorised to seek any information it requires to fulfil its duties.
The CF&P Committee has the authority to set up specific sub-groups and/or task and finish groups as appropriate to enable it to fulfil its responsibilities. Frequency Monthly Membership o Accountable Officer (Chair) Nominated Deputies o Chief Finance Officer (Vice Chair) o Director of Nursing & Quality Deputy Chief Finance o Chief Operating Officer Officer – but cannot act in o Clinical Director - Partnerships and Engagement vice chair capacity o Clinical Director – Commissioning o Clinical Director - Primary Care Deputy Chief Operating o CCG Appointed Lay Member – Governance Officer – but cannot act in o CCG Appointed Lay Board Member – Secondary Care vice chair capacity Specialist o Non- Executive GP Board member (at least one)
In the absence of the Chair (or matters where a conflict has been declared) or the Vice Chair, a Chair will be nominated from the executive Board Directors who are not GP’s Quoracy The meeting shall be deemed quorate when no less than four of the non GP board members are present (this includes executive directors one of who must be a Lay member)
In attendance o Locality leads x 5 – North Staffordshire CCG o Deputy Chief Operating Officer o Heads of Commissioning (as required) o Senior Planning and Development Manager o Head of Governance o Head of Medicine Management (or nominated deputy)
Other members of the CCG, Staffordshire and Lancashire CSU and local authority may be invited/co-opted as required to attend in an advisory capacity or to provide assurances.
Resources to provide administrative support.
Version 1.2 Date Agreed CCG CFP Committee 17 June 2015 CCG Governing Board – 1 July 2015 Review Date The CF&P Committee shall carry out an annual self- assessment to review its own performance, membership and terms of reference. Any resulting change to the terms of reference or membership will be presented to the Governing Board for approval.
1. Main Objectives of the Committee 1.1 To oversee the performance of North Staffordshire CCG in delivering the national targets and objectives included in the local commissioning plan, ensuring the effective and efficient use of resources whilst delivering financial balance.
1.2 To assure the Governing Board that the commissioning portfolio delivers against contracted performance metrics and outcomes.
1.3 Monitor ‘in year’ financial position and compliance with financial duties. Receiving a detailed report of the financial position and progress towards meeting the targets within the CCG financial plan
1.4 To provide a performance framework which proactively manages the CCG’s Financial, Performance and Quality Innovation, Productivity and Prevention (QIPP) agenda.
1.5 To provide assurance in the delivery of these areas to the Governing Board, reviewing and approving performance reports prior to submission to the Group.
1.6 To hold to account the Localities and the Senior Management Team of the CCG for their responsible areas, and when deemed necessary, require full delivery plans by exception.
2. Membership
o Accountable Officer (Chair)* o Chief Finance Officer * o Director of Nursing and Quality * o Chief Operating Officer * o Clinical Director - Partnerships and Engagement * o Clinical Director – Commissioning o Clinical Director - Primary Care o CCG Appointed Lay Member – Governance* o CCG Appointed Lay Board Member – Secondary Care Specialist* o Non- Executive GP Board member (at least one to attend)
3. Quoracy 3.1 The meeting shall be deemed quorate when no less than four of the non GP board members are present (officers identified for quoracy purposes by ‘*’, one of who must be a Lay Member). This will include the Accountable Officer, if they are not a GP. 3.2 Any quorum of meeting shall exclude any member affected by a conflict as set out in Clause 27 and 28 of the constitution. If this clause has the effect of rendering the meeting inquorate, then the Chair of the Committee shall decide whether to adjourn the meeting to permit the appointment or co-option of additional members.
Where the Chair of the meeting is found to be conflicted and excluded from all or part of the meeting, or are not in attendance, the committee shall appoint a chair from the non GP members of the committee present.
A decision put to a vote at the meeting shall be determined by a majority of the votes of members present. In the case of an equal vote, the Chair of the Committee shall have a second and casting vote.
4. Frequency of Meetings 4.1 Monthly.
5. Authority 5.1 The Commissioning, Finance & Performance Committee (CF&P) is established in accordance with North Staffordshire Clinical Commissioning Group’s (CCG) constitution, prime financial policies and scheme of delegation.
5.2 The CF&P Committee is a sub-committee of the North Staffordshire CCG Governing Board and has no executive powers other than those specifically delegated in these Terms of Reference.
5.3 The CF&P Committee is authorised to seek any information it requires to fulfil its duties.
5.4 The CF&P Committee has the authority to set up specific sub-groups and/or task and finish groups as appropriate to enable it to fulfil its responsibilities
6. Reporting 6.1 To provide assurance to the CCG Governing Board on Commissioning, Finance and Performance of commissioned services.
6.2 The formal minutes of the CF&P Committee will be forwarded to the Governing Board for information when agreed as accurate by the Committee.
7. Duties
Commissioning
7.1 To undertake monitoring of performance against national, regional and local metrics and provide assurance to the CCG Governing Board that services delivered for patients are done so effectively, consistently and in line with specified requirements and regulation.
7.2 To consider and review high level financial issues and risks, and ensure corrective plans are in place where variation from plan requires action.
7.3 To scrutinise the performance of commissioned contracts, assure the CCG Governing Board of compliance and oversee action plans where performance is deemed to need corrective actions.
7.4 Oversee and recommend to the Governing Body the development of a commissioning Strategy for the organisation, ensuring the meaningful involvement of stakeholders and the public in its development.
7.5 Oversee and recommend to the Governing Body the development of an Annual Business Plan for the CCG, ensuring it encompasses national and local requirements together with CCG objectives for the commissioning and delivery of healthcare.
7.6 Oversee and recommend to the Governing Body the development of yearly commissioning intentions for all providers.
7.7 Oversee the contribution to the Joint Strategic Needs Assessment, making recommendations as appropriate to the Governing Body and ensuring that the outcomes are reflected in the priorities set by the CCG for its commissioning and decommissioning of healthcare services.
7.8 Recommend to the Governing Board joint commissioning arrangements with the local authorities and other partners as appropriate.
7.9 Oversee the development of care pathways and services that support the vision of the CCG and promote clinical quality and safety in all commissioned services, making recommendations to the Governing Board as appropriate.
Finance and Performance
7.10 The Committee will review and have oversight of finance and performance in relation to the following areas:
performance against national and local targets ‘in year’ financial position. Receiving a detailed report of the financial position and progress towards meeting the targets within the CCG financial plan Compliance with financial duties To approve QIPP schemes and any additions or amendments thereof implementation of QIPP schemes. Receive updates on both the financial and activity performance of each scheme achievement against CCG incentive schemes. Receive a report of the actual and forecast performance to inform the achievement of incentive schemes implementation of investments / transformation schemes. Receive updates outlining financial, activity and delivery against key performance indicators for each scheme. Receive and review departmental delivery plans for indicators or performance areas by exception. Challenge delivery plans produced to achieve targets or improve performance. Resolve key performance issues raised by accountable members of the Senior Management Team. Identify and allocate resources where appropriate to improve performance. Oversee the development of new schemes and services, approving the appropriate business cases while ensuring that all necessary evidence is provided to support the decisions made. Make recommendations to the Governing Board on the commissioning and decommissioning of services, including overseeing an investment prioritisation process on behalf of the Governing Board. Receive and act appropriately on evaluations of pilot projects and services.
7.11 Receive commissioning finance and performance governance related policies for expert view and approval prior to submission to the Governing Board.
7.12 To form and dissolve any sub groups as deemed necessary to progress the requirements of the Sub Committee.
7.13 Receive regular assurance reports from groups aligned to the committee. Monitor action plans submitted by any sub-group of the Committee.
7.14 Review and agree terms of reference for all groups that report directly into the Committee to ensure that membership and functions are satisfactory.
8. Administration 8.1 The Committee will have nominated secretarial support to provide continuity in the organisation and execution of meetings. The secretary will be responsible for supporting the Chair in the management of the business of the Committee
8.2 Full minutes will be kept of all meetings, and circulated by confidential means.
8.3 The Committee will provide a calendar of business to ensure that its reporting arrangements on all aspects of commissioning, finance and performance are clear and robust; this will be updated on an annual basis.
8.4 Agendas and papers will be distributed to Committee members at least 3 working days in advance of the meeting.
8.5 Conflicts of interest are to be declared and recorded at the beginning of each meeting and/or at any point where a conflict arise. If a conflict arises, then the Chair may request members to withdraw at the appropriate discussion point.
8.6 The Committee will conduct its business at all times in accordance with any national guidance and relevant codes of conduct and good governance practice. The Committee will have regard at all times for the Nolan seven principles of public life.