DUDLEY CLINICAL COMMISSIONING GROUP BOARD AGENDA
Thursday, 2 May 2013 1.00pm – 4.05pm at the Boardroom Kings House, Dudley, DY2 8PE
Presented Time Agenda Item Attachment By 1 pm 1. Apologies
1 pm 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 for discussion or vote on any questions relating to that item.
3. Minutes from meeting 7 March 2013 Enclosed Dr Hegarty
4. Matters Outstanding Enclosed Dr Hegarty 5. Questions from the Public
To respond to questions from members of the public present at the meeting on the provision of health care to the population served by the CCG.
1.05pm 6. Chairman’s & Chief Officer Report
Verbal Mr P Maubach 6.1 Report
1.15pm 7. Patient Experience Story Presentation Dr L Pope 8. Quality & Safety
1.35pm 8.1 Presentation from DGFT on Mortality Presentation Mr R Calender 1.50pm 8.2 CCG Response to Francis Report Enclosed Miss Bartholomew 2.05pm 8.3 Report from Quality and Safety Committee Enclosed Dr L Pope
9. Commissioning
2.15pm 9.1 Report from Clinical Development Committee Enclosed Dr S Mann 2.25pm 9.2 Update from Health & Well Being Board Enclosed Mr N Bucktin 2.35pm 9.3 Agreements Made Under Section 75 of The Health Act Enclosed Mr N Bucktin 2006
10. Communications & Engagement
2.45pm 10.1 Communications & Engagement Update Enclosed Mrs J Jasper
11. Governance
2.55pm 11.1 Report from Audit Committee Enclosed Mrs J Jasper 3.05pm 11.2 Black Country Cluster Handover Document Enclosed Mr M Hartland 3.15pm 11.3 Risk Management Strategy Enclosed Mr M Hartland 3.25pm 11.4 Black Country Assurance Framework Enclosed Mr M Hartland 3.35pm 11.5 Risk Register Dudley CCG Agenda – 2 May 2013 1 | Page
12. Finance and Performance
3.45pm 12.1 Report from Finance & Performance Committee Enclosed Dr J Rathore
13. Primary Care
3.55pm 13.1 Report from Primary Care Development Committee Enclosed Dr J Rathore
4.05pm Close 14. For Information
14.1 Glossary Enclosed
Time & Date of next meeting Thursday 4th July 2013, 1pm Venue: to be confirmed
Dudley CCG Agenda – 2 May 2013 2 | Page
Enclosure 1
DUDLEY CLINICAL COMMISSIONING GROUP BOARD PUBLIC
MINUTES OF THE MEETING HELD IN PUBLIC ON THURSDAY, 7 MARCH 2013 AT 1.00 PM, BOARDROOM KINGS HOUSE
ATTENDEES: Miss R Bartholomew Head of Nursing, Quality & Patient Safety Dr J Darby GP Board Member (Halesowen & Quarry Bank) Dr K Dawes GP Board Member (Sedgley, Coseley, Gornal) Dr R Edwards GP Board Member (Kingswinford, Amblecote & Brierley Hill) Dr P D Gupta GP Board Member (Dudley & Netherton) Mr M Hartland Chief Finance Officer Dr M Heber Secondary Care Clinician Dr D Hegarty GP Board Member (Chair of CCG) Dr T Horsburgh LMC Representative Mrs J Jasper Lay Member – Patient & Public Engagement Dr R Johnson GP Board Member (Halesowen & Quarry Bank) Ms V Little Director of Public Health, Dudley PCT Dr S Mann Clinical Executive – Acute & Community Commissioning Mr P Maubach Chief Officer, Dudley CCG Dr N Plant Clinical Executive – Partnership Commissioning Mr J Polychronakis Chief Executive Officer, Dudley MBC Dr J Rathore Clinical Executive – Finance & Performance
IN ATTENDANCE: Mrs L Broster Head of Communications Mr N Bucktin Head of Partnership Commissioning Mr P Capener Interim Governance Support Mrs S Cartwright Organisational Development Lead Dr R Gee GP Engagement Lead Mr A Gray Healthwatch Dudley Mrs C Gower Office Manager, Minutes, Dudley CCG Mrs A Tennant Head of Service Improvement & Quality
APOLOGIES FOR ABSENCE: Mr J Hall ICM, Dudley CCG Dr M Mahfouz GP Board Member (Dudley & Netherton) Dr L Pope Clinical Executive – Quality & Safety Mr S Wellings Lay Member – Governance (in the Chair)
MEMBERS OF THE PUBLIC/PRESS:
There were 7 members of the public present
Dr Hegarty welcomed Mr Andy Gray who was attending as a representative for Healthwatch Dudley.
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24/2013 DECLARATIONS OF INTEREST 6/2
Members were asked to disclose any interest they may have, direct or indirect, in any of the 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. Declaration of interest was declared from Ms Little and Mr Polychronakis regarding Item 13.1, Primary Care Development Committee. Declaration of interest was declared from all GPs present regarding item 13.1 on the recommendation for LES extension to September 2013.
25/2013 MINUTES OF THE MEETING HELD ON 3 JANUARY 2013
Accepted as a true and correct record. Dr Dawes noted that he was present at this meeting on 3 January 2013.
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26/2013 MATTERS OUTSTANDING
CLINICAL COMMISSIONING GROU
THURSDAY 7 MARCH 2013
Action Issue Action For Deadline Comments Number
Dr Pope to raise issue around 126/2012 Update confidentiality in relation to LP REMAIN AS AN ACTION March 2013 carers strategy
3 | P a g e 27/2013 QUESTIONS FROM THE PUBLIC
No questions from the public were received.
FOCUS ON THE PATIENT VOICE
28/2013 GILLIAN’S STORY
There was a 10 minute film featuring a patient’s experience in the acute and community environments. There was no discussion following the film.
CHAIRMAN’S & CHIEF OFFICER REPORT
29/2013 REPORT
The areas covered in Mr Maubach’s verbal report were as follows:
• Authorisation. The new independent NHS Commissioning Board announced on Tuesday 11 December 2012 that Dudley CCG has been authorised with 2 conditions. The work on these conditions has now been completed, re-submitted and accepted.
• Francis Report. More detailed work with the Commissioning Board remains outstanding. The CCG will be focusing on this over the next 2 months.
• Preparation for 1st April 2013. Contracts with providers are on target and on time. The only delay is in relation to the Commissioning Board regarding Specialised Services.
• Operational Issues. There are concerns around the high level of Urgent Care demand at Dudley Group (DGoH). There have been several occasions when they have reached escalation Level 4 (their highest level). This is partly due to issues around delayed transfer of care into the Local Authority (LA), however these issues have been eased following discussions with colleagues in the LA. Mr Maubach gave assurance that all colleagues concerned were co-operating in addressing the issues and pressures and wished to acknowledge the success of joint partnership working. It was also noted that these issues are not just related to Dudley they are across the West Midlands.
Resolved:
1. The Board noted the report for assurance 2. COMMISSIONING 3.
4 | P a g e QUALTIY AND SAFETY
30/2013 REPORT FROM QUALITY AND SAFETY COMMITTEE
Miss Bartholomew presented this report to the Board on behalf of Dr Pope for assurance that the Quality and Safety Committee are effectively responding to and acting upon quality concerns within the Dudley Health Economy. The report provides details and update of the key topics discussed at the most recent Quality & Safety Committee meeting held on 11 February 2013. Miss Bartholomew highlighted the planned themed visits mentioned in the report, the Tissue Viability themed visit to be undertaken at Dudley Group Foundation Trust (DGFT) plus the absconds/suicides and children being placed on adult wards themed visit which is being undertaken with Dudley and Walsall Mental Health Partnership Trust (DWMHPT). Regarding the latter visit, Dr Horsburgh informed that Walsall have recently received funding for Tier 3 Care at Home, which could be a solution for Dudley.
Resolved:
1. The Board agreed to accept the report for assurance
31/2013 RESPONSE TO THE FRANCIS REPORT
Miss Bartholomew updated the Board of the progress and the response to date to the recent publication of the Francis Report. The Report includes 290 recommendations and has far reaching implications for the health economy and the appropriate governance of organisations. There are National, Local, Local Authority and organisational implications. The key points Miss Bartholomew highlighted were the proposed approach to the response to the Report, the warning signs which are as follows:
• Failure to meet targets- elective surgery • Outpatient waiting times, cancer waiting times and financial performance • National Reviews, lack of data submitted was the excuse • E.g. Cancer Peer Review- Unclear who has responsibility for following up peer review. • Auditors report on risk management and assurance system • Annual surveys of staff and patients, the voice of the local community • Whistle blowing- Allegations about leadership • Royal college Review • Quality Impact Assessment of the cost improvement programmes • Foundation Trust status – communication between all regulators around the table • Everybody waiting for the formal investigation, no consideration of action for themselves.
The other key point highlighted was the format of the forthcoming visit to Dudley Group Foundation Trust which will be a review into the quality of care and treatment provided along with 13 other Trusts in England. The 14 hospital trusts will be investigated as part of the review on the basis that they have been outliners for the last two consecutive years on either the Summery Hospital Level Mortality Indicator or the Hospital Standardised Mortality Ratio.
Mr Polychronakis highlighted that a measured response and defined outcomes were critical and the important issues only should be concentrated on in the response.
5 | P a g e Miss Bartholomew assured that her team would continue with their current approach to their response and will present further at the next Board.
Resolved:
1. The Board noted the content of the report 2. The Board agreed to accept the report for assurance
COMMISSIONING
32/2013 CLINICAL DEVELOPMENT COMMITTEE REPORT
Dr Mann presented the report to the Board for approval. The report summarises the issues discussed at the Clinical Development Committee held on 20th February 2013. The key points discussed were the agreement of the Older People’s Mental Health Service Specification, support for the Dudley Obesity Strategy, the proposal for Rowley Regis Primary Care Assessment Centre, the Clinical Leads agreed for each of the priority areas and the agreement that Clinical Development Committee will manage and report on QIPP.
There were questions around the opening hours and the geographic position of the proposed Primary Care Assessment Centre. It has been proposed that this centre would be based at Rowley Regis Hospital and would be open 365 days a year for 12 hours a day, with times to be agreed. A full financial evaluation is being prepared and will be discussed as part of the urgent care work stream.
The Clinical Leads were noted for each of their priority areas as listed below:
Children’s Services – Tim Horsburgh Urgent Care – Steve Mann Primary Care Mental Health – Mona Mahfouz Improving Care in Older People – Nick Plant Diabetes Services – Helen Moran Cardiology – Jonathan Darby Ophthalmology – Steve Mann Community Nursing Service – Nick Plant Alcohol = Mona Mahfouz
Dr Horsburgh suggested that due to Dr Mohfouz’s heavy workload it may be more appropriate that Dr Becky Lewis from Feldon Lane Surgery take the Alcohol priority area.
Resolved:
1. The Board agreed to endorse the report
33/2013 DUDLEY JOINT HEALTH AND WELLBEING STRATEGY 2013 - 2016
Dr Plant presented this report to the Board for noting and approval. The Board were invited to note the final Joint Health and Wellbeing Strategy (JHWS) as approved by the Health and Wellbeing Board.
6 | P a g e The key points for noting are that the Strategy is approved, that the priorities are reflected in the CCG’s Strategic Plan and that further work takes place on the development of action in relation to priorities. There will be no financial implications.
Dr Plant highlighted the five priorities identified in the JHWS which are:
1. Making our neighbourhoods healthy – by planning sustainable, healthy and safe environments and supporting the development of health enhancing assets in local communities.
2. Making our lifestyles healthy – by helping people to have healthy lifestyles and working on areas which influence health inequalities, such as obesity, alcohol, smoking and the early detection of ill health.
3. Making our children healthy – by supporting children and their families at all stages but especially the early years; keeping them safe from harm and neglect, supporting the development of effective parenting skills and educating young people to avoid taking risks that might effect their health in the future.
4. Making our minds healthy – by promoting positive mental health and wellbeing.
5. Making our services healthy – by integrating health and care services to meet the changing Dudley borough demography, starting with urgent care.
Health and Wellbeing partners now need to address how they will co-ordinate their respective activities to ensure that the identified priorities are delivered. To facilitate this, it is planned to hold a series of “spotlight” events bringing partners together to focus on each of the priority areas in turn. The first event will take place in Spring 2013 and will focus on “making our children healthy”
Dr Horsburgh and Mr Polychronakis stressed that ‘wellbeing’ is crucial to focus upon with the jobless aspect being a top priority.
Resolved:
1. The Board noted the report
COMMUNICATIONS & ENGAGEMENT
34/2013 RESPONSE TO COMMUNICATION AND ENGAGEMENT STRATEGY CONSULTATION
Mrs Jasper presented the report to the Board to advise of the approach of Dudley CCG in their collaborative and empowering engagement and communications with member practices, staff, patients, carers, public, communities and partner agencies. The Board were requested to note the engagement activity on this strategy and approve for implementation. The Strategy has been fully costed, the workings of which can be seen in the Action Plan which has been costed to account for core activity of the Communications and Engagement Team. For any new commissioning activity individual budgets will need to account for the cost of effectively engaging and communicating.
The strategy has been informed by working with stakeholders over the past year. Activities to help shape and inform the strategy include: 7 | P a g e
CCG Board development session, 2 workshops looking at what we mean by meaningful engagement and how the CCG should be engaging, a facilitated session on being an effective representative, online survey, visits to different community groups seeking feedback on a model of engagement, large public event seeking feedback and views on how the CCG should engage, regular public Healthcare Forum meetings, visits to Patient Reference Groups within practices, social media presence.
Mrs Jasper stated that the strategy is ambitious and seeks to harness an empowering approach to engagement whilst recognising that empowerment needs to take place within the CCG as well as with stakeholders. The strategy is clear as to how the CCG will communicate effectively with stakeholders. This will ensure a relationship is developed where the CCG acts upon information and makes informed decisions in collaboration with stakeholders and partners. A graphic was also produced alongside the strategy to encourage people to look at it and to be able to see the strategy on one page. Feedback has been overwhelmingly positive with praise given to what the CCG are trying to achieve and applauding the vision. The graphic has also attracted positive attention from the Kings Fund.
Mrs Jasper recommended the following points:
. That the Board recognise the effort taken to engage on the development of the strategy by all partners and stakeholders . That each Board member recognises their role in delivering an empowering approach to communications and engagement . That the Board endorses the strategy and the value in the action plan attributed to it in full . That the board supports the implementation of the action plan and associated costs, particularly those for the extra staffing . That the Board pays thanks to those members of the public who have taken time to feedback to us and improve this document
Resolved:
1. The Board noted the engagement activity on the Strategy and approved for implementation 2. Thanks were noted to Mrs Broster, Lorna Prescott and Mr Stenson for their hard work on the Strategy 3. Mr Hartland confirmed that the Strategy remains within the financial envelope
GOVERNANCE
35/2013 REPORT FROM AUDIT COMMITTEE
Dr Rathore presented the report to the Board to advise of the issues discussed at the Audit Committee held on 29th January 2013. The key points to be noted are:
. That the CCG governance arrangements are being reviewed. An external consultant has been commissioned to review the CCG’s governance arrangements in preparation for 1st April 2013. Work on this commenced week beginning 4th February 2013.
8 | P a g e . Concerns regarding the low level of staffing to assist with the closedown of the annual accounts and also the fact that the guidance has been published very late and in some cases has not been received from the Department of Health. On this basis the Lay Members did not feel in a position to assure that everything was in place for a successful closedown of the accounts. . Concerns regarding the process for updating the risk register and capturing and adding new risks. The Committee have received the risk register last updated on 10th December 2012 and was concerned about the lack of progress and updating of the register by the Quality and Safety Committee and the process for capturing and adding new risks
The Board discussed concerns around cashflow i.e. wages being paid to staff, issues with the Commissioning Board on time and capacity with moving forward and the Area Team not being fully developed and problems this may cause. Board agreed that a smooth transition needs to be assured.
Resolved:
1. The Board noted the report 2. The Board did not feel fully assured regarding account closure and recommended that a meeting be arranged with the Commissioning Board to gain assurance of the processes in place
36/2013 SIRO & CALDICOTT GUARDIAN
Mr Maubach advised the Board of the significance of the functions of the Senior Information Risk Officer and the Caldicott Guardian. The CCG is mandated to nominate organisational leads with respect to the roles of Senior Information Risk Officer and Caldicott Guardian. The Senior Information Risk Officer is responsible for ensuring organisational information risk is properly identified and managed and appropriate assurance mechanisms exist. The Caldicott Guardian is the senior person responsible for protecting the confidentiality of patient and service/user information and enabling appropriate information sharing.
The Board were requested to approve Mr Hartland as the designated Senior Information Risk Officer/Information Governance lead for the CCG and Dr Johnson as the designated Caldicott Guardian for the CCG.
Board questioned that Mr Hartland and Dr Johnson were appropriately trained for these roles and whether they had capacity to deliver within these roles. It was confirmed that Mr Hartland will be receive the appropriate training prior to 1st April 2013 and that Dr Johnson had received the appropriate training.
Resolved:
1. Board approved that Mr Hartland and Dr Johnson be assigned to these roles
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FINANCE AND PERFORMANCE
37/2013 FINANCE AND PERFORMANCE COMMITTEE REPORT
Mr Hartland presented the Finance and Performance Committee report to the Board to update on the issues discussed at the meeting held on 20th December 2012, 24th January 2013 and 19th February 2013. The Board were requested to note the following key points:
The revised target surplus of £5,557,000. Until January the PCT has been reporting a year end surplus of £5,992,000. During that month the Local Area Team (LAT) increased the control total by £1.8m to £7,792,000. Of this £5,557,000 relates to the CCG which will be carried forward into the CCG next year. The CCG is on target to achieve the revised surplus.
CCG Forcast to achieve all financial duties. During the year service improvement and quality has been overspent, the principal reason being the over-performance on community and acute contracts. The overspend has been offset by underspends in partnership commissioning, primary care and corporate services.
A potential risk during the remainder of the year is the cost of retrospective continuing care appeals. These are being processed to identify the liability for this year and also the ongoing recurrent costs.
The Clinical Executive Team has been managing the non-recurrent spending programme. The £8m programme was increased by £1m following the winter pressures allocation from the LAT. Requests for non-recurrent funding have now ended as a result of the increase in the control total.
The CCG’s Financial Plan has been rated green by the LAT. However Dudley has identified to the LAT a potential risk of £5-6m in respect of specialised services, which will need to be reflected in the Plan.
The CCG’s element of the £6.8m QIPP target is £5.66m and at the end of January it was forecast to over-achieve this by £420,000.
The Committee routinely discusses those schemes not achieving their targets and the action plans in place to address these. Commissioners are reviewing those schemes not delivering the required outcomes. The QIPP Plan has been aligned with the Financial Plan and the Strategic Commissioning Plan. Plans have been developed for 2013/14 and 2014/15. The intention is that there will be a greater level of engagement with stakeholders on the QIPP programme.
The ownership of QIPP has been part of the debate on the restructuring of the CCG’s Committees. The Committee endorsed the proposal that overall implementation of QIPP will be managed by the Clinical Development Committee from 1st April 2013. The performance financial monitoring of the schemes will continue to be debated at the Finance and Performance Committee.
Negotiations are progressing well on the contracts with the three main providers – Dudley Group Foundation Trust, Black Country Partnership Trust and Dudley and Walsall Mental Health Partnership Trust.
The CCG Board delegated sign off of the CSU Contract to the Chief Officer and Chief Finance Officer. The financial value has been agreed but the contract has not yet been signed. This has been provided to the CCG’s solicitors, Mills and Reeve, for final review before contract signature.
Resolved:
1. The Board endorsed the report for approval and assurance 10 | P a g e
PRIMARY CARE
38/2013 REPORT FROM PRIMARY CARE DEVELOPMENT COMMITTEE
Dr Rathore presented the report to the Board to update on issues discussed at Primary Care Development Committee held on 20th February 2013. The key points raised were as follows:
The NHS Property Services is now overseeing premises development although the role of Community Health Partnerships is unclear at this stage. The Strategic Partnering Board is reviewing the Kate’s Hill and Pensnett schemes. The CCG is involved in discussions to ensure that the local commissioning perspective is considered. Planning permission had been granted for the Lye scheme and the business case is being developed by NHS Property Services. The CCG is assessing the commitment required for services which would be delivered from the new site.
Ms Little expressed her concerns on the closure of Kates Hill as this is situated in a deprived and needy area which will no longer be serviced. Dr Horsburgh agreed to report back to the Local Medical Committee (LMC) regarding the process. Dr Hegarty and Mr Maubach have raised concerns with the Commissioning Board and will question their strategic intentions and how they will be re-investing savings made into that area.
The IT Strategy Group met on 13th February 2013. The Group confirmed DGFT as a provider of IT services to the CCG and noted that PCT staff had transferred to the Acute Trust from 1st January 2013. The CCG has commissioned strategic IT services from the Commissioning Support Unit (CSU). Mr John Thornbury, IT Director at DGFT, presented the Acute Trust’s strategy for the next few years. The Group debated how DGFT’s strategy linked with the CCG IT strategy. The Acute Trust strategy appeared realistic and achievable and to meet primary care’s requirements for systems to be as inter-operable as possible. Mr Thornbury had joined the CCG IT Strategy Group.
The Group discussed whether the CCG should define a preferred system provider for GPs. The systems in Dudley are iSoft and these practices are currently in the process of moving to Emis Web, and Vision. The operability between Emis Web and MSD and contract plus is currently being tested. Once assurances are provided around this costings have been prepared to roll out Emis Web to other practices affected by the prepared ISOFT issue. The offer will also be made to all practices in Dudley.
The Group signed off the IT replacement programme for practices and an implementation programme was being established by IT. Mobile working solutions were being piloted by a small number of practices. The preferred solution would be purchased in the new financial year.
Recommendations for LES extension to September 2013 pending review
It was proposed that the additional cost of all LESs, which was being used to top up the national DES, should also continue for six months pending the review and that the Nursing Home LES, which started in December 2012, should run until March 2014 with a review in December 2013.
Following discussion the Board agreed that all CCG practice should continue with the LES for 6 months.
11 | P a g e The Primary Care Foundation work
The CCG had commissioned Primary Care Foundation to carry out a baseline audit of activity within practices to help them identify issues and pressures. At a higher level it would inform the CCG on how it could support and develop practices.
A Practice Managers’ workshop took place on 13th February facilitated by the Primary Care Foundation. Follow up workshops were being organised in each locality and practice visits would be arranged to talk through their individual reports and key issues. It was noted that practice participation was voluntary. Full reports would go to the practices with the CCG receiving the high level indicators. Nationally the NCB was expected to require each practice to produce an improvement plan and the baseline audit would be a good starting point for this.
Primary Care Strategy
The paper provided an update on the development of the primary care strategy which was being led by a core group. It included feedback from members on the initial discussion paper and comments from the GP engagement event.
The strategy would be discussed at the forthcoming Healthcare Forum. The aim would be for either the next iteration or the final draft to be presented to the Committee in April. At the appropriate stage the strategy would be shared with the NCB on the basis elements of it were the responsibility of that body and also the Local Authority.
Resolved:
Due to Dr Hegarty having a declaration of interest Mrs Jasper agreed to oversee the recommendation.
1. The Board agreed to endorse the report
39/2013 UPDATE FROM PRIMARY CARE STRATEGY
Dr Rathore presented this report to the Board to provide an update on the work undertaken to date to develop the Primary Care Strategy, to identify the emerging themes based on feedback and input and the next steps in the process.
A core group has been established to steer the process and has met 3 times. An initial discussion paper was produced and circulated before and after GP Engagement Event 29th January 2013. The CCG Primary Care Development Committee has received a verbal update on progress to date. Feedback received to date, (including that from round table discussions on 29th January), has been collated and is being incorporated into the work. Five or six key themes are now beginning to emerge which are likely to form the core of the strategy
Mrs Goodlad informed the Board that the draft Strategy has now been circulated since this report was written.
Resolved:
1. The Board noted the report for assurance
12 | P a g e ANY OTHER BUSINESS
None
DATE OF NEXT MEETING
Monday 25th March 2013 1pm – 3pm Boardroom Kings House, Dudley.
MINUTES ACCEPTED AS A TRUE RECORD
PRINTED TITLE
SIGNED DATE
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DUDLEY CLINICAL COMMISSIONING GROUP BOARD
Date of Report: 2nd May 2013 Report: CCG Response to the Francis Report Agenda item No: 8.2
TITLE OF REPORT: The Francis report- how our response aligns to our objectives
To inform the Board of our approach to the recommendations in the PURPOSE OF REPORT: Francis Report
AUTHOR OF REPORT: Rebecca Bartholomew
MANAGEMENT LEAD: Rebecca Bartholomew
CLINICAL LEAD: Liz Pope
This report aligns our framework for implementation of the Francis Report KEY POINTS: recommendations against our corporate objectives.
The Board approves this framework and requires the Quality and Safety RECOMMENDATION: Committee to report back the full set of actions at the September Board meeting.
FINANCIAL IMPLICATIONS: N/A
WHAT ENGAGEMENT HAS N/A TAKEN PLACE:
Decision ACTION REQUIRED: Approval Assurance √
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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 22nd April 2013 The Francis report- how our response aligns to our objectives and how we gain assurance
KEY THEMES SUMMARY
Aligning our approach to assurance of implementation of the recommendations to our corporate objectives:
• Improving Quality and safety - delivering compassionate care • Reducing health inequalities in healthcare provision for our population • Delivering the best possible outcomes within the resources
KEY THEMES
Improving Quality and Safety – Delivering Compassionate Care
• Patients journey and outcome is our currency – the Commissioning Support Unit will be populating a clinical portal which will allow us to triangulate compliance to system and processes, the patient journey and outcomes and any balancing measures across our health economy
• Patient focussed approach to commissioning a patient centred service – the local CQUINS have been informed by identified areas for improvement
• Put the patient journey and outcome first, the performance to follow and the financial health will be achieved – local contract monitoring through Clinical Quality Review Meetings with providers. Development of a monitoring matrix via the local agreement with stakeholders.
• Challenge and support our providers in the delivery of ‘Compassionate Care’ delivered by committed staff – local contract monitoring through Clinical Quality Review Meetings with providers. Development of a monitoring matrix via the local agreement with stakeholders. Local CQUIN include a patient safety climate survey for our main providers
• Continually improve constructively the culture of candour, transparency and openness – the communication and engagement teams’ vision and strategy is designed to capture negative and positive experiences and outcomes from our health population. The family and friends test reporting is now required from April rather than being voluntary.
Reducing Health Inequalities in Healthcare Provision for our Population
• Base our future decisions on the patient journey, outcomes and experience – an example of this is the planned improvements in the cardiology pathway which allow the receiving cardiologist to have sight of the patients electrocardiogram prior to the patient attending for their appointment thus reducing the patient pathway by getting appropriate investigation earlier in the pathway
• Listen to the community of Dudley and act upon any care contact which is not of a standard that we would accept for our own family – the communication and engagement teams’ vision and strategy is designed to capture negative and positive experiences and outcomes from our health population. All of our members are encouraged to email our Clinical Lead for Quality and Safety with any cases of poor quality experience.
• Effectively analyse data to monitor patient outcomes and performance of our providers – the Commissioning Support Unit will be populating a clinical portal which will allow us to triangulate compliance
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to system and processes, the patient journey and outcomes and any balancing measures across our health economy
• Use a matrix of information shared across all local stakeholders and regulators – there is an aspiration by local stakeholders to develop a collaborative and constructive approach to provision of healthcare for our community. The CCG will continue to provide assurance through its monitoring and improvement agenda. The aim is to incrementally improve the rigor and robustness of the assurance processes as themes for improvement emerge and the needs of our population change. This will obviously be against the backdrop of any local or national requirements.
Delivering the best possible outcomes within the resources available
• High quality safe healthcare and getting it right first time costs less – the improvement agenda will be working on the CCGs 12 strategic priorities, overseen by our Clinical Development Committee. These priorities will be refreshed annually by our Governing Body.
• Focus on the Human element of cost in all that we commission – one area that bridges most of our improvement work streams is discharge from a care setting. This is an area where we have received patient complaints and so we will be reviewing this with all relevant stakeholders.
• Maintain the focus on best value for money for our Dudley community – monitoring of contracts and fair but firm negotiations with providers and scoping locally and nationally on best practice will provide a backdrop to comparisons of our achievement of best value for money
• Do not allow Cost Improvement Plans and efficiency measures to impact on the delivery of high quality Patient Care – the main providers cost improvement plans are all reviewed and signed off by the Quality team. It is important to note that some of the cost improvement projects include investing in permanent staff to reduce agency and bank costs.
DECISIONS REFERRED TO THE BOARD
To ask the Board for approval that the Quality and Safety Committee will use these key themes as the framework for mapping all of the framework recommendations on the action we will be taking as a CCG
RECOMMENDATION
That the Board approves this framework and requires the Quality and Safety Committee to report back the full set of actions at the September Board meeting.
APPENDICES
None
Rebecca Bartholomew
Chief Quality and Nursing Officer
April 2013 3 | Page
DUDLEY CLINICAL COMMISSIONING GROUP BOARD
Date of Report: 24th April 2013 Report: Quality and Safety Agenda item No: 8.3
TITLE OF REPORT: Report from Quality & Safety Committee
PURPOSE OF REPORT: To provide assurance to the Board.
AUTHOR OF REPORT: Joe Cahill/Wendy Humpage
MANAGEMENT LEAD: Rebecca Bartholomew
CLINICAL LEAD: Dr Liz Pope • To provide details of and update the Clinical Commissioning Board regarding the key topics discussed at the most recent meeting of the KEY POINTS: Quality & Safety Committee held on 16 April 2013; • To assure the Board that the Quality & Safety Committee is effectively responding to and acting upon quality concerns within the Dudley Health Economy.
That the Board is assured of progress made by the Nursing and Quality RECOMMENDATION: team regarding quality assurance of providers.
FINANCIAL IMPLICATIONS: N/A.
WHAT ENGAGEMENT HAS N/A. TAKEN PLACE: Decision ACTION REQUIRED: Approval Assurance
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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 2 May 2013 Report from Quality & Safety Committee
KEY INDICATOR SUMMARY Quality Current Priority Measure Detail Quality Improvement objective outcome Affected by A full investigation and response is given for all 14 complaints received during March anticipated complaints. For upheld complaints an action plan is 2013 for NHS Dudley; anticipate NHS Complaints N/A involvement implemented and monitored and a summary England assuming responsibility for of NHS published on our website (you said, we did). primary care complaints from April 2013. England http://www.dudleyccg.nhs.uk/patient-insight/ DGFT did not submit voluntary data for Friends & Set regionally Friends & Observe Friends & Family data and respond to any March. Data submission is compulsory Family Test monthly Family data trends reported. from April 2013. Reduce HCAIs Zero MRSA Overall, activity performance has been Healthcare bacteraemia below target during 12/13 however there Aim to reduce number of HCAIs during 2013/14; Acquired ; 38 C diff was an increase in C diff rates in awaiting refreshed C diff action plan from DGFT. Infections cases for DOWN IS GOOD February 2013. 2013/14 DGFT crude mortality rates decreasing; monthly DGFT has been classed as a mortality specialised mortality meetings attended by CCG Mortality In SHMI range SHMI outlier by NHS England, based upon quality leads; acute trigger tool used by Mortality historic data. Review Panel; Bruce Keogh visit 7/5/13. Never Never Root Cause Analysis report received, currently Zero cases One never event reported in March. Events events under review with the Area Team. Reducing avoidable Numbers have reduced from Q3; DGFT has Grade 3&4 pressure Number of changed Pressure Ulcer Assessment Tool from April Pressure ulcers pressure Grade 3&4 avoidable pressure ulcers. 2013; CQUIN to significantly reduce avoidable Ulcers ulcers Grade 3 pressure ulcers and to achieve zero tolerance for avoidable Grade 4 pressure ulcers. DOWN IS GOOD Reduction in 50 serious incidents reported in Q4; slight DGFT has acknowledged the increase in falls serious incidents increase over Q3; most frequent incident resulting in fracture as an area of concern, and a trends are slips/trips/falls and grade 3&4 request has been made for the Falls action plan to Serious Number of pressure ulcers; significant increase in be updated. DGFT to review systems and Incidents SIs falls and decrease in grade 3&4 pressure processes involved in Root Cause Analysis reports; ulcers from Q3. Concerns raised CSU has offered Root Cause Analysis training to DOWN IS GOOD regarding the quality of Root Cause DGFT. Analysis reports from DGFT. Arrow indicates direction of outcome. 2 | Page
ITEMS REPORTED BY EXCEPTION
Never Events
One never event was reported in March and is currently under review with the Area Team.
Mortality Indicators
The latest Summary Hospital Mortality Index (SHMI) figures were published in January 2013 on the NHS Information Centre website. The date period covered is July 2011 to June 2012. DGFT registered a value of 1.0363. Since this value is above 1, this is technically above the expected value. However, this value is within that which can be ascribed to natural variance; therefore DGFT are classed as having a mortality rate that is within the expected range.
Ordinarily this would mean that we would RAG rate the current position on mortality as green. However we have rated this as amber because NHS England has classed DGFT as a mortality outlier and will be conducting a review of the services on 7/5/13. The CCG will therefore await the outcome of this review and any consequent actions and recommendations, should they arise, will be addressed by the Quality and Safety Committee.
ITEMS DISCUSSED
DGFT • Dr Mark Hopkin presented an update report on a proposal to change the paediatric nurse asthma service following the Child Asthma Death Serious Case Review. • DGFT had a very successful CQC Compliance Inspection where they were deemed to be fully compliant in all six outcomes reviewed by the CQC Compliance Inspectors. • A DGFT Ward Sister has won the national ‘Nurse of the Year Award’ for innovative ways of working. • DGFT launch a new Nursing Strategy on 7 May 2013. The Chief Nursing Officer for England will be attending.
BCPT • Monitor has made the decision to give BCPT a further six months to improve upon the good work they are currently completing in relation to their Governance Framework, prior to a final decision being made regarding Foundation status.
DWMHT • An appreciative enquiry visit is being considered in relation to absconds and suicides at DWMHT. Information is awaited regarding a previous appreciative enquiry visit undertaken by Walsall CCG.
Ramsay • Recent CQC inspection deemed compliant on all but one outcome (failure to obtain two references for three employees prior to starting work). CQC accepted Ramsay’s action plan to remedy this issue.
Primary Care • Concern raised re lengthy tick list received by GP practices following patient contact with the 111 service, resulting in difficulty actually defining what was actually wrong with the patient. Dan King to raise this concern with the 111 provider. • Measles – there are no triggers in Dudley for doing a catch-up and there have been no confirmed measles cases for over a year. Awaiting guidance from NHS England re future management. • Childhood immunisation – there have been a number of incidents where duplicate/wrong dose vaccines have been given in the last 12 months. Actions are being implemented to ensure the errors do not continue which includes further training for the Practice nurses.
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Corporate • The local incident reporting system is no longer in existence. Local Primary Care incidents were previously reported and logged on to Safeguard. Rebecca Bartholomew will be meeting Faye Baillie from the Area Team to discuss a resolution. • The Quality and Safety risks on the Risk Register were reviewed, some were resolved or mitigated.
DECISIONS TAKEN BY COMMITTEE UNDER DELEGATED POWERS FROM BOARD None.
DECISIONS REFERRED TO THE BOARD None.
RECOMMENDATION For the Board to receive assurance from the Quality and Safety Committee is it is effectively responding to and acting upon quality concerns within the Dudley Health Economy.
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DUDLEY CLINICAL COMMISSIONING GROUP BOARD
Date of Report: 2nd May 2013 Report: Clinical Development committee Agenda item No: 9.1
TITLE OF REPORT: Report of Clinical Development Committee
To inform the Board of progress on implementing key QIPP initiatives in PURPOSE OF REPORT: line with the strategic plan
AUTHOR OF REPORT: Mrs Alison Tennant
MANAGEMENT LEAD: Mrs Alison Tennant and Mr Neill Bucktin
CLINICAL LEAD: Dr Steve Mann
• The QIPP projects for 2013-14 are summarised • Summary of current performance against Quality Premium outcomes • Funding for improved triage for the falls service was approved KEY POINTS: • Funding for additional mental health worker support for service users in community settings was approved • Risks were reviewed
• That the Board approve the content and format of reporting of QIPP
RECOMMENDATION: • That the Board approve the content of the report
FINANCIAL IMPLICATIONS: £20,000 recurrent funding committed.
WHAT ENGAGEMENT HAS Engagement on priorities was undertaken through the consultation TAKEN PLACE: programme in 2012-13
Decision ACTION REQUIRED: Approval Assurance
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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 2ND MAY 2013 CLINICAL DEVELOPMENT COMMITTEE
KEY INDICATOR SUMMARY
Quality Premium measures
In order to receive a quality premium payment in 2014-15, Dudley CCG has a number of goals to attain. There is a risk that some of these goals may not be attained and actions are required to mitigate these.
Total Quality Premium for Dudley Committee responsible CCG £ 1,542,500
% National Goals Award Financial Award CDC Domain 1 12.50% £ 192,813 CDC Domain 2&3 25.00% £ 385,625 Q&S Domain 4 12.50% £ 192,813 Q&S Domain 5 12.50% £ 192,813
% Local Goals Award Financial Award PCDC Hypertension 12.50% £ 192,813 PCDC Atrial Fibrillation 12.50% £ 192,813 PCDC Dementia 12.50% £ 192,813
NHS Constitution % Requirements Award Financial Award F&P RTT 18 weeks -25% -£ 385,625 F&P A&E 4 hr Wait -25% -£ 385,625 62 day Waits Cancer F&P Treatment -25% -£ 385,625 Cat A Ambulance F&P response Times -25% -£ 385,625
Award Amount at Risk £ 964,063
Amber areas are those which show a 50% or lower risk of missing the goal using historical data. Domain 5 is rated red due to the significant challenge for this specific goal.
The Clinical Development Committee will be monitoring all goals but will be taking actions to address domains 1, 2 and 3.
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Domain 1: Preventing people from dying prematurely - To earn this portion of the quality premium, the potential years of life lost (adjusted for sex and age) from amenable mortality for a CCG population will need to reduce by at least 3.2% between 2013 and 2014
Dudley Directly Standardised Rate PYLL per 100,000 pop.
4,000
3,500
3,000
2,500 2,000 Female 1,500 Male 1,000
500
0 2003 2004 2005 2006 2007 2008 2009 2010 2011
The CCG is working with the Office of Public Health to map the interventions which will increase life expectancy and are part of the CCG priority work streams and monitor their impact. The priority areas of stroke, diabetes, cardiology, community nursing and older people are addressing a number of these factors. E.g. identifying and reviewing people at high risk of stroke who are not on anticoagulant therapy.
Domain 2: Enhancing quality of life for people with long term conditions and Domain 3: Helping people recover from episodes of ill health or following injury are measured under one indicator.
To earn this portion of the quality premium, there will need to be a reduction or a zero per cent change in emergency admissions for these conditions for a CCG population between 2013/14 and 2014/15.
In Dudley, avoidable emergency admissions have shown a weak trend downwards over the past years. Individual QIPP initiatives are tracking the elements which make up the composite rate.
Indirectly Standardised Rate / 100,000 pop. Dudley by Quarter (2003-2011)
300
250
200
150 R² = 0.0731
100
50
0 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35
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Domain 4: Ensuring that people have a positive experience of care
To earn this portion of the quality premium, there will need to be: 1) Assurance that all relevant local providers of services commissioned by a CCG have delivered the nationally agreed roll-out plan to the national timetable 2) An improvement in average FFT scores for acute inpatient care and A&E services between Q1 2013/14 and Q1 2014/15 for acute hospitals that serve a CCG’s population.
Dudley Group are very likely to achieve the first element of this Domain which is to deliver the nationally agreed rollout. They have been delivering consistent scores of around 70% for acute inpatient care although these have dropped slightly in the last quarter of 12/13.
Domain 5: Treating and caring for people in a safe environment and protecting them from avoidable harm A CCG will earn this portion of the quality premium if:
• There are no cases of MRSA bacteraemia for the CCG’s population; and • C. difficile cases are at or below defined thresholds for CCGs.
Achieving within threshold performance for both elements of this Quality Premium will prove challenging. MRSA requires zero cases to qualify and C.diff requires nearly 50% reductions on the previous year.
All local Quality Premium targets are likely to meet the goals and are tracked on a monthly basis
All NHS Constitution measures associated with the Quality Premium award are likely to meet requirements.
QIPP project progress
On the following page is a summary of all QIPP projects underpinning each priority for 2013/14. These projects together deliver £5.4million savings. They have been rated in three ways.
• Progress: Where a plan is on track, it is rated green; if there are delays in the plan but there are actions in place to mitigate, it is rated amber; if the plan is at significant risk of non delivery it is rated red.
• Finance: Plans are rated on progress against the monthly financial target. Due to no April finance data being available some boxes are white. Where an immediate saving has been made due to a lower block contract value being agreed the plan is green. If a plan is focused on quality and efficiency and has no financial implications it is black.
• Activity: The direction of expected activity is shown in column titled ‘activity aim’. The adjacent column shows the current direction of activity.
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Project Financial Activity Activity Priority QIPP Schemes Quality Improvement progress target aim levels
Children seen in Improving Improving access, Increase in numbers of community outcomes for early intervention, children being seen in services children and commissioning new community settings more young people pathways promptly
Reduced Improving Mental Health Service Easier and faster access to waiting Primary care Transformation services. Reduce bed based times mental health Programme services Improving People access to Enhanced More patients accessing accessing Alcohol psychological input to support for tackling alcohol 0 support support the care pathway problems services Reducing falls, Reduced increasing support for Reduced emergency emergency Improving care dementia patients, not admissions, falls, length of admissions for older people admitting older people stay to hospital Reduced Integrating community Community emergency services to support Reduced emergency nursing admissions patients and prevent admissions services admissions to hospital Patients New diabetes service seen in Improving Increase in primary care model, increasing primary diabetes support, increase in numbers identification of care services diagnosed diabetes Reduced Improving Patients seen by right waiting Cardiology Outpatient access to specialist quicker/ Increase in times Redesign cardiology care plans to primary care Reduced new Reduced first consultant Ophthalmology Glaucoma outpatient outpatient appointments referrals Reduced Improving stroke mortality Improving prevention, rapid Improvement in stroke 0 rates from Stroke Care access to treatment mortality stroke and improved rehab Range of measures to Reduced increase productivity, costs Better use of procure more Cost savings resources effectively and reduce activity Reduced Reducing A&E attendance, emergency Improving reducing emergency Urgent care model admissions urgent care admissions, reducing ambulance use
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ITEMS DISCUSSED
Community Respiratory service: Proposal to develop community focused respiratory service to support patients in the community and improve care so that patients are supported to manage their condition better. (Priority: community nursing services)
Paediatric Respiratory Service: Proposal to review paediatric asthma service to provide improvements in primary care management of respiratory conditions as well as specialist advice. (Priority: supporting children and young people)
Falls triage service: Proposal to jointly commission improved triage service for patients experiencing or at risk of falling in conjunction with local authority to meet need of increasing older population and reduce fractures and other consequences (Priority: improving care for older people)
Mental Health Recovery Project: Proposal to jointly commission increased mental health worker support for service users on recovery plans involving movement from secondary to community settings. (Priority: improving primary care mental health)
Risks around maternity and community dermatology services were discussed.
Francis Report: Implications for committee operations
QIPP Plan: Next steps for identifying and quantifying pipeline of projects to ensure delivery of QIPP financial and quality agenda
Quality Premium: Identified committee responsibility for delivery of Domains 1, 2 and 3 outcomes. Recognition of commissioning team input to delivery of national measures re RTT, cancer 62 day RTT, 4 hour A&E wait and ambulance 8 minute response time.
DECISIONS TAKEN BY COMMITTEE UNDER DELEGATED POWERS FROM BOARD
Joint Funding of Falls triage service: £10,000 annually recurrently
Joint funding of Mental Health Recovery Project: £10,000 annually recurrently
DECISIONS REFERRED TO THE BOARD
None
RECOMMENDATION
That the Board are assured that the committee is delivering its responsibilities and approve the content and format of this report.
Alison Tennant
Head of Service Improvement
22nd April 2013
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DUDLEY CLINICAL COMMISSIONING GROUP BOARD
Date of Report: 2nd May 2013 Report: Dudley Health and Wellbeing Board Agenda item No: 9.2
TITLE OF REPORT: Report of the Dudley Health and Wellbeing Board
To advise the Board of matters considered by the Dudley Health and PURPOSE OF REPORT: Wellbeing Board
AUTHOR OF REPORT: Neill Bucktin, Head of Partnership Commissioning
MANAGEMENT LEAD: Neill Bucktin, Head of Partnership Commissioning
CLINICAL LEAD: Dr David Hegarty, Chair of the Governing Body
1. The Dudley Health and Wellbeing Board was formally established on 1st April 2013 as a statutory committee of Dudley MBC and will hold its first meeting on 29th April 2013.
2. The Board is due to consider reports on:-
• Proposals for its future development KEY POINTS: • The implications of the Francis Inquiry and Winterbourne View Reports for Dudley • Implementation of the obesity and dementia strategies • Development of Healthwatch • Adult Social Care Local Account 2011/2012
3.The Board will also receive a presentation from Black Country Partnerships NHS FT
RECOMMENDATION: That matters considered by the Health and Wellbeing Board be noted.
FINANCIAL IMPLICATIONS: None arising directly from this report
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Separate processes of engagement have taken place, where WHAT ENGAGEMENT HAS appropriate, or are planned for all issues considered by the Health and TAKEN PLACE: Wellbeing Board.
Decision ACTION REQUIRED: Approval √ Assurance
DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 2nd May 2013
Report of the Health and Wellbeing Board
INTRODUCTION
The Board will be aware that whilst the Dudley Health and Wellbeing Board (HWB)has been meeting in shadow format for 12 months, it became formally established as a statutory committee of Dudley MBC on 1st April 2013.
This report sets out those issues which the Board will be considering at its first meeting on 29th April 2013.
FUTURE DEVELOPMENT OF HEALTH AND WELLBEING BOARD
The CCG Board has already received the Joint Health and Wellbeing Strategy (JHWS), as informed by the Joint Strategic Needs Assessment (JSNA) and noted that the HWB has agreed that the CCG’s Strategic Plan “takes proper account” of the JHWS as required under Section 14Z13 (4)(b) of the Health and Social Care Act 2012.
The HWB is now turning its attention to how the JHWS is delivered and it is proposed that five “Spotlight” events will focus on each of the JHWS priorities in the following order:-
• Making our services healthy • Making our lifestyles healthy • Making our children healthy • Making our minds healthy • Making our neighbourhoods healthy
The first event will focus primarily on urgent care, take place in early June and involve a range of key stakeholders. The output from this event will, inter alia, inform the refresh of the CCG’s Strategic Plan.
It is proposed to hold four meetings in public during the course of the year, the first of which will be on Wednesday, 26th June 2013 in the form of a conference and formal launch of the JHWS.
FRANCIS INQUIRY AND WINTERBOURNE VIEW REPORTS
The HWB will be requested to note the general themes and recommendations arising from the Francis Inquiry and how they relate to the responsibilities of the CCG, providers, Healthwatch, Health Overview and Scrutiny Committee, Office of Public Health and the HWB itself.
It is proposed that local NHS organisations be asked to submit their action plans, developed in response to the Francis Report, for consideration at the meeting of the HWB scheduled for September 2013.
The CCG’s Quality and Safety Committee has already received a report on action being taken in response to the recommendations of the Department of Health’s report into events at Winterbourne View. In particular, the Committee has noted the register of people with learning disabilities or autism and who have mental health conditions or behaviour that challenges in NHS funded care.
The HWB will be advised of a number of other measures in place to respond to the DoH report under the auspices of the Dudley Safeguarding Adults Board and the Learning Disabilities Partnership Board including:-
• Safeguarding processes • Use of a self advocacy group to validate the experience of service users • Transition arrangements between adults and children’s services • Restraint and challenging behaviour • Progress with reviews for clients in NHS funded care • Development of the Joint Improvement Plan
OBESITY AND DEMENTIA STRATEGIES
The HWB will be requested to ratify the refreshed Dudley Borough Obesity Strategy and Improvement Plan for 2013 – 2017. This has already been considered by the Board’s Clinical Development Committee.
Reducing the prevalence of childhood obesity is a key feature of the CCG’s commissioning priority for children’s services. This includes working in partnership with NHS England and DMBC’s Office for Public Health on implementing the revised service specification for health visiting, including their responsibilities to encourage breast feeding take up. The reduction of obesity is also of relevance to other priorities including the improvement of diabetes, stroke and cardiology services.
The Board will be aware that obesity reduction is a long standing priority for Dudley. The latest obesity health needs assessment highlights that:-
• Adult obesity prevalence is increasing although levels are lower than England. The health inequality gap widened between 2004 and 2009. • Child obesity prevalence is higher than England, although the rate of increase may be slowing down. • Breast feeding initiation and duration are lower than the England and Regional rates. Young people do not see breast feeding as a viable option. • Adult physical activity rates have increased, whilst fruit and vegetable intake remains at low levels
The strategy is based upon the vision of creating “...an environment and culture where adults and children in Dudley have the opportunity to maintain a healthy weight” and adopts a 3 tier approach to tackling obesity with action at the environmental, personal lifestyle and weight management treatment levels along the prevention- treatment continuum.
The HWB will be requested to encourage partners to contribute to the improvement plan and incorporate appropriate actions into their own plans.
The HWB will be invited to note a number of actions underway in Dudley in response to national dementia initiatives including:-
• Use of assistive technologies • Dementia friendly communities • Dudley Dementia Gateways
The Board will be aware that, as part of the CCG’s strategic plan, work is taking place to implement a revised service specification for older people’s mental health services, delivered through the contract with Dudley and Walsall Mental Health Partnership NHS Trust, as well as meeting the quality premium target on dementia diagnosis.
The HWB will also be asked to sign up to the “Dementia Care and Support Compact” which forms part of the Prime Minister’s “Challenge on Dementia” to deliver major improvements in dementia care and research by 2015, as well as noting the draft Dudley Dementia Strategy, currently the subject of consultation.
DEVELOPMENT OF HEALTHWATCH
Following a procurement process, Healthwatch Dudley will be provided by Dudley Council for Voluntary Service (CVS).
The HWB will be receiving an update on progress with the development of Healthwatch Dudley including:-
• development of the website www.healthwatchdudley.co.uk • ensuring the LINk legacy • recruitment of chief officer, participatory research officer, communications development officer and administration officer • Healthwatch launch event • governance and accountability arrangements
ADULT SOCIAL CARE LOCAL ACCOUNT 2011/2012
All local authorities with responsibility for adult social care are required to produce an annula account to the public outlining how they have performed over the previous year and highlight areas of improvement.
The Dudley Account focuses on 6 main outcomes:-
• information and advice • active and supportive communities • flexible integrated care and support • workforce • risk enablement • personal budgets
The HWB will be requested to note the Local Account.
BLACK COUNTRY PARTNERSHIPS NHS FT
The HWB will be receiving a presentation from the Chairman of the Foundation Trust.
RECOMMENDATION
That matters considered by the Health and Wellbeing Board be noted
Neill Bucktin, Head of Partnership Commissioning
April 2013
DUDLEY CLINICAL COMMISSIONING GROUP BOARD
Date of Report: 2nd May 2013 Report: Agreements Made Under Section 75 of the Health Act 2006 Agenda item No: 9.3
TITLE OF REPORT: Agreements Made Under Section 75 of The Health Act 2006
To advise the Board of agreements entered into by the CCG under PURPOSE OF REPORT: Section 75 of the Health Act 2006
AUTHOR OF REPORT: Neill Bucktin, Head of Partnership Commissioning
MANAGEMENT LEAD: Neill Bucktin, Head of Partnership Commissioning
CLINICAL LEAD: Vacant
• Under the terms of the Transfer Order, the CCG has inherited a number of agreements entered into by the former Dudley PCT with Dudley MBC under the provisions of the Health Act 2006.
• These agreements provide for lead commissioning arrangements, integrated service provision and the operation of pooled budgets for 4 service areas.
KEY POINTS: • The Health and Wellbeing Board’s duty to encourage integrated working and integrated services mean that it must “...provide such advice assistance or support as it thinks appropriate for the purpose of encouraging the making of arrangements under section 75...in connection with the provision of such services”. Therefore, the use of this power may extend to other areas in future.
• This report advises the Board of those agreements in place at present.
RECOMMENDATION: That the Agreements entered into under Section 75 of the Health Act 2006 be noted
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FINANCIAL IMPLICATIONS: The CCG’s financial contribution to these agreements is set out in the report.
WHAT ENGAGEMENT HAS Not applicable TAKEN PLACE:
Decision ACTION REQUIRED: Approval √Assurance
DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 2nd May 2013
AGREEMENTS MADE UNDER SECTION 75 OF THE NHS ACT 2006
INTRODUCTION
The CCG has inherited a number of agreements made under the provisions of Section 75 of the NHS Act 2006. This report sets out those agreements for the Board.
SECTION 75 OF THE NHS ACT 2006
This legislation, as amended by Regulations made by the Secretary of State for Health provides for CCGs, NHS England and NHS Trusts/Foundation Trusts to enter into agreements with local authorities which enable:-
• One body to act as the “lead commissioner” for a particular service area (usually learning disability or mental health services) through the delegation of that function • Integrated service provision between health and social care • The pooling of budgets for a service area
AGREEMENTS IN DUDLEY
At present four such agreements exist between the CCG and Dudley MBC as follows:-
• lead commissioning of learning disability services (with Dudley MBC as the lead commissioner) • pooled budget for the provision of the acquired brain injury service • pooled budget for the provision of the community equipment service • pooled budget for the placement of children under 19 with disabilities outside Dudley
The relevant financial contributions are set out below:-
Agreement CCG Contribution Dudley MBC Contribution £ £
Learning Disability Services Delegation of function only Delegation of function only
ABI 32,556 83,666
CES 478,194 863,986
Children with 185,400 785,600 Disabilities
GOVERNANCE
The operation of each agreement is overseen by a joint committee with representatives from both the CCG and Dudley MBC. The approval of decisions delegated to these committees is delegated to the Chief Accountable Officer under the CCG’s scheme of delegation.
HEALTH AND WELLBEING BOARD’S DUTY TO ENCOURAGE INTEGRATED WORKING
Under Section 195 of the Health and Social Care Act 2012, Health and Wellbeing Boards have a statutory duty to encourage the use of Section 75 Agreements to promote integrated working.
As the work and role of the Health and Wellbeing Board develops. It is likely that this mechanism will be used further.
RECOMMENDATION
That the Agreements entered into under Section 75 of the NHS Act 2006 be noted.
Neill Bucktin, Head of Partnership Commissioning April 2013
DUDLEY CLINICAL COMMISSIONING GROUP BOARD
Date of Report: 2nd May 2013 Report: Communications and Engagement Agenda Item No: 10.1
TITLE OF REPORT: Communications & Engagement Update
To update the Board on the work being undertaken by the PURPOSE OF REPORT: Communications & Engagement Team.
AUTHOR OF REPORT: Mrs Laura Broster
MANAGEMENT LEAD: Mr Paul Maubach
CLINICAL LEAD: Dr David Hegarty
• £3,356.36 AVE for Media Coverage • Key topics of coverage- CCG Go Live, 100k funding for community KEY POINTS: groups, Big white Wall A&E trial • New Intranet & Internet sites go Live • Social Media Activity is rising
To accept this report for information on the teams activity. RECOMMENDATION: Any comments on its content and how useful it is would be gratefully received.
• The CCG has a statutory duty to involve. Failure to do so could result in costly judicial proceedings. • All activity reported is covered by the existing communications & FINANCIAL IMPLICATIONS: Engagement activity unless it states otherwise. • AVE is a method of estimating the value of editorial media coverage, which is widely used throughout the PR industry. This report details all CCG engagement activity known to the WHAT ENGAGEMENT HAS Communications & Engagement Team on behalf of the CCG. TAKEN PLACE: □ Decision ACTION REQUIRED: □ Approval □ Assurance
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Date: 2nd May 2013
35/50
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22nd April 2013 • Primary Care Strategy • Update from attendees at Patient Leadership Course • Feedback on group development • Meet & Greet , Paul Maubach
4th June 2013 • Deliberative session with wider public to inform the future CCG Commissioning Strategy & Health & Wellbeing Board Spotlight Event
623 (up 203 since last Board report)
Not promoted yet, launched 1st April, 28 likes, 13 people talking about
£3,356.36
CCG Go Live, 100k funding for community groups, Big white Wall A&E trial
• Building Health Partnerships • Board development • Healthwatch Launch Session on Engagement • Social Value Workshop • Developing Community • Creative collaboration Info Directory Board development Session • E t
• NHS 111 implementation • Intranet / internet build • Stroke Review • Annual report • Duty to report contribution • New accommodation
14th May 2013
Communications & Engagement Board Update
May 2013
1.0 Introduction
This report is intended as a brief update for Board Members on the activity of the Communications & Engagement Team.
It is recognised that this is a superficial way of reporting on some delicate matters but the Head of Communications is happy to discuss further details with those who are interested.
2.0 Media Management
2.1 Proactive Media Releases
Below is a list of the topics that the team has proactively released to the media. Proactive can be summarised as areas which the CCG wants to bring to the medias attention.
• Dudley A&E Trial on Patients with minor illnesses • Healthy Boost for Dudley • Dudley CCG Goes Live • Walkin Centre Extended Hours for Easter • New Mental Health Support Service Launches for Patients in Dudley – Big White Wall
2.2 Reactive Media Releases
Below is a list of topics which the CCG Communications & Engagement Team has been asked to comment on. Responses could include a quote or a full briefing with the reporter. Reactive are areas which are sought by the media, they can still be managed in a proactive way and are still seen as opportunities by the team to get positive messages out as the list below shows.
• Specialist Dementia Nurses • CCG Priorities • A&E Trial Update
3.0 Media Coverage
While much of the media coverage arises from news releases, statements and media briefings produced by the Communications team, other factors outside the control of the organisation influence the actual amount of coverage achieved in any period.
We are currently trialling a press clippings service.
The table below details a breakdown of positive, neutral and negative CCG coverage.
Page Media Publication Num Published Value Reach Sentiment J4bcommunity.co.uk Internet (Web) 0 28/03/2013 £34.00 1254 Positive UK Key Express & Star (Dudley & Regionals Stourbridge) 31 28/03/2013 £508.08 38574 Positive Internet TheYamYam (Web) 0 03/04/2013 £26.00 952 Positive
Internet TheYamYam (Web) 0 04/04/2013 £26.00 952 Positive
Internet Pharma Field (Web) 0 05/04/2013 £15.00 774 Positive
TheInformationDaily.com Internet (Web) 0 08/04/2013 £166.00 6192 Positive UK Key Express & Star Regionals (Wolverhampton) 14 06/04/2013 £272.70 31984 Positive UK Key Express & Star (Dudley & Regionals Stourbridge) 5 08/04/2013 £505.89 38574 Balanced UK Key Regionals Stafford Express & Star 5 08/04/2013 £102.34 10511 Balanced
Internet TheYamYam (Web) 0 12/04/2013 £26.00 952 Positive
Internet Halesowen News (Web) 0 12/04/2013 £55.00 2040 Positive
Internet Dudley News (Web) 0 12/04/2013 £73.00 2907 Positive
Internet Stourbridge News (Web) 0 12/04/2013 £145.00 5400 Positive UK Additional Regionals Stourbridge News 9 11/04/2013 £170.10 48047 Positive
Internet Stourbridge News (Web) 0 13/04/2013 £145.00 5400 Positive
Internet Halesowen News (Web) 0 13/04/2013 £55.00 2040 Positive
Internet Dudley News (Web) 0 13/04/2013 £73.00 2907 Positive UK Key Express & Star (Dudley & Regionals Stourbridge) 18 12/04/2013 £157.68 38574 Positive UK Additional Regionals Halesowen Chronicle 20 11/04/2013 £230.05 28009 Balanced UK Key Regionals Stafford Express & Star 18 12/04/2013 £83.30 10511 Positive UK Key Regionals Express & Star (Walsall) 18 12/04/2013 £88.40 16070 Positive UK Key Express & Star Regionals (Wolverhampton) 18 12/04/2013 £212.10 31984 Positive UK Additional Regionals Dudley Chronicle 1 11/04/2013 £36.16 38309 Positive UK Additional Regionals Halesowen Chronicle 1 11/04/2013 £29.96 28009 Positive UK Additional Regionals Stourbridge Chronicle 1 11/04/2013 £32.40 38142 Positive UK Key Express & Star Regionals (Sandwell) 18 12/04/2013 £88.20 14520 Positive
£3,356.36 443588
3.1 Advertising Value Equivalent (AVE)
AVE is a method of estimating the value of editorial media coverage, which is widely used throughout the PR industry. Without the contract mentioned above, it is almost impossible to calculate the AVE achieved in this period. The team achieve AVE this month of £3,356.36.
3.2.1 Publications During this period, the PCT received coverage in the following publications:
• Express and Star (All editions) • Stourbridge News • Dudley News • Chronicle (All editions) • The YamYam Website • Pharmafield Website • The Information Daily Website
4.0 Campaigns
This section details the current CCG supported campaigns.
4.1 111
The CCG has We are preparing for the delayed public launch on this campaign. However the soft launch has happened and we are supporting practices to feedback 3.2 Choose Well on their experiences of the service so far. We will continue to support pre go live comms on this to ensure stakeholder awareness in preparation for public launch.
5.0 Engagement Activities
The CCG has undertaken the following engagement activities:
5.1 Building Health Partnerships
Building Health Partnerships (BHP) is a national programme designed to improve health outcomes through supporting the development of effective and productive partnerships between Clinical Commissioning Groups (CCG) and voluntary, community and social enterprise (VCSE organisations), alongside Health and Well-being Boards and Local Authorities. From discussions so far, 3 workstreams have been identified: .
Bringing Information Sources Together o o Engagement
o Research, evaluation and impact of VSCE
Further meetings have been scheduled in partnership to develop the workstreams and project.
5.5 Patient Opportunity Panel
The third meeting took place in February and the group worked through a development session to try and define their role and objectives and to work towards identifying outcomes as a group.
5.6 Patient Reference Groups
Work continues with practices around the borough to increase and reinvigorate Patient Reference Groups. The Directed Enhanced Service for PRGs has also been extended for a further year now until end of March 2014 which will act as an incentive.
5.7 Meetings
Several meetings have taken place:
• DMBC re future of engagement and meetings with DACHS
• Community Engagement Working Group and Delivery Group looking at Engaging Together and developing and delivering an empowering approach to engagement across the borough
5.8 Advice & support given
The team have been approached by CCG commissioners and other staff on the following:
• Stroke Review
• Urgent Care
• Pain relief pathway
6.0 Health Overview & Scrutiny Committee
The Health Overview and Scrutiny Committee looks at the work of the CCG and National Health Service (NHS) providers. Typically, the committee undertakes reviews of health issues and considers and responds to inquiries, considers proposals by the NHS to develop or vary services, responds to national and local consultations. Meetings are open to the public and attended regularly by the press. In Dudley it acts as a ‘critical friend' by suggesting ways that health related services might be improved.
At the last meeting on 27th March 2013 the following papers were presented by the CCG:
• Update on Improvements to Care for Diabetes Patients
Dudley Group FT also presented on the Mortality Indicators.
Papers can be found at http://cmis.dudley.gov.uk/cmis5/Committees/CurrentCommittees.aspx The meeting schedule for 2013/14 is yet to be agreed. The dates will be subject to approval at next full council although it is likely to follow traditional July, slept, Nov, Jan, March pattern.
7.0 Freedom of Information Requests (FOIs)
The team now coordinate the CCG response to FOIs.
Since 1 April 2013 to date (18th April) - 3 FOIA’s received, one responded to. Two outstanding but are not due for release until week 1 May 2013.
The requests thus far have been for:-
• Management Services Contract • Commissioning Support Decision • Contact Details within CCG
Not any trend yet, based on between 1 April to date.
Dudley CCG staff training is scheduled for Thursday 16th May 2013, the SIRO and Caldicott Guardian Training has been completed. Both the SIRO and Caldicott Guardian passed the online exam.
8.0 Member Practice Communications
The team have produced 34 editions of CCG news so far, this has moved to a Monthly publication and now has an interactive feature on the CCG intranet site. Enabling member practices to feedback real-time on items included in the newsletter. The team will be working closely with the Head of Membership (once appointed) to further enhance the communication to members. .
9.0 Other Activity
• Twitter- The team have started to manage the CCG Twitter account and now have 603 (18th April 13) followers an increase of 203 since the last Board meeting. Follow @Dudleyccg. • Facebook- the team launched the CCG facebook account on the 1st of April. This is yet to be promoted officially but we already have 28 page likes. • CCG Intranet- The CCG has a new Intranet site with logins now sent out to all member practices too. This new site has been built after consultation with a Practice Manager rep to provide a portal for sharing news, corporate calendar and CCG policies. There is a specific GP Member area with useful resources to support general practice business. • CCG Public Internet- The CCG has revamped the public site www.dudleyccg.nhs.uk to put more emphasis on how we want the public to see our role. The site has been to move away from a website that simply acts as a corporate info portal and move towards a site that give the public a gateway to contact us about the services we commission on their behalf. Key features include a live twitter feed, live patient experience stories (which the team are now responding to) and a CCG publication scheme of key documents. • Prospectus – the CCG is required to publish a prospectus for its local population by 31st May 2013, this is detailed in page 6 of supporting planning 2013/14 for Clinical Commissioning Groups. Laura Broster and Neill Bucktin will ensure that a publication is produced and circulated to relevant stakeholders and made available to the public via the CCG website and GP practice waiting areas.
DECISIONS TAKEN BY COMMITTEE UNDER DELEGATED POWERS FROM BOARD
The first meeting of this Committee will take place on Tuesday 14th May 2013 therefore there are no decisions made to refer to the Board.
DECISIONS REFERRED TO THE BOARD
The first meeting of this Committee will take place on Tuesday 14th May 2013 therefore there are no decisions made to refer to the Board.
RECOMMENDATION
Board is asked to note the report for assurance.
DUDLEY CLINICAL COMMISSIONING GROUP BOARD
Date of Report: 2nd May 2013 Report: Audit Committee Report Agenda item No: 11.1
TITLE OF REPORT: Audit Committee Report
To advise the Board of the key issues discussed at the Audit Committee PURPOSE OF REPORT: nd on 22 March 2013
AUTHOR OF REPORT: Mr M Hartland, Chief Finance Officer
MANAGEMENT LEAD: Mr M Hartland, Chief Finance Officer
CLINICAL LEAD: Dr J Rathore, Clinical Lead for Finance and Performance
• Accounts closedown on target to achieve deadline and control total. • Revised approach to risk management agreed. KEY POINTS: • CCG Constitution agreed. • Counter Fraud and Internal Audit Plans for 2013/14 agreed. • No compliance issues.
The Board is asked to note the issues discussed at the Audit Committee on 22nd March 2013 and the recommendation to approve and adopt the RECOMMENDATION: changes to the Constitution.
FINANCIAL IMPLICATIONS: None
WHAT ENGAGEMENT HAS None TAKEN PLACE:
Decision ACTION REQUIRED: Approval Assurance
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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 2ND MAY 2013 AUDIT COMMITTEE REPORT
1. INTRODUCTION The report summarises the key issues discussed at the Audit Committee on 22nd March 2013.
2. KEY INDICATOR SUMMARY The following items are indicators of the current position in relation to the main responsibilities and obligations of the Committee as defined in the CCG Constitution and Terms of Reference.
Indicator Position RAG 1. Year-end Accounts and Close-down − Accounting Policies Agreed − Annual Governance Statement (AGS) No issues − Annual Report No issues 2. CCG Governance Arrangements – Constitution Agreed 3. Internal Audit Good progress 4. Counter Fraud No significant issues 5. Standing Orders and Standing Financial Instructions – Compliance. No issues 6. Risk Management Processes ratified
3. ITEMS DISCUSSED
3.1 Year-end Accounts and Closedown 2012/13 − Accounting policies in relation to the accounts were approved. − It was recognised that the PCT accounts are being completed by CCG finance staff on behalf of the Local Area Team (LAT) of the National Commissioning Board (NCB). − The accounts are on track to be completed in line with the Department of Health timeline for submission on 22nd April 2013. − The year-end revenue control total is expected to be delivered. − External audit have given positive indications to the proposed methodology for closing the accounts. − A generic Annual Governance Statement has been produced for the Cluster, which is to be tailored to local circumstances. − Across the Cluster two Annual Reports are to be produced – one for Birmingham and Solihull and one for the Black Country. The production of the Reports is being led by the Commissioning Support Unit, although the CCG will contribute Dudley information.
3.2 CCG Governance Arrangements – Constitution A review of the Constitution has been carried out by an external consultant to ensure the document is fit for purpose from 1st April 2013. A small number of changes were identified relating to voting rights, quoracy, revision to the Committee structure and changes to Standing Orders, Standing Financial Instructions and Prime Financial Policies.
The Scheme of Delegation within the Constitution gave the Audit Committee delegated authority to approve changes to the document. The Committee agreed to recommend to the Board approval and adoption of the changes to the Constitution. The Board subsequently approved the Constitution on 2nd April 2013 and it has been sent to the Local Area Team.
3.3 Internal Audit − The 2012/13 work-plan will be completed in time for the Head of Internal Audit Opinion on the work carried out during the year for the purposes of the annual accounts. This is expected to provide significant level assurance on the systems within the PCT. − There have not been any CCG specific audit reports providing less than significant assurance. − Outstanding audit recommendations have been signposted to successor organisations. None have transferred to the CCG. − The 2013/14 Internal Audit Plan has been agreed.
3.4 Counter Fraud There are a number of open fraud investigations that have been transferred to the NCB and the CCG, dependent on the context of the issues. CCG cases will continue to be overseen by the Committee.
The Committee approved the draft Counter Fraud Plan 2013/14. This will be tailored to the individual requirements of the CCG.
3.5 Charitable Funds Arrangements agreed for the transfer of residual charitable funds to Dudley and Walsall Mental Health Partnership Trust.
3.6 Standing Orders (SOs) and Standing Financial Instructions (SFIs) The Committee reviews compliance with SOs and SFIs. Of particular interest is compliance with procurement rules by reviewing tenders and the use of waivers. There were no significant areas of concern and the Board will be informed of significant breaches of SFIs by exception.
3.7 Risk Management The Committee approved the revised approach to risk whereby each Committee of the Board manages its own applicable risks and Audit Committee oversees the process to provide assurance to the Board. To enhance such assurance it is proposed to invite Committee Chairs to Audit Committee periodically to describe each Committee’s approach to risk management
A revised Risk Framework is in the final stages of drafting and the Board development session on 25th April is dedicated to Governance and Risk Management.
4. DECISIONS TAKEN BY COMMITTEE UNDER DELEGATED POWERS FROM BOARD The Committee agreed to recommend to the Board approval and adoption of the changes to the Constitution.
5. DECISIONS REFERRED TO THE BOARD None.
6. RECOMMENDATION The Board is asked to note the issues discussed at the Audit Committee on 22nd March 2013 and the recommendation to approve and adopt the changes to the Constitution.
M Hartland Chief Finance Officer April 2013
DUDLEY CLINICAL COMMISSIONING GROUP BOARD
Date of Report: 2nd May 203 Report: Black Country Cluster Handover Document Agenda item No: 11.2
TITLE OF REPORT: Black Country Cluster Handover Document
To assure the Board that legacy issues from the Cluster have been PURPOSE OF REPORT: adopted in CCG plans and strategies.
AUTHOR OF REPORT: Mr M Hartland, Chief Finance Officer
MANAGEMENT LEAD: Mr M Hartland, Chief Finance Officer
CLINICAL LEAD: Dr D Hegarty, CCG Chair
• Handover document produced March 2013. KEY POINTS: • Document provides overview of issues to handover to CCG. • No significant issues of concern.
RECOMMENDATION: The Board is asked to note the report for assurance.
FINANCIAL IMPLICATIONS: None
WHAT ENGAGEMENT HAS None TAKEN PLACE:
Decision ACTION REQUIRED: Approval Assurance
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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 2ND MAY 2013 BLACK COUNTRY CLUSTER BOARD HANDOVER DOCUMENT
1. INTRODUCTION During 2012/13 financial year the Black Country Cluster developed a legacy document designed to capture knowledge that has been accumulated through managerial and clinical interactions over the years to handover to new organisations. This paper identifies for the Board issues to note and any immediate actions required.
2. LEGACY DOCUMENTS The document “Black Country Cluster Handover Document, March 2013” has been prepared to:-
• Retain a “log” of organisational memory as the NHS undergoes major structural changes to how it is organised and managed. • Enhance the robustness of handover arrangements. • Capture and transfer organisational memory and information. • Ensure quality and safety is not put at risk during structural change.
The report contains information on:-
• All services provided to the local population • Quality and views of the Care Quality Commission • Workforce • Summary of key planned changes • Organisational assets and liabilities • Stakeholder map • Governance within the Cluster • Performance • Financial information • Provider capacity
Key points to note for the CCG are:-
The document appears to be factually correct in relation to Dudley and there are no significant points of correction proposed. One financial value in relation to Dudley Group Foundation Trust’s financial outturn has been misquoted, but this is not material.
It refers to the Quality Management structure in operation within the Cluster and the process for dissemination to new organisations via the Black Country Cluster Quality Handover Document. The CCG’s response to this document is in a separate Board report.
The document refers to two Transfer Schemes from the PCT to the CCG. The Assets and Liabilities Scheme has had due diligence performed over the last month and there are no significant areas of concern or ongoing unknown obligation in the CCG. The Staff Transfer Scheme was received in draft form at the last Board and has now been finalised by the Local Area Team and ratified by the CCG.
The assessment of the finances of the Cluster was described. These were correct at the time of drafting, but the financial year to which it referred has now ended. There are no financial risks described that are not contained in the CCG Financial Plan.
Primary care provider development is discussed. The Cluster identified a need for improved capacity, capability, flexibility and viability in primary care with an emphasis on developing services that facilitate improved levels of health, better management of disease and uniformly high quality of care. This agenda will be led by NHS England.
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3. CONCLUSION There are no significant issues described in the Black Country Cluster Handover Document that have not been included in relevant CCG plans and strategies; therefore there is no requirement for an action plan.
4. RECOMMENDATION The Board is asked to note the report for assurance.
5. APPENDICES Black Country Cluster Handover Document
M Hartland Chief Finance Officer April 2013
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DUDLEY CLINICAL COMMISSIONING GROUP BOARD
Date of Report: 2nd May 203 Report: Draft Risk Management Strategy Agenda item No: 11.3
TITLE OF REPORT: Draft Risk Management Strategy
The purpose of this Risk Management Framework is to set out the way in PURPOSE OF REPORT: which the CCG identifies; monitors and manages its strategic, operational, financial and compliance risks.
AUTHOR OF REPORT: Mr M Hartland, Chief Finance Officer
MANAGEMENT LEAD: Mr M Hartland, Chief Finance Officer
CLINICAL LEAD: Dr D Hegarty, Chair
The original Risk Management Strategy has been updated to reflect the CCG’s new governance structure, that the risk management process is KEY POINTS: being managed by the Audit Committee, and also the working practices of the Commissioning Support Unit.
RECOMMENDATION: The Board is asked to approve the revised Risk Management Strategy.
FINANCIAL IMPLICATIONS: None
WHAT ENGAGEMENT HAS None TAKEN PLACE:
Decision ACTION REQUIRED: Approval Assurance
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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 2ND MAY 2013 DRAFT RISK MANAGEMENT STRATEGY
1. INTRODUCTION The original Risk Management Strategy has been updated. This is to reflect the CCG’s new governance structure, the fact that the Audit Committee is now managing the risk management process and also the working practices of the Commissioning Support Unit.
The purpose of the Risk Management Framework is to set out the way in which the CCG identifies; monitors and manages its strategic, operational, financial and compliance risks.
2. RECOMMENDATION The Board is asked to approve the revised Risk Management Strategy.
3. APPENDICES Draft Risk Management Strategy
M Hartland Chief Finance Officer April 2013
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Risk Management Framework
2013 - 2014
Version.1 19/04/2013
1 RM FRAMEWORK
CONTENTS
INTRODUCTION 3
RISK STRATEGY AND VISION 4
RISK MANAGEMENT POLICY 7
APPENDIX 1 GLOSSARY OF RISK TERMINOLOGY
APPENDIX 2 RISK ASSESSMENT SCORING METHODOLOGY
APPENDIX 3 BAF & RISK REGISTER FORMAT
2 RM FRAMEWORK INTRODUCTION Successful organisations manage risks to the delivery of their core business objectives explicitly and effectively.
Risk to the Group’s business can take various forms, e.g. financial risk, risk to the services commissioned, risks to patients, the public or specific stakeholders, risks from missed opportunities or from policy failures, and risks to our reputation. Accordingly, we need a clear understanding of how such risks should be managed. Doing this properly is central to planning to succeed and avoiding failure; to meeting our key objectives and targets; to creating confidence in a watchful public; to take opportunities; and to meeting the demands of good corporate governance. It will also make us better able to learn the value of appropriate risk-taking and benefit from innovation.
The purpose of this Risk Management (RM) Framework is to set out the way in which the Group identifies, monitors and manages its strategic, operational, financial and compliance risks.
The RM Framework has two elements:
Risk Strategy & Vision This sets out why risk management is important for the Group
Risk Management Policy This details the Risk Management system of the Group
3 RM FRAMEWORK I. RISK STRATEGY & VISION
INTRODUCTION The purpose of this strategy is to set out why Risk Management (RM) is important, in what context it should be seen and why it needs to be an intrinsic part of the way in which the Group operates.
All organisations face uncertainty. Uncertainty presents both risk and opportunity. Effective RM increases the probability of success and reduces both the probability of failure and the uncertainty of achieving the Group’s overall objectives. It provides a rigorous and robust framework for the Group to focus on what it needs to measure, monitor and manage if it is to deliver its core objectives. In summary, the successful implementation of a robust RM process is vital to achieving the Group’s objectives.
GROUP RISK PROFILE The key risks facing the Group relate to:
• Commissioning safe, high quality services for patients • Remaining financially viable • Working effectively with others to deliver patient-centred health services • Operating in accordance with the statutory and regulatory framework • Developing and maintaining an effective and well motivated workforce
AN INTEGRATED APPROACH In contextual terms, RM is one element of an integrated approach to corporate governance for every organisation. Both Performance Management and Risk Management are ultimately concerned with the achievement of the organisation’s strategic objectives. They are critical elements of the Group’s corporate governance framework along with leadership. How significant risks are managed can have a major impact on performance and the way in which an organisation’s objectives are achieved.
RM is one tool to improve performance. It must be part of a coherent system of management within the organisation with the other following key elements:
• Business planning • Financial planning and management • Performance management and monitoring • Appraisal and personal development of staff
4 RM FRAMEWORK
GOVERNANCE
- Corporate priorities - Decision making RM - Culture and values P - Resource prioritisation - Organisational PERFORMANCE system to identify, - Risk “appetite” MANAGEMENT measure, mitigate & COMPLIANCE
and monitor risks to INTEGRATED - Evidence that corporate and other CORPORATE corporate objectives key objectives GOVERNANCE are being met FRAMEWORK - Evidence that risks are managed effectively PLANNING - Legal and regulatory requirements - Commissioning Plan - Group Policies - Financial Plan & QIPP - Staff appraisal
RISK MANAGEMENT FRAMEWORK STATEMENT The Group recognises the important contribution that effective and explicit RM can make to the achievement of objectives at strategic, operational, financial and compliance level.
RM does not exist to stifle innovation or risk taking itself but to demonstrate that the organisation clearly identifies risks to its objectives, measures these, has monitoring systems in place and manages risk in a proportionate way. RM is an essential and important activity because it:
• is an intrinsic part of good management, not an add-on activity • focuses on what is important in achieving the organisation’s objectives • promotes better decision making, planning and prioritisation by a comprehensive and structured understanding of Group activity and the volatility of our business • assists project management by aiding in the identification of opportunities and threats to a given project • promotes greater and clearer accountability within the Group • promotes stakeholder confidence in the organisation
Our RM activities are therefore designed to:
• relate to what the Group states it wants to achieve • support effective delivery of services and partnerships • be targeted at critical risks
5 RM FRAMEWORK • be proportionate to those risks • not seek to stifle innovation or promote the avoidance of all risk • track and report critical risks in a transparent manner • be integrated into everyday management of the Group • act in concert with planning, resource allocation and performance management activities • meet regulatory requirements.
The critical success factors for effective RM include: • clearly identified responsibilities for senior management and governing body members • an agreed and effective RM Framework • the existence of an organisational culture which supports well thought-through risk taking and innovation • management of risk embedded in day-to-day management processes and consistently applied • management of risk is linked to the achievement of strategic and operational objectives • Risks are actively monitored and regularly reviewed on a constructive ‘no blame’ basis
RISK – THE REGULATORY REQUIREMENTS As well as the practical benefits to be gained by RM, the Group is also required to meet a variety of regulatory requirements in respect of risk management.
NHS England NHS England requires CCGs to operate a framework that effectively identifies and manages risk.
The Annual Governance Statement (AGS) All NHS bodies are required to produce an AGS that summarises the main systems and processes in place for risk management and internal control and discloses any material control weaknesses in any financial year. This is a statutory requirement and must be signed off by the Chief Accountable Officer.
The accompanying Risk Management Policy sets out the detail of the Group’s RM Framework. It details how risks are identified, quantified, how options to deal with them are identified, how decisions on risk management are taken, implemented and evaluated. The governing body, managers and staff are responsible for ensuring that the RM Framework is implemented. A glossary of risk management terms is included as Appendix 1.
6 RM FRAMEWORK II. RISK MANAGEMENT POLICY
INTRODUCTION The purpose of the RM Policy is to set out the RM Framework used by the Group to support the achievement of its strategic, operational, financial and compliance based objectives.
This policy covers in detail the following:
• Definition of risk • Leadership and accountability arrangements • Our RM approach • Risk measurement • Risk appetite • Monitoring arrangements • Decision making • Risk registers • Risk training • Annual Governance Statement
DEFINITION OF RISK There are many definitions of risk. The one used for the purposes of this policy is that risk is defined as the possibility that an event will occur and adversely affect the achievement of objectives.
The resources available for managing risk are finite and so our aim is to achieve an optimum response to risk, prioritised in accordance with our evaluation of the risks. We use the term ‘risk appetite’ to refer to the amount of risk which we are prepared to accept, tolerate, or be exposed to at any point in time.
RM is the process by which we: • identify risks in relation to the achievement of our objectives; • assess their relative likelihood and impact; • respond to the risks identified, taking into account our assessment and risk appetite; • review and report on risks - to ensure the risk profile is up to date, to gain assurance that responses are effective, and identify when further action is necessary.
The goals of RM are to: • take a proactive approach, anticipating and influencing events before they happen; • facilitate better informed decision making; • improve contingency planning.
LEADERSHIP AND ACCOUNTABILITY ARRANGEMENTS
The leadership and accountability arrangements for RM in the Group are as follows:
7 RM FRAMEWORK The Governing Body The governing body has responsibility for establishing the overall strategic direction of the Group. It provides oversight of risk management by:
• creating the environment for risk management to operate effectively; • being periodically apprised of the corporate risk profile and examining whether management is responding appropriately; and • considering the formal annual review of the effectiveness of the system of internal control (the AGS).
Audit Committee The Audit Committee considers and advises the governing body on the strategic processes and policies for risk, control and governance and the system of internal control, including the content of the AGS prior to endorsement by the governing body. This Committee will provide input to risk management by:
• monitoring the development and continuous improvement of the risk management process and the Board Assurance Framework (BAF); • reviewing the level of risk accepted; • being regularly apprised of the corporate risk profile and examining whether management is responding appropriately. This will involve at least annual presentations by other Committee chairs and their respective Chief Officer/Head Of on the management and assurance of risk that falls to that Committee’s responsibility; and • advising on the formal annual review of the effectiveness of the system of internal control and the content of the AGS.
The Audit Committee will be provided with:
• A report summarising any significant changes to the Group’s BAF and Risk Register for each meeting, with associated action plans • The Group’s Risk Management Strategy and Policy and proposals for continuous improvement of the risk management process and culture as appropriate.
Other Committees Other governing body Committees will consider and advise the governing body (and periodically the Audit Committee) on the management of risks specific to their area of responsibility (e.g. the Quality & Safety Committee will consider and advise on risks related to quality and safety)
Each Committee will be provided with:
• A report summarising any significant changes to the Group’s BAF and Risk Register, in relation to the risks assigned to that Committee for each meeting, with associated action plans.
Chief Accountable Officer The Chief Accountable Officer is responsible for ensuring that a system of risk management is maintained. This includes:
• setting and communicating the RM strategy; • providing leadership and direction over the risk management process; 8 RM FRAMEWORK • regularly reviewing the risk profile; • conducting an annual review of the effectiveness of the system of internal control in support of the AGS.
The Chief Finance Officer (CFO) The CFO co-ordinates the risk management process and works with the Audit Committee and Clinical Executive in establishing effective RM processes, but is not responsible for the management of risks. He is responsible for developing and implementing the process and maintaining the BAF and Risk Register and reporting mechanisms. The CFO will:
• Refresh and update the Group’s RM Framework as necessary • Act as the key link to the Audit Committee • Ensure corporate and other key risks are reported to each meeting of the Audit Committee, highlighting any significant changes • Co-ordinate the production of the AGS
Chief Officers and Heads Of All Chief Officers and Heads Of are responsible for:
• Ensuring the RM Framework is implemented consistently within their own areas of responsibility • Taking an active and visible role in the management of risks within the Group • Ensuring that risks in relation to their areas of responsibility are suitably captured and kept up to date within the BAF and Risk Register, and that is regularly reviewed by their respective management teams • Demonstrating how significant risks are being managed • Providing assurance for the AGS • Incorporating risk into decision making process
Other Managers Everyone with a line or project management role is responsible for assessing and communicating risks within their sphere of responsibility, including assessing when a risk should be considered for escalation to the BAF and Risk Register. Hence responsibilities include:
• Ensuring that the RM Framework is implemented in their area of responsibility • Contributing to the identification and management of risks • Include risk in decision making
Risk Owners Risk owners are responsible for ensuring that each risk assigned to her/him, is managed and monitored over time.
All GP Members and Group Employed Staff Whilst this policy document sets out defined processes for managing risk, successful risk management can only be accomplished on a day to day basis by staff at all levels through their working practices. Risk management is part of every GP member and group employed staff’s responsibilities and everyone has a role in carrying out
9 RM FRAMEWORK appropriate risk management, through awareness of the risk profile, supporting risk identification and assessment, and designing and implementing risk responses.
The responsibilities of individual members of staff are therefore to:
• Be familiar with the Risk Management Policy • Take general steps in their every day working to reduce risk • Inform their GP Locality Chair in the case of GPs and line manager / supervisor in the case of employed staff, of issues in their work activities that they consider are material risks • Immediately report any incidents or near misses or any other incident they feel is relevant to their line manager / supervisor
Internal Audit The Internal Audit team plays a key role in evaluating the effectiveness of, and recommending improvements to, the RM process. This is based on the systematic review and evaluation of the policies, procedures and operations in place to:
• establish, and monitor the achievement of, the Group’s objectives; • identify, assess and manage the risks to achieving these objectives; • advise on, formulate, and evaluate policy; • ensure the economical, effective and efficient use of resources; • ensure compliance with established policies (including behavioural and ethical expectations), procedures, laws and regulations; • safeguard the Group’s assets and interests from losses of all kinds, including fraud, irregularity or corruption; and • ensure the integrity and reliability of information, accounts and data, including • internal and external reporting and accountability processes.
In addition, Internal Audit should add value through:
• supporting and facilitating the identification of risks and the development of processes and procedures to assess and effectively respond to risks; • the identification and recommendation of potential process improvements; • the provision of advice to manage risks in developing systems, processes, projects, and procedures; and • encouraging best practice.
Responsibilities of Management Teams The collective responsibilities of the Chief Officers and Heads Of are to:
• Ensure consistent implementation of the RM Framework across the Group • Assess that suitable actions are taken to mitigate different levels of risk, including those raised by Internal Audit or other external sources of assurance • Ensure that controls are prioritised and that risk responses are proportionate • Include risk in the decision making process
The responsibilities of the Executive Team are to:
• Share learning, intelligence, experience and good practice across the organisation
10 RM FRAMEWORK • Analyse and prioritise risks requiring corporate action • Advise the Audit Committee on significant risk issues and their mitigation • Co-ordinate the quarterly risk report to the Audit Committee • Prepare the AGS • Championing risk within the Group • Oversee business continuity within the Group.
OUR RM APPROACH The eight components of our RM Framework are described below.
• Internal environment – The internal environment encompasses the tone of the Group, and sets the basis for how risk is viewed and addressed by the Group’s people, including risk management philosophy and appetite, integrity and ethical values, and the environment in which they operate. • Objective setting – Objectives must exist before our managers can identify potential events affecting their achievement. RM ensures that we have in place a process to set objectives and that the chosen objectives support and align the Group’s mission and are consistent with its risk appetite. • Event identification – Internal and external events that could potentially affect achievement of the Group’s objectives must be identified, distinguishing between risks and opportunities. • Risk assessment – Risks will be analysed, considering likelihood and impact, as a basis for determining how they should be managed. Risks are assessed on an inherent and residual basis. • Risk response – Our managers select risk responses (avoiding, accepting, reducing or sharing risk) developing a set of actions to align risks with the Group’s risk tolerances and risk appetite • Control activities – We will ensure that policies and procedures are established and implemented to help ensure the risk responses are effectively carried out by our managers • Information and communication – Relevant information is identified, captured and communicated in a form and timeframe that enables our people to carry out their responsibilities. • Monitoring – The RM process is monitored and modifications made as necessary. Monitoring is accomplished through governing body, Committee and management activities, separate evaluations and risk based auditing.
The RM cycle requires that there is clarity about what our corporate objectives are, and that an appropriate environment is in place to facilitate the effectiveness of RM. It is important to establish that everybody involved has a common understanding of what needs to be achieved, before risks are managed. Our ten step approach to managing risk is set out overleaf. This will be adopted throughout the Group.
11 RM FRAMEWORK
1) IDENTIFY RISKS 2) ASSIGN OWNERSHIP
4) SET “APPETITE” 3) RISK ANALYSIS
6) ASSESS 5) IDENTIFY RESIDUAL RISK CONTROLS
8) REPORT ON 7) IDENTIFY GAPS & RISKS ACTIONS
9) AUDIT & 10) REVIEW COMPLIANCE RESPONSES
12 RM FRAMEWORK
MANAGING RISK
STEP ACTIVITY
1) EVENT IDENTIFICATION – We will use workshops; interviews; incident reporting and other systems to identify risks IDENTIFYING RISKS All risks captured on the Group’s BAF and Risk Register should be categorised according to our Identify what are the critical risks to Strategic Objectives. The BAF and Risk Register must be produced in the approved Group achieving objectives. format.
2) EVENT IDENTIFICATION - All risks will be assigned an owner. OWNERSHIP The owner means the person who must understand, monitor and control the risk but does not Establish who is responsible for managing have to be the one that directly takes all actions to mitigate a particular risk. It is important that the risk the owner is involved in determining a risk score. Risk owners must have sufficient authority to take on responsibility for their risks
3) RISK ASSESSMENT - RISK ANALYSIS We will score the risks identified using the risk assessment set out in the risk measurement section. Measure the risks identified to determine a risk score This stage will rank risks in order of relative importance.
4) RISK ASSESSMENT – SET Our aim is not to remove all risk and it is necessary to recognise that some level of risk will “APPETITE” always exist. Risk appetite is the amount of risk that the Group is prepared to accept, tolerate, or be exposed to at any point in time. The level of risk we are prepared to accept to achieve our objective Our risk appetite can be expressed as a boundary, above which we will not tolerate the level of risk and further actions must be taken. The risk appetite is monitored by the inherent and residual risk assessment figures.
13 RM FRAMEWORK
MANAGING RISK
STEP ACTIVITY
Our risk appetite is not necessarily static. The governing body may vary the amount of risk which it is prepared to take depending on the circumstances.
5) RISK RESPONSE & CONTROL Consider and agree which risk response(s) are most appropriate: ACTIVITIES - IDENTIFY RESPONSES / • Terminate: stop the activity that is producing the risk CONTROLS • Treat: put in place a mitigating process • Tolerate: accept the risk because its impact and likelihood are low and/or other control Identify what controls are used / will be options are unacceptable (e.g. because of cost) used to mitigate the risk • Transfer: move the risk to another organisation (e.g. through insurance or outsourcing). • Take the risk which relates to taking opportunities rather than doing nothing.
It is important to quantify in financial terms the actual or estimated costs of implementing the responses wherever possible. Risk responses need to be proportionate to the risks involved.
6) RISK ASSESSMENT - ASSESS Score the risks again using the same risk assessment matrices. The ‘residual risk’ is the RESIDUAL RISK exposure arising from a specific risk after a risk mitigation procedure has been implemented to manage it and making the assumption that the control is working as expected.
7) RISK RESPONSE & CONTROL Where the residual risk has not reduced sufficiently to be within the Group’s risk appetite then a ACTIVITIES - IDENTIFY GAPS AND further response is required. These actions should be recorded on the BAF and Risk Register as ACTIONS a ‘Gap in Control’.
8) INFORMATION & COMMUNICATION - Formally report on risks together with controls to mitigate risks and an assessment of their REPORTING effectiveness. This can be done on a comprehensive basis (all risks), selective basis (only High risks), or categorical basis (strategic risks) depending on the requirements of the particular forum. The frequency of risk reporting to the different forum will be at agreed intervals.
14 RM FRAMEWORK
MANAGING RISK
STEP ACTIVITY
9) MONITORING - AUDIT CONTROLS & Assurance will be obtained to confirm that the residual risk assessment, based upon the controls RESPONSES/TEST COMPLIANCE in place, is reasonable. Assurance may be sought from management, internal audit, external audit or other sources as and when appropriate. The sources and results of assurance will be recorded within the BAF and Risk Register
10) MONITORING - REVIEW The Audit Committee will periodically review how effective the RM cycle and overall system of internal control has been overall.
Has the process added value? Has there been a positive outcome? What evidence exists to demonstrate this? How does this get communicated and to whom? Were the reporting processes appropriate and reports well received? What should be done differently next time?
They will advise the governing body on RM improvements, and the content of the AGS, taking into account the views of Internal Audit (the Head of Internal Audit Opinion) and other independent advisers as appropriate
15 RM FRAMEWORK
RISK MEASUREMENT It is essential that the same principles for measuring risks are used across all Group activities so that risks can be compared across functions in a consistent manner.
There are three important principles for assessing risks:
• ensure that there is a clear structure to the process so that both likelihood and impact are considered for each risk; • record the assessment of risk in a way which facilitates monitoring and the identification of risk priorities; • be clear about the difference between inherent and residual risk.
For each risk identified, an assessment should be made of the likelihood of it occurring and the relative impact on our work if it does. The more clearly risks are defined at the identification stage the more easily they can be assessed.
All risks should be scored in terms of their likelihood and potential impact using the following five point scale. The score for the likelihood and impact are multiplied to provide an overall risk assessment. More detail of how to assess likelihood and impact is contained in Appendix 2.
Likelihood Impact 5 Almost certain 5 Catastrophic 4 Likely 4 Major 3 Possible 3 Moderate 2 Unlikely 2 Minor 1 Rare 1 Insignificant
Each risk is assessed twice. Firstly the ‘inherent’ risk, which is the exposure arising from a specific risk in the absence of any actions management might take to alter either impact or likelihood. Secondly the ‘residual risk’ which is the exposure arising from a specific risk after action has been taken to alter the risk’s impact or likelihood.
RISK APPETITE
Our risk appetite can be expressed as a boundary, above which we will not accept the level of risk and further actions must be taken:
Impact Multiplier Catastrophic 5 5 10 15 20 25 Major 4 4 8 12 16 20 Moderate 3 3 6 9 12 15 Minor 2 2 4 6 8 10 Insignificant 1 1 2 3 4 5 Multiplier 1 2 3 4 5 Likelihood Rare Unlikely Possible Likely Almost certain
16 RM FRAMEWORK
Key RISK APPETITE Unacceptable level of risk exposure which requires 20-25 immediate corrective action to be taken Unacceptable level of risk exposure which requires 10-16 constant active monitoring, and measures to be put in place to reduce exposure Acceptable level of risk exposure subject to regular 5-9 active monitoring measures Acceptable level of risk exposure subject to regular 1-4 passive monitoring measures
The risk appetite is monitored by the inherent and residual risk assessment figures. Generally we will wish to manage closely all residual risks scoring 10 or over and would not want to be exposed to residual risks scoring over 16.
Our risk appetite is not necessarily static. The governing body may vary the amount of risk which it is prepared to take depending on the circumstances.
MONITORING ARRANGEMENTS The following monitoring arrangements will be applied, according to residual risk score
Risk score Monitoring by Frequency 1-4 Managers At least annually 5-9 Chief Officers/Heads Of Quarterly and their management teams 10-16 Clinical Executive At least quarterly
Committees Each meeting 20-25 Clinical Executive Quarterly or more frequent
Committees Each meeting
Governing Body Six monthly
DECISION MAKING (KEY DECISIONS, PROJECT DOCUMENTS, POLICY FRAMEWORK DOCUMENTS) There should be evidence to show that risks have been considered when making decisions. It is good practice to ensure that all reports to governing body, Committees and management meetings include an assessment of the risks related to the course of action being proposed. As such, all reports, Project Plans and Policy documents submitted to governing body and Committees must have a documented risk assessment that is summarised in the cover report.
17 RM FRAMEWORK
BOARD ASSURANCE FRAMEWORK The purpose of the Board Assurance Framework (BAF) document is to maintain information on the principal risks to the Group and the sources of assurance and results of these, which are in place to confirm that risk mitigation is adequate and operating effectively.
The Group will maintain a BAF in accordance with NHS guidelines, which requires the Group to have a BAF in place that:
• covers all of the organisation’s main objectives; • identifies which objectives and targets the organisation is striving to achieve; • identifies the risks to the achievements of objectives and targets; • identifies and examines the systems of internal control in place to manage the risks; • identifies and examines the review and assurance mechanisms which relate to the effectiveness of control; and • records the actions taken by the Board to address the control and assurance gaps.
The BAF will be structured as set out in Appendix 3.
RISK REGISTER The purpose of a Risk Register is to maintain information on all the identified risks relating to specific objectives.
A Corporate Risk Register will be maintained by the CFO which reports on the high level risks to the Group’s strategic objectives.
• The Risk Register will be structured as set out in Appendix 3
• The content of the Risk Register is subject to the Freedom of Information Act and any relevant exclusions within the legislation will apply to any disclosure.
• The Risk Register will be held electronically (rather than paper based).
• The Risk Register will be available on the Group’s Intranet on a Read Only basis to all staff. The CFO will determine which individual members of staff can add, amend and delete content from the Risk Registers.
INCIDENT REPORTING Incident Reporting is a fundamental element of the identification of risk and a key component of NHS governance. All staff are actively encouraged to report incidents. The main aim is to record and analyse the overall profile of incidents and near misses and identify hotspots and prioritise action in order to learn from these events within a supportive culture. All incidents should be recorded on an incident form and entered onto the Group’s database for analysis. The Group will report all patient safety incidents to the National Reporting and Learning System and staff must comply with policy on the reporting of Serious Incidents.
18 RM FRAMEWORK
COMMUNICATION AND RISK TRAINING The Risk Management Framework will be available to all staff, service users, the public and other stakeholders on the Group’s website. The Framework will also be communicated to all staff via management channels.
Effective implementation of the Strategy requires all staff to be aware of the Group’s approach to risk management and clear about their roles and responsibilities within the process.
Training events will be provided for all managers to give them the necessary skills to carry out their own risk assessments and to produce and maintain the Risk Register (including identification and implementation of risk controls). Governing body members will also be trained.
ANNUAL GOVERNANCE STATEMENT (AGS) All CCGs are required to produce an AGS that summarises the main systems and processes in place for risk management and internal control together with the findings of the annual review of effectiveness.
The scope of internal control spans all activities of the Group and is designed to ensure that the Group’s policies and decisions are put into practice; the organisation’s values are met; laws and regulations complied with; financial and other published information is accurate and reliable; and that human, financial and other resources are managed effectively and efficiently.
Chief Officers, Heads Of and their management teams are the main source of assurance about the organisation’s system of internal control. They are also accountable for disclosure of significant internal control issues within their span of control.
There is no standard definition of what constitutes a significant internal control issue that should be disclosed in the AGS. The Chartered Institute of Public Finance and Accountancy (CIPFA) suggest the following criteria should be used in making these judgements:
• The issue seriously prejudiced or prevented achievement of a strategic objective • The issue has resulted in a need to seek additional funds to allow it to be resolved, or has resulted in significant diversion of resources from another aspect of the business • The external auditor regards it as having a material impact on the accounts • The Audit Committee, or equivalent, advises it should be considered significant for this purpose • The Head of Internal Audit reports on it as significant in the annual opinion on the internal control environment • The issue, or its impact, has attracted significant public interest or has seriously damaged the reputation of the organisation
19 RM FRAMEWORK
APPENDIX 1 GLOSSARY OF RISK TERMINOLOGY
TERM DESCRIPTION
ASSURANCE An evaluated opinion, based on evidence gained from review, on the organisation’s governance, Risk Management and internal control framework
EXPOSURE The consequences (as a combination of impact and likelihood) which may be experienced by an organisation if a specific risk is realised
RISK RESPONSE or Any action taken to mitigate a risk CONTROL
INTERNAL CONTROL Systems in place to manage risk
RISK The possibility that an event will occur and adversely affect the achievement of objectives.
RISK ASSESSMENT The process of assessing the impact of a risk and the likelihood of its occurrence
RISK MANAGEMENT The process of mitigating risks to ensure that they are reduced to an acceptable level
RISK MITIGATION The action taken to reduce a risk through specific controls
RISK PROFILE The documented and prioritised overall assessment of the range of specific risks faced by the organisation
INHERENT (GROSS) RISK the exposure arising from a risk before any action has been taken to manage it
RISK RATING this is derived from the scoring mechanism and is designed to allow the organisation to prioritise its Risk Management activities
RESIDUAL (NET) RISK The exposure arising from a specific risk after action has been taken to manage it. Residual Risk should be lower than the inherent risk
ANNUAL GOVERNANCE This is an annual Statement that summarises the STATEMENT main systems and processes in place for Risk Management and internal control together with the findings of the annual review of their effectiveness.
20
APPENDIX 2 RISK ASSESSMENT SCORING METHODOLOGY
The risk evaluation matrix is a simple approach to quantifying risk by defining qualitative measures of impact (severity) and likelihood (frequency or probability) using a simple 1-5 rating system. This allows the construction of a risk matrix, which can be used as the basis of identifying risk. The risk score is Impact x Likelihood=Risk Score
Impact (Severity)
Impact score (severity levels) and examples of descriptors
Domains 1 Negligible 2 Minor 3 Moderate 4 Major 5 Catastrophic Impact on the Minimal injury Minor injury or Moderate injury Major injury leading to Incident leading to safety of requiring illness, requiring requiring professional long-term death patients, staff no/minimal minor intervention intervention incapacity/disability or public intervention or Multiple permanent (physical / treatment. Requiring time off Requiring time off Requiring time off injuries or irreversible psychological work for >3 days work for 4-14 days work for >14 days health effects harm) No time off work Increase in length of Increase in length of Increase in length of An event which hospital stay by 1-3 hospital stay by 4-15 hospital stay by >15 impacts on a large days days days number of patients
RIDDOR/agency Mismanagement of reportable incident patient care with long- term effects An event which impacts on a small number of patients Quality / Peripheral Overall treatment or Treatment or service Non-compliance with Totally unacceptable complaints / element of service suboptimal has significantly national standards level or quality of audit treatment or reduced effectiveness with significant risk to treatment/service service suboptimal Formal complaint patients if unresolved (stage 1) Formal complaint Gross failure of patient Informal (stage 2) complaint Multiple complaints/ safety if findings not complaint/inquiry Local resolution independent review acted on Local resolution (with Single failure to potential to go to Low performance Inquest/ombudsman meet internal independent review) rating inquiry standards Repeated failure to Critical report Gross failure to meet Minor implications meet internal national standards for patient safety if standards unresolved Major patient safety Reduced implications if findings performance rating if are not acted on unresolved Human Short-term low Low staffing level Late delivery of key Uncertain delivery of Non-delivery of key resources / staffing level that that reduces the objective/ service due key objective/service objective/service due organisational temporarily service quality to lack of staff due to lack of staff to lack of staff development / reduces service staffing / quality (< 1 day) Unsafe staffing level Unsafe staffing level Ongoing unsafe competence or competence (>1 or competence (>5 staffing levels or day) days) competence
Low staff morale Loss of key staff Loss of several key staff Poor staff attendance Very low staff morale for mandatory/key No staff attending training No staff attending mandatory training mandatory/ key /key training on an training ongoing basis Statutory duty/ No or minimal Breach of statutory Single breach in Enforcement action Multiple breaches in inspections impact or breech legislation statutory duty statutory duty and of guidance/ Multiple breaches in prosecution statutory duty Reduced Challenging external statutory duty performance rating if recommendations/ Complete systems unresolved improvement notice Improvement notices change required
Low performance Zero performance rating rating
Critical report Severely critical report 21
Impact score (severity levels) and examples of descriptors
Domains 1 Negligible 2 Minor 3 Moderate 4 Major 5 Catastrophic Adverse Rumours Local media Local media coverage National media National media publicity / coverage – – coverage with <3 days coverage with >3 days reputation Potential for public short-term reduction long-term reduction in service well below service well below concern in public confidence public confidence reasonable public reasonable public expectation expectation. MP Elements of public concerned (questions expectation not in the House) being met Total loss of public confidence Business Insignificant cost <5 per cent over 5–10 per cent over Non-compliance with Incident leading >25 objectives/ increase/ schedule project budget project budget national 10–25 per per cent over project projects slippage cent over project budget Schedule slippage Schedule slippage budget Schedule slippage Schedule slippage Key objectives not met Key objectives not met Finance Small loss Risk of Loss of 0.1–0.25 per Loss of 0.25–0.5 per Uncertain delivery of Non-delivery of key including claim remote cent of budget cent of budget key objective/Loss of objective/ Loss of >1 claims 0.5–1.0 per cent of per cent of budget Claim less than Claim(s) between budget £10,000 £10,000 and £100,000 Failure to meet Claim(s) between specification/ slippage £100,000 and £1 million Loss of contract / payment by results Purchasers failing to pay on time Claim(s) >£1 million Service / Loss/interruption Loss/interruption of Loss/interruption of >1 Loss/interruption of >1 Permanent loss of business of >1 hour >8 hours day week service or facility interruption Environmental Minimal or no Minor impact on Moderate impact on Major impact on Catastrophic impact impact impact on the environment environment environment on environment environment
Likelihood (frequency or probability)
Likelihood 1 2 3 4 5 score Descriptor Rare Unlikely Possible Likely Almost certain Frequency Do not expect it to This will probably Will probably Will undoubtedly How often might happen/recur but it Might happen or recur never happen/recur but it is happen/recur, possibly it / does it is possible it may do occasionally happen/recur not a persisting issue frequently happen so Probability Will it happen or <0.1 per cent 0.1–1 per cent 1–10 per cent 10–50 per cent >50 per cent not?
Risk Score (Impact x Likelihood)
Likelihood Consequence 1 Rare 2 Unlikely 3 Possible 4 Likely 5 Almost certain
1 Negligible 1 2 3 4 5
2 Minor 2 4 6 8 10
3 Moderate 3 6 9 12 15
4 Major 4 8 12 16 20
5 Catastrophic 5 10 15 20 25
22
APPENDIX 3 BAF AND RISK REGISTER FORMAT
[See attached example]
23
DUDLEY CLINICAL COMMISSIONING GROUP BOARD
Date of Report: 2nd May 203 Report: Black Country Cluster Board Assurance Framework Agenda item No: 11.4
TITLE OF REPORT: Black Country Cluster Board Assurance Framework
To inform the Board of the CCG’s response to the transfer of risk from PURPOSE OF REPORT: the Black Country Cluster to the CCG.
AUTHOR OF REPORT: Mr M Hartland, Chief Finance Officer
MANAGEMENT LEAD: Mr M Hartland, Chief Finance Officer
CLINICAL LEAD: Dr D Hegarty, CCG Chair
• Four risks transferred to all CCGs in the Black Country. KEY POINTS: • Not all appropriate for transfer in current form. • All accepted risks assigned to a CCG Committee.
The Board is asked to accept the 4 risks and the recommendations RECOMMENDATION: quoted throughout the report.
FINANCIAL IMPLICATIONS: None
WHAT ENGAGEMENT HAS None TAKEN PLACE:
Decision ACTION REQUIRED: Approval Assurance
1 | Page
DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 2ND MAY 2013 BLACK COUNTRY CLUSTER BOARD ASSURANCE FRAMEWORK
1. INTRODUCTION The Black Country Cluster Board developed and managed a Board Assurance Framework (BAF) for the four PCTs. This has been transferred to receiver bodies, including Dudley CCG. Due diligence on the document has taken place over the last month. There are four risks that have been assigned to CCGs within the BAF, these are:-
• Failure to control demand • Failure to agree a robust delivery plan with provider services • Failure to tackle health inequalities • Lack of focus and resources to implement the QIPP schemes.
2. CCG RESPONSE The CCG’s response to the transferring risks is:-
2.1 Failure to control demand – there is an ongoing risk to the CCG that contracts with providers will over perform. It is not thought that this risk increases following the transfer of commissioning responsibility to the CCG, but systems are not yet embedded to assure the Board that the risk can be removed. Recommendation - accept the risk and assign to Finance and Performance Committee.
2.2 Failure to agree a robust delivery plan with providers – this risk was on the Cluster Risk Register as a consequence of issues across the Black Country, but it remains a risk in Dudley due to scope and content of service improvement plans in contracts with providers. Recommendation – accept the risk and assign to Clinical Development Committee.
2.3 Failure to tackle health inequalities – this risk is as pertinent in Dudley as it is across the Black Country and although the Strategic Plan identifies the CCG’s plans to reduce inequalities, the risk as stated exists. Recommendation – accept the risk and assign to the Clinical Development Committee.
2.4 Lack of focus and resources to implement QIPP schemes – the delivery of QIPP in Dudley CCG is key to its success both from a Local Area Team assurance perspective and to provide resource to facilitate service change. Finance and Performance Committee on 18th April recommended QIPP delivery to be added to the CCG risk register due to the current levels of assurance relating to the achievement of the target. The Black Country view of lack of resources and focus is not accepted however in Dudley. Recommendation – not to accept the risk in its current form as quoted above, but replace with a new risk regarding the delivery of QIPP financial targets and assign to Clinical Development Committee.
3. RECOMMENDATION The Board is asked to accept the 4 risks and the recommendations quoted throughout the report.
4. APPENDIX Extract from the Black Country Board Assurance Framework.
M Hartland Chief Finance Officer April 2013
2 | Page
Black Country Cluster Board Assurance Framework 2012/13
Principle Risks
Accountab Accountability Initial Risk Residual Risk ility Owner Sponsor Score L x C Key Controls Gaps in Control Gaps in Assurance Score Management Assurance Actions Destination Principle Objective 2: 2.1 Failure to control demand S Cartwright 3.89 x 4.33= New QOF Cluster Gaining consensus through None as performance reports 3 x 4 = 12 Performance reports and Updated Jan 2012 as All CCGs 16.84 urgent/emergency care strategy. clinical senate on policy and should show each economy actions will be to Board performance reports agreeing commissioning group performance through performance show progress. Score Policy for procedure of LCV. configuration reports reduced from Amber Intensive support is being given to to Green. Needs to be the E/D at SWBH to improve quality monitored. Score of care, performance against increased back to indicators has not fallen. Amber
2.2 Failure to agree a robust A Williams 3.44 x 4.44 = Contracts with Providers and None None 3 x 4 = 12 QIPP plans agreed and No change Jan 2012 All CCGs delivery plan with provider 15.27 delegated plans to CCG's reflected in contracts and services delegation to CCG's. 2.3 Failure to tackle Health Adrian Phillips 3.75 x 4.00 = Improvement in major social policy Current economic climate and Investment plans not 4X4=16 Health improvement All CCGs Inequalities 15.00 areas of marmot- eg early years, other failures of government commensurate with levels iof strategies and public young people's employment, investment in the marmot areas health ineqaulity; data collection investment programmes reduign inequalities in income, and health inequality impact improving working conditons, assessment long measures environments, improving health promotion by risk reduction across social gradients
2.5 Lack of focus and J Green 3.11 x 4.33 = A substantial proportion of the QIPP None None 2 x 2 = 4 Performance is being Updated Dec 2011, All CCGs resources to implement the 13.47 schemes have been included within reported through finance score reduced QIPP scheme signed contracts, therefore external reports. Currently on target stakeholders are committed to to overachieve by 10% delivery targets.
DUDLEY CLINICAL COMMISSIONING GROUP BOARD
Date of Report: 2nd May 203 Report: Risk Register Agenda item No: 11.5
TITLE OF REPORT: CCG Risk Register
PURPOSE OF REPORT: To inform the Board of the CCG Risk Register.
AUTHOR OF REPORT: Mr M Hartland, Chief Finance Officer
MANAGEMENT LEAD: Mr M Hartland, Chief Finance Officer
CLINICAL LEAD: Dr D Hegarty, CCG Chair
• Committee led assurance process implemented. KEY POINTS: • Full register brought to Board for assurance. • Red risks only to be reported to the Board in future.
RECOMMENDATION: The Board is asked to note the report for assurance.
FINANCIAL IMPLICATIONS: None
WHAT ENGAGEMENT HAS None TAKEN PLACE:
Decision ACTION REQUIRED: Approval Assurance
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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 2ND MAY 2013 RISK REGISTER
1. INTRODUCTION The CCG has developed a revised process for risk management, whereby Committees are responsible for the management of relevant pertinent risks.
The Board will receive in future red risks only. For assurance this paper includes the full risk register for review.
2. RISK REGISTER The attached risk register includes risk up to 22nd April 2013. There are no residual red risks, but Committees will be required to ensure action plans are progressed to reduce risks to these target levels.
3. RECOMMENDATION The Board is asked to note the report for assurance.
4. APPENDICES Risk Register.
M Hartland Chief Finance Officer April 2013
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11.5.1 Dudley risk register_22_April_2013 amended.xlsx MASTER RR
ID Original Date Revised Date Risk Description Controls Initial risk Actions Target Risk Residual risk Review date Owner Management Lead CCG committee - risk P I Score P I Score P I Score owner 21 15/12/2005 22/04/2013 Children not receiving their routine childhood There is a waiting list group which meets 4 4 16 22/04/2013- Vaccines. Action plan to be constructed for consideration at committee. Reduce 1 4 4 2 4 8 01/06/2013 Pauline MacDonald Alison Tennant Primary Care vaccines at the scheduled times resulting in regularly. The group is chaired by Sue Cooper and residual score to 2x4 = 8 amber Development Committee potential increased morbidity. members include CH manager, NCCD, PBC 04/03/13 - Waiting list w/c 11/3/2013 is 163 children waiting for appts after all available clinic spaces Manager (unsure of new title), and contracts staff. have been filled. Waiting list produced by CH staff. A database Dr Wong (Green's) & Dr Yarwood-Smith (Cradley Road) have >20 children waiting. Dr Barhay maintained by PH Intelligence team, waiting list (Wordsley Green), Dr Cartwright (Central Clinic), Dr Price (The Limes) & Dr Shah (Thorn's Road) all report produced last year and will be produced at have >10 children waiting. For many years there has been a Child Imms Waiting List Group (hosted by the end of this year. Primary Care Commissioning) which met to consider waiting lists and took action to contact Practices New waiting list report is part of the Child Health with large lists, ensure they provided more appts, and provided support to ensure waiting lists did Data Warehouse Project but this is currently ‘on not develop. Changes due to NHS Reforms (staff moving / leaving on MARS) has meant that the hold’ due to slippage of other critical reports. group has not met since before August 2012. Concerns remain about capacity on the Primary Care Commissioning team to reestablish the group.In the group's absence, Dudley Primary Care commissioning colleagues have been asked to contact Practices with large waiting lists as and when they occur. Concern remains that previous progress to reduce the waiting list (from four-figures) will be lost. Achieving <100 waiting per week has proved elusive. Numbers are likely to increase without continued performance management. Current owner of risk leaves the commissioning organisation on 31 March 2013. 12/2012 - Waiting list w/c 10/12/2012 158 children (after all available clinic spaces filled), five Practices >10 children waiting. 10/2012 - Waiting list w/c 22/10/2012 108 children (after all available clinic spaces filled).
41 26/09/2011 01/04/2012 Risks to women and neonates as a result of Monitoring via Clinical Quality Review Meetings 4 4 16 Recommendation made and accepted by BC Cluster Board that any GP practice located within a 16 1 4 4 1 4 Jun-13 01/06/2013 Nighat Hussain Alison Tennant Clinical Development increased volume of patients which has led to (DPCT/DGFT). Monitoring of SIs (DPCT/DGFT). minute travel time from City Hospital would not be able to book patients at Russell Hall Hospital. Committee inadequate staffing levels at certain times with Action plans to address capacity issues in triage New cap agreed for 13/14 through contracting round which allows for sufficient staffing for demand. particular issues around specialist medical staffing (DGFT). Maternity services review across the Black and capacity issues in triage area. Country.
46 03/02/2011 22/04/2013 The Emis Web product does not currently have a Ensure no further Implementations of Emis Web 4 4 16 22/04/2013 - Being considered at IT strategy group. Evidence sought. To remain amber 1 4 4 3 4 12 01/06/2013 Paresh Patel Matt Hartland Primary Care working Application Interface (AI) that is essential to GP Surgeries is authorised until Emis have As of 15/04/13 - There is no change to this risk Development Committee for Numerous products to function as designed, provided a working AI that has been tested and As of 27/02/13 - Solution still being piloted at Worcester St, progressing well. Still awaiting final which might prevent effective clinical practice. signed off. confirmation of successful bi directional data transfer. Risk rating can be reduced. (Changed rating from 5,4 =20 to 3,4 =12)
As of 26/11/12 - Emis will be piloting a solution over the next few weeks and Worcester St Surgery are one of the pilot sites.
Awaiting EMIS solution. No Firm indications from Emis when a solution will be provided.
47 23/02/2012 11/03/2013 The lack of resource to effectively deliver and Incident reporting policy, organisational 4 3 12 Contract agreed with CSU which includes SI reporting, quality reviewing and summary level reports 2 3 6 2 3 6 01/06/2013 Becky Bartholomew Becky Bartholomew Quality & Safety manage a functioning incident reporting system is awareness of access to governance team and ad for Board. Committee preventing the organisation meeting mandatory hoc methods of raising concerns. requirements and best practice in quality measurement.
49 23/02/2012 11/03/2013 The lack of structures in place to provide Now requested for inclusion of reporting to 3 4 12 Medicines management now reported on quarterly to CQRM. 2 3 6 2 3 6 01/06/2013 Alison Tennant Becky Bartholomew Quality & Safety assurance over provider implementation of clinical CQRM, medicines management team awareness. Committee audit and effectiveness might adversely impact commissioner reputation. 50 23/02/2012 11/03/2013 The lack of resilience to support core governance Cross skilling in the team (limited due to reduced 3 4 12 Contract agreed with CSU which includes SI reporting, complaints management and summary level 2 4 8 2 3 6 01/06/2013 Becky Bartholomew Becky Bartholomew Quality & Safety responsibilities such as SI and complaints numbers) and collaborative working (including reports for Board. Committee management might result in failure to meet leave requests) across team. mandatory timescales for response and investigation. 51 23/02/2012 11/03/2013 The delayed development of an effective CSS Cluster and CCG quality leads meeting regularly, 4 4 16 CSU offer agreed. Systems being tested. 1 4 4 2 4 8 01/06/2013 Becky Bartholomew Becky Bartholomew Quality & Safety structure will reduce the level of assurance over Cluster Lead input to CCG Board though lacking Committee quality to the CCG. systems to underpin the work.
55 01/11/2005 01/04/2012 Some stroke patients in whom it is appropriate 4 4 16 BCCN are planning an urgent robust external audit of stroke performance reporting across the 1 4 4 2 4 8 01/06/2013 Alison Tennant Becky Bartholomew Quality & Safety and clinically indicated to scan may not receive a network. Committee CT scan within 24 hours of admission. This potentially results in a delay in diagnosis, and DGFT has discussed stroke care at board level and business cases are imminent for additional stroke therefore treatment, and could result in a poorer physician time and CT scanner in A&E. outcome for the patient. 04/12/12: DGFT has introduced the agreed fast track pathway to identify patients most likely to benefit from thrombolysis, starting the assessment in the ambulance and then, if appropriate, directing paramedics straight to the CT scanner door for immediate clinical assessment by a clinician competent to initiate thrombolysis. Then, if appropriateness confirmed, direct access to the CT scanner and when thrombolysis criteria met, initiating thrombolysis in the CT scan room. The aim is to reduce door-to-needle times to less than 30 minutes. Russells Hall Hospital currently provides this service 12 hours a day and aims to provide access for 24 hours from January 2013. Access to this pathway is via the Bleep Stroke nurse 7557.
1 of 4 26/04/2013 11.5.1 Dudley risk register_22_April_2013 amended.xlsx MASTER RR
56 04/05/2011 26/02/2013 Mandatory Training. Cluster approach to mandatory training owned by 3 4 12 Modules now agreed at Cluster. CCG has added safeguarding. Modules being delivered. 2 3 6 2 3 6 01/06/2013 Alice Copage Matt Hartland Quality & Safety HR and H&S team to ensure compliance for Committee Mandatory training modules.
58 08/05/2012 22/04/2013 CCG allocation for 2013/14 does not meet existing Financial constraint in 2012/13 using invest to 3 4 12 22/04/2013 - Negotiations with LAT on risk sharing progressing. Remain amber 1 4 4 3 4 12 01/06/2013 Matt Hartland Matt Hartland Finance & Performance delegated budgets from the PCT upon which save principles on all new investments, holding 05/03/13 - Allocation received, in line with expectation but a further risk is now apparent regarding Committee financial plans are built. contingency reserve and financial prudence. specialised services allocation impact.
08/05/12 - MH challenging the Department of Health, ensuring they are aware of current financial plans, commitments and potential impact of allocation shortfall. Confirmation of allocation to be confirmed in December 2012. 60 21/04/2012 26/02/2013 Safeguarding - the delivery of effective Liaison referral process streamlined, and risk 4 4 16 26/3/13: The BCPFT have now in place a Safeguarding Children Service lead to manage the 2 4 8 1 4 4 01/06/2013 Pauline Owens Becky Bartholomew Quality & Safety safeguarding systems by commissioned services is managed, senior manager appointed (BCPFT). safeguarding and LAC service. The BCPFT did submit a business case to the commissioners, but it did Committee potentially limited by: 1) increase in safeguarding not contain sufficient data/information to evidence the need for additional resources within the caseload and looked after children activity; 2) safeguarding team. Business case resubmitted by BCPFT with additional data and evidence. The CCG changes in processes across provider; 3) frontline has provided additional resources to the team 1 WTE Nurse and 1WTE band 3 admin support to the workload reducing CPA support to team. team.
61 21/04/2012 11/03/2013 The failure to deliver the health component of the Continued engagement with BCPFT to identify 4 4 16 Evidence from each organisation being presented at health forum in April 2013 for peer review. 2 4 8 3 4 12 01/06/2013 Becky Bartholomew Becky Bartholomew Quality & Safety Ofsted action plan will be regarded by partner opportunities to improve capacity and meetings Committee agencies as a failure of engagement across with Local Authority to discuss concerns. commissioning and adversely impact the CCG reputation. 64 09/07/2012 09/07/2012 The failure of the Acute Trust to share their E-mail assurance received from Acute Trust this 4 5 20 DGFT has shared top line CIP information. Process now in place to share information with CCG in a 1 5 5 3 4 12 01/06/2013 Liz Pope Becky Bartholomew Quality & Safety Quality Impact Assessment ahead of service work has been completed. systematic manner which will allow proper scrutiny. Committee redesign might prevent adequate commissioner Medical Director escalated to Cluster. scrutiny and result in a reduction in quality of service to patients. 65 25/09/2012 25/09/2012 Clinicians have informed PCT that when patients Specialist oversight. 5 3 15 Letter to all GPs, pharmacists, community staff. Advise use lower strength first, then change to 1 3 3 1 3 3 01/06/2013 Duncan Jenkins Alison Tennant Quality & Safety need high doses, cannot be achieved with lower higher. Avoid both strengths in use at same time. Practice declaration re communication and policy Committee strength due to large volume required. review. Advice to be printed on authorisation charts. GP education session delivered November 2012. 66 14/03/2013 14/03/2013 Community Dermatology Service provided by DGFT asked to continue to provide. If unable, 5 3 15 provider is continuing service using current arrangements and recruiting GPwSI to cover sessions in 1 3 3 1 3 3 01/06/2013 Alison Tennant Alison Tennant Clinical Development DGFT may cease with effect from 1 April 2013. service will have to be tendered. Service will have the future. Recommended for closure Committee This would result in the practices of KAB and SWL to be suspended whilst tender occurs. locality groups of having no access to a community service. It would result in patients having to be referred into the Acute Trust. The referring practices will incur additional commissioning costs as a result of increased acute referral and this will detrimentally affect their commissioning performance. It would create an inequity with other locality groups who do have access to community services. There is no impact on patient quality or safety.
67 12/04/2013 Current reorganisation of Health Visiting Service Monthly performance review meeting with Trust, 4 4 16 Meeting scheduled to take place with BCPNHSFT on 29/4/13 to review mechanism for allocating 1 3 3 4 3 12 01/06/2013 Linda Cropper Neill Bucktin Clinical Development could result in breakdown in continuity of care to GPs escalating concerns through locality meetings caselodas to individual health visitors, in order to ensure that this does not affect continuity of care Committee patients due to process used to allocate HV and GP Lead, direct performance review with the and appropriate links are in place with GP practices caseloads and consequent risks to safeguarding provider children 68 22/04/2013 LIFTCo Directorship should provide early insight 4 3 12 Liason with NHS Property Services, Local Area Team and Community Health Partnerships 1 3 3 4 3 12 Jun-13 Matt Hartland Matt Hartland Primary care Premises development - uncertainty regarding development committee process for new premises developments following closure of PCT could have impact on development of primary care,especially in deprived areas of the borough. 69 22/04/2013 Group to be established as lever to raise and 4 4 16 To agree Terms of Reference for Group, understanding CCG responsibilities 1 4 4 3 4 12 01/06/2013 Alison Tennant Alison Tennant Primary care GP Performer group not estalished, and definition discuss legitimate concerns development committee of responsiities between CCG and LAT unclear 70 22/04/2013 PMO process and challenge established 4 4 16 Detailed plans for be agreed asap. Organisational leads for projects in process of reviewing current 1 4 4 3 4 12 01/06/2013 Alison Tennant Alison Tennant Clinical development QIPP delivery - lack of detailed action plans to plans and agreeing new ones. Action plans will be in place by 10/5/13 committee achieve QIPP target.
2 of 4 26/04/2013 ID Original Date Revised Date Risk Description Controls Initial risk Actions Target Risk Residual risk Review date Owner Management Lead CCG committee and P I Score P I Score P I Score date closed 47 23/02/2012 11/03/2013 The lack of resource to effectively deliver and Incident reporting policy, organisational 4 3 12 Contract agreed with CSU which includes SI reporting, quality reviewing and summary level reports 2 3 6 2 3 6 03/02/2013 Alison Tennant Quality & Safety manage a functioning incident reporting system is awareness of access to governance team and ad for Board. Committee preventing the organisation meeting mandatory hoc methods of raising concerns. requirements and best practice in quality 16/04/2013 measurement. Becky Bartholomew 50 23/02/2012 11/03/2013 The lack of resilience to support core governance Cross skilling in the team (limited due to reduced 3 4 12 Contract agreed with CSU which includes SI reporting, complaints management and summary level 2 4 8 2 3 6 06/03/2013 Alison Tennant Quality & Safety responsibilities such as SI and complaints numbers) and collaborative working (including reports for Board. Committee management might result in failure to meet leave requests) across team. mandatory timescales for response and 16/04/2013 investigation. Becky Bartholomew 55 01/11/2005 01/04/2012 Some stroke patients in whom it is appropriate 4 4 16 BCCN are planning an urgent robust external audit of stroke performance reporting across the 1 4 4 2 4 8 08/01/2013 Nighat Hussain Quality & Safety and clinically indicated to scan may not receive a network. Committee CT scan within 24 hours of admission. This potentially results in a delay in diagnosis, and DGFT has discussed stroke care at board level and business cases are imminent for additional stroke 16/04/2013 therefore treatment, and could result in a poorer physician time and CT scanner in A&E. outcome for the patient. 04/12/12: DGFT has introduced the agreed fast track pathway to identify patients most likely to benefit from thrombolysis, starting the assessment in the ambulance and then, if appropriate, directing paramedics straight to the CT scanner door for immediate clinical assessment by a clinician competent to initiate thrombolysis. Then, if appropriateness confirmed, direct access to the CT scanner and when thrombolysis criteria met, initiating thrombolysis in the CT scan room. The aim is to reduce door-to-needle times to less than 30 minutes. Russells Hall Hospital currently provides this service 12 hours a day and aims to provide access for 24 hours from January 2013. Access to this pathway is via the Bleep Stroke nurse 7557. Becky Bartholomew 64 09/07/2012 09/07/2012 The failure of the Acute Trust to share their E-mail assurance received from Acute Trust this 4 5 20 DGFT has shared top line CIP information. Process now in place to share information with CCG in a 1 5 5 3 4 12 26/03/2013 Liz Pope Quality & Safety Quality Impact Assessment ahead of service work has been completed. systematic manner which will allow proper scrutiny. Committee redesign might prevent adequate commissioner Medical Director escalated to Cluster. scrutiny and result in a reduction in quality of 16/04/2013 service to patients. Becky Bartholomew A risk is an event which, should it occur, will lead to a negative outcome that compromises the ability to achieve an objective. Likelihood Almost Certain Rare = 1 Unlikely = 2 Possible = 3 Likely = 4 = 5 Negligible = 1 IL 2L 3L 4M 5M Minor = 2 2L 4M 6M 8H 10H Moderate = 3 3L 6M 9H 12H 15E Major = 4 4L 8H 12H 16E 20E
Consequence Catastrophic = 5 5L 10H 15E 20E 25E
1. A Risk Score is calculated by multiplying the "Likelihood" of the risk occurring by the "Consequence" of its impact should it materialise. 2. Post mitigation risks of 12H or more should be escalated to the Corporate Risk Register. 3. Post mitigation risks of 10H or less should be managed at a local level.
DUDLEY CLINICAL COMMISSIONING GROUP BOARD
Date of Report: 2nd May 203 Report: Finance and Performance Committee Report Agenda item No: 12.1
TITLE OF REPORT: Finance and Performance Committee Report
To advise the Board on key issues discussed at the Finance and PURPOSE OF REPORT: th Performance Committee on 18 April 2013
AUTHOR OF REPORT: Mr M Hartland, Chief Finance Officer
MANAGEMENT LEAD: Mr M Hartland, Chief Finance Officer
CLINICAL LEAD: Dr J Rathore, Clinical Executive for Finance and Performance
• Financial targets for 2012/13 all expected to be achieved. • New risk raised for QIPP delivery. KEY POINTS: • Predicted Quality Premium 2013/14 achievement discussed • Performance indicators and action plans reviewed for items not achieving required targets.
RECOMMENDATION: The Board is asked to note the report for assurance.
FINANCIAL IMPLICATIONS: None
WHAT ENGAGEMENT HAS None TAKEN PLACE:
Decision ACTION REQUIRED: Approval Assurance
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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 2ND MAY 2013 FINANCE AND PERFORMANCE COMMITTEE REPORT
1. INTRODUCTION This report summarises the key issues discussed at the Finance and Performance Committee on 18th April 2013.
The following items are indicators of the current position in relation to the main responsibilities and obligations of the Committee as defined by the CCG Constitution and Terms of Reference. The indicators and report separates finance and performance issues. They both relate to the 2012/13 financial year, but will report for 2013/14 in future reports.
2. KEY INDICATOR SUMMARY – FINANCE
Key Indicator Plan To date Variance RAG 1 Annual Budget 393,742 2 Allocation variations since last month 0 3a Acute and Community 253,527 258,167 (4,640) 3b Partnerships 70,763 68,389 2,373 3c Primary Care 56,518 53,458 3,059 3d Corporate Services 7,708 5,645 2,063 3e Reserves 5,228 2,525 2,702 3f Total Revenue Resource Limit 393,742 388,185 5,557 4 Capital Resource Limit 200 0 200 5 Running Costs 7,708 5,645 2,063 6 Cash Limit (PCT) 525,815 523,019 2,796 7 Balance Sheet 8 Better Payment Practice Code – NHS 90% 92.40%
9 Better Payment Practice Code – non-NHS 90% 93.45% 10 QIPP 5,661 5,795 134 11 Workforce 12 Activity A&E 66,587 66,583 4 Day Cases and Electives 32,764 34,940 (2,177) Emergency and Non-Electives 27,983 32,424 (3,441) Assessment Unit Discharged Home 3,755 4,519 (763) Outpatient First 88,502 91,663 (3,161) Outpatient Follow up 243,810 250,364 (6,555) Outpatient Procedures 35,072 36,728 (1,656) Total 498,473 516,221 (17,749) 13 Localities
3. ITEMS DISCUSSED – FINANCE
3.1 Revenue Resource Limit The CCG is currently forecast to achieve a surplus on its revenue resource limit of £5,557,191, meeting its control total of £5,557,000. The position by workstream is outlined in the key indicator summary, with acute and community the only workstream overspending in 2012/13.
3.2 Capital Resource Limit The CCG has a capital resource of £200,000. There has been no spend to date with no further expenditure expected resulting in an underspend against its capital allocation. This was a proactive decision due to the migration of GP systems to a preferred provider.
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3.3 Running Costs As described in section 3d, the CCG is forecast to underspend against its indicative running cost allowance in 2012/13.
3.4 Cash Limit The CCG is expected to achieve its cash target for the year, but returned £2,752,000 to the Department of Health in March. The cash surplus was because of the volume of creditors at the year-end, due in part to SBS payment processes and NHS payment timeframes.
3.5 Better Payment Practice Code – NHS and Non-NHS The CCG is required to pay 90% of trade creditors within 30 days. As at March the CCG’s cumulative performance for both NHS and non-NHS creditors met the targets at 92.4% and 93.45% respectively.
3.6 QIPP The QIPP target for 2012/13 is £5.661m and the project performance reports for February have confirmed that the target is forecast to overachieve by £0.134m at £5.795m. The target for 2013/14 is £5.3m and a full analysis of delivery plans is to be presented to the next Committee.
The Clinical Development Committee is responsible for the delivery of the QIPP agenda; however the Finance and Performance Committee will monitor and provide assurance to the Board on the financial requirements of the service change model.
3.7 Activity Dudley Group Foundation Trust (DGFT) reported an overperformance of 3.5% against the activity plan at February 2013. The variance is largely due to outpatient activity where the planned level of QIPP savings for 2012/13 has not been achieved. Day case activity is over-performing by 6.6% due to over-performances within Gastroenterology, Clinical Haematology, Urology and Medical Oncology. Emergency activity is reporting an overperformance with a significant proportion relating to an increase in Paediatric Emergency activity.
3.8 Localities Whilst localities do not have formal delegated budgets, it is proposed to report the indicative financial performance to the Committee. This will commence with effect from April 2013 activity.
3.9 Risks As we are in the last month of the financial year, there were no risks reported to the Committee that would materially impact on the achievement of the CCG’s control total. Risks do remain, however, to the achievement of 2013/14 financial plans. These are:-
• Specialised Services. The Local Area Team (LAT) has agreed to repatriate funding where a misappropriation of activity is proved to have occurred. A risk sharing proposal has been agreed in principle, but the detail is yet to be agreed. The resultant impact is unknown at this stage.
• 2% Non-recurrent Reserve. Financial plans assume full return of the non-recurrent reserve. The LAT has indicated that this will occur, but formal notification has not been received.
• QIPP. The programme at its current level must be delivered. It may also need to increase dependent on the mitigation of the risks above.
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4. KEY INDICATOR SUMMARY PERFORMANCE
Note Grey cells denote unavailable data at this time GP Scorecard figures are for January 2013
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5. ITEMS DISCUSSED – PERFORMANCE The Committee discussion can be categorised as follows.
5.1 Performance Indicators The Committee discussed the performance of NHS Dudley against national and Strategic Health Authority performance measures. At this point in the year the CCG is under-performing in the following areas:-
Improved Access to Psychological Therapies - at the end of quarter three the percentage of people who have depression and/or anxiety disorders who received psychological therapies was 3.5%, but still below the target of 3.8%. The current performance against this key performance indicator has been reviewed and found to be affected by resourcing issues within the service. As a resolution for current reduced rate of patients, posts have been advertised to ensure full service establishment and activity.
Patients waiting 6 weeks and over for Diagnostic tests (year to date) - in January performance for NHS Dudley was 2.8% of patients waiting 6 weeks and over for a diagnostic test against a target of 1% or lower. February figures demonstrate 0.2% of patients exceeding the 6 week target which meets the national target. Year to date the performance is 1.5%. NHS Dudley will not achieve this target for the year. The recent issues with staffing levels for echocardiography have now been resolved.
A&E quality indicators – in October DGFT achieved two of the A&E clinical quality indicators - 3.3% unplanned re-attendance rate against a target of <5% and 3% left the department without being seen against a target of <5%
The following indicator targets were not achieved:-
• 95.9% patients assessed within 15 minutes of arrival by ambulance (target 95%) and Median time to treatment 60 minutes (target 60 minutes) • 5.8% unplanned re-attendance rate against a target of 5% • 2% of patients leaving before being seen against a target of 5%.
Maternity Health Checks - Maternity Health Checks - at quarter three the percentage of women who had completed a health and social risk assessment by 12 completed weeks of pregnancy was 71.4% compared to a target of 90%. Year to date the performance is 77%. The PCT has been allocated money by the Department of Health to investigate and develop measures to improve early booking rates. The aim of the project is to understand the medical and socio-demographic profiles of late bookers, as well as their views and reasons for late access to antenatal care.
There were two items the Finance and Performance Committee required further interrogation of issues at the Quality and Safety Committee, namely MRSA screening (for non-electives) and the reporting of serious incidents.
5.2 Mortality Indicators The latest Summary Hospital Mortality Index (SHMI) figures were published in January 2013 on the NHS Information Centre website. The data period covered is July 2011 to June 2012. DGFT registered a value of 1.0363. Since this value is above 1, this is technically above the expected value. However, this value is within that which can be ascribed to natural variance; therefore DGFT are classed as having a mortality rate that is within the expected range.
5.3 Quality Premium The Committee received a report on the predicted outcome of the achievement of the national domains in the Quality Premium. There is a differential in the predicted outcomes, but none are achieving 100%. In relation to the overall quality premium, information collected to date would
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suggest that achieving the Quality Premium requirements for the national goals will prove the most challenging and therefore present the greatest risk to achievement.
6. DECISIONS TAKEN BY THE COMMITTEE UNDER DELEGATED POWERS FROM BOARD The addition of risks to the Risk Register. Full detail of QIPP savings plans to be presented to next Committee
7. DECISIONS REFERRED TO BOARD None.
8. RECOMMENDATION The Board is asked to note the report for assurance.
M Hartland Chief Finance Officer April 2013
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DUDLEY CLINICAL COMMISSIONING GROUP BOARD
Date of Report: 2nd May 203 Report: Primary Care Development Committee Report Agenda item No: 13.1
TITLE OF REPORT: Primary Care Development Committee Report
To advise the Board on key issues discussed at the Primary Care PURPOSE OF REPORT: th Development Committee on 19 April 2013.
AUTHOR OF REPORT: Mr M Hartland, Chief Finance Officer
MANAGEMENT LEAD: Mr M Hartland, Chief Finance Officer
CLINICAL LEAD: Dr J Rathore, Clinical Executive for Finance and Performance
• Primary care IT and information strategies on target for completion by 13 July. KEY POINTS: • Process for agreeing premises developments are unclear. • Enhancement to primary care development programme agreed. • New risks identified.
The Board is asked to note, for assurance, the issues discussed at the RECOMMENDATION: Primary Care Development Committee on 19th April 2013 and approve the recommendations to the Board.
FINANCIAL IMPLICATIONS: None
WHAT ENGAGEMENT HAS None TAKEN PLACE:
Decision ACTION REQUIRED: Approval Assurance
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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 2ND MAY 2013 PRIMARY CARE DEVELOPMENT COMMITTEE REPORT
1. INTRODUCTION This report summarises the key issues discussed at the Primary Care Development Committee on 19th April 2013.
The following items are indicators of the current position in relation to the main responsibilities and obligations of the Committee as defined by the CCG Constitution and Terms of Reference. As the Primary Care Development Committee is a development committee, not an assurance committee, the indicators relate to strategic issues rather than performance metrics.
2. KEY INDICATOR SUMMARY
Key Indicator Summary Process On target for Agreed Completion
1. Production of Primary Care Strategy.
2. Production of an IT and Information Strategy.
3. Premises development.
3. ITEMS DISCUSSED The Committee was not quorate; therefore all decisions made by the Committee are to be referred to the Board for ratification.
3.1 Primary Care Strategy The Strategy is developing well and will be presented to Board on 4th July following further consultation at the CCG Members’ event on 14th May.
3.2 Primary Care Foundation The programme led by the Primary Care Foundation is complete with 100% compliance from member practices. Relevant outcomes will be used to inform the Primary Care Strategy.
3.3 IT and Information Strategy The framework for the Strategy has been agreed and semi-structured interviews will be conducted over the next few weeks with key personnel to inform the strategy. First draft is expected in July.
GP systems – the migration of practices from iSOFT to EMIS Web is progressing and will be completed according to plan. The offer to all members to migrate to EMIS Web has been made and plans are currently being constructed.
Emails – a programme to migrate GP practices to the Dudleyccg domain is being constructed and practices have been identified as pilots prior to roll-out to all.
Capital Refresh Programme – the roll out programme is being finalised and will be distributed shortly.
3.4 Premises Development
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The Committee expressed concern regarding the uncertainty relating to processes for premises developments following the closure of the PCT and the impact this could have on current schemes, particularly as some are in the most deprived areas of the Borough. Whilst the CCG is not responsible for premises development, the Committee agreed that the CCG needs to be in a position to influence NHS England, NHS Property Services and Community Health Partnerships; therefore priorities for both primary care and commissioned estate should be prepared.
3.5 Enhanced Services The process for the administration and payment of Directed and Local Enhanced Services was discussed and this will change following the closure of the PCT. Practices will receive correspondence from both NHS England Local Area Team and the CCG to clarify processes both short and long term.
Specifications for the new DES and Minor Surgery are to be distributed shortly by NHS England. Due to the delay in the issue of the Minor Surgery DES specification, the Committee agreed, subject to Board approval, the continuation of the Minor Surgery LES at its current level of remuneration.
A discussion occurred regarding services to be included in the “basket of services”, led by recent suggestions for Depot Injections to be undertaken in general practice. It was agreed that the review of this LES, due to be completed by the end of May would include this and other relevant procedures.
3.6 Primary Care Development Programme There are various strands to this programme and the following recommendations to the Board were made:-
• The EVTS programme to be renamed “Dudley GPwSI Development Programme”. The appointment of two GPwSI with a specialism in Commissioning/Engagement and Neurology to commence. • Practice nurse mentor vacancy to be appointed. • Practice Manager Mentorship scheme to be reviewed. • Additional GP mentor to be appointed. • Primary care training and education budget process to be managed by the Practice Managers’ Alliance.
3.7 Quality and Productivity Indicators There is no change to the national specification for indicators for 2013/14, therefore similar documentation will be utilised. The process for agreeing three clinical care pathways was agreed and will be confirmed to practices.
3.8 Business Cycle It was agreed the business cycle for the Committee needs to be presented to the next meeting.
3.9 Risks There are two risks currently assigned to this Committee:-
• Children not receiving routine childhood vaccinations – agreed to reduce from red to amber following improvement in uptake. • Operability of application interface in EMIS Web – it is understood that this is now connected, but the risk will remain as amber until evidenced.
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Two new risks were raised:-
• The process for premises development as described previously. • Delays in the establishment and operation of the GP Performers’ Group, a joint meeting of NHS England and the CCG to consider issues relating to primary care practitioners.
3.10 Primary Care Metrics The Committee agreed that at future meetings they will be presented with relevant metrics and scorecard information that will assist the development of primary care. Where relevant they will appear in the key indicator summary above.
4. DECISIONS TAKEN BY THE COMMITTEE UNDER DELEGATED POWERS FROM BOARD None; the Committee was not quorate.
5. DECISIONS REFERRED TO BOARD 5.1 Continuation of Minor Surgery LES at current level until DES specification continued by NHS England. 5.2 Recommendations relating to primary care development programme are agreed. 5.3 Change in risk rating of childhood immunisations and adoption of new risks. 5.4 Agreement of process for Quality and Productivity (QP) indicators.
6. RECOMMENDATION The Board is asked to note the issues discussed at the Primary Care Development Committee on 19th April 2013 and approve the recommendations to the Board.
M Hartland Chief Finance Officer April 2013
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GLOSSARY
ABBREVIATIONS
Abbreviation Meaning #NOF Fractured Neck of Femur £K £1,000 equivalent A&E Accident and Emergency ABC / ABCD Above and Beyond the Call of Duty (Local surveys which include praise for nominated staff members as well as assessment of services) ACRA Advisory Committee on Resource Allocation ACS Acute Coronary Syndrome AD Assistant Director AfC Agenda for Change AHSN Academic Health Science Networks ALE Auditors Local Evaluation ALOS Average Length of Stay (in hospital) AMI Acute Myocardial Infarction AMMC Area Medicines Management Committee AMPDS Anti-D An antibody occurring in pregnancy Anti-TNF Drugs used in the treatment of rheumatoid arthritis and Crohn’s disease ARIF Aggressive Research Intelligence Facility ASAP As soon as possible AVE Advertising Value equivalent BACs Bank Automated Credit BCC Black Country Cluster BCG Bacillus Calmette-Guerin BCUCG Black Country Urgent Care Group BFT Behavioural Family Therapy BLCCB Black Country Local Collaborative Commissioning Board
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BME Black Minority Ethnic BMJ British Medical Journal BPAS British Pregnancy Advisory Board BSCCP British Society of Colposcopy and Cervical Pathology CAB Citizens Advise Bureau CABG Coronary Artery Bypass Graft CAMHS Children and Adolescent Mental Health Service CASH Contraception and Sexual Health CAT Change Agent Team CBSA Commissioning Business Support Agency CCBT (CBT) Computerised Cognitive Behavioural Therapy CCF Capable Care Forum CCG Clinical Commissioning Group CCRN Comprehensive Clinical Research Networks CQI Continuous Quality Improvement CEO Chief Executive Officer CHADD The Churches Housing Association of Dudley & District Ltd CHD Coronary Heart Disease CIS Community Investment Strategy CMO Chief Medical Officer CMS CNST Clinical Negligence Scheme for Trusts CNT Community Nursing Team CONNECT Mental Health information website for staff COSHH Control of Substances Hazardous to Health Regulations 2002 CPA Care Programme Approach CPN Community Psychiatric Nurse CRL Capital Resource Limit CSSD Central Sterile Services Department CT scan Computer Topography CQUIN Commissioning for Quality and Innovation CQRM CVD Cardio Vascular Disease CWAS Coventry and Warwickshire Audit Services
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DACHS Directorate of Adult Children and Housing Services DCS Dudley Community Services DCVS Dudley Community Voluntary Service DES Directed Enhanced Service DfES Department for Education and Skills DGoH Dudley Group of Hospitals DNA Did not attend DoH Department of Health DoS Directory of Service DTC Diagnostic and Treatment Centre DXA Dual X-ray Absorptiometry (measures bone density). E&D Equality and Diversity EAU Emergency Assessment Unit EBME Electro Bio-Mechanical Engineer ECA Extra Care Area ECM Every Child Matters ECT Electroconvulsive Therapy ED Emergency Department EI Early Implementer EI Early Intervention EMI Older People with Mental Illness (Elderly Mentally Ill) EPP Expert Patients Programme EPR Electronic Patient Record ERMA Emergency Response & Management Arrangements ERT Enzyme Replacement Therapy ESR Electronic Staff Record FCEs Finished Consultant Episodes FED Forum for Education and Development FHS Family Health Services FIP Computerised data collection facility used by community health teams. FMC Facility Management Centre FOI Freedom of Information FYE Full Year Effect GMS General Medical Services
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GOWM Government Office for the West Midlands GP General Practitioner GPAQ General Practice Assessment of Quality GPwSI GPs with Special Interest GU Genito-urinary GUM Genito-urinary Medicine HCAI Health Care Acquired infection HENIG Health Economy NICE Implementation Group HF Heart Failure HIC Health Improvement Centre HIV Human Immunodeficiency Virus HPA Health Protection Agency HPS/S Health Promoting Schools / Service HPU Health Protection Unit HR Human Resources HSC Health and Safety Commission HSCQC Health and Social Care Quality Centre HSE Health and Safety Executive HSMR HT Home Treatment HV Health Visitor IAPT Improved Access to Psychological Therapies IC Infection Control ICAS Independent Complaints Advocacy Service ICNA Infection Control Nurses Association ICP Integrated Care Pathway ICSM Interim Customer Services Manager IFR Individual Funding Request IG Information Governance IOSH Institute of Occupational Safety and Health IT Information Technology IUCD Intrauterine Contraceptive Device JCAB Joint Clinical Advisory Board JCC Joint Consultative Committee
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JD Job Description JE Job Evaluators JM Job Matching KLOE Key lines of enquiry KSF Knowledge and Skills Framework LAA Local Area Agreement LAC Looked After Children LBC Liquid Based Cytology LD Learning Disability LDP Local Delivery Plan LEA Local Education Authority LIFT Local Improvement Finance Trust LIG Local Implementation Group LIT Local Implementation Team LMC Local Medical Committee LNG Local Negotiating Committee LPS Local Pharmaceutical Scheme LRF Local Resilience Forum LTC Long Term Conditions LVD Left Ventricular Dysfunction LVSD Left Ventricular Systolic Dysfunction MAPA Management of Actual and Potential Aggression MAU Medical Assessment Unit MBC Metropolitan Borough Council MDT Multi Disciplinary Team MIMT Major Incident Management Team MIRE Major Incident Response Executive MLSOs Medical Laboratory Scientific Officers MRSA Methicillin Resistant Staphylococcus Aureus MSS Medium Secure Service NCA Non contract activity NCB National Commissioning Board NCRS National Care Record System NELHI National Electronic Library for Health Information
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NICE National Institute for Clinical Excellence NGMS New General Medical Services NHS National Health Service NHSCPT NHS Community Practice Teacher NHSCSP NHS Cancer Screening Programme NHSLA NHS Litigation Authority NHSP National Healthy Schools Programme NICE National Institute for Clinical Excellence NOF New Opportunities Fund NPfIT National Programme for IT NPSA National Patient Safety Agency NRF Neighbourhood Renewal Fund NRLS National Reporting and Learning System NRT Nicotine Replacement Products NSF National Service Framework OAT Out of Area Treatment OBD Occupied Bed Day OD Organisational Development ODM Oesophageal Doppler Monitoring OOH Out of Hours OSC Overview and Scrutiny Committee OT Occupational Therapist PALS Patient Advice and Liaison Service PAF Positive Assurance Framework PAS Patient Administration System PAU Paediatric Assessment Unit PbR Payment by Results PC Personal Computer PCDB Primary Care Delivery Board PCDC Primary Care Development Committee PCT Primary Care Trust PDF Portable Document Format PDP Personal Development Plan PDS Personal Dental Services
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PDSA Plan, Do, Study, Act PDU Professional Development Unit PE Pulmonary Embolism PEAK Database holding the main registered details of patients and associated referral, contact, caseload, outpatient, inpatient, MH Act and clinic information. PEAT Patient Environment Action Team PEC Professional Executive Committee PEPP Pooled Budget External Placement Panel PFI Private Finance Initiative PICU Psychiatric Intensive Care Unit PID Project Initiation Document PIN Personal Identification Number PMLD Profound and Multiple Learning Difficulties PMS Primary Medical Services PPA Prescription Pricing Authority PPIF Patient and Public Involvement Forum PSA Public Service Agreement PSHE Personal and Social Health Education PTCA Percutaneous Transluminary Coronary Angioplasty Q&A Questions and Answers QA Quality Assurance QIPP Quality, Innovation, Productivity and Prevention QMAS Quality Management and Analysis System QOF Quality and Outcome Framework QPDT Quality and Practice Development Teams RACPC Rapid Access Chest Pain Clinic RAS Respiratory Assessment Service RCA Root Cause Analysis RES Race Equality Scheme RHH Russells Hall Hospital RIDDOR Reporting of Injuries, Diseases and Dangerous Occurrences Regulations RMO Responsible Medical Officer RRL Revenue Resource Limit RSL Register Social Landlords
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RTT Referral to Treatment Target SAP Single Assessment Process SEPIA Mental health computer system SFBH Standards for Better Health SFI Standing Financial Instructions SHA / StHA Strategic Health Authority SHMI SIC Statement of Internal Control SLA Service Level Agreement SRE Sex and Relationship Education SSD Social Services Department SSDP Strategic Services Development Plan STI Sexually Transmitted Disease STRW Support, Time & Recovery Worker TB Tuberculosis THUNDERBURDS The High User Number Delivering Early Referrals By Urgent Right Direction System TIA Transient Ischaemic Attack TP Teenage Pregnancy TPT Teenage Pregnancy Team UHBT University Hospital Birmingham Trust Vaccs & Imms Vaccinations and Immunisations WAN Wide Area Network WCC World Class Commissioning WIC Walk in Centre WMAS West Midlands Ambulance Service WMHTAC West Midlands Health Technology Advisory Committee WMSCG West Midlands Strategic Commissioning Group WMSSA West Midlands Specialised Services Agency WTE Whole Time Equivalent
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Black Country Cluster Handover Document
March 2013 Black Country Cluster Legacy Document March 2013
Useful contact details Organisation Contact details Phone/email/internet site Birmingham, Black Country and Solihull Area Team 0121 695 2222 Dudley CCG 01384 321763 http://www.dudleyccg.nhs.uk/ Sandwell and West Birmingham CCG 0121 612 2839 https://www.sandwellandwestbhamccg.nhs.uk/ Walsall CCG 01922 618388 http://www.walsallccg.nhs.uk/about/ Wolverhampton City CCG 01902 444888 http://www.wolvescityccg.nhs.uk/ Dudley MBC 0300 555 2345 http://www.dudley.gov.uk/ Sandwell MBC 0845 358 2200 http://www.sandwell.gov.uk/ Walsall MBC 01922 650000 https://www.walsall.gov.uk/ Wolverhampton City Council 01902 551155 http://www.wolverhampton.gov.uk/ Birmingham Cross City CCG 0121 255 0536 https://www.bhamcrosscityccg.nhs.uk/ Birmingham South Central CCG 0121 255 0795 https://www.bhamsouthcentralccg.nhs.uk/ Solihull CCG https://www.solihullccg.nhs.uk/ Birmingham City Council http://www.birmingham.gov.uk/ Solihull Council 0121 704 6000 http://www.solihull.gov.uk/
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Contents 1. Introduction ...... 4 2. Description of Patch ...... 5 3. Information on all Services provided to the Local Population ...... 6 3.1. Primary Care ...... 6 3.2. Acute Hospital and Community Services ...... 7 3.3. Mental Health and Learning Disabilities ...... 8 3.4. Tertiary Services ...... 8 3.5. Other Providers ...... 8 4. Quality ...... 9 4.1. Context ...... 9 5. Workforce ...... 10 6. Summary of Key Planned Changes ...... 11 7. Organisational assets and liabilities ...... 11 8. Stakeholder Map ...... 11 9. Governance ...... 13 9.1. Cluster Board ...... 13 9.2. Programme Management Approach ...... 13 9.3. Risk ...... 14 10. Views of Care Quality Commission ...... 14 11. Performance ...... 14 12. Financial Information ...... 15 13. Provider Capacity ...... 20 13.1. Introduction ...... 20 13.2. Provider Challenges ...... 21 13.3. Primary Care Provider Development ...... 22 13.4. Acute and Community Care ...... 23 13.5. Mental health and learning disabilities services ...... 23 13.6. Social care and health services ...... 23 13.7. Patients and the public, other stakeholders and local politicians ...... 23 13.8. Activity Changes ...... 24 13.9. Headline implications for Providers ...... 25 13.10. Financial Challenge to Providers ...... 25 13.11. Challenge to Black Country Cluster ...... 25 13.12. Workforce performance ...... 25 14. Appendix 1 ...... 27
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1. Introduction
The National Quality Board (NQB) has published a document1 that sets out the requirements for existing organisations to maintain and improve quality during the transition.
The Black Country Cluster was formally established on 1 December 2011 and brought together, under a single senior management structure, four Primary Care Trusts (PCT) – Dudley, Sandwell, Walsall and Wolverhampton City.
The Cluster has two main roles:
• Securing resilience, leadership and continuing delivery: • To ensure that its constituent PCTs have the management capacity in 2011-12 and 2012-13 to remain focused on priorities for planning, developing and delivering safe, high quality healthcare services for local people, and to provide leadership for the staff who have to deliver this vital work
Each Cluster is required to produce a legacy document that captures the knowledge that has been accumulated through managerial and clinical interactions over the years to handover to the new organisations.
This Legacy Document has been prepared for the Cluster the purpose of which is to:
• Retain a ‘log’ of organisational memory as the NHS undergoes major structural changes to how it is organised and managed. • Enhance the robustness of handover arrangements. • Capture and transfer organisational memory and information. • Ensure quality and safety is not put at risk during structural change.
This legacy document is intended to be organic and will be updated at regular intervals until March 2013 when the PCTs are legally abolished. It is intended that the document is updated as follows:
• 1st review March 2012 • 2nd review September 2012 • 3rd review March 2013
Another principle is that the legacy document will be ‘live’ until the final handover when PCTs are abolished.
It is acknowledged that there is a distinction to be made between legacy documents and documents that will need to be archived in compliance with the Department of Health (DH) Records Management: Code of Practice2 . This will be relevant as members of staff leave up until the PCTs are abolished. Guidance has been circulated to all staff to ensure consistency in judgements on whether documents are for the legacy, need to be archived or can be destroyed. Consideration to Freedom of Information, Data Protection Act and Common Law of Confidentiality will help inform the guidance.
1 NQB, Maintaining and improving quality during the transition: safety, effectiveness, experience, 2011 2 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4131747 Page 4 of 62
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The maintenance of the Black Country Legacy document has been the responsibility of the Transition Committee.
2. Description of Patch The Black Country Cluster was formally established on 1 December 2011 and brought together, under a single senior management structure, four PCTs – Dudley, Sandwell, Walsall and Wolverhampton City.
The Cluster serves a population of more than 1 million people and controls an annual healthcare commissioning budget of around £2 billion.
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Digital Mapping Solutions from Dotted Eyes (C) Crown Copyright and/or database right 2009. All rights reserved. License number 100019918
Further information on Health Inequalities can be found in PCTs’ JSNA, Public Health Annual Report and supporting legacy documents. These are available through the relevant Local Authority website or by contacting the Public Health departments in each of the Local Authority areas.
The Black Country Cluster consists of the following Clinical Commissioning Groups (CCG):
• Dudley Clinical Commissioning Group • NHS Walsall Commissioning Group • Wolverhampton Clinical Commissioning Group • Sandwell and West Birmingham Clinical Commissioning Group (covering part of Birmingham)
3. Information on all Services provided to the Local Population 3.1. Primary Care
The following table details the numbers of each primary care contractor in each of the PCT areas:
Dudley Sandwell Walsall Wolverhampton
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GPs 52 63 67 53 Dentists 45 44 30 38 Optometrists 49 49 31 62 Pharmacies 70 76 69 66
Further information can be obtained from each local Clinical Commissioning Group (for GPs) or the Area Team (for the other contractors). 3.2. Acute Hospital and Community Services
The main providers of acute and community services for the Black Country Cluster are:
• The Dudley Group Foundation NHS Trust • Royal Wolverhampton Hospitals NHS Trust • Walsall Healthcare NHS Trust • Sandwell and West Birmingham • University Hospital Birmingham • Black Country Partnership Foundation Trust (Children’s Services Dudley)
The Dudley Royal Walsall Sandwell Group Wolverhampton Healthcare and West Foundation Hospitals NHS NHS Trust Birmingham NHS Trust Trust NHS Trust
No of Beds 700 700 518 1,000
Workforce 4,810 inc 7428 inc Bank 4129 bank 6,283 5782.43 WTE 3386 WTE 4,110 ex bank £154,048,828 £153,737,64 Contract £223,156,141 (Sandwell £211,516,566 1 inc Value PCT) CQUIN £415 m 12 month Contract Ends 2013 Ends 2013 rolling Length contract
CQC Full Full Full Full Registration
NHSLA Level 1 Level 2 Level 1 Level 2 Level Financial £153,000,88 Outturn £176,474,500 £386,961,00 5 2010/11
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3.3. Mental Health and Learning Disabilities The main providers of Mental Health and Learning Disability Services are:
• Dudley and Walsall Mental Health Partnership NHS Trust • Black Country Partnership Foundation NHS Trust
Dudley and Walsall Black Country Mental Health Partnership NHS Partnership NHS Trust Foundation Trust
Workforce 1025 WTE 1200 +
Contract £701,000 Dudley £26,835,351 Value
Contract Dudley ends 2012 Length
CQC Full Full Registration
NHSLA Level 1 Level Financial
Outturn £52,2 m Dudley £27,418,351 2010/11
In the future, most services will be commissioned by the local Clinical Commissioning Group. Services such as GUM will be commissioned by the local public health department and services such as screening will be commissioned by the Area Team. 3.4. Specialised Services Specialist services tend to be high in cost and low volume. Due to this they are often only provided in specialist centres to a population of more than one million people. The transfer scheme for Birmingham East and North PCT holds details of each of the specialised contracts. Further details can be obtained from the Area Team.
3.5. Other Providers The quality of care homes across Black Country Cluster is diverse, as are the measures in place to monitor and improve quality outcomes. All four localities are in the process of, or have already developed mechanisms in partnership with local authorities to oversee quality standards. A range of ten quality outcomes have been agreed with health and local authority leads which support a range of outcomes to define quality in care homes across the Black Country. The implementation of outcomes and the understanding of how user and carer experience impacts care home quality is of paramount importance to the CCGs in the Black Country.
Significant work has been undertaken in raising the standards of quality in nursing homes in Walsall through the implementation of a contract monitoring quality framework. Analysis has supported a 5 Page 8 of 62
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per cent reduction in category 3 and 4 pressure ulcers over a 12 month period for nursing homes through implementation of the framework.
One of the main areas of action post Winterbourne was the mandate to CQC to visit 150 services across England with a similar client profile as Winterbourne. To date a range of care homes with this client profile have been reviewed by CQC across BCC. Where concerns are raised PCTs are developing proposals for improvement with the relevant provider and local authority, these will be monitored closely to ensure compliance against the standards is carried through.
In addition regular information sharing meetings between health, local authority and CQC regional leads are held across the patch, enabling a joint intelligence forum to share concerns and issues regarding the quality of care provision in care homes.
Further information about the quality of care in Nursing Homes is within the Quality Handover Document.
4. Quality
4.1. Context The Inquiry into Mid Staffordshire NHS Foundation trust identified that whilst there was adequate handover in relation to finance, quality was not given as much priority when there was an organisational change.
Over the past two years the Black Country Cluster has had to face some of the greatest challenges in the history of the NHS. Despite its relatively strong financial position rising demand, demographic changes and costs of new drugs and technologies mean that each of the four constituent CCGs within the Cluster will have to deliver high levels of efficiency savings if the cluster as a whole is to improve the quality of the comprehensive care available to patients within the area.
The Cluster Board recognised that quality is a systemic issue where success or failure will be determined by a complex set of interactions between individuals and organisations during a time of turbulence. Quality remains the Board’s guiding principle and acts as the glue that binds all the constituent organisations, existing, emerging and new-together.
In considering how the Cluster Board maintains and improves quality during this period of substantial change, this summary draws on the National Quality Board ‘Maintaining and improving quality during the transition: safety, effectiveness, experience- Part One’ to guide the development of this agenda.
The Cluster Board sees the Quality and Safety Committee, supported by the developed Black Country Clinical Senate and local Quality and Safety Committees as crucial to developing and taking forward the Quality Agenda.
Further detail in relation to quality can be found in the Quality Handover document for the Black Country Cluster. This is available through each CCG and the Area team.
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5. Workforce Since 1 October 2012, the receiver organisations have been managing the workforce who have been successful in obtaining permanent positions. Information in relation to the key performance indicators can be obtained from the successor bodies.
The Cluster has however, between October and March 2013 instigated a MARS (mutually Agreed Resignation Scheme) and Voluntary Redundancy scheme (VR). At the end of March 2013 a significant number of staff will be made compulsorily redundant.
The figures for the staff movement as at February 2013 are as follows:
Birmingha Heart of South Solihul Wolverhampto Walsal Dudle Sandwel Tota m East & Birmingha Birmingha l PCT n PCT l PCT y PCT l PCT l North PCT m PCT m PCT Birmingham Community Health Care (Estates) 30 3 0 0 0 0 0 0 33
BILCS 0 5 0 0 0 0 0 0 5 Clinical Commissionin g Groups 53 29 47 45 45 48 55 58 380 Commissionin g Support Unit 77 69 77 26 34 20 85 55 443 Mediquip (Equipment Loans) 24 0 0 0 0 0 0 0 24 Local Authority 19 27 9 12 22 21 100 50 260 National Commissionin g Board - LAT 91 24 23 5 26 28 22 23 242 Public Health England 5 5 2 1 0 1 0 4 18
RETS 3 0 0 0 0 0 0 2 5 NHS Property Services 64 25 2 23 36 5 32 11 198 160 Total 366 187 160 112 163 123 294 203 8
Workforce reductions Birmingha Heart of South Solihul Wolverhampto Walsal Dudle Sandwel Tota m East & Birmingha Birmingha l PCT n PCT l PCT y PCT l PCT l North PCT m PCT m PCT
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Compulsor y Redundanc y 31/03/13 20 35 8 11 10 13 12 29 138 Voluntary Redundanc y 31/01/13 12 10 9 3 1 4 3 7 49 MARS 19/10/12 52 32 22 11 43 18 33 49 260 Left/Leavin g via other routes 25 18 16 12 9 52 5 2 139 Total 109 95 55 37 63 87 53 87 586
Please note – this is a snapshot at the end of February 2013. Numbers are constantly changing.
6. Summary of Key Planned Changes The Cluster published the System Plan in 2012. The CCGs have taken the elements of this pertinent to their local area and developed their Integrated Plans, which are available from each CCG. These plans indicate the proposed system changes.
7. Organisational assets and liabilities Each PCT has two transfer schemes, one covering assets and liabilities including property and one covering staff. These are available from each successor body (the staff transfer scheme is confidential).
8. Stakeholder Map
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Police Private NPSA Services Healthcare Providers CQC Monitor
Care/Nursing LINks Homes
Clinical Commissioning Trade Unions Groups
Employees National Quality Board
Black Patient Groups/Forums Audit Commission (inc BME Groups) Country Cluster
Health Service Mental Health Providers Ombudsman
Educational Specialist Providers Establishments
Charity and Local Authorities Voluntary Sector
Strategic Legal advisors/ Health Authority NHSLA Department of Primary Acute Health Care Providers Providers
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9. Governance
9.1. Cluster Board On the 01 October 2012, the Area Team Director took responsibility as accountable officer for the PCTs. As such, governance arrangements to support this change were reviewed and revised a structure implemented as below.
Black Country Cluster Board Birmingham and Solihull Cluster Board
Joint Primary Care Transitional Quality and Finance and Audit Committee Remuneration Committee Committee Safety Committee Performance Committee Joint JNCC Committee
Black To fulfil the BSol To include: Country statutory PH transfer responsibility of CSU staff transfer the PEC PCT closedown Quality and safety NCB transfer across the two Separate monthly PropCo clusters meetings Monthly Monthly meetings Chaired by Steve Cartwright (has to be clinical chair Commissioning due to PEC Support Unit requirements) Board
CCGs x7
Health and Safety: 7x local quality Collaborative 7x local F&P Currently just a Black Lead officers for Committees: and safety Commissioning committees Country Committee Audit – Director of Finance committees Network Proposed to leave as is Remuneration – Wendy Saviour
with Head of Estates Primary Care – Karen Helliwell/Steve Cartwright providing senior level Transitional – Les Williams support into the Q&S – Steve Cartwright committee F&P – Director of Finance/Les Williams CSU – N/A JNCC – Les Williams/Staffside
9.2. Programme Management Approach The Cluster used the centrally co-ordinated PMO to identify and share best practice, retain effective management oversight and accountability for the QIPP Programme and ensure a common performance and delivery framework for the Cluster. In practice, this was delivered through each locality and each PCT/CCG PMO.
In terms of the more detailed functions of the PMO, capability to provide assurance for the following specific management functions of the Cluster was facilitated by the PMO:
• Document Configuration: Maintaining QIPP project documents (plans, Programme/Project Reports); • Plan monitoring: through assurance, challenge and support, monitoring of QIPP Programme Costs and net deliverable savings
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• Communications Management: Supporting Stakeholder Engagement/Communications • Quality Monitoring: Maintaining a programme Knowledge Base (best practice hub) • Workforce Re-configuration: Monitoring of Governance structures • Reporting: SHA and Cluster requirements (internal/External) • Risk and Issue Management: Maintaining Corporate/QIPP initiative Risk/Issue Registers • Benefits Realisation: Maintenance of benefits realisation and dependency networks
The PMO functions are based on the principles outlined in the PRINCE2 project management and Managing Successful Programmes (MSP) methodologies through a series of planned stages which are already underway.
9.3. Risk The Black Country Cluster has continued to identify, mitigate and manage risks across the health system throughout 2012/13. This has ensured that appropriate actions are in place to help health organisations to move to the new arrangements for April 2013, while maintaining financial control and service performance, with a focus on continuing to improve the quality and safety of services for patients. The following processes are currently in place within the Black Country Cluster: • Board Assurance Framework
• Transformation Board Risk Log
The Board Assurance Framework was stood down in February 2013 by the Audit Committee and the high level risks transferred to the successor bodies as part of the handover process. The risk register for the transition became the BAF, monitored by the Transition Committee. The risk register and the final BAF can be found in appendix 1.
The overarching risks can be found in the Annual Report 2012/13 for each PCT within the Annual Governance Statement. This is due to be published in June 2013.
10. Views of Care Quality Commission These are available within the Quality Handover Document.
11. Performance Appendix 2 shows the latest performance for the Integrated Performance Measures from the Operating Framework for 2012/13 for NHS Dudley; Sandwell PCT; NHS Walsall and Wolverhampton City PCT.
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12. Financial Information
12.1 FINANCIAL PERFORMANCE
12.1.1 Income & Expenditure Summary – Achieving Financial Balance To date the Cluster has generated a revenue surplus of £24.9m in the seven months to December 2012. This is ahead of trajectory, with the full year forecast being a £31.6m planned surplus in line with the revised control total. Collectively the Cluster is forecast to deliver the control total, however as reported in month 7, there has been an amendment between the individual PCT targets for Sandwell & Dudley, whereby the Dudley PCT target has increased by £1m and the Sandwell surplus target reduced by £1m. This was been agreed with the StHA.
NHS Trust performance information has been received for the first eight months of the financial year. However, recent months have yet to be validated and is therefore subject to change. Walsall PCT is reporting a year to date variance against Foundation Trusts of £1.3m and Dudley, Wolverhampton City and Sandwell PCT are all reporting over performance on key contracts of £3m, £4.5m and £7.3m respectively. Performance of local Trusts is analysed in section 2.2.1).
The Cluster has received the September Prescribing performance data relating to the current financial year, and in conjunction with local financial modelling (which takes into account trends over the previous three financial years) it is forecast to underspend. This has been validated against the Prescription Pricing Authorities (PPA) own forecast released within the latest report (which in some cases is greater than the PCT internal modelling).
The Cluster has a QIPP target of £102m for the 2012/13 financial year, the majority of which having been built into contractual arrangements (split across price efficiency and individual schemes). QIPP performance monitoring therefore forms a component of the ongoing contract management regime. Financial monitoring information provided to the StHA in December reported the forecast outturn position expects the target to be achieved.
Table 1 below shows the summary Cluster financial performance for the period April to December 2012/13.
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YTD Forecast Table 1 : Cluster Summary Financial Annual YTD YTD Surplus / Surplus / position Budget Budget Spend (Deficit) (Deficit) £'000 £'000 £'000 £'000 £'000 Summary financial performance 2012/13 Commissioning Healthcare 1,457,045 1,013,369 1,024,643 (11,274) (17,340) Primary Care 292,362 195,773 193,887 1,886 2,287 Prescribing 203,816 142,066 133,886 8,180 9,854 Management & Other 146,828 95,964 92,451 3,512 4,642 Contingencies 12,520 4,150 17 4,167 6,549 Planned Surplus 25,587 17,361 12 17,349 25,587 Overall Total 2,138,158 1,468,683 1,444,863 23,819 31,579
Control total (as agreed with StHA) 31,579 Variance from StHA Control Total 0
The majority of the YTD surplus has arisen against the Planned Surplus line, however there are other lines which are reporting minor variances. In order to offset the contract over performance, £4.2m of the contingency budgets have been factored into the YTD position.
Financial performance has also been analysed by PCT, and this is shown in summary in Table 2 below.
YTD Forecast Table 2 : Summary Financial position by Annual YTD YTD Surplus / Surplus / PCT Budget Budget Spend (Deficit) (Deficit) £'000 £'000 £'000 £'000 £'000 Summary financial performance 2012/13
Dudley 537,389 392,819 388,189 4,630 5,992 Wolverhampton 498,377 369,726 357,201 12,525 16,808 Walsall 492,356 360,876 358,815 2,061 2,113
Sandwell 613,475 448,565 442,858 5,706 6,666 Overall Total 2,141,597 1,571,986 1,547,063 24,922 31,579
Control total (as agreed with StHA) 31,579
Variance from StHA Control Total 0
Table 3 (below) shows the breakdown of the financial position across legacy organisations.
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YTD Forecast Table 3 : Summary Financial position by Annual YTD Surplus / Surplus / Legacy Organisation Budget Budget YTD Spend (Deficit) (Deficit) £'000 £'000 £'000 £'000 £'000 Clinical Commissioning Groups (CCGs) Dudley CCG 393,804 286,896 283,152 3,744 4,718 Wolverhampton City Consortium 361,227 269,583 257,409 12,175 17,587 Walsall CCG 359,208 267,440 264,981 2,459 1,411 Sandwell & West Birmingham CCG 399,958 227,016 226,040 976 3,024 Birmingham Cross City LCG 30,280 16,517 16,799 (282) (426) Sub Total CCGs 1,544,477 1,067,452 1,048,381 19,071 26,313
Cluster (inc Estates) 519,425 352,100 349,829 2,272 3,029 Local Authority 74,257 49,130 46,653 2,477 2,237
Overall TOTAL 2,138,158 1,468,683 1,444,863 23,819 31,579
12.2 Commissioning Healthcare
12.2.1 Acute Trust contract performance Data has been received from Trusts for November 2012, and is being validated by the HCS so is therefore subject to change. The current forecast suggests that the most significant over performance will be within Sandwell PCT (£5.6m) and Wolverhampton City PCT (£6.4m). Less significant variation to plan is anticipated at this stage across Walsall and Dudley PCTs (£1.4m and £3.4m respectively).
Activity reports provided by the RWH Trust show a year to date overspend of £4.2m and a forecast outturn overperformance has been assessed at £5.7m. Over- performance amounting to £2.4m is forecast at Sandwell & West Birmingham. Dudley Group of Hospitals and Walsall Manor Hospitals forecast to outturn at £0.9m and £1.4m above plan respectively.
12.3 Primary Care There is an anticipated forecast overspend against the Pharmacy contract line in 2012/13 of £1.7m based on the year to date (October) information from the PPA, despite budgets being revised to reflect the increased costs associated with dispensing notified to PCTs. These are offset by forecast surpluses across other Primary Care budgets, the most significant of which is prescribing at £9.8m, resulting in an overall surplus of £12.1m against Primary Care resources.
12.4 Contingency Through the financial planning process each PCT set aside resources totalling £17.4m to provide a contingency fund. The fund will be utilised on a non-recurrent basis to mitigate financial pressures that may arise during the year. To date, £4.8m has been allocated to meet various investment needs across the cluster, and a further £3.3m of the remaining balance has been released into the year to date position to offset other performance variations. Any uncommitted contingency will act as a buffer against further financial risk for the remainder of the financial year
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(see section 3.2). It is anticipated at this stage that the contingency will be fully utilised across the cluster by the end of the financial year (£11.0m having been invested non-recurrently in various schemes and the remaining £6.3m off-setting forecast performance variations).
12.3 FINANCIAL RISK MANAGEMENT
12.3.1 Planned use of 2% Non-Recurrent Resources As set out in the NHS Operating Framework for 2012/13, the West Midlands Strategic Health Authority have established a non-recurrent reserve, to which all PCTs are required to contribute 2% of their allocation. This resource is being utilised to support service redesign, QIPP transformational changes and workforce redesign.
3.2 Financial Risk Assessment An assessment of risks for 2012/13 has been undertaken which attempts to identify the headline financial issues that each PCT may have to accommodate during the next three months. The figures are summarised in Table 4:
Table 4: Assessment of Main Financial Risks Full Cost Cluster Like- Risk Assessment 2012/13 Total lihood Sandwell Wolves Dudley Walsall £m % £m £m £m £m Further overperformance- Acute contracts (0.5%) 4.2 50% 1.1 1.0 1.1 1.1 Estimated Restructuring Costs* 5.5 80% 1.5 1.3 1.4 1.3 Continuing Healthcare – retrospective claims Total 9.7 2.6 2.2 2.5 2.3
*The financial position includes provision for estimated restructuring costs.
There is already £14.5m of secondary care over-performance accounted for within the reported financial position. At this point in time there is potential for further over- performance, and this has been estimated at 0.5% of the overall contract values. The risk identified in Sandwell regarding the premises for Drug & Alcohol Treatment has now crystallised. The estimated risk of £2.5m (break clause fee & dilapidations work) for enacting the break clause has been reduced to approx £1.3m through negotiations with the landlord and Sandwell MBC. This has been fully covered within the financial position of Sandwell PCT.
Restructuring costs have been assessed as being approximately £6.9m. However, the final impact of this risk is unlikely to be known until later in the financial year. At this moment in time, the risk has been covered within the forecast financial positions.
12. 4 RESOURCES
12.4.1 Capital Plan Capital Expenditure plans for 2012/13 comprise the following elements:-
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• Health Centre improvements; • New Health Centre development schemes; • Maintenance of Existing Capital Stock; • IM&T Schemes; • Capital transfer to fund Revenue Schemes.
There has been a slow start to capital spend, however this is expected to gather pace over the next few months. There is currently a forecast under-utilisation of approx £0.7m, and further detail by PCT can be seen in Appendix 3 to this report.
4.2 Revenue Resource Limit & Cash Limit The Cluster has a statutory duty to manage within the Resource and Cash limits. The Cluster is forecasting a surplus against the 2012/13 Revenue Resource Limit, and as a consequence is also forecasting an under-utilisation of available Cash.
The latest consolidated Revenue Resource Limit (RRL) is now estimated to equate to £2.138bn, having increased by £0.4m from that reported to the Board in October.
Table 5: Audit Trail of RRL Movement Total £'000s Planned RRL Startpoint (as per Mth 7) 2,134,925 Winter Pressures 3,516 Clinical Excellence 363 National Commissioning Underspend 357 Public Health Transition Team 87 Joint Commissioning Development - MH & LD 70 MH PbR Development 50 Delivering excellence in Dementia care 46 Other 21 NSCT adjustment (277) Adjustment to anticipated resources (1,000)
Month 9 RRL 2,138,158
12. 5 OTHER PERFORMANCE MEASURES
12.5.1 Public Sector Payment Policy The Government’s target requires that 95% of trade invoices should be paid within 30 days. The position for December 2012 is set out below in table 6. Following the implementation of the new SBS system across the Black Country, investigations are underway into the Sandwell PCT performance as it is significantly lower than the other three PCTs performance levels. An update will be provided in future reports.
Table 6: PSPP information for April to December 2012/13 TOTAL NON NHS TOTAL NHS Amount Number Amount Number £000s £000s
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Total to Month 6 239,674 47,818 1,029,268 8,216 Within 30 Day Target 216,043 43,480 1,012,318 7,397 Outside of Target 23,631 4,338 16,950 819
% Achievement 90.14% 90.93% 98.35% 90.03%
12.6 Conclusion
Financial performance during the first nine months of the 2012/13 financial year continues to be on plan, with the year to date surplus being ahead of trajectory.
The position for Sandwell PCT has improved as some of the risks being managed have been mitigated, or substantially reduced which gives confidence in the ability for the Cluster to deliver its overall control total. All organisations will continue to review risks locally during the remainder of the financial year.
The expectation is that the control total of £31.6m surplus for the Black Country Cluster will be met at this stage of the financial year.
13. Provider Capacity
13.1. Introduction The Black Country health system will look markedly different by 2014/15. • Quality and the patient experience will improve, reflected in reduced health inequalities for the population, less deaths from avoidable causes, reduced levels of infection and pressure sores, elimination of ‘never’ events and improved clinical outcomes alongside reduced waiting times. • Acute services will continue to be provided to people within their local communities based on an agreed core ‘dgh’ level of service. • A greater proportion of care will be provided in local communities, closer to where people live. • More specialised acute services will operate across the whole of the Black Country, from a reduced number of inpatient sites, providing consistent and higher quality outcomes, from sustainable acute, mental health and community services. • The quality and range of services provided in primary care will increase and all health services will be aligned and in some areas integrated with social care provision. • There will be six NHS providers operating in the system, delivering more integrated services across secondary care and community boundaries • More services will be delivered across organisational boundaries as more integrated commissioning between health and social care delivers effective, co- ordinated and cohesive care services to the local population • All NHS providers will have achieved foundation trust status, with a more engaged local population contributing to the development and delivery of high quality care
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Improvements in the provision of quality services will include:
• Reduced health inequalities suffered by the population, with the Black Country moving towards being/no worse than the rest of England • Improved safety, outcomes and access for people, including: o Less deaths from avoidable causes o Reduced infection rates in hospitals and other settings of care, especially C.Diff, MRSA, MSSA and E coli in hospitalised patients o Reduced incidence of pressure sores o Elimination of ‘never events’ o Improved clinical outcomes, from concentration of specialist expertise and compliance with evidence-based medicine and practice o Reduced waiting times at all stages of care o Improved health and well-being • Clinical Commissioning Groups and the National Commissioning Board will lead on all commissioning issues, providing clear clinical leadership to redesign of services based on improving quality, reducing health inequalities and achieving greater value for money • The shape of the workforce will change with less people employed across the system and in providers with commensurate changes in competencies, particularly for staff working in community settings. • There will be a greater range of providers and greater integration between health and social care services • Greater efficiency will be evident in the system including services being provided from a lower number of beds than currently
13.2. Provider Challenges From a commissioning and system management perspective, it is recognised that the current shape and configuration of services and treatment pathways is unsustainable. From a provider perspective, the combination of efficiency requirement driven by net reductions in the national tariff and the impact of QIPP places significant financial pressures on provider organisations which will require greater integration in the planning and delivery of services.
More specifically the Black Country cluster has identified specific challenges for Providers and Commissioners in the management of healthcare demand.
National tariff Changes - National tariff changes (efficiency) will place a pressure on acute providers over and above existing internal efficiency plans. When combined with the impact of QIPP plans on activity/income, this may pose financial and clinical viability issues for certain services.
Running Costs - There is a concern that running cost reductions will constitute a threat to organisational capacity to achieve transformational change.
Transforming Community services - Requirements of the Transforming Community Services (TCS) Policy will require significant management input and organisational development work to enable services to become effective within the new organisations.
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Variation in primary care practice - impacting on quality outcomes for patients for example, monitoring of disease prevalence in the community has improved, but some diseases are still being under-diagnosed (hypertension, stroke, diabetes and chronic obstructive pulmonary disease). Also there is insufficient capacity to manage increasing levels of care provided outside of hospital.
The settlement for the Local Authority - will create extra pressure for adult social care. There are already reductions in the local authorities commissioned residential care service which will have an immediate and adverse impact on secondary care productivity.
13.3. Primary Care Provider Development The Cluster faces challenges presented by the predicted changes in its population demographics, future funding allocation scenarios and the shape of its health services. Without changes to the configuration and delivery of services it is likely that the health economy and therefore the Cluster will face significant financial challenges that will impact on the viability and sustainability of services. Strategically the Cluster has identified the need to respond to the future health needs of the people of the Black Country through a focus on: raising general levels of health throughout the population; managing illness more effectively and investing in equality. A key enabler to the delivery of these aims will be the development of improved capability, capacity, flexibility and viability in primary care with the emphasis on developing services that facilitate improved levels of health, better management of disease and a uniformly high quality of care.
As the developing strategy indicates, currently, too much effort is focussed on the delivery of treatment services within hospital settings and the health economy needs to be rebalanced so more care and services are provided outside of hospital to deliver effective care in community settings. Primary care services in the Black Country need to be enhanced and developed in order to achieve this aim. In particular, the Cluster will need to find ways of developing the capacity, capability and flexibility of primary care providers to deliver a greater range of sustainable and viable services, targeted at patient needs and that are both productive and of a uniformly high quality. This may involve the development of shared service arrangements, collaborative working and/or federation models to maximise efficiency and productivity for GP primary care providers. Some progress has been made in developing primary care based services, including outpatient services led by consultants from several trusts, or GP specialists, in Dudley (community ENT, Dermatology and Uro-gynaecology) and in Right Care Right Here (community Gynaecology, Dermatology, Orthopaedics, Rheumatology, Ophthalmology, Respiratory, ENT, Cardiology and Diabetes). While these are encouraging developments, it has to be recognised that this model is not feasible for all individual practices, given skill mix and economy of scale issues. The CCGs will need to work on developing mechanisms for referral from practice to practice, overcoming the traditional reluctance to do so. In addition, there needs to be clarity about the perceived conflict of interest issue and a national view on resolution of this would be welcomed.
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13.4. Acute and Community Care The impact of successful implementation of QIPP schemes and provider efficiency, as well as pursuing the strategic intent to move care into community and primary care and social care settings, will result in more capacity being available than is required. This will provide the opportunity for debate with providers about how the system should operate in the future. Issues for consideration will include repatriation of services currently provided to Black Country residents out of area, making care cheaper and more locally accessible, as well as more detailed consideration of the Black Country’s response to issues arising from current short term and any longer term changes in services at Stafford Hospital. We will also look at how specialist services are provided to best effect within this capacity, to ensure clinical quality excellence and improved outcomes for patients.
Within these debates, through the Quality and Sustainability Review, acute care will continue to be provided from the four main hospital sites in the Black Country in Dudley, Sandwell, Walsall and Wolverhampton although the range of services will be different with greater concentration of specialist services. The intent is to ensure that acute hospitals have a sustainable future, in terms of range of services and income versus costs, and all will be operating as Foundation Trusts. Community service provision will be streamlined with hospital care, delivering better integrated pathways and improved patient experience, as well as significant efficiencies. This may result in some rationalisation in usage of Community premises. There will be a new Midland Metropolitan Hospital in Smethwick, replacing City Hospital, Birmingham and Sandwell District General Hospital. There will be midwifery-led units at Walsall Manor and Royal Wolverhampton Hospitals in addition to the MLU at City Hospital and the recently-opened Smethwick MLU.
13.5. Mental health and learning disabilities services These will have been redesigned, to offer single point of access, a greater level of specialised service provision offered in the Black Country for local people, expanded capacity and capability in primary care mental health, reducing the need for admissions and facilitating discharge from acute secondary mental health care, reduced variation in patterns of care, and clear arrangements for transfer between services, removing the current lack of cohesiveness and disjointed provision, particularly in CAMHS and young on-set dementia services. The Dudley and Walsall Mental Health NHS Trust will be a Foundation Trust.
13.6. Social care and health services These will be well-aligned, with expanded joint commissioning and effective Health and Well-Being Boards giving rise to more coherent service provision for local people in the areas in which they live, and with reduced delays in discharge and effective re-ablement services. Services for children and older people will be co- ordinated and demonstrate growing emphasis on prevention as well as treatment.
13.7. Patients and the public, other stakeholders and local politicians These groups will have increased trust and confidence in the quality of services provided and will have been fully involved in the strategic debates which shape future patterns of provision.
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13.8. Activity Changes As can be seen across the Black Country there are four notable activity changes during the period 2011/12 to 2014/15, these being:
• Items Prescribed – the four PCTs continue to plan for an increase in the volume of prescriptions – at a rate of 3.5% per year • Acute First Outpatients – a 5% reduction is anticipated. This change in activity varies amongst the four PCT’s. Wolverhampton PCT is planning a reduction of 7.7%, Dudley PCT a reduction of 10.6%, Sandwell PCT a reduction of 2.6% and Walsall PCT an increase of 1.5%. • Acute Follow-Up Outpatients – an 8.8% reduction is anticipated. As with first outpatients the change in activity varies amongst the four PCTs. Wolverhampton PCT is planning a reduction of 13.6%, Dudley PCT 19.4% Walsall 0.3% and Sandwell PCT is planning a reduction of 0.4%. • Elective and Non-elective Spells – elective activity is shown as decreasing by 4.4% and non-elective activity reduces by 4.5%.
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13.9. Headline implications for Providers Even with aligned financial plans between the Black Country health economy and Providers there are a number of factors that represent a clear and present challenge to commissioner and provider organisations.
13.10. Financial Challenge to Providers Incremental pay increase, VAT and National Insurance increase, price pressures such as new technologies, cost of new drugs, fuel increases, contract efficiencies and other net reduction in income.
13.11. Challenge to Black Country Cluster • Reduces first outpatient activity by 1.8% • Reduces follow-up outpatient activity by 4.7% (by March 2013 – data not yet available to 2014/15) • Reduces elective activity by 5.5% for inpatients and by 6.5% for day cases • Reduces non-elective activity by 1.5% • Reduces A&E activity by 4% (by March 2013 – data not yet available to 2014/15) • Reduces workforce numbers in line with activity and financial changes. From March 2012 to March 2013, the number of FTEs in the two mental health providers will reduce by 42, a fall of 1.4%. For the Cluster, the number of FTEs will reduce by 157, or 13.7%.
The delivery of QIPP schemes is therefore critical to ensuring that the listed targets will be achieved and significant progress has already been made, with savings of £59.8m achieved in 2010/11, and savings of £113.9m forecast for 2011/12, placing the Cluster £14.4m ahead of target. However, there is no complacency, as the Cluster believes that realising savings becomes harder each year, and the Cluster is developing a transformational approach to deliver these remaining savings. This is based on strategic change led by CCGs, agreed with providers, local authorities and local politicians and the public, retaining viable service provision in all areas of the Black Country and potentially moving away from transactional contracting to greater risk sharing and contracts based on incentivising quality performance within known finances. Looking beyond 2012/13, the Black Country health economy has a planned surplus of £20m by 2014/15 which gives the Cluster the necessary sound financial position within which to deliver significant change. 13.12. Workforce performance All providers and PCTs have submitted a workforce plan through the annual process and each organisation has confirmed key input from the Nursing, Medical and Human Resources Directors and signed off by each of the Chief Executives. A review of provider workforce plans was undertaken with the involvement of workforce and local commissioners, finance and quality leads. Following the implementation of the Transforming Community Services national initiative, there is a requirement for providers to review the need to redesign services and service delivery, particularly in relation to QIPP and workforce plans. . Workforce planning is being embedded within Strategic Change Programmes and planning is from the ground-up with the delivery of specific pathway workforce plans
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being the joint responsibility of programmes and local CCGs. In addition, the Cluster has developed mechanisms to review and monitor the workforce implications of changes to services as follows:
• Feedback to Cluster and local management teams • Workshop to engage providers was held in January 2012 with further events planned throughout the year. • Ongoing review and monitoring of workforce through QIPP both at Cluster and local level • Engagement with CCGs
To begin to iterate a strategic workforce plan that can be used to help leverage change and support the delivery of QIPP benefits, the Cluster will combine programme plans with the outputs of the Quality and Sustainability Review to identify short, medium and long term strategic workforce objectives that will be monitored and performance managed by the Cluster.
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14. Appendix 1 Board assurance Framework (Feb 2013)
Black Country Cluster Board Assurance Framework 2012/13
Principle Risks Res idu Initial al Risk Gaps Ris Account Scor in k ability e L x Gaps in Assura Sco Management Destin Sponsor C Key Controls Control nce re Assurance Actions ation Principle Objective 1: Establish robust performance management systems across the Black Country Cluster 1.1 Loss of staff expertise, M 4.11 Legacy None None 3 x Legacy documents Ongoing None capacity and organisational Madder x document, Skills 4 = at PCT Boards and memory s/K 4.44 Exchange, Critical 12 Cluster Board June Sharpe + Role analysis 2011, skills 18.2 exchange, 5 implementation of the cluster transitions process, PCTs workforce plan. Legacy document approval from SHA
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1.2 Failure to achieve data J Green 3.11 Data Validation by None None 3 x Monthly No update None accuracy and consistent data x HCS, advice on 4 = reconciliations by Dec 2011 definitions 3.89 definitions from 12 HCS with Acute = HCS & PCT Trust, Monthly 12.1 informatics expert contract 0 performance meetings with Trusts 1.3 Failure to agree consistent J Green 3.00 Monthly process None None 3 x Cluster Board None reporting systems and control x of consolidating 4 = Finance & systems 3.89 performance 12 Perfomance reports = across the Cluster 11.6 7 Principle Objective 2: Delivery of QIPP and better health outcomes for the population we serve
2.1 Failure to control demand S 3.89 New QOF Cluster Gaining None 3 Performance Updated Jan All Cartwrig x urgent/emergency consensu as x reports and actions 2012 as CCGs ht 4.33 care strategy. s through perfor 4 will be to Board performance = clinical mance = through reports show 16.8 Policy for senate on reports 1 performance progress. 4 procedure of LCV. policy and should 2 reports Score Intensive support agreeing show reduced from is being given to commissi each Amber to the E/D at SWBH oning econo Green. to improve quality group my Needs to be of care, configurat perfor monitored. performance ion mance Score against indicators increased has not fallen. back to Amber 2.2 Failure to agree a robust A 3.44 Contracts with None None 3 QIPP plans agreed No change All delivery plan with provider Williams x Providers and x and reflected in Jan 2012 CCGs services 4.44 delegated plans 4 contracts and = to CCG's = delegation to 15.2 1 CCG's. 7 2
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2.3 Failure to tackle Health Adrian 3.75 Improvement in Current Invest 4 Health All Inequalities Phillips x major social economic ment X improvement CCGs 4.00 policy areas of climate plans 4 strategies and = marmot- eg early and other not = public investment 15.0 years, young failures of comm 1 programmes 0 people's governme ensura 6 employment, nt te with reduign investmen levels inequalities in t in the iof income, marmot health improving areas ineqau working lity; conditons, data environments, collecti improving health on and promotion by risk health reduction across inequa social gradients lity impact assess ment long measu res 2.4 Lack of involvement and J Green 3.44 QIPP plans in the None None 2 Performance is Updated Dec None ownership of QIPP process by x process of being x being reported 2011, score key stakeholders particularly 4.11 devolved to 2 through finance reduced local government and GP = CCGs, Cluster, & = reports. Forecast of Consortia 14.1 LA/Public Health 4 10% 4 divisions. Central overachievement PMO being by end of year. established to Quarterly oversee, assurance performance challenge meetings manage, & in place challenge the divisions in their delivery.
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2.5 Lack of focus and resources J Green 3.11 A substantial None None 2 Performance is Updated Dec All to implement the QIPP scheme x proportion of the x being reported 2011, score CCGs 4.33 QIPP schemes 2 through finance reduced = have been = reports. Currently 13.4 included within 4 on target to 7 signed contracts, overachieve by therefore external 10% stakeholders are committed to delivery targets. 2.6 Variance between PCT's A Schemes of Still Conso 2 Delegation agreed Pattern of None levels of delegation to consortia Williams Delegation variability rtia x and development CCG's now and consortia's ability to deliver in are still 4 work on going mostly on QIPP consortia in = established. 3.22 develo 8 Consistent x pment approach 3.67 being taken =11. across the 82 Cluster Principle Objective 3: Ensure safe and smooth transition of PCT arrangements to receiving organisations
3.1 Failure to agree a stable A 3.67 Development of Pattern Patter 2 Development work Pattern now None pattern of GP consortia Williams x the Consortia still not n not x underway with established 4.11 underway finalised finalise 2 good engagement in all areas = d + through Consortia other than 15.0 4 lead groups. Wolverhampt 8 on. Further work planned for this area Principle Objective 4: Develop a cluster wide strategy for quality improvement
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4.1 Failure to maintain adequate S Ali/S 3.56 Strategic priorities None 2 Board reports, NCB resources Cartwig x and assessment x incident data, ht 4.33 of risks. 2 workforce data, = Monitoring - minutes from 15.4 turnover of key 4 clinical senate. 1 staff, monitoring Quality leads of clinical functioning and incidents and Black Country trend analysis re better care emerging and operational group enduring risks. meeting monthly Involvement of sharing lessons senate. New and working on quality lead quality issues strucutre in place together. and has addressed resources for the quality agenda. Extra resources in place for Dudley through the CCG 4.2 Failure to achieve a common S Ali 3.56 Leadership from None 2 Clinical exec NCB data sets, indicators and x medical and x minutes. CCG systems 3.78 nursing directors. 4 composition. = 13. quality lead in = 46 each CCG. Clear 8 line of sight from CCG thru to cluster board. Reports from CCG to Cluste Board via Clinical Executive.
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4.3 Inadequate leadership focus S Ali/S 2.78 Clinical Executive None 2 Clinical exec NCB on quality issues Cartwrig x in place as a x minutes. Report to ht 4.33 committee to the 2 Cluster Board. = Board with agreed = Monthly reports 12.0 ToR, membership 4 from the leaders 4 from all CCG's. presented at MD and Director Clinical Executive of Nursing lead on by clinical Leads. quality agenda with quality team established at PCT and CCG level. Each CCG has a lead for quality and they are supporting the Cluster quality leads for their locality. CCGs now engaged and preparing for authorisation. 4.4 Failure to reconcile differing L 3.11 Clinical Executive None the None 1 System Plan, Medical None local priorities Williams x and Clinical Cluster the X system Plan Director to 3.78 Senate agree Board will system 3 Implementation ensure that = priorities. The decide if plan = Plan Board there is a 11.7 cluster System there is a has 3 minutes robust 6 Plan 2012/2013 failure to been process of has co-ordianted reconcile sign engagement and codified these difference off by during the in detail s. the development
Clinica of the l strategy. Senate Continuing , CCG reports on Boards progress to , cluster Board Cluster through Board updates on
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and System Plan the Implementati SHA on Risk update September 2012
4.5 Failure to maintain cluster R 3.11 Appointment of 2 Lack of None 2 Board Develop and None wide stakeholder engagement Haynes x x PPI reps on regular x minutesWebsiteCo distribute 3.78 Cluster Board. channel 3 pies of briefings, regular = Stakeholder brief (apart = monitoring of stakeholder 11.7 and stakeholder form 6 distribution, brief.Further 6 event took website)fo feedback from stakeholder placeCreation of r general recipients event spring Cluster website to stakehold 2012 make Board er papers and other engagem information widely ent.Possi available.Circulati ble gap on of information (or including details overlap) of Cluster in work appointments and being
summary of carried Board discussions out by to key Cluster stakeholders Communi including PCT cations staff, Consortia team and chairs, Provider individual organisations, PCT Overview and involveme Scrutiny nt/engage Committees.More ment joined up Cluster team. wide approach to responding to media inquiries. Principle Objective 5: Lead the organisational development programme and the deployment of the workforce across the Cluster to
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secure service delivery and a successful transition 5.1 Loss of key staff during M 4.11 Planned exit None None, 1 Board Report Updated None transition Madder x schemes eg MARS the x August 2012 s 4.22 validation panel Assist 4 = ensures that key ant = 17.3 skills are not lost to Chief 4 4 the organisation. Execut Natural turnover is ive - monitored and HR will reported to the presen Cluster Board t workfo rce reports to the Cluster Board 5.2 Problems caused by lack of R 3.44 More standardised Lack None 3 None Produce None staff engagement leading to lack Haynes x approach across of x accessible of ownership of the objectives of 4.00 Cluster to internal clarity 3 summaries the cluster = communications, or = covering key 13.7 with weekly e- confusi 9 objectives 6 briefings and monthly on (e.g. QIPP face to face briefings. over plans, objecti System Staff ves Plans). No communications to change include regular
cluster updates. Encourage feedback and Creation of Cluster questions via website to make JNCC, Staff Board papers and Council, other information Team Briefs widely available.
Circulation of information including
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details of Cluster appointments and summary of Board discussions to key stakeholders including PCT staff 5.3 Risk caused by imposition of J Green 3.67 Establishment of None None 2 System Plan, Updated None external financial targets x Cluster wide x Cluster fianical December 3.67 consistent fiancial 2 modelling template 2011. Score = planning & scenorio = reduced 13.4 modelling. QIPP 4 7 'Plan B' options in
System Plan would provide potential further savings opportunities if necessary 5.4 Lack of information M 3.56 Organisations to be Unsur Discus 3. National guidance Implementati None regarding a future structure Madder x in a state of e of sions 5 imminent. Letter to on of national s/R 3.67 readiness for any the at 6 all staff re transition guidance. Haynes = organisational future Board x due to go out end 13.0 change. archite level 3. of January. In May Ensure 7 cture 6 2012, all staff have regular Staff of the 7 had letters updates. communications to NHS = informing them of include regular 1 their proposed Encourage cluster updates as Undefi 3. destination feedback and structure develops. ned 0 organisation and questions via
future 7 staff have had the JNCC, Staff Wide circulation of structu opportunity to raise Council, information regarding res for concerns. All staff Team Briefs. sills exchange a movements are Recruitment numbe being tracked and commenced r of reported to the for CCGs. teams. SHA. Ongoing staff Consultation engagement underway for Conce CSU rns Updated
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over August 2012 further runnin g cost reducti ons.
Lack of clarity over CCGs/ Commi ssionin g Suppo rt Units and which or how many staff they may emplo y.
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5.5 Failure to take care of the M 3.25 1:1 meetings with all None, None, 1 Board report Implementati None individual needs of our staff and Madder x staff. Developing Cluster the x on and responding inflexibly s 3.88 engaging in your Board Assist 4 monitoring of =12. future develoment will ant = uptake of 61 support prrogramme monito Chief 4 programme r Execut activities. workfo ive - Planned rce HR will additional activity presen programme t of support workfo pre and post rce interview to reports complement to the engagement Cluster strategies Board are on going. Updated August 2012 5.6 Failure to invest in IT J Green 3.25 Cluster wide review In the Curren 3 Interim solutions to Acting DoF None solutions to support x of IT services has absen tly x secure continued to lead organisational development 3.63 been commissioned ce of a have a 4 delivery have been review of 11.8 to look at the future clear disper = implemented at services 0 requirements of strateg sed 1 Dudley PCT. CCGs, Cluster, y, situatio 2 Service review is Commissioning there n underway. Support Services, is a regardi and LA/Public risk of ng Health. loss of provisi valuabl on.
e Combi staffin nation g of resour PCT, ces Acute which Trust, could and affect Mental service Health deliver trust
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y. provid ers.
Transitional Risk register (Feb 2013)
Please Note: This log manages key strategic transition risks within Birmingham, Solihull and the Black Country Clusters. It is not intended to be an exhaustive list of all risks identified and being managed by the Clusters receiver organisations i.e. CCG’s and CSS. Each of these receiver organisations manages their own risk registers and these should be referred to if more operational information is required. This log is regularly reviewed by risk owners and on a monthly basis it is tabled at the BSoL and BCC Transition Committee for assurance and sign-off (This committee includes NED representation from both Clusters).
Risk Description Initial Initial Existing Control Measures In Place Mitigating action to be taken & Risk Progress / Completion Current status and Residual Residual Risk Owner
Score Risk (Risk prevention Measures already in Timescale Actionee update (including date of update) Risk Score Risk Level C x L Level place to reduce likelihood of C x L occurrence)
ID rk Stream rk
Failure to ensure successor 5x4= 20 H Transition Committee in place Agree formal dates for transfer of NCB AT 21.12.12 Cluster closedown plan submitted to 4x2= 8 L Wendy
1G organisations are properly Transition Leads and Programme responsibilities to successor Directors SHA in November for review and sign-off. Saviour prepared and established, Responsibility identified to Directors of organisations (When Possible) All NCB AT Directors now in post and assigned including staff, budgets, NCB Area Team Complete closedown plan to reform work streams. Transfer orders contracts, and equipment Cluster Boards receive highlight reports Implement closedown plan completed and issued to the DoH on the and Handover appropriately to successor Programme risks reported and updated (Corporate owner for BCC now 16.01.13 bodies: NCB, Public Health monthly identified)
Legacy England, Property Co, Key staff identified and in place for Develop joint approach with BSOL communications and transition work cluster and NCB Area Office as it is engagement Monthly Reform Milestone tracker developed (September onwards) Regular SHA Reviews BCC & BSol Boards have endorsed joint committee structures which will create resilience in governance and decision making processes.
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Risk Description Initial Initial Existing Control Measures In Place Mitigating action to be taken & Risk Progress / Completion Current status and Residual Residual Risk Owner
Score Risk (Risk prevention Measures already in Timescale Actionee update (including date of update) Risk Score Risk Level C x L Level place to reduce likelihood of C x L occurrence)
ID rk Stream rk th
Lack of guidance on Transfer 5x5=25 H October DoH transition team workshop Work continuing with SHA colleagues to Kimara 21.12.12 Further guidance received 7 and 2x1=2 Closed Alison th 2G schemes leading to inability gave early advice and guidance on obtain answers from the DH. Sharpe 10 Dec. Guidance received on claims. Taylor to complete list for the DH Transfer Schemes. Guidance expected on 14.1.13 on completion by deadline. Centre has issued guidance throughout of annex 3 of the transfer scheme. Transfer November and December. schemes completed and issued to the DoH on Mills and Reeve advising on work the 16.01.13 Further guidance expected 14.1.13
Legacy and Handover (three days prior to return due)
Lack of staff at FMC leading 5x5=25 H This is a serious business continuity Lynne Allen has this in scope and is Lynne Update from Transition Committee meeting 3x2=6 L Alison
3D to lack of service for bulk issue for Dudley and the BCC Cluster. developing a solution to discuss with Allen 08.01.13: Discussions between Lynne and Taylor orders and controlled Karen Helliwell Alison have led to a remedial solution being stationery to primary care. put in place. This is no longer considered a major risk, although consideration still need to be given to long term sustainability/ Legacy and Handover
BSol initial return was done 5x2=10 M KS working with colleagues to de-merge Work underway to separate returns Kimara Update from Kimara Sharpe at Transition 2x1=3 Closed Alison by the cluster rather than data. Sharpe Committee meeting 08.01.13: The separation Taylor
4BSol PCT. Risk of not being able to of the BSol returns is now complete. This risk separate out functions due is now closed. to clustering of PCTs Legacy and Handover
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Risk Description Initial Initial Existing Control Measures In Place Mitigating action to be taken & Risk Progress / Completion Current status and Residual Residual Risk Owner
Score Risk (Risk prevention Measures already in Timescale Actionee update (including date of update) Risk Score Risk Level C x L Level place to reduce likelihood of C x L occurrence)
ID rk Stream rk
Failure to complete 5x4= 20 H Transition Committee receiving Appoint/identify and manage transfer Kimara 21.12.12 Joint committee structures and 5x2= 10 M Alison
5G handover work, monthly highlight reports. process flexibly. Sharpe transfer arrangements now in place across Taylor documentation and SHA plan template completed. Develop joint approaches with BSOL both clusters and signed off by each board. implementation through Responsibility identified to Directors of Cluster. Identify overall management of effective processes NCB AT. transition with Local Area Team. Monthly highlight reports to Cluster Transfer Scheme Boards. Provisional contracts signed with CSU to deliver specific elements of transition. Quality and Safety handover plan completed. Implementation of plan now has executive sponsor. Monthly Reform Milestone tracker. Regular SHA Reviews. SHA plan template for closedown complete.
Risk of not identifying the 5x4=20 H Department of Health guidance on Awaiting copies of MOUs and SLAs for Kimara 07.12.12. Meeting held with Steve Wainwright 4x2=8 L Alison
6D right third part access to transfer schemes has been issued legal opinion on transfer of data Sharpe to move this forward. Taylor systems leading to inability throughout November and December Partial information received 10.1.13. Risk to undertake work. This is reduced. specifically for HCCS Transfer Scheme
CCG authorisation – failure 4x3= 15 M CCGs set up as Board sub committees Undertake mock authorisation panel CCG RO’s All CCGs have now gone through the 2x1= 3 Closed 4 x CCG
7G of CCGs to achieve ISROs in post exercise (As agreed with CCGs) authorisation process. No significant concerns RO’s authorisation Monthly reports to Board Complete Accountability Agreements identified with moving to full authorisation. Board to Board challenge process (July) Mitigating actions to address red indicators Accountability Agreements developed ongoing. S&WB and Dudley CCGs now fully Agreed development plans supported authorised. by Cluster Outcome of Board to Board challenges Receiver Authorisation Participation in management process increasing Monthly Reform Milestone tracker Regular SHA Reviews CCGs allocated to authorisation waves
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Risk Description Initial Initial Existing Control Measures In Place Mitigating action to be taken & Risk Progress / Completion Current status and Residual Residual Risk Owner
Score Risk (Risk prevention Measures already in Timescale Actionee update (including date of update) Risk Score Risk Level C x L Level place to reduce likelihood of C x L occurrence)
ID rk Stream rk
Failure to establish a viable 4x3= 12 M CCU set up as Board sub committee Rob Bacon appointed as the Managing Rob 9.1.13 CSU have passed all authorisation 2x1= 3 Closed Rob
8G and sustainable CSU Interim Senior Leadership Team in place Director Bacon milestones to date. Full staff team appointed Bacon Monthly report to Board Appoint to leadership team to. Organisational strategy and development CSS reports to Transformation Board (September). sessions being delivered for staff. Buy, Make Monthly Reform Milestone tracker Comms services accredited as an at and Share mix now clarified with Clusters Regular SHA Reviews scale provider. CCGs. Signed contracts will be in place with Checkpoint 2 passed NCB to decide on hosting arrangements CCG’s within the Clusters by week ending Development plan agreed with Business and issue licence to operate (October). 18.01.13 Receiver Authorisation Development Unit Function mapped staff appointed to Develop business plan for Checkpoint 3 structure (November). achieved (End August.) CCGs agree signed contracts with the Consultation on staff structure CSU (December). completed
RA function – no successor. 5x4=20 H Discussions held with CSU Service to be provided through CSU Kimara Discussions being held with DGH. Risk has now 3x1=3 Closed Alison
9D Risk of staff not being able to Sharpe been mitigated and is closed. Taylor access patient records for day to day work Legacy and Handover
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Risk Description Initial Initial Existing Control Measures In Place Mitigating action to be taken & Risk Progress / Completion Current status and Residual Residual Risk Owner
Score Risk (Risk prevention Measures already in Timescale Actionee update (including date of update) Risk Score Risk Level C x L Level place to reduce likelihood of C x L occurrence)
ID rk Stream rk
Failure to manage conflict of 4x4= 16 H Declaration of Interest sought for each Transfer responsibilities in accordance Kimara 21.12.12. All CCG and CSU receiver 3 x 1 = 3 Closed Chairs of with closedown/ Sharpe organisations now operating in shadow form
10G interests in ‘designate’ roles Transition and Cluster Board. Tran - Chief Executive, Executive Proactively addressing Conflicts of handover plan (August Onwards). with full boards and governance structures in Comt & Directors etc. Interest on each agenda item. Add Conflict of Interests to Board place. Considerations of conflict of interest Cluster CCGs and CSS now formally established Report Templates. now established throughout governance and Boards ad ‘receiver’ organisations. accountability structures. Monthly highlight reports to Transition
Legacy and Handover Committee and Cluster Boards. Paper to May BCC Board raising issues. SHA Accountability Review. CCG’s Constitution. Adherence to Nolan Principles. NHS Managers Code of Conduct. Raised with the SHA. Agreement in place on how dual accountabilities are handled by developing the ‘sender’ / ‘receiver’ approach to future work (August).
Failure to avoid delay of 4x4= 16 H Paper to BCC Cluster Board raising Transfer responsibilities in accordance Kimara Update from Transition Committee meeting 4x3= 12 M Alison
11G transition through excessive issues(May). with closedown/ handover plan (August Sharpe 08.01.13: Clusters have now agreed to Taylor workload placed on Monthly highlight reports from onwards). proceed with RETS scheme. The proposed individuals with considerable transition leads to Transition Retention and Exit Terms Scheme staff team will include Finance and closedown or multiple areas of Committee. (RETS) in development leads. The definitive numbers for the finance responsibilities/roles Monthly highlight report to Cluster and closedown team are clear and it is Boards. anticipated that six staff will be used for
Legacy and Handover Agree how dual accountabilities are closedown. The application for this is now handled between Cluster and receiver awaiting approval from the SHA. organisations.
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Risk Description Initial Initial Existing Control Measures In Place Mitigating action to be taken & Risk Progress / Completion Current status and Residual Residual Risk Owner
Score Risk (Risk prevention Measures already in Timescale Actionee update (including date of update) Risk Score Risk Level C x L Level place to reduce likelihood of C x L occurrence)
ID rk Stream rk
Failure to recognise potential 5 x 4 = H Clinical leads within CCG’s. Implementation of Quality and Safety All Quality and Handover process now well 5 x 2 = 10 M Alison 20 Handover document. NCB AT established and involving joint working across
12G failing organisations during Clinical Executive. Taylor transition especially in Monthly reports to the Boards on Directors both Clusters. All SHA checkpoints and relation to Quality and Safety Quality and Safety. deadlines met. Quality handover documents Quality and Safety Committee in place being kept up to date for CCG’s. Risk Summits.
Legacy and Handover Quality and Safety Handover Plan. SHA Scrutiny. Development of Quality and Safety Handover document.
Lack of clarity with respect to 3x3=9 M Raised with director of BCC Finance To be tabled at November Kimara Paper tabled at November meeting of BCC 1x1=1 Closed Alison
13G internal audit services post Transformation Board Sharpe Transformation Board. Taylor 31 March 2013 Legacy and Handover
Failure to determine 5x5=25 H Raised with LAT Director of Finance To be tabled at November Kimara Paper tabled and duty and cases now included 1x1=1 Closed Alison
14G adequate continuity for Transformation Board Sharpe in closedown and handover plans to receiver Taylor counter fraud open cases organisations after 31 March 2013 Legacy and Handover
Failure to maintain effective 4 x 3 = M Joint working with BSOL Cluster Failure to maintain effective Kimara Endorsement of joint committee structure – 2 x 1 = 2 Closed Alison 12 governance arrangements to oversee Sharpe November Board.
15G governance arrangements to supported by CSU (July). Taylor oversee transition across and Shared approaches considered and transition across and between BB and between BB and BSOL signed off by Cluster Board (October). BSOL Clusters Clusters Joint Committee Structure mapped. Continued dialogue between Boards. TOR for joint Transition Committee
Legacy and Handover signed off my BCC Transformation Board (October). National change to accountability to Local Area Office (October).
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Risk Description Initial Initial Existing Control Measures In Place Mitigating action to be taken & Risk Progress / Completion Current status and Residual Residual Risk Owner
Score Risk (Risk prevention Measures already in Timescale Actionee update (including date of update) Risk Score Risk Level C x L Level place to reduce likelihood of C x L occurrence)
ID rk Stream rk
The risk of health and safety 5x5=25 H Handover interviews should be Reminder to be issued to Cluster line Mal Detailed guidance and templates for handover 4x3=12 M Alison problems arising as a result undertaken with all exiting staff. HR did managers of importance of robust exit / Madders / exits interviews have been developed and Taylor
of system and people provide guidance and templates for this handover interviews. were issued in the Cluster Weekly Brief to all changes, including clarity of but it is down to individual’s line staff on the 31.01.13. Still potential risk of line responsibility for managing managers and currently no auditing is in managers not keeping comprehensive sites, completing training place on process. training records / incident logs etc. in period 33G records, reporting accidents of organisational closedown. and incidents, and local NEW induction of staff.
Legacy and Handover
Records management – 5x4=20 H Awareness raised through Team Brief Staff going on VR will be required to Kimara Further work needs to be undertaken in a 4x4=16 H Alison
16S unclear what records are and posters complete a comprehensive leaving Sharpe systematic way 10.1.13 Taylor held where form. Further assurance required around the Blitz on paper records by the Director of transfer and disposal of electronic and paper Governance and Head of IG during records. month of February. Further work on IT records to be
Legacy and Handover undertaken
Failure to agree current 5x4= 20 H 4 x PH Transition Groups in meeting Pursue function and staff transfers early Nicola Update from Transition Committee meeting 4x3= 12 M Nicola (December). Benge 21.01.13: PH allocations now confirmed with 17G Public Health Functions to regularly. Benge transfer to the Local PH Transition plans signed off by DoH. PH financial allocation will be confirmed LA’s. Indications are that allocations will cover Authority Responsibility identified to Nicola 17th December. existing PH funding requirements. Risk still Benge. remains however in regards to preparedness Monthly reports to Cluster Boards. to transfer for some areas such as ICT NCB AT support. provision, office accommodation and contract stabilisation. Public Health Transfer Vender support via KPMG. Monthly Reform Milestone tracker. Regular SHA Reviews. Guidance received on basis of transfer (June). Due diligence office established (July)
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Risk Description Initial Initial Existing Control Measures In Place Mitigating action to be taken & Risk Progress / Completion Current status and Residual Residual Risk Owner
Score Risk (Risk prevention Measures already in Timescale Actionee update (including date of update) Risk Score Risk Level C x L Level place to reduce likelihood of C x L occurrence)
ID rk Stream rk
Closure of St John’s and PH 5x4=20 H Dudley PH transfer steering group have Discussions being held with LA to take Andrew 05.02.13 Dudley PH team will now be 4x1=4 L Nicola on head lease of St. Johns House. BCC Lawley accommodated with Falcon House, Dudley. It
18D not being able to access IT an estates sub-group looking at this Benge issue. BCC Cluster estates lead in cluster will serve notice on the head is planned that they move in before 31.03.13. dialogue with Council on this. lease contract in the New Year. Dudley Detailed work now underway to ensure they Council has confirmed that they will have full IT connectivity in place for move. then negotiate with the Landlord to take on the head lease. Update from Transition Committee meeting Public Health Transfer 08.01.13: The PCT have now served notice on St. Johns House. This now allows the Local Authority to enter into discussions regarding taking on the head lease to accommodate PH staff. With premises confirmed this will allow IT connectivity to be developed.
Public Health financial 5x3=15 H All transfers now have steering group in Reviews of all budget lines on-going. Nicola Update from Transition Committee meeting 4x1= 4 L Nicola
19G allocations are not enough to place led by Local Authorities. Sandwell & Dudley of particular concern Benge 23.01.13: Public Health Allocations now Benge cover the current as funding gaps have been identified in announced and do not place significant cost commitments of Public each financial allocation. The success of pressures on LA’s. There is however still health teams and the transfers is largely dependent on significant work required in stabilising commissioning costs the funding allocation issued to each contracts, and ensuring ICT provision from the local authority by the Department of 31st March.
Public Health Transfer Health. The allocation was due to be announced on the 17th December. However this has now been delayed till the week beginning 15th January. The continued delay places significant risks and uncertainty in regards to being assured that PH contracts and funding for staff are in budget and affordable.
Lack of involvement in 3 x 4 = M CCG and Cluster reps on 4 x HWBB. Regular briefings on NHS documents 4xCCG All Boards now established in shadow form. 3 x 1 = 3 Closed 4 x CCG 12 received by HWBB’s. RO’s NCB AT Directors now identified to sit on
20G progressing/supporting/ HWBB reps on 4 x CCG Boards. RO’s influencing the development Continued engagement each. Transfer of Health and Wellbeing Briefings provided over summer to each Boards meeting. Public Health
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Risk Description Initial Initial Existing Control Measures In Place Mitigating action to be taken & Risk Progress / Completion Current status and Residual Residual Risk Owner
Score Risk (Risk prevention Measures already in Timescale Actionee update (including date of update) Risk Score Risk Level C x L Level place to reduce likelihood of C x L occurrence)
ID rk Stream rk
Failure to manage the 5x4= 20 H JNCC. Issue staff consultation letter to all Mal 09.01.13 All 3b appointments now made to 4x 1 =4 L Alison remaining BCC staff (late October). Madders receiver organisations. A handful of
21G reduction in workforce to Task and Finish Groups. Taylor achieve organisational Transformation Board. Identify and issue ‘at risk’ notice to staff exceptions are due to last minute targets Monthly reports to Board. (November) restructuring of receiver organisations. 1:1 Effective relationship with JNCC. meetings nearly complete for all at risk staff. Local agreements made and Risk notices now being issued.
Human Resources implemented. Monthly Reform Milestone tracker. Regular SHA Reviews. Complete reviews and harmonising HR policies (September) Implement national policy particularly voluntary and compulsory redundancy MARS undertaken across the cluster with circa 200 applications received which have been reviewed by panel and remuneration committee. Cluster board signed off agreed application 25th September 2012. 175 staff exited Cluster employment on the 19th October.
Failure of transfer BILCS 5x5=25 H Stakeholder engagement process has Opened discussions with CSU to explore ? Action plan in place to bottom out preferred 4x4=13 H TBC service to new hosting been underway since September 2012. options re a temporary arrangement solution or acceptable alternative arrangements before 31 Currently, in talks with Sandwell re pending conclusion of Sandwell option March 2013 possibility of their hosting service – but or (b) permanent solution to offer BILCS no firm decision reached as yet. service. 34G Human Resources New
th
UNISON have withdrawn 5x5=25 H JNCC had agreed with the process and If the Cluster considers staff groups as Mal 20 December Staff informed that 90 3x1=4 Closed Alison
22G their support for the Clusters signed off the 90 day consultation. part of individual PCTs then numbers Madders consultation closed and 30 day consultation Taylor 90 day consultation Pressure nationally form UNISION drop to under 100 and a 30 day now in place. meant this support was withdrawn in consultation can be used. November Human Resources
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Risk Description Initial Initial Existing Control Measures In Place Mitigating action to be taken & Risk Progress / Completion Current status and Residual Residual Risk Owner
Score Risk (Risk prevention Measures already in Timescale Actionee update (including date of update) Risk Score Risk Level C x L Level place to reduce likelihood of C x L occurrence)
ID rk Stream rk
Risk of closedown if RETs 4x5=20 H Close down of accounts must be Clusters have applied to the SHA for a Mal 05.02.12 RETS scheme now authorised by 4x2=8 M Alison delivered by each PCT following 1st April RETS. 21.01.13 Clusters have now Madders SHA. Staff team and budget identified.
23G aren’t agreed for finance Taylor staff and governance 2013. agreed to proceed with RETS scheme. However still no clarify about who the host support The proposed staff team will include employer will be post March 31st. This may Finance and closedown leads. The create some uncertainty / issues for identified definitive numbers for the finance team staff.
Human Resources are clear and it is anticipated that six staff will be used for closedown. The application for this is now awaiting approval from the SHA.
Risk of loss of corporate 5x3=15 H Exit interviews proposed. Exit interview template developed by Mal 05.02.13 Detailed guidance and templates for 1x5=5 L Alison HR and issued to Cluster line manager. Madders handover / exits interviews have been
24G memory with personnel Taylor leaving This includes handover of soft developed and were issued in the Cluster intelligence, PCT hardware, keys and Weekly Brief to all staff on the 31.01.13 fobs, name badges etc. 09.01.13 update: HR has issued the tools to
Human Resources ensure this happens. It is however dependant on line managers completing the process thoroughly and ensuring information and resources are re-allocated as appropriate. With the constant flux in line managers for some staff there remains a risk of this not being completed thoroughly.
Failure to maintain support 4x3= 12 M JNCC established. Continue established programme of Mal Staff side representation at meetings sporadic 2x2= 4 L Mal
25G of JNCC for transition 1 to 1 meetings with convenor. work and scheduled meetings. Madders due to staff moving on. Madders changes JNCC chaired by Director of Operations Still seeking clarity on the role of the JNCC with Executive Directors and ISROs in post 31st March 2013 attendance. Human Resources
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Risk Description Initial Initial Existing Control Measures In Place Mitigating action to be taken & Risk Progress / Completion Current status and Residual Residual Risk Owner
Score Risk (Risk prevention Measures already in Timescale Actionee update (including date of update) Risk Score Risk Level C x L Level place to reduce likelihood of C x L occurrence)
ID rk Stream rk
ESR – dependant on 3x4=12 M Leases and ownership in place but need Being led at national level Mal 09.01.13 Assurance given by DoH that this is 3x1=3 Closed Alison to be formally transferred to receiver Madders in hand and national solution will ensure
26G McKesson to deliver a Taylor national solution of closing organisation. complete transfer of data and responsibilities PCTs and transferring data from 1st April 2013. and responsibilities to new organisations.
Human Resources
The inability of a robust and 3x4=12 M Project Group set up. Business case National and regional advice being Nick Update from Transition Committee meeting 1x1=1 Closed Rob ICT
27S sustainable social enterprise approved by BCC Transformation and sought. CSU will host service post Dunaway 08.01.13: Based on national guidance the Bacon being set up for Sandwell IT BCC Cluster Board. 1.4.12. Review of social enterprise social enterprise model is no longer viable. by 31st March 2012 model currently being undertaken BCC Board has therefore agreed for Sandwell ICT to form part of the CSS. At scale ICT offers are now being developed for CCG.
Failure to manage staff 5x4= 20 H Transition Committee Establish dates for ICT requirements BCC / Update from Transition Committee meeting 2x2= 4 L Alison
ICT and transfer with remaining successor BSoL 08.01.13: Significant work underway to
28G moves with appropriate IT Transformation Programme. Taylor support throughout Clusters Monthly highlight report to Boards organisations (CSU, NCB, 4 x PH Cluster manage staff moves. Extra capacity assigned Continued Executive management focus transfers to local authorities and ICT leads to ICT departments dealing with transfers. on these issues. NHSPS) & CSU Moving all staff into their new receiver Complete discussions on IT (July). organisations by the 31st March or before is a Completed IT mapping (August). challenge.
Failure to accommodate 5x4= 20 H Transition Committee. Executive team of NHS Property Clive Rex Establish dates for transfer with remaining 4x3= 12 M Clive Rex Estates requirements of new Transformation Programme. Services now appointed. successor organisations (Wolves and 29G receiver organisations Monthly highlight report to Boards Wolverhampton CCGs, 4 x PH transfers to Estates Continued Executive management focus local authorities and NHSPS). on these issues. Completion of BCC / BSoL Estates Transition strategy (June) Office requirements now confirmed for LAT, CSU, Dudley and S&WB CCGs.
The risk of delay or 5x4= 20 H Updates from Estates leads at Report to be tabled at Transition Clive Rex To be confirmed following Transition 5x3=15 H Clive Rex
disruption to capital Transition Committee. Membership of Committee on the 12th February 2013. Committee meeting. schemes and lack of NHSPC leads on Transition Committee Estates 32G clarity over future approval, delivery and NEW ownership issues
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Black Country Cluster Legacy Document March 2013
Risk Description Initial Initial Existing Control Measures In Place Mitigating action to be taken & Risk Progress / Completion Current status and Residual Residual Risk Owner
Score Risk (Risk prevention Measures already in Timescale Actionee update (including date of update) Risk Score Risk Level C x L Level place to reduce likelihood of C x L occurrence)
ID rk Stream rk
Failure to manage staff 5x3= 15 H Transition Committee. HR staff team has been increased to Mal All stage 3 appointments across the receiver 1 x 1 = 1 Closed Alison moves with appropriate HR Transformation Programme. deal with demand. Madders organisations were completed by the 21st
30G Taylor support Monthly highlight report to Board Complete recruitment to LAT and CSU December deadline. Recruitment to staff in Estates Continued Executive management focus on target for 21st December 2012 stages 4 and 5 now underway along with on these issues. developing options for re-deployment of staff Mal Madders appointed as Transition now formally ‘at-risk.’ lead for BCC & BSol (August). HR team collocated at St Chads Court.
Risk of payroll function being 5x3= 15 H Payroll contracts extended for Black Work to extend payroll contract for Alison Work to extend payroll contract for BSol staff 4x4=12 M Alison destabilised post 1st April. Country. This issue related to BSol BSol staff Taylor Taylor 31G Finance
Key • G - General • D – Dudley • S – Sandwell • Wa – Walsall • W – Wolverhampton • HOB – heart of Birmingham • Sol – Solihull • BEN – Birmingham East and North • Sou – South Birmingham
• C&L – Consequence and Likelihood
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Appendix 2 Performance information (January 2013)
Ambulance
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