Public Meeting of Stoke-On-Trent

PUBLIC MEETING OF STOKE-ON-TRENT CLINICAL COMMISSIONING GROUP GOVERNING BODY Tuesday, 4th August 2015 at 1.30pm – 4.00pm The Minton Room, Stoke-on-Trent Clinical Commissioning Group, Herbert Minton Building, 79 London Road, Stoke-on-Trent ST4 7PZ

AGENDA

Decision / Enc / Agend To Note / Item Item description Table / a No Discussion / Presenter Pres. Information Welcome and Apologies for Absence PR 1 Verbal To Note 1.30pm Declarations of Interest

In accordance with Standing Order 7.3.2 (i) members PR 2 Verbal To Note and non-members are asked to declare interests 1.30pm

which are relevant and material to this meeting Dr Prasad Rao, CCG Chairman Confirmation of Quoracy (following consideration of PR 3 interests declared pertaining to the agenda) Verbal To Note 1.30pm Dr Prasad Rao, CCG Chairman Minutes from previous meeting held on 2nd June 2015 Enc 4.1 Action List and Matters Arising Enc 4.2 PR 4 Minutes from the Annual General Meeting held on 30th Enc 4.3 To Note 1.30pm June 2015 (10 mins) Dr Prasad Rao, CCG Chairman PR Chairman’s Address 5 Enc 5 To Note 1.40pm Dr Prasad Rao, CCG Chairman (10 mins) Clinical Accountable Officer’s Report AB  Executive Forum Chair’s Report To Note / 6 Enc 6 1.50pm  Planning Committee Chair’s Report Decision (15 mins) Dr Andrew Bartlam, CCG Clinical Accountable Officer Audit Committee Chair’s Report 26th May 2015 JH Audit Committee Chair’s Report 14th July 2015 Enc 7.1 Decision 2.05pm 7 John Howard, Chair of the Audit Committee and CCG Enc 7.2 (10 mins) Lay Member Governance IS Governing Body Finance Report 8 Enc 8 To Note 2.15pm Iain Stoddart, CCG Chief Finance Officer (15 mins) Governing Body Assurance Report C Leads 9 Dr Andrew Bartlam, Clinical Accountable Officer; Enc 9 To Note 2.30pm CCG Clinical Leads (40 mins) Quality Report 10th June 2015 LC Quality Report 8th July 2015 Enc 10.1 10 To Note 3.10pm Lorraine Cook, CCG Head of Quality and Governance Enc 10.2 (10 mins)

Clinical Accountable Officer: Dr Andrew Bartlam Chairman: Dr Prasad Rao

Risk Register LC To Note / 11 Lorraine Cook, CCG Head of Quality and Governance Enc 11 3.20pm Decision (5 mins) Patient and Public Engagement / Patient Congress Update AV/MW 12 Dr Asuri Vasudevan, CCG Clinical Director Children, Verbal To Note 3.25pm Young People and Maternity and PPI (10 mins) Margy Woodhead, CCG Lay Member - PPI Equality & Inclusion Updates on Progress JA • EDS 2 (Equality Delivery System) Enc 13.1 13 Decision 3.35pm • WRES (Workplace Race Equality Standard) Enc 13.2 (10 mins) Julia Allen, Equality and Inclusion Business Partner West Midlands Ambulance Service Contract 2015-16 - MW Improving the Delivery of Out of Hospital Care 14 Enc 14 To Note 3.45pm Marcus Warnes, Interim Accountable Officer North (10 mins) Staffordshire CCG

LC Complaints Annual Report 15 Enc 15 Decision 3.55pm Lorraine Cook, Head of Quality and Governance (10 mins)

Any Other Business

 Questions from the Public PR 16 Verbal Information  Any other key issues 4.05pm Verbal

DATE/TIME OF NEXT MEETING: Date Time Venue Chair The Minton Room, Stoke-on-Trent Tuesday 6th October 2015 1.30pm PR CCG, 79 London Road, ST4 7PZ The Minton Room, Stoke-on-Trent Tuesday 1st December 2015 1.30pm PR CCG, 79 London Road, ST4 7PZ

Clinical Accountable Officer: Dr Andrew Bartlam Chairman: Dr Prasad Rao

Agenda Item 4.1

Minutes of the Public Meeting of Stoke-on-Trent Clinical Commissioning Group Governing Body Held on Tuesday 2nd June 2015 at 1.30pm – 4.00pm The Minton Room, Stoke-on-Trent CCG, Herbert Minton Building, 79 London Road, Stoke-on-Trent UNCONFIRMED MINUTES

Present: Dr Prasad Rao (Chair) (PR) CCG Chairman Dr Andrew Bartlam (AB) CCG Clinical Accountable Officer Iain Stoddart (IS) CCG Chief Financial Officer John Howard (JH) CCG Lay Member – Governance Dr Chandra Kanneganti (CK) CCG Clinical Director, Community Services, Long Term Conditions and End of Life Margy Woodhead (MW) CCG Lay Member – Patient and Public Involvement Dr Steve Fawcett (SF) CCG Clinical Director, Acute Services Dr Waheed Abbasi (WA) CCG Clinical Director, Mental Health & Specialist Dr Simon Mellor (SM) Groups Lorraine Cook (LC) CCG Secondary Care Doctor Dr Asuri Vasudevan (AV) CCG Head of Quality and Governance CCG Clinical Director Children and Young People’s Rachel Barker (RB) Services and Patient Public Involvement In Val Lewis (VL) CCG Executive Assistant attendance: Filippa St Aubin D’Ancey (FD) Manager, HealthWatch Stoke-on-Trent Lesley Mountford (LM) Communications and Press Manager Public Health Director David Rogers (DR) Apologies: Sandra Chadwick (SC) Communications and Press Manager Louise Rees (LR) CCG Chief Operating Officer Interim Director of Adult Social Care and Protection, Zafar Iqbal (ZI) Stoke City Council Dr Harald Van Der Linden (HvdL) Public Health Representative LMC Secretary Roise Trainor (RT) CCG Nurse Board Member

Members of Edna Fynn Member of the Public the Public: Ian Syme Member of the Public Dave Blackhurst Member of the Press (The Sentinel) Mr Gallimore Member of the Public Robert Cheatle Actavis Anne Brassington Member of the Public Karen Whitfield Member of the Public K. Lester Member of the Public J. Blackshaw Member of the Public S. Young TEVA Frank Gallimore Member of the Public F. Ahmad Vision K. Hopkins Vision J. Wright Mylan Ken Hampson Member of the Public

Action

Agenda Item 4.1

1. Chairman’s Introduction, Welcome and Apologies PR welcomed members to the Governing Body meeting and welcomed Iain Stoddart in his role as CCG Chief Finance Officer.

IS provided a brief introduction to members of the Governing Body and the public.

Apologies for absence were noted as above.

2. Members’ Declaration of Interest There were no Declaration of Interests declared.

The Declaration of Interest Register was available for review at the meeting. 3. Confirmation of Quoracy The meeting was confirmed as quorate.

4. Minutes from previous meeting held on 7th April 2015 The minutes of the meeting held on the 7th April 2015 were noted and agreed as a true and accurate record of the meeting.

5. Chairman’s Address PR presented the report to provide an address to the meeting of Stoke-on-Trent Clinical Commissioning Group Governing Body. Details as follows:

PR thanked all of the teams both within the CCG and the frontline staff across the health economy for their continued hard work.

Financial Recovery PR highlighted that the Joint Financial Recovery Group continued to meet on a regular basis between Stoke-on-Trent and North Staffordshire CCG.

Step Up / Step Down PR highlighted that Stoke-on-Trent CCG and North Staffordshire CCG spent the period from January to March 2015, seeking the views of the public, patients and others about a proposed new model of care. A number of engagement events and activities had taken place and patients and the public were asked to share their views about the proposed model of care. The feedback had been analysed and both Stoke-on-Trent and North Staffordshire CCGs were considering the findings and this information would be used to develop the model further.

Q3 Assurance PR highlighted that members of the CCG Governing Body met with members of the NHS England Area Team on the 24th March 2015, to discuss the third quarter assessment of Stoke-on-Trent CCG. NHS England were assured in four of the six domains. The formal letter from NHS England was enclosed for members review.

Collaborative Working PR highlighted the continued collaborative working with North Staffordshire CCG, and the combined weekly Director meetings between the two CCGs to ensure that both continued to work in a strategically and operationally integrated way.

PR reiterated that both CCGs were clear that this represented strong and effective collaboration, and not a merger, and that each CCG would continue to work to their 2

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respective constitutions and for their respective member practices, ensuring that local determination and sovereignty was paramount.

Operational Plan PR confirmed that the CCG’s Operational Plan – “Putting Patients First”, for April 2015 – March 2016, was submitted to NHS England in April. A considerable amount of work had been undertaken to ensure that the plans were realistic, robust and that patients remained central in all considerations around clinical commissioning. The final version of the plan would be made available on the CCG website imminently, and a patient and public friendly version would be produced which would be used to promote the plan with the public. There was a positive track record of achievement in Stoke-on-Trent and the CCG would continue to aim to deliver on the plans.

Social Prescribing PR highlighted that the Voluntary Sector “Social prescribing” HUB had commenced and that it was an innovative service and a positive example of partnership working. The local voluntary, community and faith sector partners had welcomed its introduction.

Rosie Trainor, Interim Executive Nurse Board Member PR advised that Rosie Trainor, Interim Executive Nurse Board Member for Stoke-on-Trent Clinical Commissioning Group had commenced her role within the CCG.

The Governing Body duly noted and received the Chairman’s Report.

6. Clinical Accountable Officer’s Report AB presented the report to provide the Governing Body with an update of issues and in particular items of business discussed at sub-committees of the Governing Body. Details as follows:

AB highlighted that the report provided details of all of the Governing Body Committees chaired by himself that had taken place between Governing Body meetings.

Organisational Development Committee AB advised that the Organisational Development Committee held its first Committee in common with North Staffordshire CCG on 25th March 2015. The meeting was used to scrutinise and appraise both CCGs Organisational Development Committee Terms of Reference and describe a way forward working more collaboratively.

Executive Forum AB advised that the Executive Forum had met on the 24th March and the 28th April since the last meeting of the Governing Body and highlighted the main terms of business (1) The Executive Forum had agreed the preferred option of a Restricted Procedure to re-specify the Urgent Care Centre / Out Of Hours Service with the current provider; (2) approved the Risk Stratification Policy; (3) agreed the option to work on a pan-Staffordshire approach to managing and funding Out Of Area Placements for Mental Health And Learning Disabilities; and (4) agreed not to approve the Prescribing Incentive Scheme (PRIS) 2014/15 And Impact of Fair Shares Budgets payment rules modification.

A discussion took place around the pan Staffordshire working and that this would be undertaken where possible. This would help to increase the capacity and capability of the CCG.

Agenda Item 4.1

Planning Committee AB advised that the Planning Committee had met on the 14th April and the 12th May since the last meeting of the Governing Body. The main items of business at each meeting were highlighted (1) the approval of the Urgent Care Strategy was recommended; (2) the approval of the proposed direction of travel of the £5 per head LES was recommended; (3) the direction of travel and proposals on what to include in the Quality Improvement Framework (QIF) was endorsed; (4) approval of the POLCV Policy Excluded and Restricted Procedures following an EDS assessment was recommended; (5) approval of the Consultant to Consultant Policy was recommended; (6) the Care Homes Strategy was recommended; (7) approval of the Frail Elderly Strategy was recommended; (8) approval of the Long Term Conditions Strategy was recommended; and (9) approval of the Dementia Strategy pending amendments around prescribing and carer support was recommended.

JH questioned if there had been any further development regarding the GP and Practice Nurse recruitment and highlighted the extent of the challenge.

AB advised that CK had taken on the role of Primary Care Clinical Director for Stoke-on-Trent CCG and that a 27 point action plan had been produced.

A discussion took place around (1) the age profile of the doctors within Stoke-on-Trent; (2) the nursing workforce levels; (3) the work with the Area Team and NHS England; (4) the need to retain trainees; (4) the need for incentives; (5) the broader national issue; (6) the national incentive to encourage doctors back to the UK; and (7) that the CCG was investigating federated working and that there were ongoing discussions with both the membership and the LMC around the issues.

SF highlighted that in order for the Urgent Care Strategy to be effective there needed to be an efficient Primary Care.

The Governing Body duly received and noted the Clinical Accountable Officer’s Report and approved (1) the Urgent Care Strategy; (2) the proposed direction of travel of the £5 per head LES; (3) POLCV Policy (Excluded and Restricted Procedures); (4) Consultant to Consultant Policy; (5) Frail Elderly Strategy; (6) Long Term Conditions Strategy; and (7) the Dementia Strategy.

7. Annual Report Of The Audit Committee 2014 / 2015 JH presented the report to provide assurance of the activity undertaken by the Audit Committee during 2014/2015, and to highlight key areas of achievement. In addition, the annual report identifies areas of further development and focus moving into 2015/2016. Details as follows:

JH advised that the Annual Report provided written assurance of the activity undertaken by the Committee during 2014/2015 and covered the following areas (1) Terms of Reference and Membership; (2) Attendance at Meetings during 2014 / 2015; (3) Training; (4) Administration and Support; (5) Internal Audit; (6) External Audit; (7) CCG Risk Management and Assurance Framework; (8) Financial Performance; (9) Information Governance; (10) CCG Annual Report and Annual Accounts 2014/2015; (11) Other matters considered by the Committee; and (12) Committee Self-Assessment (review of 2013/2014 areas for development and identified areas for 2014/2015).

JH thanked Lisa Taylor (Quality and Governance Manager) for the drafting of the Audit Annual Report, advised that the report was in the standard format; and highlighted the key 4

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areas for members attention including (1) the rag rating by Internal Audit on areas reviewed as part of the Internal Audit Plan for 2014 / 2015; (2) the mitigating actions put in place following the QIPP review; (3) the level of assurance provided from the Head of Internal Audit in the form of the Head of Internal Audit Opinion; and (4) the standard of work.

PR and AB both thanked JH and the committee for the thorough update and level of scrutiny.

The Governing Body duly noted the contents of the Audit Committee Annual Report for 2014/2015.

8. Audit Committee Chair’s Report – Meeting Held On The 21st April 2015 JH presented the report to provide the Governing Body with an update of issues discussed at the Audit Committee meeting held on the 21st April 2015. Details as follows:

JH summarised the items discussed at the meeting (1) the Draft Annual Report and Annual Accounts 2014/2015; (2) the External Audit Update (including Benchmarking your Annual Report, Informing the Audit Risk Assessment, Audit Progress and Emerging Issues Report, Fee Letter 2015/2016); (3) the Internal Audit Annual Report 2014/2015 and Supporting Compendium; (4) the Internal Audit Strategy for 2015/2016 – 2017/2018 and the Internal Audit Plan for 2015/2016; (5) the Counter Fraud Progress Report and Draft Anti-Fraud Work Plan 2015/2016; (6) the Senior Information Responsible Owner (SIRO) Report 2014/2015; and (7) the Self-Assessment Checklist Update.

JH highlighted that the Audit Committee had also met on the 26th May 2015 in order to receive and approve on behalf of the Governing Body, the Annual Report and Accounts 2014/2015, and advised that the Committee provided the necessary scrutiny and challenge required. External Audit had reviewed the Annual Report and Accounts and provided an unqualified opinion. A full report would be provided to the next meeting of the Governing Body in August.

JH congratulated the CCG on achieving the surplus. AB confirmed that the CCG was no longer in financial recovery.

JH advised that the Audit Committee had recommended approval by the Governing Body to the extension period of the CCG’s Raising Concerns at Work Policy, in order to align the review dates with North Staffordshire CCG. The Governing Body duly agreed to ratify the decision made by the Audit Committee.

AB offered thanks to Adrian Tomkins (Deputy Chief Finance Officer) for his support during the transition period of the Chief Finance Officer role.

MW questioned the use of the accounting language within the report, particularly the use of the word surplus, as this implied that the CCG had money available that they were not spending on services.

IS advised that it was an operating requirement of the CCG to achieve a surplus and this was subject to normal business rules. This ‘surplus’ must carried forward to allow the CCG to spend what was allocated in the following financial year, but if not achieved would have to be taken from the allocation. There was a need to clarify this at the AGM with the public.

The Governing Body duly noted the contents of the Audit Committee Chair’s report of the meeting held on the 21st April 2015, and ratified the extension period of the CCG’s Raising 5

Agenda Item 4.1

Concerns at Work Policy.

9. Finance Report IS presented the finance report to highlight the draft final outturn position for 2014/15. Details as follows:

The report highlighted the pre Audited final outturn position of a £1.697m surplus, which was under the planned control total surplus for 2014/15 of £1.786m, but was a significant improvement from the forecast position of £500k surplus reported at month 11. The final outturn position incorporated the full and final agreement reached with University Hospitals of North Midlands (UHNM) for the main Acute Contract and substantial delivery of the Finance Recovery Plan actions as reported in year.

IS confirmed that the CCG had delivered the surplus for 2014/2015 and that the report highlighted the actual final end of year position, following the audit procedure. The CCG had delivered both the running costs and the cash allowance. The accounts had been lodged with NHS England and were available publically, both on the Stoke-on-Trent CCG website and within the Annual Report.

JH raised a concern around Stoke-on-Trent CCG being described as part of a challenged health economy, when grouped within other CCGs within the Staffordshire footprint, especially as it had achieved its financial targets, as this did not allow the CCG to celebrate its success. The CCG had demonstrated that it had the correct level of grip around finance.

PR reiterated that the CCG had consistently performed well.

AB provided a note of caution for the following year as a number of the successful schemes had been non recurrent. There was a need for the recurrent QIPP to deliver as the financial position was predicated on demand.

IS highlighted the 2015/2016 target and the significant challenge that the CCG would be facing, but reiterated that other CCGs were facing the same issues as the demand on services continued to grow within the NHS. There was a need to ensure that the CCG and the services provided remained fit for purpose, and that new models of care were created. The role of the CCG was to support the direction of travel which should be clinically led.

The Governing Body duly (1) noted the CCG’s improved (pre Audited) final outturn position for 2014/15 of a £1.697m surplus which was £89k below the original planned control total surplus for the year of £1.786m, however represented a significant improvement from the reported outturn position at month 11 of £500k surplus; (2) noted the CCG had delivered its running costs within the set allocation; (3) noted the CCG had delivered its cash requirements; and (4) noted the draft outturn was still subject to formal external audit review and the final audited accounts werereported to Audit Committee on the 26th May prior to submission to NHS England.

10. Governing Body Assurance Report The report was presented to provide assurance to the Governing Body on (1) if local people receive good quality care; (2) if patient’s rights under the NHS Constitution are being promoted; and (3) if health outcomes for local people are improving. Details as follows:

Quality - SF highlighted that 105 C Difficile cases had been reported as at the end of March 2015, against a tolerance of 76 and this was discussed in further detail within the Quality 6

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Report.

A&E – SF advised that the 95% target for 4 hour waits had not been achieved which had increased the pressure in Acute. The CCG was investing leadership and capacity to affect change and had formed an Urgent Care PMO which would work across the Local Health Economy to deliver whole system change (including delivery of the Sturgess recommendations). The high level benefits of this programme had been identified as (1) improving the system’s ability to address and support urgent care needs in a community setting across Staffordshire; (2) a reduction in avoidable ED attendances; and (3) a reduction in the number of and duration of non-elective admissions and timely, safe and discharge home. The 'Whole System Plan' was presented to the Systems Resilience Group on the 14th May 2015 and contained 80+ actions. A draft plan had been submitted to NHS England to highlight how the 90% target would be achieved in July and the 95% target would be achieved from October 2015.

AB confirmed that he chaired the System Resilience Group (SRG) meetings and that the membership included both Commissioners and Providers. All schemes were evaluated and prioritised for greatest impact. There was further work required regarding winter modelling.

MW raised a concern that despite the work that had been done, the situation was not improving and questioned if this was as a result of discharging into community, due to the workforce issues being experienced, or if there were increased admissions to Urgent Care. The key focus needed to be identified to solve the problem.

SF advised that it would unhelpful to focus on just one particular area as there was a system wide issue. The SRG was identifying the issues through capacity and demand plans and the schemes that had been established were the correct ones, but some required further depth.

AB confirmed that the level of activity contracted was correct and had been brought in line with the plan, however there were issues relating to admissions management, length of stay, and the systems in the community.

A discussion took place around (1) the short timelines for the increased trajectories and the consequences of failure; (2) the need for robust modelling within each scheme and the degree of confidence being known; (3) the need for the right level of clinical support; (4) the innovation required to improve the situation; (5) UHNM A&E being a trauma centre; (6) specialised commissioning; and (7) the potential impact of the military base in Stafford.

IS highlighted that military services were the responsibility of NHS England to commission, but the impact on the service would be mapped and assessed.

SF advised that regular audits were completed and unannounced visits undertaken to ensure that UHNM were held to account.

Public Health – LM highlighted the current campaigns and Pan Staffordshire work in relation to preventing people getting ill, to prevent attendance in an urgent care setting.

Community NHS111 – CK advised that the procurement process had been completed. The new contract would commence from 01/10/2015 for five years and would continue to be held by Staffordshire Doctors Urgent Care (SDUC).

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Primary Care Strategy – It was highlighted that this was key to delivering the Five Year Forward view. A Primary Care event had been organised for the 25th June 2015, all practices and key stakeholders had been invited. Views from the event would be combined to create the strategy.

Planned Care SF advised that the 18 week target had been achieved last year, but as a consequence of the major incident experienced at UHNM in January, a large number of operations had been cancelled and the waiting list for operations was at a peak.

Cancer Targets – SF highlighted that the cancer targets remained under pressure.

Cancer Wait 62 Day - 6 out of 60 patients breached the 62 day target. The breaches occurred when the patients were seen and treated at University Hospitals North Midlands. The CCG were not assured regarding the performance and the internal process in place at UHNM. A sub-committee of Primary Care had been established and would continue to monitor the performance.

A discussion took place around (1) the choice and referral system; (2) the public perception of the breaches; (3) the need to highlight the issues with patients; (4) the impact on patient safety and experience; and (5) the comparison to national performance.

LC advised that the assurance had been sought in relation to the patient safety through CQRM. A detailed clinical review and analysis had been provided which confirmed that no patients had to come to harm as a result.

Mental Health IAPT – WA advised that the target had been achieved last year, but noted that at month 1 only 490 of 550 referrals had been achieved. A remedial action plan was in place with the Provider.

WA highlighted that there was a need to work on a proposal for a joint Healthy Minds Service across Stoke-on-Trent and North Staffordshire for 2016/2017. The current North Staffordshire service was working well, but the national report had highlighted capability issues within the Stoke-on-Trent service. Monthly monitoring of the service was being undertaken following the receipt of the trajectories requested for both target and contracted activity from North Staffordshire Combined Health Care NHS Trust for 2015/16.

The Governing Body duly received and noted the Governing Body Assurance Report.

11. Quality Open Report LC presented the report to support the delivery of the CCG vision of ensuring consistent high quality and safe care; and to provide assurance that the structures and processes are in place for sustaining and improving all three domains of quality; positive patient experience, safety and clinical effectiveness. Details as follows:

LC advised that Stoke-on-Trent CCG Quality Committee had met jointly with North Staffordshire CCG Quality Committee monthly since April 2015 and were chaired by either Sally Parkin, Clinical Director for Quality, Partnerships and Engagement of North Staffordshire CCG or Dr Steve Fawcett, Clinical Director of Quality for Stoke-on-Trent CCG as a an interim arrangement until the newly appointed Director of Nursing and Quality begins in post. The Joint Quality Committee met for the second time on the 13th May 2015, and was joined by 8

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Rosie Trainor, the newly appointed Interim Board Nurse for both CCGs.

LC highlighted the key areas discussed at the meeting including (1) Infection Prevention and Assurance; (2) Serious Incident (SI) Framework 2015: Supporting Learning to Prevent Recurrence and Revised Never Events Policy and Framework; (3) Patient Experience; (4) CCG Main Provider Updates; (5) Freedom to Speak Up; (6) The Care Act 2014 Briefing Paper; (7) Provider Quality Accounts 2014/2015; and (8) West Midlands Quality Review Service (WMQRS).

Infection Prevention and Assurance LC highlighted that the Quality Committee received an update in relation to MRSA and C Difficile for the CCG and its Providers. The Head of Infection Prevention and Control (HIPC) presented the end of year infection control figures for Stoke-on-Trent CCG as follows: Non acute MRSA - 5 reported of which 1 was deemed avoidable, 1 was allocated to a 3rd party and 3 were deemed unavoidable. C Difficile - 105 reported cases against an annual tolerance of 76; of which approximately a 3rd were deemed avoidable.

Members also noted the final end of year figures reported for UHNM as follows: Royal Stoke - 75 reported cases of C Difficile against an annual tolerance of 50. Whilst there were RCAs still to be finalised, the vast majority had been deemed unavoidable to the Trust. County Hospital - No reports of MRSA and 23 C Difficile’s against an annual tolerance of 22.

In respect of 2015/2016, members noted that both County and Royal Stoke had reported an MRSA Bacteraemia, and the HIPC had attended the PIR meeting for each MRSA, where initial findings advised that both were deemed avoidable. The CCGs Board Nurse would be meeting with the Infection Prevention Control Lead shortly to discuss the work plan for the year and to identify any further actions required.

LC confirmed that the CCG Infection Control lead attends all Post Infection Review meetings. All cases of MRSA bacteraemia across the Trust would be followed by a commissioner review and visit to ensure that lessons learned were implemented on the unit and across the Trust. The latest visit was undertaken on the 21st April 2015.

Serious Incident (SI) Framework 2015: Supporting Learning to Prevent Recurrence – (NHS England Issued 27th March 2015) Members noted that the revised Serious Incident Framework issued by NHS England had made a number of changes effective from the 1st April 2015. In order to simplify the process of SI management, two key operational changes had been made (1) the removal of grading; and (2) a single timeframe of 60 working days had been agreed for the completion of investigation reports. It was likely that there would be a reduction in the number of incidents reported as SIs over the year due to the change in the criteria application.

LC highlighted that 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.

Patient Experience LC advised that there were 132 pieces of feedback received in quarter 4; a decrease of 21 from quarter 3 and that during this quarter there were 51 PALS enquiries, 58 soft intelligence feedback records, 11 complaints and 5 MP letters. The number of complaints was in line with 9

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previous quarters.

LC highlighted that the CCGs Complaints Policy was being reviewed and would be submitted to the Joint Quality Committee in June 2015.

LC advised members that unannounced visits would continue to be undertaken at A&E.

JH welcomed the detailed information provided in relation to SSOTP and highlighted the continued concerns around the staffing levels at SSOTP which would be discussed at the scheduled Board to Board meeting between Stoke-on-Trent CCG, North Staffordshire CCG and SSOTP.

The Governing Body duly received and noted the Quality Open Report.

12. CCG Corporate Risk Register LC presented the report to provide assurance to the Governing Body that risks are being identified and managed as part of the CCG internal assurance process. Details as follows:

LC confirmed that Risk Owners had reviewed their risks during April and May 2015.

New Risks No new risks had been added to the Corporate Risk Register since the last Governing Body Meeting.

Amended Risks There had been no changes in risk score since the last meeting.

Risks Proposed for Closure There were no risks proposed for closure.

LC advised that there was a piece of work taking place to align the Risk Register between Stoke-on-Trent and North Staffordshire CCGs.

IS recommended that further column be included within the Risk Register to highlight when the action is expected to deliver. ACTION: LC to discuss with the Quality and Governance Manager. LC A discussion took place around the need for narrative, the confidence in delivery, the challenge back to the Governing Body and the risk element of the CCG. ACTION: To discuss LC further at the next meeting of the Quality Committee.

MW welcomed the suggestion and highlighted the need to focus on what has a positive impact for the patient or what progression could be taken to resolve the risk.

The Governing Body duly noted the CCG Corporate Risk Register.

13. Patient And Public Involvement (PPI) / Patient Congress Update AV / MW provided a verbal update on Patient and Public Involvement (PPI). Details as follows:

The report highlighted that the CCG’s PPI Strategy contained a commitment to communicate the nature and content of our PPI and associated work programmes in ongoing ways, via different formats to the public, specific patient and community groups, member general 10

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practices, and local stakeholder organisations and that the update was part of this commitment and assurance.

Patient Congress Update AV highlighted that The Patient Congress met in May and the main agenda items included (1) updates and discussion on key CCG strategic pieces of work that Patient Congress members have been involved with; (2) updates and discussion on activities planned for national Patient Participation Group week; (3) planning and involvement of the Patient Congress in our upcoming engagement event to be held alongside the Annual General Meeting; (4) future ‘meet the congress’ events, with September canvassed for a potential event; (5) the role and remit of Patient Congress members, including payment mechanisms and an agreement for signature; and (6) The Patient Congress would have its first meeting in common with North Staffordshire CCG Patient Congress in July.

Patient and Public Involvement Steering Group Update AV advised that the PPI Steering Group provided assurance in respect of Patient Involvement in the Commissioning cycle, but also reports in respect of the PPI element of the Communications and Engagement Strategy. The group met on the 26th March 2015 and agreed a revitalised way forward for the PPI Steering Group and refreshed the Terms of Reference.

MW highlighted that the PPI Steering Group now reported into the Quality Committee and into the Planning Committee.

MW highlighted that Laura Janda (Senior Planning and Development Manager) was the operational lead for PPI.

PR questioned if the Patient Congress would be involved in promoting the AGM.

MW advised that a meeting was scheduled following the Governing Body to discuss involvement and how members could support the process. Patient Congress members felt there was a necessity to engage with the public at the event.

PR highlighted that there would be increased patient/public involvement at the AGM compared to previous years.

The Governing Body duly noted the Patient And Public Engagement / Patient Congress Update.

14. Cancelled Operations Report SF presented the report which was requested at a previous meeting to provide an update regarding current cancelled operations performance. Details as follows:

SF advised that the local target for 2014/2015 was to maintain the levels reported in 2013/2014. However, the target was exceeded in November 2014. Over the 6 weeks period, between the 17th December 2014 and 27th January 2015 (inclusive), there were 326 Urgent and Cancer operations cancelled. The major incident experienced at UHNM increased the pressure on the beds and impacted on the cancelled operations.

SF highlighted that patient impact from cancelled operations and that there was a personal story behind each and every cancellation, but assurance had been provided that no harm had come to any patients as a result of a cancelled operation. 11

Agenda Item 4.1

SF highlighted that the situation would be monitored through CQRM and a series of internal actions had been undertaken. Assurance had been provided that there was adequate theatre capacity over the summer.

It was noted that a patient story highlighting the impact of a cancelled operation had been provided to a previous closed meeting of the Governing Body. This story highlighted the lack of communication to patients when operations were cancelled with little notice and the wider consequences of this to the patients and their family. Concern was raised with respect to how the decision was communicated to the patient particularly as it had been reported that the clinician had not spoken to the patient directly. This had been fed back to UHNM. The clinician making the decision to cancel the operation should communicate directly to the patient and that this should not be via voicemail or through the administration team.

SF advised that staff at UHNM did not take the decision to cancel operations lightly and that they did not like having to make this decision but often circumstances were outside of their control.

PR praised the public for their understanding during the major incident but expressed the need to ensure that patients were not unnecessarily affected.

JH thanked SF for the report and requested clarity around the draft remedial action plan which had been withdrawn in relation to cancelled operations.

SF advised that there was need to understand the capacity and demand available and that the draft remedial action plan did not take this into account. There would need to be effective dialogue prior to an action plan being created.

IS highlighted the need to triangulate the data to ensure that there was alignment which could be explored at the Director Of Finance meeting.

The Governing Body duly received and noted the cancelled Operations Report.

15. Progress Report Step Up And Step Down (SUSD) Programme CK presented the report to provide an update as requested at a previous Governing Body meeting. Details as follows:

CK advised that the update responded to those questions asked in the context of “Commissioners proposals for a new way to care for the people of Stoke-on-Trent and North Staffordshire”, and the commissioning intentions of, and actions being taken, jointly with North Staffordshire CCG.

CK advised that (1) the move to the model of care continued to progress with an emphasis on putting in place key transformational elements in the Step Up and Step Down approach, for effective practice in the management of patients; (2) commissioners and providers were working towards achievement of the transformational changes required from Step Up and Down by October 2015; (3) formal evaluation panels had taken place to review and recommend the next steps in securing sustainable implementation of new provision; (4) the assurance framework was in place to oversee the implementation of the SUSD; and (5) the engagement and communication strategy for the next phase was being progressed

CK provided an overview of Step Up and Step Down and reiterated that the proposed model had been created as change was needed to utilise how the bed base was used. There was a 12

Agenda Item 4.1

need to manage patients differently and to ensure that the services available were suitable to this.

A discussion took place around the use of Longton Cottage Hospital and Cheadle Hospital, both located within the South of the City (1) that the use of these sites may change; (2) the differences between the facilities in the North of the City; (3) that the proposals were still being developed; (4) the possible impact on the patients within these areas; (5) the change in pathways required; and (6) the need to ensure that appropriate services were in place before any change to the bed base was undertaken.

MW raised a concern that both the hospitals being looked at were in the South of the City and that patients living within this locality were not happy with this and did not feel that they had been consulted with.

CK highlighted that the model would ensure that beds were used more efficiently and effectively and improve the patient experience. Due to the age of the buildings other hospitals within the City were better suited to this model.

AB advised that the use of the beds would be reviewed at the Overview and Scrutiny Committee meeting in September.

JH reiterated the need to ensure that there were appropriate services in place before the bed base was removed.

The Governing Body duly received and noted the Step Up Step Down Progress Report.

16. Questions From The Public Mr Gallimore raised a number of concerns in relation to the perceived closure of Longton Cottage Hospital and highlighted that it was a hospital brought and paid for by the manufacturing industry, given to the residents of Stoke-on-Trent. Mr Gallimore expressed concern that it was only the services within the South of the City that were being affected by closures , whilst facilities in the North of the City were protected, and questioned if the closure of small local hospitals would increase the admissions to UHNM. Mr Gallimore also raised concerns in relation to the nursing workforce and the investment in services in the community.

AB advised that the public were being consulted with regarding any change in services offered at local hospitals and that all views would be considered prior to any decisions being made. UHNM admissions would not be affected as a result of bed closures at Community hospitals.

CK reiterated that consultation had been undertaken and that the use of the sites was being examined. Any decisions made would be in the best interest of the residents of Stoke-on- Trent and the necessary workforce would be available within community services.

Ian Symes highlighted the success of the previous Chief Finance Officers and iterated the need for this to continue now that Stoke-on-Trent and North Staffordshire CCGs had appointed a new CFO.

IS reiterated that he had a wealth of experience to bring to the CCG which would be used for the benefit of the population of Stoke-on-Trent.

Agenda Item 4.1

Ian Symes highlighted a concern in relation to the Step Up Step Down proposal as previous attempts to upgrade the service in the community had failed and that the reduction in bed capacity could have a huge effect on patients, and raised concerns around the consultation and engagement process and the performance of SSOTP. CK advised that no contracts had been signed and consultation had been undertaken. There was continued work with Providers and the service provision was being examined.

PR reiterated that there was a need to ensure that all of the appropriate services were in place to ensure that patients were not affected and that all decisions taken by the CCG were for the benefit of the patients, to ensure that they received the best treatment possible and were not put at risk. There was need to ensure that money was spent in the right place.

Ian Symes raised concerns around the Oregon model and the services highlighted for decommissioning at the North Staffordshire CCG Board meeting.

SF advised that the Oregon model was an analytical/ methodology programme budgeting tool used to assess services. Any services highlighted through the tool were reviewed in detail at CPAG meetings and were not decommissioned, but examined to identify if alternative interventions would be more suitable. Consultation would be undertaken with the public if any services were identified as having no benefit. The process was fully transparent and finance and clinical teams were involved.

IS confirmed that the tool helped to ensure that the money was being spent on the right services and to identify if services were being paid for twice.

Edna Fynn raised concerns in relation to District Nursing (1) the current workforce issues experienced both in relation to recruitment and retention of staff; (2) the lack of full inductions and training being provided to new staff; (3) the training issues and in particular the services offered by District Nurses; and (4) the patient impact, and advised that she had attended the SSOTP Open Governing Board to raise her concerns following the last meeting and had spoken directly to the Nurse Board representative but was not happy with the responses received.

PR advised that the concerns would be raised at the Board to Board meeting scheduled between Stoke-on-Trent and North Staffordshire CCGs with SSOTP.

AB advised that the recruitment and retention of the workforce was key, and that the CCG recognised that the service offered by District Nurses was crucial in the sustainability of Primary Care. Money had been invested by the CCG to SSOTP.

Members of staff from Longton Cottage Hospital raised concern regarding the potential closure of Longton Cottage Hospital, the morale of the staff working there, the lack of open and honest communication from the management teams and the impact on both staff and patients following the closure at short notice earlier in the year. A concern was raised that the decision had already been made to close the hospital and was not being made public.

CK expressed concern around the communication issues between the management teams and the staff employed at Longton Cottage Hospital and reiterated that no decisions had been made to close any sites. Only the services within hospitals was being investigated.

AB highlighted that the temporary closure earlier in the year was as a direct result of patient safety concerns due to the critical staffing levels. The management decision was taken 14

Agenda Item 4.1

internally and this should have been communicated to staff. PR advised that the staffing concerns should be raised at the Open SSOTP Governing Board and advised that these concerns would be raised at the Board to Board meeting scheduled between the organisations. PR reiterated his thanks to all of the staff for their continued hard work.

Dave Blackhurst highlighted the article published within the trade press relating to Cancer and End of Life procurement.

AB advised that the procurement phase was ongoing and therefore the CCG could not comment.

Dave Blackhurst questioned who had been responsible for cancelled operations if these had not been a consultant decision as discussed within the Cancelled Operations report.

SF advised that decisions had been clinician led as far as the CCG was aware, the issues that were raised were relating to the communication to the patient of the cancelled operations, as the CCG had been made aware that it was not always been the consultant who communicated this directly to the patient.

Dave Blackhurst questioned what the 110 treatments were that were discussed in relation to Oregon at the North Staffordshire Governing Body.

SF advised that the lines highlighted were in relation to risks and covered numerous areas. Oregon was a complicated process and involved looking at coding and risk share to ensure that money was being spent in the correct areas.

Ian Symes highlighted a number of complaints that had been received in relation to the lack of follow up / after care for patients that had attended alternative hospitals via the choice and referral centres.

SF advised that work should lead through the Lead Commissioners and that each organisation had their own CQRM who would hold each organisation to account.

PR thanked the members of the press and public for attending the meeting.

17. Date, time and venue of next meeting Tuesday 4th August 2015 at 1.30pm in The Minton Room, Stoke-on-Trent CCG, Herbert Minton Building, 79 London Road, Stoke-on-Trent.

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 actions carried out promptly without waiting for the issue of the minutes.

These minutes are signed as being a true record of the meeting, subject to any necessary amendments being made, which will, if any, be recorded in the following meeting’s minutes.

Signed: ......

Position: ...... Date:......

Agenda item 4.2

Action Tracker 4th August 2015 (Public Meeting)

MEETING REFERENCE AGENDA ITEM Action Responsible Outcome / update DATE Officer 02/06/2015 12 CCG Corporate To include an additional column within the Risk LC to discuss Risk Register Register to highlight when the action is expected with the to deliver. Quality and Governance A verbal update will be Manager provided at the meeting. To discuss the need for narrative, the confidence in delivery, the challenge back to the Lorraine Cook Governing Body and the risk element of the CCG at the next meeting of the Quality Committee.

Agenda Item 4.3

Minutes of the Annual General Meeting of Stoke-on-Trent Clinical Commissioning Group Governing Body Held on Tuesday 30th June 2015 at 11.30am – 12.30pm The Kings Hall, Kings Road, Stoke-on-Trent, ST4 1HH UNCONFIRMED MINUTES

Present: Dr Prasad Rao (Chair) (PR) CCG Chairman Dr Andrew Bartlam (AB) CCG Clinical Accountable Officer Iain Stoddart (IS) CCG Chief Financial Officer Sandra Chadwick (SC) CCG Chief Operating Officer John Howard (JH) CCG Lay Member – Governance Margy Woodhead (MW) CCG Lay Member – Patient and Public Involvement Dr Steve Fawcett (SF) CCG Clinical Director, Acute Services Dr Waheed Abbasi (WA) CCG Clinical Director, Mental Health & Specialist Dr Simon Mellor (SM) Groups Dr Chandra Kanneganti (CK) CCG Secondary Care Doctor CCG Clinical Director, Community Services, Long Term Dr Asuri Vasudevan (AV) Conditions and End of Life CCG Clinical Director Children and Young People In Lorraine Cook (LC) Services and PPI attendance: CCG Head of Quality and Governance Rachel Barker (RB) Lisa Taylor (LT) CCG Executive Assistant (minutes) Laura Janda (LJ) Quality and Governance Manager Filippa St Aubin D’ancey (FsaD) Senior Planning and Development Manager Robin Scott (RS) Communications Lead Manager Communications Manager Rosie Trainor (RT) Apologies: Val Lewis (VL) CCG Interim Nurse Board Member Zafar Iqbal (ZI) Manager, Health Watch David Rogers (DR) Public Health Representative Communications Team Manager Louise Rees (LR) Interim Director of Adult Social Care and Protection, Dr Harald Van Der (HvdL) Stoke City Council Linden LMC Secretary

Action 1. Chairman’s Introduction and Welcome PR welcomed members to the second Stoke-on-Trent CCG Annual General Meeting and introduced members of the Governing Body to the public in attendance. PR thanked members of the CCG for their continued commitment to the population of Stoke-on-Trent and extended his thanks to all the hard working front line healthcare staff. PR thanked Laura Janda and the Communications Team for their hard work in creating the event.

PR highlighted the positive progress made by the CCG; the ongoing work to ensure that patients receive the best services; the need to work closely with other CCGs and Providers within the Staffordshire footprint to obtain the best possible services and value for patients. PR provided a brief introduction of his role both within the CCG and within the local area as a GP at Belgrave Medical Practice. 1

Agenda Item 4.3

2. Annual Report 2014 / 2015 Presentation AB presented the annual report to the AGM and highlighted (1) the CCG Vision; (2) the CCG values; (3) the strategic aims; (4) the key successes; (5) the areas of improvement required; and (6) how improvements would be driven.

3. Annual Accounts 2014 / 2015 Presentation IS presented the annual report and highlighted his position of Joint Chief Finance Officer for both Stoke-on-Trent CCG and North Staffordshire CCG. IS highlighted (1) the key financial focus for Stoke-on-Trent CCG; (2) what the CCG had done so far; (3) how the CCG spent the money it received during 2014 / 2015; and (4) the challenges and focus for the future.

IS explained the financial surplus and advised that this was mandated by NHS England for the CCG to achieve. Once achieved the CCG could then spend the full resources allocated to it in the following year.

IS highlighted the national deficit of the NHS and the particular challenges faced within the Staffordshire footprint and reiterated the success of Stoke-on-Trent CCG in achieving a surplus when neighbouring CCGs were in financial deficit.

4. Questions from the Public PR introduced the Question and Answer section of the AGM and invited members of the public to raise any questions direct to the Governing Body.

Mike Jones, Haymarket PPG Member questioned the surplus and advised that to a lay person the word surplus suggested a saving by the CCG, at a time when many services were under resourced.

IS advised that the term surplus was a misnomer. The CCG was mandated to achieve its planning figure and a surplus by NHS England in order to receive its full allocation the following year. Failure to achieve the surplus would result in less funding the following year as this would be deducted. CCGs obtained their funding through Parliament via NHS England.

IS highlighted that the funds allocated were weighted to an areas deprivation and population age. Stoke-on-Trent CCG had been underfunded in previous years however this was now being brought up to the correct level although this would be a slow process. There was a need to identify other resources to benefit the local population. IS reiterated that all money allocated was spent on the residents of Stoke-on-Trent and offered to discuss the surplus with individuals in further detail following the meeting if required.

MJ thanked IS for his clarification and advised that the lay person does not always understand the full breakdown and that the terminology can be contradictory to the messages provided. MJ praised the work of the local GPs and expressed the need for patients to understand the difficulties faced and to not waste resources.

Diane Lea, Health and WellBeing Board Chair and Chief Executive of Staffordshire Housing highlighted the need for prevention to reduce admissions and the need to build relationships between the voluntary sector to increase capacity for the future and questioned if the CCG would be taking a lead role in this.

AB confirmed the need to work closely with partners and highlighted the challenge from NHS England to further involve the voluntary sector. 2

Agenda Item 4.3

SC highlighted the lost opportunities particularly around the care of the elderly and the opportunities for influencing the design of services and models of care.

Dr Jagadish Boyapati, local GP expressed his congratulations to the CCG for the performance and the hard work during 2014 / 2015 and advised that he was proud to be a member of the CCG. Dr Boyapati requested further clarification on the investment in community services as a significant proportion of the allocations had been spent within the acute sector.

AB highlighted the Five Year Forward View and reiterated that prevention was a key focus for the CCG across the whole of Staffordshire. The work taking place in collaboration with the Local Authorities, Public Health and the Health and WellBeing Board was critical to drive strategies that would allow money to be transferred from acute to community. There was a need to ensure that the necessary services were in place within the community to allow this transfer to happen. AB highlighted that every £1 spent within the community setting provided a £6 benefit.

Carole Burt, Chief Executive Officer North Staffs Users Group (NSUG) requested further clarification around the work being undertaken in Mental Health and asked if the drive and commitment to improve services was still there.

PR confirmed that the CCG Clinical Director for Mental Health, Dr Waheed Abbasi, was passionate about these services and ensured that this remained on the agenda of all committee meetings.

WA advised that Mental Health remained a top priority for the CCG and highlighted (1) the work which had taken place pan Staffordshire to produce the Mental Health Strategy; (2) the improved access to services for those in crisis; (3) the increased support provided to patients; and (4) the continued work to improve services.

5. Close of Meeting PR closed the meeting and thanked members of the public and members of the CCG for their hard work and continued support and reiterated that the NHS could not make progress without the support of the public.

These minutes are signed as being a true record of the meeting, subject to any necessary amendments being made, which will, if any, be recorded in the following meeting’s minutes.

Signed: ......

Position: ...... Date:......

AGENDA ITEM 5

REPORT TO THE PUBLIC MEETING OF STOKE-ON-TRENT COMMISSIONING GROUP GOVERNING BODY ON THE 4TH AUGUST 2015

TITLE CHAIRMAN’S ADDRESS

PURPOSE To provide an address to the meeting of the Stoke-on-Trent Clinical Commissioning Group Governing Body.

I am grateful for the hard work and dedication of front line staff in primary, community and hospital settings and would like to thank everyone for their continued professionalism and support.

Collaborative Working We continue to work with our neighbouring CCGs, notably North Staffordshire CCG, and our secondary care providers in a collaborative and supportive way to respond to the collective challenges experienced.

The work surrounding collaborative working has continued to be developed and the staffing structure for the majority of staff across both Stoke-on-Trent and North Staffordshire CCGs has been released to staff to continue with collaborative working.

A more formal management of change will commence for staff on bands 8b and above which we are hoping to undertake by September at the latest.

We are also meeting as joint North Staffordshire and Stoke-on-Trent CCG Governing Bodies to work through how we further align the executive functions whilst maintaining our sovereign CCGs. 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 North Staffordshire CCG will allow both CCGs to work more efficiently, to avoid unnecessary duplication and reduce the additional workload.

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 members.

Annual General Meeting The CCG’s Annual General Meeting took place on Tuesday 30th June, held at The Kings Hall, The Kingsway, Stoke-on-Trent. Holding an AGM is a statutory duty for the CCG and is where the CCG presents its final accounts and is held to account for the use of taxpayer’s funds. The event was well attended by members of the public and partner organisations. (Copies of the Annual Report are available on request and the document is available on the CCG website http://www.stokeccg.nhs.uk/annual-reports).

The meeting offered opportunities for the public to meet CCG staff, as well as a variety of Providers and voluntary groups who provided exhibition stands at the event. Senior members of the CCG presented the highlights and achievements of the previous year, the annual reports and accounts, the patient congress and the challenges the future is likely to bring.

Following the AGM a roundtable discussion focussing on the future of healthcare in the city took place. Patients and public were invited to meet members of the organisation to help shape the future of local services through focussed discussions on aspects of the local NHS.

The roundtable discussions included mental health services, hospital services, community services, primary care and quality of care, with attendees encouraged to choose which debate they most wanted to contribute to in advance. This provided an additional forum to identify specific healthcare issues and to celebrate health services locally, and the NHS more generally.

The feedback from the event can be viewed on the CCG website http://www.stokeccg.nhs.uk/you-said-we-did. An action plan will be produced by the 1st October 2015.

Primary Care Stoke-on-Trent and North Staffordshire CCGs held a Primary Care Strategy event for primary care teams on Thursday 25th June to agree shared values and a shared vision for primary care over the next 5 years. The event included breakout sessions which covered 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 were shared with the Joint Patient Congress at the beginning of July and the resultant feedback will help drive the primary care strategy.

CCG Quarter 4 Assurance Informal Feedback The CCG attended the Quarter 4 / Annual Checkpoint Assurance Review with NHS England on 2nd July 2015. The review went well and representatives of the CCG Senior Executive Team had the opportunity to share some of the areas of work that the CCG were proud of.

NHS England provided positive feedback following the review meeting and that they would be recommending to the Regional Team that CCG should be ‘assured’ against five of the six domains. The formal feedback will be provided at the end of July, following a Regional, then National moderation process.

We have had an exceptionally challenging year (which is continuing into this year) and the Executive Team recognise and appreciate the hard work and commitment from every member of the CCG and practices to improve services, quality and care for our patients.

Director of Nursing I am delighted to announce that we have successfully appointed Jayne Downey to the substantive role of Director of Nursing and Quality across Stoke-on-Trent and North Staffordshire CCGs. We look forward to welcoming Jayne when she starts in November.

Director of Community Services It is with regret that we announce that Dr Chandra Kanneganti will be leaving the CCG in his role of Clinical Director for Community Services, Long Term Conditions and Primary Care. Dr Kanneganti has provided invaluable support and been a capable and enthusiastic Clinical Director who has been relied on for novel and creative thinking. He has networked well outside the CCG and provided a broader remit of experience through his other roles and interests. Chandra will be taking on a Board level role within the newly formed GP Federation within Northern Staffordshire to provide support to member Practices.

RECOMMENDATIONS Decision Note X Receive X Information What is required as an Approve outcome from the Governing Body

The Governing Body is asked to receive and note the Chair’s Report.

CLINICAL LEAD OPERATIONAL LEAD AUTHOR Dr Prasad Rao, CCG Sandra Chadwick, Chief Rachel Barker, CCG Executive Chairman Operating Officer Assistant

AGENDA ITEM 6

REPORT TO THE PUBLIC MEETING OF STOKE-ON-TRENT CLINICAL COMMISSIONING GROUP GOVERNING BODY ON THE 4th AUGUST 2015

TITLE CLINICAL ACCOUNTABLE OFFICERS REPORT

PURPOSE To provide the Governing Body with an update of key issues since the last meeting and in particular items of business discussed at sub-committees of the Governing Body.

The aim of these changes is to enable our CCGs and local authorities to be able to work more collaboratively to improve health and social care provision across Staffordshire and Stoke-on- Trent. The overwhelming priority, as always, is to improve quality of care for patients. Initially the Congress will establish three work streams: • Fit and Well • High Risk and Independent • In The System

A launch event for all staff was held in July.

Financial Recovery The CCG has submitted and have had approved the financial and activity plans for the Financial year ahead. The CCG is meeting all system requirements planning to deliver a 1% surplus of £3.7m

The CCG closed the end of the 2014/15 financial year and produced its annual accounts at the end of May and received a clean audit opinion.

The CCG delivered a better than expected end of year position, through financial recovery by NHS England and the implementation of a Finance Recovery Plan, delivering a surplus of £1.697m. This was a significant 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 £1.786.

A&E Performance In terms of national performance metrics, the urgent care system continues to face challenges 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 (95%). There has been a continued effort to improve the service provided and this has been reflected in the past two weeks. Since 5th July the trust has recorded a 90%+ performance in 13 of the last 16 days, averaging just under 92%. However our system wide 1

urgent care system continues to remain under extreme pressure. 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.

Model of Care NHS Stoke-on-Trent and North Staffordshire Clinical Commissioning Groups (CCGs) are considering how they commission community based services for patients who are currently admitted to a hospital bed and have been seeking the views of the public, patients and others about the proposed new model of care. The proposal is to create a new model of care for patients who are admitted to and discharged from hospital. Currently this model is referred to as “Step Up Step Down”.

A “step up” model of care would see a diagnostic and assessment centre introduced in the community, aligned with accessible home-based services, improving the quality of care for all patients’ and avoiding unnecessary admissions into hospital. A “step down” model of care would see a consultant responsible for the patients’ care from the point of acute admission to discharge.

Bed provision within community hospitals is seen as a necessary part of the model, but not the only or main way that patients’ will be cared for in the community, in the future. Commissioners will continue to commission newly redesigned services to deliver care as close to home as possible which may signal a change of use for community hospital beds.

The CCGs are confident that there is sufficient capacity in the community to support people at home whilst consultation on the future of the community hospitals, and Longton in particular, is undertaken. As such, and without pre-empting the outcome of formal consultation, the CCGs are not in a position to continue to meet the significant costs of keeping the wards open using temporary staff for longer than 16 August.

This will in no way pre-empt the consultation we are planning for A New Model of Care, during which the future of Longton Cottage Hospital will be discussed and decided through the formal process consultation lays out.

Chairs reports The recommendations captured in this report provide a summary of business undertaken since the last Governing Body at three of the Governing Body’s sub-committees chaired by the Clinical Accountable Officer, namely: • Organisational Development Committee (9 June) • Executive Forum Committee (26 May and 23 June) • Planning Committee (9 June)

RECOMMENDATIONS Decision X Note X Receive Information What is required as an Approve outcome from the Forum The Governing Body is asked to note the contents of the attached Chairs report and ratify decisions made by the Governing Body sub-committees Chaired by the Clinical Accountable Officer and in particular:

Organisational Development Committee (9 June) The Governing Body is asked to note the items of business and decisions made by of the Joint Organisational Development, in particular approval of the following: • A joint terms of reference will be produced making a formal Joint Organisational Development Committee.

• An Establishment Group will be developed as a sub-committee of the Joint Organisational Committee to look at vacancies and structures and ensure that across Northern Staffordshire we have the capacity and capability to deliver our priorities. • It was agreed that final structures would need to be signed off by the Joint Organisational Development Committee. • The procurement of a development programme to underpin changes to structures has been deferred. • An action plan to address the recent 360 feedback is to be devised. • 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. • Legislative changes which came into effect on the 5th April 2015 relating to the following polices; a) Shared Paternal Leave b) Maternity Policy c) Special Leave. All related polices have been updated to reflect the key legislative changes and will be brought to Governing Body for approval and ratification. • Promotion of ‘Health and Wellbeing’ policy across both organisations in light of sickness absence trends.

Executive Forum (26 May 2015) The Governing Body is asked to note the items of business and decisions made by of the Executive Forum Committee, in particular approval of the following: • There had been an agreed shift in activity this financial year within the West Midlands Ambulance Service, reducing overall ambulance arrivals at the acute trust by 1097 per annum, with a growth value of 2.5%. This was agreed as being manageable, as long as demand management plans delivered expected levels. • Three of the original bidders were still participating in the Cancer and End of Life procurement process and have now proposed to form a consortium • The End of Life technical specification and outcomes framework had been amended and approved by patient champions and recommendations regarding financial principles and payment mechanism were still to be submitted for Programme Board approval. Where relevant, lessons learnt from the Cancer procurement would be incorporated in to the EOLC process to improve and shorten the process where possible.

Executive Forum (23 June 2015) The Governing Body is asked to note the items of business and decisions made by of the Executive Forum Committee, in particular approval of the following: • Members agreed the proposal for a Membership Participation, Development and Transformation Scheme for GP member practices in Stoke-on-Trent CCG for 2015/16. Both North Staffordshire and Stoke-on-Trent CCG are committed to supporting Primary Care to work at scale and develop a Multi-speciality community provider (MCP) model to allow primary care to become a sustainable, able to meet the challenges of seven day working and universal coverage of enhanced primary care schemes. To achieve this, the CCG are committed to support practices to collaborate/ work in a federation and for Primary Care to develop the structure, methods of working and processes to take on this challenge.. • Members agreed funding for Map of Medicine QuickStart/Map Sidebar for use in general practice and within the CCGs choice and referral centre. The anticipated benefits included (1) instant access to comprehensive, evidence- based local pathways; (2) easy access to the Excluded and Restricted Procedures Policy; (3) a reduction in referrals to Tier 4 services; (4) improved utilisation of locally commissioned Tier 3 services; (5) standardised referral pathways across the patch; (6) improved quality of 3

referrals; and (7) instant access to up to date reports. • Members agreed to fund ‘academic’ approaches for general practice teams in Stoke-on- Trent and North Staffordshire to help drive down avoidable usage of A&E and unplanned admissions. • Members received an overview and extensive update of the Step Up Step Down model and a proposal for a ‘plan B’ in the event of not reaching a mutually agreed plan with UHNM or SSOTP. It was agreed that the Executive Forum would recommend approval of Option B to the Governing Body but continue to complete work around the Step Up Step Down model with Provider’s, to identify if an agreement could be reached. • Members received the MOU between Stoke-on-Trent City Council Public Health and Stoke-on-Trent CCG which outlines how we will work together to ensure improvements in population health and wellbeing, through effective commissioning of health and other services, disease prevention and health improvement.

Planning Committee (9 June) The Governing Body is asked to note the items of business and decisions made by the Planning Committee, in particular approval of the following: • Members received an update on the Health Education West Midlands (HEWM) workforce returns process for our three major providers which is undertaken annually and asks specific questions on workforce modelling. The three main providers in Northern Staffordshire have all been assessed as ‘partially assured’ by commissioners using the criteria set out by HEWM. • Planning Committee agreed to commission a prime provider to deliver the entire Stroke Pathway further to receiving a report outlining the redesign of the Stroke Pathway Commissioning Model. The ‘Prime Provider’ model will deliver the greater benefit both financially and operationally, in securing the full integration of acute, community and voluntary sector Stroke services across the LHE, and eliminating the potential for double payments for episodes of care in the acute and bed-based rehabilitation phases of the Stroke pathway. • Members approved the combined TECS Strategy / Implementation Plan which aims to (1) continue the ongoing development and implementation of the Staffordshire cross- economy TECS strategy in the delivery of health and social care along agreed patient pathways, (2) to develop and rollout technological solutions and enhancements for cost effective delivery of safe, good quality care for people with long term conditions and (3) to promote clinician / patient shared care via various modes of digital delivery e.g. Flo Simple Telehealth. The Planning Committee approved the TECS Strategy / Implementation Plan.

CLINICAL LEAD OPERATIONAL LEAD AUTHOR Dr Andrew Bartlam, Sandra Chadwick, Laura Janda, Clinical Accountable Chief Operating Officer Senior Planning and Officer Development Manager

AGENDA ITEM 7.1

REPORT TO THE PUBLIC MEETING OF STOKE-ON-TRENT CLINICAL COMMISSIONING GROUP GOVERNING BODY ON THE 4TH AUGUST 2015

TITLE AUDIT COMMITTEE CHAIR’S REPORT – MEETING HELD ON THE 26TH MAY 2015

PURPOSE To provide the Governing Body with an update of issues discussed at the Audit Committee meeting held on the 26th May 2015.

This written report from the Chair of the Audit Committee aims to highlight to the Governing Body the key issues discussed at each meeting, in line with its Terms of Reference and key responsibilities.

It aims to provide the Governing Body with formal assurance on the CCGs, systems and processes reviewed by the Audit Committee, to highlight any areas of concern and support the preparation of the Annual Governance Statement for inclusion in the Annual Report and Accounts.

The attached report provides a summary of items discussed at its last meeting held on the 26th May 2015, as follows: • External Audit Review • CSU Auditor Phase 2 Report • Annual Report and Annual Accounts 2014 / 2015 • Annual Counter Fraud Report 2014 / 2015 • Freedom of Information Annual Report 2014 / 2015 • Audit Committee Annual Report 2014 / 2015 • Scheme of Delegation and Prime Financial Policies • Information Governance Report • Declarations of Interest Quarterly Review • Hospitality and Gifts Register • Update on the Review of the Assurance Framework and Risk Register

RECOMMENDATIONS Decision X Note X Receive X Informatio X What is required as an outcome from Approve n the Forum The Governing Body is asked to note the contents of the Audit Committee Chair’s report of the meeting held on the 26th May 2015, and in particular: • To note the approval of the Annual Report and Annual Accounts 2014 / 2015 by the Audit Committee, on behalf of the Governing Body • To ratify the decision of the Audit Committee to approve the Scheme of Delegation and Prime Financial Policies for a further 12 month period up to May 2016 CLINICAL LEAD OPERATIONAL LEAD AUTHOR John Howard, Lay Member Lisa Taylor, Governance for Governance / Chair of Manager the Audit Committee

Audit Committee Chair’s Report

Report from the Audit Committee Meeting Held on the 26th May 2015

The main purpose of this meeting was to review and approve the Annual Report and Annual Accounts 2014 / 2015, on behalf of the Governing Body, prior to the national deadline for submission of the 29th May 2015. In undertaking this role, the Audit Committee received a range of assurances from External Audit, and year-end annual reports to provide assurances on internal controls in place, as follows:

1. External Audit Review Grant Thornton presented its audit findings to the Committee (to management and those charged with governance) in accordance with the requirements of International Standards on Auditing (UK and Ireland) 260.

Grant Thornton advised of the following key messages which Governing Body members are asked to note: • That they expected to issue an opinion which is unqualified in respect of the main financial statements. • There are no material unadjusted items. There is one item of £0.5m which is detailed within the adjusted items list and all other adjustments identified during the audit have been made within the final set of financial statements. • The notes to the draft accounts were amended for a number of disclosure errors. • A number of adjustments were recommended to improve the presentation of the accounts which the CCG made.

On the basis of the work undertaken by the CCG’s External Auditors, Grant Thornton, and having regard to the guidance on the specified criteria published by the Audit Commission, the CCG’s External Auditors were satisfied that in all significant respects the CCG put in place proper arrangements to secure economy, efficiency and effectiveness in its use of resources for the year ending 31st March 2015.

The Audit Committee noted further work required in relation to journal controls and requested assurance on this at its meeting in September. In addition, it was noted that QIPP will remain a significant challenge to the CCG during 2015 / 2016 although revised arrangements via a Project Management Office (PMO) are now in place, with improved governance arrangements via the Finance Recovery Group.

The final fees charged by Grant Thornton for this audit were confirmed at £75,000 along with confirmation that there were no fees for the provision of non-audit services.

The Audit Committee noted the presentation of the External Audit Findings Report prior to receiving the CCG’s Annual Report and Annual Accounts 2014 / 2015, and approved the content of the Letter of Representation to be signed by the Chair of the Audit Committee and Chief Finance Officer following the meeting.

2. CSU Auditor Phase 2 Report The Audit Committee received a progress report from representatives of the Midlands and Lancashire Commissioning Support Unit (CSU) on the year-end synopsis of the audit review of the CSU, to provide assurances to the CCG of the controls and procedures in place which it undertakes on the CCG’s behalf.

Members noted that areas covered by the audit included the mandated areas of payroll and finance, along with contract management, which was chosen by CCGs to review.

The Audit Committee received assurance that recommendations from mid-year reports had been actioned, and for the exceptions above objective level from the year-end report a process is now being established with auditors to address these. The Audit Committee requested the action plan with clear timelines against at its next meeting in July 2015 to receive assurance on progress in this area. Particular assurance was requested around the area of contract management.

3. Annual Report and Annual Accounts 2014 / 2015 Members will recall that the Audit Committee on behalf of the CCG, was given delegated authority by the Governing Body, as stated within its terms of reference, to review and approve the submission of the draft Annual Report and Accounts.

Members received and scrutinised the final Annual Report and Annual Accounts 2014 / 2015, including the contents of the Annual Governance Statement and Remuneration Report. Members noted minor amendments since the receipt of the draft version, following the outcome of the audit process and receipt of the CSU Auditor Reports. In addition, end of year performance and sickness information has been included along with the reference in the Annual Governance Statement that whilst the CCG is assured around the internal governance structures of its Governing Body and Sub-Committees, the CCG needs to be mindful of the emerging concerns regarding the growth of committees and groups external to the CCG, involving a number of external partner organisations. Moving into 2015 / 2016, the CCG needs to be assured in respect of any accountability and decision making arrangements for these groups and the appropriate reporting mechanisms into the CCG governance structures. In addition, the CCG needs to continue to ensure that it remains clinically led with the patient voice at the heart of local decision making, ensuring lay representation / observation where appropriate in all forums.

Following the receipt of the External Audit Findings Report earlier in the meeting, and the presentation of the Annual Report and Annual Accounts by CCG officers, the Audit Committee were happy to approve, on behalf of the Governing Body, the submission of the Annual Report and Accounts 2014 / 2015 to NHS England by the national deadline of the 29th May 2015.

4. Annual Counter Fraud Report 2014 / 2015 The CCG’s Counter Fraud Service providers, CW Audit Services, presented the Annual Counter Fraud Report for the period 2014 / 2015 and confirmed 31.4 days had been utilised throughout the year against 43 days allocated. The under-utilisation of days is linked to the reactive element of the workplan not being utilised as whilst there have been 3 referrals to the service during the year; no full investigations have taken place.

Members received positive assurance of the high number of responders within the CCG through the staff survey to measure Counter Fraud awareness and gain feedback for future planning work.

Members were appraised of an ongoing piece of work focussing on Continuing Healthcare for all CCGs, of which Stafford and Surrounds CCG are the lead commissioner on behalf of all CCGs locally. The final report will be shared in due course however the Committee requested an update at its next meeting from Counter Fraud along with a report on the Continuing Healthcare process to understand further the processes in place, to receive assurance that this situation is improving.

5. Freedom of Information (FOI) Annual Report 2014 / 2015 The Committee received the FOI Annual Report 2014 / 2015 noting the 230 requests for information received compared to 197 during 2013 / 2014. Members noted that 43 requests were not responded to within the timescale, although these were managed to the respondent’s satisfaction through the negotiation of an extended timescale. The Audit Committee was pleased to note that no requests have been escalated to the Information Commissioner.

Members noted that additional staff have been recruited within the CSU FOI Team and therefore the CCG should notice a further improved proactive service in the future, with the FOI Team offering greater advice and assistance. During 2015 / 2016, the CCG will look to include further information on its website to assist the public in access to information about the CCG.

6. Audit Committee Annual Report 2014 / 2015 The Audit Committee received its draft Annual Report which provided assurance of the activity undertaken by the Committee during 2014 / 2015, and to highlight key areas of achievement. Members supported the development areas identified through its self- assessment, particularly relating to the further development of the Recommendation Tracker Report and the closer link to the Quality Committee, relating to the clinical element of the Risk Register.

This report was received in full by the Governing Body at its meeting on the 2nd June 2015.

7. Scheme of Delegation and Prime Financial Policies The Audit Committee received assurance, on behalf of the Governing Body, that the CCG’s Scheme of Delegation and Prime Financial Policies have been locally reviewed and remains up-to-date and therefore no changes were proposed. The Audit Committee therefore approved the Scheme of Delegation for a further 12 month period, noting that this will be reviewed again in May 2016, or earlier should any changes be required.

The Governing Body is therefore asked to ratify the approval of the Scheme of Delegation and Prime Financial Policies.

8. Information Governance (IG) Report Members received assurance on the progress being made within the CCG in respect of information governance and the CCG’s statutory obligations, and in particular: • A review of the contents of the Caldicott Guardian Log as at 31st March 2015; • The transfer of SIRO responsibility from John Leslie to Iain Stoddart, Chief Finance Officer from the 1st June 2015 with refresher training planned for September 2015. • The IG Service Review meeting planned with the CSU for the 18th June 2015 to discuss the service delivery mechanism from the 1st April 2015 – 31st March 2016, the support available and to agree the Improvement Plan for the CCG.

Members were concerned to note the reduced level of support being provided to the CCG by the CSU and whilst assurance was received that this had been raised with the new SIRO and the CSU and interim arrangements were being made, the Audit Committee requested that this be escalated given the length of time this had continued.

9. Declarations of Interest Quarterly Review Audit Committee members scrutinised the quarterly update of the Declarations of Interest Register for Governing Body Members, as it does at every meeting as a standing agenda item.

To protect both the CCG and its employees from any challenges of actual or perceived conflicts of interest, the Audit Committee discussed how it could be assured that the contents of the register are robust and therefore provide a high standard of assurance to the Governing Body, its Member practices and the population that it serves; and in doing so demonstrate the principles of good governance at all times in terms of openness and transparency.

The Audit Committee was advised by its External Auditors that some NHS organisations have started to compare the content of its Declarations of Interests Register and completed forms, with the information held on the Companies House website. Following discussion, the Audit Committee agreed that this would be a positive step to strengthen its internal controls in this area and therefore has requested that the Quality and Governance Manager undertakes this review during June 2015.

This review will be applied to all voting Governing Body members without exception, with a report on its findings supplied to the Audit Committee at its next meeting in July 2015. These findings will also be shared with the Clinical Accountable Officer as the individual responsible for declarations of interests and their monitoring.

The Governing Body will be updated on the outcome of this piece of work following scrutiny by the Audit Committee of the report and its findings.

10. Hospitality and Gifts Register Members received and reviewed the Hospitality and Gifts Register for the period 2014 / 2015 noting that in line with the CCG’s policies and procedures in relation to gifts and hospitality, staff are advised that they should never put themselves in a position where there could be any suspicion that their business decisions could have been influenced by accepting hospitality from others. Members noted the six entries on the register for 2014 / 2015.

11. Update on the Review of the Assurance Framework and Risk Register Members received assurance on the review process underway to align the Risk Registers across Stoke-on-Trent and North Staffordshire CCGs and the timeline proposed to completion. Members noted that the two registers had been mapped to understand those risks common to both organisations and those separate, and in undertaking this review the principle risks to each organisation will be identified and confirmed.

The Audit Committee will receive the CCG’s Assurance Framework and further progress in this area at its next meeting in July 2015.

John Howard Chair of the Audit Committee / Lay Member for Governance

June 2015

AGENDA ITEM 7.2

REPORT TO THE PUBLIC MEETING OF STOKE-ON-TRENT CLINICAL COMMISSIONING GROUP GOVERNING BODY ON THE 4TH AUGUST 2015

TITLE AUDIT COMMITTEE CHAIR’S REPORT – MEETING HELD ON THE 14TH JULY 2015

PURPOSE To provide the Governing Body with an update of issues discussed at the Audit Committee meeting held on the 14th July 2015.

The attached report provides a summary of items discussed at its last meeting held on the 14th July 2015, as follows: • External Audit Report • Internal Audit Report • Counter Fraud - NHS Protect Commissioning Organisation Self Review Toolkit - Proposed Review Report for NHS Provider Organisations - Overseas Visitor Report • Information Governance Report • Declaration of Interest Detailed Review • Freedom of Information Report – Quarter 1 2015 / 2016 • QIPP Prescribing Issues • Assurance Framework 2015 / 2016 – Progress Report • Commissioning Support Unit Service Auditor Report Action Tracker • Audit Tracker • Cycle of Business • Waiver of Standing Financial Instructions

RECOMMENDATIONS Decision X Note X Receive X Informatio X What is required as an outcome from Approve n the Forum The Governing Body is asked to note the contents of the Audit Committee Chair’s report of the meeting held on the 14th July 2015, and in particular: • Ratify the decision of the Committee to approve the Information Governance Policy, including the Information Governance Management Framework and Improvement Plan for 2015 / 2016. • Ratify the decision of the Committee to re-approve the Information Governance Handbook for a further 12 months. CLINICAL LEAD OPERATIONAL LEAD AUTHOR John Howard, Lay Member Lisa Taylor, Governance for Governance / Chair of Manager the Audit Committee 1

Audit Committee Chair’s Report

Report from the Audit Committee Meeting Held on the 14th July 2015

1. External Audit Report The CCG’s External Auditors, Grant Thornton presented the Annual Audit Letter which summarised the key findings arising from the work carried out at the CCG for the year ended 31st March 2015. Members noted that these detailed findings from their audit work had been reported to those charged with governance in the Audit Findings Report at the Audit Committee meeting held on the 26th May 2015.

Members noted the unqualified regularity opinion provided and detailed within this document which should be made publically available.

A discussion took place regarding understanding the current position on QIPP performance within the CCG and it was agreed that this would be a main agenda item of the next meeting in October. It was noted that this remains a key focus of the Financial Recovery Group and forms part of the work plan for Internal Audit during 2015 / 2016.

2. Internal Audit Report Members received a progress report against the agreed Internal Audit Plan for 2015 / 2016 noting that many areas of the plan were already work in progress and final reports would be received at future meetings.

Minor changes to the audit plan were approved to allow for areas of work to be undertaken in a timelier manner. In addition a Staffordshire-wide Topical Session has been arranged by Internal Audit for the 15th October open to all interested staff focussing on co- commissioning including conflicts of interest, the appointment of External Auditors and contract management.

Members noted that on the 26th October 2015, all RSM International member firms (of which Baker Tilly is one) will unite under a single global brand. Our Internal Auditors name will therefore change from Baker Tilly to RSM. The Committee received assurance that existing contacts and relationships will remain unchanged.

3. Counter Fraud NHS Protect Commissioning Organisation Self Review Toolkit Members received an update on the Commissioning Organisation Self Review Toolkit issued by NHS Protect on the 18th June 2015, to be completed and submitted by the 31st July 2015. Members noted that this piece of work was being completed by the CCG’s Local Counter Fraud Specialist, with liaison with key officers of the CCG. Members were assured that this work was progressing well with deadlines noted.

Proposed Review Report for NHS Provider Organisations Members were appraised of the proposed review reports for NHS provider organisations, as per the NHS Protect Standards for Commissioners Standards 1.9 and 1.10. It was noted that in accordance with the NHS Standard Contract Condition 24; anti-fraud and security management, a review has been undertaken of the Self Review Toolkits submitted to NHS Protect by the lead NHS providers to the CCG. Service Condition 24 places a requirement on commissioning bodies to review the anti-fraud, bribery and corruption provision of all the providers where they are the lead commissioner and the contract value is over £200,000 per year.

Queries have been raised with NHS Protect nationally regarding Care Homes where NHS contracts would reach this value, and therefore potentially included in this assessment.

The Audit Committee noted the completed self-review toolkits for Mid Staffordshire NHS Foundation Trust, Staffordshire and Stoke-on-Trent Partnership Trust and the University Hospital of North Staffordshire (noting these assessments were submitted to NHS Protect before the changes in providers. These assessments have been reviewed and self- assessed rag ratings presented to the Audit Committee. The CCG’s LCFS confirmed that following review of the Self Review Toolkits submitted by the lead providers of NHS Services within the CCG area, that there were no concerns to bring to the attention of the Chief Finance Officer or Audit Committee.

Overseas Visitor Report The Audit Committee received an exception report relating to overseas visitor activity at the CCG secondary care providers and the possible inappropriate costs to the CCG. This followed two published Department of Health reports on the issue of the costs of overseas visitors to the NHS which suggested that activity can have an impact on CCGs budgets.

Following the review undertaken by the LCFS, it was confirmed that identified overseas visitor activity levels relating to Stoke-on-Trent CCG are low, and therefore the fraud risks to the CCG imposed by overseas visitors is low. It was agreed however that awareness raising, of the Hospital Charging Regulations and the associated fraud risks and budgetary implications of referring overseas visitors into secondary care without firstly notifying the Overseas Visitors Department should take place with practices identified as having a higher level of referral than the mean for the CCG. This can be undertaken via the ‘inform and involve’ element of LCFS agreed Anti-Fraud Work Plan for the CCG.

4. Information Governance (IG) Report Members received the IG Report, of which key areas to note are: • There have been no IG related incidents reported since the last meeting. • 3 issues have been recorded on the Caldicott Issues Log since the last meeting. • A full mandatory training programme has been issued for all members of staff for 2015 / 2016 to ensure that the 95% target of staff who have completed their IG training is maintained. • The IG Policy, including the IG Management Framework and Improvement Plan for 2015 / 2016 has been reviewed against legislation, the recently issued version 13 of the toolkit and local arrangements, with minor amendments incorporated. The Audit Committee therefore approved the IG Policy for ratification by the Governing Body. • The IG Handbook has been reviewed with no changes required at this present time. The Audit Committee therefore re-approved the Handbook for a further 12 months, noting that this would be further strengthened in-year if findings from information audits or the implementation of the work plan suggest that this is required.

The Governing Body is asked to: • Ratify the decision of the Committee to approve the IG Policy, including the IG Management Framework and Improvement Plan for 2015 / 2016. • Ratify the decision of the Committee to re-approve the IG Handbook for a further 12 months.

5. Declaration of Interest Detailed Review The Audit Committee has been looking at ways in which it can further strengthen the internal controls in place within the CCG relating to declarations of interest, and as a result provide assurance to the Governing Body of such controls.

At the Audit Committee meeting held in May 2015, members were advised by its External Auditors that some NHS organisations have started to compare the content of its Declarations of Interests Register and completed forms, with the information held on the Companies House website. The Audit Committee agreed that this would be a positive step and all voting members of the Governing Body were advised. Members duly received a findings report of this detailed review presented by the Quality and Governance Manager.

Members noted the limitations of the review whereby a search function by individual name was not available; however a search by company name was undertaken and cross referenced with the contents of the CCG register.

The Audit Committee was pleased to note that interests have been appropriately declared and in a timely manner, with only minor queries raised. The findings report has been shared with the Clinical Accountable Officer as the CCG responsible officer for declarations of interests and their monitoring; who was supportive of the recommendations proposed and will discuss these findings and recommendations at regular 1:1 meetings in the near future.

In addition, a second stage review will be undertaken with Internal Audit to undertake a ‘director’ search. A comparison of any new or amended interests against information contained within Companies House will be undertaken on a quarterly basis or as declared by officers.

6. Freedom of Information (FOIs) Report – Quarter 1 2015 / 2016 Members received the Freedom of Information Report for the period quarter 1 2015 / 2016 noting 54 requests were received. Members noted that whilst the complexity of FOIs is increasing there was a need to understand further the number of FOIs where extensions to response times had been sought and whether process issues were having a negative impact in this area. In addition, members requested that future reports contain a comparison of numbers and themes for the previous quarters to enable further analysis.

7. QIPP Prescribing Issues The Audit Committee received an exception report from the Head of Medicines Optimisation relating to the partial delivery of QIPP targets during 2014 / 2015 and the over performance on the medicines optimisation budget. The Committee discussed the processes behind prescribing budget setting, QIPP allocation and noted the areas of learning identified and being implemented during 2015 / 2016 as a result. Members welcomed the attendance of the Head of Medicines Optimisation to understand these issues further and the medicines optimisation team’s desire to look at how medicines optimisation intervention can benefit savings in other budgets.

8. Assurance Framework 2015 / 2016 – Progress Report In line with the Terms of Reference of the Audit Committee, members were appraised of the work being undertaken to review the contents of the CCG’s Assurance Framework and to identify the principle risks which if not mitigated against, would threaten the delivery of the CCG’s strategic objectives. In addition, to identify where these may be common risks applicable to both Stoke-on-Trent CCG and North Staffordshire CCG, to further support collaborative working with our neighbouring CCG.

Members noted that a draft Assurance Framework 2015 / 2016 had been presented at the weekly Joint Directors Meeting across both CCGs and comments were now being received. Full scrutiny of the revised Assurance Framework is therefore scheduled at the next meeting in October, following the launch of the contents of the Assurance Framework 2015 / 2016 at the Governing Body.

9. Commissioning Support Unit (CSU) Service Auditor Report Action Tracker Members received the CSU Recommendation Tracking Report following receipt of the Service Auditor reports at its last meeting in May 2015. Members noted the good progress and completion of many actions identified relating to financial ledger, payroll, and contract management. Members requested attendance from CSU senior management at the next meeting to appraise the committee of progress to support the contents of the Annual Governance Statement at the appropriate time.

10. Audit Recommendation Tracker 2014 / 2015 Members received the Audit Recommendation Tracker report for the period 2014 / 2015 noting management progress against the completion of agreed actions identified through Internal Audit Reports. Members noted that some updates had not been obtained due to availability of officers and requested that this be updated between meetings and circulated to members to ensure that areas of work remained on target, and to enable officers to be held to account for slippage where appropriate.

The Audit Committee confirmed it would be seeking a 90% completion rate of actions identified during 2014 / 2015 at its next meeting, to ensure these were being implemented in a timely manner. Good progress was noted for recommendations relating to Patient and Public Involvement; however it was noted that lead officer responsibility for this portfolio remained allocated on a temporary basis and more permanent arrangements were required. The Committee agreed to review recommendations within this area further at the next meeting.

11. Cycle of Business Members received the draft Audit Committee Cycle of Business for 2015 / 2016, noting that new areas had been included within the Cycle of Business as a result of the end of year committee self-assessment process, such as a review of the clinical element of the CCG Risk Register, ensuring clear links with the CCG Quality Committee.

Audit Committee members requested minor amendments and approved the Cycle of Business for 2015 / 2016. Members also confirmed their wish to meet privately with Internal and External Auditors (without officer presence) twice yearly moving forward, as supported within the NHS Audit Committee Handbook.

12. Waiver of Standing Financial Instructions The Audit Committee noted the authorisation of a waiver by the CCG’s Chief Financial Officer to renew the Script Switch license software for a further 3 year period in line with the CCG’s Standing Financial Instructions section 17.5.3 (i) where specialist expertise is required and is available from only one source. Confirmation of funding within the CCG’s current budget was confirmed.

John Howard Chair of the Audit Committee / Lay Member for Governance July 2015

AGENDA ITEM 8

REPORT TO THE PUBLIC MEETING OF STOKE ON TRENT CLINICAL COMMISSIONING GROUP GOVERNING BODY ON THE 4TH AUGUST 2015

TITLE GOVERNING BODY FINANCE REPORT

PURPOSE In summary, the Report highlights the month 3 financial monitoring position and the initial forecast outturn position based on month 2 Acute data.

2. The actual ledger position at the end of month 3 and hence the position reported to NHS England differed from the true position being reported due to a final batch of journal entries not being picked up by the national Shared Business Services (SBS) and being processed before the ledger closed. The position reported to NHS England via the ledger as a surplus at month 3 year to date of £376k which was £223k behind a planned surplus of £599k. The CCG has taken swift action to ensure this situation does not arise again by accelerating the month end process by a day.

The month 3 reported position is based on initial month 2 activity data from Providers this is early in the financial year and whilst in month and year to date indicates activity and costs to be below plan does not give enough assurance upon which to base any forecast at this stage.

The CCG has only received Prescribing data for April in time for the production of this report due to the reporting timelines, this report shows spend year to date is currently above plan but will return within plan for the forecast position

To achieve the planned surplus position of £3.7m the CCG must deliver in full the QIPP programme of £10.57m, the majority of which is scheduled for delivery in the latter part of the year and the Step Up and Step Down work programmes still remain uncontracted at this time.

RECOMMENDATIONS Decision Note X Receive X Information X What is required as an outcome from Approve the Forum The Governing Body is asked to :-

1. Note the CCG’s month 3 position which stands at £1.109m surplus. The year to date position is an improvement on the planned £974k surplus position at month 3 by £135k. 2. Note the CCG’s position within this report differs from the ledger position at month 3 and that formally reported to NHS England as a result 3. Note the CCG’s forecast outturn position which is in line with the planned surplus of £3.7m.

1 4. Note the initial month 2 contract performance at UHNM. 5. Note the current and forecast performance against the CCG £10.6m QIPP programme.

CLINICAL LEAD OPERATIONAL LEAD AUTHOR Iain Stoddart, Chief Adrian Tomkins, Deputy Finance Officer Chief Finance Officer

2 Executive Summary: 2015 / 2016 Month 3 Financial Position

This update report for the 2015/16 financial year covers the 3 month period to 30th June 2015. The financial position set out within this report is based on external information provided to the CCG, e.g. Acute activity initial month 2 data and Prescribing data for month 1. 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 3 the CCG Financial Plan baseline resource level stood at £375.810m. This is built up of £369.825m for Programme expenditure which includes £1.697m returned non recurrently for the prior year’s surplus and £5.985m allocation to meet Running costs. The CCG received an additional non recurrent allocation of £728k in month 3 relating to GP IT.

Initial month 2 data received from UHNM indicates at the end on May (month 2) activity and costs appear to be under the contracted levels and would give an underspend of £196k 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 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 3 data has also been received from West Midlands Ambulance Trust and this also indicates activity upto June 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 month 1 against Prescribing, this indicates spend to be above plan, forecast reporting is that spend will return to planned levels as a result of the QIPP programme delivering in full.

Continuing Care information has now been received for expenditure up to June this indicates that costs are currently on plan including accommodating the ‘Top Slice’ expected from NHS England of £1.068m relating to the payment of retrospective claims from pre April 2013. Early reports indicate the Continuing Healthcare QIPP programme over achieved its May 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 3 these costs were £282k 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 £10.57m (net) with the majority of the savings profiled to be achieved in the latter part of the year. Performance to month 3 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.

The CCG reports the monthly position to NHS England through a return called Non ISFE that reflects the ledger position at the close of each month, this then forms part of the Finance & Risk Assurance process that is now in place. A copy of the Non ISFE return for month 3 is attached for information. Due to an issue with journal entries not being processed by SBS as a result of guidance relating to the National treatment of the Continuing Healthcare Top Slice the month 3 ledger position did not reflect the true month end position, this has been picked up by the CCG and actions have been put in place to ensure similar issues do not re occur. This was also discussed at the monthly assurance meeting with NHS England.

In summary whilst the CCG has only received to date month 2 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 act ivity would return to those planned within the current forecast position.

The CCG is reporting a month 3 pos ition of £1.109m surplus year to date and a forecast outturn position of £3.7m surplus, the year to date being an improvement on the planned year to date position by £135k. The forecast position being in line with plan.

The CCG is also reporting an underlying surplus position of £9.84m (2.64%) when removing non recurrent resource allocation and spend.

4 Month 3 2015/16 and Forecast Outturn Financial Summary

CCG Current Position CCG Forecast Annual Stoke on Trent CCG YTD Budget YTD Actual YTD Variance Forecast Variance budget £000 £000 £000 £000 £000 £000 Acute 41,536 41,291 -245 165,885 165,885 0

Mental Health 10,027 10,309 282 40,107 40,107 0

Continuing Care 6,184 6,185 1 21,531 21,531 0

Community 16,377 16,335 -42 59,240 59,240 0

Primary care 14,158 14,209 51 56,632 56,632 0

Other 3,934 4,002 68 15,737 15,737 0

TOTAL PROGRAMME 92,216 92,331 115 359,132 359,132 0

Running Costs 1,496 1,246 -250 5,985 5,985 0

Reserves (incl Contingency) -733 -733 0 6,962 6,962 0

TOTAL SPEND 92,979 93,577 -135 372,079 372,079 0

Surplus 974 0 -974 3,731 0 -3,731

TOTAL 93,953 93,577 -1,109 375,810 372,079 -3,731

CCG Underlying position

Stoke CCG £'m Resource Programme Allocation (month 3) 369.825 Running Costs Allocation 5.985 less non rec surplus return -1.697 Less additional month 3 non rec allocation -0.728 Total Recurrent Allocation 373.385

Expenditure Programme Spend 364.218 Contingency 1.876 Running Costs Spend 5.985 less non recurrent spend (1%) -3.738 less non recurrent spend (CHC Topslice) -1.068 less non recurrent spend (BCF Top Up) -3.000 less non recurrent spend (other) -0.728 Total Recurrent Spend 363.545

Underlying position 9.84 2.64%

5 1. University Hospital of North Midlands (UHNM)

The agreed contract value for UHNM stands at £143.6m following the protracted negotiation round earlier in 2015 and as a result of a contract variation relating to additional A&E activity signed off as part of the final plan approved by NHS England in May. 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.

Summary by Point of Delivery

SLA Month: May 2015 Year to Date Point of Delivery Activity Finance Activity Finance Activity Finance Plan Actual Var % Vol Plan Actual Var % Price Plan Actual Var % Vol Plan Actual Var % Price

AandE 66432 £7,081,177 5535 5714 179 3% £590,485 £607,076 £16,591 3% 10762 10988 226 2% £1,147,795 £1,170,374 £22,579 2%

Day Case 23577 £15,453,227 1766 2016 250 14% £1,171,116 £1,249,929 £78,813 7% 3614 4151 537 15% £2,360,422 £2,543,440 £183,019 8% Elective 4313 £12,117,151 313 284 -29 -9% £891,795 £785,439 -£106,357 -12% 656 602 -54 -8% £1,869,316 £1,630,523 -£238,793 -13% Regular Day Attenders 2169 £782,989 162 1 -161 -99% £58,980 £365 -£58,614 -99% 335 6 -329 -98% £120,833 £1,524 -£119,309 -99%

Emergency 32273 £45,704,271 2758 2605 -153 -6% £3,954,567 £3,883,016 -£71,551 -2% 5405 5027 -378 -7% £7,743,223 £7,597,847 -£145,376 -2% Non Emergency 11795 £8,566,596 996 984 -12 -1% £722,053 £669,380 -£52,673 -7% 1969 1806 -163 -8% £1,426,462 £1,236,189 -£190,272 -13%

Elective XBD 1441 £341,318 103 91 -12 -12% £24,347 £20,540 -£3,807 -16% 218 199 -19 -9% £51,422 £45,968 -£5,454 -11% Emergency XBD 10130 £2,288,651 872 913 41 5% £196,517 £207,028 £10,511 5% 1707 1889 182 11% £385,203 £423,362 £38,159 10% Non Emergency XBD 437 £161,164 35 51 16 46% £12,905 £18,038 £5,133 40% 73 73 0 0% £26,949 £25,930 -£1,019 -4%

Outpatient First 77095 £8,980,184 5815 5667 -148 -3% £677,319 £657,139 -£20,180 -3% 11932 11490 -442 -4% £1,389,580 £1,346,145 -£43,435 -3% Outpatient Follow Up 130804 £8,651,940 9864 9848 -16 0% £652,873 £676,892 £24,019 4% 20237 19998 -239 -1% £1,338,518 £1,352,791 £14,273 1% Outpatient Procedure 22634 £3,886,069 1704 2089 385 23% £293,076 £360,143 £67,067 23% 3487 4210 723 21% £599,261 £724,341 £125,080 21%

Block £3,654,872 £300,642 £300,642 £0 0% £601,285 £601,285 £0 0% Non FCE £25,948,524 £2,016,115 £2,146,276 £130,161 6% £4,121,654 £4,285,762 £164,108 4%

Total £143,618,132 £11,562,791 £11,581,903 £19,112 0% £23,181,922 £22,985,483 -£196,439 -1%

At the time of finalising the Month 3 financial position the CCG was in receipt of the initial month 2 Service Level Agreement Monitoring (SLAM) information, this is shown within the table above and indicates activity levels in A&E, Daycase and Outpatient Procedures points of delivery over- performing along with costs associated but Elective, Emergency and Outpatient attendances to be underperforming. The SLAM report highlights under-performance at £196k for month 2 before data challenges, penalties and other adjustments are applied.

Key variations

• A& E attendances 226 above plan (2%) and £23k over

• Elective / Daycases 154 above plan (3.3%) and £175k under (4%)

• Non Elective admissions 378 below plan (7%) and £145k under (2%)

• Out Patient First appointments 442 below plan (4%) and £43k under (3%)

• Out Patient Follow Up appointments 239 below plan (1%) and £14k over (1%)

Significant validation work continues following receipt of the data to ensure the activity is valid. 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 2 (May) data is still 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.

2. Other main contracts (2015/16)

Staffordshire and Stoke on Trent Partnership Trust (SSOTP)

The final contract value for SSOTP is £55.6m. 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 2 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 £31.1m and operates on a ‘block contract’ basis. Work continues with Combined Healthcare to deliver activity reporting on a ‘Cluster’ basis. Month 3 and forecast positions both reflect spend at planned levels

West Midlands Ambulance (WMAS)

The contract value with WMAS for the Emergency Ambulance service is £9.6m. 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 3 position activity reporting up to month 1 has been received from the Provider, this indicates activity to be 305 journeys below plan (2.3%) this has been built in at month 3 as £44k below planned expenditure levels with activity assumed to return to plan in the forecast position in line with assumptions made throughout the month 3 report.

3. Continuing Healthcare

The CCG has an annual budget for Continuing Care and Funded Nursing Care of £21.5m; this budget also covers the CSU costs relating to the assessment and nursing team. Monitoring information received suggested spend at the end of June to be on plan.

The CCG received written notification from NHS England that it will again be expected to contribute to a National risk pool relating to the payment in year of retrospective continuing healthcare claims, this would equate to £1.07m for the CCG, this spend is now being accommodated within the planned budget.

As part of the 2014/15 Finance Recovery Plan the CCG approved a business case supplied by the CSU that through increased clinical and admin support would result in reduced spend through regular up to date case reviews and workload processing for 2015/16 the anticipated QIPP saving is now £790k, within the month 3 year to date position delivery of £295k of this target has already been achieved £100k above plan the assumption within the forecast is that this scheme will now achieve above its full year target saving and delivery is forecast at £975k.

7 The reported month 3 position is in line with plan, as a prudent assumption the overall forecast position is spend continuing at planned levels.

4. Prescribing

When compiling the month 3 report national Prescribing data up to the end of month 1has been received for 2015/16. This indicates that to the end of April spend was £67k above plan. This is again very early in the year but already poses a risk to the financial position and close monitoring of this spend will continue. The assumption made in this report is therefore that the forecast spend will return to planned levels upon delivery of the QIPP savings.

Within the financial plan there is an expectation that QIPP savings of £822k will be achieved and the Medicines Optimisation team have profiled delivery of these schemes. To date savings totalling £77k have been generated and the expectation and reported forecast is that the full £822k will be achieved by year end.

5. Quality, Innovation, Productivity and Prevention (QIPP)

The final Financial Plan detailed a required QIPP programme of £10.57m net of investment (£11.1m 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 3 report against the areas of focus for the 2015/16 QIPP programme.

Plan at Month Actual Year to date Forecast Annual Plan 3 Delivered Forecast Variance Variance £000 £000 £000 £000 £000 £000 Comments Acute Step Up 4.49 4.49 delivery of savings from October Planned Care 1.00 0.16 1.00 -0.16 UHNM month 2 planned care under plan phased delivery Emergency Activity 0.94 0.23 0.23 0.94 UHNM month 2 unplanned care under plan local data collected re schemes per FRG Other Acute 0.13 0.03 0.08 0.50 0.05 0.37 WMAS under plan month 3 and 111 reprocurement

Mental health OOA 0.40 0.10 0.03 0.29 -0.07 -0.11 savings rephased per workbook scheme being signed off by CCG

Community Step Down 1.33 1.33 delivery of savings from October Pathways 0.67 0.05 0.22 0.05 -0.45 delivery of savings from October

Continuing Care 0.79 0.20 0.30 0.98 0.10 0.19 April over delivered re profile Prescribing 0.82 0.21 0.08 0.82 -0.13 proposed re profile of delivery from Meds Opt

Total 10.57 0.93 0.76 10.57 -0.17 0.00

The Month 3 savings target was £934k actual reported delivery was £765k (81%), £169k 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. Additional savings have been identified as a result of the reprocurement of the NHS 111 service and these are being forecast as £365k.

Of the £10.57m program £7.4m 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.

As a result of the ongoing monitoring at FRG it has been highlighted 2 schemes are now unlikely to deliver the planned levels of savings ie Physio and Mental Health, to mitigate these reduced

8 savings via the Performance and Delivery Steering group further plan B schemes are being identified to ensure the CCG delivers the savings target in full and creates some headroom within the in year financial position to accommodate any future risks

6. Strategic Support

The CCG was required to set aside 1% of its baseline recurrent allocation to be used each year on a non-recurrent expenditure basis, this equates to £3.7m.

This was used as Strategic Support to fund:

• Follow Up Backlog at UHNM £1m • Risk Reserve for Better Care Fund £1.14m • Seasonal Resilience funding of Longton Cottage hospital beds £840k • Accelerated clearance of Continuing Healthcare Retrospective claims £500k • Minor Schemes £240k – Finance Recovery project management and Capacity and Demand modelling.

7. Running Costs

The CCG received a significantly reduced allocation for 2015/16 to deliver the running costs of the Organisation £5.985m. The CCG is not permitted to exceed this allocation; any funds however that are not fully can be used to support additional programme costs.

The month 3 position is reported as £250k below plan due to current vacancies unfilled to June, the reported forecast position is spend returning to planned levels, the CCG continues to work in conjunction with North Staffordshire CCG to ensure maximum efficiency is achieved within the running costs envelope through working in a collaborative way and avoiding duplication wherever possible. There are currently several vacancies within the CCG and these are being reviewed as part of that process.

The breakdown of spend is as below:

Plan £m Forecast £m Variance £m CCG Pay Costs 2.793 2.793 0

CCG Non Pay 1.257 1.257 0

CSU 1.935 1.935 0

Total 5.985 5.985 0

Discussions with the CSU are still not fully concluded with respect to the level of recharge in 2015/16 due to queries on certain aspects on charging levels and the assumption regarding services which are subject to business cases.

8. Balance Sheet

The CCG Statement of Financial Position as at 30th June 2015 shows the level of indebtedness between the CCG and other parties (mainly NHS providers). Significant entries include:

• Accounts Receivable £18.7m. • Accounts Payable £20.1m • Cash £497k - this level of cash ensured the CCG delivered its obligations in relation to cash. • Provisions £0.8m – provisions created relating retrospective continuing healthcare claims and prior year contracting issues

Statement of Financial Position £ Non-FurrenP AssePs 0

Fas h 497,322 AccounPs Receivable 18,694,491 FurrenP AssePs 19,191,813 TOTAL ASSETS 19,191,813

AccounPs Payable 20,141,023 Accrued LiabiliPies 806,480 FurrenP LiabiliPies 20,947,503

Long Term LiabiliPies 0

RePained Earnings incl. In Year (1,755,690) ToPal Taxpayers EquiPy (1,755,690) TOTAL EQUITY + LIABILITIES 19,191,813

9. Cash flow

The CCG plan for 2015/16 is £371.169m 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 30,842 37,013 3,866 3,866 40,879 11.01% 10,037 2.71% May 61,684 62,803 4,162 8,028 70,831 19.08% 9,147 2.47% June 92,525 88,648 4,147 12,174 100,822 27.16% 8,297 2.24% July 123,367 August 154,209 September 185,051 October 215,892 November 246,734 December 277,576 January 308,418 February 339,259 Mar c h 370,101 March Supplementary CHC Ris k Pool Cont 1,068 1,068 1,068 Total 371,169 321,673 49,496 49,496 371,169 100.00% 0 0.00%

10. Better Payment Practice Compliance

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 92.7% based on count for non NHS payables (95.7% by value) and 95% based on count for NHS payables (99.8% by value).

Statistics to the end of June are as follows:

10 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 212 33,519,267 3 9,841 215 33,529,108 98.6 100.0 98.6 100.0 MAY 157 2,234,027 21 90,550 178 2,324,577 88.2 96.1 93.9 99.7 JUN 180 20,289,968 5 38,083 185 20,328,051 97.3 99.8 95.0 99.8 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 549 56,043,262 29 138,474 578 56,181,736 56043.26196 138.47413 56181.73609 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 897 4,341,162 26 31,186 923 4,372,348 97.2 99.3 97.2 99.3 MAY 960 4,775,394 102 473,100 1,062 5,248,494 90.4 91.0 93.6 94.8 JUN 1,094 4,718,285 103 109,937 1,197 4,828,222 91.4 97.7 92.7 95.7 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 2,951 13,834,842 231 614,223 3,182 14,449,065

3,500 69,878,104 260 752,697 3,760 70,630,801 93.1 98.9

AGENDA ITEM 9

REPORT TO THE PUBLIC MEETING OF STOKE-ON-TRENT CLINICAL COMMISSIONING GROUP GOVERNING BODY ON THE 4 AUGUST 2015

TITLE GOVERNING BODY ASSURANCE REPORT

PURPOSE To provide assurance to the Governing Body on the CCGs performance against quality metrics, NHS Constitution targets and NHS Outcomes Framework indicators.

SUMMARY OF DOCUMENT & KEY ISSUES FOR DISCUSSION If Strategy / Business Case / Service Specification need to include the engagement process during the development to gain influence and sign off with Patients/Public/Localities and other Stakeholders. The attached report offers assurance to the Governing Body on the CCGs performance against quality metrics, NHS Constitution targets and NHS Outcomes Framework indicators. The report is by exception and includes only those indicators that are currently at risk or failing. Narrative on key risks, actions and assurance is provided. For the July 2015 assurance report he following indicators are included as at risk: • MRSA and CDiff performance against trajectories • Serious Untoward Incidents • A&E waits • 12 hour trolley waits • Admitted patients to start treatment within a maximum of 18 weeks from referral • Patients on incomplete non-emergency pathways (yet to start treatment) should have been waiting no more than 18 weeks from referral • Patients waiting for a diagnostic test should have been waiting less than 6 weeks • Maximum one month (31 day) wait from diagnosis to first definitive treatment for all cancers • Maximum one month (31 day) wait from diagnosis to surgical treatment for cancer • Maximum two month (62 day) wait from urgent GP referral to first definitive treatment for cancer • Maximum two month (62 day) wait from referral from NHS screening service to first definitive treatment for cancer • Proportion of population accessing psychological therapies (IAPT) • Recovery rate for individuals who access psychological therapies (IAPT)

RECOMMENDATIONS Decision Note Receive X Informatio What is required as an outcome from Approve n the Forum The Governing Body is asked to receive the Governing Body Assurance report.

CLINICAL LEAD OPERATIONAL LEAD AUTHOR Andrew Bartlam Sandra Chadwick Laura Janda Clinical Accountable Chief Operating Officer Senior Planning and Officer Development Manager

GOVERNING BODY ASSURANCE REPORT July 2015

QUALITY UHNM Comments SSOTP Comments CHC Comments WMAS Comments Do provider level indicators from the National Quality Dashboard show that: • Methicillin-resistant Staphylococcus aureus (MRSA) During April 2015, the Trust (including Royal Stoke and County) reported 2 cases of MRSA against a cases are above zero zero tolerance (one at Royal Stoke and one at County). For the Royal Stoke case, this was deemed as avoidable. For the County MRSA case, this was deemed Trust attributable and avoidable. During May, 1 further case has been reported at Royal Stoke, deemed unavoidable, resulting in 3 cases of MRSA reported at UHNM. YES NO NO A range of learning outcomes / actions have been identified, such as: • Assurance around decolonisation and daily cleaning of screening with Senior Nurse rounds. • Further wound care training for staff. • Education on documentation (inserting invasive devices – medical and nursing)

• the provider has reported more C difficile cases The Trust (including Royal Stoke and County) reported 25 Clostridium difficile between April-May Five cases have been reported There was 1 than trajectory 2015, against an annual tolerance of 74. during April-May 2015 (two cases report of in April and three in May 2015), Clostridium against an annual tolerance of 10. difficile reported during April 2015. Whilst the YES YES YES annual tolerance is zero, a PIR is underway to determine if this was avoidable / unavoidable. Does the provider currently have any unclosed Serious Please see narrative below. Please see narrative below. Please see Untoward Incidents (SUIs)? ** YES YES YES narrative below. **National guidance states that this question must be answered ‘YES’ if there are any unclosed SUI’s on the STEIS system. However the National target is zero SI’s open beyond 45 days (60 days for Never Events), as reflected in the CCGs Serious Incident Policy. This is to allow completion of a Root Cause Analysis with closure and sign off by the Commissioner, which then allows for closure on the STEIS system We have no unclosed SUIs over 45 days. However, there will always be unclosed SUI’s on STEIS to allow for investigation to occur. We have raised this at National level. Commissioners have a well-established SI sub group which meets monthly to review all open SI’s and reports to monthly Clinical Quality Review Meeting. There are no issues with SUIs over 45 days at present. NHS OUTCOMES FRAMEWORK 5: Treating and caring for people in a safe environment and protecting them from harm Current performance/trend SOT: Incidence of healthcare associated infection (HCAI) i) MRSA (CCG WIDE) MRSA - There were 2 cases of acute attributable cases of MRSA bacteraemia reported in April 2015. 1 case occurred at the Royal Stoke Hospital Incidence of healthcare associated infection (HCAI) ii) C.Difficile (CCG WIDE) (report not yet finalised), while the other occurred at the Alder Hey Children’s Hospital, Liverpool and was deemed trust attributable and avoidable.

8 C Difficile cases (3 acute and 5 non acute cases) reported as at the end of April 2015, against a tolerance of 87. Key risks: Actions: Assurance: • The adverse effect to patient experience and health in The health economy wide and local infection prevention and control forums are now operational. An IPC strategy and work plan have been developed which • Joint CCG infection Prevention and Control the event of contracting avoidable MRSA Bacteraemia. sit alongside the provider IPC work plans. The commissioning work plan focuses on the following areas: Group chaired by the Executive Nurse Board • The adverse effect to patient experience and health in • MRSA Member. the event of contracting avoidable Clostridium Difficile • Clostridium difficile – reduction of avoidable infections through: • Work plan for the CCG Head of Infection, infection. o Community antimicrobial prescribing, focusing on: Prevention and Control. . Urinary tract infection • Bi-monthly reports to the Quality Committee . Wound infection . Patient and public engagement . Implementation of the Clostridium difficile reduction strategy • Infection prevention and control in care homes • Blood culture contaminants The Infection Prevention and Control (IPC) themed review to the Royal Stoke Hospital at the University Hospitals of North Midlands was initiated in response to the organisation having 6 Trust apportioned MRSA bacteraemia during 2014/15, of which 4 were deemed avoidable, with one of the areas also reporting an outbreak of Clostridium difficile. The Health Economy has established a short term task to finish group focussing on the production of a C Difficile Reduction Plan to be signed off by all parties. The weekly IPC teleconference has been re-established. The HIPC is working closely with Medicines Optimisation.

GOVERNING BODY ASSURANCE REPORT July 2015 Key findings • The Infection Prevention and Control Team (IPT)are seen as an approachable source of advice, support and education • The focus of the IPT is clearly centred around prevention • The IPCT are visible on the wards and are seen as part of the ward team • All staff spoken to stated that they saw IPC as their (the wards) responsibility, with the IPT available for specialist advice, education and information • While the IPT undertake audits, these were not seen as punitive but as supportive to ensure standards were maintained or raised • The ward sisters and matrons appeared to be leading and not afraid to challenge sub-optimal practice • The standard of decoration and environmental cleanliness was excellent, on the whole • All staff were aware of the RCA process and many had been involved • All staff were aware of the findings from the RCA’s and the impact of these upon their practice • All staff we spoke to were patient centred and passionate about the care they gave UNPLANNED CARE Lower Reporting NHS CONSTITUTION Operational Standard SOT Threshold Month A&E waits Patients should be admitted, transferred or discharged within 4 hours of their arrival at an A&E department Stoke-on-Trent CCG Four hour wait Standard 95%

Current 89.1% 95% 90% MAY15 83.2% Percentage of patients who spent 4 YTD hours or less in A&E. (E.B.5) 83.9% 73% 95% 117% 88 88 87 85 83 82 77 79 80 79 80 83 89 n/a 18 months annualised Month Jun-15 JJASONDJFMAMJ # V A LU E! trend to Mar-14

No waits from decision to admit to admission (trolley waits) over 12 hours 0 0 MAY15 6

Key risks Actions: Assurance: 12 Hour Waits FOH - Senior leaders within the CCG are planned to meet with Senior • SRG (including clinical quality sub group) and Urgent Care Business Meeting th Month UHNM National %age Leaders in Royal Stoke on Monday 6 July to discuss options to expand • 12 hour Breach Review Group April 2015 4 52 7.7% the clinical model. June has seen an extraordinary increase in the • Escalation Meetings May 2015 6 28 2.1% numbers of patients being discharged at the point of streaming by 74% • Whole System Plan / SMART plan compared with May. Demand • TDA Exception Report

Demand at the front door managed to below SLA levels January - March • Two tier (Gold and Silver / Strategic and Tactical) on call system in situ A WMAS programme is being developed to support the requirements Month Average Demand SLA +/- of the SRP, to stretch existing targets, report more accurately the December 307 303 +4 whole picture and bring together existing schemes to streamline January 265 301 -36 actions and focus on priorities using best practices models.

February 300 317 -17 March 318 334 -16

April 316 323 -7

May 331 325 +11

UNPLANNED CARE Lower Reporting NHS CONSTITUTION Operational Standard SOT Threshold Month

Ambulance waits Category A calls resulting in an emergency response arriving within 8 minutes (Red 1)2,696 Stoke-on-Trent CCG Ambulance Red 1 Standard 75%

Category A calls resulting in an Current 73.5% emergency response arriving within 8 75% 70% MAY15 73.5% minutes - Red 1 incidents: YTD 78.4% 48% 75% 102% immediately life threatening and the 83 76 83 91 92 80 82 77 70 85 80 86 74 n/a 18 months annualised benchmarking based on Month May-15 most time critical. (E.B.15.i) MJJASONDJFMAM P trend to Mar-14 current month

Key risks: Actions: Assurance: NHS Stoke on Trent CCG SOTCCG – performed above target across all 3 key indicators for May 2015 • Divisional Commissioning Meeting • Job cycle times • Contract Review Board • Handover delays Attempting to align all current contract obligations with the aims of the local LHE. This will • CQRM 2

GOVERNING BODY ASSURANCE REPORT July 2015 • Delivery of the Profiled outcomes (See & treat, Hear & treat, Convey to include all known initiatives including pathfinder and additional Patient Group Directives hospital, convey to an alternative and non-conveyance) (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. The additional PGDs are intended to reduce conveyance by treating more patients at home with the additional drug treatments available to the crews. 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. PLANNED CARE Lower Reporting NHS CONSTITUTION Indicator Operational Standard SOT Threshold Month Referral to treatment waiting times for non-urgent consultant led treatment Admitted patients to start treatment within a maximum of 18 weeks from referral Stoke-on-Trent CCG RTT 18 weeks admitted adjusted Standard 90%

The percentage of admitted pathways Current 82.6% 90% 85% MAY15 82.6% within 18 weeks for admitted patients YTD whose clocks stopped during the 79.8% 67% 90% 113% 88 95 96 94 95 94 95 95 94 82 77 77 83 n/a 18 months annualised period on an adjusted basis. (E.B.1) Month May-15 MJJASONDJFMAM P trend to Mar-14

Patients on incomplete non emergency pathways (yet to start treatment) should have been waiting no more than 18 weeks from referral Stoke-on-Trent CCG RTT Incomplete Standard 92% 92% 87% MAY15 90.5% The percentage of incomplete Current 90.5% pathways within 18 weeks for patients YTD on incomplete pathways at the end of 90.3% 86% 92% 98% 97 97 97 96 96 96 96 95 93 92 91 90 90 n/a 18 months annualised the period. (E.B.3) Month May-15 MJJASONDJFMAM P trend to Mar-14 Key risks: Actions: Assurance: Both CCGs will fail the admitted and incomplete targets up to the end of July Monthly monitoring in place through the Contract Review Board. Monthly Planned Care Performance reported monthly to the Commissioning, Finance and Performance Committee 2015. Operational Group set up. SRG overview. (North Staffordshire) and the Executive Forum (Stoke) and then reported as part of the Contract queries raised. respective CCGs Governing Body monthly assurance reports.

Diagnostics test waiting times Patients waiting for a diagnostic test should have been waiting less than 6 weeks Stoke-on-Trent CCG Diagnostic Wait Standard 99%

Current 98.6% 99% 94% MAY15 98.6% The percentage of patients waiting 6 weeks or more for a diagnostic test. YTD 97.9% 87% 99% 111% (E.B.4) 98 98 99 100 100 98 98 98 98 97 98 97 99 n/a 18 months annualised Month May-15 MJJASONDJFMAM P trend to Mar-14 Key risks: Actions: Assurance: There remains issues with Children’s sleep studies and Endoscopy waiting Monthly monitoring in place through the Contract Review Board. Performance reported monthly to the Commissioning, Finance and Performance Committee times. Provider has informed the CCGs that performance will be back on line Contract Query raised and RAP in place. (North Staffordshire) and the Executive Forum (Stoke) and then reported as part of the from June 2015. respective CCGs Governing Body monthly assurance reports. Cancer waits - 31 days Maximum one month (31 day) wait from diagnosis to first definitive treatment for all cancers Stoke-on-Trent CCG First Definitive Treatment Standard 96%

Current 94.8% Percentage of patients receiving first definitive treatment within one YTD 93.7% 0% 96% 192% month of a cancer diagnosis. (E.B.8) 98 97 97 95 100 99 95 97 90 92 96 93 95 n/a 18 months annualised Month May-15 MJJASONDJFMAM P trend to Mar-14 96% 91% MAY15 94.9% APRIL Stoke-on-Trent CCG – 92.6% 7 out of 94 patients were treated after 31 days. The 6 breaches occurred at University Hospitals of North Midlands (1 x head and neck; 1 x gynaecology; 4 x lung). 1 x upper gastrointestinal -UGI at University Hospitals Birmingham NHS Foundation Trust

Achieved 2014/15 – slightly lower than national performance

Maximum 31 day wait for subsequent treatment where that treatment is surgery 94% 89% MAY15 92.3% Stoke-on-Trent CCG

GOVERNING BODY ASSURANCE REPORT July 2015 Subsequent surgery Standard 94%

Percentage of patients receiving Current 92.3% subsequent treatment for cancer YTD within 31-days, where that treatment 90.3% 77% 94% 111% 92 100 95 100 100 96 94 100 100 82 100 89 92 n/a 18 months annualised is Surgery. (E.B.9) Month May-15 MJJASONDJFMAM P trend to Mar-14

APRIL Stoke-on-Trent CCG – 88.9% 2 out of 18 patients were treated after 31 days.

APRIL North Staffordshire CCG – 88.9% 2 out of 18 patients were treated after 31 days.

Achieved 2014/15 – better than national performance

Key risks: Actions: Assurance: Demand is a key pressure on the pathway. Significant demand peaks were experienced Trajectory Quality issues reported through joint Clinical Quality Review Meeting in April and into May with increases in: Head and Neck (64%), Urology (6%), UGI (8%), UHNM predict that all 31 days targets will be achieved by the end of April 2015. Performance reported monthly to the Commissioning, Finance and Performance Committee Dermatology (56%) and Breast (42%). Drivers for demand are: health profile of the (North Staffordshire) and the Executive Forum (Stoke) and then reported as part of the Staffordshire population, national cancer campaigns, social media, emergency A performance notice will be raised on receipt of confirmed failure of this target in April respective CCGs Governing Body monthly assurance reports. pressures since January 2015 have impacted on elective and cancer pathways. from the Trust (not raised as it was agreed in the end of year contract negotiations that no new notices would be raised in quarter 4 2014/15). Plans that are in place are (see 62 day target). Cancer waits - 62 days Maximum two month (62 day) wait from urgent GP referral to first definitive treatment for cancer Stoke-on-Trent CCG Urgent GP referral Standard 85%

Percentage of patients receiving first Current 72.3% definitive treatment for cancer within YTD two months (62 days) of an urgent GP 73.6% 70% 85% 100% 73 79 81 81 83 89 87 84 69 73 79 75 72 n/a 18 months annualised referral for suspected cancer. (E.B.12) Month May-15 MJJASONDJFMAM P trend to Mar-14 APRIL Stoke-on-Trent CCG – 75.0% 15 out of 70 patients breached the 62 day target. The breaches occurred when the patients were seen and treated at University Hospitals North Midlands (2 x lung; 1 x Lower 85% 80% MAY15 72.3% GI; 1 x Other; 1 x Skin; 2 x Head and Neck; 8 x Urology).

APRIL North Staffordshire CCG – 68.9% 14 out of 45 patients breached the 62 day target. All breaches occurred when the patients were seen and treated at University Hospitals North Midlands (1 x Gynaecological; 2 x haematology; 1 x Lower GI; 1 x skin; 2 x Lung; 5 x Urology, 2 x UGI).

Not achieved 2014/15 – North Staffordshire CCG 81%, Stoke-on-Trent CCG 79.5% - not achieved nationally 83.7%.

Maximum 62 days wait from referral an NHS screening service to first definitive treatment for all cancers Stoke-on-Trent CCG Screening service referral Standard 90%

Percentage of patients receiving first Current 80.0% definitive treatment for cancer within YTD 62- days of referral from an NHS 90.0% 40% 90% 140% 88 67 67 92 100 100 100 100 60 75 86 100 80 n/a 18 months annualised Cancer Screening Service. (E.B.13) Month May-15 MJJASONDJFMAM P trend to Mar-14 90% 85% MAY15 80%

APRIL 2015 – Stoke-on-Trent and North Staffordshire CCGs achieved 100%

Stoke-on-Trent CCG did not achieve 2014/15 - 85.3% North Staffordshire CCG achieved 2014/15 – 90.2%

Key risks: Actions: Assurance: Demand is a key pressure on the pathway. Significant demand peaks were Trajectory Quality issues reported through joint CQRM - 62 day breaches: Route Cause Analysis’ reviewed experienced in April and into May with increases in: Head and Neck (64%), UHNM predict that all target will be achieving all targets by the end of May 2015. from quality aspect through CQRM and will be picked up routinely through Contract review Urology (6%), UGI (8%), Dermatology (56%) and Breast (42%). Drivers for board. demand are: health profile of the Staffordshire population, national cancer A performance notice will be raised on receipt of confirmed failure of this target in April from campaigns, social media, emergency pressures since January 2015 have the Trust (not raised as it was agreed in the end of year contract negotiations that no new Performance reported monthly to the Commissioning, Finance and Performance Committee impacted on elective and cancer pathways. notices would be raised in quarter 4 2014/15). (North Staffordshire) and the Executive Forum (Stoke) and then reported as part of the Plans that are in place are: respective CCGs Governing Body monthly assurance reports.

GOVERNING BODY ASSURANCE REPORT July 2015 • 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 Multidisciplinary Team (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 coordinator to review the forecast position and identify pathway delays. • The Cancer team is relocating to sit within the Surgical Division to improve communication and allow further embedding within Clinical forums. • Intensive Support Team (IST) support (with a focus on reviewing Urology and Lung pathway) • Resolution of pathway issues through the Local Health Economy Cancer Local Implementation Team

MENTAL HEALTH AND SPECIALIST GROUPS TRANSFORMING CARE – LEARNING DISABILITIES NHS England (NHSE) is disappointed with the progress made nationally in discharging long stay patients to community based services. Commissioners have been required to lead Current performance/trend SOT: care and treatment reviews (CTRs) of all those remaining in health services and ensure that there is a clear discharge plan, with timeframes for discharge. Care and Treatment Reviews (CTR) are currently being performed. (Second round of CTRs). Outcomes sent to Area Team. New NHSE Guidance has been given regarding the future of CTRs for patients under Transforming Care Key risks: Actions Assurance: • Small number of patients have been placed in out of area services due • Task and Finish Group established to consider future bed based provision for • Stoke-on-Trent Monthly Transforming Care meeting (North Staffordshire CCG to the complex nature of their needs Learning Disability (LD) patients (including provision of Assessment & Treatment representative, Stoke-On-Trent Social Care and Area Team representative included) • Patients stepped down to CCG commissioning responsibility from services) and/or alternative models of service established to monitor issues and progress Specialised Commissioning colleagues – 12 patients identified as being • Second round of CTR visits are currently taking place, 9 have been completed with • Weekly reporting to NHS England under their remit who are of a Stoke on Trent origin the remainder due in the next few weeks. • Database of Outcomes of Care & Treatment Review process • On-going difficulties in agreeing funding with social care and CCG’s • Of the 3 patients requiring alternative arrangements 1 has been discharged with a • HSCIC database updates – continuous updating. HSCIC will upload at the end of the ability to fund community placements. further 1 to be discharged imminently. month. • 3 patients identified as requiring alternative to current hospital • Care and Treatment Reviews in A&T and Telford Unit have been completed – placements within 6 months as a result of Care & Treatment Reviews. originally 5 patients (2 have been discharged: 1 of these to a Specialised placement, • Further patients in A&T and Telford Unit are currently included in the and one on S17 leave) Transforming Care cohort • Webinar workshops organised for July, focusing on Admissions and Discharge • Action plan for planned and unplanned admissions and discharges to protocols, which will need to be updated. hospital for patients under Transforming Care. • Provider engagement event held 25 June 2015. Very well attended and many contacts with potential providers made by commissioners. Procurement via LD Framework agreement planned and procurement colleagues involved in planning this work.

Lower Reporting NHS CONSTITUTION Operational Standard SOT Threshold Month Proportion of population accessing psychological therapies (IAPT) 15% n/a M2 0.9%

GOVERNING BODY ASSURANCE REPORT July 2015 Recovery rate for individuals who access psychological therapies (IAPT) 50% M2 45.8% Key risks: Actions Stoke-on-Trent: Assurance: • Achievement of targets, as these have been set at:- • Trajectories received for both target + contracted activity from CHCT 2015/16 • Monthly meetings in place to monitor current contract.  15.5% Population Accessing IAPT • Work ongoing to forecast underfunding prevalence population – paper being prepared for • Project Team taking forward commissioning of joint Healthy Minds (IAPT) service across  51.5% Recovery Rate the Board North Staffs / Stoke-on-Trent for 2016/17. • Written feedback from National Team highlighting under funding • National Team feedback- report has been received and all actions are being implemented • Paper being prepared regarding under funding and low prevalence rates for Stoke-on- • Registered population has increased since service procurement took place in and reviewed at the monthly Contract Review Meetings Trent. 2012/13 which will mean we are not commissioning sufficient capacity

AGENDA ITEM 10.1

REPORT TO THE STOKE-ON-TRENT CLINICAL COMMISSIONING GROUP GOVERNING BODY ON THE 4TH AUGUST 2015

TITLE QUALITY REPORT (OPEN) 10th JUNE 2015

PURPOSE • To support the delivery of the CCG vision of ensuring consistent high quality and safe care; • To provide assurance that the structures and processes are in place for sustaining and improving all three domains of quality; positive patient experience, safety and clinical effectiveness.

The Joint Quality Committee met for the third time on the 10th June 2015. Unfortunately, Stoke-on-Trent CCG was not quorate, in line with its terms of reference and this is currently being reviewed. When forming the Joint Quality Committee, both CCGs committed to a 6 month review, which will commence in July to report to each Governing Body on progress by the 6 month deadline of October. Difficulties in meeting quoracy will be considered as part of this review.

The following are the key areas (focussing on Stoke-on-Trent CCG) discussed at the meeting which the Committee would like to bring to the Governing Body’s attention: 1. Unannounced Visit to A&E Department - Royal Stoke University Hospitals of North Midlands 2. Revised Complaints and Concerns Policy 3. Nursing Home Strategy 4. Infection Prevention and Control 5. Primary Care Quality Assurance 6. Risk Register 7. Patient and Public Involvement Update

This report should be read in conjunction with the Integrated Finance and Performance Report (Quality Section).

RECOMMENDATIONS Decision X Note X Receiv X Informatio X What is required as an Approve e n outcome from the Forum The Governing Body is asked to: • Note the contents of the Quality Report. • Approve the revised Complaints and Concerns Policy, as recommended by the Quality Committee. CLINICAL LEAD OPERATIONAL LEAD AUTHOR

Dr Steve Fawcett Lorraine Cook, Head of Lorraine Cook, Head of Clinical Director Acute Quality and Governance Quality and Governance Services Quality Report (Open) Key Highlights of the Joint Quality Committee Held on the 10th June 2015

Stoke-on-Trent CCG Quality Committee met with North Staffordshire CCG Quality Committee for the third time on the 10th June 2015.

The following are the key areas (focussing on Stoke-on-Trent CCG) discussed at the meeting which the Committee would like to bring to the Governing Body’s attention.

1. Unannounced Visit to A&E Department - Royal Stoke, University Hospitals of North Midlands (UHNM) Since the 1st April 2015, there have been 25 over 12 hour trolley breaches (4 in April, 6 in May and 15 in June – as at the 14th June 2015). The 15 in June were all reported on the 1st June 2015.

Representatives of the CCG undertook an unannounced quality visit to the A&E Department at UHNM on the morning of the 1st June 2015. This was triggered by the Local Health Economy information morning report which indicated that the Trust was on EMS Level 4 with a longest wait to be seen time of 5 hours and 38 minutes. The CCG was also aware of two over 12 hour trolley breaches at the time of visiting. The Visiting Team focussed on patients experience and safety of those patients in the queue on the corridor and spoke to all patients / relatives in the queue with the exception of 2 patients who were asleep.

The Joint Quality Committee received the full visit report and was advised that the Visiting Team were assured that the patients in the Emergency Department on the 1st June 2015, between 11.00 am – 1.00 pm were safe and well cared for in an organised environment, and that feedback from patients experiencing waits in the corridor was overall positive.

2. Revised Complaints and Concerns Policy 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 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 and recommended this to Governing Body 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 Governing Body is asked t o approve the revised Complaints and C oncerns Policy, as recommended by the Quality Committee.

3. Care Home Strategy The Joint Quality Committee considered the draft Care Home Strategy at its meeting in April 2015, whereby the Committee requested that further public engagement and involvement be undertaken as part of the development of the strategy. Members received assurance of the presentation of the draft strategy to representatives from Age UK, Healthwatch Stoke-on-Trent and EngAGE at an event held on the 2nd June 2015. All those in attendance at the event were in agreement with the focus of the strategy including the four highlighted priority areas and the contents of the draft implementation plan. The strategy was positively received with representatives in attendance wishing to be involved in subsequent steering groups to support and oversee the implementation.

Members noted the range of individuals and groups leading on work areas linked to the delivery of this strategy and requested sight of the progress against the implementation plan, with clear identification to who is responsible for delivery.

4. Infection Prevention and Control The Quality Committee received an update in relation to MRSA and C Difficile for the CCG and its Providers. Infection Prevention and Control continues to be included on the CCG Risk Register focussing on patient experience and safety. The CCG is currently breaching its infection control objectives for both MRSA and Clostridium Difficile as at the end of April 2015. There were 0 cases of CCG and 2 acute attributable cases of MRSA bacteraemia reported in April 2015. 1 case occurred at Royal Stoke Hospital while the other occurred at the Alder Hey Children’s Hospital, Liverpool.

UHNM has reported 2 MRSA Bacteraemia during April 2015, one at Royal Stoke and one at County Hospital. For the Royal Stoke case, the post-infection review investigation process has been undertaken to consider the root cause and any lessons to be learned and the report is currently being finalised. For the County MRSA case, this was deemed Trust attributable and avoidable.

The Trust (including Royal Stoke and County) reported 13 Clostridium difficile for April 2015. For Royal Stoke this equates to 9 cases of Clostridium difficile during April against a cumulative objective of 4 to the end of April, therefore breaching the internal cumulative objective. The HIPC is currently forming a short life working group involving all stakeholders across the health economy to agree how best to reduce the local incidence of CDI. A C Difficile reduction plan has been agreed with the provider. For County this equates to 4 cases of Clostridium difficile at the end of April 2015 against an objective of 2 cases.

Infection Prevention and Control Themed Review - April 2015 The Infection Prevention and Control (IPC) themed visit review to the Royal Stoke Hospital at the University Hospitals of North Midlands was initiated in response to the organisation having 6 Trust apportioned MRSA bacteraemia during 2014/15, of which 4 were deemed avoidable, with one of the areas also reporting an outbreak of Clostridium difficile.

There were a number of key findings with the Infection Prevention and Control Team (IPT) seen as an approachable source of advice, support and education with the focus of IPT centred on prevention. All staff spoken to stated that they saw IPC as their (the wards) responsibility, with the IPT available for specialist advice, education and information with audits undertaken to ensure standards were maintained or raised. In addition, the ward

sisters and matrons appeared to be leading and not afraid to challenge sub-optimal practice

The Head of Infection, Prevention and Control continues to work closely with the Trust to ensure that lessons learned are embedded across the organisation and shared across the health economy.

5. Primary Care Quality Assurance The Joint Quality Committee received its first Joint Primary Care Report for both Stoke-on- Trent and North Staffordshire CCGs.

Care Quality Commission Members noted that the Care Quality Commission has visited 12 practices across Stoke- on-Trent of which 10 of the 12 practices have been rated as ‘good’, 1 ‘requires improvement’ and one report is awaited. Once all reports have been completed, a summary will be brought to a future meeting of the Quality Committee.

The CCGs are asking practices to share their experience and lessons learned with those practices which are yet to receive a visit. The CQC has announced that further inspections will be carried out during September 2015.

Recruitment and Retention The Joint Quality Committee noted that an action plan is currently in place to support the GP workforce and the CCGs continue to work closely with Dr Ken Deacon, Medical Director at the NHS England Area Team to advise on, and take forward, initiatives with shared purposes. Members noted that Stoke-on-Trent currently has approximately a 10% recruitment gap in GPs and requested a more detailed report at a future meeting on this area. In addition, a review of the risk on the CCG Risk Register was requested. Members noted that at the time of writing, there are also 6 vacancies across the nursing workforce (Stoke-on-Trent and North Staffordshire combined).

6. Risk Register The Joint Quality Committee received a progress report and timeline on a piece of work which has commenced as part of the CCG’s commitment to work more closely with North Staffordshire CCG, and to do things once where possible. This piece of work will review and align the two Risk Registers currently in operation across the CCGs to enable one register to be maintained. Members noted the timeline to review and identify one lead risk owner across both CCGs for each risk where appropriate, noting that Board level lead ownership will remain separate with each individual Board. Alongside this, the CCGs will review and identify the principles risks to each organisation which threaten the delivery of the CCGs strategic objectives to confirm the contents of its Assurance Framework for 2015 / 2016.

7. Patient and Public Involvement Update Stoke-on-Trent CCG Quality Committee received a progress report on patient and public involvement and noted the revitalisation of the Patient and Public Involvement Steering Group and refresh of its terms of reference and the recruitment process due to commence for outstanding members of the Patient Congress following a review of the remit of members and role outlines. Members noted the work ongoing with the Local Authority via the Stoke-on-Trent Community Action Partnership and the CCG’s involvement in the ‘My City, My Say’ annual campaign along with partners across the City. This enables us to engage on a wider footprint across the City and will allow us to be part of the annual survey of local services sent to all households across Stoke-on-Trent.

AGENDA ITEM 10.2

REPORT TO THE STOKE-ON-TRENT CLINICAL COMMISSIONING GROUP GOVERNING BODY ON THE 4TH AUGUST 2015

TITLE QUALITY REPORT (OPEN) 8th JULY 2015

The Joint Quality Committee met for the fourth time on the 8th July 2015. Stoke-on-Trent CCG is still experiencing some difficulty in meeting its quoracy requirements in line with its current terms of reference; however it is pleasing to note that the CCG was quorate for part of the meeting where decisions were required. The six month review focussing on how the Joint Quality Committee is progressing is due to commence this month, where quoracy will be one of the items for discussion.

The following are the key areas (focussing on Stoke-on-Trent CCG) discussed at the July 2015 meeting which the Committee would like to bring to the Governing Body’s attention: 1. Dignity and Respect Charter 2. NICE 3. Terms of Reference: Joint Safeguarding Group Complaints and PALS Assurance Group 4. Infection Prevention and Control Assurance Report and Strategy Work Plan 5. Quality Reports (focussing on the CCGs main Providers) 6. Quality Impact Assessments

This report should be read in conjunction with the Integrated Finance and Performance Report (Quality Section).

RECOMMENDATIONS Decision Note X Receive X Information X What is required as an Approve outcome from the Forum The Governing Body is asked to: • Note the contents of the Quality Report. CLINICAL LEAD OPERATIONAL LEAD AUTHOR Dr Steve Fawcett Lorraine Cook, Head of Lorraine Cook, Head of Clinical Director Acute Quality and Governance Quality and Governance Services

Quality Report (Open) Key Highlights of the Joint Quality Committee Held on the 8th July 2015

Stoke-on-Trent CCG Quality Committee met with North Staffordshire CCG Quality Committee for the fourth time on the 8th July 2015.

The following are the key areas (focussing on Stoke-on-Trent CCG) discussed at the meeting which the Committee would like to bring to the Governing Body’s attention. 1. Dignity and Respect Charter 2. NICE 3. Terms of Reference: Joint Safeguarding Group Complaints and PALS Assurance Group 4. Infection Prevention and Control Assurance Report and Strategy Work Plan 5. Quality Reports (focussing on the CCGs main Providers) 6. Quality Impact Assessments

1. Dignity and Respect Charter Members received the 12 Point Gold Standard Charter for Dignity and Respect which has been produced on behalf of the Health and Wellbeing Board of Stoke-on-Trent by Healthwatch Stoke-on-Trent.

The Charter puts the individual at the centre of every aspect of service and makes it clear what each individual can and should expect from any service they access.

Members noted that this Charter had been launched at Stoke-on-Trent CCG’s Annual General Meeting and was positively received. The principles of the Charter will be encompassed within quality visits to gain feedback on whether these principles are fully embedded within organisations.

2. NICE Members noted that Stoke-on-Trent CCG no longer has a Clinical Associate with a portfolio for NICE and highlighted the potential risk which this brings in the timely review of NICE guidance. It was noted that there is a review currently being undertaken across North Staffordshire and Stoke-on-Trent CCGs focussing on the portfolios of the current Clinical Associates and that at present, North Staffordshire CCG employs an individual on a sessional basis focussing on this area of work. In principle, it was agreed that this work could be undertaken across Northern Staffordshire and the Committee requested that this be formally explored, with assurance received at the next meeting of the Committee. This assurance should include the processes in place to review NICE Guidance now and in the future, including regular assurance reports to the Committee on progress.

3. Terms of Reference: Joint Safeguarding Group Complaints and PALS Assurance Group The Joint Safeguarding Group and the Joint Complaints and PALS Assurance Group report to the Joint Quality Committee and in line with good governance the terms of reference for each were submitted for review and approval. Subject to minor amendments for the Joint Safeguarding Group Terms of Reference relating to accountability structures, the Joint Quality Committee approved the two sets of Terms of Reference.

4. Infection Prevention and Control Report and Strategy Work Plan The Quality Committee received an update in relation to MRSA and C Difficile for the CCG and its Providers along with the draft Strategy Work Plan. Infection Prevention and Control continues to be included on the CCG Risk Register focussing on patient experience and safety.

The CCG is currently breaching its infection control in-year objectives for both MRSA and Clostridium Difficile and members noted the range of work being undertaken to support improvement in this area. In addition, a C Difficile Recovery Working Group has been reformed with main objectives of focus agreed and support from medicines optimisation in areas of prescribing.

The Executive Board Nurse (who holds Board level responsibility for Infection Control) advised the Committee that the Strategy would be considered at the Health Economy wide meeting next week and therefore requested that this was not approved at this time, until appropriate scrutiny had taken place. This will be reconsidered by the Joint Quality Committee at its meeting in August 2015.

5. Quality Reports – Main Providers

University Hospital of North Midlands (UHNM) Members received the Quality Report for UHNM and noted the following areas: • A&E 12 Hour Trolley Breaches RCA panels continue to be held. From the reviews and RCAs undertaken and evidence presented at the meeting it has been confirmed that there was no harm or detrimental impact on patients outcomes to any of the patients as a result of the long wait in the Emergency Department. • A&E 4 Hour Wait Key plans have been established over coming months to improve the performance relating to the A&E 4 hour wait target. The Joint Quality Committee noted that one of these included a new larger discharge lounge which opened on the 18th May. It was noted that this would form part of a quality visit in the future to monitor patient experience. • Outpatient Backlog Members noted the number of patients who are overdue their follow up appointments and the clinical validation exercise currently ongoing at UHNM. The CCG Clinical Director for Quality agreed to raise this as an agenda item at the next meeting of the Planned Care Group to receive assurance on progress in this area.

Staffordshire and Stoke-on-Trent Partnership Trust (SSOTP) Members received the Quality Report for SSOTP and noted that within community hospitals, there are systems and processes in place to cover staffing requirements and this information is shared with the CCG. 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. 3

Staffordshire Doctors Urgent Care (SDUC) Members received the Quality Report for SDUC and noted the following areas: • Reporting continues to improve to focus on the quality impact of performance breaches on patients. • A recruitment agency has been commissioned to promote SDUC and look further afield to attract more GPs into the service. • SDUC have introduced diverting some or all telephone activity to the Vocare National Triage Service either as a planned action or in response to increasing activity pressures.

North Staffordshire Combined Healthcare NHS Trust (NSCHT) Members received the Quality Report for NSCHT and noted the following areas: • In the absence of a national tool for safer staffing, the CCGs received assurance at the last CQRM of the work the Trust is undertaking on assessing safer staffing in community services, including participation as a pilot site. • The results of the NHS National Staff Survey 2014 have identified that the Trust did not experience any improvement in any of the key findings measures. It experienced deterioration in five measures relating to patient service matters. These related to staff satisfaction, with the quality of work / patient care they are able to deliver, being able to contribute to improvements, feeling safe to raise concerns about unsafe clinical practice and staff making a difference to patients / service users. The Trust has increased the risk score on the corporate Risk Register from 8 to 12 as a result of the survey findings and the action plan was considered at the May meeting of the CQRM. This will be considered again when the directorates have completed their own reviews and contributed fully to the action plan.

NSL Non Urgent Transport Service Members received the Quality Report for NSL and noted the following areas: • Commissioners and Quality met with UHNM renal unit staff to facilitate discussion about the NSL Service to the Renal Unit. UHNM staff reported that they were beginning to see some improvement with a reduction in the delays experienced by patients. • Members requested further information within the next report relating to the NSL Service provided to the Renal Unit.

Rowley Hall Members received the Quality Report for Rowley Hall and noted the following areas: • Rowley Hall Hospital is a small private hospital delivering NHS and private healthcare. Previously, Stoke-on-Trent CCG had requested a report from Rowley Hall following a complaint received during 2014 where further assurances were requested on whether this was an isolated incident or more common across the organisation. • Members noted that Stafford and Surrounds CCG is the lead commissioner for this Provider and requested a further report in the future.

Douglas Macmillan Hospice Members received the Quality Report for Douglas Macmillan Hospice for the end of the financial year 2014 / 2015 and noted the following areas: • Members noted that the Hospice received 1623 referrals during 2014 / 2015 of which 79% were for cancer patients and 18.7% for non-cancer patients. Over 60% of referrals are received from GPs and hospital Clinical Nurse Specialists, the primary care aim was pain / symptom control for 93.7% of patients. • It was noted that the Quality Team are undertaking a visit in July 2015.

6. Quality Impact Assessments The Joint Quality Committee received assurance on the processes in place to review the quality impact assessments of proposed QIPP schemes on a monthly basis. Members noted that this was working well with a proposal to undertake this on a quarterly basis moving forward, with a quarterly report to Joint Quality Committee on the areas considered to ensure the Committee is fully informed and assured.

Steve Fawcett Lorraine Cook Clinical Director for Quality Head of Quality and Governance July 2015

AGENDA ITEM 11

REPORT TO THE PUBLIC MEETING OF STOKE-ON-TRENT CLINICAL COMMISSIONING GROUP GOVERNING BODY ON THE 4TH AUGUST 2015

TITLE CCG CORPORATE RISK REGISTER

PURPOSE To provide assurance to the Governing Body that risks are being identified and managed as part of the CCG internal assurance process.

New Risks No new risks have been added to the Corporate Risk Register since the last Governing Body Meeting.

Amended Risks There have been no changes in risk score since the last meeting.

Risks Proposed for Closure Risk ID 78 has been reviewed and is proposed for closure. This risk is described as:

There is a risk that the organisation will not achieve its statutory duty to deliver financial balance in the current financial year due mainly to activity and costs pressures from its main acute contract. The predicted deficit is in excess of £5m annualised as at Month 4 report. The organisation will suffer both reputational damage and financial pressures that are likely to continue into the following financial years.

The Governing Body is asked to approve the closure of this risk as the CCG delivered all of its statutory financial duties and targets during 2014 / 2015.

The current Corporate Risk Register (residual risk scores 15 and above) is attached at Appendix 1 where updates are provided for each risk. The risk matrix is enclosed for information purposes at Appendix 2.

RECOMMENDATIONS Decision X Note X Receive Information What is required as an Approve outcome from the Forum The Governing Body is asked to:  Note the contents of the report.  Approve the closure of Risk ID 78. CLINICAL LEAD OPERATIONAL LEAD AUTHOR Lorraine Cook, Head of Lisa Taylor, Quality and Quality and Governance Governance Manager

CORPORATE RISK REGISTER AS @ 16TH JULY 2015 (APPENDIX 1) RISKS SCORING 15 AND ABOVE Risk Description Of Risk Initial Residual Change Last Controls to Mitigate Last Action Comment ID Risk Risk Risk Review

Category Score Score Manager Exec Lead Date Added Responsible Date of Next 14 Patient experience is compromised because of failure to 16/07 During May we achieved the 90% trajectory 16/07/15 During May we achieved the 90% trajectory achieve 4 hour target due to increased activity / flow target on 2 days. June this figure rose to 9 days with target on 2 days. June this figure rose to 9 days with a through the system. a further 5 achieving over 95%. July to the 13th of further 5 achieving over 95%. July to the 13th of the 01/06/2012 10/08/2015 the month we have achieved 4 days over 90% and a month we have achieved 4 days over 90% and a further 4 days over 95%. The system is beginning to further 4 days over 95%. The system is beginning to show signs of improvement. Its important to note show signs of improvement. Its important to note that that escalation levels appear to be more stable. escalation levels appear to be more stable. When we

Clinical AND Operational 16 16 ↔ When we reach L3 the time spent at that level has reach L3 the time spent at that level has reduced reduced indicating that the system is managing to de-indicating that the system is managing to de-escalate escalate more consistently. The system is currently more consistently. The system is currently on plan to on plan to attain planned trajectory levels agreed by attain planned trajectory levels agreed by SRG and Jolley Paul (5PJ) Stoke On Trent CCG

Clinical Director for Care Unscheduled SRG and NHSE. The risk remains severe. NHSE. The risk remains severe.

58 The lack of capacity within general practice could risk the Jan 15: Progress report on actions submitted to Feb 15: Progress on actions continue to be monitored delivery and implementation of the community model of Executive Forum in Jan 15 with assurance of some at Executive Forum. The actions will support care challenge and implications of a probable GP Clinical actions completed, and further actions identified recruitment and retention (particularly retention)

24/09/2013 recruitment and retention crisis. 09/03/2015 increasing number of actions to 23. Risk score however a number of actions are beyond the CCGs 16 16 ↔ reviewed and remains unchanged prior to Executive control (e.g. with the Area Team etc). Therefore the Forum meeting. Score to be reviewed at next risk score has been reviewed and proposed to remain Clinical Director for monthly update. at 16 at this point in time. Blenkinsop (5PH) Sarah NHS North StaffordshireNHS T f i C it 65 The failure to undertake the necessary shift of resources There is improved data and information collection 15/07/15 - Implementation of Step Up and Step Down from a bed based focus to a community based service in a on the main transformation initiatives through the continues with model and funding shifts agreed this

timely manner. Strategic Cross Economy Transformation Team (CETT) with month, risk reviewed and remains unchanged. 14/04/2014 15/09/2015 weekly review of the level of activity and the 18/05/15 - Risk reviewed. Shift to Step Up and Step assumptions made on the imapct that activity is Down in model of care will drive shift away from expected to have on activity at UHNS. Provider and dependency on beds to a at home focus. Shift of commissioner actions are expected from each resources to enable this assumes beds will no longer weekly review. be a cost to commissioners and that the plan that 20 16 ↔ Sanzeri DaveSanzeri (CCG) SOTCCG increases community capacity as beds are not utilised by commissioners is met to activity and time. Failure to keep to the plan will compromise commissioner finances and put at risk the patient outcomes

Clinical Director for Community Services expected from "the home first" model of care. recommend monthly review until assured that shift to plan is secured. CORPORATE RISK REGISTER AS @ 16TH JULY 2015 (APPENDIX 1) RISKS SCORING 15 AND ABOVE 66 The significant financial budgetary cuts at Stoke on Trent • Section 256 in place • Funding transfers in place 15/07/15 Risk reviewed no change - BCF City Council over recent and coming years greatly impacts and detailed within CCG LTFM. • Direction set by implementation continues. 18/05/15 risk reviewed.

on the level of services they can provide. The impact on Strategic Comprehensive Spending Review to shift funding BCF plan in place and PIDs being prepared to establsih 14/04/2014 the social care domiciliary budget is evident and will 15/09/2015 from health to social care – Section 75 in place to delivery plans in all key schemes. BCF assumes significantly impact on sustainability of existing services. undertake this faster than national timeline transition to new model of care which releases (positive) • Monthly Transformation Exec. Group reources for social care AND assumes a new (TEG) mtgs • Monthly Cross Economy Leadership framework for social care and how it is utilised with a Group (CELG) mtgs • Local Authority representation move away from high intensity and high costs 20 16 ↔ Sanzeri DaveSanzeri (CCG) SOTCCG on Governing Body • Clinical Accountable Off. packages to one of early intervention and better use representation on Health & Wellbeing Bd • Primary of reablement to improve individual functionality and focus for Hds of Commissioning • Strengthened mauintain individual independence. In light of risk governance via Senior Officers Group as part of associated with BDCF deliver and financial

Clinical Director for Community Services Better Care Fund negotiations implications of anything less than success recommend monthly review..

76 The CCG has invested specifically to increase the capacity of Recruitment trajectory agreed and in place which is 15/07/15 Risk Reviewed no change. 18/05/15 Risk community nursing to bring nursing to upper quartile levels when subject to monitoring and review under project reviewed. Commissioners have issued new LTC compared nationally at 50 nurses : 100,000 population. This management arrangements. Investment and the specification which reinforces role of community investment is to enable more delivery at primary care and 15/07/2014 15/09/2015 associated recruitment is stated in the contract and teams and ILCTs or other local integrated working community care and to improve patient care. A planning contract management and compliance procedures arrangements. Move to Step Up arrangements has assumption in committing the investment was that the increase in community nursing capacity would support the are applied. Commissioning Team with Clinical lead meant pulling escalation elements of the specification implementation of integrated local care teams as a foundation have review arrangements in place, an ILCT project and aligning these to the Step Up implementation for transforming patient care. Any delay in appointing nurses or group is in place that involves and is led by NEb CCG plan. Subject to transition under direct clinical Strategic AND Operational 16 16 ↔ any failure to deploy nurses to the ILCTs affects and puts at risk DaveSanzeri (CCG) SOTCCG Locality. governance of consultants for key pathways of the ability to transform patient care (particularly in the diabetes, respiratory and heart failure suggest management of LTCs). The ILCTs are based on a set of monthly reviews as risk to change is now significant assumptions on the number and competence of nurses aligned but risk rating remains unchanged.

with each patient population and practices with an objective of Clinical Director for Community Services building the capacity to manage the LTC needs of patients proactively within primary and community care any delay in deployment puts at risk achieving improved health outcomes for patients and avoiding unnecessary acute attendances and 77 SSOTP are reporting significant backlogs in a range of All services and therapies and the community 15/07/15 Risk reviewed no change. 18/05/15 Risk community services and are forecasting significant levels (> hospital inpatient services for older people are reviewed. There are additional pressures in the

10% variation) of underperformance (fewer patients being Si specified and the specifications are held in the system with the LHE move towards Step Up / Step

15/07/2014 seen than planned) in services and therapies. In addition, 15/09/2015 contract. Contract monitoring and reporting Down and what this means for the capacity required wards in community hospitals have been closed primarliy processes are being used to challenge the provider from SSOTP and the deployment of staff in delivery of as a consequence of shortfalls in staffing and the potential 12 16 ↔ and to secure remedial actions that are expected to the model of care. Due to complexity of transition and for patient care and safety to be compromised. These address the backlog and waiting times. number of reviews of community services suggest

circumstances are a risk to patient access to care in Clinical AND Operational keep to monthly review. although there are changes

outpatient and inpatient settings and put at risk the health DaveSanzeri (CCG) SOTCCG and additional pressures suggest risk remains at same

outcomes for patients. Clinical Director for Community level. CORPORATE RISK REGISTER AS @ 16TH JULY 2015 (APPENDIX 1) RISKS SCORING 15 AND ABOVE 78 There is a risk that the organisation will not achieve its July 15 - At the end of 2014 / 2015, the CCG delivered statutory duty to deliver financial balance in the current all of its statutory financial duties and targets: - Kept

financial year due mainly to activity and costs pressures Financial expenditure within the resources allocated 10/08/2015 19/08/2014 from its main acute contract. The predicted deficit is in [£357.215m] and delivered a surplus of just over excess of £5m annualised as at Month 4 report. The £1.697m - Kept cash within a prescribed limit of organisation will suffer both reputational damage and £359m and paid over 95% of invoices on time - financial pressures that are likely to continue into the 25 15 ↔ Chief Finance Officer Maintained the costs of running the CCG within following financial years. £6.167m [less than £25 per head of population] - Stoddart (CCG) Iain NSCCG Ensured 1% of CCG spending was on non recurrent projects - Delivered efficiency savings which we reinvested into services. Risk reviewed and therefore proposed for closure for 2014 / 2015.

AGENDA ITEM 13.1

REPORT TO THE PUBLIC MEETING OF STOKE-ON-TRENT CLINICAL COMMISSIONING GROUP GOVERNING BODY ON THE 4TH AUGUST 2015

TITLE EQUALITY & INCLUSION UPDATE TO GOVERNING BODY FOR EDS 2 (EQUALITY DELIVERY SYSTEM)

PURPOSE To inform the Governing Body of progress of the equality performance of Stoke on Trent Clinical Commissioning Group including delivery against the Public Sector Equality Duty (PSED) and compliance assurance for: • EDS progress (Equality Delivery System 2)

SUMMARY OF DOCUMENT & KEY ISSUES FOR DISCUSSION If Strategy / Business Case / Service Specification need to include the engagement process during the development to gain influence and sign off with Patients/Public/Localities and other Stakeholders. Background EDS is the NHS wide equality performance framework mandated by NHS England from April 2015, for all commissioning organisations and their provider partners (public and private sector). The aim is to make access to healthcare good and fair for everyone across our local communities, including people from vulnerable protected characteristic groups, and to decide what the NHS needs to do next.

From April 2015, EDS2 implementation by NHS provider organisations was made mandatory in the NHS standard contract. EDS2 implementation is explicitly cited within the CCG Assurance Framework, and will continue to be a key requirement for all NHS clinical commissioning groups (CCGs).

Update on progress: also see Appendix 1 for further details SOT CCG and NS CCG are planning their first joint EDS annual public grading for 2015. However they are requested to agree which priority joint care pathways evidence gathering will focus on.

(For example: long term conditions; community mental health services; end of life and cancer care; services for people with learning disabilities in Staffordshire; urgent care services; stroke services. Source: Staffordshire and Stoke 5 Year Strategic Plan 2014-2019, page 23 The Immediate Priorities. How Boards and senior leaders routinely promote their commitment to equality within and beyond their organisation. Source: EDS Goals & Outcomes summary from NHS England.)

EDS evidence gathered and annually presented to local communities of interest should publicly show: how do local people from protected groups fare compared with people in general [in healthcare]?

Evidence is currently being gathered retrospectively by senior leaders and commissioners for CCG’s 2014 equality performance and the public grading in 2015, as well as our current 2015 performance which will be publicly graded in 2016. EDS staff support sessions are underway re evidence collection and a series of short 5 to 10 minute presentations for the October public grading.

A first joint annual public grading event is planned for Tuesday 27 October 2015 9.30 until 3.30 at North Staffordshire CCG in the Brampton room.

Our EDS public grading should be displayed on CCG EDS webpage as an accessible report and summary dashboard. Links will be shown to our larger provider partner EDS annual grading results.

CCG senior leads, workforce, engagement and commissioner leads support embedding into day to day practice for delivery of all 4 Goals and 18 required Outcomes over a 4 year public grading cycle (CCG equality performance in 2014 to 2017), with support from E&IBP (Equality & Inclusion Business Partner) and SHRBP (Senior Human Resources Business Partner), as appropriate. A public grading of Achieving or Excelling to be in place and maintained for all 4 Goals by 31 March 2018.

EDS grading key:

Excelling Achieving Developing Underdeveloped

Undeveloped Developing Achieving Excelling    

People from all People from only People from most People from all protected groups fare some protected protected groups protected groups poorly compared with groups fare as well fare as well as fare as well as people overall OR as people overall people overall people overall evidence is not

available

RECOMMENDATIONS Decision X Note Receive X Informatio What is required as an outcome from Approve n √ the Forum The Governing Body is asked to:

1) Consider and discuss equality performance progress for EDS 2.

2) To agree which priority joint care pathways evidence gathering will focus on for 2014 and 2015.

3) Agree a Clinical Lead and EDS Champion from SOT CCG to present evidence to EDS stakeholder group / representatives from local communities of interest at the annual public grading event on 27 October 2015.

4) Agree that ‘EDS progress updates and any business risks’ appear as a standing agenda item at public Board meetings.

CLINICAL LEAD OPERATIONAL LEAD AUTHOR Dr Chandra Kanneganti Dave Sanzeri Head of Julia Allen Clinical Director for Commissioning Equality & Inclusion Transforming Community (Community based) / Alex Business Partner Services Palethorpe Head of Governance NSCCG

Appendix 1

EDS update on progress:

Background EDS is the NHS wide equality performance framework mandated by NHS England from April 2015, for all commissioning organisations and their provider partners (public and private sector).

The Equality Delivery System (EDS) was commissioned by the national Equality and Diversity Council in 2010 and launched in July 2011. It is a system that helps NHS organisations improve the services they provide for their local communities and provide better working environments, free of discrimination, for those who work in the NHS, while meeting the requirements of the Equality Act 2010.

The main purpose of the EDS2 was, and remains, to help local NHS organisations, in discussion with local partners including local populations, review and improve their performance for people with characteristics protected by the Equality Act 2010. By using the EDS2, NHS organisations can also be helped to deliver on the Public Sector Equality Duty.

Update on progress August 2015 SOT CCG and NS CCG are planning their first joint EDS annual public grading for 2015. Evidence gathering by CCGs will focus on EDS Goals 1 and 4 and their required Outcomes (see summary below). However both CCGs are requested to agree which priority joint care pathways evidence gathering will focus on.

EDS evidence gathered and annually presented to local communities of interest should publicly show: how do local people from protected groups fare compared with people in general [in healthcare]?

A first joint annual public grading event is planned for Tuesday 27 October 2015 9.30 until 3.30 at North Staffordshire CCG in the Brampton room. • An invite will be sent shortly to the EDS ‘stakeholder’ group • An informal EDS ‘stakeholder’ group has been developed by CCG – CCG need to evidence involvement from patient / carer/ voluntary sector reps from each of the 9 local protected characteristic groups • EDS stakeholder group reps will receive refresher / new training in how to grade CCG evidence on 27 October • The annual public grading event will be minuted to facilitate an EDS report which should show the grading dashboard across the EDS 4 Goals and 18 required

Outcomes, with recommendations to CCG for any improvements over the next 12 months.

Embedding evidence gathering for annual public grading events • E&IBP attended Joint Heads of Commissioning meeting 13 April 2015 to embed EDS evidence gathering template for suggested use by commissioners • 2 July delivered 1 hour EDS evidence gathering training to commissioners from both SOT CCG & NS CCG. 3 more sessions are planned at both CCGs. NSCCG: Thurs 30th July 10 am St Giles Room. SOT CCG: 29 July 10 am in the Minton room; 4 Aug 2pm in the Spode room. • Awaiting confirmation from CEOs of the joint care pathways evidence should focus on for 2014 evidence re goal 4; and 2015 evidence focus. Evidence gathering can then begin both retrospectively for 2014, and for CCG’s 2015 performance. • A pre EDS support session is planned for senior staff from both CCGs on 22 July 9am until 10 for 2 Clinical Leads / Cheryl Hardisty / Alex Palethorpe / Dave Sanzeri. Short 10 minute presentations of evidence for EDS Goals 1 and 4 (re 2014 performance) are required ie Better Health Outcomes for all; and Inclusive leadership at all levels.

The last EDS public grading held by each CCG and their respective EDS reports are attached.

SOT CCG EDS Report October 2014 (2013 equality performance)

Stoke-on-Trent CCG EDS Grading Report_v

NSCCG EDS Report October 2014 (2013 equality performance)

North Staffordshire CCG EDS Grading Rep

Aims for 2015 joint grading of equality evidence • To address much of the feedback received from the EDS stakeholder groups at the 2014 public grading events (details are shown below in ‘likely challenges’) • To address any shortfalls identified in CCG’s EDS public grading in October 2014. • To generate robust evidence which is disaggregated by each of the protected groups in terms of monitoring and feedback on (1) who is taking up services locally (2) patient satisfaction levels (3) Equality Analysis (EA) or Pre PEAR Assessment Toolkit providing feedback from protected groups on any adverse impacts arising from changes in healthcare, and mitigation by CCG to re-shape services to be more inclusive for protected groups. • To address provision of evidence for Goals 1 and 4 (and required Outcomes) – see attached EDS summary below

NHSEDS2GoalsNOutc omes.pdf

• To develop a new EDS action plan for any agreed joint improvements which can become embedded during the following 12 month period. • Evidencing due regard: To embed practical ways of gathering regular feedback from representatives of local protected groups re their experience of fair access to healthcare information, services, premises and employment opportunities; and impacts from healthcare changes under early stage consideration by CCG. • To work with our larger provider partner organisations to provide CCG with timely assurances of their own annual EDS compliance leading to improvements for vulnerable protected groups. This includes their website display of latest EDS summary grading dashboard and report; and an annual response via Contract Managers to the new Equality and Inclusion Monitoring Schedule which was embedded into larger provider contracts from February 2015.

Likely challenges for 2015 EDS public grading by local communities of interest: • Definitely not enough evidence for at least 5 protected characteristics • Need more evidence of patient involvement in their own care – suggest using more patient stories which identify the experience of people from local protected groups • More information needed on effective communication with protected groups • Commissioning leads must ensure that evidence about services is provided • Evidence needs to be broader eg about visually impaired patients and carers • Lots of evidence about fail and elderly people but more evidence required from other protected groups • Evidence should be offered to stakeholders before the annual public grading event, as too much evidence was provided to work through on the day, without having had chance to view beforehand. • More evidence specifically around Mental Health and Younger People was required. • It is important for CCG to note that the number of graders / stakeholders was relatively small and did not represent the 9 protected groups set out in the Equality Act 2010. It is therefore worthwhile focusing attention in 2015 on developing the informal EDS stakeholder group in terms of greater numbers and more extensive representation. • The development of the EDS stakeholder / scrutiny group may support a much more objective grading in the future. Source: EDS public grading reports 2014 SOT CCG and NS CCG.

• To embed EDS evidence generating, gathering and presenting to local communities of interest into our day to day practice. This includes equality leadership at all levels; commissioning; engaging specifically with local protected group patient / carer/ voluntary sector / staff reps to gather their feedback on any adverse impacts from CCG planning and decision making; inclusive workforce practices.

EDS Business Risks (potential): • CCG failing to embed EDS equality performance framework into day to day practice; monitoring option routinely provided to protected groups through provider contract requirements and through self-declaring ESR (electronic staff record) profile; and effective annual evidence presentation to EDS stakeholders • Poor representation of protected group stakeholders and by locality at annual public grading event ie develop stakeholder group reps involvement and close working with CCG

• Low public grading of required Outcomes highlighting lack of specific evidence for at least 5 out of 9 protected characteristic groups • Failing to show CCG learning and feedback from previous year’s annual public grading recommendations made by EDS stakeholders / graders • Larger provider partner organisations failing to embed EDS annual public grading and timely display of accessible grading report on their website (with recommendations for improvements) and summary dashboard of grading.

Legal background information

EDS 2 and the Equality Act 2010

This act brings with it the anticipatory duty to make reasonable adjustments to ensure the service is accessible and relates to service provision and employment of staff.

The Act also brings with it the General and Specific Equality duties, the Public Sector Equality Duty (PSED) 3 aims are: 1. eliminate unlawful discrimination, harassment and victimisation and any other conduct prohibited by the Act; 2. advance equality of opportunity between people who share a protected characteristic and people who do not share it; and 3. foster good relations between people who share a protected characteristic and people who do not share it.

The Equality Act 2010 identified nine protected groups (characteristics); 1. Age 2. Disability – including physical, sensory, mental health and Learning Disability 3. Gender Reassignment 4. Race 5. Gender 6. Sexual orientation (lesbian, gay, bisexual, heterosexual) 7. Religion or Belief 8. Pregnancy and Maternity up to 26 weeks post birth) 9. Marriage and civil partnership (employment and training only)

The Equality Delivery System provides one form of evidence that the CCG is paying due regard to the PSED.

What does due regard mean?

Due regard means that the Clinical Commissioning Group has given advanced consideration to issues of equality and discrimination before making any planning, strategy or policy decision that may be affected by them. That is a valuable requirement that is seen as an integral and important part of the mechanisms for ensuring the fulfilment of the aims of anti-discrimination legislation set out in the Equality Act 2010. In addition, evidence of due regard may be required in the case of any legal challenge. The Brown Principles are attached as developed by the Equality and Human Rights Commission.

Due regard Brown Principles.pdf

Agenda Item No:

Stoke-on-Trent

Equality Delivery System (EDS2) Grading 2014 Results Report

1. Introduction This report provides an overview of the results of the Equality Delivery System grading carried out on evidence presented by the Clinical Commissioning Group during October 2014 to local people.

2. Purpose To allow the Governing Body to have a clear understanding of the CCGs current grading against the four goals of the Equality Delivery System, highlighting areas of excellence and areas for development, including a proposed action plan for improving outcomes in 2015/16.

3. Background The Clinical Commissioning Group uses the Equality Delivery System (EDS2) (NHS England, 2013) as its performance toolkit to support the organisation in meeting statutory equality and human rights requirements such as showing due regard to the Public Sector Equality Duty.

The four Equality Delivery System Goals are: Goal 1 Developing better health outcomes for all; Goal 2 Developing for improved patient access and engagement; Goal 3 Developing for empowered, engaged and well supported staff, and; Goal 4 Developing for inclusive leadership at all levels.

4. Grading 2014 The CCG presented evidence to the public grading panel (the panel) on 9th October 2014 and that evidence focused on the following areas: • Long Term Conditions

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• Mental Health • The Frail Elderly • District Nursing service • Patient and Public Involvement • Communications • How leaders promote equality and diversity within and beyond the CCG

The specific EDS Goal the CCG is addressing this year is as follows:

1. Better health 1.1 Services are commissioned, procured, outcomes designed and delivered to meet the health needs of local communities 1.2 Individual people’s health needs are assessed and met in appropriate and effective ways 1.3 Transitions from one service to another, for people on care pathways, are made smoothly with everyone well-informed

2. Improved 2.1 People, carers and communities can readily access patient hospital, community health or primary care services and should access and not be denied access on unreasonable grounds experience 2.2 People are informed and supported to be as involved as they wish to be in decisions about their care 2.3 People report positive experiences of the NHS

4. Inclusive 4.1 Boards and senior leaders routinely demonstrate their leadership commitment to promoting equality within and beyond their organisations

The evidence gathered was, as far as possible, outcome focussed and the CCG was asked to think creatively about how it would like to present the evidence at the grading event.

4.1 Scrutinisers The scrutinisers present on the day were representatives from a wide range of relevant local stakeholders including the Third sector, community sector and public and patient forums, they also represented the following protected characteristics: age, disability, sexual orientation, gender reassignment, race, religion or belief, sex, and ensured that they considered all nine protected characteristics as set out in the Equality Act 2010 when scrutinising the evidence presented by the CCG.

The scrutinisers were also provided with Equality Delivery System scrutiny training facilitated by the Equality & Inclusion Team from Midlands and Lancashire Commissioning Support Unit and received the evidence before the grading event to facilitate their full involvement in the grading process.

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4.2 Grading results

Overview of Grading Results 2014 120%

100%

80% excelling 60% achieving 40% developing 20% undeveloped Percentage of Scrutiners 0% 1.1 1.2 1.3 2.1 2.2 2.3 4.1 Equality Delivery System Outcomes Graded

Outcome 1.1 Services are commissioned, procured, designed and delivered to meet the health needs of local communities

The grading panels graded the CCG as Developing for this outcome, the scrutinisers felt that there is a good evidence of intent but there were gaps with not all protected groups being not included. The panel felt that the CCG was moving in the right direction but felt that there was more work required including the production of equality analysis and evidence the involvement of local people across protected groups in the commissioning and procurement processes. Other Comments raised by the scrutiners:  People know more about their own health so more involvement in decision making is needed  If older people are leaving the city and more young people moving in what are the implications of this?  Evidence needed around pharmacists medication reviews across primary care and not only nursing homes

Outcome 1.2 Individual people’s health needs are assessed and met in appropriate and effective ways

Due to the equal split between developing and achieving on this outcome the group decided to award Developing following additional discussion the decision was based on the fact that 24% of the panel graded the CCG as undeveloped. The panel felt that there was clear evidence that the CCG was making progress but that there was still more work to be done with providers of services. Scrutiniser comments also included the following:  Evidence needed to show more data is required around the protected characteristic of Race

Stoke-on-Trent CCG EDS Grading Report_v0.1_171014_jwct 3

 My knowledge of the CCG tells me that there is more happening than the evidence presented shows  Good evidence but more needed around patient involvement in their own care suggest using more patient stories which identify protected groups.  More info needed on effective communication with diverse groups

Outcome 1.3 Transitions from one service to another, for people on care pathways, are made smoothly with everyone well-informed

The majority of scrutinisers awarded Developing for this outcome, however 25% felt that the evidence was undeveloped, but this may have been down to less knowledge of services than others or they were looking for evidence that wasn’t made available. One person though the CCG was Excelling in this area and stated that the evidence was good and good outcomes being demonstrated. Other comments included:  Not enough information here to judge effectively  Evidence needs to be broader e.g. visually impaired  Commissioning leads must ensure that evidence about services is provided

The majority of the scrutiners liked that the CCG was listening and learning from patients to inform the redesign of services, but it was felt that this can vary service to service, and for different protected groups. It is clear from this that more work needs to be done to ensure the standardisation of practice across care pathways for people from across all protected groups.

Outcome 2.1 People, carers and communities can readily access hospital, community health or primary care services and should not be denied access on unreasonable grounds

The majority of scrutinisers (57%) awarded Developing for this outcome. The panel felt that there was evidence that the CCG had made progress on this outcome and felt that this narrative evidence and patient stories would have been stronger with representation from CCG staff carrying out the work programmes and more evidence in the patient stories across protected groups, which would have provided a higher grade. Scrutiners comments included:  More evidence is needed around Race and Gender Reassignment  Lots of evidence about the elderly and frail but more evidence needed across other diverse groups

Outcome 2.2 People are informed and supported to be as involved as they wish to be in decisions about their care

The majority of scrutinisers (57%) awarded Developing for this outcome however a small minority graded undeveloped. Possibly the earlier distribution of evidence would assist with this and allow more time to look at evidence put forward. Comments from scrutinisers included:  There is a lot of work being done to involve people in decision making

Stoke-on-Trent CCG EDS Grading Report_v0.1_171014_jwct 4

 Work with Engage is exceptional

Outcome 2.3 People report positive experiences of the NHS

The majority of scrutinisers (57%) awarded Developing for this outcome and the panel members noted that the CCGs evidence for 2015 grading needs to show more responses from local people who are using the NHS and be disaggregated by protected characteristic. The scrutiners also felt that there were not enough responses from people about services the CCG commissions to give achieving or excelling at this point.

Outcome 4.1 Boards and senior leaders routinely demonstrate their commitment to promoting equality within and beyond their organisations

This outcome was awarded Achieving with 86% of scrutinisers voting for this grade. The scrutinisers identified that the CCGs Governing Board were obviously fully committed to the agenda and felt that the CCGs community engagement plans were good but that there was still more work to do to engage people across all protected groups.

4.3 General comments made by the scrutiners about the evidence provided by the CCG:  The CCG needs to ensure that the evidence is distributed to them a few days before scrutiny takes place so that they get chance to fully check all the evidence before the grading event itself. Many felt that on the day there was too much evidence to work through without having chance to see it beforehand.  Many of the scrutinisers felt that more evidence specifically around Mental Health and the also the involvement of young people was needed.

4.4 Comparison between 2013 grading and 2014 grading

Objective Outcome 2013 2014 1 Better health 1.1 Services are commissioned, procured, designed and delivered to A D outcomes meet the health needs of local communities 1.2 Individual people’s health needs are assessed and met in A D appropriate and effective ways 1.3 Transitions from one service to another, for people on care A D pathways, are made smoothly with everyone well-informed 1.4 When people use NHS services their safety is prioritised and A Not they are free from mistakes, mistreatment and abuse graded in 2014 1.5 Screening, vaccination and other health promotion services E Not reach and benefit all local communities graded in 2014 2 Improved 2.1 People, carers and communities can readily access hospital, D D patient access community health or primary care services and should not be denied and experience access on unreasonable grounds 2.2 People are informed and supported to be as involved as they D D wish to be in decisions about their care 2.3 People report positive experiences of the NHS A D

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2.4 People’s complaints about services are handled respectfully and A Not efficiently graded in 2014 3. Inclusive 4.1 Boards and senior leaders routinely demonstrate their D A leadership commitment to promoting equality within and beyond their organisations 4.2 Papers that come before the Board and other major Committees D Not identify equality-related impacts including risks, and say how these graded in 2014 risks are managed 4.3 Middle managers and other line managers support their staff to D Not work in culturally competent ways within a work environment free graded in 2014 from discrimination

5. Next steps Scrutiny this year was carried out for the first time by external scrutinisers from local stakeholder groups. The comparison in the results to 2013 above demonstrates the disparity that can exist between what external stakeholders think about services and how the CCG perceives itself in terms of inclusion. There has been a marked improvement in leadership around equality and diversity which is demonstrated in the move from Developing to Achieving in outcome 4.1.

It is important for the CCG to note that the number of scrutinisers taking place was relatively small and did not fully represent all nine protected characteristics set out in the Equality Act 2010 it is therefore worthwhile focussing attention in 2015 on developing the scrutiny group in terms of greater numbers and working towards more extensive representation. Interestingly, there are discrepancies in grading across most of the outcomes that have been scrutinised which may reflect the scrutiniser’s particular, existing knowledge of services and/or health issues that have been addressed this time. The development of the scrutiny group may support a much more objective grading in the future.

It is recommended that as well as addressing the issue of provision of evidence and further developing services the action plan that will be developed in conjunction with the CCG should address the scrutiny group issue as laid out above. This will support the CCG in achieving a consistent assessment across all outcomes from members of the public as well as staff.

6. Conclusion

This paper has set the results of the public and staff grading of the evidence presented for EDS2 grading. The results on the whole were very positive with all but two outcomes moving to achieving or excelling. The report also sets out recommendations from the grading panel on how to move forward in 2015.

7. Recommendations

Members are asked to: 1. Acknowledge the content of the report and the outcomes of the public grading against the NHS Equality Delivery System outcomes in 2014. 2. Note the CCGs assurance to date. 3. Support the proposed next steps and recommendations set out by the

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scrutiners for moving forward in 2015.

Julie Wall Head of Equality & Inclusion NHS Midlands and Lancashire CSU

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Agenda Item No:

North Staffordshire Clinical Commissioning Group Equality Delivery System (EDS2) Grading 2014 Results Report

1. Introduction

This report provides an overview of the results of the Equality Delivery System (EDS2) grading carried out on evidence presented by the Clinical Commissioning Group (CCG) during October 2014 to local people.

EDS2 provides this forum and the Clinical Commissioning Group Board an assurance mechanism for compliance with the Equality Act 2010 and co-design equality objectives with users of services, to ensure improvements in the experiences of patients. The four Equality Delivery System Goals are: Goal 1 Developing better health outcomes for all; Goal 2 Developing for improved patient access and engagement; Goal 3 Developing for empowered, engaged and well supported staff, and; Goal 4 Developing for inclusive leadership at all levels.

4. Grading 2014

It was agreed at the Commissioning team meeting of 1st September 2014 that the CCG would present evidence to local people against the outcomes of goal 2 and that the evidence would focus on the following areas:  Cancer Pathway  Hearing Aids  Mental Health  Transforming hospital services to community based services

The CCGs grading by local people took place on 2nd October 2014 and the EDS2 outcomes

North Staffordshire CCG EDS Grading Report_v0.1_171014_jwct 1 considered were: 2. Improved 2.1 People, carers and communities can readily access hospital, patient access and community health or primary care services and should not be denied experience access on unreasonable grounds 2.2 People are informed an supported to be as involved as they wish to be in decisions about their care 2.3 People report positive experiences of the NHS

2.4 People’s complaints about services are handled respectfully and efficiently

To ensure the work is manageable in the time available and to ensure that the evidence gathered was meaningful and helpful as possible, any evidence gathered reflected the needs of people from the following Equality Act protected characteristics:

 Age – specifically older people  Disability – specifically mental health and people with hearing impairments  Sexual Orientation – specifically lesbian, gay and bisexual people  Gender Reassignment – those people who are undergoing or who have undergone gender transition  Sex – both male and female The evidence gathered was, as far as possible, outcome focussed and the CCG was asked to think creatively about how it would like to present the evidence at the scrutiny event.

4.2 Grading Results 2014

Outcome 2.1 People, carers and communities can readily access hospital, community health or primary care services and should not be denied access on unreasonable grounds 33.3% 0% 11.1%

55.6%

A. Undeveloped – all or most protected groups... B. Developing – some protected groups fare we... C. Achieving – most protected groups fare wel... D. Excelling – all protected groups fare well

The response to the above outcome shows that over half of the members of the scrutiny panel (55.6%) felt the CCG was at Developing level although a smaller number (33.3%) thought that the CCG was Achieving. One person thought that the level was still at Undeveloped. Only the scrutinisers who had graded as Developing left comments, these

North Staffordshire CCG EDS Grading Report_v0.1_171014_jwct 2 included:  Not enough evidence  Definitely enough evidence for at least 5 protected characteristics  Dementia services have plans to develop better services but not yet implemented. Cancer and EOL services have aims to improve and currently have good consultation. Good evidence regarding medicines management and LD services

Outcome 2.2 People are informed and supported to be as involved as they wish to be in decisions about their care

11.1% 11.1% 11.1%

66.7%

The responses above show that just over two thirds of the scrutinisers felt that the CCG was at Achieving level for this outcome. However grading responses were spread across the four possible grades. Responses included:  Lots of clear sources of evidence from a range of methods showing the effort put into reacting to all groups in the community and seeking their involvement  Cancer and EOL services show evidence of engagement  Call to Action shows opportunities for involvement and efforts made to engage under- represented groups  Lots of evidence to include young people 1.) Outcome 2.3 People report positive experiences of the NHS 0% 11.1%

44.4%

Due to the close grading on this outcome the scrutiny panel awarded a Developing + to reflect their decision. Once again one person felt that the evidence provided should only have achieved Undeveloped. It is unclear as to whether the same person scored Undeveloped across all the outcomes but it does demonstrate diverse expectations in terms of provision of evidence being provided. Through action planning the CCG will work hard to

North Staffordshire CCG EDS Grading Report_v0.1_171014_jwct 3

achieve a definite Achieving when this particular outcome evidence is scrutinised next year. Scrutinisers feedback was:  Positive feedback sometimes to the patients’ surprise. There seems a present expectation that the service would be poor  Home treatment team appear to do a good job  The responses to carers surveys are all positive  Blood glucose testing – patient complained and improvements made with no further complaints  Needs more evidence  There are many positive outcomes but there are also many negative ones for the mentally ill, but home treatment team appear to do a good job provided it is not a home situation that is causing the problem

Outcome 2.4 People’s complaints about services are handled respectfully and efficiently

11.1% 11.1% 11.1%

66.7%

Just over two thirds of the scrutinisers (66.7%) graded the evidence for this outcome as Achieving and demonstrates a concrete improvement from 2013 in moving from Developing. It is important however to acknowledge that 22% of the scrutiners felt that the CCG was still developing or undeveloped, this was born out by some of the feedback where scrutiners felt that they needed more evidence on how the contract with the CSU is being monitored to ensure that all complaints received are being handled respectfully and efficiently. 4.3 Comparison between 2013 grading and 2014 grading Goals Outcome 2013 2014 Goal 1 1.1 Services are commissioned, procured, designed and D Not Better health delivered to meet the health needs of local communities graded in 2014 outcomes 1.2 Individual people’s health needs are assessed and met D Not in appropriate and effective ways graded in 2014 1.3 Transitions from one service to another, for people on U Not care pathways, are made smoothly with everyone well- graded in 2014 informed 1.4 When people use NHS services their safety is prioritised D Not and they are free from mistakes, mistreatment and abuse graded in 2014 1.5 Screening, vaccination and other health promotion D Not services reach and benefit all local communities graded in 2014 Goal 2 2.1 People, carers and communities can readily access D D Improved hospital, community health or primary care services and patient should not be denied access on unreasonable grounds

North Staffordshire CCG EDS Grading Report_v0.1_171014_jwct 4 access and 2.2 People are informed and supported to be as involved as D Achieving experience they wish to be in decisions about their care 2.3 People report positive experiences of the NHS D D +

2.4 People’s complaints about services are handled D A respectfully and efficiently Goal 3 3.1 Fair NHS recruitment and selection processes lead to a A Not A more representative workforce at all levels graded in 2014 representative The NHS is committed to equal pay for work of equal A Not and supported 3.2 value and expects employers to use equal pay audits to graded in workforce 2014 help fulfil their legal obligations 3.3 Training and development opportunities are taken up A Not and positively evaluated by all staff graded in 2014 3.4 When at work, staff are free from abuse, harassment, A Not bullying and violence from any source graded in 2014 3.5 Flexible working options are available to all staff A Not consistent with the needs of the service and the way graded in 2014 people lead their lives 3.6 Staff report positive experiences of their membership of A Not the workforce graded in 2014 Goal 4 4.1 Boards and senior leaders routinely demonstrate their D Not Inclusive commitment to promoting equality within and beyond their graded in 2014 leadership organisations 4.2 Papers that come before the Board and other major New for Not Committees identify equality-related impacts including 2014 graded in 2014 risks, and say how these risks are managed 4.3 Middle managers and other line managers support their U Not staff to work in culturally competent ways within a work graded in 2014 environment free from discrimination

5. Next steps Scrutiny this year demonstrates that the CCG is improving in comparison to 2013 with regard to the EDS2 Goal 2 outcomes based on the evidence that has been scrutinised so far. It is advised that the CCG focuses on the EDS2 outcomes not reviewed and graded in 2014, primarily Goal 1, 3 and 4 especially as two outcomes were graded as undeveloped in 2013 e.g. Outcome 1.3 Transitions from one service to another, for people on care pathways, are made smoothly with everyone well-informed and Outcome 4.3 Middle managers and other line managers support their staff to work in culturally competent ways within a work environment free from discrimination.

Goal 3 and its 6 outcomes focus specifically on staff and it is advised that this grading be carried out by CCG staff in 2015.

As the number of scrutinisers taking place was relatively small and not fully representative across all protected characteristics it may be worthwhile focussing attention on developing the scrutiny group in terms of greater numbers and working towards more extensive representation. Interestingly, there are discrepancies in grading across all four outcomes that have been scrutinised which may reflect scrutiniser’s particular, existing knowledge of serves and/or health issues that have been addressed this time. The development of the scrutiny group may support a much more objective grading in the future.

North Staffordshire CCG EDS Grading Report_v0.1_171014_jwct 5 achieving a consistent assessment across all outcomes from members of the public as well as staff.

6. Conclusion

This paper has set the results of the public and staff grading of the evidence presented for EDS2 grading. The results on the whole were very positive with all but two outcomes moving to achieving. The report also sets out recommendations from the grading panel on how to move forward in 2015 in section 5 Next Steps.

7. Recommendations

Julie Wall Head of Equality & Inclusion NHS Midlands and Lancashire CSU

North Staffordshire CCG EDS Grading Report_v0.1_171014_jwct 6

The goals and outcomes of EDS2

Goal Number Description of outcome

Better health 1.1 Services are commissioned, procured, designed and delivered to meet the health needs of local communities outcomes 1.2 Individual people’s health needs are assessed and met in appropriate and effective ways

1.3 Transitions from one service to another, for people on care pathways, are made smoothly with everyone well-informed

1.4 When people use NHS services their safety is prioritised and they are free from mistakes, mistreatment and abuse

1.5 Screening, vaccination and other health promotion services reach and benefit all local communities

Improved 2.1 People, carers and communities can readily access hospital, community health or primary care services and should not be denied access on patient access and unreasonable grounds experience 2.2 People are informed and supported to be as involved as they wish to be in decisions about their care

2.3 People report positive experiences of the NHS

2.4 People’s complaints about services are handled respectfully and efficiently

A representative 3.1 Fair NHS recruitment and selection processes lead to a more representative workforce at all levels and supported workforce 3.2 The NHS is committed to equal pay for work of equal value and expects employers to use equal pay audits to help fulfil their legal obligations

3.3 Training and development opportunities are taken up and positively evaluated by all staff

3.4 When at work, staff are free from abuse, harassment, bullying and violence from any source

3.5 Flexible working options are available to all staff consistent with the needs of the service and the way people lead their lives

3.6 Staff report positive experiences of their membership of the workforce

Inclusive 4.1 Boards and senior leaders routinely demonstrate their commitment to promoting equality within and beyond their organisations leadership 4.2 Papers that come before the Board and other major Committees identify equality-related impacts including risks, and say how these risks are to be managed

4.3 Middle managers and other line managers support their staff to work in culturally competent ways within a work environment free from discrimination

A refreshed Equality Delivery System for the NHS Due regard – Brown principles

These principles have been taken from the Equality and Human Rights Commission’s paper on making fair financial decisions (Equality and Human Rights Commission, 2012).

Case law sets out broad principles about what public authorities need to do to have due regard to the aims set out in the general equality duties. These are sometimes referred to as the 'Brown principles' and set out how courts interpret the duties. They are not additional legal requirements but form part of the Public Sector Equality Duty as contained in section 149 of the Equality Act 2010. Under the duty local authorities must, in the exercise of their functions have due regard to the need to

Eliminate unlawful discrimination, harassment, victimisation and other conduct prohibited by the Act Advance equality of opportunity between people who share a protected characteristic and those who do not Foster good relations between people who share a protected characteristic and those who do not.

In summary, the Brown principles say that:

• Decision-makers must be made aware of their duty to have 'due regard' and to the aims of the duty. • Due regard is fulfilled before and at the time a particular policy that will or might affect people with protected characteristics is under consideration, as well as at the time a decision is taken. • Due regard involves a conscious approach and state of mind. A body subject to the duty cannot satisfy the duty by justifying a decision after it has been taken. Attempts to justify a decision as being consistent with the exercise of the duty, when it was not considered before the decision, are not enough to discharge the duty. General regard to the issue of equality is not enough to comply with the duty. • The duty must be exercised in substance, with rigour and with an open mind in such a way that it influences the final decision. • The duty has to be integrated within the discharge of the public functions of the body subject to the duty. It is not a question of 'ticking boxes'. • The duty cannot be delegated and will always remain on the body subject to it. • It is good practice for those exercising public functions to keep an accurate record showing that they had actually considered the general equality duty and pondered relevant questions. If records are not kept it may make it more difficult, evidentially, for a public authority to persuade a court that it has fulfilled the duty imposed by the equality duties.

Bibliography Equality and Human Rights Commission. (2012). Making Fair Financial Decisions: An Assessment of HM Treasury's 2010 Spending Review conducted under Section 31 of the 2006 Equality Act. Manchester: Equality and Human Rights Commission.

AGENDA ITEM 13.2

REPORT TO THE PUBLIC MEETING OF STOKE-ON-TRENT CLINICAL COMMISSIONING GROUP GOVERNING BODY ON THE 4TH AUGUST 2015

TITLE EQUALITY & INCLUSION UPDATE TO GOVERNING BODY FOR WRES (WORKPLACE RACE EQUALITY STANDARD)

PURPOSE To inform the Governing Body of progress (March to July 2015) of the equality performance of Stoke-on-Trent Clinical Commissioning Group (SOTCCG) including delivery against the Public Sector Equality Duty (PSED) and compliance assurance specifically for: • WRES (Workplace Race Equality Standard)

The first WRES Reporting Template has been submitted to NHS England by 1 July 2015, showing SOT CCG’s annual ethnicity data for the 9 WRES Indicators. This information is also publicly displayed on a new WRES CCG webpage and will feature in the national WRES dashboard of commissioner and provider performance, by NHS England.

The CCG is evidencing giving due regard to this 1 April 2015 annual ethnicity workforce data and want to link this information to the next Annual Equality & Inclusion Report, which is due on the CCG website as a Governing Body approved report no later than 31 January. The aim is to identify any significant shortfalls and help to improve workplace experiences and representation at all levels for BAME staff. Monitoring of larger providers for WRES compliance is also incumbent upon the CCG, where they are the co-ordinating commissioner and via robust contract management.

Midlands and Lancashire Commissioning Support Unit (CSU) Human Resources have provided the ethnicity data required for the 9 WRES Indicators or metrics, where this is available from ESR (Electronic Staff Records) and NHS Jobs. Some improvements may be required eg to self-declared data to support fuller data reporting in 2016.

Governing Body members should note that future Workplace Equality Standards are likely from NHS England with specific focus on disability; gender; and sexual orientation.

For an update on WRES progress: see Appendix 1 for further details

‘WRES progress update and business risks’ to appear as a standing agenda item at public Governing Body meetings.

Regular WRES updates to be cascaded to CCG staff from the WRES Governing Body Champion and by Communications and Engagement Lead, following each public Governing Body meeting. Future WRES standing agenda items will include a summary update on progress, with a fuller Paper following the annual submission reporting date to NHS England in 2016.

The next Governing Body meeting will receive the WRES Action Plan (2015) with a request for discussion and approval. The draft plan will be developed by both Equality & Inclusion and Human Resources Business Partners and will provide 2015 equality performance evidence towards Equality Delivery System Goal 3: A represented and supported workforce.

A WRES CCG action plan is being developed by 1 August, following submission to NHS England by 1 July 2015, of SOT CCG WRES Reporting template (an annual snapshot of CCG ethnicity data at 1 April 2015). This action plan will also monitor larger provider partner compliance through a website review and provider assurances submitted to CCG contract management team for their co-ordinating commissioner organisation.

RECOMMENDATIONS Decision x Note Receive x Information x What is required as an outcome from Approve the Forum

The Governing Body is asked to

1) Consider and discuss equality performance progress for the new WRES.

2) Evidence that they are giving ‘due regard’ to using the 9 indicators or metrics contained in the Workforce Race Equality Standard to help improve workplace experiences, and representation at all levels within their workforce, for Black Asian Minority Ethnic (BAME) staff; and assurance, through the provision of evidence, that their Providers are implementing the NHS Workforce Race Equality Standard. The provisions of the NHS Standard Contract require CCGs to seek assurance from, and receive an annual report on their WRES compliance [and plan for improvements], from providers. Note: ‘Due regard’ is a legal term that requires proportionality and relevance (see the ‘Brown Principles’ from the Equality and Human Rights Commission ie EHRC, detailed on page 5 below).

3) Agree a Board member WRES Champion from Stoke-on-Trent CCG to take a lead role in championing the WRES at all levels and ensuring CCG is embedding any learning into our practices for measurable year on year improvements (see Governing Body Statement of Commitment).

CLINICAL LEAD OPERATIONAL LEAD AUTHOR Dr Chandra Kanneganti Dave Sanzeri Head of Julia Allen Clinical Director for Commissioning Equality & Inclusion Community Services / Long (Community based) / Alex Business Partner Term Conditions / End of Palethorpe Head of Life Care and Primary Care Governance NSCCG

Appendix 1

WRES update on progress August 2015:

• WRES Briefing was developed by Equality & Inclusion team at M&L CSU for CCG (April 2015). This followed the CCG E&IBP attending NHS England’s first WRES Workshop at Skipton House, London on 16 March; and WRES Briefing event in Manchester on 31 March. • A WRES Briefing Update was developed May 2015 • Board Statement of Commitment was approved and for website display by Joint ODC 9 June • New WRES CCG website page was developed June 2015 • Final WRES Reporting Template (Apr 2015) from NHS England, was approved by Joint ODC 9 June and for display on CCG website by 1 July 2015 (legal compliance due date). • Unique WRES webpage URL was submitted to NHS England ahead of due date 1 July. This is to be displayed on a national WRES dashboard for commissioners and providers. • The WRES Reporting template is designed to help NHS organisations to present and publish their progress in implementing the WRES. It is designed to complement rather than substitute any existing reporting process and will assist with annual requirement that the WRES annual report must be published as a stand-alone report on provider websites. • The Technical Guidance for the WRES (March 2015) is complemented by a series of FAQs and Supplementary Guidance for Commissioning organisations is due out from NHS England later in 2015.

WRES Briefing WRES update May Board WRES WRES webpage SOTCCG WRES v4.docx 2015.docx Statement of Committcontent SOT CCG Jun Reporting Template Ju

WRES Business Risks (potential): • CCG failing to embed giving due regard to WRES 9 Indicators and any significant findings into day to day practice; monitoring option routinely provided to protected groups through self-declaring ESR (electronic staff record) profile, with periodic refresh opportunities for the workforce. • Under Data Protection Act requirements, CCG must not publicly disclose any data that could lead back to any individual member of staff. Any internal scrutiny of declared workforce data must remain confidential at all times. • Failing to show CCG learning and feedback from previous year’s WRES findings and recommendations made to CCG Governing Body • Larger provider partner organisations failing to transparently embed WRES into day to day practice and timely, accurate display of annual data report on their website (with any significant findings and recommendations for improvements), and timely submission of WRES data to their co-ordinating commissioner organisation.

Background The WRES was mandated by NHS England in April 2015, for all commissioner and their larger provider organisations (public and private sector).

Clinical Commissioning Groups have two roles in relation to the Workforce Race Equality Standard – as commissioners and as employers. In both roles their work is shaped by requirements arising from:

• The NHS Constitution • Their Public Sector Equality Duty and that of the providers they commission work from • The NHS Standard Contract and associated documents • The Technical Guidance to the Workforce Race Equality Standard.

Applying the Workforce Race Equality Duty to the CCG’s own workforce

NHS Constitution Clinical Commissioning Groups and NHS England are required both as employers and as commissioners to take account of the NHS Constitution in their decisions and actions.

“The Secretary of State for Health, all NHS bodies, private and voluntary sector providers supplying NHS services, and local authorities in the exercise of their public health functions are required by law to take account of this Constitution in their decisions and actions.

“4.a. The Constitution applies to all staff, doing clinical or non-clinical NHS work – including public health – and their employers. It covers staff wherever they are working, whether in public, private or voluntary sector organisations. The rights are there to help ensure that staff: are treated fairly, equally and free from discrimination;

“The NHS commits: to provide all staff with personal development, access to appropriate education and training for their jobs, and line management support to enable them to fulfil their potential (pledge);

“4.b (Staff) have a duty not to discriminate against patients or staff and to adhere to equal opportunities and equality and human rights legislation. http://www.nhs.uk/choiceintheNHS/Rightsandpledges/NHSConstitution/Documents/2013/the- nhs-constitution-for-england-2013.pdf

The CCG’s own workforce and the WRES The Public Sector Equality Duty came into force on 5 April 2011. The Equality Duty applies across Great Britain to the public bodies listed in Schedule 19 (as amended) and to any other organisation when it is carrying out a public function. It requires public bodies to • have due regard to the need to eliminate discrimination • advance equality of opportunity • foster good relations between different people when carrying out their activities. The Equality Act 2010 (Specific Duties) Regulations 2011 came into force on 10 September 2011. The specific duties require public bodies to publish relevant, proportionate information showing compliance with the Equality Duty, and to set equality objectives.

In accordance with the Public Sector Equality Duty, the NHS England Technical Guidance on the Workforce Race Equality Standard http://www.england.nhs.uk/wp- content/uploads/2015/04/wres-technical-guidance-2015.pdf requires Clinical Commissioning Groups to have “due regard” to the Workforce Race Equality Standard as a means of meeting that duty.

Whilst the provisions of the NHS Standard Contract require CCGs to seek assurance from, and receive an annual report from, providers, they are not required by the Standard Contract to apply the Workforce Race Equality Standard to themselves in precisely the same way.

Requiring CCGs to implement the WRES in its entirety is felt to be problematic given that a substantial number of CCGs have extremely small workforces (often below 100 staff) and the full data provisions of the WRES would not be easily directly applicable. Nevertheless it is felt important that all commissioning bodies including CCGs do have due regard to the WRES, whilst the largest commissioner, NHS England, intends applying it to its own workforce just as any provider would be expected to.

The formulation that CCGs are required to have “due regard” is used in acknowledgement that very small organisations could not be expected to apply the WRES precisely to themselves, but that all CCGs, in exercising due regard, would be expected to apply the WRES to themselves using the key case law principles known as the “Brown Principles.”

Due regard Brown Principles.pdf

CCGs are expected to give “due regard to using the indicators contained in the Workforce Race Equality Standard to help improve workplace experience, and representation at all levels within their workforce, for Black and Minority Ethnic staff” . In practice this means:

• CCGs must collect data on their workforce by protected characteristic and in particular by ethnicity. That data should be both workforce data and staff survey data. Some CCGs already take part in the National Staff Survey. Others may conduct their own surveys. They must analyse that data against each of the WRES metrics; • Data analysis must be approached with some caution because in substantial numbers of CCGs the number of staff employed are small with the result that very small changes in numbers on workforce and survey metrics may result in substantial changes in percentage terms. Such changes should be treated with caution but such changes should not be ignored since, especially where they signify a trend or indicate a concern, they may be extremely useful. • Notwithstanding data concerns, similar patterns of less favourable treatment may well exist. For example it is very likely that BME staff are under-represented in the most senior employed posts within CCGs even where Governing bodies themselves are more representative. • CCGs should produce an annual report showing the results of their staff survey and workforce data for internal analysis but caution should be used regarding wider publication due to DPA considerations. The report should indicate what steps CCGs are taking to improve the relevant metrics. In doing so however, they will need to give consideration to how (and indeed whether) such data is published and what conclusions are drawn, since small numbers may identify individuals. Where numbers or percentages are used (as they will be) consideration should be given the risk of identification of individuals in accordance with the provisions of the Data Protection Act. Where publication might reasonably lead to the identification of individuals due to small numbers, as will be the case in many CCGs, it should be assumed that, whilst such a report should be prepared for internal use to enable improvement to the treatment and experience of BME staff to be made, its wider publication may well not be appropriate. Should FOI requests be subsequently made, publication of data that enables the identification of individuals would also not normally be appropriate other

than where there is a clear public interest in such disclosure (potentially, for example, in respect of the ethnicity of Board members).

Assurance and reporting systems

The Technical Guidance summarises the milestones as follows:

Milestone Activity April 1st 2015 Baseline date for comparison with April 2016 July 1st 2015 Publication of 1st April 2015 data including identification of any shortcomings and plans to address them April 2015 – Work to start to address any data shortcomings and to understand and address March 2016 shortfalls identified by the WRES indicators April 2016 Baseline date for comparison with April 2015 1st May 2016 Baseline data to March 31st 2016 should be published to Commissioner (for providers), on Trust web site and shared with Board and staff It should include steps underway to address key shortcomings in data, or significant gaps between the treatment and experience of white and BME staff.

Providers are required to provide to commissioners an initial baseline report on their initial data for the nine WRES indicators for April 2015 no later than July 1st 2015.

The Technical Guidance Para 10.4 states

In the first Annual Report to Commissioners in April 2016, organisations will want to set out their own assessment of the challenge and risks they face in closing the gaps between the metrics for White and BME staff, alongside their plans to close whatever gap between the treatment and experience the data reveals.

Providers are expected to publish each annual report and the baseline data, as a stand- alone report on their web site and CCGs are expected to publish that report on their own web site. CCGs and providers will note that the Standard Contract states: 28.5 The Provider and each Commissioner must ensure that any information provided to any other Party in relation to this Contract is accurate and complete.

Agenda Item 13.2 Appendix 1

Equality & Inclusion Briefing NHS Workforce Race Equality Standard

1.0 Introduction This briefing gives an update about NHS England’s decision to establish a Race Equality Standard across all NHS organisations.

2.0 Background On 31st July 2014 NHS England published plans to tackle race inequality across NHS workforces by setting a ‘Race Equality Standard’ for NHS organisations.

http://www.england.nhs.uk/2014/07/31/tackle-race-inequality

This followed an announcement by the NHS Equality and Diversity Council Chaired by Simon Stevens – Chief Executive of NHS England – that action will be required to ensure employees from Black and Minority Ethnic (BME) backgrounds have equal access to career opportunities and fair treatment in the NHS workplace.

The Equality and Diversity Council pledged its commitment, subject to consultation with the NHS, to implement two measures to improve equality across the NHS, which would start in April 2015. The first measure – a workforce race equality standard - will, for the first time, require organisations employing almost all of the 1.4 million NHS workforce to demonstrate progress against a number of indicators of workforce equality, including a specific indicator to address the low levels of BME Board representation (Black minority ethnic). (NB the second measure is making the Equality Delivery System (EDS) mandatory through the NHS Standard Contract).

These indicators have now been published (February 2015) as ‘the defined metrics’ and is available at:

http://www.england.nhs.uk/wp-content/uploads/2015/02/wres-metrics-feb-2015.pdf

There are nine metrics. Three of the metrics are specifically on workforce data and five of the metrics are based on data from the national staff survey indicators. It is intended that the staff survey indicators will highlight any differences between the experience and treatment of white staff, and BME staff in the NHS with a view to close the gap between these metrics. The final metric requires provider organisations to ensure that their Boards are broadly representative of the communities they serve.

The metrics (as published) are set out in Appendix 1. All providers (other than primary care), as holders of the NHS Standard Contract 15/16, except ‘small providers’ will be expected to implement the race equality standard from April 2015. An annual report will be required to be submitted to the “Co-ordinating Commissioner” outlining progress on the Standard.

2.1 Rational for the Standard The proposal put to the EDC on July 29th 2014 was that there should be a National Workforce Race Equality Standard, built from a small number of indicators for which most Trusts already collect data (a mix of NHS national survey data and local workforce data). In addition there would be one Board membership metric linked to the diversity of the Board.

M&LCSU Equality & Inclusion Briefing: WRES April 2015 1

This Standard would then be used to gauge the current state of race equality within NHS organisations and track what progress is being made to identify and promote talented BME staff as well as helping to eliminate wider aspects of discrimination in the treatment of BME staff.

The Standard takes a small number of indicators and requires NHS organisations to close the gap between the BME and white staff experience for those indicators. So for example, research by Kline (2013) Discrimination by Appointment. Public World. http://www.publicworld.org/files/Discrimination_by_appointment.pdf) suggests the likelihood of BME staff being appointed from shortlisting is much less than the likelihood of white staff being appointed from shortlisting. Similarly there are significant differences in many Trusts between the likelihood of BME and white staff accessing non-mandatory training – the kind that improves career development and promotion opportunities.

Organisations will be expected to do what the best ones already do, to scrutinise and understand the data and act on it, and then work towards a level playing field where the treatment of staff is not unfairly affected by their ethnicity.

NHS Employers found it is twice as likely that BME staff will enter the disciplinary process as white staff yet whilst some Trusts seek to understand this and reflect on how to change this, others do not. One consequence of potentially discriminatory recruitment and promotion processes may be the imbalance in the representation of BME staff across pay grades, irrespective of the balance of the workforce within individual occupations. All NHS organisations covered by the NHS Standard Contract are now expected to collect this data as many already do and are now be required to do what many NHS organisations do not currently do, that is, to analyse the data and work out how to reduce the differences in treatment for which there is no objective justification.

Some organisations have already made strides in doing this and it shows in their data. Others are starting on this journey. What the Workforce Race Equality Standard will do is to require all organisations to not just collect such data, but to analyse and act on it, seeking to narrow the metrics gap between the treatment of BME and White staff.

The second part of the Standard concerns data that is already published in the NHS national staff survey and which considers the differences between the White and BME staff responses on four indicators.

Finally, organisations are expected to consider whether their Board membership is broadly representative of the population served and this is explained further in the Technical Guidance.

2.2 Benefits for implementing the Standard NHS Employers have highlighted the considerable cost of not being an equality employer. The benefits will include less grievances, more likelihood of attracting and appointing the best staff, less bullying, less disciplinary cases, less turnover and sickness absence, and more importantly of all, better BME staff morale with benefits for all patients. There may be upfront costs but real benefits in the short to medium term.

3. What does this mean for CCGs? All Commissioners of NHS services will be expected to have due regard to NHS Standard Contract and to use the Standard (and the Equality Delivery System) themselves.

Some CCGs already participate in the NHS National Staff Survey. Further developmental work on the applicability of the Standard to CCGs is currently underway.

M&LCSU Equality & Inclusion Briefing: WRES April 2015 2

In 2015-16 each CCG will need to demonstrate the following: • That they are giving due regard to using the indicators contained in the Workforce Race Equality Standard to help improve workplace experiences, and representation at all levels within their workforce, for Black and Minority Ethnic staff; and assurance, through the provision of evidence, that their Providers are implementing the NHS Workforce Race Equality Standard; • That they are implementing EDS2 to help meet the Public Sector Equality Duty and improve their performance for people with characteristics protected by the Equality Act 2010; and assurance, through the provision of evidence, that their Providers are doing the same. • CCG will need to ensure that they receive timely advice support and guidance from equality and HR workforce specialists in the collation and interpretation of the data.

3.1 Board Level commitment Successful equality, diversity and inclusion work, including work to implement the Standard, requires specialist advice and support; but it is increasingly recognised that leadership must come from Board level.

At the outset, prior to implementing the Standard, the organisation’s Board and senior leaders should confirm their own commitment to workplaces that are free from discrimination – where all staff are able to thrive and flourish based on their diverse talent. Therefore Board level sponsorship and support of this work will be crucial to drive the changes forward.

3.2 Timeline of Implementation The following timeline has been formalised with particular emphasis on two key deadlines: 1st April 2015 – to start work collating the baseline data and July 1st when the information must be published.

Milestone Activity Completed by April 1st 2015 Baseline data for comparison with April 2016. HR Lead

July 1st 2015 Publication of 1st April 2015 data including HR / E&I Leads identification of any essential shortcomings.

April 2015 – March Work to start to address any data shortcomings HR / E&I Leads 2016 and to understand and address shortfalls identified by the WRES indicators.

April 2016 Baseline data for comparison with April 2015 HR Lead should be completed including steps underway to address key shortcomings in data, or significant gaps between the treatment and experience of white and BME staff.

1st May 2016 Baseline data to March 31st 2016 should be HR / E&I Leads published to Commissioner (for providers), on Trust web site and shared with Board and staff.

4. Recommended actions:

1. The CCG will be required to review all of their providers with the exception of ‘small providers’ (The definition of a ‘small provider’ is clarified in the NHS Standard 2014/2015 Updated technical Guidance and for the CCG the Small Provider category now includes those providers whose aggregate annual income for the relevant

M&LCSU Equality & Inclusion Briefing: WRES April 2015 3

Contract Year, in respect of services provided to any NHS commissioners commissioned under any contract based on the NHS Standard Contract is not expected to exceed £200,000.) at least annually to ensure that their providers are meeting the WRES metrics. (appendix 2 provides a reporting framework the CCG can adopt) 2. The CCG will need to report on the metrics set out in Appendix 1 in their Annual Report to NHS England. 3. The CCG needs to review its own workforce in relation to the metrics set out in the WRES and report annually to NHS England. 4. The CCG will need to review the Detailed Service Offers with the Commissioning Support Unit for Human Resources, Contract Management and Equality and Inclusion to ensure the CCG receives the support they need as this is a new requirement and may not be covered by existing offers. 5. The CCG will need to consider the findings of year 1 review of both the CCG workforce and that of its providers and consider actions required where there are gaps or under-representation in the workforce for Black and Minority Ethnic Groups.

The Governing Body are asked to:

• Note the content of the E&I Briefing • Agree to actions set out in sections 3, 4 and Appendix 1.

Julia Allen Interim Equality and Inclusion Lead April 2015

M&LCSU Equality & Inclusion Briefing: WRES April 2015 4

Appendix 1 - Workforce Race Equality Standard November 2014 f or implementation from April 2015

Workforce Race Equality Indicators

Workforce metrics For each of these three workforce indicators, the Standard compares the metrics for white and BME staff 1 Percentage of BME staff in Bands 8-9 and VSM compared with the percentage of BME staff in the overall workforce

2 Relative likelihood of BME staff being recruited from shortlisting compared to that of white staff being recruited from shortlisting across all posts

3 Relative likelihood of BME staff entering the formal disciplinary process, compared to that of white staff entering the formal disciplinary process, as measured by entry into a formal disciplinary investigation

[Note. This indicator will be based on data from a two year rolling average of the current year and the previous year]. 4 Relative likelihood of BME staff accessing non mandatory training and CPD as compared to White staff.

National NHS Staff Survey findings. For each of these four staff survey indicators, the Standard compares the metrics for each survey question response for White and BME staff. 5 KF 18. Percentage of staff experiencing harassment, bullying or abuse from patients, relatives or the public in last 12 months

6 KF 19. Percentage of staff experiencing harassment, bullying or abuse from staff in last 12 months

7 KF 27. Percentage believing that trust provides equal opportunities for career progression or promotion

8 Q 23. In the last 12 months have you personally experienced discrimination at work from any of the following? b) Manager/team leader or other colleagues Boards. Does the Board meet the requirement on Board membership in 9. 9 Boards are expected to be broadly representative of the population they serve.

E&I Briefing: WRES was developed by

Ramzan Mohammed, Equality & Inclusion Business Partner South, M&LCSU (E&I Briefing: WRES lead)

Julia Allen, Interim Equality & Inclusion Lead, M&LCSU (E&I Briefing: WRES support)

Issued to CCGs and CSU 20 April 2015. Updated 1 May 2015 CSU.

M&LCSU Equality & Inclusion Briefing: WRES April 2015 5

Agenda Item 13.2 Appendix 2

WRES update May 2015: to Equality & Inclusion Business Partners

I am attaching update to WRES Briefing for use in your CCGs and especially with HR Leads and Procurement / Contract Manager Leads at CSU and CCGs. Also latest Technical Guidance from NHS England website, dated March 2015. Metric 4 has been slightly changed (see page 16). This has now been incorporated into our WRES Briefing v 4.

Here are some early additional pointers arising from the discussions I have been having with CCGs:

HR Leads: • Discuss the need for an early standard consistent reporting template / dashboard for publishing on CCG websites

• Need to gather this data for CCGs, and for CSU workforce – ensure using the latest Technical Guidance and metrics from NHS England. Note key dates of 1 April 2015; 1 July 2015 to be displayed on website. Ensure senior committee cycle has a Paper going before them to approve WRES data (largely unscrutinised, with analysis and improvements to follow in the next year) onto the website.

• Include data from: NHS Jobs; ESR; formal disciplinaries and publishing of relevant data / tracking for HR being involved at right stages

• Ensure CCG can access Board level declared data and that all data displayed cannot be traced back to any individual(s) (according to Data Protection Act)

• Consider whether CCG do national NHS England Staff Survey? If No, the CCG need to include WRES metrics in their own Staff Survey, to be compliant with this mandated WRES (by NHS England).

E&I Leads: • Recommend WRES is a standing agenda item at each meeting of a senior committee (governance route may differ in each organisation). E&I BP / Lead to give a short overview of progress and Q&A, so understanding becomes embedded into reporting scrutiny and recruitment practices for improvements for BAME (Black Asian Minority Ethnic) staff.

• Discuss with senior E&I Lead at CCG and CSU – decide which senior committee this goes to, and action in a timely way.

• Recommend to E&I Lead in CCGs that a Board level Champion takes the lead on driving forward the WRES. Also a statement of commitment should be displayed on website and communicated to staff as a first step with WRES.

Procurement Leads / Contract Managers: • Work with HR Leads and Procurement Leads / Contract Managers to ensure larger providers make their 1 July data submission to lead Commissioner organisation.

What about when we have the data? Organisations will be expected to scrutinise and understand the data and act on it, and then work towards a level playing field where the treatment of staff is not unfairly affected by their ethnicity.

Agenda Item 13.2 Appendix 2

All NHS organisations covered by the NHS Standard Contract are now expected to collect this data and to analyse the data and work out how to reduce any differences in treatment for which there is no objective justification.

NHS Standard Contract 2015/16 except ‘small providers’ and primary care, will be expected to implement the Standard from April 2015.

A Small Provider in contract terms is one who expects to earn less than £200K in the relevant year from all contracts it holds that are based on the NHS Standard Contract.

An annual report will be required to be submitted to the Co-ordinating Commissioner outlining the provider’s progress in implementing the Standard. Provider organisations should publish their Annual Report on the standard as a separate report on their website so the progress on implementing the Standard is easily accessible to all patients, staff and the wider public.

Also see Technical Guidance for essential supporting details for implementing the WRES.

As you discuss with your CCG E&I Leads keep the E&I team informed of any key actions required / considerations by adding to this update information. This can then be shared with our CCGs to help build awareness and understanding of what is required.

Update to support WRES implementation: 5 May 2015 Julia Allen Interim E&I Lead M&LCSU

Governing Board Statement of Commitment: NHS Workforce Race Equality Standard (WRES) Equality & Inclusion

NHS England’s decision to establish a Race Equality Standard across all NHS organisations is reflected within this high level statement of commitment from Stoke on Trent Clinical Commissioning Group.

We are fully committed to inclusive workplaces that are free from discrimination – where all staff are able to thrive and flourish based on their diverse talent. This is evidenced through our organisational values - enacted through our behaviours at all levels, robust recruitment processes; support for team working and wellbeing in the workplace; and active awareness of equality and inclusion requirements embedded within our workplace practices.

Leadership of the Workforce Race Equality Standard is achieved through Board level sponsorship and support of this work and is acknowledged as crucial in driving the changes forward. Successful equality, diversity and inclusion work, including work to implement the Standard, requires specialist advice and support; it is also recognised that leadership must come from Board level.

Our obligations:  The Board to understand the principles of the Workforce Race Equality Standard and ensure high level reporting of findings is embedded across Senior Committees and Business Groups to enact through our business processes  A Board level Sponsor to take the lead role in championing the WRES at all levels, and ensuring our organisation is embedding any learning into our practices for measurable year on year improvements  Board meetings to record an annual update of WRES actions and progress  The current internal WRES Briefing and regular updates are to be presented to Senior Management Teams / Senior Committees as appropriate for approval  Data will be gathered across our organisation for the 9 metrics for the WRES at 1 April 2015 and annually  Our workforce findings will be displayed on our website by 1 July annually for the WRES 9 workforce metrics  Main provider partner workforce findings will also be displayed on their websites by 1 July annually and timely assurances of compliance reported to the lead commissioning organisation  In the case of CCGs, we will ensure our main provider partners are also compliant with the requirements of the NHS England Standard  We will analyse these annual data findings and consider any significant gaps and how we can bring in improvements where practical  We will work collaboratively with our Human Resources, Equality and Inclusion, Organisational Development and Business Intelligence colleagues and main provider partner organisations to learn from the data findings to demonstrate progress against a number of indicators of workforce equality, including a specific indicator to address the low levels of BAME Board representation (Black Asian minority ethnic).  A summary of findings and progress will be reported within our Annual Equality and Inclusion Report for display on our website no later than 31 January annually.

The Governing Board will ensure through overview and reporting processes that our organisation is giving ‘due regard’ to:  using the indicators contained in the Workforce Race Equality Standard to help improve workplace experiences, and representation at all levels within our workforce, for Black Asian and Minority Ethnic (BAME) staff; and assurance, through the provision of evidence, that our Providers are implementing the NHS Workforce Race Equality Standard  CCG will need to ensure that they receive timely advice support and guidance from equality and HR workforce specialists in the collation and interpretation of the data where held centrally and within CCG.  CCG will need to report on the metrics set out in Appendix 1 in their Annual Report to NHS England.

Governing Board WRES Statement of Commitment June 2015 1

 CCG needs to review its own workforce in relation to the metrics set out in the WRES and report annually to NHS England.

WRES Briefing M&LCSU - Appendix 1 - Workforce Race Equality Standard November 2014 for implementation from April 2015

Workforce Race Equality Indicators

2 Relative likelihood of BME staff being recruited from shortlisting compared to that of white staff being recruited from shortlisting across all posts

6 KF 19. Percentage of staff experiencing harassment, bullying or abuse from staff in last 12 months

7 KF 27. Percentage believing that trust provides equal opportunities for career progression or promotion

Governing Board WRES Statement of Commitment June 2015 2

Due regard – Brown principles

These principles have been taken from the Equality and Human Rights Commission’s paper on making fair financial decisions (Equality and Human Rights Commission, 2012).

In summary, the Brown principles say that:

Workforce Race Equality Standard REPORTING TEMPLATE Template for completion

Name of provider organisation Date of report: month/year

Name and title of Board lead for the Workforce Race Equality Standard

Name and contact details of lead manager compiling this report

Names of commissioners this report has been sent to

Name and contact details of co-ordinating commissioner this report has been sent to

Unique URL link on which this report will be found (to be added after submission)

This report has been signed off by on behalf of the Board on (insert name and date)

Publications Gateway Reference Number: 03496 Report on the WRES indicators

1. Background narrative a. Any issues of completeness of data

b. Any matters relating to reliability of comparisons with previous years

2. Total numbers of staff a. Employed within this organisation at the date of the report b. Proportion of BME staff employed within this organisation at the date of the report Report on the WRES indicators, continued

3. Self reporting a. The proportion of total staff who have self–reported their ethnicity b. Have any steps been taken in the last reporting period to improve the level of self-reporting by ethnicity c. Are any steps planned during the current reporting period to improve the level of self reporting by ethnicity

4. Workforce data a. What period does the organisation’s workforce data refer to? Report on the WRES indicators, continued

5. Workforce Race Equality Indicators For ease of analysis, as a guide we suggest a maximum of 150 words per indicator.

Indicator Data for Data for Narrative – the implications of the data and Action taken and planned including e.g. does reporting year previous year any additional background explanatory the indicator link to EDS2 evidence and/or a narrative corporate Equality Objective For each of these four workforce indicators, the Standard compares the metrics for White and BME staff. 1 Percentage of BME staff in Bands 8-9, VSM (including executive Board members and senior medical staff) compared with the percentage of BME staff in the overall workforce 2 Relative likelihood of BME staff being appointed from shortlisting compared to that of White staff being appointed from shortlisting across all posts. 3 Relative likelihood of BME staff entering the formal disciplinary process, compared to that of White staff entering the formal disciplinary process, as measured by entry into a formal disciplinary investigation* *Note: this indicator will be based on data from a two year rolling average of the current year and the previous year. 4 Relative likelihood of BME staff accessing non-mandatory training and CPD as compared to White staff Report on the WRES indicators, continued

Indicator Data for Data for Narrative – the implications of the data and Action taken and planned including e.g. does reporting year previous year any additional background explanatory the indicator link to EDS2 evidence and/or a narrative corporate Equality Objective For each of these four staff survey indicators, the Standard compares the metrics for each survey question response for White and BME staff. 5 KF 18. Percentage of staff White White experiencing harassment, bullying or abuse from patients, relatives or the BME BME public in last 12 months 6 KF 19. Percentage of staff experiencing White White harassment, bullying or abuse from staff in last 12 months BME BME 7 KF 27. Percentage believing that trust White White provides equal opportunities for career progression or promotion BME BME 8 Q23. In the last 12 months have you White White personally experienced discrimination at work from any of the following? BME BME b) Manager/team leader or other colleagues Does the Board meet the requirement on Board membership in 9? 9 Boards are expected to be broadly representative of the population they serve

Note 1. All provider organisations to whom the NHS Standard Contract applies are required to conduct staff surveys though those surveys for organisations that are not NHS Trusts may not follow the format of the NHS Staff Survey

Note 2. Please refer to the Technical Guidance for clarification on the precise means of each indicator. Report on the WRES indicators, continued

6. Are there any other factors or data which should be taken into consideration in assessing progress? Please bear in mind any such information, action taken and planned may be subject to scrutiny by the Co-ordinating Commissioner or by regulators when inspecting against the “well led domain.”

7. If the organisation has a more detailed Plan agreed by its Board for addressing these and related issues you are asked to attach it or provide a link to it. Such a plan would normally elaborate on the steps summarised in section 5 above setting out the next steps with milestones for expected progress against the metrics. It may also identify the links with other work streams agreed at Board level such as EDS2.

Produced by NHS England, May 2015

AGENDA ITEM 14

REPORT TO THE PUBLIC MEETING OF STOKE-ON-TRENT CLINICAL COMMISSIONING GROUP GOVERNING BODY ON THE 4TH AUGUST 2015

TITLE WEST MIDLANDS AMBULANCE SERVICE CONTRACT 2015-16 - IMPROVING THE DELIVERY OF OUT OF HOSPITAL CARE

PURPOSE This paper summarises outcomes of the contract negotiations highlighting key points for CCG Accountable Bodies.

Outturn of the 2014-15 saw an over performance of c.3% (activity and finance) with varying levels of performance across the 22 CCGs. Two of the three Key Performance Indicators were achieved by WMAS (Red 1 and Red 19). Outturn on the Red 2 performance target was marginally missed; in what was a challenging year due to Industrial Action and other issues.

The work undertaken across Local Health Economies during 2014-15 resulted in a set of commissioning intentions for 2015-16 designed to drive integration of the ambulance service as part of the urgent care system.

One of the clear commissioning intentions for 2015-16 is to reduce conveyance rates to Emergency Departments (ED) for which there is a national CQUIN in the 2015-16 contracts. This national CQUIN is supported by a set of local CQUIN schemes most notably the Paramedic Pathfinder.

The Paramedic Pathfinder CQUIN scheme is designed to review Very High Service Users (VHSUs) to identify suitable alternative services commissioned by CCGs, to avoid conveyance to ED. The scheme is predicated on a number of things: CCG commissioning strategies; an up to date Directory of Services; development of a referral and follow up hub; the implementation of the Electronic Patient Record Form (EPRF) and an operational MiDoS.

Investment in this CQUIN is intended to improve urgent care systems by maximising local health economy systems in a more joined up and integrated way to maximise but also provide insight into system gaps where CCGs may want to consider commissioning services.

An event held on 11th June 2015 brought together commissioners and providers to develop Pathway templates to manage performance. These templates are to be varied into the 2015- 16 contract ensuring commitment from both WMAS and CCG commissioners. The event also exposed the opportunities CCGs could explore with WMAS in their expression of interest to become an Urgent and Emergency Care Vanguard site.

CCGs are therefore encouraged to consider the impact ambulance services in their area could have in delivery of Vanguard submissions.

RECOMMENDATIONS Decision Note X Receive X Information What is required as an outcome from Approve the Forum The Governing Body is asked to receive and note the West Midlands Ambulance Service contract 2015-16 - improving the delivery of out of hospital care.

CLINICAL LEAD OPERATIONAL LEAD AUTHOR Marcus Warnes, Interim Accountable Officer, North Staffordshire CCG

AGENDA ITEM 15

REPORT TO THE PUBLIC MEETING OF STOKE-ON-TRENT CLINICAL COMMISSIONING GROUP GOVERNING BODY ON THE 4th AUGUST 2015

TITLE STOKE-ON-TRENT CCG COMPLAINTS, PALS AND MP LETTERS ANNUAL REPORT 2014 / 2015

PURPOSE To present the Complaints, PALS and MP Letters Annual Report for the period 2014 / 2015 to the Governing Body to provide assurance of the processes available for patients and the public to provide feedback on our NHS Services, and how patient feedback is used within the CCG to identify learning and change.

Background All patients who are unhappy about a service that is funded or provided by the NHS have a right to make a complaint. In Stoke-on-Trent, we actively encourage patients and their families to complain when they are not satisfied with the service, care or treatment they receive. Some patients complain to the CCG because they are unhappy about something we have done or a decision we have made. Others will have a choice about whether to complain directly to the provider of their care services or to the commissioner.

In Stoke-on-Trent, this means people who use a range of services, whether in our local hospitals, health centres or in their own homes could choose to make a complaint to Stoke- on-Trent CCG. The role of commissioners in relation to complaints, is part of the complaint regulations, set out in national guidance and was highlighted in a Parliamentary Health Committee Report in January 2015 which suggested ways commissioners could become more involved in complaints across the local health and social care economy.

As a CCG, we take all negative feedback very seriously and our Clinical Accountable Officer reviews all responses personally before they are sent. Complaints handling and any trends or themes identified from them are shared, with quarterly reporting to the Quality Committee.

Developments during 2014 / 2015 During 2014 / 2015, we have worked hard with colleagues within the Complaints Team at Midlands and Lancashire Commissioning Support Unit to improve our complaints handling, complaint responses and timeliness of responses from the CCG to ensure that the quality of responses is of the highest standard that we would wish our population to receive.

We have established a Complaints and PALS Assurance Group, with North Staffordshire CCG, which meets on a bi-monthly basis with representation from our lay members and Healthwatch (Stoke-on-Trent and Staffordshire). This group reviews a selection of complaints and PALS enquiries to confirm quality of responses and handling, and to ensure any further learning is captured and shared accordingly.

This has also been the group responsible for the review of our Complaints and Concerns Policy which is referred to within the Quality Report for ratification by Governing Body members at this meeting, following consideration by the Quality Committee. Once approved, this will be available on the CCG website and further supporting information and literature will be produced to assist members of the public in how to access the Complaints and PALS Services.

RECOMMENDATIONS Decision Note Receive X Information What is required as an outcome from Approve the Forum The Governing Body is asked to receive the Complaints, PALS and MP Letters Annual Report for the period 2014 / 2015.

CLINICAL LEAD OPERATIONAL LEAD AUTHOR Andrew Bartlam Lorraine Cook, Head of Lisa Taylor, Quality and Clinical Accountable Quality and Governance Governance Manager / Officer Midlands and Lancashire CSU

Agenda Item 15

Stoke-on-Trent CCG Complaints, PALS and MP Letters

2014/15 Annual Report

David Brewin and Katie Adams

Midlands and Lancashire CSU

Contents

Page 1 Contents

Page 2 Introduction

Page 3 Complaints

Page 4 PALS

Page 5 - 9 Trends

Page 9 Ombudsman

Page 10 Lessons learnt – ‘You Said, We Did’

Page 10 Complaints Governance

Page 10 Planned Developments 2015/2016

1. Introduction and Background

Complaints and MP Letters All patients who are unhappy about a service that is funded or provided by the NHS have a right to make a complaint. In Stoke-on-Trent, we actively encourage patients and their families to complain when they are not satisfied with the service, care or treatment they receive. Some patients complain to the CCG because they are unhappy about something we have done or a decision we have made. Others will have a choice about whether to complain directly to the provider of their care services or to the commissioner. In Stoke-on-Trent, this means people who use a range of services, whether in our local hospitals, health centres or in their own homes could choose to make a complaint to Stoke-on-Trent CCG. The role of commissioners in relation to complaints, is part of the complaint regulations, set out in national guidance and was highlighted in a Parliamentary Health Committee Report in January 2015 which suggested ways commissioners could become more involved in complaints across the local health and social care economy.

We explain how to complain to us on our website and through printed leaflets. We offer patients the choice to complain by telephone, post, text, email or by using an online form.

Some local people will approach their MP with a problem or complaint about local NHS services. In turn, the MP will forward the complaint to the CCG for us to investigate and respond to. Where the letter is about the experience of an individual constituent we would treat this in the same way as a complaint from a patient. General enquiries about policy or wider CCG matters are dealt with separately and not addressed here.

We acknowledge complaints within three working days and we then work through the following steps below.

Complaint Phase Action Assessment • Complaint is assessed as being within scope of our service and acknowledged • Consider early and informal resolution - look at whether it can be resolved by the end of the next working day Summary of • Personal contact to agree a summary of complaint and desired complaint outcomes • Explanation of process and timescales • Consent sought Investigation • Complaint sent for investigation with agreed timescale and desired outcome • Investigation response of adequate quality received and accepted Complaint Response • Co-ordinated response to complaint drafted for sign off • Response agreed by senior management and sent out to complainant Lessons Learned • Further actions identified to resolve the individual complaint • Wider service improvements identified and implemented

Complaints in the NHS have been high profile nationally throughout 2014/15 and a series of reports and publications have influenced the way we work. They are likely to lead to further significant changes in the coming year. Reports have included a new publication from the Parliamentary and Health Service Ombudsman called ‘My Expectations for Raising Concerns and Complaints.’ This supplements the Ombudsman’s six principles for remedy to provide a framework for handling complaints.

Total complaints for this year are set out below.

Figure 1 2014/15 Complaints and MP letters received each month

Month Complaints MP Letters

April 2014 7 2 May 2014 5 5 June 2014 2 1 July2014 1 4 August 2014 2 3 September 2014 4 3 October 2014 4 7 November 2014 4 1 December 2014 2 1 January 2015 3 2 February 2015 2 2 March 2015 6 1

Total 42 32

Common themes from these complaints include: access and waiting times, building closer relationships, and safe, high-quality, co-ordinated care.

2. Complaint Outcomes During 2014 / 2015, the CCG has moved away from categorising its complaints by outcome, to ensure that learning is sought from all complaints. National reporting of complaints statistics requests that the CCG confirms the outcome of its complaints, categorised as below.

Of the 42 complaints received, 33 complaints were concluded during 2014/15 of which the outcomes were:

Complaint Outcome Count of Outcome Code Closed by Patient 1 Complaint/Issue Not Upheld 3 Complaint/Issue Outside of Scope 3 Complaint/Issue Partially Upheld 5 No consent therefore closed 5 Provider Investigating 6 Complaint/Issue Upheld 10 Grand Total 33

3 Patient Advice and Liaison Service The Patient Advice and Liaison Service (PALS) is a free, informal, confidential help and advice service for patients, carers and their families. It helps people when they need advice, have concerns or do not know where to turn. It can help to prevent lengthy formal complaints by swift action to resolve concerns. PALS can help with queries about a range of NHS services and can be contacted in a variety of ways. Between 1 April 2014 and 31 March 2015 we received 160 PALS enquiries.

Below is a chart which shows the comparison over the last two years and more detail about the categories of complaints we received.

Figure 2 2013/14 Complaints, MP letters and PALS compared to 2014/15

2013/14

341 2014/15

160

59 68 42 32

Complaint MP Letter PALS

There has been a significant reduction in the numbers of complaints, MP letters and PALs enquiries we have received during 2014/15. The most notable reductions were in MP letters which showed a reduction from 68 to 32 or 53% and in PALs enquires which dropped from 341 to 160 which also represents a 53% fall. There is no clear reason for this. Evidence from other CCGs in Staffordshire has also indicated a reduction in PALs enquiries and this could be attributable to better understanding of the role of CCGs, and also the development of other bodies, for example Healthwatch.

Figure 3 2014/15 Complaints, MP letters and PALS Service by Sub-subject

Service Speciality/Pathway Sub-subject (primary) 2014/2015 General Enquiry / Request for information 1 Chiropody CCG Services General Enquiry / Request for information 1 Access to services 1

Service Speciality/Pathway Sub-subject (primary) 2014/2015 Choose and Book Access to appointments 1 Communications and Poor communication / information Choose and Book Engagement 1 Ears, Nose and Throat Advice re referral for treatment / hospital 1

Service Speciality/Pathway Sub-subject (primary) 2014/2015 Audiological Medicine General Enquiry / Request for information 1 Autism, IFR/Funding Issues Access to services 1 Cancer Services, End of Changes in Provision Life 1 Access to services 3 Clinical care / treatment 1 General Enquiry / Request for information 1 Commissioning CCG Services No care package in place 1 Decisions Poor communication / information 1 Treatment not available / not funded by CCG 1 Prescription Issues (General) 1 End of Life General Enquiry / Request for information 1 Falls Access to services 1 IFR/Funding Issues Funding Issues 2 Phlebotomy Access to services 1 Wheelchair Services Equipment, aids and appliances 1

Service Speciality/Pathway Sub-subject (primary) 2014/2015 Care of Older People Access to services 1 Funding Issues 1 Access to services 1 Continuing Continuing Care / Complaints handling/problems/response 1 Healthcare Retrospective Review General Enquiry / Request for information 1 IFR decision query 1 No care package in place 1 Infertility Services Access to services 1

Service Speciality/Pathway Sub-subject (primary) 2014/2015 CCG Services Clinical care / treatment 1 Hospital - Out of Area Dental / Orthodontic Delay in providing transport 1

Service Speciality/Pathway Sub-subject (primary) 2014/2015 Individual Funding Clinical care / treatment 1 IFR/Funding Issues Requests (IFRs) Funding Issues 3

Service Speciality/Pathway Sub-subject (primary) 2014/2015 Access to services 1 111 Service Diagnosis issues 1 NHS 111 Service Disinterested / uncaring behaviour 1 CCG Services Clinical care / treatment 1

Lack of Information about area of concern 1 Dental / Orthodontic Poor communication / information 1 Out of Hours Failure to follow procedure 1 Physiotherapy Discharge Issues 1

Service Speciality/Pathway Sub-subject (primary) 2014/2015 Autism, Mental Health Treatment not available / not funded by CCG 1 Access to services 2 North Staffs Follow-up Care 1 Combined Healthcare Mental Health Medication problems 1 NHS Trust Unanswered calls / emails 1 Wait time 2

Service Speciality/Pathway Sub-subject (primary) 2014/2015 Access to services 1 Attitude 2 Clinical care / treatment 1 NSL - Patient Transport Delay in providing transport 4 Transport Services Failure to provide transport 1 Inappropriate behaviour 1 Transfer arrangements 1

Service Speciality/Pathway Sub-subject (primary) 2014/2015 General Surgery Waiting lists for treatment / operation 1 Nuffield Health Orthopaedics Access to services 1

Service Speciality/Pathway Sub-subject (primary) 2014/2015 Access to male / female GP / clinican 1 Attitude 1 Out of Hours Out of Hours Delay in Diagnostics / Test Results 1 Delay / failure – attendance / home visit (GP) 2 Wait time 1

Service Speciality/Pathway Sub-subject (primary) 2014/2015 Ramsay Health Care Gynaecology Clinical care / treatment 1 UK Out Patients Access to appointments 1

Service Speciality/Pathway Sub-subject (primary) 2014/2015 Dental / Orthodontic Clinical care / treatment 1 Diabetes Medication problems 1 Access to appointments 2 Access to services 2 Admission, Discharge and Transfer 1 District Nursing Attitude 1 Clinical care / treatment 1 Staffordshire and Continuity of Care 1 Stoke-on-Trent District Nursing, Tissue Partnership Trust Viability Equipment, aids and appliances 1 Access to services 1 End of Life Care during terminal stages 1 General Enquiry / Request for information 2 Health Visiting Inappropriate language 1 Health Visiting, Maternity Clinical care / treatment 1 Home Oxygen Service Access to services 1

Minor Injuries Speciality, Imaging Clinical care / treatment 1 Out of Hours Diagnosis issues 1 Out Patients Wait due to cancellation of appointment 2 Pain management Access to appointments 1 Physiotherapy General Enquiry / Request for information 2 Access to appointments 5 Advice re referral for treatment / hospital 1 Clinical care / treatment 1 Podiatry/Chiropody Rudeness 1 Wait time 1 Waiting lists for treatment / operation 1 Rehabiliation, Stroke Clinical care / treatment 1 Access to appointments 1 Rheumatology Delay in Diagnostics / Test Results 1 Safeguarding Issue General Enquiry / Request for information 1 Sexual Health Access to appointments 1

Service Speciality/Pathway Sub-subject (primary) 2014/2015 Cancer Services Clinical care / treatment 1 Cardiology Referral wait time 1 Care of Older People Attitude 1 Discharge Issues Admission, Discharge and Transfer 1 Diabetes Transfer arrangements 1 Discharge Issues Admission, Discharge and Transfer 2 Emergency Medicine Clinical care / treatment 1 Estates General Enquiry / Request for information 1 Gastroenterology Access to appointments 3 General Surgery Operation - adverse outcome 1 Waiting lists for treatment / operation 1 Gynaecology Access to services 1 Delay in Diagnostics / Test Results 1 Maternity Attitude 1 Laundry 1 University Hospital of Medicines Management Access to appointments 1 North Staffordshire Mental Health Access to services 1 NHS Trust General Enquiry / Request for information 1

Property / Valuables 1

Referral wait time 1 Neurology Waiting lists for treatment / operation 1 Access to appointments 2 Ophthalmology Advice re referral for treatment / hospital 1 Referral wait time 1 Orthopaedics Breach of confidentiality 1 Access to appointments 1 Out Patients Delay in Diagnostics / Test Results 2 Unanswered calls / emails 1 Paediatrics Treatment not available / not funded by CCG 1 Phlebotomy Attitude 1 Radiology Wait due to cancellation of appointment 1 Respiratory Diagnosis issues 1 Rheumatology Waiting lists for treatment / operation 1 Tests/Investigations Clinical care / treatment 1

Service Speciality/Pathway Sub-subject (primary) 2014/2015 Access to appointments 1 Cancer Services Delay in Diagnostics / Test Results 1 Cardiology Clinical care / treatment 1 CCG Services Access to services 1 Referral Assessment Service Clinical care / treatment 1 Colonoscopy Delay in Diagnostics / Test Results 1 Clinical care / treatment 1 Emergency Medicine Dignity and respect 1 Respiratory Follow-up Care 1 Endscopy, Pain management Disinterested / uncaring behaviour 1 Falls Clinical care / treatment 1 Access to appointments 1 Wait due to cancellation of appointment 1 General Surgery Waiting lists for treatment / operation 4 University Hospitals of Follow-up Care 1 North Midlands NHS Clinical care / treatment 1 Trust. Access to appointments 1 Gynaecology Referral wait time 1 Haematology Clinical care / treatment 1 Imaging Wait time 1 Maternity Clinical care / treatment 1 Neurology Wait due to cancellation of appointment 1 Ophthalmology Wait time 1 Access to appointments 1 Access to services 1 Orthopaedics Advice re referral for treatment / hospital 1 Waiting lists for treatment / operation 1 Out Patients Access to appointments 1 Radiology Access to appointments 1 Test Results Delay Delay in Diagnostics / Test Results 1 Tests/Investigations Access to medical records 1 Transport Transfer arrangements 1 Urology Access to appointments 1

Of the 74 complaints and MP Letters received during 2014 / 2015, the above tables categorise these into the service provider and type of concern that these relate to. The CCG can see a trend in the complaints received, particularly in the following areas:

Continuing Healthcare Retrospective Reviews – the CCG is aware of the backlog in cases being reviewed which is not only a local, but national issue. The CCG is working hard to address this issue and liaising on a national level to understand how this can be rectified sooner than anticipated.

NSL Non Urgent Patient Transport – The CCG is aware of the number of concerns relating to this contract, particularly regarding delays being experienced to and from appointments. The CCG continues to work hard with this provider to improve its performance and a range of steps have been taken e.g. extra crews implemented, improved processes at the Command and Control Centre.

District Nursing Service – The CCG is aware of the shortage of staff across a range of community services, including District Nursing and is working with Staffordshire and Stoke-on-Trent partnership Trust to understand the depth of this shortage and provide support to improve on this position.

Whilst a number of complaints have been received in relation to University Hospitals of North Midlands, it is also noted that this is the CCG’s main acute provider and there is no correlation or trends in respect of the areas / departments these complaints relate to. The CCG continues to hold the Clinical Quality Review Meetings on a monthly basis with all of its main providers.

3. The Parliamentary and Health Service Ombudsmen (PHSO)

The complaints process in England has two stages. The first is called ‘local resolution’ and includes our complaint response, any meetings we hold with complainants and cases that are reopened and considered a second time. When local resolution comes to an end every complainant has a right to approach the PHSO to request a review of any aspect of how a complaint was handled. The PHSO will then decide whether to consider the case or not.

During 2014/15, the CCG is aware of the following cases considered by the PHSO:

1. Complaint regarding the development of a pressure wound and the processes of how this pressure wound had occurred (ref 9179) Whilst the CCG reviewed and responded to this complaint during 2013 / 2014, this case was considered by the PHSO during 2014 / 2015. After review of the case file, the PHSO decided to partially uphold this complaint, in particular with reference to poor communication between nurses and patients and their families along with being unable to see that the management of the patient’s risk of the development of pressure sores was adequate.

Following receipt of this outcome, the CCG met with the Provider concerned to form and agree an action plan which was considered and monitored by the CCG’s Executive Nurse and Quality Committee. A range of actions were identified including a review of its risk assessment documentation and a review and relaunch of the Provider Pressure Ulcer Prevention and Management Guidelines. The revised guidelines are now explicit regarding skin assessments and positional changes and a patient repositioning chart is now included. The provider has provided assurance and evidence of the ongoing monitoring and compliance of these guidelines.

The Provider also reviewed its established wound management training package and this is being rolled out as part of its mandatory training package, which all clinical staff are required to complete annually. The provider is also working with other local providers to share knowledge and experience in relation to the processes in place for skin care bundles, including the sharing of template documentation. The learning and changes implemented as a direct result of this complaint have been shared with the complainant and PHSO.

2. Complaint regarding the phasing out of acupuncture by the CCG and the way in which the CCG handled the complaint (ref 7040) Whilst the CCG reviewed and responded to this complaint during 2013 / 2014, this case was considered by the PHSO during 2014 / 2015. After review of the case file, the PHSO decided not to uphold this complaint and confirmed that there was no evidence to support the claim of the CCG withdrawing funding and that there was evidence of extensive discussion and attempts at local resolution by the CCG.

3. Complaint regarding the Ambulance Service and Out of Hours GP Service (ref 9598) Whilst the CCG reviewed and responded to this complaint during 2013 / 2014, this case was considered by the PHSO during 2014 / 2015. After review of the case file, the PHSO decided not to investigate the matters raised.

4. Complaint regarding the failure of the CCG to undertake a proper consideration of an application for NHS funded fertility treatment (ref 6346) Whilst the CCG reviewed and responded to this complaint during 2013 / 2014, this case was considered by the PHSO during 2014 / 2015. After review of the case file, the PHSO decided not to uphold this complaint.

4. Lessons Learned – ‘You Said, We Did’

Stoke-on-Trent CCG views complaints as an opportunity to learn and improve. When we resolve a case we always try to identify tangible changes as a result of a complaint. This could be a change for that individual patient or more commonly a wider improvement to a service. We have changed our reports to capture this information and we share it with complainants as part of the response letter.

Below is a sample of ‘lessons learned’ as a direct result of a complaint received during 2014 / 2015:

• Following a complaint regarding a delay in receiving imaging results, the Imaging Department at the University Hospital of North Midlands (UHNM) now have a daily report in place to monitor their reports to ensure these are reviewed by the relevant clinicians, with internal targets established to ensure that no report waits longer than seven days from when the image is acquired.

• Following a complaint regarding the way in which a call was handled within Staffordshire Doctors Urgent Care (SDUC), the call handler has received feedback from her line manager on the handling of the call and the call listened to, to enable appropriate reflection. In addition, complaints and performance are discussed at the CCG Contract Meetings to receive feedback on actions implemented.

• Following a complaint received regarding the treatment by the District Nurse Team and the Tissue Viability Specialist Team provided by Staffordshire and Stoke-on-Trent Partnership Trust (SSOTP), improvements have been made to the recording and documenting of telephone conversations between services. In addition, staff have been informed of the importance of ensuring patients and carers are fully informed of the rationale behind decisions made (in this particular case relating to a change in pressure mattress), including education with a clear explanation of processes and procedures.

• Following a number of complaints received during 2014 / 2015, and as part of an ongoing review of the NSL Non Urgent Patient Transport Service contract, NSL Transport have invested in additional resources and increased their crew members in operation.

• Following a complaint received regarding the delay in access to appointments at Rowley Hall, a senior manager is now responsible for overseeing the whole bookings service to improve both customer care and efficiency, outcomes and communication. Improvements have also been made to their internal ‘tracking system’ to be able to monitor referrals in a pathway more closely. It is also pleasing to note that a designated medical secretary has been allocated to the area concerned to ensure that patients are actively managed and monitored in a more timely manner.

5. Complaints Governance

• The CCG Quality Committee receives a quarterly ‘Patient Insight Report’ which includes data and analysis covering a range of patient experience measures. This covers complaints, MP letters and PALS enquiries received in the last quarter. • Stoke-on-Trent and North Staffordshire CCGs have established a joint ‘Complaints and PALs Assurance Group.’ Membership of this group, formed from the two CCGs includes representatives from the CCGs Quality Team, the Lay Member for Patient and Public Involvement, Complaints Manager and Healthwatch. This group meets on a bi-monthly basis and reviews anonymised records as well as receiving performance reports and oversees improvements in complaints delivery, including the review of the Complaints Policy. • Complaint response letters are clinically reviewed by our Clinical Directors or Nurse Board Member, dependent on the service the complaint relates to, prior to being agreed and signed by our Clinical Accountable Officer, Dr Andrew Bartlam before they are sent out to patients.

6. Planned Developments 2015/16

• Agree a revised Complaints Policy • Develop further the role of the Complaints and PALS Assurance Group and ensure it contributes to improving quality • Introduce measures of complainant satisfaction • Improve evidence of learning from complaints through improved lessons learned and clearer links to service improvement

May 2015