SANDWELL AND WEST BIRMINGHAM CLINICAL COMMISSIONING GROUP
Finance & Performance Committee Minutes of Meeting held on Monday 26th June 2017 Boardroom Kingston House 13:00 – 15:00
Attendees: Vijay Bathla Chair Julie Jasper Vice Chair David Hughes Deputy Chief Finance Officer Laura Mainwaring Head of Financial Management Ian Sykes SCR GP Lead Janette Rawlinson Lay Member *Bev Morris Nursing, Quality and Performance Lead Hazel Barnes PA to Chief Finance Officer
Apologies: James Green Chief Finance Officer Martin Stevens Head of Business and Contract Performance Julie Warner Business and Contract Performance Manager
*part meeting
Item Subject 1. Welcome and Apologies VJ welcomed everyone to the meeting. Received apologies were noted as above
2. Declarations of Interest To request members to disclose any interest they have, direct or indirect, in any items to be considered during the course of the meeting and to note that those members declaring an interest would not be allowed to take part in the consideration or discussion or vote on any questions relating to that item. JJ declared her role as Audit Committee Chair, of Dudley CCG. No conflict was identified IS and VJ declared interest as GP’s. No conflict was identified. 3. Minutes from April 2017 The minutes were approved as a true record no amendments. 4. Action Report The action register was discussed and approval to remove actions was agreed. An updated Action Register will be circulated with the minutes from this meeting. 5. Chair’s report None
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Item Subject 6. Finance Report DH presented the report for month 2 and advised that there is limited information available. Month 1 data should be treated with caution as it is early to make and assumptions so not too much emphasis has been placed on this data. Two key issues were highlighted: Practice moves and QIPP. The funding allocation transfer in relation to practice moves is yet to be agreed and pose potential risk.
Headlines SWB CCG overall Revenue Resource Limit is £798m with a planned surplus for the year of £19m made up of the cumulative surplus of £21m minus the £2.5m mandated draw-down funding. SWB CCG QIPP target for 2017/18 is £25.1m. The CCG is operating within its Running Cost Allowance of £11.5m.
Executive Summary DH presented an Executive Summary. All primary indicators are green. The year to date position shows £12k ahead of the planned surplus.
Financial Position DH went on to present a Statement of Financial Position with a summary of portfolio. Slight pressures were noted in Community Services in respect of interpreters and non NHS costs as well as Mental Health Joint Commissioning.
The CCG’s Revenue Resource Limit of £798m is made up of baseline allocation of £771m with further in year adjustments of £27m which were highlighted in the Finance Paper.
Practice Moves DH advised that eight practices will be leaving SWB CCG and one practice will be joining. This amounts to 26.000 patients leaving and 8,000 patients joining. This amounts to £2m movement of expenditure out of SWB CCG.
The net movement is £23m but there is difficulty in identifying the same level of expenditure reduction. Following a deep dive it has been identified that Sandwell Practices expenditure is much higher than those in Birmingham creating a cost pressure as a result of Birmingham practice movements.
Work is currently being done with Birmingham South Central CCG to agree the value of allocation to transfer. However, it has proved difficult to determine the basis for the funding transfer and obtain historic information on allocations from existing PCT organisations prior the CCG’s existence.
Contract Finance DH presented an overview of the main contracts – SWBH Trust and Dudley Group.
Prescribing Performance DH highlighted a slight forecast overspend of around £400k which is predominantly driven by a reduction in the amount of rebates since moving to Bayer.
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Item Subject Primary Care Expenditure is forecast to breakeven with total expenditure against its delegated resource of £78.9m. There has been a £2m increase in resource plus additional monies over and above the delegated resource as well as collaborative payments.
QIPP The CCG’s overall QIPP target for the year is £25.1m. DH noted that some of this is contractually secure and some is covered by Prescribing initiatives. However, this QIPP programme is not developing as it should be. Instead the CCG is using the contingency of £3.5m which has been set aside plus £5.5m set aside for investment. DH will bring a quarterly detailed update to Finance and Performance Committee.
Statement of Financial Position DH took members through the Balance sheet in the report.
Cash Efficiency The CCG current bank balance is slightly higher than we like to run it due to an influx of cash at the end of month 1 which has now been resolved.
• Members approved the contents of the Finance Report
6.1 Section 117 Update 13.50 Bev Morris joined the meeting Bev Morris provided members with an update on progress in relation to Section 117 patient reviews undertaken by SWB CCG and Sandwell MBC for patients eligible for Section 117 aftercare and for patients identified as being in comparable joint funded cohorts. A summary table was provided of reviews undertaken so far.
The report highlighted 58 patients that the Local Authority have funded. Reviews have taken place on 49 patients. A number of assessments require rescheduling due to non-attendance of patient or social worker.
A quarter of patients reviewed had no health issues. Therefore, 15 patients do not qualify for funding.
1 patient is deceased.
JJ requested an agreed position statement for each patient and for it to be made clear to the Local Authority that if they do not engage for the remainder of the reviews, joint funding will be withheld. This was agreed by members of the committee.
Actions: A further update will be presented to the committee in August LM will feedback at the next joint meeting with the Local Authority, Finance and Performance Committee’s disappointment with the outcome of the review process and make clear that no contributions will be made until reviews are completed.
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Item Subject 7. Performance Report DH presented the Performance Report in Martin’s absence.
IAPT IAPT is currently underperforming between 4 and 5%
Infections There have been no new infections in May.
RTT DH reported that headline level is satisfactory with improvement in elective activity in April and May. The number of incomplete pathways is falling but there are a number of breaches at specialist level. Plans are in place to achieve at specialty level by July.
Diagnostics The Trust failed to meet the 1% target with 1.77%. This was due to the Trust initially refusing to pay an inflated locum cost. However, no cheaper locum could be found so payment was agreed which led to delays. They predict to achieve target in May.
A&E A&E performance is currently 84.95% against the STF target of 93%. NHSI have agreed for them to reach 90% by the end of July and the Trust are confident. 20% extra capacity has been created at Sandwell.
Cancer The CCG failed to meet the 31 day target and the 62 day target in April. The CCG Cancer Steering Group is establishing a process for following up the breaches. All breaches have now been treated.
WMAS Date is consistent with previous months. Results from the pilot are still awaited as these have been further delayed due to Purdah. The number of handover delays has reduced.
MSA There were 22 breaches for the CCG and 17 for SWBHT. All were capacity related.
Cancelled Operations The Trust failed to meet the target. 6 patients waited over 28 days following cancelled surgeries. All patients have been rebooked and treated.
Dementia Little change was reported in dementia diagnoses. There is still work to be done in this area.
• Members approved the Performance Report
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Item Subject 8 SWBHT Contract Update 14.54 JR left the meeting NHS England and NHS Improvement have commissioned an independent review of the whole health care system for Sandwell and West Birmingham in order to identify any concerns regarding MMH and the affordability.
GE Finnemore Healthcare (GEFH) has been appointed to undertake the review. Further detail has been with GEFH in order to express the CCGs position regarding the MMH and STP. DH circulated a document produced regarding the review for information.
Regular updates will be brought to Finance and Performance Meetings.
9 Finance and Performance Risks FP06 – Reviewed, no change FP09 – Sent for closure following the last meeting – gaps in controls were identified FP10 – Reviewed, no change FP11_2016a – Risk remains the same. JG and DH have met with Finnemore and workshops are being arranged. FP04_17a – Remains the same Date and Time of Next Meeting Monday 24th July 2017 Boardroom Kingston House
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Minutes of the SWBCCG Quality and Safety
On Monday 19th June 2017, 1-3pm, Kingston House, 2F Board Room
Present: Dr Sam Mukherjee – Chair, ICOF (Chair) Dr Inderjit Marok – Vice Chair, ICOF Claire Parker – Chief Officer for Quality, SWBCCG Michelle Carolan – Deputy Chief Officer for Quality, SWBCCG Tom Richards – Quality Manager, SWBCCG Richard Nugent – Lay Member Alison Braham – Primary Care Quality Lead, SWBCCG Therese McMahon – Non-Executive Nurse John Clothier - Healthwatch Representative Jodi Woodhouse – Quality Improvement Team Manager, SWBCCG Jasmin Andrews - Quality Improvement Lead, SWBCCG Jackie James - Quality Improvement Co-ordinator, SWBCCG
In Monique Sinclaire - Deputy Designated Nurse for attendance: Safeguarding Children, SWBCCG Richard Thompson – Head of Continuing Healthcare, SWBCCG Sandeep Pahal - Medicines Quality Pharmacist, SWBCCG Jamila Dhansey - Medicines Quality Technician, SWBCCG Helen Geoghegan – Customer Care Officer, SWBCCG (Minutes)
Apologies: Elizabeth Walker – Head of Medicines Management, SWBCCG Shabana Ali - Medicines Quality Operational Lead Pharmacist, SWBCCG Martin Stevens – Head of Business and Contract Performance, SWBCCG
1.2 Declarations of Interest: Dr Sam Mukherjee and Dr Inderjit Marok declared an indirect interest in the following items relating to Medicines Management spend:
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Item 11 AYMES prescQipp Rebate Offer Item 13 Polypharmacy PDS PPI Toolkit Item 14 Short Acting Bronchodilator Overuse Audit
It was decided that Richard Nugent will chair these items.
It was agreed if any further interests are identified, to raise these at the time.
1.3 Minutes of the previous meeting held on Monday 15th May 2017
The minutes were accepted as an accurate record of the meeting, subject to the following amendments:
2.6 John Clothier stated at the previous Q&S there was a discussion around what information is readily available with indicates that practices are likely to be judged harshly by the CQC. Claire Parker highlighted concerns around practices who do not engage when offered support and therefore the information being captured through the matrix may not present the concerns, even if SWBCCG are aware of some difficulties. She believes the softer intelligence should therefore be presented at QSG where representatives from NHSE and CQC sit. Sam Mukherjee advises this should be raised at the PCCC in the first instance. It was agreed Alison Braham will take this issue to PCCC.
Action: Alison Braham to provide update on non-engagement of practices regarding support from SWBCCG for CQC visits, in the private session of the PCCC.
2.7 Remove PCCF and element relating to SCR and replace with PCCC as this is where the dashboard is reported.
15.3 ‘Secondary Schools in Birmingham and Sandwell have started buying (FGM) training’ should read ‘Primary Schools’
1.4 Action Register/ Matters Arising:
All actions are updated in the enclosed Action Log.
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2 Quality Report
Tom Richards provided an update on the Executive Summary, including data up to and including May 2017. 2.1 Primary care: 2.2 In May, 117 incidents were reported. This is a significant drop as at one point approximately 180 incidents were being reported.
Sandwell & West Birmingham Hospital Trust (SWBH)
2.3 Two Never Events reported:
• April – Wrong side anaesthetic block in Orthopaedics; • June – Laser eye surgery performed twice on the same eye at The Eye Hospital.
2.4 Claire Parker raised that as these areas are critical in terms of recurrent themes, it must be established whether these departments are embedding any lessons learnt into future processes to reduce the risks or just if incident reporting has improved in these areas.
Michelle Carolan and Sam Mukherjee confirmed they have visited The Eye Hospital 2.5 following a previous Never Event at a Nurse-Led Clinic and reviewed the processes with them. They found the staff to be engaging, however were challenged initially as the
Clinicians found it intimidating for them to observe. Michelle Carolan stated that although busy waiting rooms can form part of the RCA, this should only be a contributing factor. 2.6 Inderjit Marok questioned whether it is an issue with the surgery markings not being signed off effectively.
2.7 Claire Parker advised that the Quality Team need more information from SWBH around how these incidents occurred, as the 72 hour briefings are now done differently
resulting in the CCG not receiving enough information about final responses and the root causes. Michelle Carolan confirmed we must understand their changing processes as there are gaps in the RCA’s and therefore we do not have complete assurance.
Action: This will be picked up at the SWBH CQRM regarding specialist dedicated teams for the completion of RCA’s and what assurance they can provide us with.
Quality Team to look into and provide an update regarding the details of the two Never Events at SWBH.
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Michelle Carolan raised that the Safety Thermometer electronic system, which SWBH 2.8 advised would keep them over the threshold, will not be rolled out until October 2017.
Action: To be picked up at CQRM
2.9 Michelle Carolan provided an update of the breakdown of mixed-sex accommodation (MSA) breaches. The waits range from a minimum stay of 45 minutes and a maximum stay of 7 hours. The MSA breaches reduce any 12 hour breaches and ensure patients are moved to wards where they can receive the appropriate clinical treatment. This led
to a conversation at CQRM regarding the ‘golden bed’ approach. SWBH are looking into the possibility of using the same idea for complex respiratory patients who need venting, but not other HDU care. ‘Golden beds’ are exempt from MSA reporting as the beds ensure a proper flow of care for patients which is vital. It was confirmed all 12 hour breaches are reported to the CCG and go directly to NHS England.
Prior to CQRM, Michelle Carolan met with the Tissue Viability Lead, Lesley McDonough 2.10 and Associate Director of Nursing, Deb Talbot, regarding the operational assurance for falls and pressure ulcers, as the unannounced visit did not identify the root causes.
2.11 It was questioned whether the vacant Falls Leads post is contributing to an increase in incidents. Therese McMahon stated the lack of formal training for prevention and management strategy of falls was evident on this visit. Risk assessments are done, but it is seen as a mandatory task. Claire Parker raised concerns that the risk assessments are being used as an excuse to say pressure ulcers/falls are unavoidable for high risk patients, rather than mitigate against the issues. Michelle Carolan confirmed ED are
now starting to do risk assessments to ensure wards are not just informed verbally of high risk patients.
2.12 The avoidability of pressure ulcers in the community were discussed with SWBH. Unlike Birmingham and Dudley where everyone identified as being at risk of pressure ulcers with equipment e.g. bed/mattress, are on their District Nurse caseload, SWBH put the equipment in place, but do not monitor their at risk patients once discharged to care
agencies. Michelle Carolan stated this is none negotiable national and statutory guidance and this cohort of patients must be on the District Nurses caseload regardless of Trust capacity issues. Failing to do so could incur litigation. Deb Talbot agreed to review processes and do some work into how to mitigate against this.
Action: Michelle Carolan to meet bi-monthly with Deb Talbot and feedback to CQRM.
2.13 Therese McMahon asked Tom Richards for the vacancy rates to be added to the Workforce chart in future reports.
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West Midlands Ambulance Service (WMAS) 2.14 No May update given for the WMAS CQRM, as this will now form part of merged Urgent Care Programme CQRM, which will encompass WMAS, Out-of-Hours and NHS 111. The first meeting is on Tuesday 22nd June 2017. An update of the joint CQRM will be given at the next Q&S.
3 Ratified CQRM minutes Ratified CQRM minutes were included for information.
In the Matters Arising section at the SWBH CQRM, it was queried whether West 3.1 Birmingham patients can be referred to the Palliative Care service. Therese McMahon confirmed both Sandwell and West Birmingham patients can be referred.
John Clothier raised that SWBH have stated that SWBCCG are planning to divert 3.2 referrals for Trauma and Orthopaedics. He questioned whether they are aware of the QSG’s assessment of the Royal Orthopaedic Hospital before diverting.
3.3 As lead commissioners for the service it was agreed that Birmingham Cross City CCG (BXC CCG) to provide SWBCCG with a formal overview of what they have been doing to rectify any concerns, including the reviews of outstanding patients for harm, prioritisation and large waiting lists. This can then be fed back to SWBH asking them to consider these issues.
Action: Tom Richards to request briefing from BXC CCG to provide to SWBH.
4 Quality Assurance Visits
Jackie James advised a programme for future visits is currently being scoped out, but at 4.1 present no further visits have been arranged. The group discussed possible locations for future visits.
Michelle Carolan advised that Dudley previously employed an independent individual 4.2 who spent time looking at their processes, including missed themes and lessons and this would therefore be a good option for support.
4.3 Michelle Carolan instructed that SWBCCG commissioned Verita to deliver RCA training and key members from our main provider organisations were invited, however SWBH did not attend.
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5 Serious Incidents
This item is covered in the Quality Report.
6 Customer Care
This item is covered in the Quality Report. There have been no new trends identified.
7 Themes/Deep Dives
A report, following a deep dive into any e-referrals issues, will be presented by Jasmin Andrews at the next Q&S, per discussion in Item 1.4. (Action 2.42 on Action Plan)
8 Contracting (by exception) This item is covered in the Quality Report.
Action: It was agreed Tom Richards will summarise any contract queries in the next Executive Summary of the Quality Report.
9 Medicines Management Sandeep Pahal provided an update on the Medicines Management report.
9.1 Sam Mukherjee queried whether the practice who has recently become open to SWBCCG support following a CQC visit, could contact the other practices to reassure them of the help that can offered. John Clothier concurred and liked the idea of practices cascading to other practices with valuable advice three to six months down
the line.
Richard Nugent stated the initiative has seen positive progress. Claire Parker 9.2 congratulated the Medicines Management team for the management of key quality indicators.
10 SWBH Quality Account response
The response was reviewed and agreed by the group.
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11 AYMES prescQipp Rebate Offer (chaired by Richard Nugent) Sandeep Pahal presented the AYMES prescQipp Rebate Offer
11.1 Prior to the report being presented, Richard Nugent raised his concerns that the Medicines Management reports do not have a cover sheet in the standard template. The cover sheet should include why the report is being presented e.g. assurance/discussion/decision and any conflicts of interest must be highlighted prior to
the meeting. It was agreed a briefing at the beginning of the report would also be helpful for lay members. Claire Parker clarified that in future, no reports will be accepted without this information. Sandeep Pahal to feed back to the team.
A rebate has been pitched by SWBCCG Medicines Management on behalf of Aymes and 11.2 has been vetted by prescQipp. This national rebate will total £60,000. The group approved they are happy for the rebate scheme to go ahead based on the drugs
forming part of the CCG and area prescribing formulary.
12 CHC Assessment Beds Richard Thompson presented the CHC Assessment Bed Pilot report.
12.1 The national driver aims to reduce the amount of CHC assessments done in an acute setting to 15%. The environment the assessments are carried out in will then be closer to the setting the patient will be going back to and therefore hopefully manages any expectations.
12.2 Sam Mukherjee queried whether the report has been submitted to SCR due to the funding aspect. Richard Thompson assured the group that the report will go to SCR following any comments made by Q&S.
12.3 Therese McMahon queried how CHC are to ensure that patients are going to be moved on hastily, as a firm process for this needs to be put into place, as the suggested five
beds in a Care Home will be filled quickly. Richard Thompson responded and stated that assessments will be arranged within two weeks. This time frame was agreed to ensure an actual representation of the patients’ needs are being assessed. The small pilot will enable the team to highlight any barriers that present. A plan for what happens if patients are not eligible for funding and what the next pathway is will be looked into.
12.4 Michelle Carolan agreed with the previous comments and felt that although the number of days between admission and moving on will be monitored; there is no
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incentive for the providers to move patients, as they will be receiving the same money regardless of the length of time patients are admitted. The Local Authority informs providers that if they go over an agreed time, they will lose a percentage off the rate agreed. She reminded the group that moving patient from an acute setting to a home
we had a contract with will have an impact on DTOC capability in respects to current staffing. Richard Thompson guaranteed this aspect is still being looked into and currently they are looking at CHC staff attending Care Homes three times a week to monitor any of our patients. There are currently no costings included for the extra resources required for nurses to manage this additional work. The group agreed these
figures are vital in order to proceed. 12.5 John Clothier queried whether keeping in mind the NHSE guidance to reduce the number of assessments in acute as patients cannot reach a stable state, deeming the assessment not valid, is a two week timeframe long enough to effectively assess? The pilot needs to cover this. Michelle Carolan raised concerns that these moves will make patients deteriorate. Either tighten criteria or reconsider turnaround times?
Action: Following any amendments being made, the report is to be submitted to SCR.
13 Polypharmacy PDS PPI Toolkit Sandeep Pahal presented the Polypharmacy and De-prescribing scheme PPI Toolkit.
13.1 It was confirmed that the educational launch for that the toolkit, aimed to aid audits for complex patients, is on the 13th July 2017.
The paperwork required for the toolkit was approved by the group. 13.2
14 Short Acting Bronchodilator Overuse Audit Jamila Dhansey presented the Short Acting Bronchodilator Overuse Audit report.
14.1 The training programme was approved by the group.
15 Updates to Risk Register Tom Richards provided an update on the pertinent risks on the Risk Register. A copy of
the Risk Register will be circulated to attendees following the meeting.
Michelle Carolan informed the group that the following two risks require updating:
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15.1 The IFR training for GP’s has now been resolved and the risk grading can be lowered, with one GP now fully trained and able to attend appeal panels. Audit and Governance requested extra narrative on the internal and external assurances. Michelle Carolan
confirmed that the external assurance is that the process has been shared with the IFR team at the CSU. The internal assurance is that the risk has been raised at Q&S and Governing Body. It was agreed the risk can be closed.
With regards to Pregabalin, if the drug is changed over, this may be challenged by Visor. 15.2 Nationally most have predominantly changed, but there could be controversy if this is overturned. The team are waiting for confirmation on whether this will be going to court. It was therefore agreed the grading needs to be reviewed.
Monique Sinclaire instructed that Audit and Governance were not satisfied with the 15.3 Safeguarding risks internal assurances, following an issue highlighted through a recent audit.
Action: Monique Sinclaire and Eileen Welch to review and include more specific wording in narrative boxes.
15.4 Tom Richards confirmed the e-referral system (ERS) risk is on the register. Michelle Carolan stated there are missing assurances for the co-hort of patients who are having appointments cancelled and therefore where patient safety is contravened. Inderjit Marok raised concerns that GP’s are not aware ERS issues need to be reported as they are not looking back on the ERS at the history for the reasons appointments are being cancelled and continuing to make a new referral. It was suggested information encouraging GP’s to report any ERS issues, along with the low incident reporting figures could be sent out via Nick’s News. Michelle Carolan queried whether in the first instance incidents should be shared with the Practices Primary Care Development Managers It was agreed the risk grading should be increased to 12 due to possible patient harm. Action: Controls to be updated to include external review meetings to take place with Dottie Tipton, Primary Care Liaison Manager, SWBH.
16 Issues to take to Governing Body
• Deep Dive – Never Events/E-referrals • CHC Assessment Beds
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17 Issues to take to Provider Organisations Any issues will be raised at each respective CQRM’s.
• SWBH E-Referral issue
18 AOB
18.1 Michelle Carolan provided an update regarding funding being removed from the SWBH Teenage Pregnancy Service. These concerns were previously raised at Q&S where Claire Parker had asked that further information from the Trust should be requested prior to any money being removed from the contract by Finance. The Trust were asked to
provide evidence as to what services they are providing using the additional money (approx. extra £100,000) and in light that the Family Nurse Partnership has been de- commissioned. 18.2 James Green, Chief Finance Officer, felt SWBCCG were paying twice, as the tariff already reflects the increase of vulnerability for the co-hort of patients in question. The suggestion to obtain additional information prior to removing the funding was not
however taken forward and James Green has written to the Trust to withdraw the service funding.
18.3 It was raised that the Trust could not provide evidence of the additional work they do for the service, following patients going onto the intermediate pathway (under 20’s). Claire Parker advised that both she and Michelle Carolan have looked into the tariffs, payments and clinical bandings of someone prior to them going onto the intermediate pathway. Visits were offered to SWBH to give them the opportunity to demonstrate how the funding is used, but evidence could not be collated.
The enhanced tariff the Trust is currently receiving means the service should be 18.4 delivered effectively regardless of any further funding. As we do not commission the service, the service should not stop.
18.5 Monique Sinclaire raised that two serious case reviews, where two children were significantly harmed, have involved FNP nurses who were going in regularly. Management reviews therefore pulled out learning and concerns regarding this service. Claire Parker acknowledged that this goes back to a review four years ago surrounding
handovers not happening between FNP and universal Health Visiting meaning the teenage mother and child were dropping through the service.
18.6 Claire Parker confirmed that we require assurance that the vulnerable group of patients
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that require ante-natal care are being maintained.
18.7 It was agreed that following the funding being removed, if SWBH cannot document the necessary evidence and attempt to de-commission the service, SWBCCG will challenge via contract route.
18.8 John Clothier informed the group that the full Christina Edkins report has now been made available. The main area of concern noted was around the lack of data sharing
between prison psychiatric services and other psychiatric services.
It was identified that the many contacts the perpetrator had with the police and social 18.9 services, including concerns raised regarding his mental health, were not reported back to his GP. As the GP is the only centralised point, it was recognised that this lack of sharing was the main reason that a mental health diagnosis was not made earlier. The report highlights that communication between services needs to greatly improve to
ensure vital information is captured and not simply filed away.
Michelle Carolan identified that 20% of individuals involved in the criminal justice 18.10 system are not registered with a GP. John Clothier advised in this instance the offender was registered with a GP, but told services he was not. Michelle Carolan stated there is the additional issue of consent to sharing the data, as mental capacity applies to patients aged 16 years old and over and if they are not high risk patients, what is the reason for sharing the information. The same principle goes for family members who request any information. 18.11 Chair of south and central chaired media event – recommendations on their website –
named in report. Not on safeguarding board – not at risk child. 18.12 An operational learning day is to be arranged with Michelle Carolan and Elaine Thompson from Birmingham CrossCity CCG leading on it. The day will include aid memoirs for staff on how to deal with difficult data sharing requests and if family members believe the information given by a patient is false. Any lessons learnt will be cascaded back through CCG PLT’s.
Action: Any updates will be brought back through Q&S.
Date and Time of the Next Meeting:
Monday 17th July 2017, 1-3pm, 2F, Board Room, Kingston House.
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Sandwell & West Birmingham CCG Minutes of the Strategic Commissioning and Redesign Committee on 22nd June 2017 13:00 – 16:00
Yemeni Community Association Greets Green Access Centre, Tildasley Street, West Bromwich, B70 9SJ
Present: Dr I Sykes (IS) GP, Black Country – Meeting Chair Dr P Hallan (PH) GP, Pioneers for Health Dr S Sarwar (SS) GP, ICOF Dr S Butler (SB) GP, HealthWorks LCG Dr B Andreou (BA) Vice Chair, GP, Sandwell Health Alliance Dr A Saini (AS) GP, Black Country Lisa Maxfield (LMf) Deputy Chief Officer Mike Perks (MP) Finance Representative Louise Piper (LP) PMO Administrator Jenna Phillips (JP) PMO Manager Richard Nugent (RN) Lay Member Geoff Foster (GF) Voluntary Sector Representative
In Attendance: Hayley Haworth (HH) Corporate PA - Minutes Debra Howls (DH) Senior Commissioning Manager
Absent with Apologies: Dr D Manivasagam (DM) GP, Sandwell Health Alliance Dr O Farooqui (OF) GP, Sandwell Health Alliance Sharon Liggins (SL) Chief Officer Olivia Amartey (OA) Deputy Chief Officer Andrew Harkness (AH) Consultant in Public Health Laura Mainwaring (LM) Head of Financial Management Martin Stevens (MS) Head of Contracting Claire Parker (CP) Chief Officer
1. Declarations of Interest:
1.1.1 JP noted that her husband is a director at Black Country Partnership which may cause a potential conflict.
1.2 Quoracy:
1.2.1 The Committee was quorate for the duration of the meeting.
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th 2. Minutes of the public SCR meeting held on 8 June 2017:
2.1.1 Item 5.7 –The Committee requested that the following be added to the end of the sentence to clarify why money should be ring fenced: for use with mental health patients.
2.1.2 Item 7.6 – Typo to be corrected ‘if’ this occurs rather than ‘it’.
2.1.3 7.10 – The spelling of the following names to be corrected, Jo Carney and Tom Howel.
2.1.4 Subject to the above amendments, the minutes were confirmed as an accurate record of the meeting.
2.2 Matters Arising
2.2.1 Item 5.13 (DNA’s and hospitals referring patients back to GP) – GF advised that the main reception of Sandwell Hospital still has posters on the wall with incorrect information. This states that if the patient fails to attend their appointment they will
be referred back to their GP and if the patient cancels their appointment twice, they will also be referred back to their GP. Additionally BA highlighted that Consultants are not aware of the ‘Standard Hospital Contract’.
Action: DH to liaise with MS about the lack of awareness from Consultants of the Standard Hospital Contract and also highlight that there are posters in the waiting are of Sandwell Hospital which contain incorrect information.
3. Action Register:
3.1 The action register was discussed and updated. Discussions took place around the following actions:
3.1.1 From Meeting 27.4.17, Item 10.1 - Bring feedback from the Outpatient Activity Meeting to a May SCR meeting.
SS advised that a meeting has taken place with the Trust who are looking to provide consultant led care 7 days per week. Once capacity has been determined, they will
look at releasing potential clinics and a task and finish group will be established to
move this work forward. Feedback will be provided following the planned care meeting.
3.1.2 From Meeting 25.5.17, Item 12.2.1 – Consideration to be given to how feedback from the Birmingham Health and Wellbeing Board could be shared with the SCR committee.
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IS advised that Dr. Nick Harding has agreed to feedback to SCR as and when appropriate.
3.1.3 From Meeting 25.5.17, Item 16.6 - Find out details of waiting times for community spirometry in Birmingham.
MS had sent an email update confirming that the current wait times in Birmingham is 2 weeks. The Committee would also like to know the waiting times in Sandwell.
Action: MS to find out details of waiting times for community spirometry in Sandwell.
3.1.4 From Meeting 8.6.17, Item 7.1 - AO to invite Tom Howell / Jo Carney and the
commissioner to the next SCR to provide an update / answer questions regarding the
mental health in-patient beds.
IS reminded the Committee that this relates to funding additional beds which was 3.1.5 discussed and agreed in principle by SCR. This has since been agreed by all Chief Officers at SWBCCG and will be taken to Governing Body in July for full and final approval
3.1.6 The Committee noted that they had previously asked about the bed situation in Sandwell, and feedback from BA suggested that there may be similar issues. The Committee noted that Governing Body should have this information available before
making their decision.
3.1.7 There were also discussions about commissioning a bed which patients outside of the
area then use. MP advised that in this situation there is the possibility of a double
payment and therefore this would need to be closely monitored. A discrepancy in figures (cost of beds) was identified; however this was thought to be due to the fact that beds are commissioned from both NHS and private providers with different associated costs.
Action: The Committee requested information about the number of mental health in-patient bed capacity in Sandwell to be made available in advance of Governing
Body making their decision about approving funding for Birmingham beds.
3.1.8 Tom Howel (TH) and Dario Silvestro (DS) (Cross City, Mental Health Joint
Commissioning Team) joined the meeting and TH advised that he had some
benchmarking data that he could send to Anet to assist with the action.
3.1.9 RN advised that the paper refers to New Models of Care being dependent upon other
facilities such as crisis cafes and other support services. TH replied that the system
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modelling work set out 12 recommendations, part of this was investment in beds however there were other pieces of work such as support services. Crisis Cafes will be implemented by repurposing current day service provision, and it is thought that personality disorder services could be provided within the existing budget by remodelling the way that services are provided. It is not anticipated that additional money will be required.
ITEMS FOR DECISION MAKING
4. Recovery and Employment Procurement – Dario Silvestro (DS) & Tom Howel (TH)
4.1 TH and DS attended to present to the Committee the proposed changes to mental health recovery and support services (previously mental health day services).
4.2 A set of proposals were shared with SCR in September and permission was given to go out for consultation, however delays were experienced due to the STP going through
governance and also the government gateway.
4.3 The consultation took place between February and May and an evaluation process
followed. TH and DS presented the final specification which includes adjustments
which have been made as a result of the consultation, and approval was requested to use the specification to go out to tender.
4.4 The Committee noted that the service is purely for the West Birmingham population and asked whether there is an equal service in Sandwell. TH replied that the difficulty is that we are sitting in separate STPs with this aligning with the strategic direction of the BSoL STP. TH noted that he would be happy to work with SWBCCG mental health commissioners / the mental health steering group to start thinking about what this
may mean for Sandwell and what inequity may look like.
4.5 It was noted that this city wide proposal covers part of the SWBCCG footprint (West
Birmingham). TH advised that there is not currently a centre located within this area; however the proposal will ensure that one of the centres is located in the heart of West Birmingham.
4.6 Discussions took place around potential inequity for the population of a registered GP list. For example, there could be a situation in a West Birmingham practice where patients living in West Birmingham would be covered by the service however patients living on the Sandwell border would not be eligible to receive to the same service. TH
noted that this is a situation that could arise, but noted that the GP Forward View
mentioned the introduction of IPS individual placement support workers and therefore there would be an expectation that this was progressed locally for the Sandwell population.
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4.7 Discussions took place about patient boundaries and exclusion criteria as the proposal presented to the Committee stated that the service was only accessible for patients registered with a Birmingham GP. The Committee highlighted that there may be Birmingham residents that are registered with a Sandwell GP who should have access
to the service. TH responded that this issue is addressable and will amend the criteria
to make it more specific to include patients on a resident of Birmingham basis.
4.8 A committee member expressed their uncertainty at funding an inequitable service
however they were reminded that that there are a number of service areas where there are different services running for Sandwell and West Birmingham patients. Committee members noted that commissioning teams should ensure that services are as equitable as possible.
Decision: The Committee approved the service in principle with the following caveats
- There should be an equivalent service in Sandwell
- The exclusion criteria should be amended to ensure that West Birmingham patients that are registered with a Sandwell GP are picked up / included in the service.
5. Diabetes Educational PID – Dr S. Muthuveloe (SM)
5.1 SM, one of the diabetes improvement leads for the CCG attended to present a project initiation document to outline plans for the next 3 years to educate GPs and Practice Nurses in the care of diabetes for patients.
5.2 Over the past few years the CCG has invested in diabetes education in 2 main ways;
firstly the DiCE clinics, and secondly the pit stop course. Because of this the CCG has
built a cohort of staff providing better care with the help of the DiCE team. The
proposal is to keep up the skills of the currently trained staff whilst building in a second wave of skilled GPs and Practice Nurses.
5.3 To keep up the skills of those trained it is proposed that there will be quarterly seminars with practical presentations from diabetes specialists It is also proposed that during year two there will be a pit stop refresher course for those who have previously completed the pit stop course.
5.4 To build a future workforce it is proposed that a foundation diabetes course will be run which will offer each practice at least 1 place.
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5.5 The total expenditure is estimated at just over £140,000 spread over a 3 year period. Funding for the proposal is being picked up by the GP Forward View. It was noted that the current spend on diabetes drugs is £12million per year, and SWBCCG are high spenders in this area.
5.6 The Committee acknowledged that the proposal fits with our Right Care priorities and it was noted that diabetes is part of the new PCCF. It was suggested that it would be
useful to have one PLT (Protected Learning Time) event per year devoted entirely to
the PCCF with some of the training delivered at such forum.
Action: HH to contact Claire Parker to advise that the SCR Committee have recommended that one PLT per year is specifically dedicated to the PCCF to up-skill colleagues to meet required standards.
5.7 There was some interest as to whether similar initiatives have had any benefit. LMf advised that AH is working on analysing the PCCF and it appears that there has been a significant difference made to diabetes care with a reduction in the number of referrals to secondary care with diabetes better managed by diabetes teams. BA
suggested that it would be useful to know where SWBCCG is with regards to the
management of major complications of diabetes in the long term (for example amputation and blindness) rather than focusing on HBA1C levels and admissions.
5.8 The Committee agreed that it would be useful to see the outcomes of the proposal to monitor its effectiveness. It was however acknowledged that with the number of patients with diabetes increasing, it may be difficult to see a true reflection of the impact of this proposal.
Decision: The Committee supported the proposal.
6. Sandwell Own Bed Instead (OBI) Short Term Re-ablement Service (STAR) and Community Alarms Capacity Options Appraisal – Hannah Ship (HS)
6.1 The Sandwell OBI service has been running since 2014. Commissioners have recently starting working with the providers to monitor data and particularly activity going
through the service. It was highlighted that Sandwell Local Authority currently
provides both the STAR service, and the community alarm element. In terms of finance we have a block payment arrangement totalling approximately £62.5 thousand for each service.
6.2 It has been identified that capacity within the STAR service has hindered our flow through OBI and also the capacity that the service can take and therefore we need an
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increase in capacity.
6.3 Last year the model was changed to introduce a social care officer who was allocated to OBI to carry out assessments, attend MDTs and complete associated administration tasks. This worked well in that assessments were completed in a timely manner
meaning patients could be accepted into the service sooner, and re ablement goals
were met quicker.
6.4 The increase in STAR capacity has been offset by an underutilisation in community
alarms that has been seen within the service. Out of 250 patients seen by the service, only 73 were chosen to have an alarm fitted. Only 13 of these patients asked for any kind of response during the time that they had the community alarm fitted. It has therefore been identified that there is not as much need for this element of the service.
6.5 Along with providers and finance colleagues, commissioners have looked at the available budget against the predicted capacity and demand over the next 12 months
to realign the budgets. It is proposed that in terms of STAR, the home team hours will
remain consistent, but the input from the social care officer will be increased one whole time equivalent. Funding will initially be increased to £92,000 and commissioners will work with providers to agree an activity based payment system for the community alarm (fitting, and mobile response). The CCG are proposing that we pay the weekly fee initially, and if the patient wants to continue with the alarm on a
long term then they would self-fund this. There is currently no data available able to
demonstrate whether the alarms are being correctly used, however this is something that HS could obtain if required. 6.6 The paper included a summary which demonstrated how the revised budget allocation would look if some of the community alarm budget was shifted to allow for the increased capacity in STAR. This would also enable a small contingency budget to do some flexing across services if required. HS clarified that no additional funding is being requested and all budgets are CCG budgets and are not aligned in the Better
Care Fund.
A STAR type service does not exist in Birmingham as they have their own social worker 6.7 dedicated to OBI, and the flow is better in Birmingham.
Decision: The Committee approved the proposed changes detailed in the paper.
7. Development of Perinatal Mental Health – Hazel Malcolm (HM)
7.1 HM attended with Sarah (Senior Commissioning Manager, Wolverhampton) and
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Shaukat Ali (Project Manager).
7.2 Last Autumn an unsuccessful bid was put in across the Black Country for perinatal mental health and there is now a second opportunity to put a bid forward with Wolverhampton CCG leading on this.
7.3 SWBCCG have completed an audit in terms of where we are for perinatal mental health and a project manager (Shaukat) has been appointed to pull the bid together.
Work done to date includes an audit, and a summit to bring stakeholders and patients 7.4 together. The project is now at the stage of formulating a robust bid with partners
working together to shape how this might look.
7.5 Any bid that goes forward will be signed off for the Joint Commissioning Group for the Black Country. HM advised that she is representing SWBCCG on the Task and Finish Group and Dr Liz England is Chairing the Clinical Reference Group.
7.6 It was highlighted that the Black Country is rated ‘red’ for perinatal mental health and the aim is to ensure that there is some system connectivity to deliver clinical outcomes and improve patient experience. A committee member noted that integration is the way forward and agreed that streamlined pathways would be
useful.
7.7 Because of the mental health cluster model, women with a perinatal diagnosis and
men with a period of perinatal mental ill health are not always recorded which is skewing suicide data. There is some work taking place with the Trust to improve the use of coding.
7.8 The paper highlighted that there are no immediate finance implications; however there will be some long term financial implications. There will be £20million transformation money across 10 areas; and the funds will be recurring until base lined into the CCG budget (approximately 2021). It is thought that the cost pressure for
SWBCCG should not exceed £225,000 and it was noted that the finance team have
been actively involved in the process and discussions to date.
Decision: The Committee approved the report and supported the bid.
8. Birmingham Mental Health Inpatient Capacity – Debra Howls (DH)
8.1 This item was discussed during item 3.1.4 (action register).
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9. Excess Treatment Cost Request IWOTCH Study – Hannah Peach (HP)
9.1 It was noted that the CCG are seeking legal advice with regards to excess treatment cost requests. The Committee were reminded that the CCG has to remain in financial balance, however CCGs are not permitted to reject ETC requests for financial reasons
hence the need for some legal guidance on the matter.
9.2 The IWOTCH study is an NIHR approved study which requests £5761.80 to cover the
cost of 3 approved nurses and 3 facilitators to provide support programmes for
patients who are prescribed opioids for chronic pain. They are looking to recruit 186 patients from 40 practices across the West Midlands and they plan to do both group and one to one support work to identify whether support mechanism better helps patients to withdraw from opioids.
9.3 The Committee agreed that the study appears to be relevant and fits with CCG priorities. It was suggested that if the study works, it is something that the CCG may
potentially be interested in replicating.
9.4 The Committee discussed the appropriateness of approving studies where legal advice
is outstanding. The awaited legal advice should address issues such as are we obliged
to fund all ETC requests, or can they be rejected, and can studies be prioritised within an allocated budget. It was noted that other CCGs have in the past rejected studies.
Decision: The Committee agreed to approve the study in principle pending legal advice and also confirmation as to whether someone from the pain clinic/pain service is involved in the study in any way.
Action: The Committee requested that HP attends SCR to provide details of the outcome of the requested legal advice with regards to ETC studies.
ITEMS FOR INFORMATION
10. PMO Update – Louise Piper (LP) & Jenna Phillips (JP)
10.1 The PMO team are still doing confirmation meetings to clarify details that have been captured to date including risks and issues. Risks and issues will be captured slightly differently and will be managed through the PMO Board. If they are quantified above the Board’s reckoning level then they will be passed up to SCR/PCCC.
11. Corporate Updates
11.1 No update.
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12.2 Health and Wellbeing Board Feedback – Dr Basil Andreou (BA)
12.2.1 No Update
13. Right Care Update – Andrew Harkness (AH)
13.1 AH had sent apologies but sent a written update which IS shared as follows:
13.2 We remain on track for September 2017 to articulate plans for three priority programme areas (respiratory, diabetes and cancers); . In year developments and potential impact . Commissioning intentions for 2018/19
13.3 NHS England has mandated a template return at the end of June, July and August. In June and July we are required to submit one programme area each month. August we are required to submit all three programme areas. We are submitting programmes as follows; . June – diabetes . July – cancers . August – respiratory, diabetes and cancers
13.4 Diabetes submission (June 2017) – a request has been made to share our CCG submission as an example of good practice, due to the range and focus of work we are undertaking.
13.5 Evaluation of the 2016/17 PCCF has shown a significant impact on areas that directly link to Right Care including diabetes, hypertension, AF and cancer. . Right Care has approached the CCG to ask to use the PCCF as a case study for them to publish through their national programme.
13.6 Elements of Right Care that may be delivered by primary care (via PCCF) for the six programme area priorities for 2017/18 and 2018/19 are being developed for consideration and will be finalised for end of August 2017.
13.7 It was suggested that it would be useful to break down Right Care to differentiate between Sandwell and Birmingham.
Action: DH to find out from AH whether it would be possible to break down Right Care to differentiate between Sandwell and Birmingham.
14. Strategic Estates Review Group
14.1 No update.
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REVIEW OF DECISIONS
15. Review of Decisions:
15.1 IS gave an overview of decisions and confirmed that there are no new items to be added to the risk register.
ANY OTHER BUSINESS
16.1 Better Care Fund (BCF) and the Responsibilities of SCR
16.1.1 Audit Committee have requested clarification around the responsibilities of SCR and what the Committee has picked up following the dissolution of the partnerships committee.
16.1.2 The Better Care Fund reports to the Health and Wellbeing Board, and it was noted
that the individual schemes have now all finished, and clinical lead posts have ceased
to exist. LMf added that the schemes were all evaluated and failed to demonstrate an
improvement on the number of admissions. Additionally the social prescribing model is being re-evaluated.
16.1.3 The Committee were of the view that the dissolved Partnership Committee did not pass any responsibilities for the Better Care Fund to SCR; however confirmation was requested of SCR responsibilities for assurance.
Action: DH to liaise with SL to confirm whether SCR has any responsibilities in relation to the Better Care Fund.
16.2 Future SCR Meetings
16.2.1 With regards to July SCR meetings;
16.2.2 13.7.17 – IS is away and therefore BA will step in as Chair.
16.2.3 27.7.17 – RN is away and has been unable to secure lay member representation to attend on his behalf. To allow RN to review papers/take a view on agenda items in
order to ensure a quorate decision at the meeting, the deadline for meeting
papers/reports is to be strictly adhered to. GF and BA also noted their apologies.
16.3 GP Five Year Forward View
16.3.1 A Committee member asked how the CCG is doing in terms of progressing towards
the end of the five year forward view. LMf advised there is a performance monitoring tool and a performance monitoring group which feeds into PCCC from an assurance
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point of view.
16.3.2 All of the money that has been received has been allocated and a focus group is set up to look at how the transformation monies will be spent.
Action: LMf to share with the Committee information regarding the progress of the GP Five Year Forward View.
DATE AND TIME OF NEXT MEETINGS
17.1 Thursday 13th July, 1-4pm, Yemeni Centre
ALL SCR MEETINGS FOR THE REST OF 2017 WILL BE HELD AT THE YEMENI CENTRE
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Sandwell & West Birmingham CCG Minutes of the Strategic Commissioning and Redesign Committee on 13th July 2017 13:00 – 16:00
Yemeni Community Association Greets Green Access Centre, Tildasley Street, West Bromwich, B70 9SJ
Present: Dr B Andreou (BA) CHAIR Vice Chair, GP, Sandwell Health Alliance Dr P Hallan (PH) GP, Pioneers for Health Dr S Butler (SB) GP, HealthWorks LCG Olivia Amartey (OA) Deputy Chief Officer, SCR Sharon Liggins (SL) Chief Officer Richard Nugent (RN) Lay Member Geoff Foster (GF) Voluntary Sector Representative Carly Sheldon (CS) Senior Finance Manager Louise Piper (LP) PMO Administrator Jenna Phillips (JP) PMO Manager Martin Stevens (MS) Head of Contracting
In Attendance: Hayley Haworth (HH) MINUTES Corporate PA - Minutes Michelle Carolan (MC) Deputy Chief Officer, Quality
Absent with Apologies: Dr I Sykes (IS) GP, Black Country – Meeting Chair Dr S Sarwar (SS) GP, ICOF Dr A Saini (AS) GP, Black Country Dr D Manivasagam (DM) GP, Sandwell Health Alliance Andrew Harkness (AH) Consultant in Public Health
1. Declarations of Interest:
1.1.1 It was noted that item 5 has general implications for all West Birmingham GPs as this is work which is potentially moving from the community to general practice.
1.1.2 SB highlighted a potential interest in the same item as he is a member of the Connected Care Partnership (Vanguard of which BCHC are partners).
1.1.3 SB highlighted that his practice is discussed as part of the SERG minutes; however no mitigation is required as the minutes are included for information with no decision
required.
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1.1.4 There is a possible conflict of interest for all GPs during item 2.2 (GPFV) however no mitigation is required as the item is for information only.
Item 8.3 – PH declared an interest during this item; however mitigation was not required as no decision was made. 1.2 Quoracy: 1.2.1 The Committee was not quorate due to an insufficient number of GPs being present. It was agreed that any decisions made by the Committee would be circulated by email to absent members for virtual decision in order to achieve quoracy.
nd 2. Minutes of the public SCR meeting held on 22 June 2017:
2.1.1 Item 3.1.4 – The spelling of Tom Howel to be corrected to Tom Howell.
2.1.2 Subject to the above amendment, the minutes were confirmed as an accurate record of the meeting.
2.2 Matters Arising
2.3 GP Forward View
2.3.1 This was included for the Committee’s information as requested from Lisa Maxfield at a previous SCR meeting.
2.3.2 The Committee were informed that the ‘red boxes’ show where there is an external dependency which we cannot do anything about.
2.3.3 Discussions took place about trainees and recruitment and SL suggested that this is a plan to be owned by primary care itself and not the CCG. SL continued that we need to start thinking about how Sandwell organises itself to have a cohesive view about
the future of the recruitment programme.
Action: Lisa Maxfield to provide an update around GPFV to the next SCR meeting.
3. Action Register:
3.1 The action register was discussed and updated. Discussions took place around the following actions:
3.1.1 From Meeting 27.4.17, Item 10.1 - Bring feedback from the Outpatient Activity
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Meeting to a May SCR meeting.
SS, SL, and OA met Rachel Barlow to discuss outpatient activity and the 5 speciality areas to be concentrated on were agreed. The Committee agreed to close this action as work will be picked up under the planned care work stream.
From Meeting 25.5.17, Item 4.8 – Review DATIX to identify incidents around x-ray 3.1.2 reporting delays with a view to explore what follow up action has taken place. This
should be fedback to SCR at the next meeting and MS to raise the issue at the
commissioners pre-meet to be addressed at the contract review meeting.
MS reported that there has been a rise in the number of incidents on DATIX. At the recent CQRM meeting the Trust were reporting 90% within 4 weeks and there are plans to make this 100%. MC added that there have been formal concerns raised by Birmingham Cross City. It was noted that the only requirements included in the contract are around access, and there are no reporting targets included. It was suggested that this should be included in the next contract. MS suggested that it
appears that there are issues with securing qualified staff to read the diagnostic test
results. It was thought that other Trusts are reporting much quicker (HEFT was thought to be 24 hours) and therefore it was suggested that we should obtain some benchmarks. MS replied that CQRM are awaiting a paper with the Trust’s response to diagnostic issues.
From Meeting 25.5.17, Item 16.9 – Pick up issues with DNA’s (hospitals incorrectly 3.1.3 referring patients back to the GP after 1 DNA) in upcoming contracting meetings.)
From Meeting 22.6.17, Item 2.2.1 - Liaise with MS about the lack of awareness from Consultants of the Standard Hospital Contract and also highlight that there are posters in the waiting are of Sandwell Hospital which contain incorrect information.
With regards to these two actions, MS advised that the Trust access policy says that if the patient contacts the Trust within 2 weeks of a DNA then they will be offered an appointment. If the patient DNA’s twice then they will be referred back to the GP. MC expressed concerns about vulnerable patients and BA advised that the new NHS Standard Contract states that there should not be a ‘blanket policy’ by discharging patients following a first failure to attend. Patients should be sent a second appointment, and if they still fail to attend then they should be referred back to the GP. BA shared an example which demonstrated that Consultants are not aware of the policy. BA also highlighted that ‘DNA’ is recorded for the patient when the Trust cancels an appointment, or if the patient checks in for their appointment more than 5 minutes late.
Action: Confirm what communication is being sent to patients with regards to DNAs and rebooking appointments to ensure that it is accurate. Once the Committee have
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received assurance that accurate information is being sent, this issue / action to be closed.
From Meeting 22.6.17, Item 3.1.7 – The Committee requested information about the 3.1.4 number of mental health in-patient bed capacity in Sandwell to be made available in advance of Governing Body making their decision about approving funding for Birmingham beds. DH to liaise with Anet Baker.
OA advised that this is part of the STP work looking at capacity and is also part of the bed utilisation work stream. SL suggested that the question should be whether there is a waiting list for beds and it was therefore suggested that the action should be re- worded as follows:
Action: Ascertain whether there is there a similar issue in Sandwell (to that of Birmingham) with out of area placements?
From Meeting 22.6.17, Item 16.1.3 – Liaise with SL to confirm whether SCR has any 3.1.5 responsibilities in relation to the Better Care Fund.
SL advised that both Better Care funds are governed through a different structure however the service redesign elements should come through SCR for conversation.
ITEMS FOR DECISION MAKING
4. Rapid Response Business Case – David Coles (DC) & Tom Odey (TO)
4.1 This item has been deferred due to the fact that there was no financial sign off.
Action: Any queries on the rapid response business case paper to be sent to HH, so questions can be answered before discussions at the next meeting.
4.2 It was suggested that it would be useful to have details of the comparable service in the West of Birmingham in order to see the variance between the 2 areas. It was noted that this would be useful when looking at any future papers which serve one half of the patient population.
5. Discharge to Assess Pilot – Richard Thompson (RT)
5.1 RT presented a paper detailing a small scale pilot for what would become the ‘discharge to assess’ scheme. RT advised that there have been some further developments to the paper.
5.2 There is a national target to reduce Continuing Healthcare (CHC) assessments
undertaken in acute hospital settings to less than 15% of all assessments completed.
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The paper and accompanying service specification outline the proposed approach to implement discharge to assess beds in community care home settings.
5.3 RT advised that the team are down to 37% and have dedicated resources to bring this down further.
5.4 The pilot activity will be funded by system resilience monies. A two tier fee structure is proposed, with an occupied bed rate of £700 per week and a vacancy rate of £300
per bed per week.
5.5 SB noted that there is a disparity of Birmingham beds against Sandwell beds, and
newly procured nursing beds to deliver this must be appropriately weighted. RT replied that there have been 2 potential solutions outlined in Tipton and Smethwick; however there is a lack of suitable beds on the Birmingham patch.
5.6 With regards to using SRG money, RT advised that this decision has not gone through the A&E Delivery Board. SL replied that this would need to go through the Board for decision.
5.7 With regards to the Better Care Fund in Sandwell, the aspiration for the additional investment is to develop a health and social care hub (potentially at Rowley) – and
within this all DTOCs would be eliminated and would include discharge to assess beds.
SL noted her expectations that this pilot would dovetail in with the implementation of this.
5.8 With regards to waiting times, part of the purpose of doing this is to get a true reflection of patient needs and improve the efficiency of flow through the hospital.
5.9 There were conversations about whether the beds would have dedicated GPs. SL suggested that RT could liaise with the intermediate care team about potential GP provision.
5.10 SL reiterated that the proposal does not address the West Birmingham area and thought should be given to this area.
5.11 RT advised that he would need to carry out some modelling work in order to answer
the question around the number of beds required by the pilot in order to achieve the
target. SL replied that modelling should take place to identify the number of beds
required in order to achieve the target.
Decision: The Committee agreed that the request for SRG money should be taken to the A&E Delivery Board, and suggested that further modelling work take place.
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6. Re-specification of BCHC’s Integrated Multidisciplinary Teams (IMT) Service – Angela Szabo (ASz), Jane Mcgrandles (JM) and Michelle Carolan (MC)
6.1 Late attempts were made to defer this item, however as ASz and colleagues did not receive the message, they attended and requested to present an updated paper /
changes which the Committee approved.
6.2 ASz explained that there were some areas of difference between the Birmingham and
West Birmingham LIS’s and the proposal is to try and standardise the West of
Birmingham with the rest of Birmingham 6.3 One of the big changes is removing simple wound care for patients that are non- house bound. This is included in the Birmingham LIS, therefore it has been set as an exclusion criterion for the West Birmingham patients who do not have this in place. ASz advised that there is a push from the community provider Trust for a consistent approach across Birmingham. The removal of suchel staples and simple wound care
will continue for Sandwell & West Birmingham CCG.
6.4 The changes affecting SWBCCG are
- A small amount of phlebotomy for practices where District Nurses are carrying
out phlebotomy appointments only where patients are able to travel to clinics
or their GP surgery where it is already being paid for under the LIS arrangement.
- A small amount of activity for assessments where there is no requirement for the nursing service to carry out any nursing interventions, but the patient has been referred to the service for observation and assessment. When this was reviewed from a Birmingham perspective it was felt that this is a core GMS service.
6.5 A two week audit took place with the community Trust to establish activity across all
of the areas for non-housebound patients and a considerable amount of patients that
could be self-medicating / self-caring (eye and ear drops and medication) were identified. There have also been conversations about vulnerability assessments that will be carried out as part of the referral process, and vulnerable patients (whether they are house bound or not) would be supported by District Nursing teams.
6.6 ASz confirmed that discussions with the Trust started one year ago. The teams are under pressure due to increasing activity levels impacting on the team’s ability to maintain a safe service. ASz confirmed that services have not been decommissioned;
however patients are being supported to self-manage.
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6.7 With regards to the impact at a practice level, ASz advised that she has picked up 4 practices within West Birmingham that have been referring for phlebotomy which annually equates to approximately 130 appointments in total across these 4 practices. For assessments this equates to around 300 appointments where the District Nursing
teams are either assessing or observing the patient.
6.8 There is a planned stage approach; the first step is to look at new referrals. The
second stage would look at all existing patient caseloads under District Nurses and
widening the scope to look at the case manager function.
6.9 With regards to engagement, it was acknowledged that the process to date has excluded the West Birmingham area and this area needs to be included in a full engagement process.
6.10 It was noted that Sandwell & West Birmingham are underperforming on appointments, therefore there is some scope to review our contribution in primary care.
6.11 MC expressed her disappointment that SWBCCG have not been engaged with sooner on something which will have a major impact on service quality for our patients and
reiterated that SWB require time for engagement.
6.12 PH noted that there has previously been a large amount of time spent redesigning /
developing the District Nursing teams to improve integration, with standard operating procedures agreed with each team. PH stated that this feels like a step backwards. 6.13 SBu highlighted a concern in that practice staff may no longer have up-to-date wound management skills since this was decommissioned from Primary Care to the LIS and therefore it may prove difficult for practices to pick this back up. 6.14 The ‘go live’ date for Birmingham is Monday 17th July. There will however be a shadow monitoring period.
Action 1: Communication to go out from SWBCCG to member practices to advise that although Birmingham practices are going live on Monday, SWBCCG practices
will not be part of this.
Action 2: Establish a group to determine how this will be moved forward given that
SWBCCG have not been party to the design / conversations to date.
6.15 JM advised that the report highlighted that we have separate LIS’s for our practices to
provide phlebotomy, and some of those practices are referring in.
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Decision: Once the two actions have been completed, a full engagement process should take place, and following this a paper should come back to SCR. This may take up to 6 months.
ITEMS FOR INFORMATION
7. Corporate Updates
7.1 No update.
7.2 Health and Wellbeing Board Feedback
7.2.1 Sandwell - Dr Basil Andreou (BA)
No Update
7.2.2 Birmingham
Papers were included in the meeting pack for Committee Member’s information.
The CQC will be looking at social care systems which will include Birmingham. This has yet to be reported to the health and wellbeing board, and committee members will be kept updated.
Measure of the CCGs – interviews took place for an Accountable Officer however the vacancy was not filled and therefore it was suggested that there may be an interim AO.
8. Strategic Estates Review Group
8.1 Rent reimbursement – NHSE have now confirmed that there will be no abatements for primary care services unless GPs are raising a rental charge for floor space. It was however noted that GPs are permitted to request a service charge contribution
without contravening the requirements in the premises directions. A letter from NHSE
confirming this was included in the meeting papers. 8.2 Minutes of the May SERG meeting – Apologies were made for the late circulation of
the notes which were only ratified the previous day. RN advised that AL is working on the estates strategy which will be shared with SCR in August.
8.3 PH noted a potential conflict at this point in the meeting. PH referred to the SERG meeting minutes and suggested that there has been a misunderstanding. The meeting minutes talk about there being a 3rd party developer, however PH confirmed that this
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has never been the case and PH clarified that there is not going to be an outside developer owning the building.
Action: RN to clarify with Andrew Lawley the following inaccuracy in SERG minutes – PH confirmed that he has never considered a third party developer scheme.
9. Update on Out of Hours Services – Claire Blackburn (CB)
9.1 CB delivered a confidential update on out of hours services.
9.2 Action: An appropriate out of hours update message should be drafted to share with practices in Nick’s news.
REVIEW OF DECISIONS
10. Review of Decisions:
10.1 BA advised that there were no decisions made and confirmed that there are no new items to be added to the risk register.
ANY OTHER BUSINESS
11.1 GPFV – Demand Management
11.1.1 There has been a document from the Department of Health around examples that could be used for demand management. This was sent out in December highlighting things which ‘could be considered’, and in June it said this is what you ‘must do’.
11.1.2 The first ‘must do’ which should be in place by September is a clinical peer review. The
team are working something up, and we have had to file a plan with NHSE confirming
that this will be completed by 13th September. A working group has been established
to look at this proposal and SL highlighted this to make members aware that this will be coming back to SCR.
11.2 Places
Action: Include places on an SCR agenda.
11.2.1 A paper was taken to Governing Body around integrated health and social care in Sandwell. This clearly defines 2 places – West Birmingham and Sandwell.
11.2.2 The future direction, if there isn’t a policy is thinking about integration within these places wrapped around the population and wrapping solutions around small pockets
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within these populations, with providers providing the solutions. 11.2.3 For Dudley there is the MCP model, however for SWBCCG there may be more of an alliance type approach. Claire Parker is leading this for West Birmingham and Sharon Liggins is leading this work for Sandwell. The aspiration is to mobilise this alliance
approach in the West of Birmingham to begin influencing the rest of Birmingham.
11.2.4 In Sandwell, through the Better Care Fund 3 fixed term project managers have been
appointed to kick start the work in Sandwell, commencing with the integrated health
and social care hub which may potentially be located in Rowley Regis. This should be in place managing all DTOCs by the end of Autumn. SL advised that the work will be taken through the Better Care Fund governance, however all work will need to come through SCR. 11.2.5 As alliances take shape, there should be consistency about a planned approach. Staff should be cognisant that there are two areas to consider.
The Committee agreed that the right way to talk about equity / development and shared learning needs to be identified, and the point we are travelling to needs to be articulated along with realistic timescales to reach it.
DATE AND TIME OF NEXT MEETINGS
12.1 Thursday 27th July, 1-4pm, Yemeni Centre
ALL SCR MEETINGS FOR THE REST OF 2017 WILL BE HELD AT THE YEMENI CENTRE
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Sandwell & West Birmingham CCG
SANDWELL AND WEST BIRMINGHAM CLINICAL COMMISSIONING GROUP Audit & Governance Committee Minutes of Meeting held on Thursday 15th June 2017 Board Room Kingston House 09:00 – 12:00hrs Members: Julie Jasper JJ Chair Therese McMahon TM Vice Chair and Board Nurse Vijay Bathla VB GP and Chair F&P Committee Richard Nugent RN Lay Member Ranjit Sondhi RS Lay Member Janette Rawlinson JR Lay Member
In Attendance: James Green JG Chief Finance Officer David Hughes DH Deputy Chief Finance Officer Matthew West MW Financial Controller Michelle Carolan MC Deputy Chief Officer Quality Tracey Barnard Ghaut TBG Assistant Director Audit (CW Audit) Shaun Grayson SG Local Security Management Specialist Paul Westwood PW Head Anti-Fraud Services Hazel Barnes HB PA to Chief Finance Officer Paul Capener PC CW Audit
This meeting will be recorded purely as an aide memoir for the minute taker to ensure an accurate transcript of the meeting, decisions and actions. Once the minutes have been approved the recording will be destroyed.
Item Subject 1. Declarations of Interest: To request members to disclose any interest they have, direct or indirect, in any items to be considered during the course of the meeting and to note that those members declaring an interest would not be allowed to take part in the consideration or discussion or vote on any questions relating to that item. Mrs Jasper declared her role as a Board member and Audit Chair of Dudley CCG. No agenda items were identified as a conflict, therefore no mitigation was required.
RS declared his wife as a non-executive director of Women’s Hospital. No agenda items were identified as a conflict, therefore no mitigation was required.
2. Minutes of meeting held on 18th May 2017 The minutes of the meeting held on Thursday 18th May 2017 were accepted as a true record with the amendment of Vijay Bathla’s title.
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3. Action Register: The action register was discussed, and approvals to remove and update actions were agreed.
3.01 A discussion was held regarding the action in relation to the Annual Report. DH advised that discussions had been held at Governing Body and the main issue revolved around ownership of the Annual Report. It was agreed that the timing of the report was not an issue but a single filter is required with a check of the overarching document following individual submissions. JR stressed that the report carries a reputational risk. JJ advised that there is a meeting arranged for her to meet with Andy Williams with MC to discuss this. The committee discussed requesting Internal Audit to review later in the year the processes in place once they had been agreed.
3.02 Action: Internal audit to carry out a piece of work to review the process of producing the Annual report. Action: JJ will report back at July’s meeting following her meeting with Andy Williams and MC.
3.03 The committee discussed Conflicts of Interest Training. An inconsistency was recognised in relation to Conflict of Interests at meetings. Some committees ask members to leave and others allow the conflicted member to remain and not take part. In view of the recent issues at PCCC meetings, JJ asked MC to attend future meetings.
3.04 Members agreed that in light of the issues with PCCF Bespoke training was required and RS stressed the importance of case studies as part of Conflict of Interest Training.
Action: MC to attend future meetings of the PCCC. Action: Explore bespoke training session for Conflicts of Interest training.
4. Chairs Report: None 5. Internal Audit 5.1 Progress Report TBG presented the Internal Audit Progress Report. There have been no changes to the audit plan since it was approved by the Audit Committee and progress against the plan is progressing well.
5.11 Two final reports were presented for assurance today; HR Processes and Continuing Healthcare. The Primary Care Co-Commissioning report is currently at draft stage with the exit meeting completed and any issues discussed. Final sign off from the Executive lead is currently awaited but significant assurance is expected. In response to RS query, TBG reported the main focus of the review is the framework and contract arrangements and three recommendations have been made. Once agreed and finalised the report will be presented at the Primary Care Committee meeting. In response to RN’s query around lessons learnt on delivery of PCCF, SS recommended that a separate piece of work be undertaken for additional assurance. JJ also requested that TBG attend PCCC meeting when the report is
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presented.
5.12 Quality assurance fieldwork has been completed and an exit meeting has been held. A draft report will be issued in the next week and once agreed and finalised will be presented at the Audit Committee meeting.
5.13 The proposed year end assurance is currently significant overall based on the three reviews completed.
5.2 Outstanding Recommendation Report There are currently 44 recommendations sitting on the system. 29 are not yet due and 17 relate to the two reports on today’s agenda. TBG advised that any six months or older are now detailed at the front of the report. There are 6 category 2 recommendations – of which 3 are over 6 months old.
5.21 MW advised that he has chased outstanding recommendations and tabled a list of agreed actions with status updates included where recieved. Members agreed that there are a number of issues in each recommendation and benefit would therefore be gained from breaking each recommendation down so individual accountability is more apparent.
5.22 SS recommended that the Recommendations are a standing agenda item at senior management meetings.
5.23 Action: JG will raise this with the Executive Team to look at how to tackle the outstanding recommendations in order to establish a review process.
5.24 Key Performance Indicators have all been met at 100%. Surveys have been issued for two completed audits and responses are expected in July.
5.3 Internal Audit Report – HR Processes TBG presented the Internal Audit Report in relation to HR Processes (Changes to Job Roles and Re-gradings). Significant assurance has been given overall with four recommendations made, one category 3 and three category 4. All recommendations have been discussed and agreed and have been placed on the recommendation tracker. The recommendations relate to the remit of the Remuneration Committee and the impact of Changes to Chief Officer Roles on those of their deputies.
5.31 Action: The Remuneration Committee will meet on 21st June 2017 where these will be addressed.
5.4 Internal Audit Report – Continuing Healthcare The Audit Report gives significant assurance overall with 13 recommendations which are mainly category 3 and 4. There is one category 2 recommendation around patient reviews not being done on a timely basis. All recommendations and actions have been discussed and agreed and will be tracked in the usual way.
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5.41 MC noted that the delays in patient reviews include an end of life patient review delay of six to nine months which is an unacceptable delay. JR noted that 62 patients have been delayed more than six months. Following the discussion on patient reviewsmembers agreed that in light of this, the assurance level for the control objective should move to limited and as a result the overall level of assurance would move to moderate. .
5.42 Actions: • TBG to reassess the level of assurance given in terms of the level 2 risk, re-draft and re-issue the report. • The re-issued report to go to Quality and Safety Committee (Q&S) prior to coming back the Audit Committee. A response from Q&S to come to Audit Committee in July • MC to discuss the delays in patient reviews with Richard Thompson, Head of Continuing Healthcare and invite him to attend Audit Committee with an action plan following re-issue of the report • MC to request a review of potential harm cases as a result of the delays.
5.5 Key Development Briefing 2017 TBG presented the paper for information. SS noted the key issue of the recent cyber attack resulting in ten to fifteen GP practices being taken offline. He advised a detailed incident report should be logged along with an action plan highlighting risks and how to mitigate against these. JR noted that the Caldicott system was still not working which is a risk. She also noted the importance for Governing Body to understand the CCG’s exposure to vulnerability and risk due to cyber attacks and similar. PW recommended that CSU provide a paper to Governing Body on all vulnerabilities the CCG faces. This should include information such as business continuity and disaster planning
5.51 Action: JG to request an incident report from CSU and paper on all vulnerabilities faced by SWB CCG with which should go to Governing Body.
5.52 Members discussed emergency resilience for the organisation. MC advised that this was discussed at OD committee and Rachel Ellis is to be invited to attend the next OD meeting to give assurance and further update regarding EPRR procedure.
5.53 Members discussed IT and Communications in relation to the recent Cyber Attack. JG advised that an IT steering group will be meeting monthly and reporting to Audit Committee in order to provide assurance to Governing Body. He gave assurance that a risk assessment was already in place
5.54 In response to JJ’s query about how we manage the IT contract, JG advised that monthly meetings are held with CSU around the scorings awarded by SWB CCG.
5.55 Action: JG will invite the IT steering group to provide an update report to the next Audit Committee in July. 6. Counter Fraud 6.1 Anti-Fraud Annual Report
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PW presented the Anti-Fraud Annual Report 2016/17 which summarised the anti-fraud activity during this financial year for the CCG. A summary of work carried out, ongoing investigations and new referrals received during the year were presented.
6.12 PW confirmed that funds have been repaid following the recent court case.
6.13 RS questioned how susceptible SWB CCG is in comparison to other local CCG’s. PW advised that this is difficult to assess. 11.16 MC left the meeting 6.14 SS advised that the fraud is more prevalent in the provider environment 11.20 MC re-joined the meeting 11.20 JG left the meeting
6.15 PW advised members that he is hoping to appoint to the team and there is likely then to be a team restructure. He is therefore hoping to be a regular attendee at future Audit and Governance meetings. • The Committee accepted and approved the contents of the Anti-Fraud Annual Report
Draft Anti-Fraud Plan 2017/18 6.2 PW presented the Draft Plan which has been approved by JG. A summary of the plan on a page was presented and the approach outlined for 2017/18 to deliver the plan. 11.22 JG re-joined the meeting 6.21 The risk of private work and risk in relation to Drugs Budget were highlighted as being identified in the November 2016 Organisational Risk Assessment which was reported to the Audit Committee in January 2017. Appendix One was presented which sets out tasks to address the risks identified.
PW advised that the NHS Protect Review Tool has been submitted by all CCG’s which has 6.22 been assessed by NHS Protect. Shropshire CCG has been identified for further assessment and findings will be shared.
• The committee accepted and approved the Draft Anti-Fraud Work Plan 2017/18
7. Governance 7.1 Tender Waivers MW reported that following the last Audit Committee he has not received any queries in relation to the Waiver Report which was presented. 11.24 VJ left the meeting 7.12 The report highlights individual tender waivers, comments and proposed actions. The committee discussed the procurement of Parachute and Capsticks. MW advised that Procurement are offering support to put together a local framework to avoid STA’s in the future. MW and JG are working on this. JR agreed with this approach but also asked if staff received training around both awareness and direct involvement on procurement as things have changed in the last year or two and there are personnel changes with the CCG so this would be timely. 11.30 TR joined the meeting 7.13 Action: MW will invite David Bailey, Procurement Lead to present procurement regulations to the Audit Committee to provide assurance and discuss training options.
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7.14 JR requested another column on the waiver report to document historic continuity with dates.
7.15 MC recommended mindfulness of Conflicts of Interest in light of the newly appointment Chief Officer of the Transformation Directorate who is currently working for Parachute and attending Public and Private Sessions of Governing Body despite employment with SWB CCG not commencing until August 2017. This has been previously discussed at Governing Body.
7.16 Action: MW will request that Procurement add this to be added to the report and request a quarterly report with an update regarding the formulation of the framework to come to Audit Committee going forward. 11.39 SS left the meeting 7.2 Conflict of Interest Action Plan 2017/18 MC updated the committee on the plan. She reported that attendance to the Working Group has been sporadic and attendance has slipped.
7.21 NHSE has not yet approved SWB CCG Constitution and we are therefore not compliant. Agreement on Practice changes is still awaited and Terms of reference are still awaited for LCG’s before NHSE will approve.
7.22 Action: JG will raise this at Chief Officers meeting. MC to provide full details of why we are not compliant.
7.23 The Register of Procurement Decisions published on the website has not been updated and is non-compliant with guidance. MC reported that this was previously handled by Jenna Phillips but is the responsibility of Martin Stevens (MS) or Olivia Amartey (AM).
7.24 Action: JG will discuss this with MS and OA.
8 Risk Register 8.1 Audit and Governance Risks AG01b – There are a number of actions following the review of the Conflicts of Interest Action Plan. The risk therefore remains the same.
8.12 Action: MC to meet with TR to word update prior to the next review of the risk.
8.13 The committee discussed a potential new risk around assurance regarding the Annual Report. A new risk was also agreed in relation to the IT issues around the recent cyber- attack. A potential risk around procurement was also discussed and agreed that further discussions will take place at July’s Audit Committee meeting.
8.14 Action: JG and TR will meet to formulate new risks.
8.2 BAF Risk Register PT01 – closure approved PC12 – reviewed and agreed remains the same PT03 and PT02– Gaps in Controls were highlighted
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Action: TR to meet with OA to complete FP05 – gaps in assurances were highlighted although JG advised that these had previously been completed. Closure was approved. PC08 – risk reviewed and agreed remains the same PC14 – The risk has been reduced and therefore removal from BAF was agreed. Action: MC to provide quarterly update to GB QS25– narrative is to be added prior to closure FP10 – reviewed and agreed remains the same PC11_16c – Narrative states risk increased to 12 but not reflected in the document. Action: TR to resolve FP11_2016a – reviewed and agree remains the same. To be updated at the next F&P meeting. OD01_17a – MC advised that this has been taken back to OD and MC and Alice McGee will review PC03_17c – more narrative was requested FP04_17a – reviewed and agreed remains the same. To be reviewed at next F&P meeting for further update.
8.3 Risk Closure Requests SC02 – SCR to complete gaps in controls and Internal and external assurances SC09 – SCR to complete gaps in controls and assurances QS07 – Q&S to complete gaps in controls and assurances QS18 – Q&S to complete gaps in controls,, external assurances and gaps in assurances QS17 - Q&S to complete gaps in controls and assurances NCM07-16b – More information requested around where the risk has been transferred to. Assessment was queried by the committee FP07 and FP09 – JG and TR completed gaps but this was not reflected on the register. Accounts audited and signed off. Action: TR to resolve SC17 – closure approved SC12_16a – SCR to completed gaps in controls and assurances Action: Ian Sykes to be invited to the Audit Committee to discuss SCR Risks
9. Key points to share with Governing Body and Staff MC and JJ to discuss outside of today’s meeting
9.1 Action: JJ and MC to provide annual report of work done by Audit Committee to Governing Body. All committees to be asked to do the same. 10. AOB No other business was raised and JJ closed the meeting. 11. Date and Time of Next Meeting: Thursday 20th July 2017 09:30 – 12:00hrs Boardroom Kingston House
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SANDWELL AND WEST BIRMINGHAM CLINICAL COMMISSIONING GROUP
Organisational Development Committee Meeting Tuesday 13 June 2017, Meeting Room 1, 4th Floor Kingston House
10:07hrs – 11:14hrs
MINUTES
Prof Nick Harding (Prof Chair NH) Chair of SWBCCG & Chair of Healthworks LCG Sharon Liggins (SL) Chief Officer, Strategic Commissioning and Redesign. Alison Braham (AB) Interim Chair of Staff Council & Primary Care Quality Lead Alice McGee (AMc) Head of HR and OD Sharon Liggins (SL) Chief Officer, Strategic Commissioning and Redesign Michelle Carolan (MC) Deputy Chief Officer, Quality
In Attendance Helen Levitt (HL) Minutes
Apologies Saba Rai Senior Commissioning Manager, Inclusion Jayne Salter-Scott Head of Engagement Sarah Makin Communications Lead, Arden and GEM CSU Therese McMahon Non-Executive, Board Nurse Andy Williams Accountable Officer
Absent without apologies
Item Subject
1. Declarations of Interest
No declarations were made. PrfNH requested for members to disclose any interest they may have, direct or indirect, in any items to be considered during the course of the meeting.
2. Minutes and Action notes from previous meeting
2.1 The minutes from the meeting held on Tuesday 11 April 2017 were accepted with the following amendments; 2.2 • Ms Carolan’s apologies to be formerly recorded.
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3. Actions/Matters Arising
3.1 Members reviewed and updated the action log.
3.2 AMc reported that a management tool is being explored in relation to function comparisons across the Black Country CCG’s as part of the collaborative commissioning work.
3.3 All other actions were either completed or deferred to the next meeting. 10.09hrs – LM joined the meeting.
4. Staff Council and Policy Development update
AB provided a verbal update on the items of business discussed at the last meeting of the Staff Council which took place on Monday 12 June 2017
AB was formerly elected as the new Chair of the staff council. AB will be writing letter of thanks acknowledging the work of members who have left the organisation.
Invitations are being extended to executive members of staff to attend future Staff Council meetings. The council are in the process of deciding on a charity to receive funds from fundraising previous events the CCG have held. The council have requested have made a request to the estates lead for desk fans and an additional fridge for the 4th floor. The rollout of electronic payslips will become effective from August 2017 for staff registered to ESR.
AB talked about setting up an alumni group for members of staff that have left the organisation who may wish to keep in touch. The Listening Ears programme is set for launch at the end of June.
Initial training for staff in relation to the Listening Ears programme has been completed, in-readiness for the launch at the end of June 2017. AB reminded members of the CCG exercise class that takes place on Wednesday afternoon. A blood donor day has been scheduled for Tuesday 18 July 2017.
Finally AB reported on the new launch for membership of the Staff Council, including the Vice Chair role.
5. Workforce Dashboard
AMc presented two workforce dashboards, one highlighting activity for 12 months for 2016/17 and the second highlighting activity up-to and including May 2017.
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Statutory training has improved, currently 95% of staff in the organisation (excluding maternity leave, long term sickness and secondments) have completed their statutory training. Members noted a slightly lower compliance rate in the completion of PDR’s. AMc reported that data issues are driving compliance rates down. No concerns were highlighted relating to sickness absence.
PrfNH enquired whether any new concerns had been raised in relation to Bullying and Harassment. AMc fed-back on the comments from the last PLT that suggested that staff understand and are familiar with the principles. Members noted that no new concerns had been raised.
AMc fed-back on the ‘Listening Ears’ programme and the HR ‘drop-in sessions’ for staff that are being organised.
6. Primary Care Development OD Plan
LM gave a verbal progress update on the GPFV. LM explained the work programme in place that identifies schemes and their associated ‘rag’ ratings.
Action: LM to circulate the work programme to members.
LM reported that clinicians have engaged with the CCG to determine whether a staff bank for GP’s, Practice Nurse etc can be established. GP’s have also expressed an interest to explore international recruitment. LM reported on an application being submitted across the Black Country STP footprint for GP practices who are interested in the proposals. Members noted that practice management training is complete across the STP footprint.
LM fed-back on the significant impact resilience monies from NHSE is having to ease workload within GP practices. The CCG IT lead has set put up trial patient access pods in GP surgeries. Feedback received to date from practices is positive. A further 10 pods are being rolled out. PrfNH agreed to highlight the pods in his weekly newsletter. Action: LM to share findings of the trail with PrfNH for his newsletter.
LM reported on the outcomes of the PCCF and the work being undertaken by AB with practices who did not reach all markers. Action: LM to share results with PrfNH.
Actions following a desktop review of the Cyber-attack are to become available for discussion shortly. Members noted that practice managers were very complimentary of the CCG in its approach and support in this type of crisis. PrfNH complimented LM
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for taking the lead during the Cyberattack.
AMc reported that future clinical leads meetings are to address concerns raised in relation to the Cyber-attack.
Emergency Resilience – non agenda item
PrfNH led a detailed discussion around emergency resilience for the organisation. Members noted that at a recent ‘stand-up and talk’ event staff were updated on EPRR procedure for the organisation and received a copy of the procedure by email via the time2talk team. The outcome of the discussion highlighted where the incident room is situated in Kingston House, where the remit of EPRR lies, a review of current technology to be undertaken.
Action: HL to invite Mrs Rachael Ellis to the next meeting to provide a further update. Action: LM to pull a team together to explore the outcomes of the desktop review.
7. Black Country and West Birmingham Joint Commissioning Board - OD Programme:
AMc reported that the minutes of the joint committee would be considered by the Committee.
Members noted that HR teams continue to work collaborately to understand organisational structures. There are plans to launch a local talent pool and to understand staffs aspirations for the future and the support required
Collaborative Commissioning Workshops are being organised across the geographical footprint.
Members noted that the next meeting of the joint committee has been scheduled for Thursday 22 June 2017.
8. CSU Scores
AMc fed-back on performance scores for the CSU. Members noted that other than Quality Safety and Infection Prevention no concerns were highlighted.
MC fed-back on the concerns relating to Quality scores.
LM complimented the IT team for the work undertaken during the IT outage and
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cyber-attack and hoped this would be reflected in the scoring.
A detailed discussion was had in relation to the Communications Service and the improvements required. Members were asked to provide any feedback to Jayne Salter-Scott
9. Risks:
The risk register was reviewed and discussed. MC raised concern around risk OD17A, which related to the Secondary Care Doctor post. AMc provided a progress update on the recruitment to the post.
Action: work force analysis and staff changes to be included on the Risk Register
Action: A risk relating to EPRR to be included on the register. The OD committee is to manage this risk going forward.
10. AOB and close of meeting
10.1 Meeting closed at 11:15hrs.
11. Date and Time of Next Meeting 11.1 Tuesday 11 July 2017, Kingston House, 4R MR1
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Sandwell & West Birmingham CCG
Minutes of the Primary Care Co-Commissioning Committee on 1 June 2017 10:00 – 11:30
Boardroom, Kingston House
Public Minutes
(AW) Andy Williams Accountable Officer (RN) Richard Nugent Lay Member (Acting Chair) (OA) Olivia Amartey Deputy Chief Officer - Strategic Commissioning & Redesign (Operations) (AH) Andrew Harkness Consultant in Public Health (LM) Lisa Maxfield Deputy Chief Officer – Strategic Commissioning & Redesign (Primary and Community Transformation) (MS) Martin Stevens Head of Business and Contract Performance
(JR) Janette Rawlinson Lay Member (Vice Chair) (JMc) Jane McGrandles Head of Primary Care Contract (AHi) Adele Hickman Primary Care Contracts Manager (MP) Michael Perks Primary Care Finance Lead (MG) Mark Guest Chief Executive, Healthwatch Sandwell (JSS) Jayne Salter-Scott Head of Engagement (AB) Alison Braham Primary Care Quality Lead (BA) Dr Basil Andreou GP, Clinical Sponsor for Mental Health, Dementia and Learning Disabilities and Clinical Lead for Children and Maternity (JJ) Julie Jasper Lay Member (BD) Bal Dhami Contracts Manager (Primary Care), NHSE (SM) Sam Mukherjee GP and GP Clinical Sponsor for New Care Models
In attendance: (SR) Saba Rai Senior Commissioning Manager (Inclusion) (LR) Lesley Ralph (Minute taker)
Apologies (SL) Sharon Liggins Chief Officer – Strategic Commissioning & Redesign (CP) Claire Parker Chief Officer – Quality (RS) Ranjit Sondhi Lay Member (Chair) (BM) Dr Robert Morley Executive Secretary, Birmingham Local Medical Committee (CE) Carla Evans Head of Primary Care – Strategic Commissioning & Redesign (AL) Andrew Lawley Head of Premises and Capital Development (JMr) Jaspreet Mander Primary Care Contracts Manager (TM) Therese McMahon Board Nurse (AC) Andy Cave Healthwatch Birmingham
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Sandwell & West Birmingham CCG
1. Apologies for absence
RN welcomed Bal Dhami (BD) to the meeting and introductions were made.
The above apologies were noted. The meeting was quorate throughout.
2. Declarations of Interest:
JJ declared a conflict of interest as a member of Dudley CCG. JJ was allowed to remain in the meeting as this did not conflict with any discussions on today’s agenda.
3. Minutes of the previous meeting
The titles of Dr Robert Morley and Richard Nugent were transposed and with this correction the minutes of the previous meeting held on 4 May were agreed as a true and accurate record.
4. Action Register/ Matters Arising:
Action 87 “The issue of GP targets being affected by the new flu vaccination plan to be added to the risk register” – this has now been added to the risk register. Action closed.
Action 86 “Confirmation of a comms plan around the new flu vaccination plan to be obtained” - this is covered in the paper from Matt Fung. Action closed.
Action 85 “The number of respiratory admissions for flu vaccinated patients in Pioneers for Health to be confirmed with Matthew Fung” – this is covered in the paper from Matt Fund. Action closed.
Action 83 “Issues with Capita/PCSE to be discussed at Operations Group who will determine if this should be added to the risk register” – a draft has been prepared for Andy Williams to send but further issues have arisen that now need to be included.
Action 79 “AL to update PCCC on SERGs vision - The next SERG meeting is next week so will be brought to July PCCC.
Action 75 “Organisational chart requested to be circulated to committee members outside of the CCG following merger of Partnerships and Operations Directorates” –
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Sandwell & West Birmingham CCG This is currently being updated to include the new directorate and will be circulated once completed.
5. Contracting update
JMc presented an update. There were no contract variations during May 2017.
During May three practices had contract and quality monitoring visits and in June a further six practices will be visited. Detailed reports and action plans will be drawn up for each practice visit. All practices will be visited over a 2 year period; practices where concerns (by CQC or otherwise) have been raised will be prioritised.
There are some GMS contract changes and an overview of these was presented at the Practice Managers PLT on 16 May 2017. Also presented was this year’s DES together with an update on the contract and quality monitoring visits.
The importance of communicating with the public that the CCG is working with and supporting practices to resolve issues was agreed. JSS suggested this is reported in conjunction with GPFV (not just about CQC) to give the public a balanced view.
Committee accepted the report.
Great Bridge Partnerships for Health (GBPH) – contract novation
JMc explained that GBPH held a PMS contract and in April 2015 they exercised their right to return to a GMS contract. It is the partnerships’ view that an error was made at this stage and they now wish for the contract to be novated to Great Bridge Partnerships for Health Limited (GBPHL). Committee was asked to approve this.
The contracts team have sought legal advice and are satisfied that GBPHL is eligible to hold a GMS contract, it has the required one GMS GP and one health professional. There are currently no other limited companies on GMS contracts in SWB CCG. SM asked for information, guidance and regulations to be sent to him and JMc will send this.
Committee approved the recommendation.
Action: JMc to send SM information on who can hold a GMS contract.
Sandwell & West Birmingham CCG PUBLIC Primary Care Co-Commissioning Committee Minutes Page 3 1 June 2017
Sandwell & West Birmingham CCG
6. Finance update
The report stated a conflict of interest in error – there were no conflicts.
MP presented a briefing report for 2017/18. The primary care delegated resource for 2017/18 is £79.0m (an increase of £1.7m on 2016/17) with additional allocations of an estimated £4.8m as per GPFV planned expenditure. The global sum has been increased from £80.59 to £85.35 per weighted capitation.
PMS Premium is phased out over a maximum of 7 years and 2017/18 is year 3. In 2017/18 £3.2m PMS premium funding is planned to be released. All PMS Premium released will be reinvested into primary care services.
Audited and approved actual spend for 2016/17 was £79.9m. Planned spend for 2017/18 is £82.4m. This equates to a planned investment increase of £2.5m for SWB CCG member practices to access in 2017/18.
Recurrent monies with the addition of GPFV provides a real term increase of £13.2m over 5 years (see page 6 table of local impact).
Risks included (i) national contract changes for premises rates, (ii) support for asylum seekers and (iii) practice moves (these have been approved by NHSE and will be adjusted by month 3 June 2017).
Details of the increased spend will be released to the public via the next stakeholder bulletin which will focus on primary care.
Committee accepted the report.
7. Risk and Issue Register Report
LM updated committee on the risk register that was reviewed by Primary Care Operations Group on 19 May 2017. Risk PC11 was reduced to 12 – this related to the transfer of practices to Birmingham South Central which has now been confirmed by NHSE.
Four new risks were added:
“If GP practices are not promptly informed in of the patients that have received a flu vaccine at Sandwell and West Birmingham Hospitals NHS Trust there is a risk to the practice achievement of their flu targets for over 65s.”
“There is a risk to GP practices ability to achieve the requirements of the PCCF if
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Sandwell & West Birmingham CCG the necessary IT templates, searches and prompts are not in place and functioning effectively.”
“11 GP practices will be affected by the termination of their BT telephone contracts which could result in them having no telephone system in place from 1st November 2017 if a suitable alternative is not put in place before that date.”
“If practice groups or the 7 practices fail to implement improved access (6.30pm – 8pm Monday to Friday and opening at weekends) by 1st September 2017, there is a risk to us receiving the funding (£6 per head) and coming under scrutiny from NHSE.”
JR asked for the wording of risks 1 and 4 to be reworded to provide more clarity.
A number of comments were made regarding the risk register:
PC11 contains incorrect spelling of constitution
PC05_17 is rated 15 and should therefore be reported on BAF
PC11_16c actions are out of date and do not correlate with the controls
The numbering system is very complex and difficult for committees to follow. AB agreed to speak with Tom Richards (who manages the risk register) to see if it could be made clearer for members to read and navigate.
New risks were noted.
Action: LM to review the wording of new risks 1 and 4. AB to review the risk register numbering system with Tom Richards to make it clearer for members to read/navigate.
8. GPFV
LM presented a spreadsheet summary of the deliverables that have a RAG status and explained that the areas in red are mostly out of SWB CCG control. They relate to finances, Public Health Education and workforce (in collaboration with NHSE). SWB CCG is on track with new models of care schemes and LM will provide more details on schemes at next month’s PCCC. There will be a monthly performance meeting going forward and LM will update PCCC monthly.
AW will pick up issues around GPFV workforce at STP level and will feedback to PCCC.
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Sandwell & West Birmingham CCG Action: AW to pick up GPFV workforce issues at STP level and feedback to PCCC.
9. Update on PCCF 17/18
LM presented a PCCF document highlighting (in yellow) a number of proposed updates to provide clarification for practices. Committee was also informed that the colour of PCCF will be changed for 2017/18 and date/version details will be added so the practices can identify this as 2017/18 version.
There has been no discussion with members due to the tight timescale but each area of PCCF has both an officer and a clinical lead who have checked and signed off the changes. They are mostly changes to clarify/give more detail or a better explanation of what is required in order to strengthen the document. It is hoped this can be implemented by quarter 2.
It was suggested that time is built into the process next year to allow for consultation. It was recommended that the changes are explained at LCG all members meetings and that practices are reassured that these changes are mainly for clarification and are not major changes to the requirements and there are no changes to payments.
Committee approved the recommended changes subject to a covering letter being sent with the revised PCCF document, that PCCF is included on LCG agendas so that discussion can take place regarding the changes and that a substantive process to include a consultation is put in place going forward. Meetings are already underway to work on the 2018/19 PCCF.
10. Any other business
i) Influenza
A paper was circulated to address questions arising from PCCC 4 May meeting and to provide an update.
This project focused on over 65s only and is showing a significant impact. It is not clear that vaccinations carried out by pharmacists is recorded – this is a matter for NHSE. A letter is sent to all patients over 65 and also ‘at risk’ groups, it was suggested this letter could offer patients other options available (ie. pharmacists, supermarkets).
JR queried flu vaccinations for patients with respiratory conditions and it was confirmed this was down to clinical decision in each case; SM informed that
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Sandwell & West Birmingham CCG respiratory patients vaccinated in hospital may need to be vaccinated again due to immunosuppression.
ii) Capita issues
BA had brought a number of patient confidential documents that had been received at his practice in error for BD to take back to NHSE. BD was unable to take these documents and advised BA to return them to the support team. BD informed that regular meetings are taking place with Capita and the situation is improved, the national team is looking into this issue. There is also now a Capita Regional Engagement Team.
11. Date and Time of the Next Meeting 6 July 2017 10:00 – 12.00 Boardroom
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Patient and Partnership Advisory Group Meeting 14th June 2017 2.00pm - 4.00pm Kingston House
Present: Ranjit Sondhi (Chair) - Vice-Chair of SWBCCG Geoff Foster - Partnership Representative - SCR Committee Graham Price - Patient Representative - Sandwell Health Alliance Geoff Tranter - Healthwatch Sandwell Deska Howe - Patient Representative - Sandwell Health Alliance Awtar Ghataora - Patient Representative - Pioneers for Health Channa Payne-Williams - Patient Representative - ICOF Chris Vaughan - Patient Representative - ICOF Alison Hortin - Patient Representative – HealthWorks Pam Jones - Patient Representative - Black Country Phil Lydon – Senior Engagement Manager SWBCCG
In attendance: Carla Evans - Head of Primary Care Linda Martin - Minute taker
Apologies: Richard Nugent - Independent Chair Leona Bird - SCVO Trevor Fossey - Patient Representative - Black Country Mark Davis - Chief Executive Officer - SCVO Jayne Salter-Scott - Head of Engagement - SWBCCG
1. Welcome and introductions:- RS welcomed everyone to the meeting. RS announced there would be a break in the meeting. Jon Dickens’ retirement event is scheduled for 3.00pm today and several PPAG members have asked to attend.
2. Apologies for Absence:- As above
3. Declaration of Interest:- None
4. Review of minutes and actions from previous meeting:- The minutes from the meetings held on the 8th March 2017 and the 12th April 2017, were read through and discussed for accuracy.
Amendment: to the 8th March 2017 minutes, page 3. Practices will now be required to open 8am – 8pm, Monday to Friday – NOT, A Local Incentive Scheme (LIS) has been introduced, requiring opening at 6.30am - 8.30pm, Monday to Friday.
1
th th The minutes from the meetings (8 March 2017 and 12 April 2017) were agreed as a true record. Matters arising and Action Log Sheet:-
Engagement Work Programme: rd Emailed to the PPAG members every 3 month. – Due July 2017
Primary Care update - Standard item on the agenda.
Tour of the Nishkam Centre: A spokesperson at the Nishkam Centre confirmed there would be a charge for the room hire and refreshments. Suggestions were to hold the PPAG meetings at one of the following centres:- • Oldbury Health Centre • Lyng Health Centre • Whiteheath Medical Centre • Yew Tree Healthy Living Centre
The PPAG members discussed engaging the PPG members in a workshop event and perhaps changing the time of a PPAG meeting to an evening meeting.
Also discussed was the difficulty in engaging patients to attend the PPG’s. Previously PL/DH have worked hard to engage nearly 30 patients to attend a PPG meeting. Feedback from the practice manager was she does not have the capacity to promote their PPG meetings. Only 3 members attended the last PPG meeting.
CV – need to include the PPG members in the surgery’s decisions, need a governing body within the surgery. AG – Active PPG members have been asked to attend surgeries to engage with the patients to attend the PPG meetings.
ACTION: • Arrange a future PPAG meeting to take place at a Practice Health Centre – LM/PL • Engage PPG members in the PPAG - PL • PPG’s to be an agenda item at a future PPAG meeting.
B Aucott will not be attending a future PPAG meeting.
ACTION: • PL to meet with BA on the 16th June 2017 re: BXC CCG engagement model.
JSS to ask the CCG to look at the issue of patients having access to their records
PL to cover access to GP medical records during the meeting.
JSS to liaise with Brian Carr (BVSC) Re: representative to attend the SCR and PPAG meetings. Complete - awaiting response.
Locality lists to be emailed the PPAG members: Outstanding action: 2
• PL to email
AM/LM to arrange dates for 2 development sessions: ACTION: • Dates in September and January emailed for availability, waiting for a few responses.
Declaration/Conflicts of Interest Outstanding action: • Template to be emailed to the PPAG members
Involvement/housekeeping template to be emailed to the PPAG members: ACTION: • Waiting for a few PPAG members to respond.
Forward Plan items listed at the end of the minutes.
5. Update from PPAG Members: • JC/GT – Quality and Safety Committee Meetings (20th March 2017 and 15th May 2017). GT highlighted issues from the feedback forms, - Primary Care - the number of incidents has fallen again, and more training and publicity is needed to correct this. Drug waste due to oversubscribing. NHS England has established a national service for General Practitioners to refer themselves to Mental Health Services. • DH/GP - See feedback sheet. (23rd May 2017)
6. Primary Care Update - Carla Evans. CE updated the group on the Primary Care Commissioning Framework (PCCF), which has been fully evaluated for 2016/17: Some practices have achieved 100%, of their contractual obligations, whereas some practices are struggling. PCCF 2017/18 - Standards have not changed, but some amendments have been made. Identifying patients at risk of falls is now part of the GP primary care contract. Practices have now been asked to look at patients with asthma and COPD.
From the 1st September 2017, the CCG is required through the NHS England to ensure practices will have extended opening times from 6.30pm - 8.00pm. The core opening hours will be from 8.00am to 8.00pm. Practices will open at weekends, but no times have been stipulated. Your Health Partnership already provides these new opening times, others practices will be asked to start providing the new opening times from 1st September 2017. For small practices, patients will be informed which GP is available within their hub which may not be the location of their own GP.
Comments: • RS - there are concerns generated around these areas (PCCF). Need to be more compliant with the requirements of the standards - across the board. • GF asked if members of the practices, who fail to achieve 100%, can still be the chair and vice chair of Board meetings and sub-committees. Maybe this should be considered. • DH – agreed with GF, should GP’s of failed practices be allowed to become chairs of meetings? The CCG should separate its commissioning function from its delivery function.
3
• CE - the CCG’s approach to practices who consistently fail to deliver, is a concern for discussion, should these practices be still eligible to sign up to the PCCF? The CQC plays a large part in determining if practices are safe to operate; some practices do require better systems in place. • DH - Practices’ are businesses so they need investment and incentives. The good performing practices need to work with the poor performance practices. • CPW - Need a reward scheme for doing well, need to promote lessons learnt? • CV - Initiative run by the Royal College of physicians and the local hospitals to bring consultants in to the practices to look at patients with COPD and Asthma conditions, a pilot scheme to prevent patients going into hospital. • DH spoke of Elaine Cook, who trained staff to deliver the respiratory work-stream programme in different practices.
7. GP online services – An update – Phil Lydon - Presentation PL demonstrated how to log on to his GP practice through the internet. Appointments can be booked or cancelled and repeat prescription can be ordered through online access. Medical records can also be viewed. 10% of patients are expected to sign up to patient online access by April, and 25% by July 2017. Figures show that Sandwell and West Birmingham CCG are not doing well compared to other CCG’s for patients who have logged onto the patient online access.
GF stated Sandwell has the lowest level of IT skills and the reading age is low at about aged 7 years.
Many of the CCG’s practices are not doing as well as expected. PL asked the group for ideas on how to increase the numbers of patients who sign up for on-line access.
RS – Need to demonstrate the service by offering incentives, adverting and promoting, demonstration videos on YouTube and refer friend incentives.
Other ideas included:
• Vouchers • A multimedia approach • Adverts on buses and in newspapers
AH – security is an issue. Can it be hacked?
PJ stated the Queen Elizabeth Hospital has a similar access system, but was not sure if other hospitals had a patient access system.
ACTION: • RS issued a challenge, for PPAG members to access their records, if the members don’t have access already.
8. Patient and Participation Groups - Update and review Item deferred to the next meeting due to lack of time
9. A.O.B • 2 – 3 items for discussion at the Governing Body Meeting 4
No items put forward due to lack of time
th Date and time of next meeting: 12 July 2017, 2.00pm - 4.00pm
5
Minutes of the SWBCCG joint ICOF/HealthWorks Locality Commissioning Group Programme Board Meeting
on Tuesday 13th June 2017 at 12.30pm till 2.30pm
Kingston House, 2R1, 438 High Street, West Bromwich, B70 9LD
Present: Prof. Nick Harding (NH) Chair (HW) Dr Ram Sugavanam (RS) Vice Chair (HW) Dr Saj Sarwar (SS) Clinical Lead (ICOF) Dr Simon Butler (SB) Clinical Lead (HW) Dr Inderjit Marok (IM) Clinical Lead (ICOF) Chris Vaughan (CV) ICOF Patient Rep Channa Payne Williams ICOF Patient Rep (CPW) Alison Hortin (AH) Healthworks Patient Rep. Orville Williams (OW) PC Finance Officer Amandeep Kaur (AK) PC Finance Officer Neena Vadher (NV) Medicines Quality Pharmacist Jamila Dhansey (JDh) Medicines Quality Pharmacist Jas Dosanjh (JDo) Business Support Officer
Apologies: Dr S Mukherjee DrM. Sinha Dr R. Muraldihar J. Morgan K. Judge S. Mir D. Lenihan
1 INTRODUCTION
1.1 Welcome and Introductions
The meeting convened where introductions were made. This is the first meeting of the joint ICOF/Healthworks Board.
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1.2 Apologies for Absence
Dr. S. Mukherjee, Dr. M. Sinha, Dr. R. Muraldihar, J. Morgan, K. Judge, S. Mir,
D. Lenihan
1.3 Declaration of Interest
There were no declarations of interest made.
2. OPERATIONS UPDATE
2.1 Chair’s Report
All present had read the Chair’s report for June 2017 prior to the meeting.
2.2 TOR for Board Meeting
The TOR from Feb 2015 was circulated to the group. NM highlighted the requirement to look at drafting a more up to date TOR for the LCG Committee. It was suggested that the CCG should define what the LCG is currently then adapt the TOR around this. The role of the LCG has changed and will continue to change, especially now as the emphasis is moving towards new models of care. The main view point is to represent the opinions of the membership. Other points to consider:-
• There are now 3 big provider networks
• What are the Primary Care intentions?
• The quoracy would need to be ratified
• How do we question the membership?
• Practice moving out of the LCG will also affect the patient population
Action: NM will gather some information and ask what the CCG’s expectations are and take to all members to discuss further.
2.3 SCR Update
SB confirmed that the SCR meetings are now twice monthly. There have been
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discussions debates and decision making on a number of processes. In the last meeting forward thinking Birmingham was discussed, mental health inpatient beds, Stone Road commissioning, AF treatment costs. There were no major agreements made.
It was agreed that in future meetings the Board should have sight of SCR minutes and can pick up any issues accordingly.
Action: Board to receive ratified SCR minutes in advance of the meeting.
2.4 Patient Rep update
Healthworks update AH reported on the event she attended with the Black Country STP workshop at Himley Hall. It was around improving the physical health for people in contact with mental health services. AH summarised that the meeting was very productive and the conclusions have been published in a final report.
AH expressed her concerns around the PCCF data information (which was circulated with the papers) and finds it difficult to understand the format. SB suggested a pre meet with the PCDM and the Patient Reps to go through the reports prior to the meeting.
Action: NM to ensure a pre meet is in place for any reports that need deciphering and to update on all members meetings for the patient representatives.
ICOF update
CV confirmed that he attended the board meeting around Your Care Connected. There are issues with the software which is not secure and has stalled the system. NHS E and YCC are working through the issues. NM confirmed that Manoj is working with the Sandwell & West Birmingham practices to get these activated and running smoothly. System one practices are taking slightly longer compared to EMIS.
CV has also been involved in choosing a training establishment for the care navigators.
CV has been working with a project called Future hospitals. This is a Partnership between hospitals in this area and the CCG and they are looking at The Royal College of physician’s initiative to try and improve the patient care around people with asthma and COPD.
CV has been involved with some work around the MMH. They have been given a large grant from Europe to try and improve their outreach to the community and to improve health and well- being.
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2.5 Engagement Update – no report
2.6 Data Sharing
This was discussed at the last joint all members meeting and it was agreed to have M codes included in the reports. The Board now needs to ratify this decision. The Board discussed this. There were some concerns around the board papers being shared publically and information needs to be confidential. It was suggested to have a confidential section of a meeting where reports can be discussed within.
It was agreed to take out identifiable information for the usual board and have M codes and practices names in the confidential section of the meeting.
3 Primary Care Development/Commissioning Framework Update
3.1 A&E Utilisation update – Dennis Lenihan
Deferred to next month’s meeting
3.2 Finance Update – Amandeep Kaur & Orville Williams
AK went through the Healthworks report.
- A&E activity per 1,000 patients 2015-16 and 2016-17. The practice with the biggest increase per 1,000 patients was M85064 (42 per 1,000 increase). M85072 showed the biggest decrease from the previous year of 44 per 1,000 increase.) M85072 showed the biggest decrease from the previous year of 44 per 1,000 patients
- % activity increase VS % list size increase The 2016-17 month 12 A&E activity for practices within Healthworks locality has increased by 3.5% when compared to the 2015-16 financial year. 14 practices are showing an increase in activities ranging from 1% to 15%. 6 practices are showing a decrease in A&E ranging from 3% to 15%.
• The board discussed the increased figures and what we can do to help these practices. NM confirmed that the PCDM has visited the practice concerned where it shows an increase.
- Self- referrals during weekday and weekend hours
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The Board discussed the data. SB raised the issue that we have this data and we need to have an understanding of it and analysing it appropriately.
- Outpatients First Activity – Specialty Areas
AK to check the HRG codes for Orthopaedic and trauma. AK to check what the Allied Health Professional episode means.
- Prescribing Activity M12 At month 12 the Healthwork LCG underspent by 500k. The biggest reduction was M85085 9 practices overspent. 11 practices underspent.
OW went through the ICOF Finance Report
• The report refers to the Prescribing Performance • At month 12 ICOF LCG outturn under spend by 1.3 m based on the PPA profile method of calculation.
IM shared his experience around his practice underspend.
- Accident and Emergency activities
The 2016-17 month 12 A&E activity or practices within ICOF’s locality has increased by 1.2% compared to the 2015-16 financial year. Approximately 10 practices are showing increase in activities ranging from 2 to 32 per 1,000 patients.
- Outpatients activities
The 2016-17 month 12 outpatient first activity for practices within ICOF’s locality has increased by 4.6% compared to the 2015-16 financial year. Approximately 8 practices are showing increased in activity ranging from 3 to 37 per 1,000 patients.
The group agreed to look at a joint combined report to analyse in future for ICOF and Healthworks. The group discussed how they would want this. SB asked if it could show HW Sandwell and HW Birmingham to define the area on the Healthworks side. It was decided to add a column to show this in the report.
Action: Finance to ensure a combined report is compiled quarterly with ICOF and Healthworks with an extra column to define HW Birmingham and Healthworks Sandwell.
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3.3 PDS and Prescribing Update - Neena Vadher and Jamila Dhansey
JDh confirmed that Neena Vadher will be taking over as the pharmacist lead for the Joint ICOF Healthworks Board. JDh is still supporting on the technician side.
NV asked the group their views on what topic should be discussed in the next peer review. DMARDs and Diabetes was suggested. It was decided to look into a possibility for having a group discussion for diabetes and have a peer discussion afterwards. Dr. Sinha is scheduled at the next all members.
Action: JDo will check the agenda to see if time can be allowed for this to happen.
NV talked through quarter 4 Jan – Mar 17 data.
NV went through the prescribing spends. - Underspent LCG is ICOF with Black Country being overspent - Overspent practices will have on-going support.
- Total analgesia prescribing this is combined data. - Most practices are heading in the right direction reduced from previous year.
Analgesic Volume is high for the Sandwell & West Birmingham CCG compared to our other neighbouring CCGs. - There is newsletter being drafted on prescribing which will be circulated. - In terms of pain project we have achieved significant savings.
q PCCF Dashboard update
NM highlighted that the current reports are not a true indication as there are appeals to resolve. The PCCF dashboard data cannot be analysed at this stage.
3.5 PCCF 17/18 – guide
Last year there was a PCCF reference guide in place for each standard. There will be an updated version available for 2017/18.
4. Any Other Business
4.1 AOB
Black Country Family Practice are in discussions to transfer into Healthworks LCG.
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This is currently going through the process.
The patient reps have requested a locality map of the joint new area.
The CCG run a GPFV monitoring group and have requested for a focus group set up to take forward the GPFV. NM has asked the board to look at recruiting PM, Nurses and GPs to be part of this to take forward.
5. Date and time of next meeting
5.1 11th July at 12.30, 2R1, KH
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Minutes of the SWBCCG Black Country LCG Board Meeting
on 15th June 2017, 15:00 – 16:00 at Portway Lifestyle Centre, Newbury Lane, Oldbury, B69 1HE
Present: Dr I Sykes (IS) Black Country LCG Chair Dr A Saini (AS) GP, LCG SCR Clinical Lead Dr S Muthuveloe (SM) GP, LCG Diabetes Improvement Clinical Lead Lindsey Smith (LS) CCG Primary Care Development Manager Pam Jones (PJ) Black Country LCG Patient Representative Trevor Fossey (TF) Black Country LCG Patient Representative Mandy Smith (MS) CCG, Finance Officer Orville Williams (OW) CCG, Finance Officer Sandeep Pahal (SP) CCG Medicines Quality Pharmacist Craig O’Keeffe (CO) CCG Business Support (Minutes)
Apologies: Kat Meredith (KM) CCG Commissioning Engagement Manager Michelle Williams (MW) CCG Medicines Quality Pharmacy Technician
1. Declarations of Interest:
No declarations of interest were identified.
2. Minutes of the meeting held on 18th May 2017 (Enc 1)
Minutes were confirmed as a true and accurate record of the meeting.
3. Action Register/ Matters Arising:
Ref 8. Lunch provision at All Members meetings: An agreement was reached for the provision of lunch at the All Members meeting held prior to the board. Action closed.
Sandwell & West Birmingham CCG Page 1 Enc 1 - Minutes
Ref 9. Patient List Size Alterations between 1st April 2016 and 31st March 2017: Confirmed that this information had now been included within the finance report which was due for discussion as part of the meeting’s agenda.
Ref 10. Useful public sources of information document: LS confirmed she had discussed with the engagement team who had suggested including this information into an accessible area on the CCG website. The engagement / communications team would be investigating further and an update provided when further information was available. Action carried forward.
Matters Arising
Introduction of Mandy Smith
IS welcomed MS as the new finance officer for the Black Country LCG, OW who would now be working with another LCG was thanked for his support.
4. Patient Representative Update
It was confirmed that the last intended patient network meeting had been cancelled and rearranged to 27th June with intentions to invite Alan Kenny as a guest speaker regarding MMH or Dottie Tipton regarding progress relating to the Rowley Regis site.
A shorter PPAG meeting had been held which had highlighted difficulties practices had been encountering in relation to patients online targets with possible means of improving uptake being explored.
In KM’s absence PJ relayed an update regarding the medicines and prescribing consultation with the overall period of consultation extended and new event dates arranged and communicated to appropriate stakeholders. A provider consultation meeting was due to be held on 22nd June from 18:00 at the Hawthorns House, Kaleidoscope venue.
It was confirmed the GP awards event being held the evening of the meeting would include invitees from PPG’s. As part of the patient network a mediation meeting had been held involving two patients, a practice representative and independent patient representative with a follow up meeting expected.
5. Finance Report
OW presented the latest finance report relating to Quarter 4. A prescribing underspend across the CCG overall was confirmed whilst as an LCG, Black Country was still
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overspent. SP confirmed herself and MW were continuing to liaise with outlying practices with a particular strategy set in relation to the LCG.
It was confirmed that significantly more positive engagement from one of the outlying practices had been noted with work to continue with other practices. Following query it was confirmed that one of the most underspent practices within the locality had instilled good practice of regular audits including a wide variety of different areas.
A&E attendances were summarised with varying percentage increases based around year on year data, the difficulties GP’s encountered and often lack of control was highlighted with situations of each high intensity user of A&E being very different. IS however confirmed the CCG were continuing to pursue methods of helping reduce these attendances overall.
It was queried if comparative data could be offered, such as performance against the CCG overall averages. MS agreed to include additional data within the next report.
Action: MS agreed to include comparative data against overall CCG averages within finance report.
Numbers of first and follow up outpatient visits were summarised with overall increases recorded compared with previous years data. AS queried if a further breakdown of outpatient data could be provided in terms of numbers referred to different specialities. LS confirmed that this information was available through Aristotle with training available for members who had not yet used the programme.
PJ queried if all outpatient visits were included within the data provided which was suggested to be correct with the exception of some highly specialised or tertiary services.
New information relating to numbers and percentages of online registered patients by practice was presented to the group. Previously discussed difficulties around improving uptake of patients registered online were highlighted whilst LS discussed the possible use of iPlato to raise awareness of online registration with patients given its proven success elsewhere. It was confirmed that training was being offered to practices and encouragement to utilise the service to try and boost uptake would be made.
Impact of online registration on booking of appointments was discussed with suggestion that practices would be allowed sufficient controls such as restrictions on total numbers of bookable appointments. Different levels of patient access were also discussed, with patients allowed access to coded records and having the ability to apply for full access. It was confirmed that full access could be granted from a particular start date and would not necessarily be retrospective.
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IS queried total numbers of patients listed per practice within online registered data and different total numbers of patients listed in other report areas. It was suggested that online registered patient data was obtained from a different source and was based on actual patient list size rather than weighted list sizes used in prescribing, A&E and outpatient attendance reports. Weighted data was confirmed to be calculated depending on the demographic and complexity of patients within a list. MS agreed to confirm accuracy of online registered patient data. It was confirmed that this would need to be an actual figure given what was being measured.
Action: MS to verify if online registered patient data is based on actual list sizes and is accurate.
It was also noted that Carters Green Medical Centre should now be added into the finance report.
Action: MS agreed to add Carters Green Medical Centre into future finance reports.
6. SCR Update
Updates from SCR meetings held on 11th May and 25th May were provided:
11th May 2017 Bethal Doula Service: Confirmed service had been extended for a further 12 months. Straight to test for suspected Colorectal Cancer: Approval of a process to speed up referrals and the pathway were noted with forms in development before wider release. CAB funding for West Birmingham: CAB service was to no longer continue whilst reinvestment of funding was being examined but not yet decided.
25th May 2017 Modality Radiology / Rheumatology Contracts: An update had been provided with some new targets agreed. Organisation for Sickle Cell Anaemia Relief and Thalassaemia Support (OSCAR): Confirmed service had been extended. Beds for Non-weight bearing patients: Confirmed funding had been made available for an additional number of beds. SWBH Influenza Vaccinations: Confirmed that vaccinations for eligible patients admitted to hospital had been agreed.
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Designated medical officer for patients with special educational needs: Confirmed an appointment had been made in line with national requirements Children’s community nursing services specification: An amended specification had been approved by the committee. Health Harmony Reporting: Clarity had been obtained from provider that biopsy reports would be communicated to both patient and GP.
7. Primary Care Quality Dashboard
Discussion at the All Members event directly prior to Board was summarised with agreement reached that LS would continue to draft a quarterly action plan including working with individual practices based upon the current dashboard content and action plan criteria’s.
LS confirmed that further inclusions would likely be made to the dashboard moving forward into future quarters such as online registered patients. PJ and TF offered to provide any necessary assistance where possible to help with engagement with patients regarding registration.
Use of the iPlato software and the improved registration rates suggested to be as a result was again discussed whilst some reservations in use were noted in terms of patient consent. LS suggested there had been ongoing discussions regarding this with some assurances offered by iPlato around texts being sent asking patients to confirm if they did wish to receive further communications whilst this would be discussed further moving forward.
8. AOB:
Black Country Family Practice LCG relocation
Following previous communication it was thought that the Black Country Family Practice would be relocating to the Healthworks LCG. LS agreed to discuss this with the practice and appropriate CCG staff to obtain an update.
Action: LS agreed to seek update around proposed Black Country Family Practice move to Healthworks LCG.
9. Date and Time of the Next Meetings
Thursday 20th July 2017, 13:00 – 15:00 – Venue to be confirmed.
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Black Country LCG Board Actions 15.06.2017
Date Ref Details of Action By Whom Deadline Comment / Response Date Raised / update Completed
18/05/17 10 Useful public sources of information document: LS LS July Engagement / agreed to attempt to create a document Communications team summarising useful sources of information for proposed making practices. information accessible through the CCG website. A further update would be provided when available. 15/06/17 11 Inclusion of Black Country LCG performance MS July against CCG overall average: MS agreed to include within future finance reports
15/06/17 12 Online register patient data included within finance MS July reports: MS to verify data is based on actual patient list size and is accurate
15/06/17 13 Carters Green inclusion in finance reports moving MS July forward: MS agreed to add practice into future reports.
15/06/17 14 Black Country Family Practice proposed LCG move: LS July LS to seek update around proposed move to Healthworks LCG
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Minutes of the SWBCCG Pioneers For Health Board Meeting
on Tuesday 27.06.17 (13:00 – 15:00)
Present: Dr Vijay Bathla, Chair (VB) Soho Health Centre Dr Sirjit Bath (SB) (left at Tower Hill M.C. 14:40) Dr B. Chaparala (BC) Holyhead Medical Practice Dr Pri Hallan (PH) Parkhouse Surgery Dr E. O’Brien (EO) Hockley Medical Practice Dr Karl Alonzo (KA) The Slieve MP Dr V Abrol (VA) City Road Surgery (from 13:27) Dr Rajiv Kalia (RK) The Slieve MP Dr S Jehmal (SJ) Dr Pal & Partner
In Attendance: Jacqui Morgan (JM) PCDM, SWBCCG Sharon Wood (SW) Business Support (Minutes), SWBCCG Kat Meredith (KM) Commissioning Engagement Manager, SWBCCG Philomena Gales (PG) Latent TB Programme Manager Carla Evans (CE) Head of Primary Care SWBCCG
Apologies:
Parmjit Kaur (PK) Medicines Management, SWBCCG Dottie Tipton (DT) Primary Care Liaison Manager SWBH Tom Richards (TR) Quality Manager Denis Lenihan (DL) Head of Information & QIPP Lead SWBCCG
Mandy Smith (MS) Finance SWBCCG
1. Apologies for absence: 2. Declarations of Interest: All declared an interest as GP, however there were no conflicts reported with today’s agenda. 3. Minutes of the public meeting held on 23.05.17 (13:00 – 15:00) It was confirmed the minutes are a true and accurate record of the meeting. 4. Action Register/ Matters Arising: The action register was discussed and updated.
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24.01.17 Open Various 28.02.17 28.03.17 7 Closed 28.03.17 7 Closed 28.03.17 10 Ongoing 28.03.17 10 Ongoing
On behalf of the group the Chair congratulated KA for winning the Pioneers 4 Health Locality Award and to Tower Hill Partnership Medical Practice Patient Participation Group for winning the Patient Champion Award. 5. LCG/CCG Chair’s update June 2017
Enc 2. Chair report 7 June 2017.pdf
6. Working Collaboratively update – verbal – PH and RK
6.1 RK provided an update and confirmed the Trust has been offered one GP session per week for this project. Funding has been agreed for physios.
Action: PH and RK to follow up with D Tipton and feedback to the group at next meeting. 25.07.17
6.2 Respiratory pilot – KA provided an overview which included asthma nurses and respiratory consultants working within GP practices, reviewing patients and upskilling GPs. Identified outcomes included increased monitoring of COPD patients so that poorly controlled patients can be referred for CT scans.
Tele Dermatology –PH provided an update, the pilot would take place for 3 - 6 months. 6.3 Practices must be ERS users, Pioneers For Health agreed to take part in this pilot and agreed one camera per practice will be needed for the pilot phase and then this is to be reviewed.
Action: PH to take forward Pioneers for Health practices to proceed with the pilot. 20.06.17
6.4 Enhanced access – PH agreed to proceed with the federation forms. Action: PH to clarify with BMA regarding federation forms. 07.07.17
7. TB Health Screening Programme
7.1 Philomena Gales, Project Manager provided a presentation on the Latent TB Screening Programme which included the following:
• Sandwell and Birmingham have some of the highest numbers and rates of TB in the country.
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• All Birmingham and Sandwell CCGs have high incidence rates of active TB
• In 2016/17 9 Pioneers for Health practices signed up to the Local Improvement Scheme (LIS) LIS
• In 2017/18 5 practices have signed up so far, deadline for practices to sign up this year is 30.06.17.
Practices can sign up to deliver either Tier 1 only – offering an IGRA test to eligible new 7.2 registrants or sign up to deliver Tier 2 as well – which is retrospective search of the Practice register to identify eligible patients
7.3 Guidance on how to sign up to the scheme and the LIS payment.
The process for LTBI testing and the eligibility criteria 7.4 For further information or support - Philomena Gales, LTBI Project Manager, 7.5 [email protected].
VA stated that patients are tested at City Hospital. PG responded that this would only be 7.6 as part of contract tracing from someone with active TB. VA suggested that this was not the case.
Practices who are experiencing any IT issues to contact the IT Helpdesk for assistance 7.7 [email protected] please use this generic email rather than Danielle Urosevic advised at the meeting.
8. Transformation & Resilience
KA provided a progress report following the agreed funding for projects: • Female GP agreed for 4 sites. 8.1 • Centralising back Office staff and standardising processes. • Nursing Home. Presentation attached for further details. Dr Hallan expressed an interest to adopt a similar scheme for a female GP.
Docman - feedback for this system was largely positive, the group however, reported large numbers of duplicate correspondence, the programme should flag up where duplicate or similar letters already in the system to avoid multiple duplicate 8.1 correspondences. 8.2 Action: JM to liaise with M Behal regarding this ‘flag up’ of duplicates facility and feedback to the group. 10.07.16
KA advised his practice is working to ensure folders are created/updated and correspondence accurately filed in folders before sharing. Patient activity can then be themed for practices to utilise.
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8.3 Transformation - Interviews will be held today 4 p.m. for Hub Manager transformation and enhanced access.
Demonstration -TPP S1 – solution for S1 practices, training scheduled for 12 noon 8.4 28.06.17.
EMIS – the Group requested a user group for EMIS users. 8.5 Action: JM to liaise with M Behal regarding an EMIS User Group. Ongoing
8.6 9. Medicines Management – PDF & PCCF 2017-18 – presentation - Parmjit Kaur (PK) Postponed until next meeting.
10. PCCF update – Carla Evans (CE) - Presentation
10.1 Following feedback received from practices regarding last year’s PCCF, changes have been made to this year’s PCCF as a result. The final version is currently with the Communications Department and will be sent to all practices electronically and will be in Nicks News this week. The PCCF is for Sandwell practices only.
10.2 VA advises he chooses not to read Nicks News as there should be other ways to receive communication. The CCG have listened to practice concerns regarding the amount of communications received via email, therefore Nicks News is utilised. In addition the Primary Care Development Mangers are also a means of communication.
Action: CE/JM to send VA and EO an email and paper copy of the revised PCCF 19.07.17
10.3 CE presented a summary of the PCCF 17/18 updated document and is essential for GPs to re-read. Key standards we outlined, all detailed in the main document.
10.4 Following the presentation the following points were made: • Can practices include conversations with consultant / coroner for example towards the target of 90 clinical consultations per 1000 patients?
Action: CE to clarify and feedback to the group. 25.07.17
• VA is unhappy with Diabetes standard 5 delivery. Management 10% from baseline, VA requested this is recorded in the minutes. • What support will practices receive from the CCG in order to f CCG fulfils 10%. The CCG are providing iPLATO text messaging service. • EOB reported there are no exception codes. • Practices report not included in the consultation of the PCCF.
10.5 PH provided an update on the GRASP tool for COPD and Asthma; this is an auditing tool
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works from read codes for all asthma and COPD patients. From reports action plans can be formulated. The CCG are currently contacting practices to arrange appointments for engineers to visit to install GRAST tool software. 11. Finance report and Aristotle use – Mandy Smith and Denis Lenihan - Postponed until next meeting
12. Prescriptions and Medicines consultation update – verbal – Kat Meredith
12.1 KM reminded the group of the purpose of the consultation: • Prescribing for clinical value
• Reducing unnecessary prescribing
• Reviewing treatments deemed as low priority e.g where the patient can self-care, where the evidence is limited for effectiveness or where it is not cost effective i.e (paracetamol, gluten free products). Doing so would allow the CCG to prioritise money saved on medicines for other chronic 12.2 or serious conditions
12.3 If the proposal is approved the CCG expect to save 1.5 million and reinvest in high cost medicines that we have approval and mandate to fund (likely to launch in the next financial year) 12.4 The consultation has been extended to 13 July following Purdah, the rearranged public meetings were poorly attended. Practices at today’s meeting were encouraged to invite a member of the engagement team to speak at their Patient Participation Groups. Members were also encouraged to share their views and the following questions were raised:
12.5 The group made the following requests/ queries: • Clear guidelines / criteria when the paracetamol can be prescribed. • Immunity against complaints. • Has any other CCG implanted this? KM to take forward queries and feedback at next meeting 25.07.17 12. AOB: No AOB raised.
Post meeting note: JM raised separately with VA following the meeting, the next step of the Quality Improvement Action Plan– VA agreed to share at next meeting best practice regarding how City Road educate and manage their newly registered pts.
11. Date and Time of the Next Meetings
Venue: Tower Hill Partnerships Medical Practice, Great Barr, Birmingham, B42 1LG Tuesday 25/07/2017 1pm-3pm Tuesday 22/08/2017 1pm-3pm Tuesday 26/09/2017 1pm-3pm
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Tuesday 24/10/2017 1pm-3pm Tuesday 28/11/2017 1pm-3pm Tuesday 23/01/2018 1pm-3pm Tuesday 27/02/2018 1pm-3pm Tuesday 27/03/2018 1pm-3pm
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Minutes of the SWBCCG SHA LCG Board Meeting
on 27th June 2017, 13:15 – 15:00 at Village Medical Centre
Present: Dr A Ahmed (AA) GP, SHA LCG Vice Chair (Acting Chair) Dr D Manivasagam (DM) GP, SHA LCG SCR Representative Dr O Farooqui (OF) GP, SHA LCG Diabetes Improvement Lead Graham Price (GP) SHA LCG Patient Representative Lindsey Smith (LS) CCG Primary Care Development Manager Phil Lydon (PL) CCG Commissioning Engagement Manager Sukvinder Sandhar (SS) CCG Medicines Quality Pharmacist Craig O’Keeffe (CO) CCG Business Support (Minutes)
Apologies: Dr B Andreou (BA) GP, SHA LCG Chair Leon Mallett (LM) CCG SHA LCG Primary Care Development Manager Deska Howe (DH) SHA LCG Patient Representative
1. Declarations of Interest: Declaration of interests were noted for all GP’s in relation to PCCF and PDS schemes whilst it was acknowledged that no decisions would be made.
2. Minutes of the public meeting held on 23rd May 2017 (Enc 1)
The minutes were agreed as an accurate record of the meeting with one amendment noted:
Page 3, Item 6 (PCCF Update), 2nd Paragraph: “It was suggested that final PCCF payments could be expected on 31st March”, should have read 31st May 2017.
3. Action Register/ Matters Arising:
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Ref 1. Sip feeds e-learning refresher training: SS confirmed that Sip feeds was not included within the PDS for 17/18 whilst it was confirmed following discussion and feedback with members that both face to face and e-learning would be made available for PDS topic training. Action closed.
Ref 5. Optimise RX Switching: Confirmed that no penalty would be incurred if prompts had not been received through manual selection of recommended medicines. Action closed.
4. Terms of Reference:
A drafted terms of reference for the LCG was introduced for discussion and suggestions of amendments and or inclusions welcomed to be fed back to the CCG. LS confirmed that all LCG’s would also be asked to review with a view to creating a standardised approach.
GP suggested the specific inclusion of PPG engagement and expansion on the range of patient engagement conducted by the CCG. GP also suggested revision of meeting arrangement, administration and frequency in particular regarding distribution of paperwork. It was suggested timeframes quoted within the drafted document did not align with current distribution with suggestion that this would need to be altered to reflect this or adjust to a more realistic timeframe.
5. PCCF Update
LS confirmed the release of PCCF 16/17 outcomes and payment information which had been circulated to practices earlier in the month and reiterated the appeals procedure available to practices should they feel any decisions have been unfair, with PCDM’s acting as first line of contact for practices.
AA summarised some concerns raised by practices at the SHA All Members event held earlier in the month including some specific practice concerns relating to final payment decisions. One of the specific concerns raised was around ensuring the same membership involved with the decision making process would not be involved within the appeals panel membership.
LS discussed the extraordinary PCCC meeting where the final decision was made and confirmed that members of that committee involved in the decision making process would not be involved within the appeals process due to conflicts of interest. Whilst membership had not been finalised as yet and was being arranged by the CCG it was
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suggested an independent GP representative would be included. AA confirmed he would relay this message back to the practice whilst querying the timeframes for the appeals process.
LS confirmed she would need to liaise with appropriate staff at the CCG and once further details around the panel and process had been established ensure this information was communicated clearly to practices.
Action: LS / LM to seek confirmation around the timeframes of the appeals process and communicate clearly to practices.
LS confirmed that the PCCF 2017/18 document released in March was in the process of being amended slightly to include further clarity around certain targets within standards and around document appendices. Otherwise it was confirmed that system searches had been repopulated and new searches added where appropriate with practice managers encouraged to utilise but report any issues should they be encountered with a user guide also having been redeveloped for system users. Should any practices encounter any problems they were encouraged to contact their PCDM (LM or LS) to explain the issue.
Following difficulties for many practices around Standard 1 and submission of numbers of clinical contacts, AA queried if a means of automatic extraction would be possible to reduce additional pressures on GP’s and their staff in completion of templates near the end of the PCCF year. LS discussed the various difficulties of this given the different approaches by many individual practices in recording their bookings. LS did suggest however that early discussions from the contracting team who would be taking a lead on that standard could introduce quarterly reporting to reduce impact near the end of the year.
LS suggested a possible pilot with willing practices to conduct both manual checks and electronic extraction to compare and verify its accuracy, AA suggested this would be something practices would be receptive to if it could lead to more efficient monitoring. LS agreed to put a suggestion forward to the contracting team.
Action: LS / LM to put forward suggested means of piloting electronic extraction of clinical contact information from practices for PCCF Standard 1.
6. Medicines Management Update:
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SS presented a prescribing update for the final quarter of 2017 (Jan – March) which also included comparisons of the quarter between 2016 and 2017. Overall underspend was confirmed as both a CCG and LCG.
Pain and analgesia prescribing was examined with positive overall performance of the LCG and the majority of its practices noted. In particular members noted the substantial and largest reductions by a specific practice. AA queried if any learning was available from this practice given the difficulties encountered elsewhere in the locality, SS confirmed that the practice would be receiving a PDS visit in the near future where a greater understanding would be sought with suggestion that this could then be shared with members.
Action: SS to deliver update when available around possible shared learning following substantial reductions from a practice within the LCG.
Pregabalin prescribing was noted to be an exception for all LCG’s and the CCG overall with targets having not been reached whilst significant improvements where expected the following year given its inclusion in 2017/18 PDS. Whilst cost efficiency was a factor amongst some areas, the focus around quality given the possible risks associated with some medications including addiction.
Oral Nutritional Supplements (ONS) were discussed with a high overall target of 50% reduction not achieved by any LCG but with positive overall performance noted given difficulties and gradual changes being implements through education and continuing discussions with providers and specialists. CCG wide performance against Sip feed targets was highlighted to be very positive with SHA as an LCG recording the best performance.
Performance against antibiotic targets for the majority of LCG’s was noted to be positive with the majority under target including resistant antibiotics and 3 day antibiotic courses. Some difficulties were noted around 3 day courses for more complex UTI’s in women particularly. Seretide and Symbicort brand and generic spend was also confirmed to be positive.
SS shared some OptimiseRX switching data whilst suggesting improvements would be encountered in this area given its relatively new introduction to practices. Differences between the systems were discussed with more quality and formulary related messages also generated in conjunction with its placement on all practice systems.
7. CCG Directors and Clinical Leads Meeting Update
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AA confirmed the primary focus of recent meetings have been based around transformation, STP’s, strategic relationships with partners and new care models discussions with no further specific update available at present.
8. Diabetes Improvement
OF discussed further work being conducted around PCCF Standard 5 which had been introduced to cover Diabetes in 2017/18 including work to reduce amounts of duplication between PCCF and QOF requirements such as aligning codes. It was confirmed that coding summary guidance was available to outline these changes and assist practices.
It was also confirmed that a slot to discuss PCCF and the National Diabetes Prevention Programme had been arranged at the GP PLT on 6th July 2017. OF also confirmed he had distributed practice visit proformas and had arranged some practice visits which it was estimated would need to last for an hour as a minimum but would vary between practices depended upon content to be covered.
Target for referrals into the NDPP programme was queried with suggestion that a 20% target was present with concerns for the capacity of the service should too many referrals be received. High DNA rates and difficulties in persuading patients to accept referrals and attend events was outlined. OF confirmed efforts to tailor education programmes via discussion with providers was ongoing but difficult. LS also outlined some queries and suggested some possible confusion around the different tools relating to diabetes monitoring and pre-diabetes screening pathways on systems and raised for awareness.
9. SCR Update
DM confirmed he had sent his apologies and was unable to attend the last scheduled SCR committee meeting. Brief discussion was held around the proposed arrangements for LCG representative cover should SCR representatives not be able to attend with suggestion that Diabetes Improvement leads for LCG’s would be expected to cover.
10. Patient Representative Update
GP provided a brief update following circulation of a patient representative update report prior to the board meeting.
Carla Evans had attended the most recent PPAG meeting to provide an update around PCCF including the positive achievements of many practices during the first year of the
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framework and continuing liaison with those practices who required it. Discussion around the improved access to be offered by primary care through different collaborative groups and individuals had been held with 08:00 – 20:00 access for patients to be provided to patients from September through different arrangements which would be detailed further moving forward.
A Healthwatch update had been provided following the most recent Quality and Safety Committee highlighting 73% of practices having recorded good or above CQC inspection ratings and 22% requiring improvement ratings (with another 5% still to be inspected). The group discussed the complexity of criteria for ratings and continued support which is offered through PCDM’s and the quality team / other CCG staff where appropriate to engage with the CQC and practices to work around highlighted required actions.
GP summarised some discussion from the PPAG meeting around the national target for 20% patient online access for each practice, with difficulties encountered by practices to meet targets being highlighted and ultimately being patients choice if they wished to access records / book appointments online whilst efforts were ongoing.
In DH’s absence, GP outlined a request from the New Care Models Board to engage with a suitable range of patients in bolstering evaluation of Vanguard services. GP also outlined some of the expected topics for discussion at the next SHA patient’s network meeting to be held on 5th July which would include the changes to medicines and prescribing consultation, the role of PPAG’s in New Care Models and GP Online services.
10. AOB:
No other business was identified.
Date and Time of the Next Meetings
Tuesday 25th July 2017, 13:15 – 15:00 at Oldbury Health Centre
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SHA LCG Board Action Register 27.06.2017
Reference Details of Action By Whom Deadline / Comment / Response Date update Completed
6 PCCF Appeals Process: LS / LM to seek LS / LM July confirmation around the timeframes of the appeals process and communicate clearly to practices 7 Electronic extraction of clinical contact LS / LM July information: LS / LM to put forward suggested means of piloting electronic extraction of clinical contact information from practices for PCCF Standard 1. 8 Sharing learning from PDS: SS agreed to SS July update the group around substantial reductions in pain prescribing by a practice within the LCG.
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Sandwell and West Birmingham Clinical Commissioning Group PUBLIC Meeting of the Governing Body
Date: Wednesday 2nd August 2017 Time: 13:45 – 16:00hrs Venue: Kingston House Room: Boardroom
AGENDA
Non-Confidential – Please ensure your phone is on silent throughout the meeting.
This meeting will be held in public and will be recorded purely as an aide memoir for the minute taker to ensure an accurate transcript of the meeting, decisions and actions. Once the minutes have been approved the recording will be destroyed. All care is taken to maintain your privacy; however, as a visitor in the public gallery, your presence may be recorded. Should you contribute to the meeting during questions from the public, you agree to being recorded.
No Subject Lead Time
INTRODUCTION
1. Apologies for Absence: Verbal Professor N Harding 13:45 2. Declarations of Interest Verbal Professor N Harding 13:50 To request members to disclose any interest they have, direct or indirect, in any items to be considered during the course of the meeting and to note that those members declaring an interest would not be allowed to take part in the consideration or discussion or vote on any questions relating to that item.
3. Minutes of Previous Meeting held on Wednesday 1 Professor N Harding 13:55 5th July 2017 4. Action Register 2 Professor N Harding 14:00 5. Questions from the Public Verbal Professor N Harding 14:05 6. Chairman’s Report Verbal Professor N Harding 14:06
7. Performance 7.1 Quality and Safety Committee Report 3 Dr S Mukherjee / Mrs C Parker 14:10 7.2 Finance Report 4 Dr V Bathla / Mr J Green 14:20 7.3 Performance Report 5 Mr J Green 14:30 • Urgent Care Report 5a 7.4 Strategic Commissioning & Redesign Committee 6 Mr Richard Nugent 14:40 Report and NHS England Right Care 7.5 Audit and Governance Committee Report 7 Mrs Julie Jasper 15:00 7.6 Organisational Development Committee Report 8 Professor N Harding 7.7 Primary Co-Commissioning Committee Report 9 Mr R Sondhi 15:10 7.8 Urgent and Emergency Care report 10 Rachael Ellis 15:20
Sandwell & West Birmingham CCG PUBLIC Meeting of the Governing Body PUBLIC Agenda Page 1 Wednesday 02 August 2017
8. Governance and Business 8.1 Safeguarding Children Annual Report 11 Mrs Gene Kelly 15:30
9. Minutes of Committees for Information (All minutes available on CCG Website) 9.1 Finance and Performance Committee Minutes 12 All 15:55 9.2 Quality and Safety Committee Minutes 13 9.3 Strategic Commissioning & Redesign Minutes June 14 and July 9.4 Audit and Governance Committee Minutes 15 9.5 Organisational Development Committee Minutes 16 9.6 Primary Care Commissioning Minutes 17 9.7 PPAG Minutes 18
10. Minutes of Locality Commissioning Groups for Information 10.1 ICOF LCG /Healthworks Minutes 19 15:57 10.2 Black Country LCG Minutes 20 10.3 Pioneers for Health LCG Minutes 21 10.4 Sandwell Health Alliance LCG Minutes 22
11. ANY OTHER BUSINESS 11.1 Items to share with staff Verbal Professor N Harding 15:59
12. DATE AND TIME OF NEXT MEETING Wednesday 6th September 2017 Boardroom, Kingston House, 13:45hrs CLOSE OF MEETING 16:00
Sandwell & West Birmingham CCG PUBLIC Meeting of the Governing Body PUBLIC Agenda Page 2 Wednesday 02 August 2017
Resolution adopted from the Public Bodies (Admission to Meetings) Act 1960: That those representatives of the press and other members of the public be excluded from the remainder of the meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest.
Guidance on Declarations of Interest
Definition of Interests A Governing Body/Committee member has a personal interest if the issue being discussed at a meeting affects the well-being or finances of the member, the member’s family, or a close associate more than most other people who live in the area affected by the issue. Personal interest are also things related to an interest the member must register such as outside bodies to which the member has been appointed by the CCG or membership of certain public bodies.
A personal interest is also a prejudicial interest if it affects the finances of the member, the member’s family or a close associate and which a reasonable member of the public with knowledge of the facts would believe it likely to harm or impair the member’s ability to judge the public interest.
Declaring interest If a member has an interest, they must normally declare it at the start of the meeting or as soon as they realise they have the interest. If a member has a personal and a prejudicial interest, they must not debate or vote on the matter and must leave the room.
Quoracy No business shall be transacted at a meeting unless there is at least one-third of the whole number of the Chair and member’s (including at least one member who is also an elected GP, one member who is a Chief Officer and one member who is considered independent (from the lay members, secondary care doctor, or registered nurse) is present.
Legend Accountable Officer – AO Chief Finance Officer –CFO Chief Officer, Operations – COO Chief Officer, Quality – COQ Chief Officer, Partnerships - COP
Sandwell & West Birmingham CCG PUBLIC Meeting of the Governing Body PUBLIC Agenda Page 3 Wednesday 02 August 2017
Minutes of the Governing Body Meeting held in PUBLIC on Wednesday 7 July 2017, 13.45 – 16:00hrs, Boardroom, Kingston House
Professor Nick Harding Chair, Sandwell & West Birmingham CCG Chair Healthworks LCG Ranjit Sondhi Vice Chair
Mrs Joyti Atri Public Health Representative, SMBC Dr Ayaz Ahmed Vice Chair, Sandwell Health Alliance Dr Basil Andreou Chair, Sandwell Health Alliance Dr Sirjit Bath Vice Chair, Pioneers LCG Dr Vijay Bathla Chair, Pioneers LCG Dr Inderjit Marok Vice Chair, ICOF LCG Dr Ram Sugavanam Vice-Chair Healthworks LCG
Mrs Sharon Liggins Chief Officer, Strategic Commissioning & Redesign Mrs Rachael Ellis Chief Officer, Emergency Mr James Green Chief Officer, Finance Mrs Claire Parker Chief Officer, Quality Mr Andrew Harkness Consultant in Public Health
Mrs Julie Jasper Lay Member Ms Therese McMahon Non-Executive Board Nurse Mr Richard Nugent Lay Member Mrs Janette Rawlinson Lay Member
In Attendance: Ms Michelle Carolan Deputy Chief Officer, Quality Mrs Lesley Ralph Minute Taker Kiri Harbottle Head of Communications and Social Marketing, Arden & Gem CSU Ms Jodi Woodhouse SWB CCG
Members of the Public: Ms Donna Mighty SWBH
Apologies Mr Andy Williams Accountable Officer Dr Sam Mukherjee Chair, ICOF LCG Dr Ian Sykes Chair, Black Country LCG
* part meeting
Sandwell & West Birmingham CCG PUBLIC - Governing Body Meeting Enc 1 - Minutes of the meeting held in public on Page 1 Wednesday 05 July 2017 Wednesday 07 June 2017- Agenda Item 3
404/17 Declarations of Interest:
405/17 Members noted that prior to the meeting-taking place; a review of the conflicts of Interest checklist in compliance with the Conflicts of Interest guidance took place.
406/17 Mrs Jasper declared her role as a Board member and Audit Chair of Dudley CCG. No agenda items were identified as a conflict, therefore no mitigation was required.
407/17 A conflict of interest was declared regarding agenda item 8.5 Integration of “place based” health and care. Clinical directors and CCG staff are potentially conflicted in terms of future business interests and CCG workforce. No pecuniary interest directly affects members present and so no mitigation is required. If matters directly affect the Chair he will hand over to the Vice Chair.
408/17 A conflict of interest was declared regarding agenda item 7.7 Primary Care Co-Commissioning Committee Report and item 8.1 Evaluation of the PCCF 2016/17. Clinical directors are potentially conflicted. These are public agenda items for information only. No mitigation was required.
409/17 Declarations declared by members of the Governing Body are listed in the CCG’s Register of Interests. The Register is available either via the secretary to the governing body or the CCG website at the following link: https://sandwellandwestbhamccg.nhs.uk.
410/17 Minutes of the public meeting held on Wednesday 7 June 2017:
411/17 The minutes of the public meeting held on Wednesday 7 June were accepted and ratified with the following amendments.
412/17 • Mrs S Liggins was present at the meeting and her attendance is not recorded. • 308/17 needs to be removed – Mrs S Liggins did not send apologies; she had been present. • Mr A Harkness was present at the meeting and his attendance is not recorded. • Ms Harbottle was not present and is recorded as in attendance. • Dr R Sugavanam was present and his attendance is not recorded. • Dr V Bathla was present and his attendance is not recorded. • A typo error identified at 401/17 “5-year forward view to be included”.
413/17 Action Register/ Matters Arising:
414/17 The action register was discussed. Deadlines/updates are due August and September 2017.
Sandwell & West Birmingham CCG PUBLIC - Governing Body Meeting Enc 1 - Minutes of the meeting held in public on Page 2 Wednesday 05 July 2017 Wednesday 07 June 2017- Agenda Item 3
415/17 Questions from the Public:
416/17 No questions were presented for members.
417/17 Chairs Report:
418/17 Professor Harding commended the efforts of communities following the Grenfell Tower fire. The effects will reverberate through the NHS for some time. Some local work is being carried out.
419/17 CitizensAID app offers advice on unfamiliar situations.
410/17 The Child Sexual Exploitation Superhero Campaign was a tremendous event. NHS will be using this as one of their three themes for 2018.
411/17 Stars of General Practice Awards event celebrated the achievement of local primary care services was an excellent event.
412/17 Public consultations have commenced regarding medicines management.
413/17 Birmingham City Council is consulting on its delivery of children’s services. Members are encouraged to participate.
414/17 Good feedback has been received following the trial of Self Care Patient Kiosks. This trial is likely to be extended across member practices.
415/17 Prof Harding attended the NHS Confederation Conference in June. Sir Bruce Keogh gave an excellent speech about where the NHS has come from, is going to and challenges for the future.
416/17 There have been lots of activities taking place around Carer’s Week and Learning Disabilities Week.
417/17 Finally Prof Harding reported that Aston Medical School has reached the fifth and final stage of approval to take medical students.
418/17 • Resolution: The Governing Body received the report for information.
419/17 Quality Report:
420/17 Ms Carolan presented the report, which highlighted data until the end of May 2017.
421/17 Sandwell & West Birmingham Hospitals: 422/17 There has been one ‘never event’ during May, further information is awaited. A subsequent ‘never event’ took place at the Eye Hospital which will be reported at the August meeting. The Safety Thermometer was 93.7% for April. A clinical leads audit from Cross City was presented at
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the last CQRM meeting around delays; the Trust has been asked to revert with a report of processes. There were 21 mixed sex accommodation breaches in April 2017; these were for a maximum of 7 hours and are supported where clinically appropriate.
423/17 There are significant vacancies and a new e-rostering tool is now being used to highlight inefficiencies and spread workforce. SWBHT has turned off their high cost agencies.
424/17 A new pilot for mortality and readmissions ‘Consultant Connect’ has been implemented and although initial numbers are small approximately one third of emergency admissions in West Birmingham have been avoided. This will be a standard CQRM agenda item.
425/17 Black Country Partnerships Foundation Trust (BCPT): No red flags for Black Country Partnerships. A high number of agency nurses are being engaged and further data is awaited.
426/17 West Midlands Ambulance Service (WMAS): The two separate clinical quality review meetings for 111 and 999 will be merged to get a wider quality buy-in and a collective view.
427/17 Ms McMahon expressed concern that the workforce data for SWBHT shows 50% of the workforce is bank or agency. The e-rostering tool will help and a big recruitment drive is underway. Ms Parker explained issues in recruitment are being experienced in many areas. Some wards now have fully filled teams and progress is being made. SWBHT have been asked to provide breakdown of split between agency and bank and should be asked what impact this has on patient care.
428/17 Ms Rawlinson raised the issues of succession planning and retirement planning.
429/17 Ms Parker will invite the Chief Nurse to attend Governing Body to provide assurance that workforce issues are being managed. National workforce issues also need to be raised with NHS Education.
430/17 Ms Jasper asked what action can be taken at STP level. The Joint Committee is not empowered to deal with workforce issues but the STP plan does include issues around workforce. Health Education England retains the statutory duty. Mr Green will pick this up with the lead of the sub- group leading on workforce.
431/17 Integrated urgent care is required to increase the clinical input by 50%.
432/17 Ms Jasper asked for assurance with regard to incidents of violence and aggression. Ms Parker assured that training is ongoing and practice staff are supported.
433/17 Ms Rawlinson referred to the Friends and Family Test surveys being carried out by text is discriminatory and may give a false assurance. Ms Parker responded that SWBHT does use paper surveys.
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434/17 Mr Sondhi questioned reference to inappropriate referrals from consultants to GPs being obtained via a Freedom of Information. Ms Carolan will investigate and inform Governing Body.
435/17 Resolutions: • The Governing Body received the report for information. 436/17 • Mr Harding and Ms Harbottle will discuss comms around nursing issues. 437/17 • Ms Parker will invite Head Nurse to give assurance to Governing Body that action is being taken to resolve workforce issues. 438/17 • Ms Carolan will investigate the source of the information about inappropriate referrals being made from consultants to GPs. 439/17 • Mr Green will ask the STP sub-committee lead for workforce to look at what can be done at STP level.
440/17 Finance Report:
441/17 Mr Green introduced the report that provides an update to Members in respect of the CCGs financial position for 2016/17.
442/17 Members noted that the overall financial performance of the CCG is rated Green.
443/17 The overall Revenue Resource Limit (annual budget) is £798m. This represents an initial baseline allocation of £771m with further in-year adjustments of £27m.
444/17 The CCG has a planned surplus of £19m for 2017/18. This is the maintenance of the cumulative surplus of £21.5m less the NHS mandated draw down funding planned for 2017/18 of £2.5m.
445/17 QIPP target for 2017/18 is £25.1m. Reaching agreement with providers has been more difficult. This risk is managed by Finance and Performance Committee.
446/17 NHSE manages the limited drawdown on surplus. £2.5m has been approved for this year and £2.4m for next year.
447/17 Mrs Liggins informed that additional unplanned pressures and NHSE initiatives that have yet to be processed through governance will increase this also.
448/17 Ms Rawlinson highlighted that no account is taken of the high social inequality in our area.
449/17 Resolution: The Governing Body received the report for information.
450/17 Performance Report:
451/17 Mr Green presented the report.
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452/17 IAPT: published national data for the final quarter of the year (16/17) are still awaited.
453/17 Referral to Treatment Times (RTT): The CCG and the Trust met their 18 week wait target in April. The 52 week wait has increased for the CCG.
454/17 Diagnostic Waiting Times: The CCG and the Trust failed to meet their target in April.
455/17 A&E performance: May data shows activity is below 81.57%. Mr Green reported that activity from 12 months ago is 5.5% lower.
456/17 Cancer waiting times: Target for 2 week wait was achieved. The 31 day measure was met; CCG failed to meet subsequent treatment target, particularly relating to Royal Wolverhampton as they 457/17 were unable to schedule patients in the required treatment times. CCG failed the 62 day waiting targets.
358/17 WAMS Performance: remains under pressure, targets set are not being achieved.
459/17 Urgent Care Report provides A&E data and is attached for information at the request of Mr Williams and Mr Harding.
460/17 Ms Rawlinson made reference to ‘urgent care from July onwards’ and questioned if this was July 2017. Mrs Liggins confirmed that following the A&E Delivery Board the Trust has made some internal changes and expects to see some impact from July 2017.
461/17 Mrs Rawlinson referred to data on page 99 showing average beds and occupied beds, some columns appear to be mislabelled and in addition the data doesn’t state the size of the ward and how many beds are needed. SL informed that the bed baseline fluctuates daily. SL will obtain further details.
462/17 • Resolutions: • The Governing Body discussed and approved the contents of the report. 463/17 • SL will request further data around bed availability so that the context can be better understood.
464/17 Strategic Commissioning and Redesign Committee Report : Thursday 8 June 2017
465/17 Mr Nugent updated members on the business of the Strategic Commissioning and Redesign (SCR) Committee held on Thursday 8 June 2017.
466/17 Health Harmonie: communication of results
467/17 It is the provider’s responsibility to communicate both normal and abnormal results to the GP and patient.
468/17 Forward Thinking Birmingham Contract 2016/17
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469/17 Committee approved additional funding of £187,000. A number of questions will be put to Jo Carney (Associate Director Mental Health, Joint Mental Health Team) on 12 June 2017 and will be fed back to SCR.
470/17 Excess Treatment Costs for Cognitive Behaviour Treatment (CBT) in Atrial Fibrillation (AF)
471/17 Committee was asked to approve a request for £11,000 to cover SWB CCG only patients. Mr Harkness and Ms Liz Walker have been asked to provide guidance and a set of principles regarding funding research before approval can be granted.
472/17 Mr Harkness has been asked to clarify the CCG’s statutory responsibility and feed back at the next meeting.
473/17 Stone Road Contract Extension
Committee approved funding to extend the contract for the midwifery service, CPN service, Doula service and minor ailment service to 31 March 2018 in alignment with the contract extension for the Stone Road Screening Service.
474/17 • Resolution: The Governing Body received the report for assurance.
475/17 Audit & Governance Committee Report:
476/17 Mrs Jasper introduced the report that provided members with an update on the items of business discussed at the meeting held on Thursday 15 June 2017.
477/17 The recommendation tracker was reviewed.
478/17 Continuing Healthcare audit required further clarification and will be re-presented for consideration.
479/17 Committee approved the Anti-Fraud Plan for 2017/18.
480/17 Committee reviewed the BAF and agreed, subject to Governing Body approval, to close risks PT01, FP05 and SC17.
481/17 New revised Conflicts of Interest Policy was issued on 16 June 2017 and proposals will be presented to Governing Body.
482/17 • Resolutions: • Committee approved closure of risks PT01, FP05 and SC17. • The Governing Body received the report for assurance.
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483/17 Organisational Development Committee Report:
484/17 Mr Harding provided an update to Committee for assurance.
485/17 Staff Council have appointment a new Chair Alison Braham.
486/17 OD will consider the operationalization of the EPRR plan and provide assurance at a future Governing Body meeting.
487/17 • The Governing Body received the report for assurance.
488/17 Primary Care Co Commissioning Committee Report:
489/17 Mr Sondhi presented the report, that updated members of the actions and outcomes from the public meeting held on Thursday 1 June 2017.
490/17 The committee approved the recommendation to refine the Primary Care Commissioning Framework (PCCF) subject to a covering letter being sent to practices highlighting the changes, with the revised document and that PCCF is included on LCG agendas for discussion.
491/17 Ms Rawlinson raised a governance issue around the tight timescale and minimal engagement for PCCF and considers earlier engagement is important.
492/17 Mr Harkness informed that Carla Evans is currently reviewing PCCF 2018/19 and in October/November 2017 a suite of standards will be put forward for consultation.
493/17 Mr Andreou highlighted outstanding IT issues. Mrs Liggins will investigate and feedback.
• Resolutions: • The Governing Body approved the recommendation to revise the Primary Care Commissioning Framework. 494/17 • Mrs Liggins will investigate outstanding IT issues and feedback.
495/17 Evaluation of the PCCF 2016/17:
496/17 Dr Ahluwalia presented a selection of indicators and potential improvements in health care delivery that PCCF has achieved across six of the standards in the PCCF.
497/17 Mr Sondhi asked if the number of contacts has significantly increased has the time spent with patient reduced. Dr Ahluwalia responded that PCCF encourages innovative methods including telephone and Skype.
498/17 • The Governing Body received the report for assurance.
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499/17 Board Assurance Framework:
500/17 • Resolution: The Governing Body approved closure of risk SC06.
501/17 Corporate Objectives 2017/18:
502/17 Ms Rawlinson drew attention to the number of risks on the BAF relating to New Care Models and MMH and sought assurance these are being dealt by the appropriate committees.
503/17 Ms Carolan will circulate the Corporate Objectives separately due to formatting problems.
504/17 • Resolution: The Governing Body approved the Corporate Objectives 20178/18.
505/17 Minutes of the Black Country and West Birmingham Joint Committee April and May:
506/17 Mr Harding presented the Minutes of the April and May meetings.
507/17 Mr Harding highlighted new HR processes for managing talent and appointment of a Programme Manager.
508/17 The clinical reference group is creating a clinical strategy and will report to STP and Governing Body.
509/17 A non-executive director has been appointed.
510/17 Work is being carried out with Specialised Commissioning.
511/17 Ms Rawlinson commented on a typo error “Ernst & Young”.
512/17 • Resolution: The Governing Body received the report for assurance.
513/17 Integration of “placed based” health and care:
514/17 Mrs Liggins presented a paper that sets out the national and local aspiration to integrate health and social care in line with the 2020 target and the local plans to change the commissioning and provider landscape.
515/17 • Resolution: The Governing Body received the report for assurance.
516/17 Single Commissioner Proposal for BSOL:
517/17 Mrs Parker updated Governing Body on the proposals for a single commissioner. Public consultation has commenced. 518/17 Mrs Parker has joined the Integration Transition Group representing West Birmingham and will
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keep officers, GP directors and Governing Body updated.
519/17 Mrs Parker confirmed that this paper was for information and not assurance. 520/17 • Resolution: The Governing Body received the report for information.
521/17 Birmingham and Solihull Mental Health Inpatient Capacity Full Case for Change:
522/17 Ms Angela Szabo and Mr Tom Howls presented a paper setting out a proposal to increase acute psychiatric inpatient capacity for adults aged 18+ in Birmingham and Solihull by 32 beds.
523/17 This is a cost to SWB CCG of £0.9m/£2.5m increase on the original contract value of £27m which represents a 10% increase.
524/17 An independent review of capacity, jointly commissioned and funded by the System Strategy Board and undertaken by Mental Health Strategies made 12 recommendations.
525/17 The business case was formally approved by SCR on 22 June 2017.
526/17 A plan to mobilise additional capacity by August 2017 has been agreed in principle with providers pending approval from CCGs.
527/17 Birmingham is in the lower quartile of 13.3 beds compared to an average of 19.6. There are 20 Forward Thinking Birmingham patients and 10 Birmingham and Solihull Mental Health Trust patients currently out of area.
528/17 There are significant performance issues particularly at lower level around prevention and escalation. There has been a s28 breach and a number of 12 hour breaches.
529/17 Ms Angela Szabo informed that the review has identified an increased investment in the community is also needed. Specialised Commissioning (NHSE) provides for Tier 4 but agreement was not reached with NHSE to include Tier 4 in this contract. Tier 0 is not funded.
530/17 Mr Nugent and Mrs Parker considered effective monitoring is imperative.
531/17 Mr Howls informed that the system modelling has provided far greater insight into how the system works and the impact changes will have on outcomes and a really strong basis on which to monitor the system going forward.
532/17 Concerns were raised that the reasons this position has occurred is unknown and there may need to be a request for a further increase. Beds were opened in April 2016 and by June 2016 it was flagged that the number of beds were insufficient.
533/17 • Resolutions: • Governing Body approved the additional funding of £0.9m by way of a 18 month variation subject to (i) beds not being available for patients out of area, (ii) monitoring is put in place and (iii) Mrs Parker is present at System Strategy Board meetings to represent SWB CCG.
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534/17 Any other business:
535/17 Quality & Safety Committee Minutes paragraph 2.33 Ambulance – Ms Rawlinson questioned the phrase “human factors” and Ms Carolan explained this is the phrase used in ‘route cause analysis’ and relates to an unintentional human error.
536/17 Quality & Safety Committee Minutes paragraph 2.39 states that violence and aggression training should be delivered at staff PLT events.
537/17 Close of Meeting
The PUBLIC meeting of the Governing Body closed at 16.20.
539/17 Date and Time of the Next Meeting:
The next meeting will be held on Wednesday 2 August 2017, Kingston House Boardroom, 13:45
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Open Action Register: Wednesday 02 August 2017
Ref Action By Whom Deadline / Comment / Response Date update Completed 494/17 Primary Care Co-Commissioning Mrs S Liggins August 2017 Committee: Mrs Liggins will investigate outstanding IT issues in respect of Primary Care Commissioning Framework and feedback 463/17 Performance Report: Mrs S Liggins August 2017 SL will request further data around bed availability so that the context can be better understood
Sandwell & West Birmingham CCG Page 1 PUBLIC Meeting of the Governing Body Enc 2 – Action Register Wednesday 05 July 2017
Ref Action By Whom Deadline / Comment / Response Date update Completed 435/17 Quality Report: 436/17 Mr Harding and Ms Harbottle will discuss Mr Harding/ comms around nursing issues. Ms Harbottle
Ms Parker will invite Head Nurse to give 437/17 Mrs C Parker assurance to Governing Body that action is being taken to resolve workforce issues. 438/17 Ms Carolan will investigate the source of Ms M Carolan the information about inappropriate referrals being made from consultants to GPs.
439/17 Mr Green will ask the STP sub-committee Mr J Green lead for workforce to look at what can be done at STP level.
48/17 Quality & Safety Report: Mrs Parker/ Dr September 2017 Patient Falls and Pressure Ulcers are being Outcomes from CNO Scrutiny report Sam subjected to a CNO scrutiny report. Once relating to Patient Falls and Pressure Mukherjee plans are available, these will be shared at Ulcers to be shared with the Governing the SWBH Clinical Quality Review Meeting Body. (CQRM) and with members.
62/17 Quality & Safety Report: Mrs Parker August 2017 Governing Body members to receive for The dashboard relation to the CQRM information the dashboard relating to reports to be presented at the June CQRM reports. meeting.
Sandwell & West Birmingham CCG Page 2 PUBLIC Meeting of the Governing Body Enc 2 – Action Register Wednesday 05 July 2017
Ref Action By Whom Deadline / Comment / Response Date update Completed 178/17 Quality & Safety Report: Mrs Parker/ Dr September 2017 Outcomes from the CQC visit at SWBH to Outcome of the CQC visit at SWBH. Sam be shared with members of the Governing Mukherjee Body.
323/17 EPRR Report: Rachael Ellis September 2017
Sandwell & West Birmingham CCG Page 3 PUBLIC Meeting of the Governing Body Enc 2 – Action Register Wednesday 05 July 2017
GOVERNING BODY Report Title: Quality Report Report author and Title: Tom Richards, Quality Manager
Date of Governing Body: Contact Details: 0121 612 2769, Wednesday [email protected] Agenda No: Enclosure no: Sign off from Chief Officers: (Before the report is presented to the Governing Body any implications relating to Finance, Quality and Commissioning must be agreed and signed by the Chief Officer. (see guidance note) Without this information the report will not be taken to the Governing Body)
Chief Finance Officer: Yes
Chief Officer for Quality: Yes
Chief Officer for Operations: Yes
Chief Officer for Partnership: Yes
Supporting Documents/further Reading: (Highlight any documents or further reading for members which supports this report)
Previous Decision (Inform the Governing Body/Committee if the paper has been reviewed or monitored by another committee and their recommendation or decision)
Summary of purpose and scope of the report: • Primary Care - GP incident decreased but now holding on around 110 incidents per month. • Primary Care - Continued incident trends pertaining to: SWBH attendance at MDT Meetings, Violence and Aggression in GP Practices, Walk-In centres failing to record and act open patient consent to share records; Acute Providers inappropriately delegating work to primary care; E-Referral system issues. • SWBH – Zero SI Pressure Ulcers since Nov 2016; SI patient falls now falling, averaging at 1 per month. • SWBH – Challenges continues to remain for Mortality and A&E 4hr performance • SWBH – Sickness rate rose to 4.48%; Good performance against mandatory training. • Safeguarding Training subject to remedial action plan trajectory. • BCP – Continued improvements in Medicines Management – fewer errors, more robust systems in place. • BCP – Quarterly Safeguarding report received praise from CCG Safeguarding leads for content. • WMAS/NHS111 – Merger of CQRM between these services – first meeting scheduled for 31st July. • Successful outcome of the IRIS domestic abuse pilot – Safeguarding Team will progress with business case to secure further support.
Recommendations: The GB is invited to approve the contents of this report.
Sandwell & West Birmingham CCG PUBLIC Meeting of the Governing Meeting Enc - Page 1
The Governing Body are requested to: Action Approve Assurance x Decision Conflicts of Interests: The recommended action by the author of the report is: No conflict identified x Conflict noted, conflicted party can participate in clinical discussion but not decision Conflict noted, conflicted party can remain in committee but not participate in discussion Conflicted party is excluded from discussion (this would be rare circumstances only) Please state rationale for above decision:
Strategic Priorities related to the report: Quality & Safety x Finance & Performance Partnership Strategic Commissioning and Redesign Organisational Development Primary Care Co-Commissioning Collaborative Commissioning Implications: Financial Assurance Framework Risks and Legal Obligations x Equality and Diversity Statutory and External Influences Further implications not stated Consultation: X Patients Staff Committees x Public Partners Sponsored By: (Chief Officer Date Report received for Governing Body
Sandwell & West Birmingham CCG PUBLIC Meeting of the Governing Meeting Enc - Page 2
Executive Summary Data contained in this report is up-to-date and includes all data up to and including June 2017.
Primary Care
Incident Reporting The incident reporting rate at CCG member practices has fallen since October 2016, with 109 incidents reported in June 2017. The percentage of more serious incidents continues to fall, with zero moderate to high grade incidents reported since February 2017.
Trends There are five existing trends: (1) Issues with the arrangement of MDT Meetings. (2) Violence and Aggression in GP Practices. (3) Walk-In Centres failing to record patient consent status for sharing their consultation record with the patient’s GP. (4) Acute Providers inappropriately delegating work to GPs (which arose as a result of a Freedom of Information Request). (5) E-referral system problems.
Contract Monitoring Visits During June 2017 the following practices received a scheduled contract and quality monitoring visit: • Swanpool • Hollyhead Primary Health Centre • Victoria Road Medical Centre • Heathfield Family Centre • City Road Medical Centre • Attwood Green Health Centre
No significant concerns identified and visit teams are currently finalising reports.
Sandwell and West Birmingham Hospitals
• ED 4 hour performance for May was 81.57% (84.95%), non-compliant with 95% national target; 3549 breaches in the month.
• Never Event reported in May due to ‘wrong side block’.
• RTT May delivery at 93.79% against the national standard of 92%. Waiting list at 32,663, patient backlog of patients at 2,024 down by c200 patients from April. There were 3x 52 week incomplete breaches. June tracking projections to deliver standard, internal forecast for 93.5%.
• Acute Diagnostic waiting times within 6 weeks as at May 99.4% recovering to compliance of 99%; 46 breaches were declared for the month of which echos were at 30, which was due to cardiology capacity issues. Plan for June is to deliver 99% with echo breaches fully recovering in July.
• 62 day cancer compliant at 85.6% at April vs. target of 85%; all other cancer targets continue to deliver. May delivery is anticipated to deliver to standards. Whilst performance is consistently good, cancer delivery requires increased ‘effort’. • Neutropenic sepsis considerable improvement on prior months, but remains below 100% standard [6/37 (16%) patients did not receive treatment within the required 1hr timeframe]. 6 patients missed the standard, all in ED.
• Elective Operations Cancellations consistently under-delivering and at 1.5% against 0.8% target in May; cancellations are the highest for a number of months at 67 on day cancellations of which 27 were validated as avoidable; No 28 Day Guarantee or urgent cancellations during May.
• Hip fractures best practice tariff performance in month improved from last month to 65% but remains below 85% standard and with consequent failure to recover additional tariff income.
• Sickness rates cumulatively are at 4.48% against the Trust target of 2.5%. Short-term sickness cases worsening to last month from 415 to 445, long term sickness remaining flat at 415.
• Mortality reviews 64% in March showing only modest improvement and remains significantly below 90% standard; key mortality rate indicators remain within confidence limits.
• MSA Breaches x7 were incurred in May; cause due to capacity issues.
• VTE delivers full year to national standard at 95.8% in May with 346 patients missing the assessment.
• MRSA – no cases year to date.
• CDiff – x3 cases year to date against a target of 5.
• Readmissions at 7.2% in May (7.1%). The Trust now tracks better than peer group.
• Pressure Ulcers – Zero SI Pressure ulcers since Nov 2016.
• Patient Falls – Now reducing, averaging 1 per month.
Workforce:
Oct Nov Dec Jan Feb Mar Apr May Sickness 4.53% 4.77% 4.9% 4.83% 4.5% 4.48% 3.15% 4.48% - Short Term 837 922 911 956 808 785 414 445 - Long Term 245 247 246 253 205 213 214 241 Bank (Nursing - Qualified) 46.77% 36.30% 41.77% 40.30% 27.10% 43.5% 42.1% 46.7% Agency (Nursing - Qualified) 18.76% 28.36% 20.17% 22.55% 18.70% 16.8% 16.3% 17.8% Turnover - Nursing 12.4% 11.7% 11.4% 11.6% 11.2% 11.7% 11.7% 11.7% Mandatory Training (95%) 87.3% 87.2% 87.1% 87.1% 87.5% 87.2% 95% 95% PDR Compliance (95%) 88.7% 88.5% 88.2% 88.1% - 87.9% 95% 95%
Black Country Partnerships
Divisional Quality Report (LD) •220 incidents were reported during May 2017 across the LD Division. There were no STEIS or never events reported during May 2017. The number of medication errors remains low. •Patient story is from the Dudley Learning Disability Physiotherapy Team. There was one formal complaint in May and 3 concerns. •There were 7 compliments. •This year’s audits are listed in the report as has the agreed Quality Improvement Priority. •The appraisal compliance is now 99.3%, after having been reset in February 2017. •The primary reason for sickness absence is gastrointestinal problems and for long term absences, anxiety/stress/depression/other psychiatric illnesses. •The turnover rates have slightly increased. The annual mandatory training is above the KPI but specialist annual mandatory training is below the KPI. •The service development is around a healing garden described by the Occupational Therapy Team in Wolverhampton.
Safeguarding Quarterly Report Wolves Safeguarding leads welcomed the report presented by BCP, noting the good strides that have been made since its original creation, and acknowledging that improvement in data capture that have been made by the Trust.
Medicines Assurance Report Report presented, noting excellent reduction in Medication Errors over the past 2 years and outlining a list of improvements to the Medicines Management process that has led to improvements in Patient Care across the Trust.
Modification of the SQPR Template Wolves and SWB CCG will meet to discuss re-formatting the SQPR to better meet the needs of both organisations, and will work with BCP to achieve a satisfactory and timely solution.
CQUIN • BCP passed all CQUIN schemes for the Q4 milestone.
West Midlands Ambulance Service/Urgent Care
West Midlands Urgent Integrated Care Meeting An initial WMUIC (West Midlands Urgent Integrated Care) teleconference meeting was held on June 22nd to outline the nature and format of this meeting going forward. The first ‘full’ meeting is scheduled for 31st July 2017. The meeting incorporates both West Midlands Ambulance and other Urgent Care service providers.
Contract Breaches:
SWBH:
Indicator Target M2 Response Operational Percentage of A & E attendances where the Service User RAP in Place was admitted, transferred or discharged within 4 hours of 95% 92.9% their arrival at an A&E department National Zero tolerance RTT waits over 52 weeks for incomplete Exception Report Received 0 2 pathways All handovers between ambulance and A & E must take place within 15 minutes with none waiting more than 30 0 65 minutes Local Safeguarding Children Level 2 Training 85% 74.2% RAP in Place Safeguarding Children Level 3 Training 85% 70.9% RAP in Place Safeguarding Adults Advanced Training 85% 79.4% RAP in Place Maternity – Smoking Status 90% 63.0% RAP in Place Exception Report Received – Proportion of stroke patients given thrombolysis 50% 0% Clinical Reasons Proportion of stroke patients who spent at least 90% of 90% 86.5% their stay on a stroke ward Proportion of stroke patients scanned within 24 hours of 100% 97.7% arrival (clock start) Morning discharges 35% 14.9% RAP in Place Compliance with the “Five Steps to Safer Surgery” process is 100% 98.9% reported using the Clinical Systems Reporting Tool (CSRT). Inter-provider tertiary referrals for patients on the 62 day cancer pathway will be made by the referring trust within 42 100% 88.0% days of initial GP referral. A&E coding should include diagnosis coding in line with the 90% 70.5% A&E data set BMI recorded by 12+6 weeks of pregnancy 90% 73.4% RAP in Place CO monitoring recorded & documented in the antenatal RAP in Place 90% 81.4% notes of all mothers by 12+6 weeks of pregnancy.
BCP:
LQR Ref KPI Description Exception Details LQGE14a % of Routine assessments carried out 189/239, with >85% target. within 8 weeks. Exception not accepted, but CCG will only consider sanction if Provider fails target on three successive months.
LQGE17 RCAs delivered within 60 working 1/2 with 100% target. days. Exception Accepted – delay due to Cyber Attack.
WMAS:
New indicators following ARP recommendations due by October 2017. Primary Care Data contained in this report is up-to-date and includes all data up to and including June 2017.
Executive Summary
Primary Care Never Events There have been Zero Never Events reported by GP Practices this year. Serious Incident Trends There have been 0 Serious Incidents reported by SWB CCG since April 2017, 0 of these were reported in June. Incident Reporting Rate and The incident reporting rate at CCG member practices has fallen since October 2016, Severity with 109 incidents reported in June 2017. The percentage of moderate-to-serious incidents is a reducing trend. Trends and Resolutions There are five existing trends: (1) Issues with the arrangement of MDT Meetings. (2) Violenence and Aggression in GP Practices. (3) Walk-In Centres failing to record patient consent status for sharing their consultation record with the patient’s GP. (4) Acute Providers inappropriately delegating work to GPs (which arose as a result of a Freedom of Information Request). (5) E-referral system problems.
Contract Visits During June 2017 the following practices received a scheduled contract and quality monitoring visit:
• Swanpool • Hollyhead Primary Health Centre • Victoria Road Medical Centre • Heathfield Family Centre • City Road Medical Centre • Attwood Green Health Centre
No significant concerns identified and visit teams are currently finalising reports.
Incidents
Never Events There have been Zero Never Events reported by GP Practices since April 2017.
Serious Incidents Trends There have been 0 Serious Incidents reported by SWB CCG since April 2017, 0 of these were reported in June. The chart below highlights SI trends.
Month # Month # Apr 0
May 0 Jun 0
Incident Reporting and Severity
The incident reporting rate at CCG member practices has fallen since October 2016, with 109 incidents reported in June 2017. The percentage of serious incidents continues to fall.
GP Incident Reporting Rate
Incident Severity
The chart below shows the percentage of incidents reported by GPs by level of severity.
GP Reporting by LCG
The following table shows a breakdown of incident reporting per LCG, for the past four months.
Black Pioneers Sandwell Health Month Healthworks ICOF Total Country 4Health Alliance Jan 24 25 18 1 34 102 Feb 22 67 12 1 34 136 Mar 25 20 9 4 43 101 Apr 23 16 5 7 25 76 May 27 25 24 7 32 115 Jun 31 23 20 3 32 109
Trends and Resolutions
Summary:
Description (Policies) Actions/Feedback CHOOSE AND BOOK/E-REFERRALS This issue was identified as a trend in May 2016. Although incidents GPs are reporting that appointments booked via the of this type have been recorded since 2014, they were largely E-Referral system (formerly known as Choose and sporadic and low in number, which didn't suggest a trend. During the Book) are not available to patients once the patient summer of 2016 however, the numbers of incidents of this type that calls the hospital to confirm their booking. E- were being reported increased significantly and the issue was formally Referrals can be directly or indirectly booked. Direct raised with the Quality and Safety Committee, who advised pursuing a booking involves the GP booking the appointment resolution to this problem via the SWBH Clinical Quality Review during the consultation, with the patient leaving the Meeting, so that the issue could be addressed at Director level. GP surgery with a confirmed attendance date. Indirect booking involves the GP printing off a list of The issue was then raised at the SWBH CQRM, where a decision to appointment options for the patient, who then leaves investigate was undertaken. In addition, a Task and Finish group was the surgery and calls the hospital at a later time to appointed to oversee this process, which included Dr Marok, the CCG confirm which appointment they would like to take. ICT Lead. MLSCU ICT Team were also tasked by the CCG to The issue affects only indirectly booked E-Referrals. investigate the issue from a Primary Care perspective. Their initial The issue is also affecting patient registered at findings confirmed that the problem was more widespread than initially member practices practces of neighbouring CCGs. thought, with patients at other CCG member practices affected. Brimingham Cross City CCG opted to lead on the collation of incidents reported by all local CCGs, with submissions of incident data being provided on a monthly basis.
The SWBH investigation revealed that appointment slots were being booked by SWBH to ensure patients met the RTT 18 week target. Often, this meant that in the time between the patient leaving the surgery and calling the hospital, the original appointment slot option that appeared on the E-Referral system was no longer available. This discovery ruled out any techinical issue that might have accounted for the anomaly, but allowed for a resolution to be reached via change of process.
At a subsequent Contract Review Meeting, SWBH confirmed that more slots would be made available and continued efforts would be taken to address the issue of backfilling. Updates on the reslution of this issue will be provided at future CQRM and CRM meetings, as there is the potential for further impact of this problem in regards to the 17-19 contract, where a significant value is attached to a CQUIN related to E-Referral performance.
The issue has persisted to date, with Feburary 2017 seeing the highest number of reported incidents in a single month (17).
DELEGATION OF WORK Trend initially identified in October 2016 and raised at the Quality and Issue pertaining to Acute Services provided by Safety committee for that month. Thus far, 8 incidents have been SWBH whereby work usually carried out by SWBH reported since October 2016. was being delegated back to Primary Care. This causes an unecessary burden of work in Primary Incident levels remain very low, therefore issue will be addressed on a Care and may increase the costs of, and duration of case-by-case basis until sufficient amount of data has been gathered waiting time for patients. to address specific issues related to partiuclar wards and departments. Reporting spike followed receipt of Freedom of Information request, which made reference to this problem being reported in the media. VIOLENCE AND AGGRESSION Options available to Practices: There has been a recent trend of violence and aggression incidents in GP Practices, where patients 1) Attempt to calm the situation: or patient relatives are the instigators and practice staff are the victims. Dealing with an aggressive patient takes care, judgement and self- control.
(i) Remain calm, listen to what they are saying, ask open-ended questions
(ii) Reassure them and acknowledge their grievances
(iii) Maintain eye contact, but not prolonged
(iv) Keep an adequate distance from the patient, but keep away from corners
(v) If the patient has a weapon, ask them to put it down (not to hand it over)
(vi) Use the panic button or call for help
(vii) Leave the room and call security or the police
(viii) If possible, move the patient to an area away from public view
2) Report the issue as an incident on Datix - this helps the CCG to monitor trends and collate useful advice to help other practices in future.
3) Issue patient with a Zero Tolerance warning letter
3) If patient is violent and aggressive in future, consider removal from practice list under the Excluded Patient Scheme
Further Information:
Patients, and sometimes their carers, become challenging, difficult, uncooperative or aggressive for a number of reasons:
• Unwell or in pain
• Drink/substance misuse
• Fear, anxiety or distress
• Communication or language difficulties
• Unrealistic expectations
• Previous poor experience
• Frustration
• Guilt that they didn't bring a sick relative in earlier.
Their challenging behaviour may take the form of:
• Being demanding or controlling
• Unwillingness to listen/uncooperative
• Verbal abuse or threats
• Physical violence against people or property.
Identifying the problem
Is it the patient?
Always consider first whether the patient’s behaviour is caused by a medical condition. If so, treat the patient as far as possible without putting yourself or others at risk.
Is it lack of resources?
Long waiting times, lack of available appointments or beds, locums unfamiliar with the department, poor communication by staff, etc may all contribute to a patient’s deteriorating mood or behaviour.
Is it the doctor?
Competing pressures on the doctor (time, resources, personal) may affect their communication style and potentially exacerbate the situation.
Assessing the risk Even if you are not in a position to determine the security policy at the trust or practice, you can seek ways to protect yourself, colleagues and other patients.
Identify high-risk situations – for example, Saturday night in the Emergency Department, or when you have to deliver bad news, or when patients are kept waiting for a very long time. Consider which staff may be vulnerable if a patient becomes violent. Reception area staff or doctors working alone in a clinic may be at greater risk.
Patients must not be denied necessary treatment even though they may be aggressive or violent. Treatment must be based on clinical need, however demanding the patient. Nevertheless you should assess and minimise the risks to yourself, the patient and others. In some cases it may be reasonable and necessary to consider alternative arrangements for providing treatment.
If systems, policies or availability of resources are compromising patient care, you must raise your concerns.
Training staff in conflict resolution and dealing with aggressive behaviour is advisable. NHS Protect offers online and in-house courses.
Consider your security requirements. Your Local Security Management Specialist (LSMS) - contactable via Michelle Carolan (Deputy Chief Officer - Quality) is responsible for security in your practice area and can advise you. If you have concerns about the safety of your environment, raise them with your Security Management Director or the LSMS.
For telephone advice and guidance, call T2T on 0121 612 4110.
WALK IN CENTRE First incidents reported in December 2016 and trend raised at the Issue reported by GP practices, whose patients are Quality and Safety Committee that month. 8 incidents in total reported reporting that despite giving consent for their records between December 2016 and Feb 2017. to be shared electronically with their GP Practice, this wasn't being carried out by the Walk-In Centre. 03/01/2017 - Quality Manager to inform Urgent Care commissioner of issue. Quality contract to raise issue formally at the next contract Review Meeting on 21st March 2017. Incident Team informed on new trend and will collate new incidents as evidence prior to the CRM.
06/04/2017 - Contract Meeting on 21st March was cancelled, so issue was rasied directly with provider. Provider confirmed with reception staff that all patients are being asked for consent, and that no further issues have been raised. CCG will continue to monitor incident reports to ascertain if trend persists.
Primary Care Updates:
June 2017
GP transfers/ NHS England has now approved SWB CCG’s latest constitution. This is available via the CCG CCG website as follows: constitution
https://sandwellandwestbhamccg.nhs.uk/images/17_SWBCCG_Constitution_V2_- _23rd_July_2014_Final_APPROVED_Updated_19_06_17.pdf
The updated constitution reflects the transfer out of 7 GP practices to Birmingham South Central CCG alongside Bellevue medical centre joining SWB CCG.
Contract and During June 2017 the following practices received a scheduled contract and quality quality monitoring visit: monitoring • Swanpool medical centre visits • Attwood Green health centre • Heathfield family centre • Victoria Road medical centre • Holyhead primary healthcare centre
No significant concerns identified and visit teams are currently finalising reports.
Primary Care The latest updates against the primary care dashboard LCG quality improvement action Dashboard plans (focused on peer support and dissemination of best practice amongst member and LCG practices) were received and subsequently shared with the Primary Care Co- quality Commissioning Committee (PCCC). improvement plans Overall LCGs chose a range of methods to ensure shared learning of best practice. Some of these included the delivery of learning presentations from higher achieving practices at LCG meetings and shared learning discussions at practice manager forums.
The Q1 primary care dashboard will be reviewed at the next PCCC meeting in August.
CQC Latest analysis of CQC ratings for SWB CCG member practices indicates the following: • 1 practice is rated as ‘Outstanding’ • 64 practices are rated as ‘Good’ • 17 practices are rated as ‘Requires Improvement’ • 3 practices are rated as ‘Inadequate’ • 6 practices are either awaiting inspection or publication of their final CQC report and rating. • 71% of our practices are rated as ‘good’ for Safety, • 80% are rated as ‘good’ for Effectiveness, • 89% are rated as ‘good’ for Caring, • 82% are rated ‘good’ for ‘Responsiveness’ • 76% are rated as ‘good’ for ‘Well-led’.
Practices rated as ‘Inadequate’ are eligible to receive support from the RCGP as part of the ‘GP practice special measures support programme’
Practices rated as ‘Requires Improvement’ are encouraged to arrange pre-inspection support from the Quality team or via their designated primary care development manager.
GP practice A new risk has been added to the primary care risk register as follows: disengagement PC06_17e - ‘If practices fail to engage with support offered and/or fail to participate in improvement schemes, there is a risk that some patients will have inequitable access to high quality care’.
Attwood Green The CCG has approved an extension to the Attwood Green (asylum seeker) wrap-around health unit health service contracts until 31st March 2018. These services include community psychiatric nursing, midwifery and Doula services.
The governing body previously approved the continuation of health screening and assessment services (delivered by Virgin healthcare) and includes GP led services.
Sandwell & West Birmingham Hospitals Data contained in this report is up-to-date and includes all data up to and including June 2017.
Summary
Sandwell and West Birmingham Hospitals Never Events There has been one Never Event reported by this Trust since April 2017: Wrong Site Surgery - The anaesthetic block was applied to the wrong side, the left, when surgery was required on the right side. Serious Incidents Trends There have been 10 Serious Incidents reported by SWBH since April 2017, 2 of these were reported in June. There has been a good reduction in Pressure Ulcer Serious Incidents since April 2013, but an upward trend in patient falls since Jan 2017. GP Reported Incidents Since April 2017, the most prevalent type of incident reported by GPs in regard to (Trends) SWBH has been issues with Diagnosis and Test (primarily, E-Referral issues). Complaints and Concerns 1) There have been 2 Complaints reported against SWBH since April 2017, 0 of these was reported in June. Quality Assurance Visits There were no Quality Assurance visits in June 2017. CQRM Summary _ ED 4 hour performance for May was 81.57% (84.95%), non-compliant with 95% national target; 3549 breaches in the month _ Never Event reported in May due to ‘wrong side block’. _ RTT May delivery at 93.79% against the national standard of 92%. Waiting list at 32,663, patient backlog of patients at 2,024 down by c200 patients from April. There were 3x 52 week incomplete breaches. June tracking projections to deliver standard, internal forecast for 93.5%. _ Acute Diagnostic waiting times within 6 weeks as at May 99.4% recovering to compliance of 99%; 46 breaches were declared for the month of which echos were at 30, which was due to cardiology capacity issues. Plan for June is to deliver 99% with echo breaches fully recovering in July. _ 62 day cancer compliant at 85.6% at April vs. target of 85%; all other cancer targets continue to deliver. May delivery is anticipated to deliver to standards. Whilst performance is consistently good, cancer delivery requires increased ‘effort’. _ Neutropenic sepsis considerable improvement on prior months, but remains below 100% standard [6/37 (16%) patients did not receive treatment within the required 1hr timeframe]. 6 patients missed the standard, all in ED. _ Elective Operations Cancellations consistently under-delivering and at 1.5% against 0.8% target in May; cancellations are the highest for a number of months at 67 on day cancellations of which 27 were validated as avoidable; No 28 Day Guarantee or urgent cancellations during May. _ Hip fractures best practice tariff performance in month improved from last month to 65% but remains below 85% standard and with consequent failure to recover additional tariff income _ Sickness rates cumulatively are at 4.48% against the Trust target of 2.5%. Short- term sickness cases worsening to last month from 415 to 445, long term sickness remaining flat at 415. _ Mortality reviews 64% in March showing only modest improvement and remains significantly below 90% standard; key mortality rate indicators remain within confidence limits. _ MSA Breaches x7 were incurred in May; cause due to capacity issues. _ VTE delivers full year to national standard at 95.8% in May with 346 patients missing the assessment. _ MRSA – no cases year to date _ CDiff – x3 cases year to date against a target of 5. _ Readmissions at 7.2% in May (7.1%). The Trust now tracks better than peer group. CQUINs The milestone report for the first quarter performance will be presented at the August Q&S.
Incidents
Never Events There has been one Never Event reported by this Trust since April 2017: Wrong Site Surgery - The anaesthetic block was applied to the wrong side, the left, when surgery was required on the right side.
Serious Incidents Trends There have been 8 Serious Incidents reported by SWBH since April 2017, 2 of these were reported in June. There has been a good reduction in Pressure Ulcer Serious Incidents since April 2013, but an upward trend in patient falls since Jan 2017.
The chart below highlights SI trends.
Top Trends Count Month # Month # (CF) DELAY in Care/Treatment 3 Apr 4 Oct
(INF) Outbreak - MRSA 1 May 4 Nov (PF) Fall/Trip/Slip while Mobilising Alone 2 Jun 2 Dec (PF) Patient Fall resulting in FRACTURE 1 Jul Jan (TH) Anaesthetic incidents 1 Aug Feb (TH) Death in theatre 1 Wrong Site Surgery (NE) 1 Sep Mar
Pressure Ulcers and Patient Falls Trends The charts below show long term trends of Pressure Ulcers and Patients Falls that fall under the Serious Incident Reporting Criteria. Pressure Ulcers are falling (with no new cases since Nov 2016); Patient Falls spiked in Feb but are now decreasing.
GP Reported Incident Trends (Top Five) Since April 2017, the most prevalent type of incident reported by GPs in regard to SWBH has been issues with Records, Communication and Information. A brief breakdown of appointment issues is shown beneath this chart.
Month/Type Count 2017 Diagnosis & Tests 30 Records, Communication & Information 30 Appointments, Discharge & Transfers 26 Clinical Care (Assessment/Monitoring) 21 Medication 7
Grand Total 60
Complaints
Complaints Types There have been 2 Complaints reported against SWBH since April 2017, 1 of these was reported in May. Please note that in the table below a single complaint may contain more than one complaint ‘type’, depending on the nature of the issue raised.
Month/Type Count (P) Sandwell and West Birmingham (Community Services) 1 (SWBH Community) - District nursing 1 Lack of Accessibility (i.e. Access to Appointments) 1 (P) Sandwell and West Birmingham Hospitals (Acute) 1 (SWBH Acute) - Unspecified/Unknown 1 Poor Communication 1 Grand Total 2
Complaints Trends
There are no current trends pertaining to complaints.
Quality Assurance Visits
Date Location Reason Outcome
Summary
Further Actions
No Quality Assurance visits were carried out in this month.
Quality Data Review
Local Quality Requirements (Exceptions):
Indicator Target M2 Response Operational Percentage of A & E attendances where the Service User RAP in Place was admitted, transferred or discharged within 4 hours of 95% 92.9% their arrival at an A&E department National Zero tolerance RTT waits over 52 weeks for incomplete Exception Report Received 0 2 pathways All handovers between ambulance and A & E must take place within 15 minutes with none waiting more than 30 0 65 minutes Local Safeguarding Children Level 2 Training 85% 74.2% RAP in Place Safeguarding Children Level 3 Training 85% 70.9% RAP in Place Safeguarding Adults Advanced Training 85% 79.4% RAP in Place Maternity – Smoking Status 90% 63.0% RAP in Place Exception Report Received – Proportion of stroke patients given thrombolysis 50% 0% Clinical Reasons Proportion of stroke patients who spent at least 90% of 90% 86.5% their stay on a stroke ward Proportion of stroke patients scanned within 24 hours of 100% 97.7% arrival (clock start) Morning discharges 35% 14.9% RAP in Place Compliance with the “Five Steps to Safer Surgery” process is 100% 98.9% reported using the Clinical Systems Reporting Tool (CSRT). Inter-provider tertiary referrals for patients on the 62 day cancer pathway will be made by the referring trust within 42 100% 88.0% days of initial GP referral. A&E coding should include diagnosis coding in line with the 90% 70.5% A&E data set BMI recorded by 12+6 weeks of pregnancy 90% 73.4% RAP in Place CO monitoring recorded & documented in the antenatal RAP in Place 90% 81.4% notes of all mothers by 12+6 weeks of pregnancy.
CQRM Summary
Item Detail Integrated _ ED 4 hour performance for May was 81.57% (84.95%), non-compliant with 95% national Performance target; 3549 Report breaches in the month _ Never Event reported in May due to ‘wrong side block’. _ RTT May delivery at 93.79% against the national standard of 92%. Waiting list at 32,663, patient backlog of patients at 2,024 down by c200 patients from April. There were 3x 52 week incomplete breaches. June tracking projections to deliver standard, internal forecast for 93.5%. _ Acute Diagnostic waiting times within 6 weeks as at May 99.4% recovering to compliance of 99%; 46 breaches were declared for the month of which echos were at 30, which was due to cardiology capacity issues. Plan for June is to deliver 99% with echo breaches fully recovering in July. _ 62 day cancer compliant at 85.6% at April vs. target of 85%; all other cancer targets continue to deliver. May delivery is anticipated to deliver to standards. Whilst performance is consistently good, cancer delivery requires increased ‘effort’. _ Neutropenic sepsis considerable improvement on prior months, but remains below 100% standard [6/37 (16%) patients did not receive treatment within the required 1hr timeframe]. 6 patients missed the standard, all in ED. _ Elective Operations Cancellations consistently under-delivering and at 1.5% against 0.8% target in May; cancellations are the highest for a number of months at 67 on day cancellations of which 27 were validated as avoidable; No 28 Day Guarantee or urgent cancellations during May. _ Hip fractures best practice tariff performance in month improved from last month to 65% but remains below 85% standard and with consequent failure to recover additional tariff income _ Sickness rates cumulatively are at 4.48% against the Trust target of 2.5%. Short-term sickness cases worsening to last month from 415 to 445, long term sickness remaining flat at 415. _ Mortality reviews 64% in March showing only modest improvement and remains significantly below 90% standard; key mortality rate indicators remain within confidence limits. _ MSA Breaches x7 were incurred in May; cause due to capacity issues. _ VTE delivers full year to national standard at 95.8% in May with 346 patients missing the assessment. _ MRSA – no cases year to date _ CDiff – x3 cases year to date against a target of 5. _ Readmissions at 7.2% in May (7.1%). The Trust now tracks better than peer group.
Focus on Staffing
Oct Nov Dec Jan Feb Mar Apr May Sickness 4.53% 4.77% 4.9% 4.83% 4.5% 4.48% 3.15% 4.48% - Short Term 837 922 911 956 808 785 414 445 - Long Term 245 247 246 253 205 213 214 241 Bank (Nursing - Qualified) 46.77% 36.30% 41.77% 40.30% 27.10% 43.5% 42.1% 46.7% Agency (Nursing - Qualified) 18.76% 28.36% 20.17% 22.55% 18.70% 16.8% 16.3% 17.8% Turnover - Nursing 12.4% 11.7% 11.4% 11.6% 11.2% 11.7% 11.7% 11.7% Mandatory Training (95%) 87.3% 87.2% 87.1% 87.1% 87.5% 87.2% 95% 95% PDR Compliance (95%) 88.7% 88.5% 88.2% 88.1% - 87.9% 95% 95%
Commissioning for Quality and Innovation (CQUIN) Update
The Commissioning for Quality and Innovation (CQUINs) payments framework encourages care providers to share and continually improve how care is delivered and to achieve transparency and overall improvement in healthcare.
SWBH CQUINs:
Scheme Q1 Q2 Q3 Q4 Comments Health and Well Being (A) – Staff Initiatives The 5 percentage point improvement should be achieved over a period of 2 years, with the baseline survey being the 2015 staff survey. Health and Well Being (B) – Healthy Food Providers will be expected to build on the four changes required in the 2016/17 CQUIN Health and Well Being (C) – Influenza Vaccinations Achieving an uptake of flu vaccinations by frontline clinical staff of 75% Sepsis (A) Timely identification of sepsis in emergency departments and acute inpatient settings Sepsis (B) Timely treatment for sepsis in emergency departments and acute inpatient settings Sepsis (C) Antibiotic review Sepsis (D) Reduction in antibiotic consumption per 1,000 admissions Mental Health – A&E Improving services for people with mental health needs who present at A&E Advice and Guidance A&G services for non-urgent GP referrals. E-Referrals Improving availability of services and appointments on the NHS e-Referral SupportingSi Safe and Proactive Discharge Improving experience and outcomes for young people as they transition out of Children and Young People’s Mental Health Services (CYPMHS). Preventing Risk Behaviours Percentage of unique adult patients who are screened for smoking status AND whose results are recorded. Wound Care Improving wound care assessment.
Personalised Care
Personalised care and support planning for people with long-term conditions.
Summary: The milestone report for the first quarter performance will be presented at the August CQRM. Black Country Partnerships Mental Health Foundation Trust The data for this report is up to date and includes all data up to and including June 2017.
Executive Summary
Black Country Partnerships Never Events There have been zero Never Events reported by this Trust since April 2017. Serious Incident Trends There have been 11 Serious Incidents reported by BCP since April 2017, 5 of these were reported in June. Other Trends There have been no concerns or incidents reported by GPs since April 2017. Complaints There have been no concerns or complaints raised by patients since April 2017. Quality Assurance Visits There have been zero Quality Assurance Visits to BCP this month. CQRM Divisional Quality Report (LD) •220 incidents were reported during May 2017 across the LD Division. There were no STEIS or never events reported during May 2017. The number of medication errors remains low. •Patient story is from the Dudley Learning Disability Physiotherapy Team. There was one formal complaint in May and 3 concerns. •There were 7 compliments. •This year’s audits are listed in the report as has the agreed Quality Improvement Priority. •The appraisal compliance is now 99.3%, after having been reset inFebruary 2017. •The primary reason for sickness absence is gastrointestinal problems and for long term absences, anxiety/stress/depression/other psychiatric illnesses. •The turnover rates have slightly increased. The annual mandatory training is above the KPI but specialist annual mandatory training is below the KPI. •The service development is around a healing garden described by the Occupational Therapy Team in Wolverhampton.
Safeguarding Quarterly Report Wolves Safeguarding leads welcomed the report presented by BCP, noting the good tsrides that have been made since its original creation, and acknowledging that improvement in data capture that have been made by the Trust.
Medicines Assurance Report Report presented, noting excellent reduction in Medication Errors over the past 2 years and outlining a list of improvements to the Medicines Management process that has led to improvements in Patient Care across the Trust.
Modification of the SQPR Template Wolves and SWB CCG will meet to discuss re-formatting the SQPR to better meet the needs of both organisations, and will work with BCP to achieve a satisfactory and timely solution.
Local Quality LQR Ref KPI Description Exception Details Requirements LQGE14a % of Routine assessments carried out 189/239, with >85% target. within 8 weeks. Exception not accepted, but CCG will only consider sanction if Provider fails target on three successive months. LQGE17 RCAs delivered within 60 working 1/2 with 100% target. days. Exception Accepted – delay due to Cyber Attack.
CQUIN Schemes BCP passed all CQUIN schemes for the Q4 milestone.
Incidents
Never Events There have been zero Never Events reported by this Trust since April 2017.
Serious Incidents Trends There have been 11 Serious Incidents reported by BCP since April 2017, 5 of these were reported in June. Current SI trends include unexpected/potentially avoidable deaths and suicides.
June Serious Incidents # Month # Month # Attempted Suicide 1 Apr 3 Oct Self Harming Behaviour 1 May 3 Nov Jun 5 Dec (SE) Death - Unexpected 1 Jul Jan (VA) Aggressive, Intimidating, or Inappropriate 2 Aug Feb Behaviour Sep Mar
Other Incidents
The majority of incidents reported by GPs relate to issues around correspondence being sent to the wrong practice. Black Country Partnerships have recently provided confirmation that GP incidents raised via Quality Matters will be responded to within 21 working days.
Month/Type Count 2017
Records, Communication & Information 1 Appointments, Discharge & Transfers 1 Grand Total 2
Complaints
Complaints Trends There have been 0 Complaints raised against BCP since April 2017, 0 of these were reported in May. There have been no trends identified this year thus far.
Incident date Concern Summary Status/Resolution
Quality Assurance Visits
Date Location Reason Outcome
Summary There have been zero Quality Assurance Visits to BCP this month.
Quality Data Review
Local Quality Requirements (Exceptions): There were two indicators that failed this month’s targets –% of Routine assessments carried out within 8 weeks, and delivery against the 60 working day standard for RCAs.
LQR Ref KPI Description Exception Details LQGE14a % of Routine assessments carried out 189/239, with >85% target. within 8 weeks. Exception not accepted, but CCG will only consider sanction if Provider fails target on three successive months.
LQGE17 RCAs delivered within 60 working 1/2 with 100% target. days. Exception Accepted – delay due to Cyber Attack.
CQRM Summary – 4th July 2017 (LD)
Item Detail Divisional Divisional Quality Report (LD) Quality •220 incidents were reported during May 2017 across the LD Division. There were no STEIS or Report never events reported during May 2017. The number of medication errors remains low. (Mental •Patient story is from the Dudley Learning Disability Physiotherapy Team. There was one formal Health) complaint in May and 3 concerns. •There were 7 compliments. •This year’s audits are listed in the report as has the agreed Quality Improvement Priority. •The appraisal compliance is now 99.3%, after having been reset inFebruary 2017. •The primary reason for sickness absence is gastrointestinal problems and for long term absences, anxiety/stress/depression/other psychiatric illnesses. •The turnover rates have slightly increased. The annual mandatory training is above the KPI but specialist annual mandatory training is below the KPI. •The service development is around a healing garden described by the Occupational Therapy Team in Wolverhampton.
Safeguarding Quarterly Report • Wolves Safeguarding leads welcomed the report presented by BCP, noting the good tsrides that have been made since its original creation, and acknowledging that improvement in data capture that have been made by the Trust.
Medicines Assurance Report • Report presented, noting excellent reduction in Medication Errors over the past 2 years and outlining a list of improvements to the Medicines Management process that has led to improvements in Patient Care across the Trust.
Modification of the SQPR Template • Wolves and SWB CCG will meet to discuss re-formatting the SQPR to better meet the needs of both organisations, and will work with BCP to achieve a satisfactory and timely solution.
Commissioning for Quality and Innovation (CQUIN) Update
The Commissioning for Quality and Innovation (CQUINs) payments framework encourages care providers to share and continually improve how care is delivered and to achieve transparency and overall improvement in healthcare.
Black Country Partnerships Foundation Trust CQUINs
Scheme Q1 Q2 Q3 Q4 Health and Well Being (A) – Staff Initiatives The 5 percentage point improvement should be achieved over a period of 2 years, with the baseline survey being the 2015 staff survey. Health and Well Being (B) – Healthy Food Providers will be expected to build on the four changes required in the 2016/17 CQUIN Health and Well Being (C) – Influenza Vaccinations Achieving an uptake of flu vaccinations by frontline clinical staff of 75% Physical Health Improving physical healthcare to reduce premature mortality in people with SMI. Cardio Metabolic assessment and treatment for patients with psychoses. Mental Health – A&E Improving services for people with mental health needs who present at A&E. Transitions out of CYP Services This CQUIN aims to incentivise improvements to the experience and outcomes for young people as they transition out of Children and Young People’s Mental Health Services (CYPMHS). Preventing Risk Behaviours Percentage of unique adult patients who are screened for smoking status AND whose results are recorded.
Summary The first milestone submission for the CQUIN scheme is July 2017, so Q1 performance summary will appear in July Q&S report.
West Midlands Ambulance Service Data contained in this report includes all data up to and including May 2017. The format of the CQRM has now changed and will, in future, be an integrated report that includes Urgent Care date. The first integrated CQRM takes place on 31st July 2017.
Summary:
West Midlands Ambulance Service Never Events There have been zero Never Events reported by this Trust since April 2017. Serious Incidents Trends There have been 10 Serious Incidents reported by WMAS since April 2017, 7 of these were reported in May. GP Reported Incidents There have been 0 GP reported incidents pertaining to WMAS so far this year. Complaints and Concerns There have been 0 Complaints reported against WMAS since April 2017, 0 of these were reported in April. There have been no trends identified thus far, although issues regarding the training and competency of staff have featured were suggested to contributory factors. Quality Assurance Visits There were zero Quality assurance visits in May 2017. CQRM Summary [3rd May The May CQRM was cancelled. This was due to the merging of 2017] CQUINs The first CQUIN milestone report will be delivered at the August CQRM
Incidents
Never Events There have been zero Never Events reported by this Trust since April 2017.
Serious Incidents Trends There have been 10 Serious Incidents reported by WMAS since April 2017, 10 of these were reported in May. A recent trend has been observed in Delays of Treatment and Care – WMAS are producing a report for the board to investigate this spike in numbers but early indication suggest no obvious reasons that would explain this at this stage.
Row Labels Count Month # Month # Clinical Care (Assessment/Monitoring) 7 Apr 3 Oct May 10 Nov Clin - Treatment Failures/Delays 5 Jun Dec Clin - Unexpected Ill Health/Deterioration 2 Jul Jan Diagnosis & Tests 3 Aug Feb Diag - Diagnosis 3 Sep Mar Grand Total 10
GP Reported Incidents
There have been 0 GP reported incidents pertaining to WMAS so far this year.
Month/Type Count
Grand Total 0
Complaints
Complaints Trends There have been 0 Complaints and Concerns reported against WMAS since April 2017.
(WMAS) West Midlands Ambulance Service Count
Grand Total 0
Quality Assurance Visits There were zero Quality assurance visits in March 2017.
Date Location Reason Outcome
Summary
Further Actions
Quality Data Review
CQRM Summary: April 2017
Item Detail CQRM Apr 2017 No CQRM in May 2017, due to forthcoming merger of CQRM with NHS111 meeting.
Commissioning for Quality and Innovation (CQUIN) Update
The Commissioning for Quality and Innovation (CQUINs) payments framework encourages care providers to share and continually improve how care is delivered and to achieve transparency and overall improvement in healthcare.
The Trust has agreed a number of CQUINs with the CCG. Each CQUIN scheme is summarised below.
WMAS CQUINs
Scheme Q1 Q2 Q3 Q4 Comments Health and Well Being (A) – Staff Initiatives The 5 percentage point improvement should be achieved over a period of 2 years, with the baseline survey being the 2015 staff survey. Health and Well Being (B) – Healthy Food Providers will be expected to build on the four changes required in the 2016/17 CQUIN Health and Well Being (C) – Influenza Vaccinations Achieving an uptake of flu vaccinations by frontline clinical staff of 75% A reduction in the proportion of ambulance 999 calls that result in transportation to a type 1 or type 2 A&E Department Proportion of 999 incidents which do not results in transfer of the patient to a Type 1 or Type 2 A&E Department.
Summary: The first CQUIN milestone report will be delivered at the August CQRM. Urgent Care Data contained in this report includes all data up to and including May 2017. The format of the CQRM has now changed and will, in future, be an integrated report that includes Urgent Care date. The first integrated CQRM takes place on 31st July 2017.
Urgent Care Summary Never Events There have been Zero Never Events reported by Urgent Care Services since April 2016. Serious Incident Trends There has been 1 Serious Incident reported in Urgent Care Services since April 2016. Intermediate Care There have been 34 incidents reported by Intermediate Care Centres since April 2016, with the main identified trend being issues with incorrect or incomplete correspondence being received from Acute Trusts. SWBH are addressing this issue via formulation of a new discharge summary template, which is being supported by a CQUIN scheme. There have been zero complaints or concerns. NHS111 There have been six incidents reported about NHS111 since April 2016; however there have been nine complaints and concerns, with the primary trend being communication issues between the service and service users. NHS111 has recently been re-procured by the CCG. Out of Hours GPs There have been three incidents and zero complaints and concerns reported about Out of Hours GPs since April 2016
Incidents and Issues
Never Events There have been Zero Never Events reported by Urgent Care Services since April 2017.
Serious Incidents Trends There have been 0 Serious Incidents reported in Urgent Care Services since April 2017.
Intermediate Care There has been 1 incident reported by Intermediate Care Centres since April 2017, with the main identified trend being issues with incorrect or incomplete correspondence being received from Acute Trusts. SWBH are addressing this issue via formulation of a new discharge summary template, which is being supported by a CQUIN scheme. There have been zero complaints or concerns.
Month/Type Count 2017 Apr 1 (ICC) (Sandwell) - Waterside Nursing Home (BUPA), 60 Dudley Road, Tipton DY4 8EG Medication 1 May 7 None Grand Total 32
NHS 111 There have been zero incidents reported about NHS111 since April 2017; however there have been nine complaints and concerns, with the primary trend being communication issues between the service and service users. NHS111 has recently been re-procured by the CCG.
Incidents Month/Type Count 2017 Apr 1 Diagnosis & Tests 1 Grand Total 1
Complaints Month/Type Count (P) NHS 111 Service 0 None Grand Total 0
Out of Hours GPs There have been three incidents and zero complaints reported about Out of Hours GPs since April 2016. Poor communication has been identified as trend.
Incidents Month/Type Count Apr None 0 May None 0 Grand Total 0
Complaints There have been no recorded complaints or concerns about Out of Hours GP services. Other NHS Contracts
Data contained in this report is up-to-date and includes all data up to and including June 2017. Please note there was no meeting for The Dudley Group. This section summarises the key points tabled at the most recent Clinical Quality Review Group for NHS services for whom Sandwell and West Birmingham CCG hold a significant budget.
Other NHS Contract CQRM Summaries The Dudley Group Serious Patient Safety Incident Report May The Trust has reported zero Never Events for the month of April 2017. A total of 20 serious incidents have been reported in April 2017 (6 General SI’s and 14 pressure ulcer SI’s).
Reporting of Serious Incidents
The Trust’s highest category of SI’s for April is “stage 3 and 4 pressure ulcers”, this equates to 70% of the reported SI’s in the month. This is similar to the percentage of pressure ulcer SI’s in preceding month March 2017 (72%). It can be seen that there has been a significant reduction in the number of SI’s reported in April 2017 (43% decrease). This decrease is primarily due to the reduction in the number of pressure ulcers being reported now that verification is undertaken by a member of the Tissue Viability Team.
Reported SI (highest category) - Stage 3 and 4 Pressure Ulcers
Pressure ulcers are reported to the Patient Safety Team by a member of the Tissue Viability team once verified as a stage 3 or 4 pressure ulcer. The lead investigator completes the RCA and then presents this in the pressure ulcer meeting. There has been a significant reduction in the number of hospital acquired pressure ulcers in April 2017, the Tissue Viability Team undertook a road show and visited wards in March 2017. This focused on the promoting the importance of preventing pressure ulcers.
Serious incidents reported within other categories
It can be seen that the second highest reporting category is patient falls (15%). RCA investigations have been commissioned and will identify if the fall was unavoidable or avoidable.
Request for Deletion from STEIS
If an incident is reported externally on STEIS and subsequent evidence, information or the investigation identifies this was not externally reportable the Lead Clinician/Director will instruct the Corporate Governance team to request deletion from the CCG.
There were 11 requests for deletion from STEIS in April 2017. A request has been submitted to the CCG for the deletion of 102 pressure ulcer serious incidents that were identified as unavoidable and that have been closed by the commissioners. Complaints Complaints for year ending 31 March 2017 and claims report for the *figures in [ ] refer to year ending 31/3/2016 year ending 31 March • 100% [100%] of complaints received during were acknowledged within 3 2017 working days
• 87% [38%] The revised timescale for a reply (within 40 working days) has shown a big improvement in response times during year.
• 49% [59%] of complaints received and closed were upheld/partially upheld.
• 26 [11] complainants expressed dissatisfaction with their response (received and investigated).
• In quarters 1,2 & 3 all further correspondence from complainants was incorrectly categorised as ‘dissatisfied’ when many were actually seeking additional information and were not therefore dissatisfied with their response. This was remedied in Q4 hence a reported reduction in actual dissatisfied complainants in that quarter.
• 115 [101] local resolution meetings held with complainants.
• 23 [12] Inquests held and closed.
• 1 [1] rule 28 - reports on ‘Action to Prevent Future Deaths’ received from Senior Coroner.
• 5 [4] Complaints accepted for investigation by the PHSO in year ending 31/3/17. Birmingham Community Healthcare Commissioner There were 1745 incidents reported within this period. It should be noted that due Quarterly to the report being produced so close after the end of the quarter that not all Summary incidents have been through the management process and coding and data could Report change. 2016/2017 – Quarter 4 Reported Incidents by Incident Type
The top three incident types for Quarter 4 are Patient Incident (1027, 59%) Staff, Visitor, Contractor Incident (326, 19%) and Medication, Medical Gas, Medication Delivery System Incidents (139, 8%).
This compares with 1844 incidents being reported for the same period in 2015/16, when the top three incidents reported were: Patient Incident (1053, 57%) Staff, Visitor, Contractor Incident (342, 19%) and Medication, Medical Gas, Medication Delivery System Incidents (159, 9%) and Infrastructure Incidents (159, 9%).
Never Event
There has been 1 Never Event reported: Retained foreign object post-procedure (Dental Division). Patient The report provides information about feedback received from patients and the Experience public, the lessons learned, action taken and themes and trends identified. This Report report provides assurance of listening in this way and supports the strategies and For Quarter 4, frameworks for engagement and involvement. 2016/17 Customer Services / Patient Advice and Liaison Service (PALS)
During quarter 4 there were 887 entries logged by the Customer Service Team onto the Trust Datix system. The following enquiry issues / themes were identified from the enquiries received:
• Calls not answered / not returned • Waiting time at appointment is too long • Waiting time for appointment and for equipment • Car parking • lack of • costs • pay on exit required (Bham Dental Hospital) • Community staff member did not attend when / as expected
Overall Friends and Family Test (recommendation) and rating report
The Trust-wide Friends and Family Test (FFT) score for the quarter was 92. This confirms 92% of respondents indicated they were extremely likely or likely to recommend the service to another. 91% of respondents also said they considered the service to be excellent or very good. This is from a total of 4326 patients who responded to the FFT question and 4255 who responded to questions about how they would rate the service.
Complaints received
The Trust received 49 formal complaints within this reporting period, with the majority of complaints once again relating to the coordination of care, particularly, poor standards or quality of care. Further detail in this regard is provided within the report.
For this period 100% of complaints were acknowledged within 3 working days and 100% were responded to within the 6 months statutory timescale or as agreed with the complainant. In addition, all complainants were offered meetings throughout the complaint investigation process. University Hospitals Birmingham Service RTT Waits Quality Performance At Trust level, the unfinished 18 week referral to treatment target was achieved in Exception April at 92.5%. The CCG-commissioned treatment functions that did not achieve the Report – May unfinished target were Neurosurgery (82.5%), Ophthalmology (79.5%) and General 2017 Surgery (83.8%).
Neurosurgery performance improved slightly and is expected to continue to show the improvements seen throughout the year. Ophthalmology performance improved slightly also at 79.5% which is the highest it has been since November.
A&E Clinical Quality – Total time spent in A&E - % waiting 4 hours or less
Performance for the A&E 4 hour wait target in April was 82.7% which was slightly below the March performance of 84.6%. There were 9,427 attendances in the month, an average of 314 per day.
Cancer targets – 62 Day GP, 31 subsequent drugs and 62 consultant upgrade
Performance for the Cancer 62 day standard was 76.1% in March compared to 67.1% in February which is the highest it has been since December.
The 98% 31 day subsequent chemotherapy standard was missed again in March with a performance of 94.1%. The breach tolerance is very small for this standard at just 4 patients. A temporary capacity issue was the main problem and the standard is expected to be met again from April.
The 62 day consultant upgrade standard was narrowly missed in March with a performance of 87.6% against a target of 90%, however the standard was achieved overall for the 2016/17 year.
Cancelled operations – 28 day guarantee
There were 2 breaches of the 28 day guarantee in April. This is a reduction from March breaches of 5 and also the lowest amount of breaches since November. A&E 4 hour Over the last 6 months the Unscheduled Care Steering Group has delivered a wait programme of service improvements with the overall objective of increasing performance against the A&E 4-hour wait target.
Reducing demand in A&E
At the beginning of January 2017, the Surgical Assessment Unit (SAU) was moved ward so that its capacity could be increased by 12 trolley spaces. This allowed new specialities to see patients in SAU, thereby reducing the number of specialty expected patients presenting in A&E.
Increasing Capacity in A&E
5 additional cubicle spaces have been created for seeing patients in the Minors part of A&E. This has helped reduce delays in and contributed to an improvement in non-admitted performance in February and March 2017.
Improving flow through the hospital
From the beginning of January 2017, ward 517 has been open to create 24 additional medical beds. This is being operated as a medicine multi-speciality ward with 7-day consultant ward rounds. However there is still an overall gap in medical beds. Since the beginning of January, 43% (3,236) of the Trust’s A&E 4-hour wait breaches were admitted to CDU. Cancer 62 day Performance for the Cancer 62 day standard was reported externally as 76.1% in GP Referral March.
As outlined last month, the 31 day subsequent chemotherapy target was again missed in March. There is a small breach tolerance for this indicator (4 breaches). This was due to a temporary capacity issue and is now resolved. April performance is expected to be within target.
Nursing and Care Homes Data contained in this report is up-to-date and includes all data up to and including June 2017.
Incidents
Incident Reporting and Trends:
Apr 4 Clinical Care (Assessment/Monitoring) 1 Medication 2 Pressure Sore 1 May 6 Clinical Care (Assessment/Monitoring) 2 Medication 2 Pressure Sore 1 Records, Communication & Information 1 Jun 5 Infection Control 1 Medication 1 Pressure Sore 1 Records, Communication & Information 1 Safeguarding 1
Complaints Trends:
Themes/Trends 2016 Apr No complaint May No complaints June No complaints
Summary: There have been 15 incidents reported against Nursing and Care homes since April 2017, with no significant trends identified thus far. Private and 3rd Sector Contracts Data contained in this report is up-to-date and includes all data up to and including June 2017.
Summary:
Private and 3rd Sector Providers Never Events There have been zero Never Events reported by Private and 3rd Sector service providers since April 2017. Serious Incidents There has been 1 Serious Incident reported by Private and 3rd Sector service providers since April 2017, 0 of these were reported in June. The have been no trends identified thus far. Other Incidents There have been 18 incidents reported by Private and 3rd Sector service providers since April 2017. The most prominent trends to emerge are issues with the Quality of Scans and communication with GPs by Health Harmonie (Community Ultrasound Service). Complaints and Concerns There have been 10 Complaints and Concerns reported about Private and 3rd Sector service providers since May 2016. 0 of these were reported in April. Trends reflect the trends identified via the incident reporting route.
Incidents
Never Events There have been zero Never Events reported by Private and 3rd Sector service providers since April 2017.
Serious Incidents Trends There has been 1 Serious Incidents reported by Private and 3rd Sector service providers since April 2017, 0 of these were reported in May. The have been no serious incident trends identified thus far.
Year/Month/Type Count 2017 Apr 0 None 0 May 1 Health Harmonie – Minor Ops 1 Grand Total 1
Other Incidents There have been 18 incidents reported against Private/3rd Sector service providers since April 2017.
Month/Type Count 2017 Apr 7 (CCG) (Private) Health Harmonie (Minor Surgery) 1 Clinical Care (Assessment/Monitoring) 1 (CCG) (Private) Health Harmonie (Ultra Sound) 4 Appointments, Discharge & Transfers 1 Diagnosis & Tests 1 Records, Communication & Information 2 (CCG) (3rd Sector) Forward Thinking Birmingham (LD) 1 Records, Communication & Information 1 (CCG) (Private) West Bourne Centre - Surgery 1 Clinical Care (Assessment/Monitoring) 1 May 8 (CCG) (Private) Health Harmonie (Minor Surgery) 3 Diagnosis & Tests 1 Records, Communication & Information 2 (CCG) (Private) Health Harmonie (Ultra Sound) 3 Clinical Care (Assessment/Monitoring) 1 Records, Communication & Information 2 (CCG) (3rd Sector) Forward Thinking Birmingham (LD) 1 Appointments, Discharge & Transfers 1 (CCG) (3rd Sector) Kaleidoscope Plus - Community Wellbeing 1 Appointments, Discharge & Transfers 1 Jun 3 (CCG) (Private) Health Harmonie (Ultra Sound) 1 Records, Communication & Information 1 (CCG) (Private) Out of Hours GP Service - Primecare 1 Clinical Care (Assessment/Monitoring) 1 (CCG) (3rd Sector) Marie Stopes International 1 Clinical Care (Assessment/Monitoring) 1 Grand Total 18
Complaints There has been 1 Complaints reported about Private and 3rd Sector service providers since April 2017. Trends reflect the trends identified via the incident reporting route.
Month/Type Count (P) Private Sector Contracts 1 (CCG) (Private) Out of Hours GP Service - Primecare 1 Poor Management of Physical Health 1 Grand Total 1
Finance and Performance Committee
Report Topic: Finance and Activity Report as at 30th June 2017 (Month 3 – 2017/18)
Report From: James Green – Chief Finance Officer
Date: Monday 26th July 2017
To provide information to the committee on the financial performance of the CCG for the period of April to Purpose of the Report June 2017.
• Sandwell and West Birmingham CCG’s overall Revenue Resource Limit (annual budget) is £802m. • The CCG has a planned surplus for the year of £19m. This is the maintenance of the cumulative surplus of £21.5m delivered for the financial year 2016/17, less the NHS mandated draw down funding planned for 2017/18 of £2.5m. Key Issues Summary • The CCG’s QIPP target for 2017/18 is £25.1m. • The CCG is currently operating within its Running Cost Allowance of £11.5m. • The funding allocation transfer in relation to practice moves is yet to be agreed and remains within the financial position within reserves.
Members of the Finance and Performance Committee are asked to:
Recommendations - Discuss the content of the report and approve the content. - Approve the content of the report
Executive Summary – CCG Assurance
Commentary Financial Performance • The table opposite is similar to the CCG assurance framework used by NHS England to assess the financial performance of CCGs. The overall Self No. Indicator Assessment performance is rated as green (as less than three indicators are amber).
• The underlying surplus is calculated by taking the forecast financial
1 Underlying Recurrent Surplus 1.9% position, adjusting for the full year effect of expenditure
commitments/savings and removing non-recurrent items. The
Surplus - Year to Date Performance - underlying surplus is 1.9% of total expenditure. This attracts a green 2 0.0% Variance rating.
• The year to date position shows £13k ahead of the planned surplus. 3 Surplus - Full Year Forecast - Variance 0.0%
• The CCG has a planned surplus for the year of £19m. This is the maintenance of the cumulative surplus of £21.5m delivered for the 4 0.5% Non Recurrent - Uncommitted Funds Yes financial year 2016/17, less the draw down funding planned for 2017/18 of £2.5m. 5 QIPP - Year to Date Delivery 100% • The CCG’s running costs allowance expenditure is forecast at £11.4m for 2017/18, producing an under spend of £167k. 6 QIPP - Full Year Forecast 100%
• The CCG is holding £3.4m (0.5% of funds and additional NHS England 7 Running Costs 100% funds) non-recurrently as directed by NHS England per STP guidelines.
These funds are budgeted in month 12. Clear Identification of Risks Against Financial Indicator Met In 8 Delivery & Mitigations Full • The CCG’s run rate is currently £39.6m. This reflects the funding allocation transfer in relation to practice moves that is yet to be agreed 9 Expenditure Run Rate Difference £39.6m and remains within the financial position within reserves.
10 Mental Health Investment Standard No • The CCG is currently failing to meet the mental health investment standard by £2m. This has arisen due to the NHSE target still including Overall: Green the element relating to practices that have transferred to Birmingham South Central CCG, and therefore once the target has been amended, it is expected that the CCG will again achieve this indicator.
1. Financial Position YTD Forecast Annual Budget YTD Budget YTD Actual Forecast Outturn Surplus/(Deficit) Surplus/(Deficit) £000 £000 £000 £000 £000 £000
Allocation 801,860 190,578 185,804 4,772 782,821 19,039
Expenditure Acute 363,276 90,222 90,503 (281) 364,647 (1,371) Community 89,938 22,521 23,339 (818) 95,494 (5,556) Mental Health & Learning Disabilities 96,936 24,234 22,695 1,539 90,507 6,429 Winter Pressures 1,430 167 167 0 1,430 0 Primary Care 90,179 21,131 20,767 364 89,296 883 Prescribing 86,808 21,121 21,008 113 86,851 (43) Better Care Fund 18,746 4,687 4,687 0 18,746 0 Reserves 23,961 (990) 0 (990) 24,471 (510) Running Costs 11,547 2,722 2,637 85 11,380 167
Total Expenditure 782,821 185,815 185,803 12 782,822 (1)
Surplus 19,038 4,760 0 4,760 0 19,038
Commentary Surplus Analysis (£000s) • The CCG’s Revenue Resource Limit for 2017/18 is £802m. £20,000
£18,000 • The year to date position shows £12k ahead of the planned surplus. £16,000 £14,000 £12,000 • The CCG has a planned surplus for the year of £19m. This is the £10,000
maintenance of the cumulative surplus of £21.5m delivered for the financial £8,000 £6,000 year 2016/17, less the NHS mandated draw down funding planned for £4,000 2017/18 of £2.5m. £2,000 £0
• A more detailed breakdown of the financial position can be found in
Appendix 1 of this document, together with details of budget movements Revised Plan Actual between2. Contractareas in Appendix Finance 2.
2. Revenue Resource Limit
The CCG’s Revenue Resource Limit (income) for 2017/18 is £802m. This represents an initial baseline allocation of £771m with further in- year adjustments of £30m. An overview of the allocation adjustments for M3 (June 2017) can be seen below:-
£000 £000 £000 Description Recurrent Non Recurrent Total Revenue Resource Limit May 2017 (Month 2) 773,495 24,591 798,086
June Additional Allocations (M3) Surplus/Deficit Carry Forward - 2016/17 Final Outturn 14 - 14 Third Sector Provider Contract adjustment with Bham CCGs - 953 - - 953 Transforming Care Partnership - NHS England Funding - 81 81 Tranformation Fund from NHSE 790 - 790 Recurrent GP Premises Funding 222 - 222 Reception & Clerical Training - (Training Care Navigators and Medical Assistants) - 98 98 Diabetes Treatment and Care Transformation Fund - Intervention funded - 7 7 NHS WiFi - national programme for primary care - 223 223 Market Rents Adjustment - 206 267 Paramedic Rebanding Additional Funding 2017-18 - 339 339 TB Allocations Qtr 1 - 59 59 HSCN - GP Funding - 251 251 Children & Young People IAPT Trainee Staff Support Costs - 293 293 Helpforce Funding for Sandwell & West Birmingham Trust - 51 51 Resilience Ambulance Funding 2017/18 - 2,032 2,032
73 3,640 3,774
Revenue Resource Limit June 2017 (Month 3) 773,568 28,231 801,860
3. Practice Moves
As discussed in previous months, work is still on-going with Birmingham South Central CCG to agree an appropriate allocation transfer for the practice movements.
In order to ensure that contract variations can be actioned and costs can move appropriately between the organisations, it has been agreed for an provisional historic cost basis to be used for an initial allocation change in M4 (July 2017) as shown below:
This allocation transfer will be finalised and further changes made later on in the financial year.
A detailed proposal to deal with the recurrent allocation transfer will be presented to the next meeting of the Finance & Performance Committee. 4. Contract Finance
The table below details the CCG’s higher value contracts. The main contracts to note are Sandwell & West Birmingham Hospitals and Dudley Group Hospitals.
YTD Forecast Forecast Annual Plan YTD Budget YTD Actual Acute Surplus/(Deficit) Outturn Surplus/(Deficit) £000 £000 £000 £000 £000 £000 Sandwell and West Birmingham NHS Trust 234,059 58,515 58,515 0 234,059 0 University Hospitals Birmingham NHS FT 24,686 6,172 6,097 75 24,686 0 Dudley Group of Hospitals NHS FT 35,315 8,829 9,145 (317) 36,382 (1,067) Walsall Hospitals NHS Trust 8,263 2,066 1,987 79 7,948 315 Heart of England NHS FT 9,070 2,267 2,132 136 8,709 361 Birmingham Women's and Children's Hospital NHS FT 13,961 3,490 3,479 12 14,292 (332) Royal Orthopaedic Hospital NHS FT 5,451 1,363 1,393 (30) 5,522 (71) Royal Wolverhampton Hospital NHS Trust 2,265 566 494 73 2,185 80 West Midlands Ambulance Services NHS Trust 19,666 4,324 4,678 (355) 20,397 (731) Worcester Acute Hospitals NHS Trust 376 94 82 12 322 54 University Hospitals of North Midlands NFT 311 78 80 (3) 321 (11) Shrewsbury and Telford Hospital NHS Trust 171 43 43 (0) 171 (0) Extended Choice 3,596 899 897 2 3,596 (0)
YTD Forecast Forecast Annual Plan YTD Budget YTD Actual Community Surplus/(Deficit) Outturn Surplus/(Deficit) £000 £000 £000 £000 £000 £000 Sandwell & West Birmingham Hospitals 27,171 6,793 6,793 0 27,171 0 Birmingham Community Healthcare Trust 17,903 4,476 4,243 233 17,671 233 Walsall Hospitals NHS Trust 321 80 83 (2) 321 0 Royal Wolverhampton Hospital NHS Trust 97 24 24 (0) 97 (0) Dudley Group of Hospitals NHS FT 371 93 85 8 349 22
YTD Forecast Forecast Annual Plan YTD Budget YTD Actual Mental Health Surplus/(Deficit) Outturn Surplus/(Deficit) £000 £000 £000 £000 £000 £000 Black Country Partnership 35,705 8,926 8,928 (2) 35,711 (6) Dudley & Walsall Mental Health 1,887 472 472 (0) 1,887 (0) Birmingham & Solihull Mental Health 999 250 241 9 1,005 (6) Forward Thinking Birmingham (BW&C) 5,430 1,357 1,352 5 5,425 5
5. Prescribing Performance
Commentary Prescribing - Outturn • The prescribing budget for 2017/18 is £86.8m,
with expenditure currently forecast of £86.6m.
• Information has yet to be received from the
Actual £000 Prescription Pricing Authority for activity relating Budget £000 to 2017/18.
• The graph below shows a comparison of prescribing expenditure over the financial years.
86,780 86,790 86,800 86,810 86,820 86,830 86,840 86,850 86,860 2013/14 to 2017/18.
Prescribing - Expenditure
£7,400,000
£7,200,000 2014/15 2015/16 £7,000,000 2016/17
£6,800,000 2017/18
£6,600,000
£6,400,000
£6,200,000
£6,000,000
6. Primary Care
The CCG primary care expenditure is currently forecast to breakeven with total expenditure against its delegated resource of £80m.
The CCG also has the following further plans in relation to the GP resilience programme, enhanced services and collaborative fees:
GP Resilience Programme YTD Surplus/ Forecast Forecast Surplus/ Cost (£) Annual Plan YTD Plan YTD Actual (Deficit) Outturn (Deficit) £000 £000 £000 £000 £000 £000 Seven Day Access/ Winter Appointments 0 0 463 (463) 883 (883) Transformational Support 853 0 23 (23) 857 (4) Improving Access 3,688 530 69 462 1,952 1,736 GP Resilience Programme 0 0 5 (5) 5 (5) Care Navigators 98 25 6 18 98 0 GP Consultation Software 0 0 2 (2) 2 (2) NHS WiFI 223 56 0 560 223 0 Total GP Resilence Programme 4,861 611 568 43 4,020 841
Non-Delegated Resource YTD Surplus/ Forecast Forecast Surplus/ Cost (£) Annual Plan YTD Plan YTD Actual (Deficit) Outturn (Deficit) £000 £000 £000 £000 £000 £000 Enhanced Services 90 23 23 0 90 0 Collaborative Fees 286 72 72 0 288 (2) Total Non Delegated 376 95 95 - 378 (2)
7. Quality Innovation Price Productivity (QIPP)
Commentary • The CCG’s overall QIPP target for the year is £25.1m. • Details of the schemes can be found in the table below.
Annual Year to Date Forecast Outturn QIPP Schemes Plan Plan Actual Variance Plan Actual Variance £000 £000 £000 £000 £000 £000 £000 Transactional Acute services 7,585 1,185 1,185 0 7,585 7,417 (168) Mental Health Services 562 139 184 45 562 562 0 Community Health Services 2,529 633 477 (156) 2,529 1,906 (623) Continuing Care Services 795 198 267 69 795 1,489 694 Primary Care services 2,270 567 567 0 2,270 2,270 0 Other Programme Services 4,181 0 0 0 4,181 4,181 0 Primary Care Co-Commissioning 700 174 269 95 700 1,080 380
Total Transactional Schemes 18,622 2,896 2,949 53 18,622 18,905 283 Transformational Acute services 3,773 947 948 1 3,773 3,773 0 Mental Health Services 1,004 252 252 0 1,004 1,004 0 Community Health Services 628 156 169 13 628 628 0 Continuing Care Services 218 54 72 18 218 218 0 Primary Care services 680 173 185 12 680 724 44 Other Programme Services 150 0 0 0 150 150 0
Total Transformational Schemes 6,453 1,582 1,625 43 6,453 6,497 44 Other Other Gains & Benefits 0 0 (96) (96) 0 (327) (327)
Total Other Schemes 0 0 (96) (96) 0 (327) (327)
Total QIPP Schemes 25,075 4,478 4,478 0 25,075 25,075 0
8. Statement of Financial Position
30 June 2017 £'000 Comments: Non-Current Assets 0 Total Non-Current Assets 0 The CCGs Statement of Financial Position Current Assets (SOFP), or Balance Sheet, provides a Inventory 0 Trade and Other Receivables 1,522 snapshot of the CCG’s financial position Accrued Income and Prepayments 3,443 on the 30th June 2017. The SOFP is made VAT 514 Bad Debt Provision (121) up of two parts which must always equal Cash and Cash Equivalents 12 each other. The top part (total assets Total Current Assets 5,370 employed) shows the CCG’s assets and Total Assets 5,370 liabilities (what the CCG owns and is Current Liabilities owed) and the bottom part (total Trade and Other Payables (13,488) Accrued Expenditure and Deferred Income (14,907) taxpayers’ equity) which shows how the Prescribing (14,362) Provisions (5,684) CCG has been financed. The SOFP Tax and Social Security (229) statement is set out in the table to the left. Total Current Liabilities (48,670)
Non-Current Assets plus/less Net Current The balance sheet cash book balance was Assets/Liabilities (43,300) £12k at the end of June 2017. This differs Non-Current Liabilities from the bank balance shown in section 9 Trade and Other Payables 0 Provisions 0 due to transaction timing differences of Total Non-Current Liabilities 0 £87k. Assets Less liabilities (43,300)
Financed by Taxpayers' Equity Additional detailed analysis of the SOFP General Fund (43,300) Revaluation Reserve 0 can be found in appendix 3. Charitable Reserves 0 Total Taxpayers' Equity (43,300)
9. Cash Efficiency
Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's ACTUAL BANK BALANCE 10 417 328 0 0 0 0 0 0 0 0 Funding from DH 54,613 55,200 57,500 0 0 0 0 0 0 0 0 Adjustments to main funding 0 2,400 0 0 0 0 0 0 0 0 0 Total cash available 54,623 58,017 57,828 0 0 0 0 0 0 0 0
Less net payments via Government Banking Service 54,206 57,689 57,729 0 0 0 0 0 0 0 0 0 0 0 0 Total net payments 54,206 57,689 57,729 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Closing BANK BALANCE 417 328 99 0 0 0 0 0 0 0 0 Actual % of closing balance (compared to opening balance 0.76% 0.60% 0.17% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% plus drawdown)
Commentary
The CCG has a bank balance of £99k at the end of June 2017. This balance was within the 1.25% of in month funding ceiling set by NHS England.
10. Better Payment Practice Code 2017-18 (April 2017 to June 2016-17 (April 2016 to March Commentary 2017) 2017) 30-June -17 30-June-17 31-Mar-17 31-Mar-17 Number £000 Number £000 The CCG is required to pay 95% of all valid invoices Non-NHS Payables: CCG within 30 days. Total Non-NHS trade invoices paid in the year 3,814 47,786 16,449 192,827 Total Non-NHS trade invoices paid within target 3,783 46,838 16,068 186,980 Percentage of CCG Non-NHS Trade Invoices Paid 99.19% 98.02% 97.68% 96.97% In Month Within Target NHS Payables: CCG During June 2017, 1,612 invoices were registered with a Total NHS trade invoices paid in the year 871 124,015 4,025 491,580 combined value of £58.2m. However, 1,594 invoices Total NHS trade invoices paid within target 846 122,258 3,959 488,595 (99%) were processed within 30 days. Percentage of CCG NHS Trade Invoices Paid Within 97.13% 98.58% 98.36% 99.39% Target
Year-to-date
Better Payment Practice Code performance for the period ended June 2017 showed that 99% of Non NHS invoices were paid within 30 days (with 98% in value terms) paid Invoices Paid on time.
101.00% Better Payment Practice Code performance for the period 100.00% ended June 2017 showed that 97% of NHS invoices were 99.00% % Passed paid within 30 days (with 99% in value terms) paid on 98.00% time. 97.00% % Amount 96.00% Passed Overall Performance 95.00% 94.00% % Target The cumulative year-to-date performance is significantly 93.00% above the required target of 95%. 92.00%
11. Conclusion
In conclusion, the key points to note from this report are:-
• Sandwell and West Birmingham CCG’s overall Revenue Resource Limit (annual budget) is £802m.
• The CCG has a planned surplus for the year of £19m. This is the maintenance of the cumulative surplus of £21.5m delivered for the financial year 2016/17, less the NHS mandated draw down funding planned for 2017/18 of £2.5m.
• The CCG’s QIPP target for 2017/18 is £25.1m.
• The CCG is currently operating within its running cost allowance of £11.5m.
• The funding allocation transfer in relation to practice moves is yet to be agreed and remains within the financial position within reserves.
12. Recommendations
Members of the Finance and Performance Committee are asked to:
• Discuss the content of the report; • Approve the content of the report.
Contact Officers
James Green – Chief Finance Officer – [email protected] - Tel: 0121 612 1568
David Hughes - Deputy Chief Finance Officer – [email protected] – Tel: 07872055022
Laura Mainwaring – Head of Financial Management – [email protected] – Tel: 07872055060 Appendix One YTD Forecast Annual Budget YTD Budget YTD Actual Forecast Outturn Surplus/(Deficit) Surplus/(Deficit) £000 £000 £000 £000 £000 £000 SOURCES OF FUNDING Confirmed Allocations - Commissioning (702,812) (165,812) (165,812) 0 (702,812) 0 Confirmed Allocations - Primary Care Co-Commissioning (80,010) (20,003) (20,003) 0 (80,010) 0 In Year Allocations (19,038) (4,760) (4,760) 0 (19,038) 0 Potential Allocations 0 0 0 0 0 0 Total Revenue Resource Limit (801,860) (190,575) (190,575) 0 (801,860) 0 APPLICATIONS - PROGRAMME Acute Services NHS Acute Services Sandwell and West Birmingham NHS Trust 234,059 58,515 58,515 0 234,059 0 University Hospitals Birmingham NHS FT 24,686 6,172 6,097 75 24,686 0 Dudley Group of Hospitals NHS FT 35,315 8,829 9,145 (317) 36,382 (1,067) Walsall Hospitals NHS Trust 8,263 2,066 1,987 79 7,948 315 Heart of England NHS FT 9,070 2,267 2,132 136 8,709 361 Birmingham Women's and Children's Hospital NHS FT 13,961 3,490 3,479 12 14,292 (332) Royal Orthopaedic Hospital NHS FT 5,451 1,363 1,393 (30) 5,522 (71) Royal Wolverhampton Hospital NHS Trust 2,265 566 494 73 2,185 80 West Midlands Ambulance Services NHS Trust 19,666 4,324 4,678 (355) 20,397 (731) Worcester Acute Hospitals NHS Trust 376 94 82 12 322 54 University Hospitals of North Midlands NFT 311 78 80 (3) 321 (11) Shrewsbury and Telford Hospital NHS Trust 171 43 43 0 171 0 Total NHS Acute Services 353,594 87,807 88,125 (318) 354,994 (1,402) Acute Services Other Non Contracted Activity & Out of Area 4,907 1,377 1,377 0 4,907 0 Individual Funding Requests 50 13 0 13 38 12 Extended Choice Contracts 3,596 899 897 2 3,596 0 Other Acute Services 1,132 128 105 22 1,113 19 Total Acute Services Other 9,685 2,417 2,379 37 9,654 31
Total Acute Services 363,279 90,224 90,504 (281) 364,648 (1,371)
Commissioned Community Services NHS Community Services Sandwell & West Birmingham Hospitals 27,171 6,793 6,793 0 27,171 0 Birmingham Community Healthcare Trust 17,903 4,476 4,243 233 17,671 233 Walsall Hospitals NHS Trust 321 80 83 (2) 321 0 Royal Wolverhampton Hospital NHS Trust 97 24 24 0 97 0 Dudley Group of Hospitals NHS FT 371 93 85 8 349 22 NHS Other 688 172 215 (43) 756 (68) Total NHS Community Services 46,551 11,638 11,443 196 46,365 187 Community Assessment NHS 111 1,719 430 430 0 1,719 0 Clinical Assessment & Urgent Care Centres 2,875 713 644 69 2,820 55 Total Community Assessment 4,594 1,143 1,074 69 4,539 55 Continuing Healthcare Continuing Healthcare - Physical Disabilities 11,195 2,799 4,013 (1,214) 16,943 (5,748) Continuing Healthcare - Children 637 159 157 2 657 (20) Continuing Healthcare - Staffing 1,619 405 362 42 1,613 6 Continuing Healthcare - Joint Funded 646 161 176 (15) 621 24 Personal Health Budgets 916 229 211 18 895 21 Funded Nursing Care 6,876 1,719 1,650 69 6,858 18 Looked After Children 794 199 116 82 753 41 Total Continuing Healthcare 22,683 5,671 6,685 (1,016) 28,340 (5,658) Other Community Services Interpreting Services 913 228 269 (41) 1,077 (164) Reablement 278 70 70 0 279 0 Safeguarding (Programme) 1,138 284 252 32 1,099 39 Carers 527 132 125 6 501 26 Hospices 236 59 62 (3) 239 (2) Palliative Care 3 1 1 0 3 0 Intermediate Care 1,489 372 325 47 1,471 18 Commissioning Schemes 66 59 53 6 60 6 Patient Transport 1,936 484 310 174 1,619 317 Non NHS Community Contracts 5,713 1,428 1,756 (328) 6,216 (503) Total Other Community Services 12,299 3,117 3,223 (107) 12,564 (263) Property Costs NHS Property Costs 3,810 953 913 40 3,685 126 Total Property Costs 3,810 953 913 40 3,685 126 Total Community Services 89,937 22,522 23,338 (818) 95,493 (5,553)
Appendix One YTD Forecast Annual Budget YTD Budget YTD Actual Forecast Outturn Surplus/(Deficit) Surplus/(Deficit) £000 £000 £000 £000 £000 £000 Mental Health & Learning Disabilities NHS Trust Contracts Black Country Partnership 35,705 8,926 8,928 (2) 35,711 (6) Dudley & Walsall Mental Health 1,887 472 472 0 1,887 0 Birmingham & Solihull Mental Health 999 250 241 9 1,005 (6) Forward Thinking Birmingham 5,430 1,357 1,352 5 5,425 5 Total NHS Trust Contracts 44,021 11,005 10,993 12 44,028 (7) Mental Health Birmingham Joint Commissioning arrangements 21,369 5,342 5,420 (78) 21,678 (309) Assessments 0 0 2 (2) 7 (7) CAMHS 319 80 55 25 338 (19) IAPT 674 168 144 24 674 0 Mental Health NCA 256 64 64 0 256 0 Mental Health Non NHS 1,380 345 299 46 1,380 0 Mental Health Placements 11,699 2,925 2,565 360 9,170 2,529 Mental Health Section 117 1,334 333 245 89 1,335 (1) Total Mental Health 37,031 9,257 8,794 464 34,838 2,193 Learning Disabilities Learning Disability Placements 7,881 1,966 932 1,034 3,577 4,305 Learning Disability Joint Commissioning 6,135 1,538 1,560 (22) 6,239 (104) Learning Disability Section 117 1,867 467 416 50 1,825 41 Total Learning Disabilities 15,883 3,971 2,908 1,062 11,641 4,242
Total Mental Health & Learning Disabilities 96,935 24,233 22,695 1,538 90,507 6,428
Winter Pressures Winter Pressure Schemes 1,430 167 167 0 1,430 0
Total Winter Pressures 1,430 167 167 0 1,430 0
Primary Care GP Commissioning (Delegated) 80,010 19,193 18,951 242 80,010 0 Local Incentive Schemes 90 23 23 0 90 0 Out of Hours 3,113 778 767 11 3,069 44 GP IT 1,818 455 386 69 1,818 0 Collaborative Commissioning 286 72 72 0 288 (2) Primary Care Non Recurrent 4,861 611 568 43 4,020 841
Total Primary Care 90,178 21,132 20,767 365 89,295 883
Prescribing Prescribing Practice Budgets 80,772 19,612 19,684 (72) 80,852 (81) Prescribing Other 4,310 1,078 919 159 4,290 20 Home Oxygen 921 230 241 (11) 930 (9) Medicines Management Clinical 806 201 165 37 779 27 Total Prescribing 86,809 21,121 21,009 113 86,851 (43)
Better Care Fund Better Care Fund 18,746 4,687 4,687 0 18,746 0 Total Better Care Fund 18,746 4,687 4,687 0 18,746 0
Reserves, Contingency & QIPP Reserves, Contingency & QIPP 2,642 (990) 0 (990) 3,152 (510) Non Recurrent Reserve 3,415 0 0 0 3,415 0 Practice Moves Reserve 17,904 0 0 0 17,904 0 Total Reserves 23,961 (990) 0 (990) 24,471 (510)
TOTAL PROGRAMME EXPENDITURE 771,275 183,096 183,167 (73) 771,441 (166)
APPLICATIONS - RUNNING COSTS CCG Running Costs 10,997 2,585 2,505 80 10,820 177 CCG Running Costs - CSU 464 115 110 5 474 (10) CCG Running Costs - NHS 111 86 22 22 0 86 0 TOTAL RUNNING COSTS 11,547 2,722 2,637 85 11,380 167 TOTAL EXPENDITURE 782,822 185,818 185,804 12 782,821 1 Required Surplus Planned Surplus 19,038 4,760 0 4,760 0 19,038 Planned Required Surplus 19,038 4,760 0 4,760 0 19,038 Total Under/(Over) Spend v RRL 801,860 190,578 185,804 4,772 782,821 19,039
GOVERNING BODY/COMMITTEE Report Title: Performance Report Report author and Title: Martin Stevens Head of Business and Contract Performance Date of Governing Body/ Committee: Contact Details: Agenda enclosure no: [email protected] 0121 612 4138 Sign off from Chief Officers: (Before the report is presented to the Governing Body any implications relating to Finance, Quality and Commissioning must be agreed and signed by the Chief Officer. (see guidance note) Without this information the report will not be taken to the Governing Body)
Chief Finance Officer:James Green
Chief Officer for Quality:
Chief Officer for Operations:
Chief Officer for Partnership:
Supporting Documents/further Reading: (Highlight any documents or further reading for members which supports this report)
Previous Decision (Inform the Governing Body/Committee if the paper has been reviewed or monitored by another committee and their recommendation or decision)
Summary of purpose and scope of the report: (Highlight key points you wish to bring to the attention of members)
The Governing Body/ Committee needs to be clear, from reading this cover sheet what the key message is and should highlight both positive and negative impact on services or the CCG.
Recommendations:
The Governing Body/Committee are requested to: Action Approve X Assurance Decision Conflicts of Interests: The recommended action by the author of the report is: No conflict identified Conflict noted, conflicted party can participate in clinical discussion but not decision Conflict noted, conflicted party can remain in committee but not participate in discussion Conflicted party is excluded from discussion (this would be rare circumstances only) Please state rationale for above decision:
Strategic Priorities related to the report: Quality & Safety Finance & Performance X Partnership Strategic Commissioning and Redesign Organisational Development Primary Care Co-Commissioning Collaborative Commissioning Implications: Financial State any financial implications for the CCG Assurance Framework Performance Risks and Legal Obligations State any risks or legal implications related to this document. Ensure the risk is entered on the CCG risk register Equality and Diversity Statutory and External Influences Further implications not stated Detail any further implications including resources and training Consultation: Patients Staff Committees Public Partners Sponsored By: (Chief Officer or Committee Chair) Date Report received for Governing Body/Committee
Report Topic: Key Indicators Performance Report – data up to June 2017
Report From: James Green – Chief Finance Officer Date 24th July 2017
To provide information to the Board on the performance of the CCG against key indicators for the financial years up Aim of Report to 2017/18.
- IAPT Discussion Points - A & E - Anti-microbial resistance prescribing
Members of the Committee are asked to: RECOMMENDATIONS 1. Discuss the contents of the report 2. Approve the contents of the report Contents
Section Page
Key Messages 2
Outcomes Domain 3 3 Outcomes Domain 5 4 The Forward View into action - Annex B Measures 5 IAF Better Health 14 IAF Better Care 15 Legend 16
1 Key Messages
Summary: Our lead roles and responsibilities:
Sandwell and West Birmingham Clinical Commissioning Group (SWB CCG) is the lead commissioner on; IAPT NHS 111 across the West Midlands. All three IAPT targets were achieved in March 2017 and local data for April and May shows performance has been sustained. WMAS across the West Midlands Home Oxygen across the West Midlands. Accident & Emergency (A&E) Urgent care for the Black Country
A&E performance (83.46%) continues to be below both the 95% national target and the local STF trajectory. The planned changes at BMEC are now contributing to the decreased performance (expected impact was a deterioration of 3%) however the remedial action plan put forwards did account for this. In accordance with the plan, 2 challenge weeks were held by SWBHT in June, Sandwell and West Birmingham CCG is leading the reconfiguration of Stroke services across Birmingham and the Black Country on focussing on professional standards and responsiveness to ED patients. They both initially demonstrated improvements however behalf of all commissioners. this was not sustained. Stroke Anti-microbial resistance prescribing Both indicators ended the year below the Quality Premium threshold. Our significant CCG redesign projects are;
Community Nursing Diabetes Right care right here – As part of the partnership programme an on-going process of redesigning services with a stronger Community focus.
2 Outcomes Domain 3. Helping people to recover from episodes of ill health or following injury
Target Previous Year Current Monitoring Year Actual Data FOT Ref Indicator Basis Mth/Qtr/ Green Red Statistic A M J J A S O N D J F M A M J J A S O N D J F M Period YTD RAG Annual
Improving recovery from mental health conditions 4.78% 4.00% 4.72% E.A.3 IAPT - People entering treatment 3.75% < 3.75% % CCG Q3 16-17 4.72% 13.50% G
54.55% 55.51% 56.23% E.A.S.2 IAPT - Moving to recovery 50% < 50% % CCG Q3 16-17 56.23% 55.54% G
50.84% 53.88% 55.61% E.A.S.2 IAPT - Moving to recovery 50% < 50% % BCPFT Q3 16-17 55.61% 53.56% G
Waiting times The proportion of people that wait 6 weeks or less from referral to entering a 59.60% 71.19% 78.62% E.H.1_A1 course of IAPT treatment against the 75% < 75% % CCG Q3 16-17 78.62% 69.80% G number of people who finish a course of treatment in the reporting period. The proportion of people that wait 18 weeks or less from referral to entering a 84.34% 91.53% 90.94% E.H.2_A2 course of IAPT treatment against the 95% < 95% % CCG Q3 16-17 90.94% 88.94% G number of people who finish a course of treatment in the reporting period
Updated
Entering Treatment CCG – Q4 data will not be available until 25th July. March national data showed achievement of the monthly plan and a year to date performance of 17.37% against the 15% plan. National quarter data can be slightly different as it includes rounding of the three months, but this should not affect the overall performance. Local data for April and May was also above the planned level. The target for 17/18 has increased to 16.8%.
Moving to recovery Both the CCG and BCPFT are above plan in March with 62.2% and 55.56%. Local data for April and May is also above the 50% target.
Waiting Times Performance against both the 6 and 18 weeks was above the national target in March, sufficiently so that any discrepancies we might see in the quarter data should still mean we have achieved the national targets as a CCG. Local data for April and May shows sustained performance.
3 Outcomes Domain 5. Treating and caring for people in a safe environment and protecting them from avoidable harm
Target Previous Year Current Monitoring Year Actual Data FOT Ref Indicator Basis Mth/Qtr/ Green Red Statistic A M J J A S O N D J F M A M J J A S O N D J F M Period YTD RAG Annual
Improvement Areas Reducing the incidence of avoidable harm 0 1 1 2 2 3 3 4 4 4 4 4 1 1 2 CCG YTD Jun-17 1 2 R E.A.S.4 MRSA Zero 0 Number 0 0 0 0 0 0 0 1 2 2 2 2 0 0 0 SWBHT YTD Jun-17 0 0 G
14 20 34 40 47 58 73 83 94 102 107 109 9 19 20 <= 109 Number CCG YTD Jun-17 1 20 G E.A.S.5 Cdiff Reduce 2 3 5 8 11 14 16 19 20 20 21 21 1 3 3 <= 30 Number SWBHT YTD Jun-17 0 3 G
Updated
MRSA CCG - There was one non-acute infection in June at UHB. SWBHT - There were no acute infections in June.
Cdiff CCG - There was one acute infection in June at DGFT. SWBHT - There were no acute infections at SWBHT in June.
4 The Forward View into action - Annex B Measures
Target Previous Year Current Monitoring Year Actual Data FOT Ref Indicator Basis Mth/Qtr/ Green Red Statistic A M J J A S O N D J F M A M J J A S O N D J F M Period YTD RAG Annual
Incomplete Referral to Treatment pathways 92.59% 92.75% 92.98% 92.43% 92.25% 91.41% 90.70% 91.31% 89.79% 91.15% 92.30% 93.04% 92.84% 93.62% CCG May-17 93.62% 93.24% G E.B.3/ % of incomplete pathways within 18 92% < 92% % 129a weeks 92.35% 92.50% 92.72% 92.06% 92.03% 91.20% 90.04% 90.58% 88.93% 90.33% 92.13% 93.09% 92.77% 93.79% SWBHT May-17 93.79% 93.28% G
4 6 8 5 3 3 9 7 9 7 11 9 14 15 CCG May-17 15 29 R Number of 52 week Referral to E.B.S.4 0 > 0 Number Treatment Pathways - Incomplete 0 2 2 0 0 1 2 2 2 1 3 2 3 3 SWBHT May-17 3 6 R
Updated RTT - Incomplete - CCG RTT - Incomplete > 52 wks - CCG 95% 20 Incompletes
90% 15 CCG - Overall the CCG met the target with 93.62%. 2147 patients out of 33654 waited over 18 weeks. General Surgery, T&O, Neurosurgery & Plastic surgery are still failing as individual specialties for 85% 10 the CCG. 80% 5 SWBHT - Overall the Trust met the national target with 94.2%. 2024 patients waited over 18 weeks, 591 over 26 weeks. Individual specialties continuing to fail were T & O, Oral Surgery, Plastic Surgery 75% 0 and Dermatology. Other than T&O the Trust should be specialty compliant by the end of July. The T&O trajectory will be re-visited at the next contract review meeting. Jul-16 Jul-17 Jan-17 Jan-18 Jun-16 Jun-17 Oct-16 Oct-17 Apr-16 Apr-17 Jul-16 Sep-16 Jul-17 Feb-17 Sep-17 Feb-18 Dec-16 Dec-17 Aug-16 Aug-17 Nov-16 Nov-17 Mar-17 Mar-18 Jan-17 Jan-18 Jun-16 Jun-17 May-16 May-17 Oct-16 Oct-17 Apr-16 Apr-17 Sep-16 Feb-17 Sep-17 Feb-18 Dec-16 Dec-17 Aug-16 Aug-17 Nov-16 Nov-17 Mar-17 Mar-18 May-16 May-17 % < 18 wks National Target Number > 52 wks National Target 52 week waits
CCG - 15 patients waited over 52 weeks. 13 at ROH, a member of the contracting team attended the last contract review meeting at ROH, and was satisfied that the delays were being managed by the RTT Incomplete - SWBH RTT- Incomplete >52 wks - SWBH Trust and were mostly down to patient choice. A representative from NHSE also routinely attends the meetings and a recovery trajectory is being looked at. We have asked for exception reports to be 95% 4 submitted. 2 patients waited at SWBHT in Dermatology, the first mainly due to the delay to 1st out patient appointment, the second had an incorrect outcome at biopsy, which is a staff training issue and also a delay from histology report to follow-up, Exception reports are attached showing the detail. 90% 3
85% 2 SWBHT - 3 patients waited over 52 weeks, 2 SWBCCG patients in Dermatology, see note above. Plus one Birmingham South Central patient in Urology, this was because of a clock restart issue which was 80% 1 down to staff training, exception report attached showing details.
75% 0 Jul-16 Jul-17 Jan-17 Jan-18 Jun-16 Jun-17 Oct-16 Oct-17 Apr-16 Apr-17 Sep-16 Feb-17 Sep-17 Feb-18 Dec-16 Dec-17 Aug-16 Aug-17 Nov-16 Nov-17 Mar-17 Mar-18 May-16 May-17
% < 18 wks National Target Number > 52 wks National Target
5 The Forward View into action - Annex B Measures Cont.…
Target Previous Year Current Monitoring Year Actual Data FOT Ref Indicator Basis Mth/Qtr/ Green Red Statistic A M J J A S O N D J F M A M J J A S O N D J F M Period YTD RAG Annual
Diagnostic test waiting times 0.43% 0.25% 0.39% 0.43% 1.07% 1.43% 0.95% 0.98% 1.85% 1.62% 0.65% 1.06% 1.97% 1.21% CCG May-17 1.21% 1.58% G % waiting 6 weeks or more for a E.B.4 0.99% > 0.99% % diagnostic test 0.32% 0.11% 0.16% 0.29% 0.85% 1.37% 0.96% 0.83% 1.41% 0.96% 0.26% 1.29% 1.77% 0.60% SWBHT May-17 0.60% 1.18% G
Updated Diagnostic Test Waiting Times - CCG Diagnostic Test Waiting Times - SWBH 2.5% 2.0% 1.8% CCG 2.0% 1.6% 1.4% The CCG failed to meet the target in May with 1.21%. There were 99 over 6 weeks waiters. 12 waited over 13 weeks, 9 MRI and 1 in each Colonoscopy, Urodynamics and Computed Tomography. 5 were 1.5% 1.2% direct referrals to InHealth MRI and being followed up by the contract lead. Individual specialties failing were Colonoscopy, Cystoscopy, Gastroscopy, Computed tomography, MRI, Non-obstetric 1.0% Ultrasound, Cardiology and urodynamics. 1.0% 0.8% 0.6% 0.5% 0.4% 0.2% 0.0% 0.0% SWBHT Jul-16 Jul-16 Jul-17 Jul-17 The Trust met the national target in May with 0.6%. There were 46 over 6 week waiters, 1 patient waited over 13 weeks in Colonoscopy. Echocardiography and CT scans failed as individual specialties Jan-17 Jan-17 Jan-18 Jan-18 Jun-16 Jun-16 Jun-17 Jun-17 Oct-16 Oct-16 Oct-17 Oct-17 Apr-16 Apr-16 Apr-17 Apr-17 Sep-16 Sep-16 Feb-17 Sep-17 Feb-17 Sep-17 Feb-18 Feb-18 Dec-16 Dec-16 Dec-17 Dec-17 Aug-16 Aug-16 Aug-17 Aug-17 Nov-16 Nov-16 Nov-17 Nov-17 Mar-17 Mar-17 Mar-18 Mar-18 May-16 May-16 May-17 May-17 but the numbers waiting are coming down and will continue to be addressed through the contract review meetings. Monthly Actual National Target Monthly Actual National Target
A & E Waiting Times < 4 hours % of patients who spend 4 hours or less 91.40% 92.88% 91.31% 88.81% 89.67% 89.14% 86.05% 82.84% 81.94% 84.19% 82.27% 85.32% 84.95% 81.57% 83.46% E.B.5 94.54% < 94.54% % SWBHT Jun-17 83.46% 83.31% R in A & E
Total number of patients who have 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 E.B.S.5 waited over 12 hours in A&E from 0 > 0 Number SWBHT Jun-17 0 0 G decision to admit to admission
Updated % < 4hrs in A&E - SWBH 100% A&E performance (83.46%) continues to be below both the 95% national target and the local STF trajectory. The planned changes at BMEC are now contributing to the decreased performance (expected impact was a deterioration of 3%) however the remedial action plan put forwards did account for this. In accordance with the plan, 2 challenge weeks were held by SWBH in June, focussing on professional standards and responsiveness to ED patients. They both initially demonstrated improvements however this was not sustained. 95%
The number of people that attended A&E in June was 18,228, a decrease from May and below the level of activity seen in June 2016 (18,702). The main reasons for ED breaches continue to be due to 90% delays in clinical decision making, ED cubicles full, awaiting a bed on AMU and “other ED delays”. (The definition of Other ED delays is Not Referred within 180mins AND does not meet any other ED reason). Commissioners have noted an increase in the number of unfilled nursing shifts across the trust in June, potentially due to an enacted decision to stop using a particular agency.
85% The trust continue to report that additional bed capacity is open, an average of 45 per week in June (down from 63 per week in May) however existing staffing resource is being utilised to cover the expanded bed base. The proportion of medically fit patients within the bed base in June has increased slightly; on average there were 64 medically fit patients per day in the acute bed based compared 80% to 60 in May. However, the number of medical discharges in June was higher than the previous month with an average of 61 per day (compared to 51 a day in May). In June there were 483 days delays resulting from delayed transfers of care, a small increase from May. Of these, 155 (32%) were attributable to health, 326 (67.5%) to social care and 2 were joint delays.
75% Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 There were zero 12 hour decision to admit breaches and we were only notified of four cases breaching the 8 hour period in June, all were at the City site.
Monthly Actual National Target
6 The Forward View into action - Annex B Measures Cont.…
Target Previous Year Current Monitoring Year Actual Data FOT Ref Indicator Basis Mth/Qtr/ Green Red Statistic A M J J A S O N D J F M A M J J A S O N D J F M Period YTD RAG Annual
Cancer - 2 week wait 94.73% 95.85% 96.10% 94.15% 95.18% 93.70% 94.75% 94.09% 95.75% 95.75% 94.40% 94.65% 95.18% 93.86% CCG May-17 93.86% 94.52% G E.B.6 All cancer two week wait 93% < 93% % 95.90% 95.41% 95.87% 94.59% 94.91% 93.01% 93.82% 93.49% 94.51% 95.34% 94.42% 93.96% 94.81% 93.15% SWBHT May-17 93.15% 93.95% G
96.71% 96.14% 98.01% 96.82% 92.86% 93.84% 93.98% 97.25% 95.76% 95.43% 96.65% 94.32% 95.93% 95.16% CCG May-17 95.16% 95.53% G E.B.7 Two week wait for breast symptoms 93% < 93% % 98.11% 96.75% 97.06% 97.58% 94.19% 93.43% 93.24% 96.41% 94.01% 96.02% 96.17% 93.62% 95.19% 96.17% SWBHT May-17 96.17% 95.71% G
Updated All cancer 2 week waits - CCG 100% CCG
95% All cancer two week wait - Overall the CCG met the target with 93.86%. 78 patients out of 1193 waited over 2 weeks. 70 of these were at SWBHT, 4 at DGFT, 2 at UHB and one at each Wolverhampton and University College London Hospitals. 90% Monthly Actual Breast - Overall the CCG met the target with 95.16%. 9 patients out of 186 waited over 2 weeks. 6 at SWBHT, one at each DGFT, Walsall Manor and Bolton NHS FT. 85% National Target
80% Representatives from SWBHT cancer team will be attending the CCG Cancer Performance Sub Group on 18th July were we will discuss long waiters and breach reasons in more detail.
75% SWBHT Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Both categories were within target in April.
All Cancer 2 week waits - SWBH
100%
95%
90% Monthly Actual 85% National Target
80%
75% Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18
7 The Forward View into action - Annex B Measures cont.…
Target Previous Year Current Monitoring Year Actual Data FOT Ref Indicator Basis Mth/Qtr/ Green Red Statistic A M J J A S O N D J F M A M J J A S O N D J F M Period YTD RAG Annual
Cancer - 31 day waits 99.12% 96.58% 94.16% 98.00% 98.73% 96.99% 97.12% 97.32% 100.00% 98.33% 96.35% 97.95% 98.33% 97.87% CCG May-17 97.87% 98.08% G % receiving first definitive treatment E.B.8 96% < 96% % within one month 99.19% 97.83% 96.43% 99.34% 98.68% 98.39% 97.54% 97.93% 98.28% 98.44% 96.95% 97.42% 99.15% 97.92% SWBHT May-17 97.92% 98.47% G
100.00% 100.00% 95.45% 96.00% 93.55% 96.43% 100.00% 96.30% 92.31% 100.00% 100.00% 100.00% 91.30% 89.66% CCG May-17 89.66% 90.38% G 31-day standard for subsequent cancer E.B.9 94% < 94% % treatments-surgery 100.00% 100.00% 94.44% 95.00% 100.00% 100.00% 100.00% 100.00% 94.12% 100.00% 100.00% 100.00% 100.00% 94.12% SWBHT May-17 94.12% 96.30% G
100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% CCG May-17 100.00% 100.00% G 31-day standard for subsequent cancer E.B.10 98% < 98% % treatments-anti cancer drug 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% SWBHT May-17 100.00% 100.00% G
97.73% 100.00% 96.49% 100.00% 96.49% 100.00% 100.00% 100.00% 100.00% 96.67% 100.00% 100.00% 100.00% 100.00% CCG May-17 100.00% 100.00% G 31-day standard for subsequent cancer E.B.11 94% < 94% % treatments-radiotherapy
SWBHT This service is not provided at SWBHT
Updated Cancer 31 day waits - CCG 100% CCG
95% 31 day first treatment - Overall the CCG met the target with 97.87%. 3 patients out of 141 waited more than 31 days. All were at UHB, two due to medical reasons and the other patient choice.
90% 31 day subsequent surgery - The CCG failed to meet the target with 89.66%. 3 patients out of 29 waited over 31 days. One at SWBHT due to medical reasons. One at UHB which was due to not being Monthly Actual tracked properly and one at HEFT where the reason is not clear. 85% National Target
80% 31 day sub anti-cancer drug - The CCG met the target achieving 100%. 20 patients were seen.
75% 31 day sub radiotherapy - The CCG met the target achieving 100%. 37 patients were seen. Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18
SWBHT Cancer 31 Day Waits - SWBH
100% The Trust were meeting all 31 day targets in April.
95%
90% Monthly Actual 85% National Target
80%
75% Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18
8 The Forward View into action - Annex B Measures cont.…
Target Previous Year Current Monitoring Year Data Actual FOT Ref Indicator Basis Mth/Qtr/ Green Red Statistic A M J J A S O N D J F M A M J J A S O N D J F M Period YTD RAG Annual
Cancer - 62 day waits 87.10% 78.67% 83.58% 88.57% 79.49% 81.67% 87.67% 87.18% 76.92% 80.70% 74.39% 88.64% 81.97% 78.08% CCG May-17 78.08% 79.85% G All cancer two month urgent referral to E.B.12 85% < 85% % first treatment wait 87.50% 84.29% 89.92% 89.78% 84.14% 86.09% 87.07% 85.31% 81.98% 85.19% 80.77% 91.57% 85.59% 85.61% SWBHT May-17 85.61% 85.60% G
100.00% 90.00% 88.89% 100.00% 100.00% 93.33% 100.00% 88.24% 100.00% 77.78% 87.50% 75.00% 100.00% 100.00% CCG May-17 100.00% 100.00% G 62-day wait for first treatment following E.B.13 referral from an NHS cancer screening 90% < 90% % service 100.00% 97.87% 95.56% 96.61% 98.18% 93.75% 95.45% 92.16% 100.00% 93.75% 93.75% 90.48% 100.00% 100.00% SWBHT May-17 100.00% 100.00% G
94.74% 95.83% 92.00% 90.91% 94.74% 100.00% 96.15% 91.30% 100.00% 85.19% 68.75% 88.89% 100.00% 93.10% CCG May-17 93.10% 95.92% 62-day wait for first treatment for cancer No E.B.14 following a consultants decision to Operational % upgrade the patient's priority Standard 93.10% 93.10% 93.33% 90.00% 95.65% 96.30% 100.00% 95.45% 94.12% 96.43% 90.48% 93.33% 100.00% 95.00% SWBHT May-17 95.00% 97.10%
Updated Cancer 62 day waits - CCG
100% CCG
95% 62 day first treatment - The CCG failed to meet the target with 81.97%. 11 patients out of 61 waited over 62 days. 5 at SWBHT, 2 due to delays in diagnostics and 3 for medical reasons. 3 were at UHB, 2 for medical reasons and one no capacity (tertiary from SWBHT day 41). Two waited at DGFT, one for medical reasons and one through patient choice. The remaining one was at RWH and was due to a 90% Monthly Actual late tertiary received on day 69 from DGFT. 85% National Target 62 day screening - The CCG achieved 100%. 12 patients were seen within target. 80% 62 day consultant upgrade – The CCG met the target with 93.1%. 2 patients waited over 62 days, one at Royal Wolverhampton and one at Heart of England. 75% Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 104 day waits 3 patients waited over 104 days. 2 at UHB, 1 in lower Gastrointestinal who waited 114 days and 1 Urological (Excluding testicular) who waited 111 days. 1 patient waited 139 days at SWBHT. Cancer 62 day waits - SWBH 100% SWBHT 95% All 62 day indicators were within target in May. 90% Monthly Actual 85% National Target
80%
75% Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18
9 The Forward View into action - Annex B Measures cont.…
Target Previous Year Current Monitoring Year Actual Data FOT Ref Indicator Basis Mth/Qtr/ Green Red Statistic A M J J A S O N D J F M A M J J A S O N D J F M Period YTD RAG Annual
Response Times 87.01% 87.11% 71.47% 71.95% 69.96% 69.50% 67.64% 72.13% 71.81% 73.28% 71.62% 70.34% 73.11% 71.30% CCG May-17 71.30% 72.13% R Category A red 1 incidents within 8 E.B.15i 75% < 75% % minutes. 76.77% 75.56% 69.10% 67.28% 68.49% 67.13% 64.58% 65.55% 65.61% 67.22% 65.63% 65.91% 69.65% 66.46% WMAS May-17 66.46% 68.00% R
Updated Ambulance Red 1 Response Time - SWBHT
100% 90% Ambulance Response Programme 80% 70% 60% The final ARP evaluation report was released 13th July. There will be a number of new national standards and these will feature in the next monthly report. 50% Monthly Actual 40% Target (%) Activity 30% 20% At CCG level, WMAS responded to 9,033 assigned incidents, 11.23% above planned activity. 10% 0% Contract wide WMAS responded to 87,594 assigned incidents, 4.49% above plan, the year to date position is over performance of 2.57%. Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18
Ambulance Red 1 Response Time - WMAS
90% 80% 70% 60% 50% Actual 40% National Target 30% 20% 10% 0% Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18
10 The Forward View into action - Annex B Supporting Measures cont.…
Target Previous Year Current Monitoring Year Actual Data FOT Ref Indicator Basis Mth/Qtr/ Green Red Statistic A M J J A S O N D J F M A M J J A S O N D J F M Period YTD RAG Annual
Handover Times 81 65 78 156 131 158 135 188 227 189 129 107 SWBHT Mar-17 107 1644 R E.B.S.7a Handovers of over 30 minutes 0 > 0 Number 2295 2335 2559 2793 2533 2720 3287 3653 4755 4943 3420 3059 WMAS Mar-17 3059 38352 R
2 1 1 8 6 9 15 21 19 11 13 5 SWBHT Mar-17 5 111 R E.B.S.7b Handovers of over 1 hour 0 > 0 Number 153 138 190 123 232 189 368 424 671 750 478 202 WMAS Mar-17 202 3918 R
Ambulance Handover Delays - SWBH Ambulance Handover Delays - WMAS 250 6000
200 5000 4000 150 3000 100 2000 50 1000 0 0 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18
Monthly Actual > 30 mins Monthly Actual > 1 hour National Target Monthly Actual > 30 mins Monthly Actual > 1 hour National Target
Crew Clear Times - Local measure 6 10 7 5 7 3 5 8 32 42 24 21 SWBHT Mar-17 21 170 R E.B.S.8a Crew clear delays of over 30 minutes 0 > 0 Number 53 49 60 62 47 41 74 89 309 374 256 184 WMAS Mar-17 184 1598 R
0 0 1 0 0 0 1 0 0 1 0 3 SWBHT Mar-17 3 6 R E.B.S.8b Crew clear delays of over 1 hour 0 > 0 Number 0 4 8 2 4 2 4 4 4 6 2 11 WMAS Mar-17 11 51 R
Ambulance Crew Clear Delays - SWBH Ambulance Crew Clear Delays - WMAS
50 400
40 300 30 200 20 100 10
0 0 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18
Monthly Actual > 30 mins Monthly Actual > 1 hour National Target Monthly Actual > 30 mins Monthly Actual > 1 hour National Target
Updated
Hospital Handovers and Turnaround (Crew Clear)
Reason for omission-Hand Overs / Crew Clear – From April 17 the ambulance service are now receiving additional incident fees, where there are Hand over delays of 45 and 60 minutes. The new reporting, has temporarily made the 30 and 60 minute reporting unavailable. Both reports will be available again from July 17.
11 The Forward View into action - Annex B Supporting Measures cont.…
Target Previous Year Current Monitoring Year Actual Data FOT Ref Indicator Basis Mth/Qtr/ Green Red Statistic A M J J A S O N D J F M A M J J A S O N D J F M Period YTD RAG Annual
Mixed Sex Accommodation Breaches 0 1 2 0 0 0 4 7 32 9 8 4 22 7 CCG May-17 7 29 R Number of mixed sex accommodation E.B.S.1 0 > 0 Number (MSA) Breaches 0 0 0 0 0 0 2 6 38 5 4 4 21 7 SWBHT May-17 7 28 R
Updated MSA Breaches - CCG MSA Breaches - SWBH CCG 35 40 There were 7 breaches in April - all at City Hospital, an exception report has been requested but is still outstanding. 30 25 30 20 SWBHT 20 15 There were 7 breaches in April, see above. 10 10 5 0 0 Jul-16 Jul-16 Jul-17 Jul-17 Jan-17 Jan-17 Jan-18 Jan-18 Jun-16 Jun-16 Jun-17 Jun-17 Oct-16 Oct-16 Oct-17 Oct-17 Apr-16 Apr-16 Apr-17 Apr-17 Sep-16 Sep-16 Feb-17 Sep-17 Feb-17 Sep-17 Feb-18 Feb-18 Dec-16 Dec-16 Dec-17 Dec-17 Aug-16 Aug-16 Aug-17 Aug-17 Nov-16 Nov-16 Nov-17 Nov-17 Mar-17 Mar-17 Mar-18 Mar-18 May-16 May-16 May-17 May-17
Monthly Actual National Target Monthly Actual National Target
12 13 IAF - Better Health
Previous Year Current Year Actual Data FOT Ref Indicator Target Statistic Basis Mth/Qtr/ A M J J A S O N D J F M A M J J A S O N D J F M Period YTD RAG Annual
Anti-microbial resistance
Anti-microbial resistance: appropriate 1.086 1.088 1.085 1.087 1.093 1.089 1.087 1.094 1.095 1.105 1.100 1.089 107a Reduce Number CCG Mar-17 1.089 13.098 G prescribing of antibiotics in primary care
Anti-microbial resistance: Appropriate 6.7 6.6 6.5 6.4 6.4 6.4 6.4 6.3 6.3 6.2 6.2 6.2 107b prescribing of broad spectrum antibiotics Reduce Number CCG Mar-17 6.2 76.6 G in primary care
Updated
107a The CCG ended the year at 1.089, which was within the quality premium threshold of <=1.161. The England average was marginally lower at 1.06. Comparator CCGs performance varied from 0.911 for Waltham Forest to 1.273 for North Manchester.
107b The CCG ended the year at 6.2, which was within the Quality Premium threshold of <=10%. It was also better than the England average of 8.9. In relation to CCGs with similar demographics SWBCCG were the third lowest with Bradford Districts being the lowest with 5.7 and Redbridge CCG the highest with 12.8.
14 IAF - Better Care
Dementia Estimated diagnosis rate of people with 65.73% 65.00% 64.76% 65.47% 65.91% 65.68% 65.42% 65.66% 65.52% 65.26% 64.79% 64.83% 60.48% 60.63% 126a Increase 67% CCG May-17 60.63% R dementia
Updated
126a - The CCG failed to meet the national target throughout the whole of the year 16/17. A joint business case has been prepared with Sandwell LA. A paper is going to the CCG SCR group in the next few weeks, this will address both diagnosis and post diagnostic support.
15 Legend
NHSE Six Clinical Priority Areas Basis CCG Sandwell & West Birmingham CCG SWBHT Sandwell & West Birmingham Hospital Foundation Trust BCPFT Black Country Partnership Foundation Trust WMAS West Midlands Ambulance Service
Statistic DSR Direct Standardised Rate ISR Indirect Standardised Rate
FOT RAG G Green - forecast to achieve target A Amber - some uncertainty but may achieve target R Red - unlikely to achieve target
Directional Arrows Improvement in data since last data point Decline in data since last data point No change in data since last data point or first publication of data
16 52 WEEK BREACH: TIMELINE OF EVENTS
Patient: Ref: RXK….489
DATE ACTION TAKEN RTT PATHWAY 31/03/16 Referral received from GP, triaged as routine and added to Gen Derm waiting list Clock starts (0 weeks)
22/09/16 Patient cancels first OPA
Clock ticking (25weeks) 10/10/16 Patient attends first OPA, reviewed by Consultant, no treatment offered patient requires referral to Plastic Surgeon for removal of lesion Clock ticking (28 weeks) 28/11/16 Patient attends OPA with Plastic surgeon, is added to IP waiting list for procedure. 35 weeks 25/01/17 Patient attends for procedure but procedure cancelled as patient is on Warfarin and INR is too high for procedure to be safely carried out. Pt relisted but is routine and requires either Dr Diaz or Mr Salahuddin to operate. Mr Salahuddin off sick. Lack of routine capacity as Dr Diaz list is prioritised for 2 WW 43 week 24/05/17 TCI for 24th May, Dr Diaz to operate, ACS informed that INR needs to be checked no greater than 48 hrs before procedure and INR needs to be <2.5
1 RCA / 52 week breach timeline 52 WEEK BREACH: LESSONS LEARNT
Patient NAME
Issue Action Plan Delay to 1st OPA Waiting time reduced from 28 weeks to 12-13 weeks Patient on anticoagulant; INR too high for procedure Ensure better communication between surgeon, patient and ACS to ensure patient ready for TCI
52 WEEK BREACH: Clinical Impact of Delay to Treatment
Patient NAME
Main Delay Reason Severity of Impact (RAG)
52 WEEK BREACH: Final Treatment Update TCI/Outcome
Patient NAME
TCI Date/Outcome Comment 24/5/2017 Patient Cancelled TCI
RCA Completed by: Rachel Clarke Date of Completion: 11th May 2017
2 RCA / 52 week breach timeline 52 WEEK BREACH: TIMELINE OF EVENTS
Patient: Ref: RXK….179
DATE ACTION TAKEN RTT PATHWAY 26/05/16 Referral received – routine pathway
Clock starts (0 weeks)
22/07/16 Seen at first outpatient appointment. Added to waiting list of biopsy. Clock ticking (9 weeks) 19/08/16 Admitted for biopsy - ? superficial BCC Routine list Clock ticking (13 weeks) Clock stop was added (in error) 30/08/16 Histology report authorised – confirmed clinical diagnosis of superficial Clock stopped basal cell carcinoma 04/11/16 Seen in follow up clinic where results of biopsy were discussed. Added to Treatment options presented – Topical treatment waiting list and phototherapy clock restarted. surgical excision. Patient chose surgical excision – added to waiting list as routine 05/06/17 Admitted for excision. 30 weeks from restart of clock 55 weeks from start of original pathway
52 WEEK BREACH: LESSONS LEARNT
Issue Action Plan Incorrect outcoming at biopsy Training planned for staff – date to be confirmed 3 month delay from histology report to follow up Escalated to clinical lead to review clinical appointment practice
1 RCA / 52 week breach timeline: RXK 52 WEEK BREACH: Clinical Impact of Delay to Treatment
Main Delay Reason Severity of Impact (RAG) Incorrectly added clock stop meant that patient was Green - no harm prematurely removed from PTL .
52 WEEK BREACH: Final Treatment Update TCI/Outcome
TCI Date/Outcome Comment 05/06/17 BCC excised Lesion excised
RCA Completed by: R CLARKE Date of Completion: 6th June 2017
2 RCA / 52 week breach timeline: RXK 52 WEEK BREACH: TIMELINE OF EVENTS
Patient: RXK…178 DATE ACTION TAKEN RTT PATHWAY 27/01/2008 Referral received at trust - Patient treated for Prostate cancer and under active surveillance. Clock starts (0 weeks)
20/10/2015 Patient attended – with regard to his Lower Urinary Tract symptoms sent for formal Uroflometry, flow rate and post void scan– clock restart not picked up. Clock stopped FUP appointment for 6 months regarding PSA/ prostrate surveillance (0 weeks) 19/11/2015 & Patient attended flow rate tests 11/12/2015 Clock stopped (8 weeks) 21/04/2016 Patient reviewed in clinic – results not available.
Clock stopped (26 weeks) 17/05/2016 Results reviewed letter to patient for further investigations; Uro- dynamics. Clock stopped (29 weeks) 17/05/2017 Patient re-booked back to Consultant FUP clinic on referral dated 21/03/2016 (reopened), flagged up as a 60 week patient. Clock stopped (82 weeks) 18/05/2017 Patient identified as 60 week wait and escalated to management, query incorrect referral attached. Patient investigated, still outstanding Urodynamics test – patient Clock stopped missed from last year. (82 weeks) 25/05/2017 Referrals reviewed – appt of the 01/06/2017 attached to the wrong referral confirmed and reattached to correct referral. Clock stopped (84 weeks) 26/05/2017 Patient attended Uro dynamics – treated with medication change
Clock stopped (84 weeks) 01/06/2017 Patient DNA’ed OPA with consultant
Clock stopped (84 weeks)
1 RCA / 52 week breach timeline: RXK3098000: Mr AW 52 WEEK BREACH: TIMELINE OF EVENTS
Patient: RXK…178 DATE ACTION TAKEN RTT PATHWAY
52 WEEK BREACH: LESSONS LEARNT
Issue Action Plan Correct clock restart not added to patient pathway. Training with regard to 18 week RTT for team members defining what constitutes a “clock Restart”. Wider RTT training needs to be identified and implemented.
RCA Completed by: Mohammed Nawaz Date of Completion: 01/06/2017
2 RCA / 52 week breach timeline: RXK3098000: Mr AW Report Topic: Urgent Care Report From: Performance Team and Debra Howls
Report For: Governing Body Date Jul-17 Aim of Report To provide information to the Board on the performance of the CCG against key indicators. IUC - NHS 111 referral rates to ED are now below the level seen in the same period last year however ambulance dispatches appear to be holding steady. There is limited evidence of seasonal trends within this data. A & E - June data not yet available, May narrative in body of report NEL Activity - Non-elective admissions (NEL) are lower YTD in 2016/17 than the same period in 2015/16 and this trend is seen at a trust level and at city hospital. The position at Sandwell has been slightly different with a slight increase in NELs for the first half of the year and then a reduced level of activity, below 2015/16 levels seen from October onwards. NEL LoS - NEL length of stay (LoS) has seen some small movements YTD at a trust and indivual site level but overall there has been little change. From July onwards LoS are above the durations seen in 2015/16, so whilst the number of NELs in 2016/17 has fallen from 2015/16, those admitted are staying slightly longer. LoS at Sandwell tends to be above the levels seen at City and this is reflective of the demographic differences. Readmissions - The readmission rates in Q1 and 2 were below the 15/16 activity however this position has worsened in Q3 with readmission rates now much more closely aligned with 2015/16 activity. This is reflected at a trust and individual site level. April and May saw a slight Key Messages decrease in readmission rates compared to previous months Bed availability - The trust is moving forwards with its bed closure plans to ensure it mirrors MMH capacity and therefore we have seen further decreases in beds open. Discharges - The weekly medical discharge rate YTD has been below the levels seen in 2016/17 with the average being 407 compared to 471 in the same period last year. June was a stronger month than May for medical discharges with 1831 discharges compared to 1579. DTOCs - Sandwell MBC continue to have zero reportable DTOCs due to investment in a community health and social care ward that accomodates patients awaiting placement or a package of care. YTD, we see an average of 462 delayed days per month, compared to 444 in the same period last year. Of those, 33% are health delays and 67% are social care; this represents a decrease in health delays this month (April was 39%). Unify returns are no longer collecting the patient snapshot detail. NHS 111 T:\Strategy\Urgent Care\IUC\Contract Management\[NHS 111 disposal routes.xlsx] Key Message - NHS 111 referral rates to ED are now below the level seen in the same period last year however ambulance dispatches appear to be holding steady. There is limited evidence of seasonal trends within this data.
ED April May June July August September October November December January February March Number of calls triaged 8485 8131 7364 7824 6935 6922 7917 7877 9465 7529 7079 8444 2016/17 Number recommended to attend A&E 674 720 642 671 598 635 642 690 722 564 643 713 % referral rate 7.94% 8.85% 8.72% 8.58% 8.62% 9.17% 8.11% 8.76% 7.63% 7.49% 9.08% 8.44% Number of calls triaged 9015 8968 7699 Number recommended to attend A&E 666 696 585 2017/18 % referral rate 7.39% 7.76% 7.60%
NHS 111 Referral to ED rate 10.00%
8.00% 6.00% 2016/17 4.00% 2017/18
Referral rate(%) 2.00% 0.00% April May June July August September October November December January February March
Ambulance April May June July August September October November December January February March Number of calls triaged 8485 8131 7364 7824 6935 6922 7917 7877 9465 7529 7079 8444 2016/17 Number of ambulance dispatches 857 852 941 862 715 787 846 1029 1261 935 871 1020 % Dispatch rate 10.10% 10.48% 12.78% 11.02% 10.31% 11.37% 10.69% 13.06% 13.32% 12.42% 12.30% 12.08% Number of calls triaged 9015 8968 7699 2017/18 Number of ambulance dispatches 1094 1048 991 % Dispatch rate 12.14% 11.69% 12.87%
NHS 111 Ambulance Dispatch rate 14.00%
12.00% 10.00% 8.00% 2016/17 6.00% 2017/18
4.00% Dispatch rate Dispatch (%) 2.00% 0.00% April May June July August September October November December January February March Accident + Emergency T:\Performance\A&E\16-17\Daily EC 4 hour wait summary Key Message - A&E performance in May (81.57%) continues to be below both the national and STF targets, the trust implemented some planned changes at BMEC in May which had a predicited impact of a 3% deterioration in ED performance. Therefore, 2017/18 performance continues to be below the rate achieved for the same period in 2016/17. At a site level performance at City hospital continues to be the worst performing site although Sandwell is also showing a worsening position.
SWBHT National Target 95% April May June July August September October November December January February March < 4 Hours 17,091 18,915 17,077 17,201 16,362 16,843 16,509 15,625 15,085 15,694 14,158 16,668 2016/17 Total Attendances 18,699 20,366 18,702 19,369 18,246 18,894 19,185 18,862 18,409 18,640 17,184 19,535 Performance 91.40% 92.88% 91.31% 88.81% 89.67% 89.14% 86.05% 82.84% 81.94% 84.20% 82.39% 85.32% < 4 Hours 15,881 15,704 2017/18 Total Attendances 18,695 19,253 Performance 84.95% 81.57% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95%
A&E Attendances - All Sites A&E Performance - All Sites
21,000 100.00% 20,000 95.00% 19,000 18,000 90.00% 17,000 85.00%
16,000 A&E A&E Attendances 15,000 A&E Attendances 80.00%
2016/17 2017/18 2016/17 2017/18 Target
City Hospital National Target 95% April May June July August September October November December January February March < 4 Hours 7,955 8,956 8,257 8,514 7,659 7,935 7,734 7,205 7,252 7,663 6,821 8,019 2016/17 Total Attendances 8,620 9,531 8,855 9,158 8,487 9,043 9,065 8,838 8,809 8,867 8,186 9,283 Performance 92.29% 93.97% 93.25% 92.97% 90.24% 87.75% 85.32% 81.52% 82.32% 86.42% 83.33% 86.38% < 4 Hours 6,241 6,731 2017/18 Total Attendances 7,774 8,552 Performance 80.28% 78.71% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95%
A&E Attendances - City Hospital A&E Performance - City Hospital
12,000 100.00% 10,000 95.00% 8,000 6,000 90.00% 4,000 85.00%
2,000 A&E A&E Attendances - A&E Attendances 80.00%
2016/17 2017/18 2016/17 2017/18 Target Sandwell General Hospital National Target 95% April May June July August September October November December January February March < 4 Hours 6,831 7,663 6,842 6,710 6,606 6,793 6,642 6,302 5,893 6,055 5,616 6,601 2016/17 Total Attendances 7,735 8,489 7,832 8,194 7,631 7,705 7,974 7,893 7,655 7,783 7,285 8,165 Performance 88.31% 90.27% 87.36% 81.89% 86.57% 88.16% 83.30% 79.84% 76.98% 77.80% 77.09% 80.85% < 4 Hours 7,605 7,777 2017/18 Total Attendances 8,837 9,466 Performance 86.06% 82.16% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95%
A&E Attendances - Sandwell General Hospital A&E Performance - Sandwell General Hospital
10,000 100.00% 8,000 95.00% 6,000 90.00% 85.00% 4,000 80.00%
2,000 75.00% A&E A&E Attendances - A&E Attendances 70.00%
2016/17 2017/18 2016/17 2017/18 Target
City Eye A+E (BMEC)
National Target 95% April May June July August September October November December January February March < 4 Hours 2,305 2,296 1,978 1,977 2,097 2,115 2,133 2,118 1,940 1,976 1,701 2,048 6 2016/17 Total Attendances 2,344 2,346 2,015 2,017 2,128 2,146 2,146 2,131 1,945 1,990 1,713 2,087 Performance 98.34% 97.87% 98.16% 98.02% 98.54% 98.56% 99.39% 99.39% 99.74% 99.30% 99.30% 98.13% < 4 Hours 2,035 1,196 39 2017/18 Total Attendances 2,084 1,235 Performance 97.65% 96.84% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95%
A&E Attendances - City Eye A+E A&E Performance - City Eye A+E
2,500 100.00% 2,000 98.00% 1,500 96.00% 1,000 94.00%
500 92.00% A&E A&E Attendances - A&E Attendances 90.00%
2016/17 2017/18 2016/17 2017/18 Target Non-Electives - Admissions Non-Electives - Average LOS T:\Performance\Urgent Care\16-17\Report data\NEL LOS Key Message - Non-elective admissions (NEL) are lower YTD in 2016/17 than the same period in 2015/16 and this trend is seen at a trust level and Key Message - NEL length of stay (LoS) has seen some small movements YTD at a trust and indivual site level but overall there has been little at city hospital. The position at Sandwell has been slightly different with a slight increase in NELs for the first half of the year and then a reduced change. From July onwards LoS are above the durations seen in 2015/16, so whilst the number of NELs in 2016/17 has fallen from 2015/16, those level of activity, below 2015/16 levels seen from October onwards. admitted are staying slightly longer. LoS at Sandwell tends to be above the levels seen at City and this is reflective of the demographic differences.
SWBHT SWBHT April May June July August September October November December January February March April May June July August September October November December January February March 2016/17 3,620 3,728 3,522 3,539 3,357 3,353 2,563 3,602 3,621 3,486 3,311 3,492 2016/17 4.2 3.6 3.4 3.6 3.9 3.6 4.0 4.1 4.1 4.4 4.4 4.2 2017/18 3,191 3,521 2017/18 4.3 4.0
SWBHT - NEL Admissions, All sites SWBHT - NEL LOS, All sites
4,000 5.0
3,000 4.0 3.0 2,000 2016/17 2016/17 2.0
1,000 2017/18 2017/18 NEL Avg Days
NEL Avg Days 1.0
NELNEL admissionsadmissions - - April May June July August September October November December January February March April May June July August September October November December January February March
City Hospital City Hospital April May June July August September October November December January February March April May June July August September October November December January February March 2016/17 1,563 1,620 1,554 1,603 1,520 1,534 1,233 1,573 1,571 1,574 1,460 1,521 2016/17 3.6 3.1 3.1 2.8 3.3 3.1 3.3 3.8 3.7 3.7 3.5 3.5 2017/18 1,411 1,555 2017/18 3.6 3.5
City Hospital - NEL Admissions City Hospital - NEL LOS
2,000 5.0
1,500 4.0 3.0 1,000 2016/17 2016/17 2.0
500 2017/18 2017/18 NEL Avg Days
NEL Avg Days 1.0
NELNEL admissionsadmissions - - April May June July August September October November December January February March April May June July August September October November December January February March Sandwell General Hospital Sandwell General Hospital April May June July August September October November December January February March April May June July August September October November December January February March 2016/17 2,046 2,099 1,963 1,928 1,831 1,815 1,328 2,024 2,040 1,906 1,845 1,961 2016/17 4.6 4.0 3.6 4.3 4.4 4.1 4.7 4.3 4.5 5.0 5.0 4.7 2017/18 1,769 1,958 2017/18 4.8 4.4
Sandwell General Hospital - NEL Admissions Sandwell General Hospital - NEL LOS
2,500 6.0
2,000 4.0 1,500 2016/17 2016/17 1,000
2017/18 2.0 2017/18 NEL Avg Days
500 NEL Avg Days
NELNEL admissionsadmissions - - April May June July August September October November December January February March April May June July August September October November December January February March
City Eye A+E (BMEC) City Eye A+E (BMEC) April May June July August September October November December January February March April May June July August September October November December January February March 2016/17 11 9 4 8 5 4 2 4 8 6 6 10 2016/17 3.2 2.9 0.3 3.0 11.8 3.3 4.0 1.0 3.4 0.5 3.2 2.7 2017/18 9 7 2017/18 2.7 2.6
City Eye A+E - NEL Admissions City Eye A+E - NEL LOS
15 15.0
10 10.0 2016/17 2016/17
5 2017/18 5.0 2017/18
NELNEL Days Days Avg Avg
NELNEL admissionsadmissions - - April May June July August September October November December January February March April May June July August September October November December January February March
Other Sites Other Sites April May June July August September October November December January February March April May June July August September October November December January February March 2016/17 - - 1 - 1 - - 1 2 - - - 2016/17 - - 19.0 - 10.0 - - - 33.0 - - - 2017/18 2 1 2017/18 3.5 5.0
Other Sites - NEL Admissions Other Sites - NEL LOS
3 40.0
2 30.0 2 2016/17 20.0 2016/17 1
2017/18 10.0 2017/18 NEL Avg Days
1 NEL Avg Days
NELNEL admissionsadmissions - - April May June July August September October November December January February March April May June July August September October November December January February March Re-Admissions T:\Performance\Urgent Care\16-17\Report data\Readmissions Key Message - The readmission rates in Q1 and 2 were below the 15/16 activity however this position has worsened in Q3 with readmission rates now much more closely aligned with 2015/16 activity. This is reflected at a trust and individual site level. April and May saw a slight decrease in readmission rates compared to previous months
SWBHT April May June July August September October November December January February March Admissions 7,434 7,393 7,601 7,317 7,267 7,214 7,215 7,589 7,182 7,268 6,865 7,605 2016/17 Re-admission 622 637 593 581 553 520 588 580 617 589 579 631 % 8.37% 8.62% 7.80% 7.94% 7.61% 7.21% 8.15% 7.64% 8.59% 8.10% 8.43% 8.30% Admissions 6,539 7,283 2017/18 Re-admission 524 569 % 8.01% 7.81%
SWBHT - Re-Admissions, All sites
9.00% 8.00% 2016/17 7.00%
2017/18
admissionsadmissions -
- 6.00% Re Re April May June July August September October November December January February March
City Hospital April May June July August September October November December January February March Admissions 2,886 2,965 3,038 2,962 2,920 2,877 2,893 2,912 2,916 2,961 2,720 2,999 2016/17 Re-admission 264 266 271 243 254 245 255 269 261 245 263 258 % 9.15% 8.97% 8.92% 8.20% 8.70% 8.52% 8.81% 9.24% 8.95% 8.27% 9.67% 8.60% Admissions 2,530 2,782 2017/18 Re-admission 213 231 % 8.42% 8.30%
City Hospital - Re-Admissions
10.00% 9.00% 2016/17 8.00%
2017/18
admissionsadmissions -
- 7.00% Re Re April May June July August September October November December January February March Sandwell General Hospital April May June July August September October November December January February March Admissions 3,341 3,283 3,201 3,131 2,991 2,994 3,021 3,284 3,078 3,054 2,884 3,195 2016/17 Re-admission 355 361 315 331 295 273 326 310 350 341 311 371 % 10.63% 11.00% 9.84% 10.57% 9.86% 9.12% 10.79% 9.44% 11.37% 11.17% 10.78% 11.61% Admissions 2,799 3,165 2017/18 Re-admission 308 333 % 11.00% 10.52%
Sandwell General Hospital - Re-Admissions
15.00% 10.00% 2016/17 5.00%
2017/18
admissionsadmissions
- - e
e 0.00% R R April May June July August September October November December January February March
City Eye A+E (BMEC) April May June July August September October November December January February March Admissions 498 467 523 459 512 526 472 536 436 457 466 510 2016/17 Re-admission 3 10 7 7 4 3 7 1 5 3 5 2 % 0.60% 2.14% 1.34% 1.53% 0.78% 0.57% 1.48% 0.19% 1.15% 0.66% 1.07% 0.39% Admissions 483 490 2017/18 Re-admission 3 5 % 0.62% 1.02%
City Eye A+E - Re-Admissions
3.00% 2.00% 2016/17 1.00%
2017/18
admissionsadmissions -
- 0.00% Re Re April May June July August September October November December January February March
Birmingham Treatment Centre & Rowley Regis Hospital Other Sites April May June July August September October November December January February March Admissions 709 678 839 765 844 826 829 857 752 796 795 901 2016/17 Re-admission ------1 - - - % 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.13% 0.00% 0.00% 0.00% Admissions 727 846 2017/18 Re-admission - % 0.00% 0.00%
Other Sites - Re-Admissions
0.15% 0.10% 2016/17 0.05%
2017/18
admissionsadmissions -
- 0.00% Re Re April May June July August September October November December January February March Bed Availability T:\Performance\Weekly Sitrep Report Key Message -The trust is moving forwards with its bed closure plans to ensure it mirrors MMH capacity and therefore we have seen further decreases in beds open.
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 2014/15 06/04/2014 13/04/2014 20/04/2014 27/04/2014 04/05/2014 11/05/2014 18/05/2014 25/05/2014 01/06/2014 08/06/2014 15/06/2014 22/06/2014 29/06/2014 06/07/2014 13/07/2014 20/07/2014 27/07/2014 03/08/2014 10/08/2014 17/08/2014 24/08/2014 31/08/2014 Wk Ending 787 793 812 813 776 776 811 814 816 814 816 818 813 813 814 814 761 763 773 775 782 775
2015/16 05/04/2015 12/04/2015 19/04/2015 26/04/2015 03/05/2015 10/05/2015 17/05/2015 24/05/2015 31/05/2015 07/06/2015 14/06/2015 21/06/2015 28/06/2015 05/07/2015 12/07/2015 19/07/2015 26/07/2015 02/08/2015 09/08/2015 16/08/2015 23/08/2015 30/08/2015 Wk Ending 751 791 771 784 790 766 767 776 774 771 773 771 768 757 764 750 734 757 758 767 759 754
2016/17 03/04/2016 10/04/2016 17/04/2016 24/04/2016 01/05/2016 08/05/2016 15/05/2016 22/05/2016 29/05/2016 05/06/2016 12/06/2016 19/06/2016 26/06/2016 03/07/2016 10/07/2016 17/07/2016 24/07/2016 31/07/2016 07/08/2016 14/08/2016 21/08/2016 28/08/2016 Wk Ending 743 736 748 710 731 742 745 733 715 749 736 711 734 735 735 735 724 716 722 742 723 722
2017/18 02/04/2017 09/04/2017 16/04/2017 23/04/2017 30/04/2017 07/05/2017 14/05/2017 21/05/2017 28/05/2017 04/06/2017 11/06/2017 18/06/2017 25/06/2017 02/07/2017 09/07/2017 16/07/2017 23/07/2017 Wk Ending 676 595 675 678 681 684 667 668 682 686 668 681 664 658 675 612 648
Beds Breakdown by Ward 02/04/2017 09/04/2017 16/04/2017 23/04/2017 30/04/2017 07/05/2017 14/05/2017 21/05/2017 28/05/2017 04/06/2017 11/06/2017 Name Av. Beds Occ. Beds Av. Beds Occ. Beds Av. Beds Occ. Beds Av. Beds Occ. Beds Av. Beds Occ. Beds Av. Beds Occ. Beds Av. Beds Occ. Beds Av. Beds Occ. Beds Occ. Beds Occ. Beds Occ. Beds Occ. Beds Av. Beds Occ. Beds CCS - Critical Care Services - City 12 12 7 6 7 6 8 6 7 5 12 10 8 6 10 9 10 9 11 11 8 6 D5 - Cardiology (Female) 12 11 12 11 12 10 12 11 12 11 12 10 12 10 12 11 12 10 12 11 12 10 D11 - Male Older Adult 20 20 20 19 20 20 20 20 21 21 21 21 21 21 21 21 20 20 20 20 20 16 D15 - Gastro/Resp/Haem (Male) 16 16 14 14 14 14 14 14 15 14 16 16 16 16 16 16 18 14 17 17 17 16 D16 - (Female) 16 16 19 17 19 16 19 18 19 19 19 19 19 19 19 19 15 15 15 15 15 14 D19 - Paediatric Medicine 8 5 8 5 8 5 8 7 11 7 11 7 8 8 8 4 8 7 8 7 8 5 D21 - Male Urology / ENT 21 21 18 18 17 7 17 15 18 14 18 17 16 15 17 17 17 17 18 9 17 17 D25 - Extra Capacity 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 D26 - Female Older Adult 20 20 20 20 20 20 20 20 20 20 20 19 20 20 20 20 20 20 20 20 20 20 D27 - Oncology 18 16 18 18 18 18 18 18 18 15 18 17 18 12 18 17 18 15 18 16 18 16 AMU 2 & West Midlands Poisons Unit - City 19 15 19 19 19 16 19 15 19 19 19 19 19 19 19 15 19 16 19 16 19 16 D7 - Cardiology (Male) 20 19 20 12 20 18 20 18 20 17 20 20 20 18 20 19 20 18 20 18 20 18 Ophthmalic Unit - City 12 6 12 6 12 7 12 7 12 14 12 15 12 9 12 12 12 6 12 12 12 19 Female Surgical Ward - City 16 12 16 16 16 8 16 8 16 14 16 13 16 13 16 16 16 12 16 15 16 12 AMU 1 - City 32 31 32 30 32 23 32 27 32 25 32 27 32 32 32 32 32 27 32 26 32 22 Neonatal Unit - City 29 21 29 19 29 18 29 20 29 17 29 20 29 18 29 9 29 12 29 15 29 14 Critical Care - Sandwell 10 8 8 7 8 6 8 6 11 10 8 6 8 6 6 6 8 7 8 6 8 7 AMU A - Sandwell 32 29 32 22 32 32 32 22 32 27 32 28 32 27 32 24 42 35 42 41 42 32 Older Persons Assessment Unit (OPAU) - Sandwell 10 10 10 9 10 9 10 8 10 10 10 10 10 10 10 9 10 9 20 20 20 15 Lyndon 1 - Paediatrics 18 14 18 12 18 8 18 14 18 10 18 15 18 17 18 12 18 14 18 11 18 12 Lyndon 2 - Surgery 24 24 33 24 33 24 33 32 24 23 24 24 24 22 24 24 24 24 33 24 24 24 Lyndon 3 - T&O/Stepdown 31 27 31 20 31 19 31 29 31 26 31 28 31 24 31 24 32 27 31 23 31 24 Lyndon 4 34 34 34 31 34 31 34 33 34 31 34 33 34 33 34 34 34 33 34 34 34 33 Lyndon 5 - Acute Medicine 34 33 34 32 34 31 34 34 34 33 34 33 34 34 34 33 34 34 34 34 29 29 Lyndon Ground - PAU/Adolescents 14 6 14 13 14 10 14 9 14 8 14 7 14 11 14 11 14 10 14 7 14 5 AMU B - Sandwell 20 20 20 20 20 19 20 20 20 16 20 20 20 20 20 20 20 20 0 0 0 0 Newton 3 - T&O 33 30 33 26 33 31 33 31 33 30 33 30 33 31 33 30 33 30 33 27 33 30 Newton 4 - Stroke and Neurology Rehab 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 27 28 28 28 28 Newton 5 - Haematology 14 9 14 11 14 9 14 13 18 14 18 14 14 13 14 14 15 15 18 16 18 13 Priory 2 - Colorectal/General Surgery 24 24 29 24 24 24 24 24 24 23 24 24 24 24 24 24 24 21 24 24 24 24 Priory 4 - Stroke/Neurology 26 24 26 17 26 20 26 22 26 18 26 21 26 20 26 21 26 17 26 21 26 16 Priory 5 - Gastro/Resp 33 33 32 30 33 28 33 33 33 31 33 31 33 33 33 33 34 34 34 34 34 33 SAU - Sandwell 20 15 22 16 20 15 22 17 22 10 22 15 18 11 18 10 20 10 22 10 22 12 Total 676 609 682 572 675 550 678 599 681 580 684 617 667 600 668 594 682 585 686 588 668 558
Total Available Beds 900
850 800 750 2014/15 700 2015/16 650 600 2016/17
Number of of Numberopenbeds 550 2017/18 500 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52
Week 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 07/09/2014 14/09/2014 21/09/2014 28/09/2014 05/10/2014 12/10/2014 19/10/2014 26/10/2014 02/11/2014 09/11/2014 16/11/2014 23/11/2014 30/11/2014 07/12/2014 14/12/2014 21/12/2014 28/12/2014 04/01/2015 11/01/2015 18/01/2015 25/01/2015 01/02/2015 08/02/2015 15/02/2015 22/02/2015 01/03/2015 08/03/2015 15/03/2015 22/03/2015 29/03/2015 804 753 753 781 763 810 781 814 804 785 772 762 778 769 786 808 751 800 817 779 782 778 774 787 780 790 783 779 771 781
06/09/2015 13/09/2015 20/09/2015 27/09/2015 04/10/2015 11/10/2015 18/10/2015 25/10/2015 01/11/2015 08/11/2015 15/11/2015 22/11/2015 29/11/2015 06/12/2015 13/12/2015 20/12/2015 27/12/2015 03/01/2016 10/01/2016 17/01/2016 24/01/2016 31/01/2016 07/02/2016 14/02/2016 21/02/2016 28/02/2016 06/03/2016 13/03/2016 20/03/2016 27/03/2016 732 733 730 703 733 708 731 732 692 724 728 709 693 680 720 726 695 701 722 702 747 710 713 694 736 752 764 698 754 723
04/09/2016 11/09/2016 18/09/2016 25/09/2016 02/10/2016 09/10/2016 16/10/2016 23/10/2016 30/10/2016 06/11/2016 13/11/2016 20/11/2016 27/11/2016 04/12/2016 11/12/2016 18/12/2016 25/12/2016 01/01/2017 08/01/2017 15/01/2017 22/01/2017 29/01/2017 05/02/2017 12/02/2017 19/02/2017 26/02/2017 05/03/2017 12/03/2017 19/03/2017 26/03/2017 720 741 702 733 687 709 698 703 715 708 698 735 728 701 734 724 671 666 686 697 684 706 720 705 679 676 685 698 672 668
18/06/2017 25/06/2017 02/07/2017 09/07/2017 16/07/2017 23/07/2017 Av. Beds Occ. Beds Av. Beds Occ. Beds Av. Beds Occ. Beds Av. Beds Occ. Beds Av. Beds Occ. Beds Av. Beds Occ. Beds 11 10 10 10 9 9 8 6 9 7 6 5 11 10 11 10 12 12 12 11 11 10 12 9 20 19 20 20 20 20 19 18 20 20 20 20 19 19 20 20 16 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 14 13 8 5 8 8 11 6 8 2 8 3 8 7 21 20 16 15 18 18 19 19 18 12 18 11 0 0 0 0 0 0 0 0 0 0 0 0 20 20 20 19 20 19 20 20 20 20 20 20 18 13 18 17 18 18 18 18 18 14 18 15 19 14 19 13 19 13 19 18 19 14 19 17 20 19 20 18 20 17 20 18 20 15 19 19 12 12 12 10 12 19 12 8 12 12 12 12 16 12 16 10 16 13 16 15 16 14 16 12 32 25 32 26 32 28 32 23 32 19 32 26 29 15 29 10 29 13 29 16 29 16 29 13 8 7 10 7 7 6 7 7 7 6 8 8 42 36 42 39 42 38 42 42 42 42 42 36 20 20 20 20 20 20 20 20 20 19 20 19 18 10 18 12 18 14 18 11 18 13 18 14 33 24 24 23 24 24 33 24 24 24 29 25 32 22 29 24 28 22 26 22 26 17 26 23 34 34 34 34 34 34 34 33 34 34 34 34 22 22 34 34 24 24 34 21 20 20 13 13 14 6 14 10 14 11 14 9 14 8 14 12 0 0 0 0 0 0 0 0 0 0 0 0 33 31 32 28 31 29 30 26 29 24 31 27 28 28 28 28 28 28 28 28 28 28 28 28 18 13 14 12 18 14 18 14 12 12 18 12 29 21 24 22 24 24 29 24 0 0 29 24 26 19 26 22 26 19 26 24 26 21 26 21 31 30 31 30 31 30 32 32 32 32 32 31 22 9 18 10 22 13 22 14 18 12 22 13 681 560 664 576 658 585 675 573 612 518 648 554 Discharges
Key Message - The weekly medical discharge rate YTD has been below the levels seen in 2016/17 with the average being 407 compared to 471 in the same period last year. June was a stronger month than May for medical discharges with 1831 discharges compared to 1579.
2016/17 2017/18 w/c 04/04/16 472 445 w/c 11/04/16 492 422 Weekly Discharges SWBH (Medical) w/c 18/04/16 468 351 600 w/c 25/04/16 498 491
w/c 02/05/16 480 307 500 w/c 09/05/16 489 286 400 w/c 16/05/16 532 337 w/c 23/05/16 501 458 300 w/c 30/05/16 488 400 w/c 06/06/16 448 484 200 2016/17
w/c 13/06/16 441 412 2017/18 NUmberdischarges of w/c 20/06/16 458 388 100 w/c 27/06/16 451 420 0 w/c 04/07/16 396 437 w/c 11/07/16 462 465 w/c 18/07/16 464 351
w/c 25/07/16 402
W/C 7/11/16
w/c 11/04/16 w/c 18/04/16 w/c 27/06/16 w/c 05/09/16 w/c 14/11/16 w/c 23/01/17 w/c 30/01/17 w/c 04/04/16 w/c 25/04/16 w/c 02/05/16 w/c 09/05/16 w/c 16/05/16 w/c 23/05/16 w/c 30/05/16 w/c 06/06/16 w/c 13/06/16 w/c 20/06/16 w/c 04/07/16 w/c 11/07/16 w/c 18/07/16 w/c 25/07/16 w/c 01/08/16 w/c 08/08/16 w/c 15/08/16 w/c 22/08/16 w/c 29/08/16 w/c 12/09/16 w/c 19/09/16 w/c 26/09/16 w/c 03/10/16 w/c 10/10/16 w/c 17/10/16 w/c 24/10/16 w/c 21/11/16 w/c 28/11/16 w/c 05/12/16 w/c 12/12/16 w/c 19/12/16 w/c 26/12/16 w/c 02/01/17 w/c 09/01/17 w/c 16/01/17 w/c 06/02/17 w/c 13/02/17 w/c 20/02/17 w/c 27/02/17 w/c 06/03/17 w/c 13/03/17 w/c 20/03/17 w/c 27/03/17 w/c 01/08/16 419 W/c31/10/16 w/c 08/08/16 394 w/c 15/08/16 479 w/c 22/08/16 440 w/c 29/08/16 447 w/c 05/09/16 460 w/c 12/09/16 468 w/c 19/09/16 516 w/c 26/09/16 453 w/c 03/10/16 495 w/c 10/10/16 469 w/c 17/10/16 531 w/c 24/10/16 379 W/c 31/10/16 438 W/C 7/11/16 406 w/c 14/11/16 456 w/c 21/11/16 429 w/c 28/11/16 513 w/c 05/12/16 456 w/c 12/12/16 519 w/c 19/12/16 492 w/c 26/12/16 407 w/c 02/01/17 431 w/c 09/01/17 441 w/c 16/01/17 434 w/c 23/01/17 412 w/c 30/01/17 404 w/c 06/02/17 491 w/c 13/02/17 431 w/c 20/02/17 402 w/c 27/02/17 484 w/c 06/03/17 524 w/c 13/03/17 446 w/c 20/03/17 448 w/c 27/03/17 402 Delayed Transfer of Care - at SWBHT by LA https://www.england.nhs.uk/statistics/statistical-work-areas/delayed-transfers-of-care/2016-17-data/ Key Message - Sandwell MBC continue to have zero reportable DTOCs due to investment in a community health and social care ward that accomodates patients awaiting placement or a package of care. YTD, we see an average of 462 delayed days per month, compared to 444 in the same period last year. Of those, 33% are health delays and 67% are social care; this represents a decrease in health delays this month (April was 39%). Unify returns are no longer collecting the patient snapshot detail.
Title: DTOC - Delayed Days by LA
Sandwell Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Sandwell Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 NHS 0 0 0 0 0 0 0 0 0 0 0 0 NHS 0 0 0 Social Care 0 0 0 0 0 0 0 0 0 0 0 0 Social Care 0 0 0 Both 0 0 0 0 0 0 0 0 0 0 0 0 Both 0 0 0 Total 0 0 0 0 0 0 0 0 0 0 0 0 Total 0 0 0
Birmingham Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Birmingham Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 NHS 183 193 229 196 176 188 201 153 161 112 142 135 NHS 171 163 155 Social Care 234 228 251 245 287 215 266 272 449 435 309 375 Social Care 324 258 312 Both 0 0 14 0 0 0 0 4 0 0 0 0 Both 0 0 2 Total 417 421 494 441 463 403 467 429 610 547 451 510 Total 495 421 469
700 600 600 500 500 400 400 300 300 200 200 100 100 0 0 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18
Sandwell Birmingham Sandwell Birmingham Title: DTOC - Patient Snapshot by LA
Sandwell Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Sandwell Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 NHS 0 0 0 0 0 0 0 0 0 0 0 0 NHS 0 Social Care 0 0 0 0 0 0 0 0 0 0 0 0 Social Care 0 Both 0 0 0 0 0 0 0 0 0 0 0 0 Both 0 Total 0 0 0 0 0 0 0 0 0 0 0 0 Total 0
Birmingham Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Birmingham Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 NHS 5 7 7 3 6 6 6 6 3 5 6 2 NHS 0 Social Care 3 9 3 6 8 3 7 7 10 9 13 13 Social Care 0 Both 0 0 0 0 0 0 0 0 0 0 0 0 Both 0 Total 8 16 10 9 14 9 13 13 13 14 19 15 Total 0
20 1 0.8 15 0.6 10 0.4 5 0.2
0 0 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18
Sandwell Birmingham Sandwell Birmingham
GOVERNING BODY/COMMITTEE Report Title: Report author and Title: Strategic Commissioning & Redesign Dr Ian Sykes & Committee Update to Governing Body Olivia Amartey Deputy Chief Officer 22 JUNE 2017 (Operations)
Date of Governing Body/ Committee: Contact Details: 2 August 2017 [email protected] Agenda Item No: 0121 612 3471
Sign off from Chief Officers: Chief Finance Officer:
Chief Officer for Quality:
Chief Officer for Operations:
Chief Officer for Partnership:
Supporting Documents/further Reading: None Previous Decision: N/A
Summary of purpose and scope of the report: This report to Governing Body updates on the business of the Strategic Commissioning & Redesign Committee held on Thursday 22 JUNE 2017.
Recommendations:
• It is recommended that Governing Body members note the contents of the report
The Governing Body/Committee are requested to: Action Approve x Assurance Decision Conflicts of Interests: The recommended action by the author of the report is: No conflict identified x Conflict noted, conflicted party can participate in clinical discussion but not decision Conflict noted, conflicted party can remain in committee but not participate in discussion
1
Conflicted party is excluded from discussion (this would be rare circumstances only) Please state rationale for above decision:
Strategic Priorities related to the report: Quality & Safety Finance & Performance Partnership Strategic Commissioning and Redesign x Organisational Development Primary Care Co-Commissioning Collaborative Commissioning Implications: Financial Assurance Framework Risks and Legal Obligations Equality and Diversity Statutory and External Influences Further implications not stated Consultation: X Patients Staff Committees Public Partners Sponsored By: (Chief Officer or Committee Dr. Ian Sykes Chair) Date Report received for Governing 25 July 2017 Body/Committee
2
1. INTRODUCTION
This report provides details of the Strategic Commissioning & Redesign Committee which took place on 22 JUNE 2017. It covers:
2. MATTERS ARISING
2.1 DNA’s and SWBH NHS Trust referring back to GP
3. ITEMS FOR DECISION MAKING
3.1 Recovery and Employment Procurement
3.2 Diabetes Educational PID
3.3 Sandwell Own Bed Instead (OBI) Short Term Reablement Service (STAR) and Community Alarms Capacity Options Appraisal
3.4 Development of Perinatal Mental Health
3.5 Excess Treatment Cost Request IWOTCH Study
4. ITEMS FOR INFORMATION
4.1 Programme Management Office Update
4.2 Corporate Updates
4.3 Health & Well-Being Board Feedback
4.4 Right Care Update
4.5 Strategic Estates Review Group
5. ANY OTHER BUSINESS
5.1 Better Care Fund (BCF) and the Responsibilities of SCR
5.2 GP Five Year Forward View
3
2. MATTERS ARISING
2.1 DNA’s and SWBH NHS Trust referring back to GP
The Committee were advised that the main reception of Sandwell Hospital still has posters on the wall with incorrect information stating that if the patient fails to attend their appointment they will be referred back to their GP and if the patient cancels their appointment twice, they will also be referred back to their GP. Additionally BA highlighted that Consultants are not aware of the ‘Standard Hospital Contract’.
Action: DH to liaise with MS about the lack of awareness from Consultants of the Standard Hospital Contract and also highlight that there are posters in the waiting are of Sandwell Hospital which contain incorrect information.
3. ITEMS FOR DECISION MAKING
3.1 Recovery and Employment Procurement
The Committee were updated on the proposed changes to mental health recovery and support services (previously mental health day services).
A set of proposals were shared with SCR in September 2016 and permission was given to go out for consultation, however these were subject to delays.
The final specification presented includes adjustments made as a result of the consultation. Approval was sought for the specification to now go out to tender.
The Committee noted that the service is solely for West Birmingham and the inequity that arises as a result of this. The Committee highlighted that there may be Birmingham residents that are registered with a Sandwell GP who should have access to the service. It was agreed that this issue would be addressed and the criteria will be amended accordingly.
Decision: The Committee approved the service in principle with the following caveats
- There should be an equivalent service in Sandwell
- The exclusion criteria should be amended to ensure that West Birmingham patients that are registered with a Sandwell GP are picked up / included in the service.
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3.2 Diabetes Educational PID
The Committee were presented with a project initiation document to outline plans for the next three years to educate GPs and Practice Nurses in the care of diabetes for patients.
The total expenditure is estimated at just over £140,000 with the funding for the proposal being picked up by the GP Forward View. It was noted that the current spend on diabetes drugs is £12million per year, and SWBCCG are high spenders in this area.
The Committee acknowledged that the proposal fits with our Right Care priorities and it was noted that diabetes is part of the new PCCF.
Action: HH to contact Claire Parker to advise that the SCR Committee have recommended that one PLT per year is specifically dedicated to the PCCF to up-skill colleagues to meet required standards.
Decision: The Committee supported the proposal.
3.3 Sandwell Own Bed Instead (OBI) Short Term Re-ablement Service (STAR) and Community Alarms Capacity Options Appraisal
The Sandwell OBI service has been running since 2014. Commissioners have recently starting working with the providers to monitor data and activity going through the service. Sandwell Local Authority currently provides both the STAR service and the community alarm element under a block contract. It has been identified that the lack of capacity within the STAR service has hindered flow through the OBI service. It is important that capacity is increased.
The increase in STAR capacity will be offset by the under-utilisation in community alarms. Along with providers and finance colleagues, commissioners have looked at the available budget against the predicted capacity and demand over the next 12 months to realign the budgets.
The realignment of the budget releases a small contingency to enable some flexing across services if required. The Committee scrutinized the data included within the paper and were assured that no additional funding is being requested.
Decision: The Committee approved the proposed changes detailed in the paper.
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3.4 Development of Perinatal Mental Health
Last Autumn (2016) an unsuccessful bid was submitted by the Black Country CCGs to improve perinatal mental health services. A second opportunity has arisen this year and Wolverhampton CCG is leading. A project manager has been appointed to progress the bid.
There will be £20 million transformation money across 10 areas; and the funds will be recurring until base lined into the CCG budget in 2021.It was highlighted that the Black Country is rated ‘red’ for perinatal mental health and the aim is to ensure that there is some system connectivity to deliver clinical outcomes and improve patient experience.
A task and finish group has been convened and has SWB CCG representation (Senior Commissioning Manager, Hazel Malcolm). Dr Liz England is Chairing the Clinical Reference Group.
The paper highlighted that although there are no immediate finance implications; there will be some long term financial implications. It is thought that the cost pressure for SWBCCG should not exceed £225,000. SWB CCG’s finance team have been actively involved in the process and discussions to date.
Decision: The Committee approved the report and supported the bid.
3.5 Excess Treatment Cost Request IWOTCH Study
It was noted that the CCG is seeking legal advice with regards to excess treatment cost requests. CCGs are not permitted to reject ETC requests for financial reasons hence the need for some legal guidance on the matter
The IWOTCH study is an NIHR approved study which requests £5761.80 to cover the cost of three approved nurses and three facilitators to provide support programmes for patients who are prescribed opioids for chronic pain.
The Committee agreed that the study appears to be relevant and fits with CCG priorities. It was suggested that if the study works, it is something that the CCG may potentially be interested in replicating.
The Committee discussed the appropriateness of approving studies where legal advice is outstanding..
Decision: The Committee agreed to approve the study in principle pending legal advice.
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Action: The Committee requested feedback re: the outcome of the requested legal advice with regards to ETC studies.
4. ITEMS FOR INFORMATION
4.1 Programme Management Office Update
The commissioning confirmation panels are on-going. Arising risks and issues are being captured and where appropriate will be referred for inclusion on either the SCR or PCCC risk registers.
4.2 Corporate Updates
No update.
4.3 Health & Well-Being Board Feedback
No Update
4.4 Right Care Update
The update highlighted that the CCG remains on track for September 2017. The three RC priority programme areas are respiratory, diabetes and cancers.
NHS England has mandated a template return at the end of June, July and August. In June and July we are required to submit one programme area each month. In August we are required to submit all three programme areas. We are submitting programmes as follows; . June – diabetes . July – cancers . August – respiratory, diabetes and cancers
Evaluation of the 2016/17 PCCF has shown a significant impact on areas that directly link to Right Care including diabetes, hypertension, Atrial Fibrillation and cancer. . Right Care has approached the CCG to ask to use the PCCF as a case study for them to publish through their national programme.
It was suggested that it would be useful to break down Right Care to differentiate between Sandwell and Birmingham.
Action: DH to find out from AH whether it would be possible to break down Right Care to differentiate between Sandwell and Birmingham.
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4.5 Strategic Estates Review Group
No update.
5. ANY OTHER BUSINESS
5.1 Better Care Fund (BCF) and the Responsibilities of SCR
Audit Committee have requested clarification around the responsibilities of SCR and what the Committee has picked up following the dissolution of the Partnerships Committee.
The Committee were of the view that the dissolved Partnership Committee did not pass any responsibilities for the Better Care Fund to SCR; however confirmation was requested of SCR responsibilities for assurance.
Action: DH to liaise with SL to confirm whether SCR has any responsibilities in relation to the Better Care Fund.
5.2 GP Five Year Forward View
The Committee requested information of the CCG’s progression with the Five Year Forward view and were advised that the performance monitoring tool and the existence of a performance monitoring group which feeds into PCCC provides assurance to organisation.
Action: LMf to share with the Committee information regarding the progress of the GP Five Year Forward View.
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GOVERNING BODY Report Title: Report Author and Title: Audit and Governance Committee Michelle Carolan, Date of Governing Body: Contact Details: 0121 612 Wednesday 02 August 2017 3830 [email protected] Agenda No: 7.5 Enclosure No: 6
Sign off from Chief Officers: (Before the report is presented to the Governing Body any implications relating to Finance, Quality and Commissioning must be agreed and signed by the Chief Officer. (see guidance note) Without this information the report will not be taken to the Governing Body)
Chief Finance Officer: Yes
Chief Officer for Quality: Yes
Chief Officer for SCR: N/A
Chief Officer for Transformation: N/A
Supporting Documents/further Reading: (Highlight any documents or further reading for members which supports this report) Previous Decision (Inform the Governing Body/Committee if the paper has been reviewed or monitored by another committee and their recommendation or decision)
Summary of purpose and scope of the report: (Highlight key points you wish to bring to the attention of members)
The aim of the report is to provide the Governing Body of the issues discussed at the Audit and Governance Committee held in June 2017 Recommendations:
• Note the report from the Audit and Governance Committee for assurance • Approve the risk closures relating to the Board Assurance framework
The Governing Body/Committee are requested to: Action Approve x Assurance x Decision Conflicts of Interests: The recommended action by the author of the report is: No conflict identified x Conflict noted, conflicted party can participate in clinical discussion but not decision Conflict noted, conflicted party can remain in committee but not participate in discussion Conflicted party is excluded from discussion (this would be rare circumstances only)
Sandwell & West Birmingham CCG Audit & Governance Committee Report Page 1 Agenda Item 7.5 - Enc 7 Wednesday 02 August 2017
Please state rationale for above decision:
Strategic Priorities related to the report: Quality & Safety x Finance & Performance x Partnership x Strategic Commissioning and Redesign x Organisational Development x Primary Care Co-Commissioning x Collaborative Commissioning x Implications: Financial State any financial implications for the CCG Assurance Framework The Audit and Governance Committee have delegated responsibility to review the Assurance Framework and provide assurance to the Governing Body
Risks and Legal Obligations The Audit and Governance Committee Review the corporate risk register on behalf of the Governing Body.
Equality and Diversity Statutory and External Influences Further implications not stated Detail any further implications including resources and training Consultation: X Patients Staff Committees Public Partners Sponsored By: (Chief Officer or Committee Julie Jasper, Lay Member and Audit Chair Chair) Date Report received for Governing Body 26th July 2017
Sandwell & West Birmingham CCG Audit & Governance Committee Report Page 2 Agenda Item 7.5 - Enc 7 Wednesday 02 August 2017
SANDWELL AND WEST BIRMINGHAM CLINICAL COMMISSIONING GROUP
Report to the Governing Body
Subject: Audit and Governance Committee
Date: 20 July 2017
Author: Michelle Carolan, Deputy Chief Officer, Quality
Remit of Subcommittee
The Audit and Governance Committee is a committee of the SWBCCG Governing Body. The Committee will inform the Governing Body of its deliberations formally by means of a report to the Governing Body meeting after the Committee has met, and informally by other means of communication.
The Committee shall review the establishment and maintenance of an effective system of integrated governance, risk management and internal control, across the whole of the organisation's activities (both clinical and non-clinical), that supports the achievement of the organisation's objectives.
Progress last Month
• Internal Audit • Progress Report • Outstanding Recommendations Report • Continuing Healthcare Internal Audit Report • PCCC Internal Audit Report • Annual Satisfaction Survey • Key development briefings • Conflicts of Interest New statutory guidance • Audit & Governance Risk Register • BAF Risk Register • Risk Closures
Sandwell & West Birmingham CCG Audit & Governance Committee Report Page 3 Agenda Item 7.5 - Enc 7 Wednesday 02 August 2017
Internal Audit
• The Internal Audit Progress Report based on work undertaken for 2017/18 was presented. There have been no changes to the audit plan since it was approved by the Audit Committee. • The recommendation tracker was reviewed; there are currently 39 recommendations sitting on the tracker. 17 are not yet due and 22 are in progress, and outstanding. • Internal Audits for PCCC and an updated Continuing Healthcare report were presented to the group. The audits were approved. • The annual customer satisfaction survey was presented: 97% rated their overall satisfaction at 7 (out of 10) or above, 94% of respondents rated added value at 7 (out of 10) or above and 98.6% would continue to recommend CW Audit services to others.
Conflicts of Interest New Statutory Guidance
• Registers of Interest – Annual requirement. Decision making staff will be published • Gifts from suppliers or contractors –Low value gifts now acceptable (below £6) • Gifts from other sources – Gifts under £50 can be accepted, over £50 can be accepted on behalf of the organization only, not in personal capacity • Hospitality - meals and refreshments: Hospitality under £25 can be accepted and does not need to be declared. Hospitality between £25 and £75 can be accepted, but must be declared. If the value of the hospitality is over £75, it must be declared and should be refused unless senior approval is given. • Sponsored Events: a new section on sponsored events. • New Care Models commissioning - a new annex has been appended which summarises key aspects of the guidance that need particular consideration within the context of new care models commissioning.
Risk Register s
• The Audit and Governance Risk Register was reviewed by the group • The committee reviewed the BAF and agreed in principle, subject to Governing Body approval, to close the following risks: FP09 PC17, PC09, PC03 PC03_17b, PC01_17b PC11_16a QS18 SC02 SC17
These are included in the papers for reference.
Sandwell & West Birmingham CCG Audit & Governance Committee Report Page 4 Agenda Item 7.5 - Enc 7 Wednesday 02 August 2017
Escalation to the Governing Body
• Annual satisfaction Scores • Conflicts of Interest new statutory guidance
Sandwell & West Birmingham CCG Audit & Governance Committee Report Page 5 Agenda Item 7.5 - Enc 7 Wednesday 02 August 2017 Governing Body - Closure Approved by Audit and Governance
26 July 2017 Page 1 of 11 FP09 Description From September UHB will be providing the payroll service. In the movement of services, there are risks that: staff will not be paid, will be paid incorrectly, or tax/pension data will be incorrectly calculated.
Old Reference Initial Probablity (1-5) Initial Impact (1-5) Initial Risk Grading Corporate Objectives N/A 2 4 8 Deliver Financial Stability and Efficiency Opened Current Probability Current Impact Current Risk Grading Committee 08/09/2016 1 1 1 F&P - James Green Reviewed Controls Actions and Updates 26/06/2017 08/09/2016 - Where staff are not paid systems are in place for manual payments to be 08/09/2016 - Ensure that there is sufficient cash at month end for manual payments to be made. made. BACs value will be approved before payment is processed so this can be assessed for 26/09/2016 - BACS payment has been signed off. reasonableness. Previous month values can be used to pay Tax, NI and Pensions. Assurances 24/10/2016 - Payroll for Sept 2016 was processed as expected. Finance Team to review the transactions, tax and NI have been received from the UHB payroll over controls and systems in place etc. through to the year end. 24/04/2017 - Risk reviewed, recommended for closure - time limited, end date reached. Risk 28/11/2016 - Risk reviewed - continue to monitor service delivery throughout the year. Initial Risk Level reduced to 1 (Time Limited) 23/01/2017 - Risk reviewed, no changes. 27/03/2017 - Risk Reviewed, no changes, but committee anticipate closure in May, to time-limited nature of risk. I - Moderate (8-15) 24/04/2017 - Risk reviewed, recommended for closure - time limited, end date reached. 22/05/2017 - FP reviewed, still awaiting closure from A&G. Current Risk Level Rating Tracker 15/06/2017 - A&G cannot close risk until ALL Risk Fields have been completed. 20/07/2017 - Closure Approved by Audit and Governance Committee. C - Very Low (1-3) 24/04/2017 - Risk reduced to 1 (Time Limited) Status Closed Closure Requested Gaps in Controls 20/06/2017 - None. Closure Reason Time Limited Closure Approved Internal Assurances 03/05/2017 - CCG financial accountant has regularly monitored performance and no issues Closure Approved have been identified. Date 20/07/2017 Closure Rules External Assurances Approval Required 03/05/2017 - UHB deliver this service to a number of NHS organisations. from A&G Responsibility James Green Gaps in Assurances ID 20/06/2017 - None. 10
26 July 2017 Page 2 of 11 PC17 Description If SWB patients are affected by national misdirection of mail problem (mostly effecting North East London, East Midlands, and South West of England) then this may result in loss of information that may affect patient care.
Old Reference Initial Probablity (1-5) Initial Impact (1-5) Initial Risk Grading Corporate Objectives N/A 2 3 6 Improving Care and Quality Opened Current Probability Current Impact Current Risk Grading Committee 19/08/2016 1 1 1 PCCC - Lisa Maxfield Reviewed Controls Actions and Updates 23/06/2017 19/08/2016 - Any incidents pertaining to this issue are reported to NHS E. 19/08/2016 - NHS E are attending next PCCC meeting to discuss the issue. 21/04/2017 - As far as we are aware there has been no impact and as a consequence closure 23/09/2016 - NHS E attended the PCCC in September and the risk was discussed. Recovery plans are in place and these requested. Risk reduced to 1 (Time Limited). will be shared by NHS E when available. 18/11/2016 - CCG received a briefing from NHSE advising that they are controlling the issues with Capita. 16/12/2016 - Since we have added this risk to the risk register we have had no reported issues. Consequently we are Initial Risk Level reducing the risk to 4. 20/01/2017 - Risk reviewed no change. I - Low (4-7) 21/04/2017 - As far as we are aware there has been no impact and as a consequence closure requested. Risk reduced to 1 (Time Limited). Current Risk Level Rating Tracker 23/06/2017 – Gaps in controls and assurances updated, closure requested. 20/07/2017 - Closure Approved by Audit and Governance Committee. C - Very Low (1-3) 16/12/2016 - Risk reduced to 4 (Partial Mitigation) Status 21/04/2017 - Risk reduced to 1 (Time Limited) Closed Closure Requested Gaps in Controls 23/06/2017 – No gaps in controls. Closure Reason Time Limited Closure Approved Internal Assurances 20/01/2017 - CCG has had no further incidents. Closure Approved Date 20/07/2017 Closure Rules External Assurances Approval Required 19/08/2016 - NHS E (who commission the service provided by Capita) from A&G 16/12/2016 - Monitored by T2T and Datix. Responsibility Lisa Maxfield Gaps in Assurances ID 23/06/2017 – No gaps in assurances. 37
26 July 2017 Page 3 of 11 PC09 Description Plans for use of Finch Road site may not meet community expectations.
Old Reference Initial Probablity (1-5) Initial Impact (1-5) Initial Risk Grading Corporate Objectives 256 2 3 6 Reduce the Health and Well Being Gap Opened Current Probability Current Impact Current Risk Grading Committee 18/03/2016 1 1 1 PCCC - Lisa Maxfield Reviewed Controls Actions and Updates 23/06/2017 18/03/2016 - 1) Planning panel in place, 2) Individual conversations taking place with locally 18/03/2016 - CCG to continue to monitor and implement plan under weekly review through Finch Road Working elected members, 3) Finch Road project plan in place. Group. 23/06/2017 – Finch road primary care centre now under the remit of Birmingham South 22/04/2016 - The CCG is working with partners to develop proposals for the site (24/6) a paper will be submitted to the Central CCG, therefore the CCG no longer owns this risk. Risk redcued to 1 (Transferred). Committee for July. 20/05/2016 - Ongoing risk. No further changes. Initial Risk Level 17/06/2016 - CCG have begun patient and stakeholder engagement events. Finch Road Co-Design Panel is meeting on 24th June 2016 to discuss proposals that will be taken forward to PCCC. I - Low (4-7) 29/07/2016 – Proposal taken to July PCCC Committee to develop services within the Finch Road site – we continue to work with colleagues around the proposals for GP access. Current Risk Level Rating Tracker 19/08/2016 - CCG has commissioned the services of plan B solutions to progress and conclude the occupancy interests. 23/09/2016 - CCG continues to progress interest from potential providers to go into Finch Road. CCG continues to C - Very Low (1-3) 17/03/2017 - Risk reduced to 6 (Partial Mitigation) maintain communication with elected members. 23/06/2017 - Risk reduced to 1 (Transferred) 18/11/2016 - Risk reviewed no change to risk. Status 16/12/2016 - Momentum skills up and running and progress on lymphedema made, now subject to finalisation of costs Closed with BCHC. Space also identified for a hub provision. 20/01/2017 - The CCG have been advised that Birmingham South Central is going to locate a new GP hub within Closure Requested Gaps in Controls Burberry Medical Practice rather than what South Central have formally agreed with SWB CCG. The Operations team is 23/06/2017 – No gaps in controls. continuing to work with local elected members and the local community. Closure Reason 17/03/2017 - To date there does not appear to have been any reputational damage to the CCG as a consequence of this risk, therefore score reviewed and reduced to 6. Transferred 21/04/2017 - Birmingham South Central have approached the CCG requesting that Finch Road be moved to Birmingham South Central CCG. A paper will be presented to Primary Care Co Commissioning Committee on Closure Approved Internal Assurances 04/05/2017 for a decision to be made. 23/06/2017 – No internal assurances. 23/06/2017 – Finch road primary care centre now under the remit of Birmingham South Central CCG, therefore the CCG Closure Approved no longer owns this risk. Closure requested on this basis. Date 20/07/2017 - Closure Approved by Audit and Governance Committee. 20/07/2017 Closure Rules External Assurances Approval Required 23/06/2017 – No external assurances. from A&G Responsibility Lisa Maxfield Gaps in Assurances ID 23/06/2017 – No gaps in assurances. 30
26 July 2017 Page 4 of 11 PC03 Description The CCG is still awaiting transfer of electronic records in relation to 100 GP contracts from NHSE. If this does not happen, the CCG do not have full access to contract info, which could impact on the outcome of any contract amendments.
Old Reference Initial Probablity (1-5) Initial Impact (1-5) Initial Risk Grading Corporate Objectives 228 4 3 12 Reduce the Health and Well Being Gap Opened Current Probability Current Impact Current Risk Grading Committee 18/09/2015 1 1 1 PCCC - Lisa Maxfield Reviewed Controls Actions and Updates 23/06/2017 18/09/2015 - Strong working relationship with NHSE, which helps facilitate access to 20/11/2015 - No further updates from NHSE to date. information on an ad hoc basis. 22/01/2016 - CCG continues to request action from NHS E. 20/01/2017 - Continue to work with NHS E. 26/02/2016 - CCG now has access to SharePoint. Training to be undertaken with contracts team. Within the next 4 20/01/2017 - The CCG has built their own electronic records since April 2015 and we have a weeks the team will have full access to electronic records. process in place to access anything historical. Risk reduced to 1 (Mitigated). 18/03/2016 - Risk remains the same. Continue to work with NHSE in accessing records. Initial Risk Level 22/04/2016 - Risk reviewed; no changes. 20/05/2016 - Risk reviewed; no changes. I - Moderate (8-15) 17/06/2016 - Risk reviewed; no changes. 29/07/2016 - Risk reviewed; no changes. Current Risk Level Rating Tracker 19/08/2016 - CCG is actively chasing NHS E for an update on when this is due to happen. 23/09/2016 - Risk reviewed; no changes. C - Very Low (1-3) 16/12/2016 - Risk reduced to 4 (Partial Mitigation) 17/11/2016 - Comment from A&G: Please update action from 19/08/2016. 20/01/2017 - Risk reduced to 1 (Fully Mitigated) 18/11/2016 - Risk reviewed, no changes. Status 16/12/2016 - Risk reviewed; downgraded to 4. This is a national issue and continues to be an outstanding action. Due to Closed the controls we have internally the risk is less than it was when it was initially opened. 20/01/2017 - The CCG has built their own electronic records since April 2015 and we have a process in place to access Closure Requested Gaps in Controls anything historical - closure requested. 23/06/2017 – No gaps in controls. 21/04/2017 – Reviewed by A&G Committee: Internal and external assurances need to be added before risk can be Closure Reason closed. 23/06/2017 – Internal and external assurances updated, closure requested. Mitigated 20/07/2017 - Closure Approved by Audit and Governance Committee. Closure Approved Internal Assurances 23/06/2017 – No internal assurances. Closure Approved Date 20/07/2017 Closure Rules External Assurances Approval Required 23/06/2017 – Strong working relationship with NHSE, which helps facilitate access to from A&G information on an ad hoc basis. Responsibility Lisa Maxfield Gaps in Assurances ID 23/06/2017 – No gaps in assurances. 27
26 July 2017 Page 5 of 11 PC03_17b Description If NHS E fail to endorse the transferring practices onto Organisation Data Service, this may have a significant impact on finances, systems and processes within the CCG.
Old Reference Initial Probablity (1-5) Initial Impact (1-5) Initial Risk Grading Corporate Objectives N/A 3 4 12 Opened Current Probability Current Impact Current Risk Grading Committee 17/03/2017 1 1 1 PCCC - Lisa Maxfield Reviewed Controls Actions and Updates 23/06/2017 17/03/2017 - Positive working relationship with BSC CCG to manage the issue throughout the 17/03/2017 - Actively chasing NHS E for a response. Positive working relationship with BSC CCG to manage the issue year to mitigate against the impact. Risk score reviewed and reduced to 9. throughout the year to mitigate against the impact. 23/06/2017 - NHS England have now endorsed the change, therefore the risk no longer exists. 21/04/2017 - The risk score has been increased as there has been no formal confirmation of the GP transfers from NHS Gaps in controls and assurances updated, closure requested. Risk reduced to 1 (Time Limited) E. 19/05/2017 – Closure requested as it has gone ahead and been changed without their endorsement, so there is no risk Initial Risk Level to financial systems. 23/06/2017 - NHS England have now endorsed the change, therefore the risk no longer exists. Gaps in controls and I - Moderate (8-15) assurances updated, closure requested. (Time Limited) 20/07/2017 - Closure Approved by Audit and Governance Committee. Current Risk Level Rating Tracker C - Very Low (1-3) 17/03/2017 - Risk reduced to 9 (Partial Mitigation) Status 23/06/2017 - Risk reduced to 1 (Time Limited) Closed Closure Requested Gaps in Controls 23/06/2017 – No gaps in controls. Closure Reason Time Limited Closure Approved Internal Assurances 23/06/2017 – CCG progressed without endorsement. Closure Approved Date 20/07/2017 Closure Rules External Assurances Approval Required 23/06/2017 – No external assurances. from A&G Responsibility Lisa Maxfield Gaps in Assurances ID 23/06/2017 – No gaps in assurances. 265
26 July 2017 Page 6 of 11 PC01_17b Description If the proposed relocation of Newport Medical Practice receives public challenge, then this may result in reputational damage to the CCG.
Old Reference Initial Probablity (1-5) Initial Impact (1-5) Initial Risk Grading Corporate Objectives N/A 3 3 9 Opened Current Probability Current Impact Current Risk Grading Committee 20/01/2017 1 1 1 PCCC - Lisa Maxfield Reviewed Controls Actions and Updates 23/06/2017 17/02/2017 - Practices have expressed a desire to submit a business case to redesign their 20/01/2017 - This risk supersedes PC11_16b. 1) Public consultation extended, following request from local community. Stony Lane Surgery and will maintain Newport as a separate practice. 2) CCG receive feedback on issue from patients and stakeholders. 3) We have received a solicitor’s letter from Newport 21/04/2017 - The application to relocate has been withdrawn as a consequence closure Association, which we have sought legal advice on and responded to. 4) There is a meeting on 7th February to review requested as risk no longer exists. Risk reduced to 1 (Time Limited). how robust the process is. 17/02/2017 - Practices have expressed a desire to submit a business case to redesign their Stony Lane Surgery and will Initial Risk Level maintain Newport as a separate practice. Risk reduced to 6. 21/04/2017 - The application to relocate has been withdrawn as a consequence closure requested. I - Moderate (8-15) 23/06/2017 - Gaps in controls and assurances updated, closure requested. 20/07/2017 - Closure Approved by Audit and Governance Committee. Current Risk Level Rating Tracker C - Very Low (1-3) 21/04/2017 - Risk Reduced to 1 (Time Limited). Status Closed Closure Requested Gaps in Controls 23/06/2017 – No gaps in controls. Closure Reason Time Limited Closure Approved Internal Assurances 23/06/2017 – Application to relocate withdrawn. Closure Approved Date 20/07/2017 Closure Rules External Assurances Approval Required 23/06/2017 – No external assurances. from A&G Responsibility Lisa Maxfield Gaps in Assurances ID 23/06/2017 – No gaps in assurances. 250
26 July 2017 Page 7 of 11 PC11_16a Description There is a reputational risk in that a GP and a senior ex-member of staff have been found guilty of fraud (misappropriation of funds) from the CCG. Sentencing of the GP and ex CCG member of staff to take place on 13th December.
Old Reference Initial Probablity (1-5) Initial Impact (1-5) Initial Risk Grading Corporate Objectives N/A 4 4 16 Improving Care and Quality Opened Current Probability Current Impact Current Risk Grading Committee 18/11/2016 1 1 1 PCCC - Lisa Maxfield Reviewed Controls Actions and Updates 23/06/2017 20/01/2017 - The sentencing has taken place. The GP has been removed as a partner from the 18/11/2016 - There is a robust communication plan in place and a whistleblowing policy. CCG members of staff have all contract. The CCG is awaiting the reimbursement of funds and no adverse media coverage has received fraud awareness training. Financial and governance arrangements have been reviewed and modified and occurred. Finance team are actively working on the reimbursement of funds. Risk Reduced to financial controls are in place and are being reviewed by both internal and external auditors. 12. 16/12/2016 - Sentencing did not take place on the 14th December. The sentencing is to take place on the 20th 20/04/2017 - Reviewed by A&G Committee: Internal and external assurances need to be December. There has been some media coverage and we have responded to all media requests. Initial Risk Level added before risk can be closed (Time Limited). Risk reduced to 1 (Time Limited). 20/01/2017 - The sentencing has taken place. The GP has been removed as a partner from the contract. The CCG is awaiting the reimbursement of funds and no adverse media coverage has occurred. I - High (16+) 20/04/2017 – Reviewed by A&G Committee: Internal and external assurances need to be added before risk can be closed (Time Limited). Current Risk Level Rating Tracker 23/06/2017 – Internal and external assurances updated, closure requested (Time Limited). 20/07/2017 - Closure Approved by Audit and Governance Committee. C - Very Low (1-3) 20/01/2017 - Risk reduced to 12 (Partial Mitigation) Status 20/04/2017 - Risk redcued to 1 (Time Limited) Open - Removed from BAF Closure Requested Gaps in Controls 23/06/2017 – No gaps in controls. Closure Reason Time Limited Closure Approved Internal Assurances 19/05/2017 – We are working with our Communications Team in advance of the court case to Closure Approved mitigate any potential reputation damage from the media. Date 20/07/2017 Closure Rules External Assurances Approval Required 19/05/2017 – GP no longer on the contract. from A&G Responsibility Lisa Maxfield Gaps in Assurances ID 23/06/2017 – No gaps in assurances. 39
26 July 2017 Page 8 of 11 QS18 Description If ligature risks at Hallam Street (BCP) are not effectively managed, this may result in harm to patients.
Old Reference Initial Probablity (1-5) Initial Impact (1-5) Initial Risk Grading Corporate Objectives N/A 3 3 9 Improving Care and Quality Opened Current Probability Current Impact Current Risk Grading Committee 21/07/2016 1 1 1 Q&S - Claire Parker Reviewed Controls Actions and Updates 25/05/2017 15/11/2016 - Risk Assessments in place to identify and mitigate against identified risks. 21/07/2016 - CCG to ask BCP for action plan. 25/05/2017 - BCP, as the risk owner, is responsible for the management of the controls. Risk 19/09/2016 - Await findings from CQC return planned visit (October 2016) reduced to 1 (Transferred) 15/11/2016 - Still awaiting CQC visit report. 20/12/2016 - Risk reviewed and reduced to 2. Risk mitigated by environmental risk assessments carried out by BCP. Closed. Initial Risk Level 20/04/2017 - Reviewed by A&G Committee: Further detail to be added to risk to explain what mitigations have been taken by BCP and if any residual risk remains. I - Moderate (8-15) 25/05/2017 - Risk lies with Provider organisation (BCP), therefore transferred (on BCP risk register), and closed. Issue will be monitored via CQRM and SI process going forward. Risk redcued to 1 (Transferred) Current Risk Level Rating Tracker 13/06/2017 - Reason for gaps: CCG not risk owner. 15/06/2017 - A&G cannot close risk until ALL Risk Fields have been completed. C - Very Low (1-3) 20/12/2016 - Risk reduced to 2 (Partial Mitigation) 20/07/2017 - Closure Approved by Audit and Governance Committee. Status 25/05/2017 - Risk reduced to 1 (Transferred) Closed Closure Requested Gaps in Controls 17/07/2017 - Not applicable as risk transferred. Closure Reason Transferred Closure Approved Internal Assurances 21/07/2016 - CQRM Meeting Closure Approved Date 20/07/2017 Closure Rules External Assurances Approval Required 17/07/2017 - Not applicable as risk transferred. from A&G Responsibility Claire Parker Gaps in Assurances ID 17/07/2017 - Not applicable as risk transferred. 58
26 July 2017 Page 9 of 11 SC02 Description If the CCG fails to properly integrate SCR and PCCC, then there is the possibility of conflict arising from commissioning decisions pertaining to services in the community that may be delivered by Primary Care.
Old Reference Initial Probablity (1-5) Initial Impact (1-5) Initial Risk Grading Corporate Objectives 162 3 2 6 Reduce the Health and Well Being Gap Opened Current Probability Current Impact Current Risk Grading Committee 22/01/2015 1 1 1 SCR - Olivia Amartey Reviewed Controls Actions and Updates 15/06/2017 27/07/2016 - 1) PCCC Committee have been established and SCR has a seat via attendance of 22/01/2015 - Ongoing updates from SCR and Capital Review Group-shared with PCCC. 2) PCCC key issues shared with Deputy Chief Officer (Operations) 2) Primary Care Operations Group in place. Deputy Chief SCR. Officer (Operations) is invited when needed on an ad hoc basis. 26/11/2015 - Standing agenda item for SCR to be added to PCCCC to ensure alignment 02/12/2016 - Risk has been fully mitigated. Risk reduced to 1 (Mitigation). 27/07/2016 - Deputy Chief Officer (Operations) is a member of PCCC. To facilitate feedback and progress of any arising agenda items between SCR/CBPG and PCCCC. Initial Risk Level 17/11/2016 - Comment from A&G: Committee to update wording of the risk to better describe what the issues are, and better describe reason for closure. I - Low (4-7) 02/12/2016 - Risk description updated as requested. Risk has been fully mitigated. Request closure. 20/04/2017 – Reviewed by A&G Committee: Internal and external assurances need to be added before risk can be Current Risk Level Rating Tracker closed. 20/04/2017 - Internal assurances have been added. C - Very Low (1-3) 02/12/2016 - Risk reduced to 1 (Fully Mitigated) 15/06/2017 - A&G cannot close risk until ALL Risk Fields have been completed. 20/07/2017 - Closure Approved by Audit and Governance Committee. Status Closed Closure Requested Gaps in Controls ***[TBC]*** Closure Reason Entered in Error Closure Approved Internal Assurances 27/07/2016 - 1) PCCC Committee have been established and SCR has a seat via attendance of Closure Approved Deputy Chief Officer (Operations) 2) Primary Care Operations Group in place. Deputy Chief Date Officer (Operations) is invited when needed on an ad hoc basis. 20/07/2017 Closure Rules External Assurances Approval Required 08/06/2017 - Not applicable. from A&G Responsibility Olivia Amartey Gaps in Assurances ID 20/07/2017 - No Gaps in Assurance. 67
26 July 2017 Page 10 of 11 SC17 Description If the mobilisation of NHS 111 is compromised then this would result in an adverse impact across the region.
Old Reference Initial Probablity (1-5) Initial Impact (1-5) Initial Risk Grading Corporate Objectives N/A 4 4 16 Improving Care and Quality Opened Current Probability Current Impact Current Risk Grading Committee 12/10/2016 1 1 1 SCR - Olivia Amartey Reviewed Controls Actions and Updates 15/06/2017 12/10/2016 - Well-resourced and defined programme and project management 29/07/2016 - Explore revised governance arrangements through the establishment of a committee in common arrangement; Clear governance structure; Independent professional legal advice. Risk 26/10/2016 - Procurement is complete and we are now moving to mobilisation. reduced to 12. 23/12/2016 - The mobilisation of NHS111 is progressing. 27/04/2017 - Reviewed at SCR. NHS111 mobilisation has happened. Risk reduced to 1. 09/02/2017 - Risk reviewed, remains the same. Recommend for closure. (Time Limited) 27/04/2017 - Reviewed at SCR. NHS111 mobilisation has happened. Risk reduced to 1. Recommend for closure. Initial Risk Level 15/06/2017 - A&G cannot close risk until ALL Risk Fields have been completed. 20/07/2017 - Closure Approved by Audit and Governance Committee. I - High (16+)
Current Risk Level Rating Tracker C - Very Low (1-3) 12/10/2016 - Risk reduced to 12 (Partial Mitigation) Status 27/04/2017 - Risk reduced to 1 (Time Limited) Open - Removed from BAF Closure Requested Gaps in Controls 12/10/2016 - 16 separate organisations involved in the procurement each of whom have to Closure Reason operate their own governance arrangement Time Limited Closure Approved Internal Assurances 12/10/2016 - Clear line of reporting through project to SCR and GB. Clear progress reports Closure Approved against a project plan. Date 20/07/2017 Closure Rules External Assurances Approval Required 12/10/2016 - Clear line of reporting through project to SCR and GB. Clear progress reports from A&G against a project plan. Responsibility Debra Howls Gaps in Assurances ID 20/07/2017 - No gaps in assurance. 76
26 July 2017 Page 11 of 11
GOVERNING BODY Report Title: Organisational Development Report author and Title: Alice McGee, Head Committee of HR and OD Date of Governing Body/ Committee: 2nd Contact Details: August 2017 Agenda enclosure no: Sign off from Chief Officers: (Before the report is presented to the Governing Body any implications relating to Finance, Quality and Commissioning must be agreed and signed by the Chief Officer. (see guidance note) Without this information the report will not be taken to the Governing Body)
Chief Finance Officer:
Chief Officer for Quality: Claire Parker
Chief Officer for Operations:
Chief Officer for Partnership:
Supporting Documents/further Reading: (Highlight any documents or further reading for members which supports this report) Organisational Development Committee Minutes
Previous Decision (Inform the Governing Body/Committee if the paper has been reviewed or monitored by another committee and their recommendation or decision)
Summary of purpose and scope of the report: (Highlight key points you wish to bring to the attention of members)
The aim of the report is to provide the Governing Body of the issues discussed at the Organisational Development Committee on 11th July 2017 Recommendations:
The Governing Body are asked to note the content of the report.
The Governing Body/Committee are requested to: Action Approve Assurance X Decision Conflicts of Interests: The recommended action by the author of the report is: No conflict identified X Conflict noted, conflicted party can participate in clinical discussion but not decision Conflict noted, conflicted party can remain in committee but not participate in discussion Conflicted party is excluded from discussion (this would be rare circumstances only) Please state rationale for above decision:
1
Strategic Priorities related to the report: Quality & Safety Finance & Performance Partnership Strategic Commissioning and Redesign Organisational Development X Primary Care Co-Commissioning Collaborative Commissioning Implications: Financial Assurance Framework Risks and Legal Obligations Equality and Diversity Statutory and External Influences Further implications not stated Consultation: X Patients Staff X Committees Public Partners Sponsored By: (Chief Officer or Committee Prof Nick Harding Chair) Date Report received for Governing 25th July 2017 Body/Committee
2
Report
Staff Council Update
The Staff Council met on 4th July 2017 and welcomed the new Staff Council membership following the staff nomination process. Sukhi Bains was confirmed as the new staff council Vice Chair. The Staff Council have agreed to set up a CCG staff alumni and also voted to purchase a corporate pass for the Black Country Living Museum using the funds raised by the CCG Olympics.
Workforce Dashboard
The committee received a dashboard and a discussion was had in relation to the workforce indicators. PDR compliance remains significantly below target rate however statutory training continues to have a positive trend and remains at 84%.
Primary Care OD Plan
The OD Committee received a verbal update on the progress against the GP Five Year Forward View and that this was being managed through a programme management approach. The Committee agreed to work with clinical leads and GP Directors at the July Clinical Leads meeting to further develop opportunities for OD within primary care
Black Country and West Birmingham Joint Commissioning Board OD Update
The OD Committee had a verbal update and assurance on the HR and OD agenda for the joint commissioning board and agreed to continue to have this as a standing item each committee meeting.
CSU Scores
The OD Committee were provided with the customer scores for Midlands and Lancashire CSU and Arden and GEM CSU. The majority of service scores are rated as satisfactory or good with the exception of three contract areas (communication, contract management and Quality). The committee were provided assurance that a plan was in place to recover the scores and deliver the service
Risks
The committee also reviewed all associated risks and updated the register.
3
GOVERNING BODY Report Title: Primary Care Commissioning Report author and Title: Carla Evans, Head of Committee Public Session Update – July 2017 Primary Care
Date of Governing Body: Contact Details: [email protected] Wednesday 2nd August 2017 Agenda No: Enclosure no: Sign off from Chief Officers:
Chief Finance Officer:
Chief Officer for Quality:
Chief Officer for Operations:
Chief Officer for Partnership:
Supporting Documents/further Reading: N/A
Previous Decision N/A
Summary of purpose and scope of the report: To update the Governing Body on the outcomes of the public session of the July 2017 Primary Care Commissioning Committee.
Recommendations: To note the contents of the report and decisions taken by the Primary Care Commissioning Committee.
The Governing Body are requested to: Action Approve Assurance X Decision Conflicts of Interests: The recommended action by the author of the report is: No conflict identified X Conflict noted, conflicted party can participate in clinical discussion but not decision Conflict noted, conflicted party can remain in committee but not participate in discussion Conflicted party is excluded from discussion (this would be rare circumstances only) Please state rationale for above decision:
Sandwell & West Birmingham CCG PUBLIC Meeting of the Governing Meeting Enc - Page 1
Strategic Priorities related to the report: Quality & Safety Finance & Performance Partnership Strategic Commissioning and Redesign Organisational Development Primary Care Co-Commissioning X Collaborative Commissioning Implications: Financial x Assurance Framework Risks and Legal Obligations x Equality and Diversity Statutory and External Influences Further implications not stated Consultation: X Patients Staff Committees X Public Partners Sponsored By: (Chief Officer Sharon Liggins Date Report received for Governing Body 19/07/2017
Public Primary Care Co-Commissioning Update to Governing Body
1.0 INTRODUCTION
Sandwell & West Birmingham CCG PUBLIC Meeting of the Governing Meeting Enc - Page 2
1.1 This paper is to update the Governing Body of the actions and outcomes from the previous meeting of the Primary Care Co-Commissioning Committee Public session which took place on 6th July 2017.
1.2 The items updates presented at the Committee for information included: • Finance Update • Risk and Issues Register Report • GPFV • Improved Access Update
1.3 The following items were presented to the Committee for decision: • Premises Business Case Review Reports
2.0 DETAIL OF THE REPORT
2.1 Finance Update 2.1.1 The primary care delegated resource for 2017/18 is £79.0m with further anticipated allocations of an estimated £4.8m. The planned expenditure for 2017/18 is £83.8m. The statutory financial duties for delegated primary care allocations are consistent with the NHS business rules.
2.1.2 A year to date underspend is £419m. £81k of Attwood Green expenditure for asylum seeker health services for quarter 1 and quarter 2 is included in the forecast; this service may be extended further.
2.1.3 The £853k non-recurrent funding to primary care for transformational support to implement the GP Forward View (GPFV) is forecast to be spent in full.
2.1.4 Risks included (i) omitted payments processed by PCSE under the GP contracts, (ii) support for asylum seekers and (iii) 2016/17 PCCF estimated costs of £342k relating to Standard 9 Medicines Management and the outstanding appeals procedure.
2.2 Risk and Issue Register Report
2.2.1 Five new risks were added:
PC06_17d ‘There appears to be a lack of IT capacity across the CCG to deliver all elements of the GPFV which could increase the risk of ‘slippage’ against the GPFV action plan’. This was highlighted by GPFV. Martin Stevens is the risk owner of this risk; a JD has been developed for additional support and is awaiting approval.
PC06_17e ‘If practices fail to engage with support offered and/or fail to participate in improvement schemes, there is a risk that some patients will have inequitable access to high quality care’.
PC06_17a ‘If Health Education England does not provide the allocated courses to our member practices as agreed and planned there could be a reputational risk to the CCG’.
Sandwell & West Birmingham CCG PUBLIC Meeting of the Governing Meeting Enc - Page 3
PC06_17c ‘If NHS England fail to release guidance around elements of the GP forward view there is a risk that there will be inadequate time to implement milestone achievements as set out in the GPFV plan’.
PC06_17b ‘If GPs are not referring patients via the NHS E-referral service (ERS), paper based referrals will be rejected by SWBH and this could impact patients when paper referrals are switched off in October 2018’.
2.3 GPFV
2.3.1 The primary care leads across the STP are jointly commissioning GPFV and are working collaboratively where possible. A GPFV Monitoring Group has been set up to ensure the performance of the GPFV is effectively monitored and risks/issues are logged and managed accordingly.
2.4 Improved Access Update
2.4.1 Assurance was provided on the progress of implementation of improved access from 1 September 2017. £3.4m funding (£6 per patient) is dependent on 100% coverage across the CCG. 7 groups of practices have formed to deliver this leaving 6 practices who intend to deliver independently.
2.4.2 Project plans have been approved through the Primary Care Operations Group and the CCG is providing IT support and advice to practice groups. Two practices (Norvic Family Practice and Five Ways Health Centre) have yet to confirm their plans. Black Country Family Practice has confirmed their intention to join Modality and further information is awaited. Malling Health Great Bridge currently provides services between 8am and 8pm Monday to Friday and discussions are ongoing with NHSE to determine if the practice would be eligible if they extended their opening hours over weekends.
2.5 Premises Business Case Review Reports
Rood End
2.5.1 Committee approved the business case for a partial refurbishment of the existing premises and a new build to form a two storey extension of the existing premises.
St Pauls
2.5.2 Committee approved the new (scaled-down) proposal to construct a new building 500m from the existing surgery and then close the existing.
Stoney Lane
Sandwell & West Birmingham CCG PUBLIC Meeting of the Governing Meeting Enc - Page 4
2.5.3 Committee approved the business case to extend into the adjacent site and complete a significant refurbishment of the existing facility.
3. RECOMMENDATIONS
3.1 Members of the Governing Body are asked to: • To note the contents of the report and decisions taken by the Primary Care Commissioning Committee
Sandwell & West Birmingham CCG PUBLIC Meeting of the Governing Meeting Enc - Page 5
GOVERNING BODY Report Title: Report author and Title: Integrated Urgent Care Presentation Rachael Ellis Chief Operating Officer - Transformation
Date of Governing Body: Contact Details: Wednesday 05 July 2017 [email protected] Agenda No: Enclosure no: Sign off from Chief Officers: (Before the report is presented to the Governing Body any implications relating to Finance, Quality and Commissioning must be agreed and signed by the Chief Officer. (see guidance note) Without this information the report will not be taken to the Governing Body)
Chief Finance Officer: James Green Chief Officer for Quality: N/A Chief Officer for Operations: Chief Officer for Partnership: N/A
Supporting Documents/further Reading:
1. Integrated Urgent Care Presentation
Previous Decision (Inform the Governing Body/Committee if the paper has been reviewed or monitored by another committee and their recommendation or decision)
Summary of purpose and scope of the report:
For information only and to provide governing body with detail the step change required by the Commissioning and Provider family to remove the barriers and deliver integration and innovation to deliver improved patient pathways Recommendations:
The Governing Body are requested to: Action Approve Assurance Decision Conflicts of Interests: The recommended action by the author of the report is: No conflict identified Conflict noted, conflicted party can participate in clinical discussion but not decision Conflict noted, conflicted party can remain in committee but not participate in discussion Conflicted party is excluded from discussion (this would be rare circumstances only) Please state rationale for above decision:
Strategic Priorities related to the report: Quality & Safety Finance & Performance Partnership Strategic Commissioning and Redesign Organisational Development Primary Care Co-Commissioning Collaborative Commissioning Implications: Financial Assurance Framework Risks and Legal Obligations Equality and Diversity Statutory and External Influences Further implications not stated Consultation: X Patients Staff Committees Public Partners Sponsored By: (Chief Officer) Date Report received for Governing Body
Sandwell and West Birmingham CCG
Governing Body Meeting
Rachael Ellis, Chief Officer – Transformation Directorate
INTEGRATED URGENT CARE GOVERNANCE STRUCTURE
2 IUC Transformation Directorate Structure
3 AMBULANCE RESPONSE PROGRAMME
4 Ambulance Response Programme – Evaluation Report 13 July 2017
Where did it begin….
• Review Ambulance Response Performance Standards
Why….
• Achieving historic standards in light of increased activity was resulting in inefficiencies
Which Resulted in ….
• Unevenly distributed Clinical Risk across the 999 population
5 ARP Pilot - Timeline
Jan 2015 – SoS approval to commence Dispatch on Disposition.
• Feb 15 - LAS & SWAS – allowed up to an additional 120 seconds of triage time.
April 2016 – Phase 2
• LAS, SWAS & WMAS – implementation of revised call categories
October 2016 – APR 2.2
• Further revision of the Call Categories
July 2017
• Release of the Sheffield University Evaluation Report
6 Expected Outcomes
• Provide a more Clinically Appropriate Response – Getting the right resource to the right patient.
• Reducing the allocation of multiple resource whether suitable or not.
• Increasing Hear and Treat; reducing instances where a vehicle response is allocated.
7 New Standards
Category % of calls National How long does the What stops the clock? in this Standard ambulance service have to category make a decision? Category 1 8% 7 minutes mean The earliest of: • The first ambulance service – response time • The problem being dispatched emergency identified responder arriving at the scene 15 minutes 90th • An ambulance response of the incident centile being dispatched response time • 30 seconds from the call (There is an additional Category 1 being connected transport standard to ensure that these patients also receive early ambulance transportation) Category 2 48% 18 minutes The earliest of: If a patient is transported by an mean response • The problem being emergency vehicle, only the arrival time identified of the transporting vehicle stops • An ambulance response the clock. If the patient does not 40 minutes 90th being dispatched need transport, the first centile • 240 seconds from the call ambulance service-dispatched response time being connected emergency responder arriving at the scene of the incident stops the clock.
8 New Standards
Category % of calls National How long does the What stops the clock? in this Standard ambulance service have to category make a decision? Category 3 34% 120 minutes The earliest of: If a patient is transported by an 90th centile • The problem being emergency vehicle, only the arrival response time identified of the transporting vehicle stops • An ambulance response the clock. If the patient does not being dispatched need transport the first • 240 seconds from the call ambulance, service-dispatched being connected emergency responder arriving at the scene of the incident stops the clock. Category 4 10% 180 minutes The earliest of: Category 4T: 90th centile • The problem being If a patient is transported by an response time identified emergency vehicle, only the arrival • An ambulance response of the transporting vehicle stops being dispatched the clock. • 240 seconds from the call being connected
9 AMBULANCE INTEGRATION WITH CAS PROJECT
10 IUC 999 / NHS 111 Clinical Assessment Service Projects
11 IUC 999 / NHS 111 Clinical Assessment Service Projects
Why Work Closer
1. Best outcomes and experience for patients
2. Efficient and effective use of NHS resources
3. Meet national policy
4. Help deliver the requirements of West Midlands STPs
12 IUC 999 / NHS 111 Clinical Assessment Service Projects
Project 1 – Crews & Paramedic Support Desk Accessing Hub Scope:
1. Ambulance staff attending any incident within the defined CCG areas
2. Ambulance staff operating the WMAS Clinical Support Desk for patients within or cases relating to the CCG areas
3. Clinical Assessment Service available 24 hours a day, 7 days a week
13 IUC 999 / NHS 111 Clinical Assessment Service Projects
Benefits:
• Supports reduced use of A&E and associated admissions and achievement of A&E national targets
• Meets the expected requirements of the Ambulance Response Programme for increased hear and treat and see and treat
• Supports meeting IUC targets of increasing clinical input to calls and completion through the IUC system
• Supports resilience to surge and major incidents
14 IUC 999 / NHS 111 Clinical Assessment Service Projects
Current Status:
Project initiation documents Developed and shared with:
• WMAS – Support given by WMAS Management Board
• Care UK – Support given by Care UK Senior Management Team
• IUC NHS 111 Development Group – PIDs approved
• Shared with Accountable Officers and will form part of the STP meeting with WMAS
• Formation of project structures and workstreams commenced
• Aim to go live in October
15 INTEGRATION URGENT CARE CAS PROJECTS
16 IUC CAS Live Projects
1. ED & 999 Validation – national pilot
2. Digital access ask NHS App
3. Numsas Pharmacy Scheme
4. Nursing Home Access to Hub (*6 Roll out)
5. OOH Direct booking Any to Any (Some elements to be completed)
6. Booking into Badger and Mallings from the IUC CAS
17 Original Top 5 IUC Projects
1. Direct Booking from NHS 111 / IUC CAS into GP Surgery – S&WB – August 2017
2. Access to the Patient Records via MIG – Coventry & Rugby – September 2017
3. Access to Patient Record – CPIS – July 2017
4. Access to Patient Record – Palliative Care (BlackPear) July / August 2017
5. IUC CAS Advanced Clinician Module – October 2017
MIG & CPIS – Potential national technical issues may delay
New Priority: Integration with West Midlands Ambulance Service NHS FT
18 Top Contractual Priorities
999
• Develop contract fit for purpose to Ambulance Response Programme targets and integration • Understand the Regional and local variance of metrics and standards • Agree the winter funding deliverables • Eradicate hand over delays and fines • Create a single point of truth within the contract of deliverables.
NHS 111 / Alliance
• Deliver key performance indicators in NHS 111 and OOH • Expand the IUC CAS to deliver key components of specifications • Integrate and support development in Staffordshire • OOH to deliver full integration including hub shift cover and reporting.
19 CHALLENGES / RISKS & ISSUES TO BE ADDRESSED All
20 Challenges / Risks & Issues to be addressed
Size & Scale
Organisational Barriers Cost
Competing Integrated Understanding & Engagement Priorities Urgent & Emergency Care
Interoperability Expectations
Skills & Data & Resource Information
21 MEETING STRUCTURE OVERVIEW
22 Transformation Directorate Meeting Structure Meeting Frequency Representation Required
Integrated Urgent Care Provider Monthly Alliance Providers Alliance Meetings Commissioners Urgent & Emergency Care Network Bi annual Commissioners Development Forum Wider Stakeholders Providers Integrated Urgent Care Quality Review Monthly Clinical Leads Meetings (IUC/999) Quality Leads Alliance Providers Commissioners Integrated Urgent Care Contract Monthly Providers Review Meetings Commissioners Integrated Urgent Care Commissioner Monthly Commissioners Meetings Integrated Urgent Care Development Monthly Commissioners Group (NHS 111/IUC) Care UK Integrated Urgent Care Development Monthly Commissioners Group (999) West Midlands Ambulance Service NHS FT
23 GOVERNING BODY/COMMITTEE Report Title: Safeguarding Children Annual Report Author and Title: Eileen Welch / Gene Report Kelly, Designated Nurses Date of Governing Body/ Committee: Contact Details: 2nd August 2017 0121 612 2489 / 2400 Agenda item: Annual Safeguarding Children Date: Prepared 20th July 2017 Report for the Governing Body Supporting Documents/further Reading: Children Act 1989 &2004, Safeguarding Vulnerable People in the reformed NHS: Accountability and Assurance framework (2015_ Working Together to Safeguard Children: A Guide to inter-agency working to safeguard and promote the welfare of children 2015 Summary of purpose and scope of the report: This is the fourth statutory annual report for Safeguarding Children 2016-2017 for Sandwell & West Birmingham Clinical Commissioning Group (SWB CCG).
Its purpose is to assure the Governing Body and members of the public that Sandwell and West Birmingham Clinical Commissioning Group (CCG) is fulfilling its statutory duties in relation to safeguarding children and in respect of all the services they commission with regard to promoting the safety and welfare of children and young people Recommendations: • The Governing Body are asked to note the content of the Report Governing Body/Committee are requested to: X Decision Action Assurance Approve Previous Decision (Inform the Governing Body/Committee if the paper has been reviewed or monitored by another committee and their recommendation or decision) Summary of Strategic Priorities: Quality & Safety Strategic Commissioning & Redesign Finance & Performance Organisational Development Partnership Collaborative Commissioning Implications: Financial State any financial implications for the CCG Assurance Framework Detail any links to the Assurance Framework
Risks and legal obligations None Equality and Diversity Improved access and support to children and their families. Most vulnerable receive targeted support Statutory and External Influences Further implications not stated Detail any further implications including resources and training. Consultation : X Patients Public Staff Partners Committees Sponsored By: (Chief Officer or Committee Chair) Claire Parker Date Received for Committee:
Safeguarding Children Unit Annual Report 2016/2017
Safeguarding Children Annual Report 2016-2017 Page 1
Contents page
1. Forward 2. Introduction 3. Executive summary 4. National & Social Context 5. Performance &Assurance 6. Primary Care 7. Multiagency Safeguarding Hub 8. Female Genital Mutilation 9. Domestic Abuse/Domestic Homicide Reviews/IRIS 10. Child Deaths 11. Serious Case reviews 12. Safeguarding Achievements 13. Strategic Objectives 16/17 progress report 14. Birmingham workplan 17/18 15. Strategic objectives/action plan17/18 16. Conclusion
Safeguarding Children Annual Report 2016-2017 Page 2
Foreword
This is the fourth statutory annual report for Safeguarding Children 2016-2017 for Sandwell & West Birmingham Clinical Commissioning Group (SWB CCG).
Its purpose is to assure the Governing Body and members of the public that Sandwell and West Birmingham Clinical Commissioning Group (CCG) is fulfilling its statutory duties in relation to safeguarding children and in respect of all the services they commission with regard to promoting the safety and welfare of children and young people.
Introduction
This report provides an update of the planned work undertaken during 2016/17 and outlines the areas for development during 2017/18. As the footprint of Sandwell & West Birmingham CCG covers both Sandwell and Birmingham Local Authorities this report will detail assurance and activities in both areas.
The main elements contained within this report are as follows: • The national context for the provision and development of safeguarding children and young people • The local context for the provision and development of safeguarding children and young people • Performance and Accountability • Primary Care Services • Prevention of Violence & Exploitation (PoVE) • Learning from Child Deaths, Serious Case Reviews and Domestic Homicide Reviews. • Sandwell & West Birmingham progress on Safeguarding Strategic objectives for 2016/17 • Birmingham Safeguarding Team Work Plan • Sandwell & West Birmingham Safeguarding Strategic objectives for 2017/18
Executive Summary
As an NHS organisation and principal commissioner of local health services, the CCG has specific responsibilities and duties in respect of safeguarding children
Safeguarding Children Annual Report 2016-2017 Page 3
(including looked after children). The report provides information about national and local safeguarding influences, how statutory requirements are being assured, and how challenges to business continuity relating to children have been managed over the last year. All NHS bodies have a statutory duty to make arrangements to safeguard and promote the welfare of children under Section 11 of the Children Act 2004. NHS bodies are statutory members of the Local Safeguarding Children Boards under Section 13 of the 2004 Act. Following recent government NHS reforms and the passage of the Health and Social Care Bill, statutory responsibilities to safeguard children are now the responsibility of NHS England, Clinical Commissioning Groups (CCGs) and the NHS Commissioning Board. The NHS has proposed changing the current way of working within the NHS with The 5 Year Forward View; these changes mean that the NHS needs to work differently. The Forward View sets out how the health service needs to change, arguing for a more engaged relationship with patients, carers and citizens so that we can promote wellbeing and prevent ill- health. https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf. The National NHS Commissioning Board has produced final guidance advice for CCGs and NHS England local teams on critical arrangements to secure children’s and adult safeguarding within the updated version of the NHS Safeguarding and Accountability Assurance Framework (2015).
In 2016 the government commissioned a National Review of Local Safeguarding Children Boards (LSCBs) and Child Death Overview Panels (CDOP). The review set out recommendations for making LSCBs more effective. Alan Wood’s review was published in May 2016. The Government’s response to the review stated that “this is the beginning of a time of considerable change”. The recommendations within the report were accepted and have been supported in legislation with a revised “Working Together” due to be published in autumn 2017.
Sandwell & West Birmingham Clinical Commissioning Group (SWBCCG) has continued to ensure statutory safeguarding standards are maintained through NHS local transition by regularly updating Local Safeguarding Children Board (LSCBs), NHS Commissioners and Provider services of local leadership, governance and quality assurance reporting of safeguarding arrangements. Safeguarding issues, incidents and training are reported via SWBCCG Quality and Safety Committee and relevant staff have received safeguarding training to level 2 and 3 standards. In the annual reporting period there have been a number of high profile inquiries and review reports.
As part of the Jimmy Savile/ Bradbury investigation, reports into historic cases of child abuse, the Independent Inquiry into Child Sexual Abuse (IICSA) has been commissioned with national initiatives to investigate whether public bodies have taken seriously their duty to protect children from sexual abuse and to identify if there have been any organisational failures to protect children. Also produced is further
Safeguarding Children Annual Report 2016-2017 Page 4
guidance to stop Female Genital Mutilation, Honour Based Violence/ Arranged Marriages and Counter Terrorism Prevention strategies in the United Kingdom.
Local partnership working/ LSCB/ NHS provider group action planning, quality monitoring, training and dissemination of key legislation requirements have been implemented across the health economy. Savile action plans by NHS providers have been produced and are being monitored via the Sandwell Safeguarding Children Board (SSCB) Health Forum which is a subgroup of the Safeguarding Children Board.
In 2016/17 Sandwell Safeguarding Children Board commissioned one Serious Case Review. In September 2016, a Serious Case Review was published from another Local Authority involving a child who had died in Sandwell. Although the death was in Sandwell, the area of residence where the child was known and lived carried out the Review with full co-operation from Sandwell agencies. The lessons learnt are specifically aimed at the district leading the review but are relevant to all. There have been no published SCRS involving West Birmingham practices during 2016/17.
The scale of organisational change in the NHS and across other organisations including Local Authority and police can create risks; The CCG has been working hard to mitigate any possible risks by ensuring partnership working with the CCG Adult Lead; NHS England by the CCG obtaining the co-commissioning of primary care services; NHS Trust providers; the Local Authority and other partners in an attempt to improve outcomes for children and young people.
There is regular attendance at Sandwell and Birmingham Local Safeguarding Children Board (LSCB) with significant CCG contribution; with Chief Officer for Quality acting Chair of the SSCB and Designated Professionals chairing Child Death and Serious Case Review Subgroups and Health Forum.
The CCG has continued to invest in the safeguarding agenda and this has been acknowledged and acclaimed by the Safeguarding Children Unit finalist status for HSJ Compassion in Care award 2016.
Safeguarding Children Annual Report 2016-2017 Page 5
National & Social Context
Performance & Assurance
Safeguarding Children Annual Report 2016-2017 Page 6
National & Social Context
The Prime Minister announced on 14 December 2015 that ministers had asked Alan Wood CBE to undertake a fundamental review of the Role and Functions of Local Safeguarding Children Boards (LSCBs) within the context of local strategic multi- agency working. This included consideration of the child death review process, and how the intended centralisation of serious case reviews would work effectively at local level. The government published The Children and Social Work Bill on the 20th May 2015. The arrangements set out in the Bill did not cover local reviews or any provisions relating to LSCBs, but the aim is for further provisions to be introduced during the Bill’s passage, taking into account the findings from the Wood Review. Further statutory guidance will be provided in a revised “Working Together to Safeguard Children” in 2017.
The Nursing profession has undergone recent changes including re-registration and revalidation to ensure all nurses are up to date to practice in their chosen field of clinical practice. Revalidation is a process that all nurses and midwives will need to engage with to demonstrate that they practice safely and effectively throughout their career. It is about promoting good practice. Nurses and midwives will need to revalidate every three years, at the point of their renewal of registration and this will replace the current Prep requirements and Notification of Practise form. http://revalidation.nmc.org.uk/
National guidance around the future of nursing has also been published leading to the following key documents: ‘Compassion in Practice’, our strategy for nursing, midwifery and care staff that concluded in March this year. Around the 6Cs - compassion, care, commitment, courage, competence, communication identified in Compassion in Practice. This work will now continue in the ‘Leading Change, Adding Value’ the nursing, midwifery and care staff framework.
The National Institute for Health and Clinical Excellence provides guidance set at a national level with regard to safeguarding, including new NICE quality standards, describing high-priority areas for quality improvement in a defined care or service area. Each standard consists of a prioritised set of specific, concise and measurable statements. They draw on existing guidance, which provides an underpinning, comprehensive set of recommendations, and are designed to support the measurement of improvement. NICE guidance recommends that health professionals are alert to key identified factors that pose a risk to a child:
• When to suspect child maltreatment • Antisocial behaviour and conduct disorders in children and young people: recognition, intervention and management.
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• Domestic violence and abuse: how health services, social care and the organisations they work with can respond effectively (PH50) February 2014. Domestic violence and abuse NICE quality standard [QS116] Published date: February 2016 and planned review of Child abuse and neglect NICE in development (GID-SCWAVE0708) expected publication date: September 2017. NICE recommend that their national standard recommendations be adopted to further improve NHS processes and systems to keep children safe. Local Safeguarding Children Boards and Health and Well Being Boards are recommended to incorporate NICE guidance in overall ‘strategies’.
Female genital mutilation (FGM) Safeguarding guidance: Female genital mutilation risk and safeguarding – guidance for professionals was published by the Department of Health in March 2015, this provides support to NHS organisations when developing or reviewing safeguarding policies and procedures around female genital Mutilation (FGM). It can be used by health professionals from all sectors, particularly designated and named safeguarding leads, and local safeguarding children board members. The forthcoming FGM mandatory reporting duty will require a referral to the police every time a confirmed case of FGM is identified in a child less than 18 years of age. On 1 April 2015, NHS England produced, ‘SCCI 2026 FGM Enhanced Dataset’, which revised what information is collected, for FGM and the method and frequency of collection. It is now mandatory to comply with these updates including Independent Contractors in Primary Care Settings documentation of FGM referrals on the national database.
The CCG have informed GPs/ Practice Managers of this new legislation requirement via their relevant meetings, newsletter and staff training. WHO is particularly concerned about the increasing trend for medically trained personnel to perform FGM. WHO strongly urges health professionals not to perform such procedures.
Forced marriage/ Honour Based Violence Revised practice guidelines are being developed alongside the revised statutory guidance “The Right to Choose” originally issued under s.63 Q(1) of the Family Law Act 1996. The statutory guidance is different to the multi-agency practice guidelines in that it provides advice and support to all frontline professionals who have responsibilities to safeguard children with or without learning disabilities, and protect all adults, with or without learning disabilities from the abuses associated with forced marriage. It also outlines the responsibilities of Chief Executives, Directors and Senior Managers within those agencies involved with handling cases of forced marriage and incorporates Honour Based Violence. Staff training, developing inter-agency policies and procedures, raising awareness and developing prevention programmes through outreach work are also included.
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The NHSE Child Sexual Exploitation (CSE) sub-group was established following the publication of the Department of Health Working Group Report (2014); Jay Report (2014) and Medical Colleges Report (2014), and provides national leadership and support to health agencies to implement the recommendations of these reports. The group is accountable to NHS England’s National Safeguarding Group and membership consists of representatives from across health agencies including Designated Safeguarding Children Professionals; Health & Justice; Care Quality Commission; Public Health England; National Working Group CSE.
Within its terms of reference and work plan the sub-group ensures that the actions relating to NHS England arising from these reports are fully implemented. The Group also provides national leadership, support and advice in relation to Child Sexual Exploitation. The Designated Nurse for SWBCCG is Vice Chair of the group and has lead on the innovative Child Sexual Exploitation (CSE) Superhero campaign; a project developed by Sandwell and West Birmingham Clinical Commissioning Group in partnership with The Children’s Society, fully endorsed by NHS England.
Performance & Assurance
Under section 11 Children Act 2004 CCG’s are required to have arrangements in place to meet their statutory duties in relation to safeguarding children. SWB CCG has robust governance arrangements in place. The Quality and Safety Committee of SWB CCG receives monthly safeguarding children reports. The function of this group is to ensure effective monitoring of safeguarding arrangements is reported through internal governance structures.
Evidence to support compliance with Section 11 is monitored by both Birmingham and Sandwell Safeguarding Children Boards (BSCB & SSCB). Reports are submitted to the BSCB & SSCB for audit and scrutiny and robustly challenged at scrutiny and peer review meetings.
Sandwell & West Birmingham CCG are compliant with section 11. There are a few areas that require strengthening and these are now included in the 2017/18 strategic plan.
How the CCG gains assurance that staff across all provider organisations safeguard and protect children:
The effectiveness of the safeguarding system is assured and regulated by a number of bodies and mechanisms. These include:
• Provider internal assurance processes and Board accountability
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• The Local Safeguarding Children Boards • External regulation and inspection- CQC • Locally developed peer review and assurance processes • Effective commissioning, procurement and contract monitoring.
All provider services, including every General Practice, are required to comply with the Care Quality Commission Essential Standard for Quality and Safety which include safeguarding standards (standard 7).
Contracts and service specifications for Provider Trust services commissioned by the CCG include service standards, information requirements and key performance indicators (KPIs) for safeguarding, work is underway to strengthen these assurances.
The Safeguarding Children Unit is responsible for the development, monitoring and reviewing of safeguarding practice by all providers Trusts, services and independent contractors. In this capacity they provide professional leadership, expert advice and support to the named professionals in each provider organisation.
As the CCG footprint covers both Sandwell and West Birmingham there is a Memorandum of Understanding in place with the Birmingham Safeguarding Team, hosted by Birmingham South Central Clinical Commissioning Group (BSC CCG) which covers Birmingham South Central (BSC), Birmingham Cross City (BCC) and Sandwell and West Birmingham (SWB) CCGs. In line with the CCG’s approach to safeguarding vulnerable children and adults, the Leads from the Hosted Team work collaboratively with provider services, conducting joint child and adult safeguarding review meetings.
The CCG Safeguarding Children Unit and Hosted Team are committed to supporting providers to develop the most effective ways of presenting and evidencing patterns of their safeguarding activity, with a clear focus on capturing and demonstrating the outcomes for children/ adults who have been identified as being at risk of abuse or neglect.
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Safeguarding response to:
Primary Care Training o
o GP Engagement
o Modern Slavery
o Looked After Children
o Advice calls
o Multi-Agency Safeguarding Hub
o Female Genital Mutilation
o DA/DHR/IRIS
o Child Death
o SCR’s
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Primary Care Training
Sandwell & West Birmingham Clinical Commissioning Group (SWB CCG) is committed to safeguarding and promoting the welfare of children and young people, who may be vulnerable. As a commissioning organisation, SWB CCG must ensure that its employees and staff working in services commissioned and contracted by them understand their role and responsibilities regarding safeguarding children and young people.
In accordance with the Children Act 2004 (Section 11) all individuals who work in health care organisations, both substantive staff and those working in services that are contracted or commissioned, must be trained and competent to recognise when a child may need to be safeguarded and know what to do in response to concerns about their welfare.
Working Together to Safeguard Children (2015) sets out statutory guidance on the responsibility of CCGs and NHS England to ensure that employees and independent contractors have an awareness of how to recognise and respond to safeguarding concerns (SWB CCG Training Strategy, 2015).
Safeguarding level 3 training; Child Sexual Exploitation, Female Genital Mutilation & Domestic Abuse
Sandwell & West Birmingham CCG commissioned a trainer to deliver face to face safeguarding training to level 3 practitioners as per statutory guidance Intercollegiate Document (2014). This training will enhance level 3 practitioner’s knowledge as the training is pertinent to child sexual exploitation (CSE), female genital mutilation (FGM) and domestic abuse (DA). The training was a scenario based session to encourage discussion.
Simon Hill is an ex-police officer and chairs Serious Case Reviews and Domestic Homicide Reviews within Sandwell and Birmingham and has a wealth of knowledge regarding these specialist subjects.
The training was split into two cohorts, cohort 1 training dates were between May- July 2016 and cohort 2 training dates were between September-December 2016.
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Aim:
To enable practitioners to identify and effectively deal with safeguarding concerns around 3 key subject areas of Child Sexual Exploitation (CSE), Female Genital Mutilation (FGM) and Domestic Abuse (DA).
Objectives: Health professionals will be better able to:
1 Explain when a child or young person’s level of need moves between early help and specialist services.
2 Recognise the signs when a child/YP is vulnerable to:
• Child Sexual Exploitation • Female Genital Mutilation • Domestic Abuse (including Coercive Control). 3 Understand how to effectively engage with:
• A child or young person at risk from CSE, FGM and DA. • A parent/carer at risk or supporting a child at risk. 4 Recognise the potential barriers to effective safeguarding within CSE, FGM and DA and consider how to overcome them.
5 Recognise the patterns of coercive control in Domestic Abuse and their impact upon adults and children.
6 Recognise the tactics used by Domestic Violence Abusers to prevent non- abusing partners and children seeking help form practitioners.
7 Understand when to share information, consult other professionals/colleagues, refer to Children’s Social Care (CSC) or police.
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Overall Evaluation for level 3 training between May - June 2016: Cohort 1
Evaluation of Level 3 Safeguarding training 30 29 30 28 26 26 25 24 24 25 23 21 20
15 Strongly Disagree 10 Disagree Agree 5 3 1 1 1 1 1 Strongly Agree 0 The learning The handouts The training The presenter What I have outcomes for provided were reflected my was focused, learnt today the course useful needs session was will help me were clear well organised improve my professional practise
Below is a bar chart indicating the overall assessment of the level 3 training for cohort 1 May-June 2016.
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Overall Evaluation for level 3 training between September – December 2016: Cohort 2
Overall a total of 196 health professionals, GP’s, ANP, HCA, Pracice nurses and practice managers attended the level 3 training. The safeguarding team plan to roll out 4 further sessions during the next finacial year 2017/2018.
ICPC GP Engagement
In 2014 the Care Quality Commission (CQC) reviewed Safeguarding Children and Looked after Children health services within Sandwell. Following the inspection a number of recommendations were set in order to improve safeguarding children within the borough.
“Attendance of both GPs and adult mental health practitioners at child protection conferences is reported by the CCG to have improved, although it remains at a low level. Neither GP practice we visited participated in child protection conferences
Safeguarding Children Annual Report 2016-2017 Page 15 although they received information from them. It is not clear whether the potential for the use of technology such as teleconferencing has been explored to increase GP participation and engagement in child protection conference discussions and decision making” (CQC, 2014).
CQC Recommendation 3.1 Source: cqc.org.uk (2014)
With NHS England Birmingham, Solihull and the Black Country Area Team work with General Practitioners to ensure participation in child protection conferences whenever possible and the routine submission of GP reports to best inform child protection conference decision making.
The above recommendation is currently being addressed and monitored within the Sandwell and health forum via an action plan, this forum reviews agency compliance a platform for scrutiny in order to ensure action plans are followed and actions are implemented and monitored within a realistic timeframe.
SWB CCG collated data for the year 2016-2017 reviewing the following;
• Number of ICPC notifications received from the local authority • Number of ICPC reports returned by GP’s within timeframe
For 2016-2017 the safeguarding unit received a total of: • 327 ICPC notifications from the Quality Development Unit (QDU) • A total of 140 ICPC reports were returned to the safeguarding team from GP practices in order for us to forward onto the QDU department. • 3 GP’s attended Initial Child Protection Conferences during 2016/2017. A decrease compared to 4 GP’s that attended in 2015-2016.
How can compliance be improved?
• Clear systems and processes have been established between health and children social care in terms of ICPC notifications being received from QDU in a timely manner. Since June 2014 the CCG Safeguarding Children Unit has been the single point of contact for both reports and invitations to ICPC’s for GP’s. This was to address data discrepancies between health and the local authority regarding primary care engagement and to coordinate a defined process.
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• To help aid and improve compliance a revised ICPC proforma for GP’s was developed and implemented in July 2016. • ACTION: Safeguarding team to audit submitted GP reports on a 6 monthly basis to ensure reports are to a high quality standard. Monitor number of submitted reports to establish if the new proforma has increased return.
Further actions for 2017/2018 to improve ICPC GP engagement
ACTION OUTCOME Continue to monitor GP engagement with To have a comprehensive and true ICPC process on a quarterly basis reflection of GP engagement with the Child Protection process in Sandwell and West Birmingham Repeat GP survey to explore rationale of To allow valid comparison of survey results poor engagement with Child Protection with previous year, which will identify if process. trends have changed or if further work is needed to improve engagement. Addition of key performance indicator (KPI) To measure GP ICPC engagement on a relating to ICPCs to the Primary Care monthly basis, and feed this into wider Dashboard quality performance indicators. CCG attendance to practice meetings/MDT To further investigate GPs individual meetings for safeguarding updates and rationale for not returning ICPCs, and promote importance of GP engagement identify solutions with the Child Protection process. Report non-return of ICPC health reports To identify the risk of GPs not engaging as a safeguarding incident on Datix. with the ICPC process, and to allow monitoring of trends
Summary
During quarters 1-4 2016-2017 there has been a total of a 43% GP engagement a decrease of 3% in GP submission of reports compared to 46% in 2015/2016.
The Safeguarding Children Unit will continue to report on GP ICPC engagement and provide reports as evidence for Ofsted and CQC for any future inspections as well as quarterly updates to Quality & Safety Sub-committee, Primary Care Quality Lead and GP practices.
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Modern Slavery
Modern slavery can take many forms including people trafficking and forced labour. It’s estimated there are more than 10,000 potential victims in the UK, and many of these are children. Organisations including representation from the Safeguarding Children’s Unit from Sandwell & West Birmingham CCG are working together – and with the West Midlands Police and Crime Commissioner (PCC) – to tackle this crime.
Examples of modern slavery:
• Forced labour – forcing people to work long hours for little or no pay in poor conditions under threats of violence to them or their families. • Child trafficking – under-18s moved into/around UK to exploit them for work, prostitution or sexual abuse. • Domestic servitude – forcing people to work, usually in private households, doing chores and childcare duties. They may work long hours for little/no pay with their freedom restricted. • Criminal exploitation – making people commit crimes, such as pick- pocketing, shoplifting, growing cannabis and drug trafficking.
The PCC has recently arranged for two new services to tackle modern slavery in the West Midlands:
• West Midlands Anti-Slavery Network (WMASN) – connecting various organisations involved in tackling modern slavery www.westmidlandsantislavery.org and • Barnardos Panel for Protection of Trafficked Children – to identify and protect child victims of trafficking and prevent them from going missing and/or being re-trafficked.
On the 02/03/17 a Safeguarding conference was held to raise awareness of the NHS modern slavery agenda. It highlighted the incidence, impact and key indicators as well as referrals mechanisms for health professionals. It was a well-received event including the ‘voice of the survivor’.
The Safeguarding Team are working to an action plan looking at:
1. Training assurance from providers – For all providers of SWB CCG to be aware of the modern day slavery agenda and referral mechanisms so they are compliant with the national guidance. 2. To devise a Referral Pathway for Sandwell and West Birmingham GP's.
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3. To ensure the CCG has an active role; influencing policies and strategies and working with other agencies by attending relevant meetings such as PPTC & WMASN. 4. CCG MASH nurses to collate health and demographic information in relation to referrals into Sandwell CSC informing quarterly reports to share at appropriate strategic meetings.
Advice Calls
Receiving and processing advice calls is a function of the safeguarding children’s team as this promotes inter-agency working and facilitates effective information sharing. Over the last year the Named Professional for Primary Care and the Lead Nurses for Safeguarding Children have received a total of 48 requests for advice. Whilst they are referred to as advice calls, it is important to note that enquiries are also received via email. Of the 48 enquiries, 29 of these came from GP’s, 6 from practice managers and 3 from practice nurses. Other professionals seeking advice include community nurses (3), physician assistants (2), Health Visitors (2), school nurse (1) and also from customer care (1). It is clear that that a variety of health professionals are accessing advice and support from both the unit and Multi-Agency Safeguarding Hub (MASH) which clearly evidences that this provision is embedded within SWB CCG.
Enquiries are recorded under categories of abuse (see table 1), enquiries outside these categories are classed as a general enquiry, of the 48 calls received 25 were classed as a general enquiry. We received 8 enquiries around sexual abuse, 5 regarding physical abuse and 4 enquiries around neglect. Other issues include FGM (2), CSE (1), Emotional Abuse (1), Domestic Abuse (1) and one case of no trace.
Table 1
Number of general enquiries 25 Number of call relating to sexual abuse 8 Number of calls relating to physical abuse 5 Number of calls relating to neglect 4 Number of calls relating to FGM 2 Number of calls relating to CSE 1 Number of calls relating to emotional abuse 1 Number of calls relating to domestic abuse 1 Number of calls relating to no trace 1 ANNUAL TOTAL 48
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The advice calls generate a variety of responses – 15 resulted in a recommendation to complete a Multi-Agency Referral Form (MARF), 10 were signposted to other Health Professionals for further action and 10 of the calls were deemed as no further action required. 3 required a referral back to the GP for the GP to gather more information and conduct further assessment, 2 were recommended for an Early Help Assessment, 2 were referred for action from School Health Nurse and 1 was recommended for a referral to Adult Social Care. The remaining 4 were already known to children’s social care and we were able to share information effectively across agencies.
In addition to the immediate response given by the team, advice call data is collated in detail thus using the information to identify trends within the data. This information is then used to identify potential learning and training needs for staff and agencies that are accessing the service.
Information sharing is vital to safeguarding and promoting the welfare of children and young people. A key factor identified in many serious case reviews has been a failure by practitioners to record information, to share it, to understand its significance and then take appropriate action (Information Sharing, HM Government, 2015).
Sharing information is an intrinsic part of any frontline practitioners’ job when working with children and young people. The safeguarding children unit can assure SWB CCG Governing Body that under section 11 of the Children Act 2004 appropriate and robust arrangements are in place to safeguard and promote the welfare of children of which there are clear processes for sharing information internally.
Multi Agency Safeguarding Hub (MASH)
The Sandwell Multi Agency Safeguarding Hub (MASH) is now well established since it opened in 2013 and continues to protect children and families who are at risk of significant harm including domestic abuse. Qualitative data is collected on a daily basis by health representatives (Lead Nurses for Safeguarding Children). Common themes have been identified as to why children have been referred into Children’s Social Care (CSC).
The data captured is from 1st April 2016 to year end 31st March 2017. This data is not representative of Children’s Social Care data.
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Table 2
Q1 2016 Q2 2016 Q3 2016 Q4 2017 Total number of referrals 349 370 398 441 actioned by the nurses
Total amount of children 815 784 904 955 assessed including siblings
The total amount of referrals actioned by the nurses for the year was 1,558. However as all children in the household are taken into consideration, this figure rises to 3,458 children.
Categories of abuse are recorded to demonstrate the varied and often complex cases received into MASH – (see figure 1). Diverse issues can be identified such as Female Genital Mutilation (FGM), Modern Day Slavery and Trafficking. The common themes have consistently been Neglect, Physical and Domestic Abuse (DA).
This is consistent when reviewing 2015/16 data as there has been an increase in referrals for physical (16) , emotional (49), domestic abuse (13) and neglect (8). There is a significant decline in referrals relating to sexual abuse (81), it is not known why this number is much lower when overall number of referrals are so much higher but it is noted that CSE figures have increased by 51% from 67 (2015-16) to 101 (2016-17).
Figure 1
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Table 3
Concern Annual total Increase/Decrease 2015/2016 2016/2017 Physical Abuse 366 ↑4% Neglect 282 ↑3% Emotional Abuse 61 ↑80% Domestic Abuse 165 ↑6% Sexual Abuse 204 ↓40%
Table 3 highlights the increase/decrease of referrals in 2016/2017 compared to 2015/2016 which demonstrates a significant 80% increase in emotional abuse referrals and a 40% decrease in sexual abuse referrals since last year.
Figure 2
Figure 2 represents the health agencies that refer into the MASH. Sandwell Hospital and the midwifery service are the top two referring health agencies. This could be a trend highlighting regular training within the hospital trust and evidences that safeguarding and referral processes are embedded within this sector.
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Given that 1,558 referrals were actioned by the nurses in MASH only 195 of these were submitted by a health professional. Further referrals may have been submitted but not met the threshold to be discussed in MASH. Nevertheless, health professionals are in the top 3 referrers with the highest number received from Education (419), Police (328) and Health (195).
Looked After Children
The annual report in relation to Looked after Children; prepared by the Designated Doctor and Nurse for Looked after Children, will be presented in a separate report. The report covers the period from 1 April 2016 to 31 March 2017. The purpose of the report is to inform the reader and give assurances that the CCG are meeting their statutory requirements in commissioning services which are safe, effective, caring, responsive and well-lead in identifying and meeting the health needs of the Looked after Children population of Sandwell and West Birmingham.
Female Genital Mutilation
The Children Act 2004 requires all statutory agencies to take responsibility for safeguarding and promoting the welfare of every child and within this legislative framework supported by statutory guidance (Working Together 2015) professionals and volunteers from all agencies have a responsibility to safeguard children from being abused through FGM.
In April 2016 HM government released latest version of the ‘Multi Agency Practice Guidelines for FGM https://www.gov.uk/government/publications/multi-agency- statutory-guidance-on-female-genital-mutilation
The FGM mandatory reporting duty is a legal duty provided for in the FGM Act 2003 (as amended by the Serious Crime Act 2015). The legislation requires regulated health and social care professionals and teachers in England and Wales to make a report to the police where, in the course of their professional duties, they either:
• are informed by a girl under 18 that an act of FGM has been carried out on her; or • observe physical signs which appear to show that an act of FGM has been carried out on a girl under 18 and they have no reason to believe that the act was necessary for the girl’s physical or mental health or for purposes connected with labour or birth.
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For the purposes of the duty, the relevant age is the girl’s age at the time of the disclosure/identification of FGM (i.e. it does not apply where a woman aged 18 or over discloses she had FGM when she was under 18).
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/57378 2/FGM_Mandatory_Reporting_-_procedural_information_nov16_FINAL.pdf
Within Sandwell & West Birmingham work has been undertaken with NHS digital to identify member practices that have not yet registered with the clinical platform to ensure compliance of the mandatory recording duty. This issue is raised through the GP safeguarding forum and is also promoted through communication via the Chairs newsletter and safeguarding news feeds.
Throughout 2016/17 the remit of the West Midlands FGM Taskforce which was set up in June 2015 continued to gain momentum. The Panel found much that is going on to tackle FGM that is positive across the region but different areas and organisations were at different places in the journey to eradicate FGM – some just setting out, with others having long established multi-agency working. The report and its nine recommendations can be viewed here http://westmidlandspcp.co.uk/wp- content/uploads/2015/06/WMPCP-Tackling-FGM-in-the-West-Midlands.pdf.
The report found that community engagement is critical to tackling FGM and highlights the crucial role that councils, health organisations and schools need to play.
A West Midlands Regional Task Force was established to take forward the report’s recommendations and the Assistant designated Nurse (Lead for Domestic Abuse) is a member of this task force which currently meets on a quarterly basis.
Previously in Sandwell FGM was discussed in the Domestic Abuse Strategic Partnership (DASP), which is a Priority Group under the Safer Sandwell Partnership (Sandwell’s Local Police and Crime Board). However, in response to the increased media attention of the issue, the DASP determined that a separate sub-group was required and so the Sandwell Stopping FGM Sub-Group was established in October 2015. Since then the membership of this forum has been strengthened and the group’s terms of reference an action plan are aligned to the work and priorities of the West Midlands Regional Task Force. The Group is chaired by an Assistant Designated Nurse from Sandwell and West Birmingham Clinical Commissioning Group, who is also the member of West Midlands Police’s Regional Task Force.
Sandwell & West Birmingham CCG now have a FGM policy – Policy & Procedures to Address FGM which was ratified at the May 2017 Quality & Safety Committee. This policy covers both adults and children and provide professionals, practitioners and anyone working with adults, children and young people with an understanding of
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FGM and what action they should take to safeguard girls and women who they believe may be at risk or have already undergone FGM.
The policy has been promoted to GP safeguarding leads in March 2017 and has had further promotion through the Chairs newsletter.
An FGM information pack was distributed to all Sandwell & West Birmingham GP practices in July 2016 which included professional and legal responsibilities as well as signposting victims for support. It is anticipated that prompting awareness across member practices of FGM prior to the ‘cutting season’ commencing will remain an annual campaign. The pack included information on the mandatory responsibility of health professionals to report cases of FGM;
Birmingham
The Birmingham CCGs are continuing to work in collaboration with stakeholders in the development of FGM services for physical and emotional health of victims through the safeguarding, equality and diversity teams, providers, third sector organisations and commissioners to accommodate the increased numbers of cases that have been identified.
Raising FGM awareness through engagement with stakeholders has taken place in the form of work with the providers in gaining assurances on their implementation of FGM awareness within their organisations. This has been accomplished through various methods such as staff training, developing online training tools or holding FGM awareness sessions outside high traffic areas within their hospitals.
A conference took place on the 6th February 2017 and coincided with the International day of Zero Tolerance to FGM, with the aim to showcase the approach in Birmingham in raising awareness of FGM and to provide an opportunity for the delegates to learn develop further knowledge. Plans for further community engagement with partner agencies and stakeholders before the commencement of the ‘Cutting Season’ where girls are forced to undergo FGM and that usually coincides with school summer holidays. This will be delivered through a variety of events and social media platforms over the year.
Prevalence
Data collection is widely recognised as a major challenge in tackling FGM on a local, regional and national basis. It is generally considered that girls born to mothers who have been cut are the children most at risk. Risk and prevalence varies across regions, reflecting the location of practicing communities.
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Due to Sandwell straddling Birmingham Local Authority under the auspices of Sandwell and West Birmingham Clinical Commissioning Group, it has proven difficult to extract Sandwell specific health data in relation to the prevalence of FGM. Mapping of the problem has therefore to date been based upon the location in Sandwell of the communities known to practice FGM.
In late 2016 the Safer Sandwell Partnership Police and Crime Board commissioned the partnership analyst from West Midlands Police to develop a problem profile for Sandwell. The analyst is currently working with members of the Sandwell Stopping FGM group to collate data from the following sources:-
Midwifery Services Research Sandwell Children’s Social Care Sandwell Women’s Aid Health and Social Care Information Centre Community Health Services Education Public Health Police Black Country Women’s Aid
The problem profile is expected to be completed in late April 2017.
Domestic Abuse/IRIS/Domestic Homicides
Sandwell
2016/17 saw an overall increase of 3.3% when comparing with 2015/16 in adults reporting domestic violence crimes and non-crimes to the police. DA recorded crime increased by 21% during 2016/17 when compared with the previous year and non- crime decreased by 5% for the same period. Anecdotal information from police suggest the increase may be because officers are now recognising more crimes than previously such as coercive control and stalking due to new legislation, training and operations such as Sentinel. There has been an unexpected decrease of 5% in the number of non-crime domestic abuse reported to the police during 2016/17 when compared to 2015/16.
Child DV crimes (those crimes where the victim was under 18 years of age) and child DV non-crimes increased by 43% during the same comparison period (although the numbers are relatively low). Police report this increase could be attributed to increased public awareness of domestic abuse, professional awareness and confidence in reporting.
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Birmingham
Within Birmingham domestic abuse incidents have increased during 2016-17 with 9491 reported crime incidents recorded.
Sandwell Multi Agency Risk Assessment Conference (MARAC)
During 2016/17 there was a 2% increase in the total number of MARAC cases discussed when compared with 2015/16. The percentage of repeat cases saw an unexpected decrease of 17% when comparing the same period. Police explain this decrease is due to the impact of their decision to return to the SafeLives definition of what constitutes a repeat incident. Previously any incident (whether a crime or non- crime) occurring within 12 months of a MARAC would be referred to MARAC as a repeat case. The consequences of returning to the SafeLives definition will result in a reduction in repeat cases heard at MARAC. This is because those cases which have been discussed at MARAC where a further incident occurs within 12 months and is deemed to be non-crime will no longer automatically be assessed as high risk and referred again to MARAC. These incidents will now be judged on prevailing risk.
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The number of children discussed at MARAC in 2016/17 decreased by 23% when compared to last year’s figure. There is currently no specific rationale available in respect of the reduction in the volume of children in the families heard at MARAC. It may be that the reduction in repeat cases have contributed to the decrease as those repeat cases may have featured more children and it must be remembered that some repeat cases would be heard more often than once or twice a year.
During October 2016, the CCG were able to resource a safeguarding lead nurse to contribute on behalf of primary care to the MARAC discussion. The benefit of have this ‘voice’ at this platform enables, primary care to share any information they feel is significant to ensure that an effective safety plan in put in place for the victims of high level abuse. The outcomes of the conference is shared with the GP practice, which then allows them to ‘flag’ records and enable a holistic assessment if the Vitim was to present at the surgery again for treatment.
Sandwell IRIS
The number of referrals to Black Country Women’s Aid from IRIS GPs fell from 49 in 2015/16 to 22 (55% decrease) in 2016/17. This decrease was attributed to a gap in IRIS funding earlier in the year. However, this period has demonstrated that GP’s need the constant reminder about the prevalence of domestic abuse within their practice population. Training in IRIS provides to encourage referrals and as soon as the facility to refer is not so apparent the referrals significantly reduce. Even though the funding stopped, GP’s could still have referred into BCWA and clients would have received support in the same way, however due to the funding not being confirmed until Q3 has meant that the expert advocacy as a single point of contact was not available to the IRIS practices. With funding from the CCG now secured, the existing cohort of GP practices will be consolidated and further cohorts trained so we should see increases in future reports.
The data collated for IRIS referrals are collated as follows:
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16 15 14 13 12 10 High 8 Medium 6 standard 4 2 1 0
From the referrals received, one referral was deemed high risk and therefore would have been considered at a Multi-Agency Risk Assessment Conference (MARAC).
Age breakdown 12 10 8 6 Total 4 2 0 20+ 30+ 40+ 50+ Under 20
IRIS continues to highlight victims from an age 50+ cohort, it is apparent that these victims may have endured domestic violence and abuse for a considerable amount of time, however never felt able to disclosure these circumstances before.
Ethnic background breakdown 19 20 15
10 6 5 1 1 1 1 Total 0
Within the demographic data captured, Oldbury and Rowley are the 2 areas were most victims are referred.
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Area breakdown 8 7 7 6 6 5 4 3 3 3 3 2 1 1 0 Total 0
Next Steps In addition the funding secured for this financial year to maintain the existing 20 practices. Additional funding has been secured from the Safer Sandwell Partnership for the sum of £40,000. It is hoped that the CCG will build on the positive outcomes identified by Birmingham University and IRIS will be further rolled out to an additional 22 practices across Sandwell.
West Birmingham IRIS
Birmingham & Solihull Women’s Aid are the provider of domestic abuse advocacy and support for 3 practice sites in West Birmingham. One practice is now not in a position to continue with the programme after merging with other practices, therefore an additional practice is currently being sought to offer training and expert advocacy too during 2017.
Due to the delay in obtaining funding during 2016-2017, Birmingham & Solihull Women’s Aid weren’t commissioned to provide IRIS support to the West Birmingham practices until October 2016. Since being commissioned the advocate has received 5 referrals from the 3 practices as detailed below.
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1.5
1
Face to face 0.5 Telephone Call
0 11/01/2017 18/01/2017 24/01/2017 17/03/2017 27/04/2017 January March April 2016/2017 2017/2018
Domestic abuse is multi-faceted and very often victims do not just endure one specific type of abuse. The following identified the complexity of this and some of the difficulties that victims face on a daily basis.
Type of abuse
20 15 15 15 15 11 10 8 8 2 5 0 0 0 Total
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Sandwell vs West Birmingham referrals 25 23
20
15 Total 10 6 5
0 Birmingham Sandwell
Domestic Homicides Reviews
Sandwell
During 2016/17 Sandwell had one Domestic Homicide incident which occurred in March 2017 (DHR case 8). This case refers to a 54 year old female, who attended her GP surgery, Hawes Lane Surgery with a stab wound to her chest. Emergency medical intervention commenced, however, she was pronounced deceased later at hospital. Two other DHRs are also continuing from 2015 DHR case 6 & 7.
Birmingham
During 2016/17 West Birmingham practices were involved with one Domestic Homicide incident which is Birmingham DHR case 23. At present there are 3 on going DHR cases (case 20, 22 & 23) with involvement of West Birmingham practices.
Child Death & Serious Case Reviews
Child Deaths 2016-2017
As part of the Child Death Overview Process (CDOP) the Birmingham’s Lead Nurse for Child Death Reviews and Sandwell’s Designated Nurse for Child Deaths share relevant health information from health organisations and providers, in order for the panels to identify any modifiable factors and make recommendations to be escalated to the respective Safeguarding Children’s Boards, as required.
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In Birmingham during the period 1st April 2016 to 31st March 2017 there were a total of 177 child deaths. Of those 35 were classified as unexpected.
In Sandwell during the period 1st April 2016 to 31st March 2017 there were a total of 40 child deaths. Of those 8 were classified as unexpected.
Sandwell Deaths (child resident in Sandwell at time of death)
Sandwell Deaths – Age bands and Gender:
33 of the deaths in Sandwell (82.5%) occurred in the first year of life and have been reviewed in a stand-alone infant mortality database. Unlike previous years there were slightly more female deaths in 2016-17.
Child Deaths by Age Group and Gender 14 13 12
11 10 9 8 7 6 5
Number Deaths of 4 Male 3 2 1 Female 0 Unknown
Age Band
Sandwell Deaths - Town of residence of death:
The number of deaths, albeit small would appear to reflect population levels within the 6 towns, with the exception of Rowley which consistently has a lower number of deaths than would be expected based on population. Smethwick has a higher than expected number of deaths based on population, but it is of note that the area has a higher number of deprived wards than other towns in Sandwell. Of the 7 deaths that occurred in Smethwick there is no particular theme.
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Town of death
2 West Bromwich 7 13 Rowley Regis Oldbury Tipton 7 2 Smethwick 9 Wednesbury
Sandwell Deaths - Ethnicity of child:
The number of 0-19 year olds in Sandwell in 2011 was 82,416.
56.3% of this population was White British, however; only 25% of reported child deaths in 2016-17 were from this ethnic background. This is in contrast to those children from a BME background where there was a higher percentage of reported child deaths compared to the population size (0-19yrs).
Deaths by ethnicity
White - British Other Ethnic Group Not known/Not Stated Mixed - White & Black Caribbean Mixed - White & Black African Mixed - White & Asian Mixed - Any other mixed Chinese Black or Black British - Caribbean
Black or Black British - African Asian or Asian British - Pakistani Asian or Asian British - Indian Asian or Asian British - Bangladeshi Asian or Asian British - Any other… Any Other White Background 0 1 2 3 4 5 6 7 8 9 10 11
Sandwell Deaths – Deprivation:
2016-17 is the first year that we have collected specific information based on the residential address of the child in relation to deprivation to further demonstrate the
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relationship between deprivation and child death. As expected most deaths have occurred in areas of greatest deprivation.
Indices of Multiple Deprivation 20 17
15 11 10
5 3 3 3 2 1 0 0 0 1st 2nd 3rd 4th 5th 6th 7th 8th 9th Index of Multiple Deprivation Decile
Infant Mortality – Sandwell residents
33 of the 40 deaths of Sandwell resident babies (82.5%) were under the age of 1 year. This represents a percentage increase on the previous year where this figure was 70% in 2015-16, and 62.5% in 2014-15.
There is a clear significant increase in the last 3 years in the percentage of Sandwell child deaths that occur in the first year of life.
Reducing infant mortality in Sandwell remains a Public Health and CCG priority.
Age at Death 14 13 12 11 10 9 8 7 6 Male 5 4 3 Female 2 1 0 Unknown 0-7 Days Between 7 1-12 months (Perinatal) days and 1 month
Sandwell Infant Mortality – Maternal smoking recorded:
A higher number than expected of mothers not smoking at ante-natal booking was seen in 2016-17. Where there is a death in the first year of life and smoking is a feature in the household, this is recorded as a modifiable factor at the Child Death Overview Panel (CDOP)
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Maternal Smoking? 26 2425 2223 2021 1819 1617 1415 1213 1011 89 67 45 23 01 Yes No Unknown
Sandwell Infant Mortality – Indices of Multiple Deprivation:
For those deaths under the age of 1 year, as expected most deaths have occurred in the areas of greatest deprivation.
Index of Multiple Deprivation of Areas Child Deaths Took Place 20
15
10
5 Areas
0 1st 2nd 3rd 4th 5th 6th 7th 8th Decile Number of Deaths Occuring in IMD
Sandwell Resident Stillbirths 2016-2017
18 stillbirths were notified to the Designated Nurse for Child Death. This would appear to be a significant reduction on reported stillbirths for the previous year (34 in total)
Sandwell stillbirths – maternal smoking:
Although there was a slightly higher percentage of mothers who had a stillbirth not smoking, it is of note that research indicates that smoking during pregnancy is a risk factor for stillbirth (NICE 2016)
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Maternal Smoking 11 10 10 9 8 7 7 6 5 4 3 2 1 1 0 Yes No Unknown
Child Deaths – Children resident in Birmingham and registered with a SWB CCG practice
36 deaths were reported to the CCG where the child resided in Birmingham and was registered with a Sandwell and West Birmingham CCG practice. This is the first year that we have been notified of all deaths where the child is registered with a SWB CCG practice, with notifications coming both from the Lead Nurse and Birmingham LSCB.
Ethnicity of reported Birmingham deaths:
There is a disproportionately high number of child deaths in children resident in Birmingham from a BME background, in line with national trends.
Ethnicity profile of reported deaths 2016/17 - SWB CCG Birmingham resident child deaths
White - British 1 Other Ethnic Group 0 Not known/Not Stated 6 Mixed - White & Black Caribbean 1 Mixed - White & Black African 0 Mixed - White & Asian 0 Mixed - Any other mixed 1 Chinese 0 Black or Black British - Caribbean 6 1 Black or Black British - African 2 Asian or Asian British - Pakistani 6 Asian or Asian British - Indian 2 Asian or Asian British - Bangladeshi 2 Asian or Asian British - Any other… 5 Any Other White Background 3 0 1 2 3 4 5 6 7
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Indices of Multiple Deprivation and Birmingham deaths:
As expected the greatest number of deaths occurred in the most deprived areas of West Birmingham.
Serious Case Reviews
In September 2016, a Serious Case Review was published from another Local Authority involving a child who had died in Sandwell. Although the death was in Sandwell, the area of residence where the child was known and lived carried out the Review with full co-operation from Sandwell agencies. The lessons learnt are specifically aimed at the district leading the review but are relevant to all.
Lessons Learnt: 1. Failure to listen to the voice of the children; 2. Persistent failure to recognise risk; 3. Lack of recognition of the long-term impact of neglect; 4. Poor inter-agency communication;
Actions: These are common themes from SCRs and aspects of this case are mentioned in a number of the multi-agency SSCB training programmes. Learning notes have been widely distributed to agencies to enable them to ensure their working practices address these important points and that staff are aware of them.
A Serious Case Review carried out during 2015–16 by Sandwell was concluded relating to sexual exploitation of a looked after child. A decision was made by SSCB that it was not in the young person’s best interest to publish the report. The SSCB Independent Chair gained the agreement of the National Panel of Independent Experts on Serious Case Reviews with this course of action.
Lessons Learnt 1. The importance of llistening to the voice of the child and considering culture and relationships 2. There was a need to strengthen and develop the multi-agency approach response to CSE 3. The Effectiveness of Health Interventions required improvement particularly when children are placed out of borough. 4. The need to ensure robust Care Planning, placements and transition for vulnerable young people.
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Actions A multi–agency group to provide governance, monitoring and assurance for all missing episodes (including missing from care, school and home) and the links with CSE now exists.
Social care and health commissioners and providers were to review the referral pathways and access for targeted services, for looked after children at risk of sexual exploitation; and those who have been placed out of the Authority. Health Services have reviewed their arrangements to ensure there is a clear and transparent process in place to transfer health information to receiving Health Trusts and Clinical Commissioning Groups when children are placed out of borough. Children’s Social Care has reviewed its fostering service and has a development plan for this.
A Serious Case Review was commenced in March 2017 regarding a young child with significant injuries who was known to a number of agencies at the time these occurred and there was concern about how they had worked together to safeguard the child. This will conclude in September 2017.
Significant Incidents not resulting in a serious case review During April 2016-March 2017 there were 5 Significant Incidents submitted to the serious case review subcommittee which after deliberation did not result in a serious case review. There was 1 Birmingham Serious Case Review commissioned in 2015 and due to be published in July 2017 which involved SWB NHS Trust Hospitals.
Safeguarding Achievments
o CSE Superhero Campaign
o Safer Sleeping Baby Box Campaign
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o rd
CSE Superhero Campaign
The Child Sexual Exploitation (CSE) Superhero campaign is an innovative project developed by SWB CCG in partnership with The Children’s Society, and is fully endorsed by NHS England.
The aim of the campaign is to raise awareness amongst healthcare professionals about CSE. SWB CCG funded and commissioned the ‘Know the Signs’ film which starred Birmingham actress Josie Lawrence and was produced by ‘Chatback’, who are a group of looked-after or birth children of foster carers. It was premiered at the HSJ learning event in September 2016 and has since been approved by the Clinical Quality Commission (CQC).
The CSE Superhero theme was developed as a response to a mother’s plea at a National Safeguarding Conference, where she spoke passionately about her daughter who was murdered whilst supporting a friend who was a victim of CSE. The call from the victim’s family was for health professionals to become ‘Superheroes’ to tackle CSE.
SWB CCG wanted to take the CSE Superhero Campaign further, thus creating a project to develop, educate and raise awareness of CSE amongst healthcare professionals and to provide them with an online learning tool and guidance resources to improve practise. It is known that disclosures are made by children to the lead professional in their life, and in many occasions this is a healthcare practitioner. The aim is equip healthcare professionals with the correct skills and training to be able to recognise the signs of CSE and better facilitate disclosures.
We have created the project in partnership with The Children’s Society due to their expertise in CSE and passion for protecting children from harm using evidence based resources. The Children's Society have also recently produced an e-learning package, 'Seen and Heard' so we wanted to utilise their expertise. The campaign is hosted on the SWBCCG website and it will be rolled out locally in Primary Care
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March/April 2017 and then launched locally in June 2017 and nationally in November 2017.
After the success of last year’s Safeguarding Conference the Children’s Safeguarding Unit hosted a conference on the 2nd March 2017 called ‘Voice of the Survivor’. The conference is for aimed at health professionals however there were a number of key partner agencies attending with 150 delegates confirmed. We had both national and local speakers who are experts in their fields of practice. They discussed Modern Day Slavery, FGM, CSE, Child Sexual Abuse (CSA) and Lessons learnt from Serious Case Reviews. We were also fortunate to hear the voice of 3 survivors sharing their experiences. They have been victims of FGM, CSE and CSA so we hope that all delegates will learn about the importance of the victims’ voice and understand their role in helping to prevent and support individuals at risk.
Baby Box Campaign
Sandwell and West Birmingham CCG worked with Sandwell CDOP and the Family Nurse partnership (FNP) in the plans to bring Finnish style Baby Boxes to Sandwell and West Birmingham. The CCG kick-started the projects with a grant of £2000 to initially provide a pilot study with vulnerable young families. This quickly progressed to the opportunity to work with Baby Box Company who agreed to use City Hospital Maternity Unit as one of their UK starter sites. It is hoped that this initiative, alongside the Safer Sleep campaigns, will help to reduce the number of sudden infant deaths in Sandwell and West Birmingham.
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Chairs Award
The Chair’s Award is presented to the team or individual who has made a significant contribution to the CCG and who live the organisation’s values.
In 2016/17 the safeguarding Unit received many nominations for both individuals in the team and the collective team.
In January 2017 the SWBCCG Chair’s award was presented to the safeguarding team for “having shown innovation, tenacity and courage in the work that they have done including the CSE superheroes, the work of the domestic abuse team in the IRIS project and the nationally recognised CSE video that worked with children and the police to develop a fantastic video”.
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HSJ Awards
In 2016 the SWBCCG Safeguarding Children Unit were shortlisted and runners up for the coveted HSJ award for Compassionate Patient Care
Sandwell & West Birmingham CCG Safeguarding Unit strategic objectives/action plan progress for 2016/17
With NHS England Birmingham, Solihull and the Black Country Area Team work with General Practitioners to ensure participation in child protection conferences whenever possible and the routine submission of GP reports to best inform child protection conference decision making.
• Clear systems and processes have been established between health and children social care in terms of ICPC notifications being received from QDU in a timely manner. Since June 2014 the CCG Safeguarding Children Unit has been the single point of contact for both reports and invitations to ICPC’s for GP’s. This was to address data discrepancies between health and the local authority regarding primary care engagement and to coordinate a defined process.
• To help aid and improve compliance a revised ICPC proforma for GP’s was developed and implemented in July 2016 a quality ICPC audit was completed to improve standard of submitted conference reports and identify incomplete ICPC’s.
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There has not been an increase in GP submission of reports or attendance at ICPC during Q1 & Q2 2016. The average percentage for submission of reports for ICPC is at 42.5%. The average percentage for GP attendance at ICPC is 3%
• The Safeguarding Children Unit will continue to report on GP ICPC engagement and provide reports as evidence for Ofsted and CQC for any future inspections
With NHS England Birmingham, Solihull and the Black Country Area Team work with GP's to ensure that health visitor attendance at GP practice meetings is consistent and routine across the borough to ensure effective communication of the identification of vulnerabilities and facilitate the provision of early help support.
• The has been a significant increase in engagement between primary care and the health visiting service over the last 12 months evidencing better communication between GP’s and the health visiting service. A total of 92 MDT meetings were held between Jan –March 2017 a 47% increase from 2015 of which 54 HV’s attended the meetings, an increase of 39% compared to attendance in 2015.
Ensure that GPs safeguarding practice is well supported through an established and robust process of regular supervision and annual appraisal.
Formal Supervision has been offered by both the Named GP and Designated Doctor whilst this is not yet embedded into practice, Primary Care staff receive support in respect of safeguarding enquiries.
To further develop the work around capturing the child's voice it is recommended that CCG build a standard for such into the commissioning of contracts.
CCG Senior Contracts Lead investigated request to add the voice of the child in local variation of NHS contract. It was confirmed that it is not possible to embed a standard, however it would be possible to add an addendum to the provider contracts service particulars, the Child Protection Policy. As well as this, all NHS contracts include a need for providers to engage with service users, this is usually via the national ‘Friends & Families’ test. All new services have to have user involvement from conception through to completion,
Safeguarding Children Annual Report 2016-2017 Page 44 often via a whole scale engagement that is commissioned and conducted by independent organisations. Organisations policy update to include the addendum of ‘the voice of the child’.
To ensure all responses to the Savile report is evidenced within the audit under the safer recruitment section
. Any allegation should be referred to the Designated Nurse. Reports and allegations directed to the Designated Nurse are to be documented on a database (secure and password protected) this includes outcomes. Refresher training of staff and volunteers every three years.
There is a robust Position of Trust policy within the CCG. All staff are aware of this and know who to contact should they have any concerns or need to refer. Procedures to be followed when allegations are made are outlined in the Bullying and Harassment Policy.
Training Level 2 & 3 training has been implemented over the last 12 months to GP’s, practice nurses, continuing healthcare nurses and practice managers to ensure competences appropriate to their role as per intercollegiate document. The overall evaluation has been very positive therefore a further 4 sessions have been commissioned to roll out level 3 safeguarding training for the next financial year 2017/2018.
GP Toolkit The GP Toolkit 2015/2016 is a tool to monitor and audit member practices safeguarding responsibilities to ensure quality assurance. Elements of the GP toolkit were aligned to section 11 standards. Future intentions for 2017/2018 will be to roll out version 2 of the GP toolkit to incorporate vulnerable adults.
Multi Agency Safeguarding Hub A secure ‘MASH nurse e-mail/in box address has been created to ensure that enquiries can be processed in a timely effective manner within primary care.
Priorities for 2017/2018
• Priorities for 2017/18
Hosted Safeguarding Team Work Plan 2016/17 • The Birmingham South Central Hosted Safeguarding Team in collaboration with its health commissioning partners (Birmingham South Central CCG, Birmingham Cross City CCG, Sandwell and West Birmingham CCG) has
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updated their work plan for 2017/18. The progress on the plan will be reported to the Joint CCG Safeguarding Committee.
• The Table below details the priorities from the Work Plan 2017/18.
Ref. No. Priority 1.0 Assurance-Provider Trusts Contract development/monitoring CQRM Provider safeguarding meetings Assurance visits Serious incidents screening Meetings with Provider
safeguarding leads 2.0 Section 11 Completion of online Audit Tool Action plan-development and
monitoring Peer review 3.0 Safeguarding audit tool 4.0 BSCB
Board meetings subgroups Annual assurance Statement and
Annual report 5.0 Training and Development CCG staff training
6.0 SCRs/SARs/DHRs
IMRs Dissemination and monitoring of
recommendations
7.0 Inspection Readiness
Ofsted & CQC 8.0 Partnership Participation in multiagency
meetings 9.0 Safeguarding policies Policies-review and development
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Sandwell & West Birmingham CCC Safeguarding Unit strategic objectives for 2017/18 are driven by the completion of CQC CCG recommendations and S11 recommendations from the SSCB scrutiny panel and BSCB peer review. These are detailed in the action plan below;
Objective Action With NHS England Birmingham, • Data shared with Primary care Solihull and the Black Country Area managers quarterly Team work with General • Identification of practices Practitioners to ensure participation compliant/none compliance in child protection conferences • Inclusion on Primary Care whenever possible and the routine dashboard submission of GP reports to best inform child protection conference decision making
Work with Public Health and • Annual awareness events Sandwell Borough Council to ensure that provider agencies have good access to multi-agency training and development on topics including female genital mutilation and child sexual exploitation. With NHS England Birmingham, Solihull and the Black Country Area • Repeat Audit Health Visitor Team work with GP's to ensure that attendance at GP health visitor attendance at GP practice meetings and report findings practice meetings is consistent and to SWB CCG's Quality & Safety routine across the borough to ensure Committee effective communication of the identification of vulnerabilities and facilitate the provision of early help support Ensure that GPs safeguarding • Utilise the Safeguarding Lead practice is well supported through an Forum(s) to deliver group established and robust process of supervision regular supervision and annual appraisal • Recognise individual requirements
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and supervision needs of GP's and arrange 1:1 sessions where requested/required
Give assurance to LSCB for the co- commissioned GP service • Version 2 of the RCGP Safeguarding Toolkit to be developed as a primary care assurance tool incorporating vulnerable adults.
• Coordinate assurance visits to GP practices using CQC Lines of Enquiry template.
To further develop the work around • Organisations Child Protection capturing the child’s voice Policy to include “the voice of the child” CCG to strengthen the area of child’s • To revisit tool to check response voice within the S11 audit tool • enhance response within the tool • Include all methods of capturing the child’s voice All staff within the organisation know Update the CCG intranet with relevant whom the lead person for Prevent Prevent information and the Prevent strategy is and how to contact them
NHSE are including within Section 32 Work with CCG Contract team to ensure of the Standard NHS Contract standard is monitored in NHS Provider 2016/17: contracts 32.2.2 A Child Sexual Exploitation Lead 32.3 The Provider must comply with the requirements and principles in relation to the safeguarding of children and adults, including in relation to deprivation of liberty safeguards and child sexual exploitation, set out or referred to legislation and statutory guidance:
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Modern Day Slavery agenda
• Support Modern Day Slavery agenda and ensure that a clear action plan is embedded within SWB CCG.
Conclusion
Following inadequate Ofsted inspections of children services in both Sandwell and Birmingham the decision has been made by both council cabinets to move their children Services into a Children’s Trust. The direction of travel for this DfE children’s social work reform is for more collaborative, cross-boundary and innovative delivery of social care.
Partners have been consulted in both Sandwell and Birmingham on proposed models and have influenced key decision making.
Moving forward it is anticipated health will play a pivotal role in the local safeguarding arrangements under the new Children and Social Work Act. The CCG under its current governance arrangements is in a strong position to meet these statutory duties.
Sandwell and West Birmingham CCG Kingston House 438-450 High Street West Bromwich B70 9LD
Tel: 0845 155 0500 Web:Safeguarding www.sandwellandwestbhamccg.nhs.uk Children Annual Report 2016-2017 Page 49