Mission Statement “In the next three years, our successful and effective partnerships with our communities, patients and partners will reduce health inequalities and deliver improvements in health for local people within the resources available”
FORMAL BOARD MEETING Wednesday 21 May 2014 Rutland Lodge, Scott Hall Road 15:00 – 18:00 (Held in Public) AGENDA
Item No. Item Presented By Paper Y/N Time 001/2014 Board Welcome and Apologies Dr Jason Broch N 15:00
002/2014 Board Declarations of Interest Dr Jason Broch N 15:03
Approval of Board Minutes from 003/2014 Board Dr Jason Broch Y 15:05 meeting held on 19 March 2014
Matters Arising / Actions from 004/2014 Board Dr Jason Broch Y 15:10 19 March 2014
005/2014 Board Chair’s Report Dr Jason Broch N 15:20
006/2014 Board Chief Officer’s Report Nigel Gray Y 15.30
Patient and Public Involvement 007/2014 Board Liane Langdon Y 15.40 Update
008/2014 Board Quality Update Dr Manjit Purewal Y 15.50
Clear and Credible Plan – 009/2014 Board Liane Langdon Y 16.00 Quarter 4 Update
Finance Update:
010/2014 Board a) Cover Sheet Martin Wright Y 16.10 b) Annex A and B Y
Corporate Risk Register 011/2014 Board a) Cover Sheet Martin Wright Y 16:20 b) Register Y
Sustainable Development Management Plan: 012/2014 Board Briony Pete 16.25 a) Cover Sheet Y b) Plan Y
Director of Public Health Report 013/2014 Board a) Cover Sheet Lucy Jackson Y 16.35 b) Report Y
LNCCG Formal Public Board Agenda – 21 May 2014
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Leeds Better Care Fund Submission (Cover Sheet): Y a) Leeds BCF Planning Template Y 014/2014 Board b) Leeds BCF Finance Nigel Gray Y 16.55 Template c) Leeds BCF Supplementary Y Information Feedback from Governance, 015/2014 Board Performance & Risk Committee Nigel Gray N 17.05 3 April 2014 Feedback from Council of 016/2014 Board Dr Jason Broch N 17.15 Members Meeting 8 April 2014 Feedback from Quality & 017/2014 Board Safety Committee Dr Manjit Purewal N 17.25 22 April 2014 Feedback from Audit 018/2014 Board Peter Myers N 17.35 Committee 14 May 2014 Questions from Members of 019/2014 Board All N 17.45 Public 020/2014 Board Any Other Business All N 17:55
Next Public Board Meeting: Annual General Meeting Tuesday 1 July 2014 15:30 – 18:00 Venue: Leeds Seventeen Nursery Lane, LS17 7HW Papers for LNCCG Board Members Declaration of Interest Register information Final Patient Assurance Group Minutes – 1 April 2014 only Draft Governance, Performance & Risk Committee Minutes – 3 April 2014 Draft Council of Members Minutes – 8 April 2014 Draft Quality & Safety Committee Minutes – 22 April 2014 Human Resources Policies Approved at GPR – 3 April 2014 Commissioning Support Unit Proposed Merger (North Yorkshire & Humber CSU and West & South Yorkshire and Bassetlaw CSU)
LNCCG Formal Public Board Agenda – 21 May 2014
Page 2 of 2 003/2014 Board
Board Meeting Wednesday 19 March 2014 Moortown Baptist Church DRAFT Minutes
Members Role Present Apologies
Dr Jason Broch (JB) Clinical Chair Nigel Gray (NG) Chief Officer Dr Manjit Purewal (MP) Clinical Director Dr Simon Robinson (SR) GP Non-Executive Director Dr Nick Ibbotson (NI) GP Non-Executive Director Dr Mark Freeman (MF) Secondary Care Consultant Martin Wright (MW) Chief Financial Officer Director of Commissioning and Liane Langdon (LL) Strategic Development Petra Morgan (PM) Management Executive Lucy Jackson (LJ) Consultant in Public Health Ellie Monkhouse (EM) Director of Nursing and Quality Peter Myers (PMy) Lay Member – Governance Graham Prestwich (GPr) Lay Member – PPI IN ATTENDANCE
Corporate Governance Lead / Rabia Patel (RP) Board Secretary Joanne France (JF) Secretariat (Minutes) Richard Gibson (RG) Head of Governance (Part)
003/2014 Board – Draft Board Minutes 19.03.2014
Page 1 of 19 Item No. Agenda Item Action 193/2014 Welcome and Apologies The Chair welcomed everyone to the last meeting of 2013/2014 Leeds North CCG Board. Board members introduced themselves to the members of the public in attendance. Apologies were noted as above. 194/2014 Declarations of Interest There were no further declarations presented at the Board in relation to the agenda items. Note 195/2014 Approval of Board Minutes 19 February 2014 Subject to the requested amendment on page 6 (AOB The Clear and Credible Plan) the Board accepted the minutes as an accurate record of the meeting held 19 February 2014. Note 196/2014 Matters Arising / Actions from 19 February 2014 All actions from 19 February 2014 are now complete. Note 197/2014 Chairs Report JB thanked Board Members and Leeds North (LN) staff for their work throughout the year and commented that LNCCG are very lucky to have staff who want to support each other to develop the organisation. JB added that given the pressures the CCG have faced, we can be assured future planning is in place to develop the CCG for its patients. JB updated the Board in the following areas:
The Better Care Fund Planning is ongoing but will be ready to meet the submission deadline. We are well on the way in developing the Leeds Wide Strategy. Our commitment to the residents of Leeds North, now that the tick boxes are out of the way is to progress public engagement. Transformation – there has been a lot of discussion over the past few weeks to ensure appropriate and robust structures are in place to underpin the work to we want to achieve through transformation. Informatics – We are currently looking at developing patient facing communication to help local people understand more about the different data sharing initiatives in the city.
Business Intelligence – LNCCG is taking the lead in building some specialist analytical capacity across health and social care to ensure that any transformational change schemes are evidence led. This work will help describe the flow of patients and money around the systems against which the impact of change proposals can be assessed.
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Page 2 of 19 Item No. Agenda Item Action Health & Care Expo 2014 – JB attended the event and spoke about how commissioning is now and what the future looks like. Discussions afterwards prompted really good conversations and ideas - our CCG was asked to be involved in further discussions about potential national pilot work. 198/2014 Chief Officers Report NG provided additional information on some of the key headings in the Chief Officers update report. Burmantofts Walk-in Centre – this is now up and running and being managed by Malling Health Ltd. Strategy and Transformation – the programmes have been agreed along with the clinical and accountable leads for each of the workstreams. NG referred Board members and those in attendance to the Transformation Programmes diagram within the report. Urgent Care – the programme will try to make it clearer to patients about the most appropriate services available to them. Effective Admission and Discharge – the programme will focus on preventing admission from A&E, early supported discharge, appropriate discharge and prevention of re-admissions.
Goods and Services Review – The focus will be on generating savings from estates and from procurement of goods and services across the economy. Performance – EM highlighted work on healthcare associated infections (HCAIs), either present in the community or acquired in hospital. Future work will focus on how the infections occur.
A&E Waiting Times – Modelling work has been undertaken to evidence what levels of performance are required to maintain target achievement - we remain confident that we will deliver and meet the target. 18 Weeks Admitted – The 90% standard was achieved for the fifth time during the year with performance for LNCCG at 91.5% in December 2013.
Cancer 62 Day RTT (Urgent GP Referral) – The drop in performance meant that the overall standard during Quarter 3 was not achieved, although year to date performance remains above the national standard. Cancer 2 Week Waits - The target was not achieved in December, but the Board can be assured that an action plan has been developed and is now in place to address current performance.
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Page 3 of 19 Item No. Agenda Item Action Ambulance Response Times – For LN YAS is consistently not achieving the Red One 8 minute and 19 minute standards. We are working with YAS to put actions in place to improve this target. Quarter 3 Assurance - Discussion has been held with the Area Team around several of the performance targets. The Area Team appeared assured following the discussions and will be providing feedback by the end of the month.
Winter Planning – Patients and public should be fully aware of what the commissioning intension looks like and the plans for next year. System remodelling will be undertaken if necessary to meet the needs of the population.
PPI - Feedback and results are being given to our Patient Groups during March 2014 following our recent consultation with patients about Call to Action and our commissioning intentions for the next two years. Organisational Development – We are working together to ensure LNCCG is robust and well governed and working alongside GPs to develop systems to ensure money and tasks are managed and accountable. LNCCG Board will continue to strive and explore further what it means to live the values of our organisation.
003/2014 Board – Draft Board Minutes 19.03.2014
Page 4 of 19 Item No. Agenda Item Action 199/2014 Patients and Public Involvement Update LL advised the Board how we are actively involving our patients and the wider public in the work we do and the update report captures some of the key activities we have undertaken during February and early March 2014. We have consulted widely on NHS Leeds North’s “Commissioning Intentions” for 2014 – 2016 and the responses (over 1,000) have been collated and will be shared with our Community and Patient Partnership Group (CPPG) and Patient Reference Group (PRG) meeting representatives in March. Following the completion of consultation we are drafting “Call to Action” reports and these will demonstrate how we talked to patients, what patients said and give key recommendations. In addition LL updated the Board on issues that have occurred since the report was written: We have invested in an asset based investment model for children receiving urgent care. This has been confirmed in the last week. We have been selected as a pilot site for the Working Voices Pilot Programme. This is work around urgent care and mental health services, and will target people who are in employment. GPr – added regarding the commissioning intension work, that it is important we show how the feedback has informed what we do, the sequence of events need to be fed through appropriate routes. Conversations with individual groups and then NG with LL will take the conversation wider. Although there has been lots of effort and involvement we must continue to ensure that we keep the public involved by responding to their suggestions. Patients Group in LNCCG has attracted interest from other CCGs to adopt a similar approach in the cycle of events so that there is a consistent approach across the city. LL advised of the next steps: Meet with Patient Groups to give commissioning intentions feedback. Publish the report on the consultation with patients on “Call to Action”. Build on the foundations laid in NHS Leeds North CCG to enhance involvement with our population. Continue with scheduled engagement activities. Review the PPI programme for 2013/14 and make improvements to the 2014/15 programme in the light of this review. Action: LL to provide an update at the next Board meeting, 21 May 2014. LL
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Page 5 of 19 Item No. Agenda Item Action 199/2014 Patients and Public Involvement Update (Continued) Public Question: What are we doing about patient reference groups in surgeries? SR advised that engagement with groups have been in existence before CCGs were established. However, it would be better to have more dialogue between the groups. CCGs would welcome further interaction and engagement as attendance is usually only around 50%. Information has been published at Council of Members meetings where all LN practices are represented. We are hoping to have more of an agenda from the CCG to take to reference groups for Q&A session with a coordinated response back to the CCG. SR added it would be good to have an email network between the CCG and members of the Practice Reference Groups. If practices were involved in getting data sharing consent for CCG purposes then we would have a further layer of involvement from patients. LL advised that in fact that emails have been provided to GPs but the consent does not include passing on personal details to CCGs. However, GPs are asking patient groups if they are happy for us to use this data. The commissioning support unit do have consent to use the personal data (email addresses) and work is progressing to ensure the data provided is consented to use by Patient Reference Groups.
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Page 6 of 19 Item No. Agenda Item Action 199/2014 Patients and Public Involvement Update (Continued) Public Question - How do we get the public to attend? SR advised there are different systems of Patient Reference Groups. Often the groups are patient led. SR advised it is a partnership with the patient and the practice as to how they want to run the groups. Public Comment - The public involvement is not good – how can we rectify this? The public don’t know enough, HealthWatch aren’t aware. NI commented that communication is key to open up links with any group. The public want an open arena to be able to ask questions. NG commented on the publicity around public attendance at Board meetings and asked if the member of the public had any suggestions to increase attendance and engagement opportunities at any of the LN Groups then please do advise us. JB advised of the difficulties, but also of LNCCG determination to engage with public for patients to have impact and involvement with the services provided by CCG. Patient Reference Groups – one of the most important things is to be aware of patients' needs from the practice. From a CCG point of view we want to piggy back off those groups, but the focus needs to be on how we can make the service that you receive in your local community better. This is not easy to do but we are dedicated to make these more robust. PMy – we need to consider how to increase attendance at Board Meetings. There is no shortage of passion but we should systematically go through the issues to understand the factors we can influence, for example, choice of venues and travel logistics. Advertising the location and venue may increase the level of attendance and the opportunity to interact with more people. JB advised that various venue options are currently being considered for the forthcoming year – The Board will be kept up to date with all options. GPr advised of other opportunities to engage with the CCG outside of the Board meetings, this is structured around getting people involved in decision making. LTHT have now closed their consultation, receiving a huge number of comments which will be disseminated through CCGs.
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Page 7 of 19 Item No. Agenda Item Action 200/2014 Quality Update EM updated the Board on key issues and actions relating to quality highlights within the CCG and its main providers. The paper presented provides a short update on HCAI national objectives from NHS England on C Diff for 2014/15, commissioned providers and an update on CQUINs. NHS England C Diff objectives and current target for this year is 45. C Diff has increased in the community – in depth work is being undertaken and there are some incentives around a 2% bid to support quality initiatives. This will also include looking to appoint an infection nurse. There is a C Diff card available as a hand out. The Medicines Management Team is working on an Application but at present this will be for GPs and community nurses for use when prescribing. Trajectories – Working with public health for trajectory during the year in relation to seasonal peaks and troughs. Providers Update – LTHT full CQC visit is taking place and the Trust is preparing for this. The CQC have approached CCGs for information. New monthly ward health checks have been introduced which includes a number of quality metrics including staffing, complaints, staff feedback and ward cleaning and HCAI. Mental Health Trust – Since the last Board meeting an inspection took place at the Mount, Woodlands Square and the Newsham Centre. All three units were found to be fully compliant. LCH – Following previous updates on the intermediate care unit at Seacroft Hospital a review took place and the suspension on this unit was lifted with caveats in place and information required provided to the Director of Nursing and Quality before this unit was re-opened. CQUINs – The key aim is to support improvements in the quality of services and the creation of new, improved patterns of care.
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Page 8 of 19 Item No. Agenda Item Action
A full update on the agreed CQUINs was provided. Schedules 4 and 6 have been amended to reflect requirements following the Francis report requirements. Update from Francis Report – As part of the contractual CCG process, the schedules within the national contract for 2014/15, which relate to quality have been reviewed to ensure reporting and data collection are captured. LNCCG Board can be assured that any action arising from the outcome of the report will be included in the contractual obligation. Development Work – Work continues with colleagues in local network links across two area teams and other CCGs. Working together to share information to ensure triangulation. Work with Leeds City Council regarding quality of care in nursing and care homes. Managers will work with the team at LCC to develop a new streamlined quality framework and inspection process, this will be a joint venture across health and social care.
EM advised of the next steps: The CCG/Public Health HCAI action plan will be refreshed and agreed at the next HCAI operational meeting in April and then shared through CCG governance processes. A full update on the agreed CQUINs and Schedule 4 and 6 to be provided for each provider to the quality sub group. CIP reviews for all providers’ for this Quarter take place in February and March 2014. A comprehensive review and scoping of the Francis Report and other key reports has taken place. Recommendations and actions for CCG’s are now being mapped to the 4 commitments to Francis to develop an action plan, which will be shared with the Executive/Board/Leeds Quality Surveillance Group when complete. Recruitment process LN are leading on the quality coffee morning at Leeds 17 to share cost improvement in relation to work to be carried out next year. GPr commented that there is a huge focus on measurement and action plans being put in place however, from the service user perspective it would be good to see in the report evidence of what has actually changed as a result of the Francis Report. What difference are we making for example, from the Family and Friends test, in relation to Francis we need to highlight the positive improvement. What difference are we making for example, from the Family and Friends survey this has taken huge steps in relation to Francis but we need to highlight the positive movement.
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Page 9 of 19 Item No. Agenda Item Action NI asked about the Family and Friends data – when will the results be available? EM advised the combined result shows that this is doing quite well, although it can be quite subjective and could depend on how and when information is captured. 201/2014 Clear and Credible Plan Report – Quarter 3 Update LL presented a report to the Board with an update in relation to the next quarter. LL advised the Board of the 110 measures in Quarter 3 and the progress made against almost all of them. Using Red / Amber / Green (RAG) rating, more than 100 are now classed as Green. However, there are some key measures that remain amber. These include: Procurement of specific groups of medicines; this has been delayed due to national changes in procurement and rulings regarding rebate schemes Review of maternity and neonatal services; this has been halted due to provider re-organisation Estates strategy; this been postponed to allow it to fit in with the national planning round.
LL advised of the promises made at the last Board meeting and the key deliverables for Quarter 4. An update on Quarter 4 will be provided at the next Board meeting. LL Recommendation
The Board are asked to:
Accept the content of this report and the progress made against our Clear and Credible Plan in Quarter 3. Resolution
The Board:
The Board accept the content of this report and the progress Note made against our Clear and Credible Plan in Quarter 3.
003/2014 Board – Draft Board Minutes 19.03.2014
Page 10 of 19 Item No. Agenda Item Action 202a/2014 Finance and Contract Update MW provided an update to the Board on the Financial Position 2013/14. (MW apologised for the missing piece of information which was provided as a hard copy to the Board members at the meeting). This report summarises the month end position of NHS Leeds North Clinical Commissioning Group (CCG). It incorporates performance against key financial duties as at 31 January 2014, highlighting areas of potential risk and potential action for the Board to discuss and ratify. We have met financial duties and there were no major surprises and we are confident that we will meet our end of year target. The financial performance and risks will be reported to the Board on a monthly basis. Recommendations
The Board is asked to:
Receive and comment on the Leeds North CCG financial position and performance against key financial duties. Review the risks highlighted within the report. Resolution
The Board:
Received and commented on the Leeds North CCG financial position and performance against key financial duties. Note Reviewed the risks highlighted within the report. Note 202b/2014 Finance and Contract Update MW provided a summary of the current financial planning assumptions together with the resultant draft revenue budget for 2014/15. These are based on the financial plans which have been prepared in line with the “Everyone Counts” planning guidance published in December 2013. Draft financial plans were submitted as per the national timetable on 14 February 2014. Our plans are set within the NHS England planning requirements, LNCCG have fully met the expected requirements. Financial Risks – This is mainly around continuing care and has been put forward by NHS England which CCGs are compelled to join. Initial guidance was that CCGs would not have to contribute but this is now becoming apparent that CCGs will have to contribute. The Board are asked to note that this is a risk, but one which will be covered by the contingency budget.
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Page 11 of 19 Item No. Agenda Item Action Contracts – The contract with LTHT was agreed and the Harrogate Foundation Trust (HFT) contract was signed off with a requirement to make efficiency savings, LNCCG and citywide efficiencies will be reinvested into the areas of mental health. GPr commented that whilst some cost cutting is inevitable – when it comes to the prescribing budget, if we lose a further £332k we need to consider how this will affect the quality of patient care. MW advised that the reduction is partly due to our success in managing the prescribing budget. Cutting out waste has enabled us to reduce the budget and reinvest in other areas. LNCCG running costs remain static for next year but there will be a 10% reduction for 2015/2016. Planning will be undertaken accordingly, in line with available budgets. As always we will continue a push to reduce waste. PM commented that we have comparison data across the CCGs Yorkshire and Humber and quality is high on the agenda. All our incentive schemes are about reducing waste and appropriate prescribing. NI – The focus of the Better Care Fund ensures appropriate services are available as an alternative to attending A&E. PM – Most of the approved 2% bids have been projects where different providers such as third sector are being used or joint working arrangements with practices to look how we can do things differently. JB - In terms of translating the change and how this appears in the budget, this is about costing transformation and although it’s a difficult task there is a huge appetite amongst commission healthcare providers to work more efficiently and more appropriately. There is definitely a strong commitment to this way of working. PMy – The headings in the Clear and Credible Plan and the alignment with the Financial Plan are very accurate and provide assurance that the CCG has strong financial plans in place to meet priorities and demands, accounting for unexpected contingency. Key Recommendations
The Board is asked to:
Receive, comment and approve the Leeds North CCG financial plans and draft 2014/15 budgets.
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Page 12 of 19 Item No. Agenda Item Action Recommendations
The Board:
Received, commented and approve the Leeds North CCG Note financial plans and draft 2014/15 budgets. 203/2014 Board Assurance Framework MW welcomed Richard Gibson, Head of Governance, to introduce the Board Assurance Framework. RG advised that the paper provides Leeds North Board with an updated position on the organisation’s Board Assurance Framework (BAF). The Board Assurance Framework is a statutory document that records the risks identified by the Board that may impact of the strategic intent of Leeds North Clinical Commissioning Group. The governance team have been working alongside risk leads to ensure we have assurance to identify potential risks for the CCG. The BAF has been developed following the Board Workshop, August 2013. The document is usually presented to the Governance, Performance and Risk Committee. However due to the cancellation of the last meeting it was imperative that the Board are kept informed of current and future risks. GPr asked that this improvement is continued and that actions taken must be shown to be effective. RG advised that the process and information will be embedded to continually provide assurance. SR – Identified Risk Ref 3, 4, 6 as examples where it is not initially clear whether this is better or worse than previously reported. For future BAF reports, the Board asked RG to use an arrow system to indicate trend movement showing whether the risks have improved, remained static or deteriorated. RG / RP PMy agreed with an arrow system and identified Risk Ref 4 and 6 where owners are allocated but regardless of trend this cannot remain on the risk register as ‘Red’ and expect the Board to be comfortable with the gaps in controls. LL advised that since the report was published we can be confident with the work recently undertaken. We have flagged in terms of a refresh, but there is a huge amount of work being undertaken and the risk is likely to reduce to Amber in July. The Hospital Trust has their strategy out for consultation which highlights how they are going to address this issue, but until LL feels confident it is better to keep the risk as ‘Red’ until the assurance is provided. When there is recommendation to change a score is ratification sought from Governance, Performance and Risk Committee? The Board were advised that this is the case.
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Page 13 of 19 Item No. Agenda Item Action Progress on the contract also involves work with the Area Team as this is not solely a CCG responsibility / action. It is not always within our gift to change the rating of a risk, we can advise and aim to influence a change providing assurance it is not the sole responsibility of LN. If it is deemed not to be full responsibility of LN then it cannot be full responsibility of LNCCG Board. NG advised of some of the anomalies with risks that are not clear cut LNCCG risks such as the specialised commissioning services. As a unit of planning, we have a shared responsibility for the city wide risk. We have the lead responsibility in terms of commissioning to ensure a sustainable system is shared with the other two Leeds CCGs. RG is asked to review the controls and the consistency of the controls and accountability placed on LNCCG Boards to take ownership if this is a city wide risk. PMy asked to look at the residual risks to LNCCG should more be contained in the Strategy rather than identified on the Risk Register. JB suggested discussing this in more detail outside of the Board meeting. Key Recommendations
The CCG Board is asked to:
Note and comment on the current BAF risks.
Resolution
The Board
Note and commented on the current BAF risks. Note
204/2014 Corporate Risk Register RG presented the Corporate Risk Register and described those risks identified by risk owners as being considered significant enough to require escalation to the LNCCG Board. The Governance Team continues to train managers in the use of the Datix System for the management of risks to ensure that all pertinent risks are captured and reviewed in-line with the Leeds North CCG Risk Management Strategy. The city-wide risk management strategy is currently the subject of an internal audit.
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Page 14 of 19 Item No. Agenda Item Action There are currently four risks on the Register and the Board were asked if they would like to comment or request any changes on the current scores. MW pointed out that a lower scoring risk could be transferred to be monitored operationally. PMy asked if the document presented to LNCCG was different from the other two Leeds CCGs. RG advised that some were cross cutting risks, and that some risks are deemed more critical in some Leeds CCGs and not solely significant to LNCCG. Each Leeds CCG has their own Risk Register. Queries regarding the City Wide Risks and who identifies the controls. EM asked if the risks are city-wide, should there be a city-wide Risk Register. JB tried to clarify the city-wide Risks and advised each CCG can determine the level of risk to their CCG. Back to GPR for further discussion and clarity. NG advised that as these are significant performance issues to LNCCG and previously discussed with Executive, will Board accept they remain on the register to assure the Board that issue RG / RP are progressing and take comments back to GPR. Key Recommendations
The Board is asked to:
Consider and agree the current corporate risks. Resolution
The Board do not fully agree or understand the current Risks but accept they remain on the register to assure the Board that issue are progressing and take comments back to GPR. Note
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Page 15 of 19 Item No. Agenda Item Action 205/2014 Policy Ratification 205a Pay Progression Policy 205b Information Governance Policies Extension LL advised that under normal circumstances the Policy changes would be presented to GPR for ratification, but as there are significant changes to the new arrangements in terms of the workforce it was felt more appropriate to bring this to the Board for consideration and support with the revised appraisal / pay process. The Pay Progression Policy is a new policy following national changes to Agenda for Change NHS Terms and Conditions. Pay progression has previously been linked to the Key Skills Framework (KSF) whereby increments would be automatic until staff reached a gateway. At a gateway managers were expected to assess performance and decide if staff are competent to progress. Under the new arrangements incremental progression is ‘closed’, which means that payroll will have to be notified of an individual’s right to progress on an annual basis opposed to specific gateways. Consultation has taken place with management, staff and trade unions. The policy was presented at the Leeds CCG Social Partnership Forum, attended by trade union representatives on 20 January 2014.
PMy asked for clarify around the behaviours and objectives gateway. LL clarified that the criteria around the behaviours and objectives, along with the assessment framework checklist is completed to assess performance and in turn determine if an employee receives an increment or not. PMy advised the Board to air on the side of caution. Note Key Recommendations
The Board are asked to approve and ratify the policies.
Resolution
The Board approved and ratified the Pay Progression policy. Note
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Page 16 of 19 Item No. Agenda Item Action MW highlighted that Information Governance (IG) is a key statutory responsibility of the Clinical Commissioning Group (CCG). Policies, processes and procedures are required to ensure that information is managed securely, safely and within the Law. The CCG has appointed a Senior Information Risk Owner (SIRO) to ensure that a robust information management framework is in place and complied with. A Caldicott Guardian has been appointed to ensure that patient information is used appropriately and within the Law. The policies to be extended are as follows: Confidentiality Code of Conduct Records Management Policy E-mail Policy Information Governance strategy Information Governance policy Safe Haven Policy Network Security Policy Policy on the safe transfer of records Internet Policy Moveable Media Policy JB asked if there are risks that could arise from extending the review. No risks. Key Recommendations
The Board is asked to approve that the CCG Information Governance policies are extended for a further 6 months to August 2014. Resolution
The Board approve that the CCG Information Governance policies are extended for a further 6 months to August 2014. Note
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Page 17 of 19 Item No. Agenda Item Action 206/2014 Feedback from Council of Members Meeting 4 March 2014 SR advised on the minutes available to the Board, but commented also on how the meetings are minuted. NI advised that the last meeting was very well attended and it enabled good constructive discussion. More action points required from the minutes, registering ideas and suggestions. PM added that discussions were around the quality of the workstreams and that engagement with practices is essential. JB advised that the Non-Execs felt that there needs to be more robustness around PPI, actions and outcomes at Council. 207/2014 Feedback from Quality & Safety Committee GPr chaired the meeting in the absence of MP. When MP arrived at the meeting it was then quorate and more in-depth and recorded discussions took place. The dashboards were introduced and the need for a mechanism to review and analyse the dashboard information to add value to the quality and provide assurance to the Board. NI – confusion around the remit of GPR and Quality and Safety Committees. NG advised that this has been discussed in the past but it could become very lengthy in terms of the necessary discussion around performance and quality items. NG is happy to discuss the future of both Committees in the current format. JB advised of the initial discussions when the CCG was established nearly a year ago. Although there is some crossover, the quality agenda needs such focussed discussion around quality and the services provided it would be better for now to keep them separate so that the emphasis on quality doesn’t diminish. GPr asked that a Quality Workshop can be arranged as soon as possible to determine the focus of the group – ‘Quality of Care’. There is a need to turn the intelligence into information for discussion at Q&S Committee. EM PMy asked for clarity on the roles and responsibilities of the two committees. NG advised that the Quality Committee has to be clinically driven and further discussions must be with the clinicians who unfortunately are absent from this discussion (EM left the room during this agenda item). The view of the Board members present was to keep the two committees separate. Serious Incident reporting was key item to be presented.
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Page 18 of 19 Item No. Agenda Item Action 208/2014 Questions from Members of Public Data Sharing Charter for Leeds – This is purely about getting it right for Leeds. Sexual Health / Drug and Alcohol Services - We are lead commissioners for these but this is part of the review programme for the Local Authority. Burmantofts Walk-in Service – was there any expressions of interest from NHS – expressions of interest were received from 19 providers, some were from NHS all were invited to bid for the service but part of the scope was to be able to cope with the timescales of the services. Six were reviewed as potential. The provider was selected on the one most able to provide the service within the required specifications. Public Participation – Patient Voice is good but there is a lack of influence and involvement. How can the public have an influence of the future choices on what happens in the NHS, how can we have an influence when the procurement is done in house? LL advised that the public do have an influence and did so with the procurement of the Walk-in Centre Provider. Woodlands – FOI requests, work is progressing with the Area Team regarding the registering of patients around allocating patients and giving patients the right to choose. We are still seeing new registrations on a weekly basis. 209/2014 AOB There were no further issues raised. Date of Next Meeting Board Workshop 16 April 2014 Public Board meeting 21 May 2014
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Page 19 of 19 004/2014 Board
Board Meeting Wednesday 19 March 2014 Moortown Baptist Church DRAFT Actions
Chair – Dr Jason Broch Secretary – Joanne France
Item Action Action Deadline Status/Progress No. by
199/2014 Patients and Public Involvement Update LL 21 May 2014 LL to provide an update on ‘next steps’ at the next Board meeting, 21 May 2014. 200/2014 Quality EM 21 May 2014 A comprehensive review and scoping of the Francis Report and other key reports has taken place. Recommendations and actions for CCG’s are now being mapped to the 4 commitments to Francis to develop an action plan, which will be shared with the Executive/Board/Leeds Quality Surveillance Group when complete 201/2014 Clear and Credible Plan Report An update on Quarter 4 will be provided at the 21 May 2014 next Board meeting. LL 203/2014 Board Assurance Framework SR – Identified Risk Ref 3, 4, 6 as examples RG / RP 21 May 2014 where it is not initially clear whether this is better or worse than previously reported. For future BAF reports, the Board asked RG to use an arrow system to indicate trend movement showing whether the risks have improved, remained static or deteriorated.
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Item Action Action Deadline Status/Progress No. by
204/2014 Corporate Risk Register EM raised regarding if risks are City Wide 5 June 2014 Risks, should there not be a City Wide Risk Register.
JB tried to clarify the City Wide Risks and advised each CCG can determine the level of risk to their CCG. Back to GPR for further discussion and clarity. RG / RP NG advised that as these are significant performance issues to LNCCG and previously discussed with Executive, will Board accept they remain on the register to assure the Board that issue are progressing and take comments back to GPR. 207/2014 Feedback from Quality & Safety Committee GPr asked that a Quality Workshop can be EM 22 April 2014 arranged as soon as possible to determine the focus of the group – ‘Quality of Care’. There is a need to turn the intelligence into information for discussion at Q&S Committee. Date of next meeting: Venue: Wednesday 21 May 2014 Rutland Lodge, Scott Hall Road, LS7 3DR 15:00 – 18:00
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Summary Report Meeting: LNCCG Board Date: 21 May 2014 Agenda Item: 006/2014 Report Title: Chief Officer’s Report Prepared by: Nigel Gray – Chief Officer Executive Lead: Nigel Gray Presented by: Nigel Gray Other meetings presented to: N/A Purpose of Report Approval Decision Assurance Information and Comment
Executive Summary This report highlights to the Board an overview of key issues of strategic importance and provides a reflection of key issues for us locally.
Annual Report draft submitted to Area Team
The draft Annual Report was submitted to the Area Team on 23 April 2014. I would like to thank everyone for their contribution and hard work to meet the very challenging deadlines we were presented with.
The full audited and signed Annual Report and Accounts, approved by the Board and signed and dated by the Chief Officer, must be submitted by the CCG on 6 June 2014. The Annual Report and Accounts will be presented at the LNCCG’s Annual General Meeting on 1 July 2014.
Primary Care Developments
You might have heard by now that we were not successful in our bid to be part of the Prime Minister’s Challenge Fund, with our proposal based around practice based integrated unscheduled care. Apparently, more than 250 expressions of interest were received. For those CCGs who were not successful, NHS England is now looking to establish some networks to share learning regionally and nationally. Here at Leeds North, we are looking into how we can develop the proposal on a more local level over the next few months.
Shadwell Health Centre is having a change of GP partners. Three of the GP partners at the Shadwell Medical Centre will be leaving the practice in May. The fourth GP partner, Dr Ian Barge, will remain with the practice. There are no plans to close this practice and patients should continue to use the medical centre as normal. Patients with concerns have been asked to contact the NHS England Customer Contact Centre for more information.
NHS England is working with the remaining GP partner to ensure immediate and longer- term plans are put in place at the practice, so that patients continue to receive high-quality and local health services.
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Page 1 of 4 Local Issues
The sad news of the events affecting local teacher Ann McGuire has shaken the city. CCG and hospital leaders met up with the local authority to consider any learning and immediate actions. I was pleased to hear this is not the norm for the city; knife crime is not prolific in the city. There has been a lot of media and safeguarding interest in this so thank you to those who have made sure we stay focused at times like this. Our thoughts, along with many others, go out to Ann’s family and her school.
Transformation and Strategy Update
Our local transformation streams are gathering pace. I updated the Board on this last month. We also have 4 work streams that we are part of across West Yorkshire. I thought It would be helpful to focus on these this month:
Stroke - This has two components. Prevention of stroke – looking at atrial fibrillation and ensure anticoagulant services are in place. The second looking at the coordination of Stroke inpatient and outpatient services across West Yorkshire. Cancer - The focus here is on reducing variations in referral and looking at key pathways and ensuring timeliness to meet the 31 and 62 day referral targets. Children - Focus here will be to look at paediatric surgery, childhood asthma and children’s mental health services. Urgent Care - This is predominantly looking at Acute Hospital Reconfiguration issues and the impact they will have on emergency centre.
We as a city have also signed off our ‘strategic statement’, see below. This pulls us together as a city and ensures a common vision and joined up thinking.
‘A best city approach to health and care services – organisations working as one’. We have 4 principles:
Working with patients, carers, young people and families to enable them to take control of their own health and social care needs.
Provide high level quality services in the right place backed by excellent research innovation and technology.
Remove barriers to make working across organisations and profession groups the norm, so people receive seamless integrated care.
Use the Leeds £, our money and other resources, wisely for the good of the people we serve in a way in which also balances the books for the city
006/2014 Board – Chief Officer’s Report
Page 2 of 4 Performance
A number of our performance indicators remain a concern. These include; HCAI, Cancer Waiting Times and ambulance response times. We have joint plans with all providers to improve these positions. Contracts have been signed with providers to encourage an improved performance position and will be monitored at least monthly. The 18 week RTT position for the year ending in March 2014 has yet to be confirmed, but we are hoping to report an achievement in this area. A significant positive start to the new financial year.
Maternity Services Update
Maternity services in Leeds are commissioned by Leeds South and East Clinical Commissioning Group (LSECCG) on behalf of all the CCGs in Leeds. The CCGs strive to commission excellent local maternity services that meet the needs of women in Leeds, offers them an equal choice of where to have their babies and most importantly, are high quality and safe. Current policy is to support our existing local providers of maternity services and work with them to improve the provision of maternity care. We believe that we currently commission enough capacity to support patient choice and thus, there are no plans to increase capacity.
We know that mothers who live in the Leeds area generally choose to give birth at St James’s or the LGI, but we also have mothers who choose to give birth in Harrogate, Wakefield, Dewsbury or Bradford and all of these hospitals already offer personalised maternity care, offering choice and continuity of care . If we were looking to change our policy and expand services to include other providers, we would do so through an open procurement process, which would involve a range of providers.
We are aware a company called One to One (North West) Limited would like to provide services in Leeds and across West Yorkshire. The main concern about One to One (North West) Limited, or any other provider, is that if we were to contract with them we would need to be assured of the governance of the service they are offering in Leeds, in particular around the transfer back to the NHS if there are complications and a patient needs emergency specialist care.
Leeds CCGs do not currently contract with One to One and have no intention to do so at this time. If a patient wishes to secure the services of One to One maternity services, they would need their GP to agree that their needs are not being met by the current range of services offered and the GP would need to refer to individual funding request and commissioning policies on our website.
CSU News
We have had news from the CSU that they are merging with North Yorkshire and Humber CSU to become Yorkshire and Humber CSU. The merger is at a very early stage, but we are assured that this will mean they are able to offer us a greater range of services and greater efficiencies. More news about developments on this will follow later in the year.
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Page 3 of 4 Being a Sustainable Organisation
We are working to reduce the amount of gas we use at Leafield House. Since the end of February, we have managed to reduce our usage by an average of 12%. Now it is getting a bit warmer we will be adjusting the heating controls again to make sure we are not overheating the building.
Specialist Commissioning.
I would like to make the Board aware of the specialist commissioning that operates at an NHS England / Area Team level. For us, the Team work out of South Yorkshire Area Team offices in Sheffield. Nationally these type of services have been over trading over this last year in 2013/14, resulting in a £62 million problem in Yorkshire & Humber alone, of which around £30 million will be attributable to LTHT on the basis of last year’s outturn. Of this around £10million is an LTHT issue affecting all of West Yorkshire. Although this is not a CCG issue, we are going to work closely with our Area Team colleagues to consider all options to sustainably address this overtrade. An action plan will be formulated between colleagues and I will update the Board further as details emerge.
Eccleshill Treatment Centre
In early April, we were informed that Care UK will no longer be providing services from the Eccleshill Treatment Centre in Bradford, as from 7 July this year. This will have a limited impact, as Leeds only sends a small number of elective cases to the unit. Colleagues at Bradford CCG are working to procure a service for the Eccleshill site for when the existing contract expires. NHS Leeds West CCG are leading these discussions for the city and are working with LTHT to ensure there is enough capacity to meet the needs of our population, including consideration of the facilities at Wharfedale.
Tour de France
Grand depart for the Tour de France will be in Leeds on 5 July. Initial assurance plans have been received from Partners / Providers. The Area Team is the lead communicator. Leeds North CCG is the cross city lead on urgent care and is working with the Area Team and Local Authority on this. We remain confident that plans are in place to ensure this even is a success.
News from the Healthwatch Leeds Team
We look forward to welcoming its new Director, Tanya Matilainen, to Leeds. She will commence her post on Tuesday 6 May. Tanya started her career in nursing and has held a number of senior posts within Healthcare.
The Board is asked to receive the Chief Officer’s report.
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Page 4 of 4 006/2014 Board
A ‘best city’ approach to health and care services - organisations working as one
As leaders of organisations across the city, we organisation’ to improve the health and wellbeing of have come together to set an ambition to create the people who live or use services in Leeds. a sustainable, high quality health and social care system. To do this we have agreed to work together in four ways: We want to ensure that services in Leeds can continue to provide high quality support that meets 1. Work with patients, carers, young people and or exceeds the expectations of children, young families to enable them to take more control of people and adults across the city; the patients and their own health and care needs. carers of today and tomorrow. 2. Provide high quality services in the right place, backed by excellent research, innovation and We know that we will only meet the needs of technology - including more support at home individuals and our population if health and social and in the community, and using hospitals for care workers and their organisations work together specialised care. in partnership. 3. Remove barriers to make team working across organisations and professional groups the norm We understand that the needs of patients and so that people receive seamless integrated citizens are changing; the way in which people want support. to receive care is changing, and that people expect 4. Use the Leeds £, our money and other more flexible approaches that fit in with their lives resources, wisely for the good of the people we and families. serve in a way in which also balances the books for the city. Front line staff, leaders and managers across organisations are coming together in many ways. This will be how we improve health and care We are working closely with the voluntary, faith and services for people in Leeds and we are committed charitable organisations, universities and investors to working together to make Leeds the Best City in to act as one; as if we were a virtual ‘single the UK for Health and Wellbeing.
Tom Riordan Chris Butler Julian Hartley Bryan Machin Chief Executive Chief Executive Chief Executive Interim Chief Executive Leeds City Council Leeds and York Partnership Leeds Teaching Hospitals Leeds Community Healthcare NHS Foundation Trust NHS Trust NHS Trust
Andy Harris Nigel Gray Phil Corrigan Clinical Chief Officer Chief Officer Chief Officer Leeds South and East Leeds North Clinical Leeds West Clinical Clinical Commissioning Group Commissioning Group Commissioning Group
...working closely with national NHS organisations, patients, their families, carers and the voluntary sector in Leeds.
Summary Report Meeting: LNCCG Board Date: 21 May 2014 Agenda Item: 007/2014 Report Title: Patient and Public Involvement Prepared by: Paul Storey – Management Executive PPI Lead Executive Lead: Liane Langdon – Director of Commissioning and Strategic Development Presented by: Liane Langdon Other meetings presented to: N/A Purpose of Report Approval Decision Assurance Information and Comment Strategic Objectives (tick all that apply) 1. To be a successful and robust organisation that puts clinicians, patients and carers at the forefront of commissioning high quality services based on the needs of local people and within the resources available. 2. To support people to be healthy for longer by promoting better disease management, prevention and early detection and treatment. 3. To drive the transformation of urgent care across the city, improving access and promoting appropriate use of urgent care services. 4. To drive the improvement of services city-wide for people with mental health needs and learning disabilities. 5. To promote choice based on quality of care and improve access to services for people in the Leeds North Clinical Commissioning group area. Executive Summary
We are actively involving our patients and the wider public in the work we do and this update report captures some of the key activities we have undertaken during March, April and early May 2014.
We have now produced a citywide and an NHS Leeds North “Call to Action” report and these documents demonstrate who we talked to, what Patients said and gives key recommendations. This document has been shared widely with our Patients and Stakeholders and is available on the CCG website. Key Recommendations
Working Assurance Groups Introduced
Several sub-groups, made up of Members of the Patient Assurance Group, have been introduced to monitor work streams to assure effectiveness and have met with commissioners. The process is being evaluated and reviewed to ensure that members are assured by the commissioners.
Key PPI Activities
Admissions Avoidance Scheme: Three surveys have been produced and this work is currently underway. A final report should be available at the end of May.
Dementia Diagnosis: An engagement plan has been developed and engagement work is currently underway to talk to patients about the new proposed dementia pathway. The engagement deadline is mid-May and a report with findings will be prepared. 007/2014 Board – Patient and Public Involvement Update
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Leeds Care Record: Leeds North CCG has been leading the development of the Leeds Care Record as part of the programme of work to look at how information is shared in Leeds at a city-wide level. There are currently 3 G.P. Practices that are trialling the system and sharing secured information with Leeds Teaching Hospitals Trust. There are plans to expand this to include all G.P. practice, community health care service and adult social care information into the Leeds Care Record. Having the right information at the right time will allow healthcare professionals more time to provide direct care and improve health and social care outcomes. .
Urgent Care: A CEED (Communication, Engagement, Equality and Diversity) plan has been developed and will be presented to the NHS Leeds PAG, with representatives from South & East, and West, for assurance on the 13 May 2014. .
Respite Care: A meeting has been held with the commissioners and an engagement plan has been written.
Community Asset Based Engagement Pilot: This approach involves using our best asset; the local community, and to engage with them directly and not through a third party. NHS England recommends that CCGs promote active citizenship, putting patients in the driving seat. This method of engagement reflects the thinking of the future and the approach is about working together with the individual third sector community groups as the direct enabler to have those conversations for us with their own communities. We are working with Voluntary Action Leeds (VAL) to look at which third sector groups we can involve in the project.
Children Take Over Day Actions: Leeds North CCG took part in children takeover day and there were a number of recommendations from the children following their time with us. The children want to be involved in commissioning decisions and we are meeting with Moortown Primary School to progress this and if the pilot is successful it will be rolled out across other schools in the CCG area.
Patient Group Meetings: There have been two meetings with our CPPG and PRGN. At the CPPG we presented feedback on “Call to Action” and “Commissioning Intentions” and Martin Wright (Chief Financial Officer) explained our budgets and how the CCG spends our financial allocation. At the PRGN we also presented feedback on “Call to Action” and “Commissioning Intentions” and Leeds University spoke to the members about a tool they are developing to help patients and the public become involved with the NHS.
Assurance Framework
The NHS Leeds North CCG Patient Assurance Group continue to meet monthly to review the effectiveness and appropriateness of the patient and public engagement activities undertaken by the CCG and others in the city conducting these on our behalf.
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Next Steps
Continue with scheduled engagement activities Review the PPI programme for 2013/14 and make improvements to the 2014/15 programme in the light of this review
Corporate Impact Assessment Regulatory implications The CCG has a duty to involve patients and the public Financial implications Legal implications The CCG has a duty to involve patients and the public Workforce implications Equality impact assessment The PAG responsibilities include providing assurance that equality and diversity are appropriately addressed in our involvement activities
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Summary Report Meeting: LNCCG Board Date: 21 May 2014 Agenda Item: 008/2014 Report Title: Quality Update Prepared by: Ellie Monkhouse – Director of Nursing and Quality Russell Hart-Davies – Head of Quality Executive Lead: Ellie Monkhouse Presented by: Dr Manjit Purewal – GP Clinical Director Other meetings presented to: Purpose of Report Approval Decision Assurance Information and Comment Strategic Objectives (tick all that apply) 1. To be a successful and robust organisation that puts clinicians, patients and carers at the forefront of commissioning high quality services based on the needs of local people and within the resources available. 2. To support people to be healthy for longer by promoting better disease management, prevention and early detection and treatment. 3. To drive the transformation of urgent care across the city, improving access and promoting appropriate use of urgent care services. 4. To drive the improvement of services city-wide for people with mental health needs and learning disabilities. 5. To promote choice based on quality of care and improve access to services for people in the Leeds North Clinical Commissioning group area. Executive Summary SUMMARY The purpose of this report is to provide the Governing Body with an oversight on the key quality issues relating to commissioned services and providers, and the actions being taken to address them.
Key points to note from the report:
HCAI The CCG breached its annual threshold of 45 C. Difficile infections, with a year-end total of 73 cases. 27 were attributed to the acute trust and 46 to the community. A total of four MRSA cases were attributed to the CCG.
Responsive actions to address the community cases are developed and monitored via an agreed action plan at the CCG HCAI group, chaired by the Director of Nursing and Quality. The most common themes identified include antimicrobial usage, recent hospitalisation, care home residence, relapsing/recurring cases and proton pump inhibitor use.
NHS England has set the C. Diff. thresholds for 2014-15, which are based on a different calculation than in previous years. The CCGs threshold for 2014-15 is 65.
The acute Trust also breached its threshold of 101 cases for 2013-14, with a year-end total of 143 cases, and a total of 7 avoidable MRSA cases for the acute Trust. The appropriate contract sanctions have been applied.
Provider HCAIs and corresponding action plans are reviewed and monitored at the provider quality groups, chaired by CCG medical and/or nursing directors. HCA performance is also reviewed at the CCG Quality Committee. 008/2014 Board – Quality Update
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Never Events Leeds Teaching Hospitals has reported one never event in February (retained swab/instrument) and two in March (one retained swab/instrument and one wrong implant). This brings the year-end total to eight, six of which related to retained swabs/instruments. An executive-level review meeting is being held to seek assurance on the Trust’s practices in theatres and sharing of learning. Membership of the meeting includes the three CCGs’ and Trust’s medical and nursing directors and a representative from NHS England.
Mortality Outlier Alerts Leeds Teaching Hospitals Trust has received two mortality outlier alerts from the CQC relating to pathological fractures and coronary atherosclerosis. These are issued where the CQC has identified that mortality rates at specialty/diagnosis level are above expected. The Medical Director at Leeds West CCG has written to the Medical Director at the Trust to request a copy of the response to the CQC. The alerts will also be discussed at the joint CCG/LTH quality meeting which is attended by Leeds North’s Director of Nursing and Quality.
Friends and Family Test Leeds Teaching Hospitals’ combined net promoter score for February was 60, compared to the national average of 64. The score has seen a downward trend over the past year, and the Trust has been asked to look into this and provide a response. The test has been rolled out as required to include maternity services. Mental health and community services providers are required to introduce the test in the forthcoming year.
CQC Visits Leeds Teaching Hospitals received a full inspection under the CQC’s new model in March; the Trust is awaiting a report which will be shared with commissioners when available.
Leeds and York Partnerships Foundation Trust received inspections of services in Leeds and York. All services in Leeds were found to be compliant but some actions were required in relation to York services and in Trust Headquarters. Key Recommendations
The Board is asked to receive this update and note the issues and actions contained within. Assurance Framework
Next Steps
N/A Corporate Impact Assessment Regulatory implications N/A Financial implications N/A Legal implications N/A Workforce implications N/A Equality impact assessment N/A
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Leeds North CCG Quality Report Highlights May 2014
1. Introduction The purpose of this brief report is to update the Board on the key issues and actions relating to quality highlights within the CCG and its main commissioned providers.
2. Health Care Acquired Infections (HCAI)
As previously reported the trajectories for C. Difficile and MRSA have been set for providers and CCG’s for 2014/15. The allocations are as follows:
Provider Objectives 14/15 Last Year Target Year End Total Leeds TH 127 104 – stretch 129 143
CCG Objectives 14/15 Last Year Target Year End Total Leeds North 65 45 73 Leeds South and 106 82 114 East Leeds West 97 98 108
The threshold for MRSA remains at zero avoidable cases. The monthly Trajectories for Leeds North have been accepted by the Quality committee on behalf of the board.
2.1 C. Difficile (C. Diff.)
CCG Allocation 2013/14 year end 45 73 objective Total Monthly objective plan Actual Communit Acute y attributed Trust attributed January 4 10 6 4 February 4 7 5 2 March 4 1 1 0
Year end 2013/14 attribution for C. Diff. for LSE CCG is 27 to acute providers and 46 within the community.
Previous reports have highlighted to in depth work with Public Health and the medicines management team with regard to gaining further knowledge into cases within primary care and insight following review. The most common themes identified include antimicrobial usage, recent hospitalisation, care home residence, relapsing/recurring cases and proton pump inhibitor use. Targeted training and education is taking place across primary care in Leeds. The HCAI operational group continues to work through these concerns, and as a result of this, refreshing the action plan to highlight the work that is taking place. The Director of Nursing is currently looking at a joint campaign with PH England to address some of the themes identified across our community. The CCG HCAI action plan has been discussed and reviewed at the Quality Committee and will continue to be monitored via this committee.
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2.2 MRSA
CCG Allocation One case has been reported to date for Q4. This brings the year-end total to 4.
Acute Trust Allocation One case was attributed to Leeds Teaching Hospitals in January. This brings the year-end total to 9, although the Trust believes that two cases have been incorrectly attributed and that the correct total is 7. Investigation into this is currently underway.
3. Provider Updates
3.1 Leeds Teaching Hospitals NHS Trust The combined score for the Trust for February was 60 compared to the national average of 64. The combined response rate for patients completing the Friends and family test remains above target at 27% for January (latest published data); the national average is 24%. There are differences with responses from inpatients 37%, (score 70) and ED 18.6% (score 48). The test was rolled out in a text message format for ED attenders on January 1st in an effort to address the poor response rate in this area and the figure above represents a considerable improvement on previous months.
A full CQC visit was undertaken in March 2014. Informal feedback indicated that inspectors saw some areas of very good practice and areas where some improvement is required. A full report has yet to be issued.
The Trust has reported one never event relating to a retained swab/instrument in February and two never events in March relating to a retained swab/instrument and a wrong implant. This brings the total for the year 2013-14 to eight (six retained swabs/instruments, one wrong implant and one feeding via a misplaced naso-gastric tube). A review meeting is to be held with CCG and the Trust’s Directors of Nursing and Medical Directors to explore the issues relating to the retained swabs/instruments and seek assurance that learning from previous incidents being applied. A discussion with NHSE and Specialist commissioning has already taken place with Leeds West CCG on behalf of the city.
The Trust has received two mortality outlier alerts from the CQC relating to pathological fractures and coronary atherosclerosis. These are issued where the CQC has identified that mortality rates at specialty/diagnosis level are above expected. Providers are expected to investigate the data and provide a response to the CQC, who will continue to examine the data for themselves in the meantime. The Trust has received two previous alerts, relating to head injury and excision of lung. In both cases the CQC accepted the response from the Trust and cancelled the alert. The Medical Director at Leeds West CCG has written to the Medical Director at the Trust to request a copy of the response to the CQC. The alerts will also be discussed at the joint CCG/LTH quality meeting.
3.2 Leeds and York Partnerships Foundation Trust An unannounced inspection took place at The Mount, Woodlands Square and the Newsham Centre on 16 January 2014 and focused on 2 outcome areas from the Essential Standards for Quality and Safety - Consent to Care and Treatment and Care and Welfare of People who Use Services. All three units were found to be fully compliant against both of these outcomes. However, CQC Inspectors also visited a number of other units providing care as part of the Trust’s North Yorkshire responsibilities, including:
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White Horse View – all standards met Bootham Park Hospital – three out of six standards inspected not met. Action required. Lime Trees Child, Adolescent and Family Unit – two out of five standards inspected not met. Action required.
Acombe Learning Disability Unit – all standards inspected met.
An action plan was developed to address issues which arose predominantly with the services in York. These were the Bootham Park site and Lime Trees Child and Adolescent unit. This action plan went to the Trust Board on 24 April for approval and sign off. The particular issues concerned documentation and suitability of the estate. The action plan addresses both short term issues as well as looking at a long term solution. The trust also carried out a wider documentation audit of other services to ensure that the issues picked up at the York services were not widespread.
The Trust Headquarters was also visited and inspected against Outcome 16 - Assessing and Monitoring the Quality of Service Provision, and found the Trust to be non-compliant in relation to insufficient attention being given to assure that actions taken to reduce service risks (where they had been identified) had been implemented, and that systems to check the quality of services provided at ward level were not always being followed. The Trust developed and provided an action plan to the CQC to address the concerns which we had raised in relation to the care and welfare of patients, and is providing a monthly update of the action plan to the Care Quality Commission. Copies are also provided to the CCG and monitored through the Quality Group.
3.3 Leeds Community Healthcare NHS Trust Following on from previous updates on the Intermediate care unit at Seacroft Hospital, a review meeting took place on 12 February 2014. This review included the senior management team from LCH and LSE CCG, as well as representatives from other CCG’s and Non-Executive Directors from LSE CCG as the lead commissioner. Further to the meeting options for relocating the unit were explored with the result that the unit has re-opened on the St James’s hospital site on Ward J31. Two visits have subsequently been undertaken by quality and safeguarding managers at the CCG. They observed that the unit is much improved in terms of estate and facilities, and patients spoken to were satisfied with their care. There are some continuing concerns regarding continued high levels of agency staff, due to vacancies and a number of staff being on annual leave. A rolling programme of follow-up visits has been arranged to monitor these issues, and the Director of Nursing and Quality has since visited the unit with the Director of Nursing from LCH. The level of provision remains at 16 beds, recruitment continues for skilled staff and a new clinical lead for the unit. The unit will not be able to increase this provision until agreed by the Directors of Nursing that there are sufficient and safe staffing levels.
A Root Cause Analysis meeting was held between commissioning, contracting and quality managers in April to explore the issues around the reopening of the unit, as a number of communication issues had been identified. The review highlighted a number of gaps including a clear plan of response when there are pressures in the system, formal risk assessment of proposals and clear lines of communication between commissioning, contracting and quality teams. The resulting report is being considered by the CCG Director of Nursing and will be shared with LCH board as lead commissioners, and as they commissioned the investigation.
The Director of Nursing and Quality has increased the frequency of provider quality meetings to Bi monthly, with a review in 6 months, and this service remains under surveillance.
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3.4. Harrogate District Foundation Trust Friends and Family test - for February the net promoter score was 67 from a combined response rate of 32.8%. The national average score is 64 from a response rate of 24%.
HCAI’s - Harrogate have reported 31 cases of C. Difficile (13 assigned to the Trust) and 5 cases of MRSA (1 assigned to the Trust) between April 2013 and February 2014.
4. CQUIN Update CQUIN Indicators for each of the main providers in Leeds have been agreed for 2014-15, containing both nationally mandated and locally agreed indicators. The national indicators relate to:
Friends and Family Test –all providers to either roll it out further or introduce it to all services. NHS Safety Thermometer - to continue to implement and to use to improve performance, particularly against pressure ulcers. Improving dementia and delirium care - sustained improvement in finding people with dementia, assessing and investigating their symptoms and referring for support (FAIR). This is for acute trusts only. Improving diagnosis in mental health –providers will be rewarded for better assessing and treating the mental and physical needs of their service users. This is for the mental health trust only.
Leeds and York Partnerships Foundation Trust Assessment and intervention on smoking cessation Identification of nutritional support needs and intervention in community Mental Health patients. Multi-agency working to develop care clusters Implementation of cluster pathways for Common Mental Health, Psychosis and Cognitive Impairment Design and agree a reporting framework for recommended quality and outcome indicators To develop and implement a liaison nurse role with primary care to improve the uptake of annual health checks for people with a Learning Disability. To incentivise the improvement of communication of dementia diagnosis and other outcomes with service users, family, carers and GPs. To demonstrate, through the National Audit of Schizophrenia, full implementation of appropriate processes for assessing, documenting and acting on cardio metabolic risk factors in patients with schizophrenia. Improvement of communication with general practitioners through sharing of care plans, diagnoses, medications and ongoing monitoring and treatment needs
Leeds Community Healthcare Dementia screening by matrons for all patients over 75 Joint development with LTHT and delivery with of a whole pathway service development plan to improve the experience of service delivery for children with complex needs and their families. Jointly reviewing discharge incidents with LTHT and developing a joint plan of improvement Incentivising community teams to attend risk stratification meetings and gold standard meetings to improve engagement with primary care.
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Leeds Teaching Hospitals Trust To improve the health and wellbeing of adult inpatients within the Cardio Respiratory and other CSUs through the identification of lifestyle risk factors and the provision of appropriate healthy lifestyle advice Develop and implement a plan to improve the timeliness of outpatient letter delivery Continued reduction in Category 2 and 3 pressure ulcers Jointly reviewing discharge incidents with LCH and developing a joint plan of improvement Improving management of patients with asthma in the Emergency Department through implementation of best practice bundles Joint development with LCH and delivery of a whole pathway service development plan to improve the experience of service delivery for children with complex needs and their families. Root cause analysis of venous thromboembolism Intravenous catheter related blood stream infection surveillance to reduce avoidable blood stream infections.
Harrogate and District Foundation Trust The CQUIN schemes are still under negotiation but proposals include:
Acute Training of staff for healthy lifestyle advice relating to alcohol Implement a process for the assessment of fragility fracture patients aged 40 years or over for their risk of osteoporosis Implementation of agreed standard discharge letter template for appropriate services. To review the discharge letter templates for services using alternative clinical systems to ensure they are compliant with the good practice template People with suspected or known dementia using acute and general hospital inpatient services or emergency departments have access to a liaison service that specialises in the diagnosis and management of dementia and older people's mental health
Community Delivery of revised service equipment model. Long term conditions in community - quarterly report on performance data e.g. time to issue within 6 hours, 24 hours and 7 days Incorporate community staff attendance at MDT meeting in GP practices Staged early implementation of community dataset (CiDS) submissions during 2014/15
5. Quality Updates
5.1 Safer Staffing Recommendation 23 of the Francis included the requirement that providers should use include evidence-based tools for establishing what each service is likely to require as a minimum in terms of staff numbers and skill mix, including nursing staff on wards, as well as clinical staff.
Further to this, the Standard NHS Contract for 2014-15 requires that providers submit a report on outcome of reviews and evaluations in relation to Staff numbers and skill mix 6 monthly (or more frequently if and as required by the Co-ordinating Commissioner). Jane Cummings, Chief Nursing Officer for England, wrote to all Chief Executives of Trusts on 31/3/14 confirming additional actions and timescales. These included the commitment to publish staffing data from April and at the latest, by the end of June 2014 in the following ways:
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A Board report describing the staffing capacity and capability, following an establishment review, using evidence based tools where possible. To be presented to the Board every six months Information about the nurses, midwives and care staff deployed for each shift compared to what has been planned and this is to be displayed at ward level A Board report containing details of planned and actual staffing on a shift-by-shift basis at ward level for the previous month. To be presented to the Board every month The monthly report must also be published on the Trust’s website, and Trusts will expected to link or upload the report to the relevant hospital(s) webpage on NHS Choices
The three main providers in Leeds (Leeds and York Partnership Trust, Leeds Community Healthcare and Leeds Teaching Hospital Trust) will be required to share their staffing report on at least two occasions with their commissioners and more often if requested.
At LYPFT an Assistant Director of Nursing is leading on this. LYPFT have taken part in a national pilot, trialling two separate tools to assess staffing requirements. A reporting process is currently being designed. The first report in June will go to the Trust Board and commissioners will ask that it is shared with them. Initially, a nationally designed tool was envisaged, but it is apparent now that Trusts will use previously designed tools rather than a specific one designed following the Francis report recommendation.
LTHT are currently rolling out the reporting of information on numbers of nurses, midwives and care staff on ward information boards at the entrance to each ward. This is displayed alongside other information such as numbers of falls, pressure ulcers etc. They do not anticipate any problems with the other requirements but they are trying to seek clarification on the requirement to report to the Board details of planned and actual staffing levels by shift for each ward, as the volume of information would be immense given their number of wards. They are querying whether it is possible to aggregate some of the information.
LCH report that they are on track to meet the reporting requirements for the reporting of their establishment review. They have reviewed all the staffing ratios on all their inpatient units as required and have prepared a draft paper for their board in June which will be shared with the CCG when it has been through their quality committee. It will include clear transparency around staffing levels.
5.2 Cost Improvement Plans Quarterly update meetings have continued with providers with regards to monitoring the quality impact of cost improvement plans. An agreed cross-city procedure has been developed by the Director of Nursing and Head of Quality to manage this process in a more formal manner in 2014/15. The guidance suggests the inclusion of a ‘star chamber’ - an annual review of the process and outcomes that includes a wide range of stakeholders. A cross-city meeting of commissioners and providers has been organised to affect this and take the process forward.
6. Next Steps A comprehensive review and scoping of the Francis Report and other key reports has taken place. Recommendations and actions for CCG’s are now being mapped to the 4 commitments to Francis to develop an action plan, which will be shared with the Executive/board when complete. Ongoing monitoring of unit at LCH to support staffing and skill mix. The CCGs Quality Strategy to be presented and discussed at the next Leeds Quality Surveillance Group A future update on the requirements of the safer staffing recommendations from providers will be provided. 008/2014 Board – Quality Update
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7. Recommendations The Board is asked to accept this report.
Paper prepared by: Ellie Monkhouse Russell Hart-Davies Director of Nursing and Quality Head of Quality April 2014
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Summary Report Meeting: LNCCG Board Date: 21 May 2014 Agenda Item: 009/2014 Report Title: Clear and Credible Plan Report – Quarter 4 Update Prepared by: Rob Goodyear – Head of Planning and Performance Executive Lead: Liane Langdon – Director of Commissioning and Strategic Development Presented by: Liane Langdon Other meetings presented to: None Purpose of Report Approval Decision Assurance Information and Comment Strategic Objectives (tick all that apply) 1. To be a successful and robust organisation that puts clinicians, patients and carers at the forefront of commissioning high quality services based on the needs of local people and within the resources available. 2. To support people to be healthy for longer by promoting better disease management, prevention and early detection and treatment. 3. To drive the transformation of urgent care across the city, improving access and promoting appropriate use of urgent care services. 4. To drive the improvement of services city-wide for people with mental health needs and learning disabilities. 5. To promote choice based on quality of care and improve access to services for people in the Leeds North Clinical Commissioning group area. Executive Summary NHS Leeds North Clinical Commissioning Group (CCG) devised a Clear and Credible Plan following CCG authorisation as a statutory body in April 2013. There is a tracker based on this plan that is used to check progress outlined. The plan sets out how we achieve our organisational aims and objectives. It does not cover performance against National measures.
Quarter 4 is an important time of year as the CCG prepares to move into the new financial year. There are 77 measures in Quarter 4 and progress has been made against all of these. Using Red / Amber / Green (RAG) rating 241 of the 242 identified actions for 2013/14 are now classed as Green. One measure remains amber, the Primary Care Access Line (PCAL) where some pathways have been developed to integrate the PCAL response, but some still need to be addressed. Key Recommendations
The Board is asked to: (a) Accept the content of this report and the progress made against our Clear and Credible Plan in Quarter 4. Assurance Framework
Next Steps
Corporate Impact Assessment Regulatory implications Financial implications Legal implications Workforce implications Equality impact assessment 009/2014 Board – Clear and Credible Plan Quarter 4 Update
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Clear and Credible Plan Report – Quarter 4 Update
Executive Summary
Introduction
Leeds North Clinical Commissioning Group (CCG) devised a Clear and Credible Plan following CCG authorisation as a statutory body in April 2013. The plan sets out how we achieve our organisational aims:
To be a successful and robust organisation that puts clinicians, patients and carers at the forefront of commissioning high quality services based on the needs of local people and within the resources available.
To support people to be healthy for longer by promoting better disease management, prevention and early detection and treatment
To drive the transformation of urgent care across the city, improving access and promoting appropriate use of urgent care services
To drive the improvement of services city-wide for people with mental health needs and learning disabilities
To promote choice based on quality of care and improve access to services for people in the Leeds North Clinical Commissioning Group area
This paper summarises the work on-going within each area against the targets set out in the Clear and Credible Plan.
Health and Wellbeing Consolidation of work undertaken throughout the year has seen some great achievement. 11.84% of smokers in the practice population have accessed support to stop smoking. 63.91% of practice population with a BMI>30 (measured at Q1) have accessed weight management service. Leeds North is working with Leeds City Council to enhance the current weight management services available. As part of the 2013/14 core engagement scheme– practices achieved an additional 24,000 Audit C monitoring – sign posting to support services has increased by 1901 brief interventions delivered (compared to 256 for the whole last year) 185 referrals to alcohol services (increase on last year - 114 for whole year). Additional ADS services have been commissioned and are now available in Wetherby, ready to go in Chapeltown, Wetherby and Seacroft and we are looking to fill a gap for Meanwood and Otley.
The number of health checks undertaken has consistently increased throughout 2013/14 and 9990 have been carried out. This has included a focus on areas of higher deprivation and further work is ongoing to identify and target areas of greatest need and what resources will be required to undertake this work.
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As part of the 13/14 core engagement – practices found an extra 794 patients in the hypertensive range and 379 patients were found with Stage 1 hypertension.
Screening for diabetes has been undertaken as part of the health check. Our local quality premium for 2013/14 included the identification and management of pre diabetes. 7 practices exceeded the 60% target 25% of the over 40 population has been screened. A total of 3846 patients, (5.73% of the 40+ population) have been identified as ‘pre-diabetic’; 72% of patients have been given lifestyle advice this year. We have increased the number people screened for diabetes to 4273. This hasn’t previously been measured in the same way but we believe this equates to an increase of 20 – 30% on last year.
Public Health North Leeds CCG has led the development of a citywide Mental Health Framework that sets out the direction and priorities mental health commissioning for the next five years. The Framework was approved by the citywide Mental Health Partnership Board in April 2014 and work will now commence to achieve the outcomes set out in the document. A review of shared care protocol for anti-dementia drugs has commenced, having been put on hold whilst a local agreement was finalised with GPs on their overall responsibilities for “amber drugs”. Initial prescribing will remain the responsibility of old age psychiatry, but once patients are established and stable on the drugs, we are looking to move the routine reviewing to GP practices. This offers the opportunity to streamline and simplify reviewing for people with dementia who already have annual reviews with the GP practice, alongside other long-term conditions. The key issues identified in initial discussions are a) GP practices will need appropriate resource to take on additional work, and b) whether it is always necessary to administer a lengthy cognitive test to monitor the effectiveness of the drugs; or whether it would be better to spend time on a holistic discussion of quality of life and coping with dementia.
Increasing the diagnosis of older people at higher risk of dementia has been undertaken by developments to the national contract for GP services, specifically the Directed Enhanced Service (DES) for dementia. All eligible Leeds North GP practices signed up to the DES in 2013-14, which operated from October 2013. The redesign of the Leeds pathway for dementia diagnosis includes agreement on when GPs can diagnose dementia when it would be inappropriate to refer to specialist memory service. The local diagnosis rate for dementia has been adopted as a metric for the local Better Care Fund, and this will include advising GPs on simple steps such as this one, so that diagnosis rate fully reflects GPs’ knowledge of patients. A research evaluation project has confirmed that, at times, a diagnosis of mild cognitive impairment can be a barrier to further diagnosis if memory problems worsen. Therefore the redesign of the Leeds pathway for dementia diagnosis includes agreement that people with mild cognitive impairment should be reviewed annually.
Transformation As part of the Primary Care Framework, practices are being supported to access tailored facilitation expertise to meet the specific needs of their practices to improve their effectiveness as clinical commissioners. As part of the 14/15 core engagement scheme, practices are also supported to ensure effective sharing of information discussed as part of the Council of members meetings.
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Workshop arranged by children health service commissioners with adult service commissioners and providers to identify key issues and potential barriers in implementing the Single EHC Plan and planning for personal budgets. Leeds North CCG LD Commissioner attends the Children’s Complex Needs Partnership Board.
Leeds North is supporting the implementation of the NICE End Of Life Framework and as part of this the provision of training for local GPs in the improved management of people at the end of life. Specific work is being undertaken with St Gemma’s hospice to identify the factors that would improve the care of people at the end of life within Leeds North Care Homes.
Implementation of the proposed national tariff for Looked After Children (LAC) Health Needs Assessments in shadow form from April 2013 has been achieved and from April 2014 agreement has been reached with Leeds Community Healthcare NHS Trust for the local LAC team to undertake these out of area assessments within a 160 mile round trip and be paid the national tariff.
Leeds Autism Diagnostic Service collecting data from referrals to identify and plan for future health provision for people on the autistic spectrum. Reviews with the commissioning manager are taking place on a six-weekly basis.
Medicines Monitoring of Amber drugs through the Local Enhanced Schemes (LES) has been completed and the results fed back to the Executive. It has been agreed that the CCG will purchase some IT software to help support practices with monitoring patients on amber drugs to help achieve the standard of compliance of 80%. The amber drug LES has been reviewed and incorporated into the NHS standard contract format and practices have signed up for 2014/15.
The practice pharmacists are developing working relationships with community pharmacists within the Leeds North area, and the CCG has commissioned the “Community pharmacy Head Lice treatment service”, which allows patients to access treatment for head lice free of charge if they fulfil the required criteria without needing to see their GP for a prescription. This work is on track and is ongoing.
Information Management and Technology Much progress has been made in Quarter 4 within this area of work, including:
Leeds North has 100% of GP practices being part of Summary Care Record (SCR). This means that all Leeds residents will benefit from Primary Care data being part of an SCR
The completion of a move of all GP systems in Leeds to nationally accredited systems
An electronic service for GPs that allows pathology tests and x-rays to be requested, tracked and the results available back to Practices as soon as they are ready within the hospital
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Wireless network established in all key buildings
Choose and Book has been included within the core engagement scheme to increase the take-up within General Practice
Electronic Discharge Initiation Document has been implemented between LTHT and Social Care which is essential for facilitating earlier hospital discharges
As expected, some areas of work have reached milestones but haven’t reached a definitive conclusion. These remain on track for delivery during 2014/15 and being carried forward into a new tracker for 2014/15. These include:
a replacement for the adult social care system
the electronic prescription service where a pilot was concluded during the quarter
Progress against the delivery of a Leeds Care Record (LCR); a shared electronic record, centred round the citizen/patient, that will enable the better integration of health and social care across organisations and thus across the city:
o Successful initial integration of basic primary and secondary care data
o Initial fast-track group of LCR users live and providing feedback for next phase of roll-out
o Information Sharing Agreement constructed and agreed across health and social care
o 40 Practices signed-up to be part of a further roll-out phase
Working towards patients having access to their own primary care medical record in line with national strategy expectations - one Leeds GP Practice has made the most significant national progress in patient on-line access
Patient and Public Involvement A change in model of PPI delivery has led to an extended recruitment to a lead role within the CCG. As such, two actions within the plan have been delayed. These are around gaining patient insight into Choice through general practices and development of measures for 2014/15. A National 360 degree stakeholder survey has been undertaken and results from this survey are expected in Quarter 1 of 2014/15.
Quality and Safety The new reporting system which collects soft intelligence from GPs now regularly feeds in to the Quality and Safety Committee at the CCG. The Saville report has been postponed to June 2014, so the CCG response is therefore delayed and now expected in Quarter 2 of 2014/15.
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Programme Budgeting The Government published planning guidance called Everyone Counts: Planning for patients 2014/15 – 2018/19 in December of last year. This set out the requirements for CCGs to submit a number of pieces of information to support our planning. They include financial templates, provider activity forecasts, the city’s Better Care Fund plan and our 2- year CCG operational plans. All of these documents were submitted in draft format on 14 February, and final versions were submitted by 4 April. Additionally the guidance required a 5-year strategy, but this will be delivered within quarter 1 of 2014/15.
Transformational change Work has been completed on reviewing and updating LYPFT service specifications to reflect transformed services. A number of service specifications were included in the contract for 14/15 and outstanding specifications were signed off by the Clinical Services Development Group in April and added as a contract variation. Tracking Child and Adolescent Mental Health Services (CAMHS) referral will be a key performance indicator for the 2014/15 contract. This has been agreed with LYPFT during KPI development discussions.
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Summary Report Meeting: LNCCG Board Date: 21 May 2014 Agenda Item: 010a/2014 Report Title: Finance Update Prepared by: Jenny Davies – Deputy Chief Financial Officer Executive Lead: Martin Wright – Chief Financial Officer Presented by: Martin Wright Other meetings presented to: None Purpose of Report Approval Decision Assurance Information and Comment Strategic Objectives (tick all that apply) 1. To be a successful and robust organisation that puts clinicians, patients and carers at the forefront of commissioning high quality services based on the needs of local people and within the resources available. 2. To support people to be healthy for longer by promoting better disease management, prevention and early detection and treatment. 3. To drive the transformation of urgent care across the city, improving access and promoting appropriate use of urgent care services. 4. To drive the improvement of services city-wide for people with mental health needs and learning disabilities. 5. To promote choice based on quality of care and improve access to services for people in the Leeds North Clinical Commissioning group area. Executive Summary
This report summarises the year-end position of NHS Leeds North Clinical Commissioning Group (CCG). It incorporates performance against key financial duties as at 31 March 2014.
Leeds North CCG was required to meet a number of key financial duties and responsibilities as follows:-
Target 2013/14 Actual
Revenue Resource Limit (RRL) Achieved subject to audit Cash Limit (CL) Achieved subject to audit Running cost limit £25 per head Achieved subject to audit Better payment practice code Achieved subject to audit
The year-end accounts have been prepared in accordance with the CCG Annual Reporting Guidance. The first draft of the Annual Report and Accounts was submitted to NHS England on the 23 April and will be subject to audit by KPMG. Key Recommendations
The Board is asked to:
(a) Note the accounts submission process and timescales.
(b) Receive and comment on the Leeds North CCG financial position and performance against key financial duties.
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Assurance Framework
Next Steps
The final audited accounts will be presented at the Audit Committee on 4 June 2014 for further review and comment, prior to formal Board approval on the same date.
Audited and approved annual accounts must be submitted to NHS England by 6 June 2014. Corporate Impact Assessment Regulatory implications Financial implications Legal implications Workforce implications Equality impact assessment
ANNUAL ACCOUNTS PROCESS AND TIMETABLE
The draft Annual report and Accounts were prepared and submitted to NHS England 23 April 2014 in accordance with the national deadline. Working papers have been sent to KPMG who are on site to conduct the statutory audit from 12 to 16 May. The draft accounts will be presented to Audit Committee 14 May for first review and comment. Once the audit has been completed the Audit report and Final Accounts will be presented to Audit Committee 4 June for final review before being presented to the Board for formal approval on the same date. Final audited accounts must be submitted to NHS England by 6 June.
FINANCIAL PERFORMANCE AS AT 31 MARCH 2014
Leeds North CCG is required to meet a number of key financial duties and responsibilities:
Revenue Resource Limit - the CCG must remain within its revenue allocation. The year-end position was an under spend of £5.1m which was in line with financial planning expectations and the control total agreed with NHS England.
Running Cost Limit - the CCG must remain within the running cost limit of £4.8m. The CCG operated within the running cost budget with an underspend of £123k.
Better Payment Practice Code (BPPC) – all NHS organisations should aim to pay all valid invoices by the due date or within 30days of receipt of a valid invoice. The CCG is compliant with the BPPC with over 95% of valid invoices paid by the due date or within 30 days of receipt.
Cash Limit – The CCG remained within the 5% tolerance for the monthly cash drawdown with only £11k as a cash book balance.
Further details are provided in Annex A and B.
010a/2014 Board – Finance Update Cover Sheet
Page 2 of 2 NHS LEEDS NORTH CCG ANNEX A 2013/14 - MARCH 2014 (MONTH 12) 010b/2014 Board SUMMARY FINANCIAL INFORMATION
Revenue Resource Allocation Recurrent Non Recurrent Total £000 £000 £000 Initial 13/14 resource Baseline 226,188 226,188 Growth 5,202 5,202 13/14 Revenue Allocation 231,390 231,390 Running Cost Allowance 4,810 4,810 Initial Resource Limit 236,200 236,200
Anticipated Allocations Return of 12/13 Surplus 4,087 4,087 Return of 12/13 Investment Fund 1,057 1,057 York Street to NHS England (-287) (-287) SCG defund SYAT Acute & MH (-3,110) 377 (-2,733) PD Network Funding 903 903 Planning Funding 10 10
Total Revenue Resource Allocation 232,803 6,434 239,237
Net Operating Costs Annual Budget Outturn Recurrent Non Recurrent Total Budget Expenditure Variance £000 £000 £000 £000 £000 £000
Purchase of Healthcare Secondary Care - NHS 101,953 4,142 106,096 106,096 105,486 (-609) Secondary Care - Non NHS 6,104 150 6,253 6,253 7,178 925 Urgent Care 10,632 293 10,925 10,925 10,751 (-174) Mental Health & Learning Disabilities 27,105 1,746 28,851 28,851 29,120 269 Long Term Conditions & Community & Childrens 26,774 593 27,366 27,366 27,305 (-62) Continuing Care 11,311 0 11,311 11,311 11,739 428 2% Transformation 0 4,628 4,628 4,628 6,227 1,599 Total Purchase of Healthcare 183,879 11,552 195,431 195,431 197,806 2,376
Prescribing 33,043 0 33,043 33,043 30,783 (-2,259)
Clinical Engagement 472 0 472 472 467 (-5)
Running Costs 4,810 0 4,810 4,810 4,687 (-123)
Reserves Planned Surplus 5,144 0 5,144 5,144 0 (-5,144) Earmarked Reserves 4,298 (-3,959) 339 339 348 9 Contingency & Other Reserves 1,158 (-1,160) (-2) (-2) 0 0 Total Reserves 10,650 (-5,119) 5,481 5,481 348 (-5,135)
Total Budget 232,803 6,434 239,237 239,237 234,091 (-5,147) NHS LEEDS NORTH CCG ANNEX B 010b/2014 Board Financial Target Information
Leeds North CCG Financial Performance Targets as at 31 March 2013
1) Better Payment Practice Code - Measure of Compliance
Target: Better than 95% Number £000s Non-NHS Creditors Total bills paid in the year 2,725 21,841 Total bills paid within target 2,670 21,730 Percentage of bills paid within target % 98% 99% NHS Creditors Total bills paid in the year 1,737 186,675 Total bills paid within target 1,716 186,536 Percentage of bills paid within target % 99% 100%
2) Monthly Cash drawdown data
Target: Not to Exceed 5% of initial drawdown
Monthly Drawdown Balance at end of the month % £000s £000s
Apr-13 15,515 308 1.99% May-13 13,878 10 0.07% Jun-13 15,193 226 1.49%
Jul-13 15,124 128 0.85% Aug-13 15,384 156 1.01% Sep-13 14,150 450 3.18% Oct-13 16,860 2,088 12.38% Nov-13 14,150 93 0.66% Dec-13 17,987 13 0.07% Jan-14 16,589 19 0.11% Feb-14 18,840 800 4.25% Mar-14 23,468 18 0.08%
3) Debtors
Target: Debt over 3 months old should be less than 10% of total debt
current 1 mth 2 mths 3 mths 3-6 mths 6-12 mths £'000 £'000 £'000 £'000 £'000 £'000
NHS 0 29 0 4 0 0 Non NHS 0 15 0 0 0 0
Total 0 44 0 4 0 0
Summary Report Meeting: LNCCG Board Date: 21 May 2014 Agenda Item: 011a/2014 Report Title: Corporate Risk Register – May 2014 Prepared by: Richard Gibson – Head of Governance Val Stewart – Governance Support Manager Executive Lead: Martin Wright – Chief Financial Officer Presented by: Martin Wright Other meetings presented to: Governance, Performance & Risk / Executive Purpose of Report Approval Decision Assurance Information and Comment Strategic Objectives (tick all that apply 1. To be a successful and robust organisation that puts clinicians, patients and carers at the forefront of commissioning high quality services based on the needs of local people and within the resources available. 2. To support people to be healthy for longer by promoting better disease management, prevention and early detection and treatment. 3. To drive the transformation of urgent care across the city, improving access and promoting appropriate use of urgent care services. 4. To drive the improvement of services city-wide for people with mental health needs and learning disabilities. 5. To promote choice based on quality of care and improve access to services for people in the Leeds North
Clinical Commissioning group area. Executive Summary 1. The Corporate Risk Register describes those risks identified by risk owners as being considered significant enough to require escalation to the CCG Board.
2. The Risk Management Strategy is the framework that sets out the process for managing operational risks across the organisation and city-wide risks are shared across the 3 CCG’s in Leeds. It is important that the each of the CCGs is made aware of all the risks that affect their population.
3. The Corporate Risks are regularly reviewed by the Leeds North CCG Governance, Performance and Risk Committee. The Leeds North CCG Corporate Risk Register (attached below) currently holds 3 risks. One risk has been newly escalated to the CRR and 2 risks have been reviewed and the risk score remains the same:
Risk No. Description Movement
258 Diagnostic Waiting Times – newly escalated
338 Cancer 2 week wait
286 Outpatient follow-up waiting list
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Key Recommendations
4. Since the last Board meeting in March 2014 some previous corporate risks have been re-scored following review and returned to the directorate for management. Those risks were discussed at the Governance, Performance and Risk Committee on 3 April 2014 and are as follows:
Risk No 343 Tour de France – now rated at amber Risk No 44 MRSA – rated at amber Risk No 226 C Difficle – rated at amber Risk No 311 Pooled Learning Disabilities Budget Overtrade – rated at amber
5. Access to the organisation’s risk register is maintained by the Collaborative Governance Team for the city. The Governance Team work with responsible Managers across the city to record, and update risks in-line with the Risk Management Strategy. All risks are logged and managed on the city-wide Datix system. Responsible managers are expected to review risks in-line with the governance cycle and escalate to corporate level if concerns are raised. Each lead director and lead manager will discuss the risks at work stream meetings.
Assurance Framework The Board is asked to: Consider and agree the current corporate risks.
Next Steps The Corporate Risk Register will be presented to the next Board meeting.
Corporate Impact Assessment Regulatory implications Financial implications Legal implications Workforce implications Equality impact assessment
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City-wide Corporate Risk Register - 9 May 2014 011b/2014 Board
ID date Review Title Description Secondary Risks (initial) Consequence (initial) Likelihood (initial)Rating (initial) level Risk Controls Gaps in controls Responsible Committee Director Accountable Manager Costs Assurance Gaps in assurance Synopsis (Current) Consequence (Current) Likelihood (Current) Rating (Current) level Risk LTHT failed Q4 62 day cancer
339 Cancer under Cancer waiting times - Failure to deliver 20 LTHT have weekly Limited ability to influence Weekly email from LTHT to 16 achievement of under achievement of performance standards Access Meetings to pathways in referring trusts, commissioners with current standard and there are still areas of Major Major 62 day urgent GP performance 62 days required nationally. monitor 62 day urgent leading to higher performance. Performance risk remaining despite additional surgical capacity having been created
08/05/2014 referral urgent GP referral to GP referral.. proportions of patients monitored monthly at APMG in gynaecology and lung surgery. The treatment of all cancers. referred later than day 38. and Elective Care
Catherine Foster Catherine remaining areas of risk are Performance and actioned insufficient capacity to deliver robotic appropriately. surgery in urology, a vacancy in histopathology which cannot be filled
Non Elective Working Group Working Non Elective until July and ongoing delays from other providers in referring patients to LTHT. LTHT has yet to provide a robust plan to recover the urology position, and is working with Susan Robins - Director of Commissioning of - Director Susan Robins commissioners to continue to press other providers to improve the timeliness of their referrals. This remains a corporate risk given the occur. to Likely at least weekly. occur to Expected potential for this standard to continue to be breached in Q1 and the potential impact on patients of
Expected to occur at least daily. More likely to occur than not. than occur to likely at More least daily. occur to Expected delays for treatment in some
Very High Priority - Reduce urgently involving Senior Management involving Senior urgently High Very - Priority Reduce pathways and due to failure to Management involving Senior urgently High Very - Priority Reduce achieve 95% in April 2014.
358 Diagnostic waiting Provider patient Failure to deliver 20 LTHT developing plans CCGs have made Plans and impacts scrutinised plan developed does not Despite significant internal focus 16 times **Newly experience and/or timeliness in with each modality to funding available to by CCG and NHS England and yet create sufficient there remains a capacity and Major Major escalated outcomes are impacted endoscopy services address capacity and commission the reviewed at Elective Care capacity to provide demand gap in the endoscopy
08/05/2014 upon by delays; Failure to impacts on the abililty process issues. Lewis Helen expected demand for Performance meeting; resilient delivery of target services and some system issues deliver the national to extend bowel cancer endoscopy in 14/15 backlog and total waiting list that appear to be impacting on standard of 99% of screening to an older including projected size jointly reviewed monthly audiology services. This means patients being seen in no age group. increases in demand that the 99% standard is more than 6 weeks, vulnerable month on month and particularly in endoscopy that the JAG timeliness measure Elective Care Working Group Care Working Elective services, impacts on the is not being met and so no reaudit CCG performance ratings can take place of LTHT to enable and ability to deliver the the extension of the age for the
requirements of the NHS Commissioning of - Director Susan Robins local bowel cancer service. There constitution are also potentially further demand risks in MRI caused by
the imminent closure of the occur. to Likely at least weekly. occur to Expected Eccleshill service. The CCGs are working rapidly to try to reprocure this and working with Expected to occur at least daily. More likely to occur than not. than occur to likely at More least daily. occur to Expected LTHT to put a contingency plan in
Very High Priority - Reduce urgently involving Senior Management involving Senior urgently High Very - Priority Reduce place, but this also puts the target Management involving Senior urgently High Very - Priority Reduce at increased risk of delivery. ID date Review Title Description Secondary Risks (initial) Consequence (initial) Likelihood (initial)Rating (initial) level Risk Controls Gaps in controls Responsible Committee Director Accountable Manager Costs Assurance Gaps in assurance Synopsis (Target) Consequence (Target) Likelihood (Target)Rating (Target)level Risk
286 Outpatient follow Failure to be seen in 20 All relevant LTHT Monthly operations follow- The provider is currently Once the delivery plan is received 16 up waiting list outpatient clinic by the specialties have up report is presented to producing updated and it will be scrutinised by the APMG Major Major date given by their clearance plans Elective Care Performance quantified clearance to ensure it is sufficiently robust
08/05/2014 consultant causing agreed with COO Lewis Helen Group (ECPG). plans for highest risk and details firm timescales for potential risk to patient team specialties. expected performance safety, particularly in More specific ECPG reports risks to Acute improvement to deliver rapid colorectal surgery and clearance plans Provider Management Group reduction in waiters. gastroenterology. requested from these (APMG). specialities through the COO but as yet no impact on numbers of Group Care Performance Elective waiters. Susan Robins - Director of Commissioning of - Director Susan Robins Expected to occur at least weekly. Likely to occur. to Likely at least weekly. occur to Expected Expected to occur at least daily. More likely to occur than not. than occur to likely at More least daily. occur to Expected Very High Priority - Reduce urgently involving Senior Management involving Senior urgently High Very - Priority Reduce Management involving Senior urgently High Very - Priority Reduce
Summary Report Meeting: LNCCG Board Date: 21 May 2014 Agenda Item: 012a/2014 Report Title: Sustainable Development Management Plan Prepared by: Briony Pete – Senior Consultant (WRM Limited) Executive Lead: Liane Langdon – Director of Commissioning and Strategic Development Presented by: Briony Pete Other meetings presented to: N/A Purpose of Report Approval Decision Assurance Information and Comment Strategic Objectives (tick all that apply) 1. To be a successful and robust organisation that puts clinicians, patients and carers at the forefront of commissioning high quality services based on the needs of local people and within the resources available. 2. To support people to be healthy for longer by promoting better disease management, prevention and early detection and treatment. 3. To drive the transformation of urgent care across the city, improving access and promoting appropriate use of urgent care services. 4. To drive the improvement of services city-wide for people with mental health needs and learning disabilities. 5. To promote choice based on quality of care and improve access to services for people in the Leeds North Clinical Commissioning group area. Executive Summary
At authorisation, Leeds North CCG developed, and has since been delivering, a sustainable development management plan (or SDMP) for 2013/14. Reporting against its progress in the annual report, and revising and setting new targets for delivery in 2014/15 is part of the ongoing assurance process.
The programme to date has achieved many successes, including; Developing and reporting against a baseline of resource use for Scope 1, 2 and partially toward Scope 3 emissions and their associated costs. Developing a green champion programme which has inducted and trained staff members to deliver the sustainability agenda. Halved general waste by introducing a recycling collection Reduced gas use by an average of 12% over a 2 month period through a staff engagement campaign Delivered six GP ‘sustainability health check’ reviews which have identified potential cost and carbon savings for GP practices of 28% (average) from utility bills. Delivered a sustainable commissioning workshop and following research to identify opportunities to integrate sustainable development as part of the year two programme.
The 2013/14 SDMP has now been evaluated, revised and updated to align to: evidence from the resource baseline collected, the release of the updated NHS & Public Health sustainability strategy and modules, and UK government and NHS driven carbon reduction targets by 2015 and 2020.
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The SDMP includes an action plan for the areas we wish to focus delivery on for 2014/15.
The key areas are: A multi-partner travel reduction plan, policy and campaign Developing a sustainable commissioning programme and establishing a baseline measurement of commissioning activity. Establishing a metric and baseline for social value assessment
The programme will continue to embed resource efficiency into its internal operations.
Key Recommendations
The Board is asked to:
Approve the SDMP and action plan and give sanction to be driven forward and embedded into the organization; Support staff and the Executive Team by giving and allowing appropriate time, by the green champion team and wider staff, to ensure successful delivery of the SDMP targets.
Assurance Framework
Next Steps
Following Board approval, the SDMP will be finalised and sent to the Sustainable Development Unit by the 6 June along with the baseline data collected on Scope 1, 2 &3 emissions.
WRM will deliver a champion workshop to develop detail to the action plan and encourage wider staff engagement to support and undertake activity.
Corporate Impact Assessment Regulatory implications Financial implications Legal implications Workforce implications Equality impact assessment
012a/2014 Board – Sustainable Development Management Plan Cover Sheet
Page 2 of 2
012 b/2014 Board
Sustainable
Development
Management Plan
2014/15
Introduction
NHS Leeds North Clinical Commissioning Group (CCG) is responsible for helping to plan and commission healthcare services across the North of Leeds. We work together with patients, communities and GP practices to ensure that the right NHS services are in place to support people and help improve their health and wellbeing.
In April 2013, we became a statutory organisation, led by GPs and nurses. We are responsible for managing local health budgets and ensuring that the NHS continues to provide high quality healthcare for local people across our area.
To do this we work closely with Leeds South & East and Leeds West CCGs to ensure that high quality community, hospital, emergency, urgent care, learning disability and mental healthcare services are available throughout Leeds.
NHS North CCG covers a population of around 200,000 people, 31 local GP practices and has responsibility for a budget of just over £241 million in 2013/14.
The North area covers a range of communities and diverse populations.
Our priorities
Our priorities for the next year are to: support families to have the best start in life; help children to live healthy lifestyles; support people to be active and healthy; increase early detection of health conditions; improve care for people with long-term conditions; support carers; and improve end of life care. Figure 1. Leeds CCG Boundaries
To help reduce health inequalities across our area, we are dedicated to working closely with local partners to help improve health and wellbeing for local people.
Our vision and values
We will align and embed our sustainability vision and values with those of our business plan; specifically: We will live in healthy and sustainable communities We will use available resources wisely and appropriately We will be innovative and use best practice to continuously improve our NHS Foreword As we plan and commission health services, we seek to do so in a way that not only reduces our negative impact on the environment but that has a positive impact on our staff and communities. Being a sustainable organisation is about finding a balance between our environmental, social and financial impacts; in our own activity, and in the value, quality and equality of the services that we provide.
With reducing budgets and increasing demand on our healthcare services we need to work in new ways, with new partners and new technologies to drive innovation and develop new models of care so that we can continue to provide exceptional value for money and deliver services in a way maximises social value.
As part of the NHS we must support the delivery of this enormous change programme; and as an individual organisation we must do our bit, however large or small, to ensure our internal operations embed the sustainability agenda.
One year on from authorisation and I’m delighted by the commitment of Leeds North CCG. At several points over the last year I have wondered ‘how will we fit all this in’… but with praise to a dedicated team of green champions that we inducted to lead the programme we have finished the year with both successes to date and exciting challenges ahead.
Our strapline is ‘together we’re better’ and it is so reassuring to see this in action. Our partnership work with Leeds South & East CCG and Leeds West CCG has saved us time, money and resources in our delivery programmes and we are benefitting hugely from the shared knowledge and best practice. We are now reaching out to wider partners and providers to help us reach the goals set out in this year’s plan.
Our in-house activities have increased recycling, reduced our gas consumption and we are now focusing our attention on greener methods of, and a reduction in overall, travel. However small these actions may be in the grand scheme of the NHS giant, every action really does count and it is important to us that we are an organisation that ‘walks-the-talk’.
And as we bring our own house in order it paves the way for our next big challenge; to embed the sustainable agenda into our commissioning processes and activities.
This Sustainable Development Management Plan captures our approach to this challenge. I am committed to its development and delivery and will formally report our progress on an annual basis.
Nigel Gray
Chief Officer
Leeds North Clinical Commissioning Group 1. What is Sustainable Development?
The term "sustainable development” is often used interchangeably with corporate citizenship, corporate social responsibility, triple-bottom line or corporate ethics, etc.
NHS Leeds North CCG uses the definition below as a working guide to support its activity in this area, accepting that the exact meaning is context specific and will continue to evolve.
1.1. A definition of sustainability….. Sustainable development is most commonly described as “...development that meets the needs of the present, without compromising the ability of future generations to meet their own needs...” (The Brundtland Commission, United Nations – Our Common Future, 1987) Sustainable development is achieved when an organisation or community is acting positively and achieving positive outcomes in the long term, in three aspects, often referred to as the “Triple Bottom Line”, these are
Economic aspects – the activity, community or organisation is financially viable in the long term. Social Aspects - the activity, community or organisation has staff, community and wider stakeholder relationships which provide the skills, engagement and support required for long term success. Overall the organisation is making a positive net contribution to society in general. Environmental aspects - the activity, community or organisation has the natural assets (air, water, materials, energy, bio-diversity etc.) it requires to be successful in the long term and makes a positive contribution to ensuring these resources are sustainable both for itself and others. Overall the organisation is making a positive net contribution to the environmental in general.
Sustainable development begins when an organisation is achieving positive results in all three areas at the same time. It is not enough in the long term to merely minimise negative impacts, though in many cases this is where we start. Sustainability is not about constraints, though initially it can feel that way. It is about a long term commitment to innovating and reorganising, what we do and how we do it, to make a positive difference in the world. This is not constrained but has limitless potential. Many organisations which embark on this sustainability journey find their social and environmental learning, investment and innovation, leads to a positive financial return on investment and the creation of long term competitive advantage.
1.2. Why is this important?
The NHS has made a long standing commitment to operating sustainably and providing positive social value through all its services and facilities. This commitment is underpinned by national policy and a wide range of regulatory and legal requirements which affect health and social care providers and commissioners.
In January 2014 the NHS Sustainable Development Unit (SDU), jointly funded by NHS England and Public Health England launched the new NHS Sustainable Development Strategy.
This clarified and re-committed all NHS organisations to delivering a sustainable health and social care system, with challenging long term targets and expectations:
Drivers for Change
Figure 2. Sustainable Development Strategy for the NHS, Public Health and Social Care System 2014-20201
The Strategy describes the vision for a sustainable health and care system by reducing carbon emissions, protecting natural resources, preparing communities for extreme weather events and promoting healthy lifestyles and environments. The challenge we are presented with, as an NHS organisation, is how to continually improve health and wellbeing and deliver high quality care now and for future generations within available financial, social and environmental resources. Understanding these challenges and developing plans to achieve improved health and wellbeing and continued delivery of high quality care is the essence of sustainable development. The strategy is supported by five modules by which we will align our own SDMP to:
Carbon hotspots module Leadership, engagement and workforce development Commissioning and procurement module Healthy, sustainable and resilient communities module Sustainable clinical and care models module
1 http://www.sduhealth.org.uk/documents/Drivers_For_Change_20140105.pdf
2. Where are we now?
At authorisation in April 2013, NHS Leeds North CCG finalised our Sustainable Development Management Plan (SDMP), and signed up to a “commitment to promoting environmental and social responsibility through CCG actions as a corporate body as well as a commissioner” as part of the process of becoming a CCG, and the ongoing process of assurance. The 2013/14 plan underpinned the way we wanted to develop our working practices so that we not only mitigate the negative impact of our activities on the environment around us, but also build in structures to ensure that our operations can have a positive impact on; our employees and members, on the communities we live in and on the surrounding environment. Following and delivering the SDMP has helped us to assess our progress over the past year and ensure we have robust plans in place for the future. We focused on four areas of sustainability within our operations:
Our Internal Operations: calculating our organisational footprint, engaging staff, instigating change in working practices.
Our GP Members: supporting GP practices to identify and implement sustainable working practices.
Our Supply Chain: identifying opportunities to develop sustainable working practices within our commissioning and procurement activities.
Our Partners; working with neighbouring CCGs, wider NHS organisations and sustainability experts to realise efficiencies and share best practice.
2.1. Progress against SDMP milestones for 2013/14 Internal Operations 2.1.1. Efficient Building Measures Our main office site was previously a clinic, and during renovations we took measures to ensure that the building refurbishment included measures to optimise resource use. This included:
T5 lighting strips were installed throughout to reduce electricity use A new efficient boiler was installed to reduce waste heat Cellars and attics were insulated to prevent heat loss.
2.1.2. Monitor and measure use Understanding where we are in terms of resource use and impact is crucial to making positive changes. As a new organisation we needed to monitor our use of utilities, travel and consumables from the beginning to understand our impact, identify where ‘hotspot’ areas of use are and set stretching targets for reduction for the coming financial year. We monitor and measure use of the following resources by taking monthly meter readings and collating information from bills, invoices and expenses claim forms: Gas, electricity, business travel, general waste, recycling, confidential waste, paper and printing.
Resource Quantity CO2 Emissions Cost
Gas 141,097 kWh 29.9 TBC
Electricity 35,611 kWh 19.9 TBC*
Business miles travelled 14,032 miles 3 £12,285
Public transport miles 9,786 miles 1 £3,265 travelled
General Waste 1.8 tonnes n/a £278
Recycling 1.7 tonnes n/a £660
Water 443 m3 0.4 TBC*
Figure 3. Resource breakdown by; Use, CO2e, and Cost
Confidential Mixed Car miles waste Paper Breakdown of emissions recycling 6% 0% 2% 0% rail (to date) General Waste 1% Gas 0% Water Electricty 1% Water
General Waste
Mixed recycling Electricty Gas 35% 55% Confidential waste Paper
rail
Car miles
Figure 4. Breakdown by CO2e 2.1.3. Staff engagement and behaviour change Getting staff engaged in our sustainability journey has been vital for our progress. We held a launch event at our team meeting in August to introduce the new programme to the staff, and used it as a vehicle to engage a team of green champions. We have three champions who have been through an external training programme to help them to identify carbon hotspots, develop behaviour change campaigns and engage staff. The champions have been key to collecting and monitoring resources. Our Green team and programme is call ‘Small Steps’. 2.1.4. Efficiency campaign An energy reduction campaign started in February targeting our gas use. Our campaign ‘Let’s waste less…’ targeted excessive gas use. Our resource monitoring alerted us to our high usage in this area so we decided this should be our first campaign focus. We asked staff to take three simple steps to reduce gas use around the office and in meeting rooms:
Keeping windows shut when the heating is on.Let’s waste Leave radiator settings at 2 or lower. less... Close blinds as it gets dark to keep the heat in.
These simple actions led to a 12% average reduction in gas use over an eight week period (comparative to the outside air temperature). We are now continuing to adjust our heating controls to ensure we are not unnecessarily heating the building over the warmer spring and summer months.
2.1.5. Waste and Water Introducing a recycling system was one of the first measures as a green team. This began by measuring and monitoring waste arising’s and amending our current waste management system to include the most suited recycling system. We have since halved our general waste arising’s and reduced our waste management costs. Our water use is low as an organisation and this has not been a target area this year, but is something we will look at in the future.
2.1.6. Travel Plan Work is underway to develop a travel plan and policy for our organisation. We are working in partnership with the other Leeds CCG’s and the CSU. Once we have finalised our baseline we plan to implement measures such as: reduce business miles through tele and video- conferencing, reduce staff commuter miles by increasing remote and flexible working, increase the use of public and exercise based transport and promote car sharing and low emission cars.
2.2. Partnerships
We are working in partnership with NHS Leeds South & East CCG and NHS Leeds West CCG on this programme of work. Together we have utilised the skills of a sustainability expert to help us to develop and deliver our individual SDMP’s and coordinate areas where we can work more effectively on programmes together, for example; running workshops to identify sustainable commissioning opportunities and developing our green champion programmes. This has helped us to realise financial and resource efficiencies, and share and develop best practice. We have been collaborating with West, South Yorkshire and Bassettlaw Commissioning Support Unit (WSYBCSU) on areas where we have identified synergies, such as travel reduction. We are also in regular contact with NHS England and the Sustainable Development Unit to gain knowledge of and feed into best practice learning and development.
GP Sustainability Programme In 2013/14 we conducted 6 “Sustainability Health-Checks” within our GP practices. This covered utilities, lighting, heating, equipment, environmental management practices, staff engagement and opportunities for renewable energy. The GP Health Checks work through a three staged approach:
The reviews have identified a total of £11,644 savings across the six practices which equates to a reduction of 37.5 tonnes CO2e. This shows an average saving of 28% reduction on utilities spend. Evaluation of the six reviews has shown a breakdown of where the highest savings have been identified. This is shown in the graph below. Knowing this information will help us to inform and develop the programme for next year.
Small Power Areas where CO2 Savings 2% have been identified Other 1% Building Heating / Cooling / Fabric Ventilation 14% Lighting
Renewables Heating / Env Cooling / Env Mgmt Mgmt Ventilation Building Fabric 13% 39% Waste
Small Power Renewables Lighting 8% 23% Other
Figure 5. CO2 savings by type Case Study: Charles Street Surgery Savings identified: £1,840 and up to 7.3 tonnes CO₂ per year Income generation identified: £1,860 and a reduction of up to 4.7 tonnes CO₂ per year (overall 40% saving/ income potential) Charles Street Surgery received a health-check in May 2013 and since then the practice:
Has commissioned the installation of a new boiler, thermostats and pumps, Has rolled out a programme to replace inefficient lighting with suitable equivalent LED technology across the surgery. Conducts regular ‘Walk-rounds’ to note best practice and to encourage staff to consider ways of saving energy on a daily basis. Is monitoring energy use on a monthly basis to identify areas of excess. “We knew there were problems with the heating system but working with the expert support gave us confidence to start putting actions in place and make some big changes that needed to happen. After this the action plan has helped us to focus on what needed to happen next to make the biggest reductions to the surgery’s footprint; and the stepped approach means we are not trying to tackle too much at once, making things more achievable”. Alan Wade, Assistant Practice Manager
Our GP Health Check programme ran in conjunction with our strategic partners - NHS Leeds North CCG and NHS Leeds West CCG - to enable the three organisations to share learnings across the programme and realise efficiencies. A further 10 health checks have been undertaken through the wider Leeds area.
Our Providers
We believe that our commissioning and procurement activities make up a large proportion of our organisational footprint; however we have not yet been able to measure this. It was important to us to first get our ‘own house’ in order before asking our suppliers and providers to do the same. In December we ran a joint workshop with NHS Leeds South & East CCG and NHS Leeds West CCG to establish areas where our commissioning processes already contained sustainable working practices and to identify which areas of our commissioning cycle should be the focus for the next year. There is currently two key areas of focus:
Working with providers: It is recognised that the ability to make significant changes is down to the service provider and working in partnership to build sustainable measures will be essential to enable change.
Supporting a major strategy revision: supporting the team responsible for this strategy and advising on how best to build sustainable practices into the commissioning cycle. “We will be recognised among the leaders in sustainability for Clinical Commissioning Groups by our, staff, local communities and key stakeholders, while underpinning the effective 3. Vision and objectives delivery of our strategy”. 3.1. Where do we want to be?
“We will be recognised as leaders in “We will be recognised for our commitment to sustainability by our, staff, local communities sustainability by our, staff, local communities and key stakeholders, while underpinning the and key stakeholders, while underpinning the effective delivery of our strategy.” effective delivery of our strategy”
The strategic aims of our three year operational plan are as follows:
Our vision is that the people of Leeds North:
Are involved in decisions made about them Will live in healthy and sustainable communities Experience a better quality of life Live full, active and independent lives Live longer and have healthier lives In the next three years, we will ensure our successful and effective co-operation with our communities, patients and partners reduces health inequalities and delivers improvements in health and well-being for local people. Our Embedded Values include:
Valuing our patients as partners Working together with our local communities Listening to people and valuing their experiences Using available resources wisely and appropriately Being innovative and using best practice to continuously improve our NHS Being a learning organisation and supporting professional development We aim to help people to manage their own health better by giving them the right information and support at the right time and in the right place. Our sustainability objectives will support the delivery of these corporate level objectives. Objectives
Our primary and key supporting sustainability objectives are shown below. Some may change and develop as our planned consultation takes place, as more baseline data becomes available and as further benchmarking becomes possible.
In line with the vast majority of NHS organisation NHS Leeds North CCG has adopted a carbon reduction target of -10% by 2015 from a 2007 base line. While we did not exist as an organisation at this time, the NHS Sustainable Development Unit has set out a methodology for organisations like us to approximate a 2007 baseline.
This SDMP will be the primary means of capturing and reporting the evidence against this target, however, the whole organisation has responsibility for delivering the changes in behaviour, processes and technology which achieve the target. Achieving this target will also contribute to other corporate objectives.
Primary Objective
Reduce Carbon Emissions by 10% by 2015 from a 2007 base line
Supporting Objectives
To be finalised following the consultation and development of initial project outlines and consultation with operational teams on resource availability and plans within teams
We will continue to increase the overall level of sustainable good practise achieved. By March 2015 we will:
Establish a baseline for travel and set corresponding associated CO2 reduction targets for March 2015 WRM are collating this currently Establish a baseline for sustainable commissioning and procurement and corresponding targets for March 2015 NB - WRM are currently researching this area Establish a baseline for social value assessment and corresponding targets for March 2015 NB - (if this is an area you want to move forward on)
4. Strategy - How will we get there?
We believe that our SDMP 2014/15 should not be ‘bolted on’ to our business plans, but that sustainable development should be embedded into our delivery plans and is an aspect of everyone’s role in a true cross cutting way, as shown below in figure 2.
A common weakness in sustainability programmes is to see sustainable development as a separate standalone activity and to create delivery structures which become isolated.
Responsibility for sustainability delivery will be embedded within each of our team service delivery plans.
Each team will have some responsibilities for: Delivering new sustainability initiated activity, Modifying existing activities to improve social and/or environmental performance, and Providing information and performance data to the Sustainability lead.
As we create our draft SDMP for 2014/15 we will enter a process of consultation with key internal and external stakeholders. This will ensure that we can align sustainable and operational working practices and embed them within the organisation and with key stakeholders.
Our SDMP will cover the following key areas:
Internal operations: where we will focus on reducing business and staff travel, working with our landlord to help reduce our energy use, and continuing to drive up our recycling rate, while reducing our waste arisings. This will include benchmarking our organisation through the Good Corporate Citizen tool.
Sustainable commissioning and procurement: including: signing up to and delivering through the Procuring for Carbon Reduction Tool and working with and supporting commissioning managers to align and embed sustainable criteria into current practices
GP Sustainability: Sharing learning from last year’s GP Healthcheck programme and finding ways to support our member practices to be more environmentally and socially sustainable.
Working in partnership: with Leeds South & East CCG, Leeds West CCG and WSYB Commissioning Support Unit to share best practice, realise cost efficiencies and maximise the development of sustainable working practices.
The action plan within this SDMP touches every part of the organisation. But we recognise we are still at the beginning of our journey, and our SDMP will need to be reviewed and revised on a regular basis as opportunities and challenges emerge. For 2014/15 we plan to focus on embedding action and developing sustainable working practices in our commissioning and procurement activities. Alongside this we will assess additional baseline data as it is collated throughout the year and integrate new targets which will stretch our sustainability ambitions for 2014/15.
5. Action Plan – What specifically will we do?
This SDMP document contains a summarised version of our sustainability action plan for 2014/15.
This plan sets out a high level overview of the key themes we have identified as being important to NHS Leeds North CCG, the main actions we plan to undertake and the associated KPI, owner and deadline for that action.
This will be a ‘living’ document and will be updated and developed over time as new information, baseline data and input from delivery personnel becomes available.
Objective Action KPI Deadline Who
1.0 Energy & Carbon 1.1 Calculate a Carbon Footprint for the Explore methods to improve the carbon footprint and extend CCG and deliver actions which reduce this to scope 3 where possible (suppliers and commissioning by 10% by 2015 from a calculated 2007 emissions) baseline. Calculate a 2007 base line using the NHS Sustainable Development Unit methodology
Combine carbon emissions results from all areas and report regularly internally to all staff on reductions in line with the
target
Monitor gas and electricity to identify ‘hotspot’ areas 1.2 Reduce gas and electricity use and emissions across Leafield House. Work with the landlord to adjust building settings for optimised use
Introduce switch off and power down policy and behaviour change campaign
Identify and trial suitable power saving devices
Objective Action KPI Deadline Who 2.0 Travel Work is underway to develop an action plan to reduce travel 2.1 Reduce staff business travel by x% by at Leeds North CCG. March 2015 from a 2013/14 base line. The Champion team is in the process of developing this Working with NHS Leeds South & East CCG, action plan within a wider working group, including Leeds NHS Leeds West CCG and NHS WSYBCSU South & East and West CCG’s and WSYB CSU.
Appropriate actions to be developed during the initial phase of the project work, current outline actions are:
2.2 Baseline data Conduct a mini-staff survey to: - understand staff preferences on travel and why - identify barriers and frustrations and test solutions
Undertake monthly monitoring of staff expenses, looking at; car miles, bike miles, public transport costs, and other (e.g. parking costs).
Utilise the results of the WYTPN survey
Research the benefits (cost/staff) of: - Working from home - Tele- and video- conferencing vs travel
Investigate / promote: - implementing a cycle to work scheme - implementing a car-share scheme. - Corporate MetroCard and First Bus schemes.
Work with West Yorkshire Travel Plan Network & peers who have developed similar programmes
Coordinate and facilitate a WebEx learning lunch for staff.
Train staff “super users” and promote the teleconference facility.
2.3 Staff & partner engagement
Develop a staff engagement campaign and behaviour change programme in conjunction with strategic partners.
** Further actions are being developed through a cross organisation travel steering group**
Objective Action KPI Deadline Who 3.0 Commissioning & Procurement 3.1 Integrate sustainability into the Actions to be informed by ongoing research into commissioning cycle and associated commissioning business cases 3.2 Develop less intensive models of care Review the current transformation team work plan and review potential to add sustainability and social value into existing
“transformative” commissioning and procurement services. 3.3 Engage with suppliers to identify suitable Supplier engagement sustainability requirements for procurement Engage local suppliers / services contracts Supplier consolidation and improving logistics 3.4 Inclusion of sustainability requirements in Contract and clauses procurement contracts Include sustainability criteria into contracts, policies and procurement.
Assessment of suppliers sustainability initiatives and amendment of contracts
Sign up and utilise the Procuring 4 Carbon Reduction tool New models of procurement 3.5 Consider and deploy new models of Services vs. Product procurement. Forward Procurement Commitment Whole Life Costing
Objective Action KPI Deadline Who
4.0 Resources (waste prevention, re-use and recycling) 4.1 Follow waste hierarchy when Identify and target areas of waste suitable for reduction managing wastes including:
Reduce overall waste arisings by 20% from the Run paper / printing reduction campaign and increase 2013 baseline awareness around use of ‘confidential waste’ bins
Reduce overall paper usage by 15% Identify ways to reduce packaging arisings
Reduce overall secure disposal requirements by Procurement exercise to ensure switch to purchase of ‘easy 15% to recycle’ office products
Collate data on level of reuse throughout organisation 4.2 Develop a re-use baseline and set appropriate target for 2015/16
Continue to promote good practice recycling 4.3 Increase recycling across site to xx% by March 2015
Objective Action KPI Deadline Who
5.0 Social Value & Community Impact Develop an approach and methodology Research and evaluate methods to measure associated social impact of our activity for social value accounting
Link with SDU work at nation level and respond to Social Develop a baseline for 2014/15 Value Module consultation due May 2014
For example; Identify ways to support and develop local - Team Challenges community engagement - Supporting local charities - Supporting education and work experience through (In alignment with the existing E&D, engagement apprentices and student placements and |Communication strategy) - Commissioning third sector to carry out engagement
Objective Action KPI Deadline Who 6.0 GP Practices
GP sustainability programme Develop ways to share the findings of the GP Sustainability Healthcheck Programme from 2013/14. 6.1 Sharing learning Issue case studies on the progress made by practices
currently receiving support. Run an ‘insight’ session at our GP practice meeting to share findings and opportunities.
6.2 Develop new programmes Support GP practices through a sustainable bulk procurement process; for example;
- securing sustainable low cost waste contracts
- purchasing low energy lighting or equipment Research and recommendations into social prescribing and the role of a GP practice as a community hub
Objective Action KPI Deadline Who
7.0 Climate Change Adaptation Preparation of statutory emergency plan - Consult and
improve Extreme weather events plan Plan for and act to mitigate the effects of Potential for emergency services or contingency plans with Climate change local partners Inclusion of resilience in all commissioning support plans Inclusion in risk register and Annual Governance Statement
Objective Action KPI Deadline Who
8.0 Health & Well Being For example; Improve staff Well Being within the - Improved staff networking organisation in relation to how Satisfied - Increase flexible working hours and Valued they feel at work - Reduced staff hours worked in own time - Reduce staff absenteeism due to sickness / stress
Objective Action KPI Deadline Who
9.0 Water Fit and implement water saving devices to reduce water use:
Small flush, big flush toilet flushing mechanism Plan for and act to mitigate the effects of Urinal control flush Climate change Reduce water waste: Reclaim grey water Harvest Rainwater
Communications Plans
Internal and external engagement and communications will be integral to this sustainability strategy and it will require communications activity at two levels: Delivery of staff and supplier/partner engagement and behaviour change programmes, essential to its delivery Delivery of staff and stakeholder information about its progress and achievements, essential to inform staff and protect and enhance NHS Leeds North CCG’s corporate reputation with stakeholders.
We plan to provide an update on progress to coincide with NHS Sustainability Day 2015 where we will deliver a high profile communication initiative which show cases our continued success in 2014/15.
Monitoring and Reporting – How will we know when we get there?
Leadership
Leadership is essential to the successful delivery of this SDMP.
The board and executive sponsor for this SDMP is Nigel Gray, and the operational lead is Rob Goodyear, Head of Planning and Performance. They will be accountable for steering the development and implementation of the SDMP over the next year.
They will present the SDMP to the board for approval on an annual basis, with progress reports reviewed every 6 months by the board.
We will create a cross functional group to steer the delivery of this SDMP and to ensure our teams operate to their full potential on sustainability. Members of this group will be accountable for the delivery and reporting against targets on behalf of their team.
It is recommended by the NHS Sustainable Development Unit that organisations build in senior independent scrutiny and challenge into their sustainability programmes. This is often most effectively delivered through a specific non-executive board appointment and this will be considered by the CCG governing board.
Measurement
Sustainability performance data will be recorded on an ongoing basis within the monitoring tool and within other agreed KPI’s, as set out in the Action Plan. Wherever possible these KPI’s will be embedded in existing business systems and new reporting requirements will be established as a last resort.
This includes the implementation and external verification and auditing of an Environmental Management System monitoring framework to ISO14001.
NHS Leeds North CCG will use the Good Corporate Citizen assessment tool on an annual basis as a high level review and measurement of progress of this SDMP.
Monitoring
It is recommended that begin the process of establishing an Environmental Management System. More accurately a “Social Value & Environmental Management System”. Such systems provide a monitoring framework for the organisations SDMP and social value and provide internal and external stakeholders with assurance that the organisation has systems in place to actively manage its sustainability impacts and activities.
The ISO14001 accreditation is the recognised certification which is and will increasing be, the standard demanded by all public sector commissioners in order to demonstrate their compliance with the requirements of the NHS SDU Sustainability Strategy and the Social Value Act.
Regional Networks
The CCG will support the re-establishment of a regional network for sustainability. These networks previously formed a knowledge sharing network across the NHS and were initiated by the NHS Sustainable Development Unit. During the initial implementation of the NHS restructuring these networks lapsed.
The NHS Sustainable Development Unit is now seeking to reinvigorate these networks and WSYBCSU will seek to act as a focal point for knowledge sharing across West and South Yorkshire.
Claire Duggan, NHS England - Area Director for Merseyside is the NHS Sustainable Development Unit network lead for the North of England with an ambition to re-establish the knowledge share opportunities.
Reporting
To ensure we are making appropriate progress we will review our progress annually at board level. It is also critical that we share our progress with our stakeholders and other key stakeholders through existing reporting requirements and stakeholder engagement activity.
Our annual report will include a section detailing our sustainability performance for the year against the targets set within the action plan, in line with current NHS England and NHS Sustainable Development Unit requirements.
Summary Report Meeting: LNCCG Board Date: 21 May 2014 Agenda Item: 013a/2014 Report Title: Director of Public Health Report Prepared by: Lucy Jackson – Consultant in Public Health Executive Lead: Lucy Jackson Presented by: Lucy Jackson Other meetings presented to: Purpose of Report Approval Decision Assurance Information and Comment Strategic Objectives (tick all that apply 1. To be a successful and robust organisation that puts clinicians, patients and carers at the forefront of commissioning high quality services based on the needs of local people and within the resources available. 2. To support people to be healthy for longer by promoting better disease management, prevention and early detection and treatment. 3. To drive the transformation of urgent care across the city, improving access and promoting appropriate use of urgent care services. 4. To drive the improvement of services city-wide for people with mental health needs and learning disabilities. 5. To promote choice based on quality of care and improve access to services for people in the Leeds North Clinical Commissioning group area. Executive Summary
This paper present the main issue highlighted in this year’s Director of Public Health Report and recommends the main issues to be noted for Leeds North CCG. Attached is the report that went to Leeds City Council summarising the main recommendations.
Summary
Under the Health & Social Care Act 2012, the Director of Public Health has a duty to produce an Annual Report on the health of the population. Since the transfer of Public Health leadership Leeds City Council now has the duty to publish this report Protecting the health of the population continues to be an important component of public health and therefore becomes a new responsibility for councillors as well as CCGs. Using the 1877 Annual Report as a comparison this year’s report focuses on infectious disease, air quality, infant mortality and the role of school nursing in protecting children’s health – covering progress and future challenges.
Background
Under the Health & Social Care Act 2012 (section 31), the Director of Public Health has a duty to write an Annual Report on the health of the local population. Within the same section of the Act, the Local Authority has a duty to publish the Report. Recent reports have been produced by the NHS, but more recently jointly between the NHS and Leeds City Council. This report is the first for a number of years to be solely under the Council.
013a/2014 Board – Director of Public Health Report Cover Sheet Page 1 of 3
This year’s report focuses in particular on infectious disease, air quality, infant mortality and the role of school nursing in protecting children’s health. The report includes real life stories of what it is like in Leeds today to experience catching measles; catching whooping cough; trying to stop smoking while pregnant; being a teenage mother; struggling with breastfeeding; and coping as a young mother with money difficulties. Data on the health of the population including life expectancy; mortality; disease prevalence e.g. coronary heart disease, respiratory disease, cancer; life styles e.g. smoking, obesity. The data is available city wide, by Area Committee, Clinical Commissioning Group and by 107 Medium Large Super Output Areas (MSOA’s – of around 6 – 8,000 population each).
The report and data are available at www.leeds.gov.uk/DPHAR
Key Issues for the CCG
1. Health Protection Deaths from infectious diseases have fallen over the years. However as mid Staffordshire Hospital highlighted the devastating impact infections can still have for individuals. Surveillance to keep track of infections and other diseases continue to be a vital bed rock for health protection – even more so in these days of mass travel.
Vaccination and Immunisation - The national MMR Catch up Campaign in 2013 highlighted the importance of vaccination but also highlighted the confusion of roles and responsibilities between different agencies as a result of the NHS re- organisation. We have now established a Leeds Screening and Immunisation Group to co-ordinate our approach locally with CCG representation. Targeted work is required to increase uptake. Tuberculosis - Multi-agency work in Leeds over the last few years has reversed an increase in tuberculosis (TB) cases. However the rate is still nearly four times higher than the USA. In 2011 20% of new arrivals to Leeds with countries with high numbers of TB cases developed TB within the first two years in the city. Implementing the recommendations of a 2013 West Yorkshire review of TB services will help further reduce the role of TB infections. CCGs need to be active in the commissioning of TB services and promote awareness within key communities. Antimicrobial Resistance: Highlighted in the CMO report last year as a major health risk and followed by the publication of the UK 5 year antimicrobial strategy. This requires the CCG to continue to work, along with Public Health colleagues to achieve awareness and influence behaviour change amongst the public in reducing the demand for antimicrobials.
The CCG needs to note the structures that are being put in place to provide assurance in relation to Health Protection within the new complex system:
That the Health & Well Being Board is establishing a Health Protection Board to ensure a Leeds wide focus on health protection issues, which will have CCG representation
013a/2014 Board – Director of Public Health Report Cover Sheet Page 2 of 3
That a Leeds Screening and Immunisation group to agree key actions to increase uptake of vaccination, immunisation and screening programmes in Leeds
2. Infant mortality Leeds currently has its lowest level of infant mortality. In 2011, 43 babies under one year died compared to almost 2000 deaths in 1877.The Leeds Infant Mortality Action Plan has been implemented since 2008 and includes actions on improving access to ante- natal care, promoting breast feeding, smoking in pregnancy, safe sleeping, and tackling child poverty. The importance of continuing this work has been recognised by its inclusion as one of the four commitments of the Leeds Joint Health & Well Being Strategy launched in 2013 by the Leeds Health & Wellbeing Board. One of the two Infant Mortality demonstration sites within Leeds is in Leeds North in Chapeltown.
3. Health in Schools The shift in responsibility of the school nursing service from the NHS to Leeds City Council means a new outcome driven service specification will be developed for 2014/15 that will support the implementation of the current review of the school nursing service. The CCG is presently represented at the School Nursing Commissioning Group by Jane Mischenko, Commissioning Lead for Children’s Serivces.
Full report can be found at www.leeds.gov.uk/DPHAR Key Recommendations
The Board is asked to:
Note the content of the DPH report Note the structures that are being put in place to provide assurance in relation to Health Protection within the new complex system: -The establishment of a Health Protection Board under the Health and Well Being Board to ensure a Leeds wide focus on health protection issues, which will have CCG representation - The formation of a Leeds Screening and Immunisation Group to agree key actions to increase uptake and ensure quality of vaccination, immunisation and screening programmes in Leeds Note that there will be a review of School Nursing within 2014/15 Assurance Framework
Next Steps
Corporate Impact Assessment Regulatory implications Financial implications Legal implications Workforce implications Equality impact assessment
013a/2014 Board – Director of Public Health Report Cover Sheet Page 3 of 3
Report author: Dr Ian Cameron Tel: 0113 247 4414
Report of Director of Public Health 013b/2014 Board Report to Executive Board
Date: 18 December 2013
Subject: Director of Public Health Annual Report 2013
Are specific electoral Wards affected? Yes No If relevant, name(s) of Ward(s):
Are there implications for equality and diversity and cohesion and Yes No integration?
Is the decision eligible for Call-In? Yes No
Does the report contain confidential or exempt information? Yes No If relevant, Access to Information Procedure Rule number: Appendix number:
Summary of main issues
1. Under the Health & Social Care Act 2012, the Director of Public Health has a duty to produce an Annual Report on the health of the population.
2. Protecting the health of the population continues to be an important component of public health and therefore becomes a new responsibility for councillors.
3. Using the 1877 Annual Report as a comparison this year’s report focuses on infectious disease, air quality, infant mortality and the role of school nursing in protecting children’s health – covering progress and future challenges.
Recommendations
4. The Executive Board is requested to:
i. Note the contents of the report.
ii. Support the recommendations including the proposal to create a Health Protection Board under the Leeds Health & Well Being Board.
iii. Recommend that the report is received by the Scrutiny Board (Health and Well-being and Adult Social Care).
Purpose of this report
1.1 To summarise the background, content and key issues from the Director of Public Health’s Annual Report 2013.
2 Background information
2.1 Under the Health & Social Care Act 2012 (section 31), the Director of Public Health has a duty to write an Annual Report on the health of the local population. Within the same section of the Act, the Local Authority has a duty to publish the report.
2.2 The first Annual Report in Leeds was in 1866 – the year of the arrival of the first Medical Officer of Health in Leeds.
2.3 Recent reports have been produced by the NHS, but more recently jointly between the NHS and Leeds City Council. This report is the first for a number of years to be solely under the Council.
2.4 The context for this year’s report is the move of Public Health to the Council and the new leadership role for the ninety-nine councillors for Leeds.
2.5 In improving the health and well being of the population of Leeds and reducing health inequalities, councillors will need to take a broad range of actions and approaches – ranging from tackling the social determinants of health; changing lifestyles; ensuring access to effective health and care services; using economic and technological developments; ensuring a natural environment that co-exists successfully with economic growth and social development; protecting the health of the population from infectious diseases and environmental hazards.
2.6 A concern for the Director of Public Health is that there may be a lack of emphasis on the importance of health protection. This was the dominant health concern faced by the first Medical Officers of Health in Leeds and still has a relevance today – hence this being the focus for this year’s report.
2.7 Although the first Annual Report in Leeds was 1866, the Director of Public Health has used the 1877 Annual Report as the basis for a comparison between then and now. This is because of a sense by the author at the time that finally there was some improvement in health in Leeds – a turning of the curve.
2.8 This year’s report focuses in particular on infectious disease, air quality, infant mortality and the role of school nursing in protecting children’s health.
2.9 As a way of highlighting the issues raised there are real life stories of what it is like in Leeds today to experience catching measles; catching whooping cough; trying to stop smoking while pregnant; being a teenage mother; struggling with breastfeeding; and coping as a young mother with money difficulties.
2.10 Along with the report are the usual data on the health of the population including life expectancy; mortality; disease prevalence e.g. coronary heart disease, respiratory disease, cancer; life styles e.g. smoking, obesity.
2.11 The data is available city wide, by Area Committee, Clinical Commissioning Group and by 107 Medium Large Super Output Areas (MSOA’s – of around 6 – 8,000 population each).
2.12 The report and data are available at www.leeds.gov.uk/DPHAR
3 Main issues
3.1 Infectious diseases
3.1.1 Deaths from infectious diseases have fallen over the years. However, the appalling scandal at mid Staffordshire Hospital highlights the devastating impact infections can still have for individuals.
3.1.2 Surveillance to keep track of infections and other diseases continue to be a vital bed rock for health protection – even more so in these days of mass travel.
3.1.3 The national MMR Catch up Campaign in 2013 highlighted the importance of vaccination but also highlighted the confusion of roles and responsibilities between different agencies as a result of the NHS re-organisation.
3.1.4 The report recommends that the Health & Well Being Board establishes a Health Protection Board to ensure a Leeds wide focus on health protection issues.
3.1.5 Multi-agency work in Leeds over the last few years has reversed an increase in tuberculosis (TB) cases. However the rate is still nearly four times higher than the USA. In 2011 20% of new arrivals to Leeds with countries with high numbers of TB cases developed TB within the first two years in the city.
3.1.6 Implementing the recommendations of a 2013 West Yorkshire review of TB services will help further reduce the role of TB infections.
3.2 Air quality
3.2.1 The industrial black smoke pollution of the Victorian era and beyond has been replaced by harmful vehicle exhaust gases. Progress has been made in reducing key specific air pollutants in Leeds over the last twenty years.
3.2.2 High levels of air pollution remain for areas living close to main roads, often in areas of high deprivation where other health issues are also present.
3.2.3 Improving air quality by reducing traffic pollution or not building new homes away from major road intersections will contribute to an increase in healthy length of life.
3.2.4 Leeds City Council should continue to work to improve air quality in partnership with other West Yorkshire local authorities.
3.3 Infant mortality
3.3.1 Leeds currently has its lowest level of infant mortality. In 2011, 43 babies under one year died compared to almost 2000 deaths in 1877.
3.3.2 The Leeds Infant Mortality Action Plan has been implemented since 2008 and includes actions on improving access to ante-natal care, promoting breast feeding, smoking in pregnancy, safe sleeping, tackling child poverty.
3.3.3 The importance of continuing this work has been recognised by its inclusion as one of the four commitments of the Leeds Joint Health & Well Being Strategy launched in 2013 by the Leeds Health & Wellbeing Board.
3.4 Health in Schools
3.4.1 The shift in responsibility of the school nursing service from the NHS to Leeds City Council provides a welcome opportunity to align the commissioning of these services even more closely with the aspirations for Leeds to become a Child Friendly City.
3.4.2 To help realise that aspiration a new outcome driven service specification must be developed for 2014/15 that will support the implementation of the current review of the school nursing service.
4 Corporate Considerations
4.1 Consultation and Engagement
4.1.1 Various work programmes described in the report have been developed with services users e.g. Infant Mortality Action Plan, school nursing service review.
4.1.2 Members of the public have helped write the report through personal stories and experiences.
4.2 Equality and Diversity / Cohesion and Integration
4.2.1 An equality impact assessment has been completed and this is appended to this report.
4.3 Council policies and City Priorities
4.3.1 The Annual Report of the Director of Public Health supports the Council’s role in improving health and reducing health inequalities as set out in the Leeds Joint Health & Well Being Strategy and the Best Council Plan.
4.4 Resources and value for money
4.4.1 The costs of producing the Annual Report of the Director of Public Health are contained within the ring fenced Public Health grant.
4.5 Legal Implications, Access to Information and Call In
4.5.1 Publication of the Annual Report of the Director of Public Health will enable the Council to meet its statutory requirements under the Health & Social Care Act 2012.
4.6 Risk Management
4.6.1 There are no risks identified with the publication of the Annual Report of the Director of Public Health.
5 Conclusions
5.1 Protecting the health of the population is a key responsibility for councillors as they take on their new public health leadership role for the city.
5.2 The health protection areas covered in the Director of Public Health’s Annual Report for 2013 namely infectious diseases, air quality, infant mortality, and the role of school nurses in protecting children’s health are as relevant today as they were to his predecessors’ in the 1860’s and 1870’s.
6 Recommendations
6.1 The Executive Board is requested to:
i. Note the contents of the report.
ii. Support the recommendations including the proposal to create a Health Protection Board under the Leeds Health & Well Being Board.
iii. Recommend that the report is received by the Scrutiny Board (Health and Well-being and Adult Social Care).
7 Background documents 1
None
1 The background documents listed in this section are available to download from the Council’s website, unless they contain confidential or exempt information. The list of background documents does not include published works.
Equality, Diversity, Cohesion and Integration Screening
As a public authority we need to ensure that all our strategies, policies, service and functions, both current and proposed have given proper consideration to equality, diversity, cohesion and integration.
A screening process can help judge relevance and provides a record of both the process and decision. Screening should be a short, sharp exercise that determines relevance for all new and revised strategies, policies, services and functions. Completed at the earliest opportunity it will help to determine: • the relevance of proposals and decisions to equality, diversity, cohesion and integration. • whether or not equality, diversity, cohesion and integration is being/has already been considered, and • whether or not it is necessary to carry out an impact assessment.
Directorate: Service area: Offic e of the Director of Public Health Public Health Lead person: Contact number: Ian Cameron 07712214791
1. Title: Director of Public Health Annual report 2013: Protecting Health in Leeds – the story continues Is this a:
Strategy / Policy Service / Function X Other
If other, please specify Annual report of the Director of Public Health
2. Please provide a brief de scription of what you are screening
The Director of Public Health is required to produce an Annual report on the health of the local population. This year focuses on health protection. The report compares and contrasts the current position in Leeds to that described in the Medical Officer of Health’s equivalent report for 1877. The focus is on communicable diseases such as measles and tuberculosis, air pollution, infant health, health in schools.
3. Relevance to equality, diversity, cohesion and int egration All the council’s strategies/policies, services/functions affect service users, employees or the wider community – city wide or more local. These will also have a greater/lesser relevance to equality, diversity, cohesion and integration.
The following questions will help you to identify how relevant your proposals are.
When considering these questions think about age, carers, disability, gender reassignment, race, religion or belief, sex, sexual orientation and any other relevant characteristics (for example socio-economic status, social class, income, unemployment, residential location or family background and education or skills levels).
Questions Yes No Is there an existing or likely differential impact for the different X equality characteristics? Have there been or likely to be any public concerns about the X policy or proposal? Could the proposal affect how our services, commissioning or X procurement activities are organised, provided, located and by whom? Could the proposal affect our workforce or employment X practices? Does the proposal involve or will it have an impact on • Eliminating unlawful discrimination, victimisation and harassment X • Advancing equality of opportunity X • Fostering good relations X
If you have answered no to the questions above please complete sections 6 and 7
If you have answered yes to any of the above and; • Believe you have already considered the impact on equality, diversity, cohesion and integration within your proposal please go to section 4. • Are not already considering the impact on equality, diversity, cohesion and integration within your proposal please go to section 5.
4. Considering the impact on equality, diversity, cohesion and integration
If you can demonstrate you have considered how your proposals impact on equality, diversity, cohesion and integration you have carried out an impact assessment.
Please provide specific details for all three areas below (use the prompts for guidance). • The Medical Officer of Health’s report for 1877 was presented to the Sanitary Committee. At that time the Borough of Leeds did not have an Equality, Diversity, Cohesion & Integration Screening process. The key equality health issues centre on geographic inequalities, related to poverty and the high mortality in the very young. For the purpose of the comparisons with the current position in Leeds these are limited to those set out in the 1877 report. However current ethnic considerations are included for tuberculosis and infant mortality.
Key findings • The report highlights that the majority of present cases of tuberculosis (TB) in Leeds originate from the Indian sub-continent. However the highest number of cases per head of population is from the black ethnic population. In 2011, 20% of new arrivals to Leeds from countries with high numbers of tuberculosis cases developed TB within the first two years in the city. • In terms of infant health, a local audit has shown that minority ethnic groups are more likely to be late bookers for their ante-natal care. In addition babies amongst Pakistan and Caribbean groups have higher infant mortality rates. For Pakistan babies, the main cause is congenital abnormalities. National and local work has highlighted the potential added risk of genetic conditions in communities where cousin marriage is common such as those of Pakistani and Bangladeshi origin.
Actions • Tuberculosis – The report recommends that the Leeds Health Protection Board should work with West Yorkshire partners to act on the 2013 independent review of TB services. This included a recommendation to re-focus activity on screening close contacts of TB cases and new entrants to identify and treat cases of latent TB. • Infant health – a specialised hospital midwife to improve access to services for black and minority ethnic groups has been appointed. − Pathways have been developed to make services more sensitive to the needs of particular groups such as asylum seekers, and gypsy and travellers. − Those couples considering marriage to a cousin are urged to seek advice and guidance, especially if there is awareness of serious illness or death amount children in their wider family.
5. If you are not already considering the impact on equality, diversity, cohesion and integration you will need to carry out an impact assessment .
Date to scope and plan your impact assessment: Not applicable
Date to complete your impact assessment Not applicable
Lead person for your impact assessment Not applicable (Include name and job title)
6. Governance, owne rship and approval Please state here who has approved the actions and outcomes of the screening Name Job title Date Ian Cameron Director of Public Health 18 November 2013
7. Publishing This screening document will act as evidence that due regard to equality and diversity has been given. If you are not carrying out an independent impact assessment the screening document will need to be published.
If this screening relates to a Key Delegated Decision , Executive Board , full Council or a Significant Operational Decision a copy should be emailed to Corporate Governance and will be published along with the relevant report.
A copy of all other screening’s should be sent to [email protected] . For record keeping purposes it will be kept on file (but not published).
Date screening completed 18 November 2013
If relates to a Key Decision - date sent to Corporate Governance Any other decision – date sent to Equality Team 20 November 2013 ([email protected])
Summary Report Meeting: LNCCG Board Date: 21 May 2014 Agenda Item: 014/2014 Report Title: Leeds Better Care Fund Prepared by: Nigel Gray – Chief Officer Executive Lead: Nigel Gray Presented by: Nigel Gray Other meetings presented to: Health & Wellbeing Board Purpose of Report Approval Decision Assurance Information and Comment Strategic Objectives (tick all that apply) 1. To be a successful and robust organisation that puts clinicians, patients and carers at the forefront of commissioning high quality services based on the needs of local people and within the resources available. 2. To support people to be healthy for longer by promoting better disease management, prevention and early detection and treatment. 3. To drive the transformation of urgent care across the city, improving access and promoting appropriate use of urgent care services. 4. To drive the improvement of services city-wide for people with mental health needs and learning disabilities. 5. To promote choice based on quality of care and improve access to services for people in the Leeds North Clinical Commissioning group area. Executive Summary
The Better Care Fund (BCF) is a national initiative aimed at promoting integration between Health and Social Care. The BCF is a single pooled budget to support health and social care services to work more closely together in local areas.
It is emphasized that the BCF is not new money. It is a redistribution of funds already within the system, or funds which will need to be released by improvements in the way integrated care is delivered. This will create challenges within the health economy, where existing spend on acute and community services will need to be re-directed to support the delivery of integrated care and jointly commissioned services.
Local areas were required to develop plans for the use of this fund, with plans overseen by the Health and Wellbeing Board. Leeds submitted the final plan for the BCF on 4 April 2014 to NHS England and Local Government Association in line with national planning requirements.
The BCF mandates a number of national conditions to be achieved in the plans submitted, which includes:
Protection for adult social care services 7 day services in health and social care to support patients being discharged and prevent unnecessary admissions at weekends Ensuring a joint approach to assessments and care planning Better data sharing between health and social care, based on NHS number Plans to be jointly agreed/signed off by health and social care partners Agreement of the consequential impact of changes in the acute sector A risk assessment of the consequence of failing to achieve proposed changes in activity levels and a plan to mitigate these 014/2014 Board – Leeds Better Care Fund Cover Sheet
Page 1 of 2
The government is also subjecting the BCF to a performance related payment scheme. The pay for performance targets relate to 5 national metrics plus one locally agreed metric:
Reducing residential and nursing home admissions Improving effectiveness of re-ablement at keeping people at home after discharge Minimising delayed transfers of care from hospital Reducing avoidable emergency admissions to hospital Improving user experience of integrated services Estimated diagnosis rate for people with dementia (local metric)
Attached are the national templates that set out our BCF plan submission for Leeds, including narrative, financial and performance information and supplementary information:
a) Leeds Better Care Fund Planning Template – submitted on the 4 April b) Leeds Better Care Fund Finance template c) Leeds Better Care Fund Supplementary Information.
Key Recommendations
The Board is requested to:
Receive the BCF plan submitted by the Leeds CCGs, the Council and the Health and Wellbeing Board setting out the approach to pooled budgets in 2015/16.
Assurance Framework
Next Steps
Corporate Impact Assessment Regulatory implications N/A Financial implications Legal implications N/A Workforce implications N/A Equality impact assessment N/A
014/2014 Board – Leeds Better Care Fund Cover Sheet
Page 2 of 2 014a/2014 Board
Better Care Fund planning template
Please note, there are two parts to the template. Part 2 is in Excel and contains metrics and finance. Both parts must be completed as part of your Better Care Fund Submission.
Plans are to be submitted to the relevant NHS England Area Team and Local government representative, as well as copied to: [email protected]
To find your relevant Area Team and local government representative, and for additional support, guidance and contact details, please see the Better Care Fund pages on the NHS England or LGA websites.
1) PLAN DETAILS a) Summary of Plan
Local Authority Leeds City Council
Clinical Commissioning Groups NHS Leeds South and East CCG NHS Leeds West CCG NHS Leeds North CCG
None. 3 x CCGs are jointly coterminous Boundary Differences with local authority
Date agreed at Health and Well-Being 27/3/2014 Board:
Date submitted: 4/4/2014
Minimum required value of ITF pooled budget: 2014/15 2015/16 £54.9m
Total agreed value of pooled budget: £2.759k 2014/15 2015/16 £54.9m b) Authorisation and signoff
Signed on behalf of the Clinical Commissioning Group Leeds South and East CCG
Matt Ward By
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Position Chief Operating Officer Date 27/3/14
Signed on behalf of the Clinical Commissioning Group Leeds North CCG
Nigel Gray By Position Chief Officer Date 27/3/14
Signed on behalf of the Clinical Commissioning Group Leeds West CCG
By Philomena Corrigan Position Chief Officer Date 27/3/14
Signed on behalf of the Council Leeds City Council
By Sandie Keene Position Director of Adult Social Services Date 27/3/14
Signed on behalf of the Health and Wellbeing Board Leeds Health and Wellbeing Board
Councillor Lisa Mulherin By Chair of Health and Wellbeing Board Date 27/3/14
c) Service provider engagement 2
Please describe how health and social care providers have been involved in the development of this plan, and the extent to which they are party to it BCF engagement
This plan has been jointly developed by all of the health and social care organisations (including both statutory and third sector providers) across Leeds that work to deliver outcomes for the Leeds Joint Health and Wellbeing Strategy and thus link into the Leeds Health and Wellbeing Board.
The development of the BCF plan has been led by the Integrated Commissioning Executive. It has been developed through a series of BCF-specific, well-attended workshops with attendance drawn from provider and commissioning organisations from across the city. It has been supported by a number of existing boards, aligned to the Health and Social Care Transformation Programme Board, which have senior representation from all service provider organisations. These boards have developed the schemes outlined in Leeds’ BCF through the “supplementary information” part of the submission:
- Integrated health & social care board - Urgent care board - Informatics board - Palliative care strategy group - Dementia board
As well as senior representation, membership also includes frontline staff from medical, nursing and mental health backgrounds, third sector representatives, patient and carer representatives, other health and social care professionals, and colleagues from Public Health.
Since the first draft was submitted in February, there has been further consultation with providers: - Series of meetings between CCG lead officer for the BCF with NHS provider chief executives - Presentation to and discussion at the Directors of Finance forum, aligned to the Transformation Board –opportunity to further focus on quantifiable savings and financial impact on the provider landscape and agreement to jointly sign off the schemes through the detailed business case and implementation phase - Consultation event with over 25 members of Healthy Lives Leeds, the 3rd sector representative collaborative.
We have also consulted with Leeds City Council’s Cabinet and Health and Wellbeing and Adult Social Care Scrutiny Board on the BCF submission.
Ongoing engagement
In addition to the specific work to develop the BCF, for the past three years, Leeds has operated a Health and Social Care Transformation Board that comprises the Chief Executive (or equivalents) from all of the city’s commissioner and provider bodies, plus third sector representation. Additionally, we are dedicated to maintaining parity of esteem between physical and mental health services.
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Significant engagement work has been completed in Leeds West and Leeds North CCGs in primary care to engage with them on the urgent need to transform services. Applications to the Prime Minister’s Challenge Fund have included additional funding to requests to extended and out of hours services, provide flexible access to clinicians via technologies such as Skype, better joining up of urgent care and out of hours care and improved access to telecare so people can live for longer in their own homes. Continuing to roll out new technologies with primary care forms part of the “enhancing primary care” scheme of our BCF.
Additionally, we are committed to clinical leadership and engagement across all sectors. In secondary care, the CCGs are working with acute hospital consultants and the local clinical senate to look beyond our shores at models of healthcare overseas, at the Intermountain Healthcare organisation in Utah, United States. Through this continued work, our aim to bring back to Leeds the best examples of good practice and innovation and this will continue to inform the schemes of our BCF.
This excellent track record of working together across the health and care economy has resulted in the city being selected as one of 14 national Integration Pioneers. For more information on our work to date, please see www.leeds.gov.uk/transform
d) Patient, service user and public engagement Please describe how patients, service users and the public have been involved in the development of this plan, and the extent to which they are party to it BCF engagement
Following on from the submission of the first draft of the BCF, HealthWatch Leeds has led a rapid consultation with the public, using both face-to-face and social media approaches, to test out and support further development of proposals. The results of this consultation tell us that, overall, the proposals set out for Leeds’ Better Care Fund were supported. A number of proposals particularly resonated, including Eldercare Facilitators, Enhancing Integrated Neighbourhood Teams and reducing emergency admissions through a case management approach to urgent care. Other findings on the proposed schemes will be used to inform development work going forwards. the full findings are attached at Appendix 6.
Furthermore, a more in-depth consultation process will take place later in 2014 once the final plan has been signed off in order to shape and develop the detail and delivery of the schemes. This will play a key role in the scoping and development we will be funding through identified “pump-priming” monies in 2014/15 as per the “supplementary information”.
Ongoing engagement
In terms of the wider context of our plans for integrated care in the city within which the BCF sits, patients, service users and the public have played, and will continue to play, a key role in its development. Building on the National Voices consultation, local patient/service user voices of all ages have been used to frame the Leeds vision for person-centred care:
“Support that is about me and my life, where services work closer together by sharing
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trusted information and focussing on prevention to speed up responses, reduce confusion and promote dignity, choice and respect”.
Our Charter for Involvement in Integration was co-produced with people who access services and their carers, includes a clear expectation that the views of people who use services will be integral to the reshaping of those services, and we are committed to providing feedback on how those views have been incorporated into our plans. In line with the Charter, patients and service users are already involved in designing services and shaping change through patient advisory and liaison groups and representation on boards and steering groups. Additionally, staff groups across health and social care have also been involved from the beginning in the development and implementation of our plans for integrated services.
Finally, the NHS Call to Action has provided us with an additional platform to further strengthen our engagement with the public more broadly. The concept of investing in social care and integrated care to reduce demand on urgent and acute care is being promoted in the city and is actively discussed at patient and public forums.
e) Related documentation Please include information/links to any related documents such as the full project plan for the scheme, and documents related to each national condition. Document or information title Synopsis and links BCF Leeds – Supplementary information This document explains in more detail the make-up of the Leeds BCF and the initiatives that will be pursued in the city next year. It also provides a more detailed rationale on the metrics that have been selected locally to measure and monitor progress. Appendix 1 - Charter for involvement Appendix 2 - Leeds integrated health and social care pioneer bid Appendix 3 – Leeds £ plan on a page Appendix 4 - Leeds Integrated Health & Social Care Outcomes Framework Appendix 5 – Integration dashboard Appendix 6 – results of HealthWatch Leeds public consultation on Leeds’ BCF Appendix 7 – Best City approach to health and social care – executive summary
VISION AND SCHEMES a) Vision for health and care services Please describe the vision for health and social care services for this community for 2018/19. What changes will have been delivered in the pattern and configuration of services over the next five years?
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What difference will this make to patient and service user outcomes? As a Pioneer, Leeds strives to be the Best City for Health and Wellbeing in the UK. Our vision is that Leeds will be a healthy and caring city for all ages, where people who are the poorest, improve their health the fastest. As part of becoming the Best City, commissioners and providers have a shared ambition to create a sustainable, high quality health and social care system. How we will work together is set out in appendix 7.
We want to ensure that services in Leeds can continue to provide high quality support that meet or exceed the expectations of the children, young people and adults across the city: the patients and carers of today and tomorrow. We know that we will only meet the needs of individuals and our populations if health and social care workers and their organisations work in partnership. We know that the needs of patients and citizens are changing; the way in which people want to receive care is changing, and that people expect more flexible approaches that fit in with their lives and families. Front line staff, leaders and managers across organisations are coming together in many ways. We are working closely with not-for-profit organisations, universities and investors to act as one: as if we were a virtual ‘single organisation’ to improve the health and wellbeing of the people who live or use services in Leeds.
To do this, we have agreed to work together in four ways:
Work with patients, carers, young people and families to enable them to take more control of their own health and care needs Provide high quality services in the right place, backed by excellent research, innovation and technology- including more support at home and in the community, and using hospitals for specialised care Remove barriers to make team working across organisations and professional groups the norm so that people to receive seamless integrated support Use the Leeds £’, our money and other resources wisely, for the good of the people we serve in a way in which balances the books for the city (see diagram at appendix 3)
Vision for health and care services
For the past two years, the health and social care community in Leeds has been working collectively towards creating an integrated system of care that seeks to wrap care and support around the needs of the individual, their family and carers and helps to deliver on our wider vision. The model below sets out how the BCF fits into this, alongside other key strategic drivers and making best use of the freedoms and flexibilities of the Pioneer programme.
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We recognise that collectively planning improved care and support services requires significant transformation of existing methods of service delivery. Greater emphasis needs to be placed on community-based support and care and significantly less emphasis on the use of acute, urgent and long term care services. Our programme of work acknowledges that people rightly expect the availability of high quality, easily accessible community-based services which they can trust.
A recent example of the approach outlined above is the South Leeds Independence Centre (SLIC), a jointly commissioned and provided intermediate care centre in a community setting. It is designed to provide reablement and rehabilitation to enable people to spend less time in hospital. Our ambition over the next five years, through continuous evaluation and learning from elsewhere, is that people of Leeds will be able to access further community facilities of this nature.
Our approach recognises that whilst services are currently delivered by different organisations, organisational boundaries in the future will continue to be more permeable and flexible, with staff working to support and care for people as part of interdisciplinary endeavour. Services must be based around the needs of people, not around organisations.
The integrated health and social care model in Leeds has been developed around three core themes: Supported self-management Risk stratification Integrated health and social care teams
Self-care and self-management (supported by Leeds’ ambition to be a digital city for health and social care), and the engagement of community, independent and third sector organisations are key to achieving improved chronic disease management, social inclusion and community cohesion. The continuing close engagement with all provider organisations will remain at the centre of our transformation programme, driving innovation and efficiency.
We need to accurately identify those individuals who would benefit from earlier
7 intervention, maximizing their independence for longer. This requires two elements: 1) Making best use of risk stratification tools to identify those who could benefit most from more targeted and holistic support and care; and 2) Ensuring that those people experience a coordinated and integrated response to their health and social care needs.
Integrated Health and Social Care Teams, covering the whole city, are a key element to wrapping care around the needs of people, their families and their carers. These teams will continue to be developed and enhanced over the next five years to better deliver care closer to home, and are increasingly improving coordination of activity between all health and social care partners.
We also recognise that developing a broader range of community-based services will require the collective pooling of resources to effect the movement of funding from acute and long term care models to those new community based services. All BCF stakeholders will continue to experience considerable financial challenges and therefore our transformation programme is designed to generate significant efficiencies across the piece to ensure that the health and care system for the city remains sustainable – and of high quality – in the long term. City leaders acknowledge that this cannot be achieved overnight and thus this plan reflects an appropriate balance between ambition and realism.
Building on a long history of joint commissioning of services, the BCF provides further opportunity to commission services together. Our ultimate ambition remains the pooling of all current resources committed to the commissioning of health and social care services - the creation of the Better Care Fund enables us to accelerate progress towards that goal, establishing appropriate governance and ensuring the appropriate sharing of risk and reward. b) Aims and objectives Please describe your overall aims and objectives for integrated care and provide information on how the fund will secure improved outcomes in health and care in your area. Suggested points to cover: What are the aims and objectives of your integrated system? How will you measure these aims and objectives? What measures of health gain will you apply to your population? Aims As an Integration Pioneer, we will be aiming: To be recognised as a national and international centre of health and social care excellence To be recognised as city which is leading the way on health and care innovation To have the ability to make commissioning and de-commissioning decisions on the basis of shared empirical, financial and outcome intelligence
In developing the BCF, partners have recognised the importance not only of integrated provider services, but also the need to increasingly jointly commission these services. As such, the Transformation Board programme aims to achieve: Better outcomes for the people of Leeds Timely access to personalised services More effective use of resources Better collaborative use of the Leeds £ 8
Better lives for people in Leeds through integrated services
Objectives The specific schemes within the Better Care Fund are framed by three key objectives to achieve the aim of a high quality and sustainable system. These themes also articulate delivery of a number of the outcomes of the Leeds Joint Health and Wellbeing Strategy, in particular the commitment to “increase the number of people supported to live safely in their own homes”. Our BCF objectives are: Reducing the need for people to go into hospital or residential care Helping people to leave hospital quickly Supporting people to stay out of hospital or residential care
What we will measure These objectives will be measured by the nationally required metrics of the BCF. We have chosen to use the dementia diagnosis rate as our “local” measure, given the focus on supporting people with dementia in our schemes and the role this can play in achieving better outcomes across our three themes.
However, there exist some local concerns about the nationally required metrics for measuring effectiveness. In Leeds, as a national Pioneer, we have taken the decision to develop two additional local metrics:
Our indicator will focus on the total number of bed days spent in care/residential home facilities. In Leeds, we believe that our success in supporting more people to live longer in their own homes is evidenced not by the rate of admissions to residential care, but by the combination of those admitted and their lengths of stay. This number has steadily reduced over the last 10 years. We are also looking at developing a measure relating to bed day utilisation across the whole health and social care system.
In terms of overall health gain, the overarching population level indicator of our Joint Health and Wellbeing Strategy is the reduction of differences in life expectancy between communities. Further detail and rationale on the metrics we will use as a city is available in the supplementary information section.
How we will measure There are positive signs from the Leeds Integrated Health & Social Care Outcome Framework (Appendix 4) that suggest progress can be measured, and we continue to evaluate progress using this tool within Leeds. Additionally, effectiveness of integration has been embedded into city wide analysis through the use of a dashboard approach (Appendix 5). We will continue to use this as part of the BCF monitoring system. In addition to this, we will monitor: Progress towards individual organisations and the health economy of Leeds achieving financial balance Using ‘Caretrak’ (our innovative product which tracks patient populations across the health and social care system based on use of the NHS Number) to ascribe both clinical and financial value to intervention Progress on the Joint Health and Wellbeing Strategy indicators especially those related to hospital admission, discharge rate and readmission as per the three objectives of our BCF.
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Achieving the objectives set out above will enable us to fully realise the potential from our Pioneer status, both in terms of transforming services for better outcomes for the people of Leeds and sharing our learning across the country. c) Description of planned changes Please provide an overview of the schemes and changes covered by your joint work programme, including: The key success factors including an outline of processes, end points and time frames for delivery How you will ensure other related activity will align, including the JSNA, JHWS, CCG commissioning plan/s and Local Authority plan/s for social care Leeds’ schemes blend existing programmes of work which we know are delivering results with more innovative proposals.
We have benchmarked our proposals against work happening in other cities, exploring what similar schemes have worked well and what evidence of impact on outcomes for both people and finances is available. Additionally, we asked the National Institute of Clinical Excellence to map key NICE guidance and resources to our BCF priorities. This has enabled us to take relevant NICE quality standards and commissioning resources into consideration when developing the schemes.
The BCF plan draws on the excellent work already in train in Leeds. A number of schemes have begun in 2013/14, with a full evaluation taking place in 2014/15, for example, the winter pressures initiatives around seven day loan equipment availability. During the course of 2014/15, where there is agreement to focus on a particular area (e.g. falls), but it is not clear at this stage what intervention would be of the most value, work will be undertaken to review the service and recommend how non-recurrent funds through the BCF might be best utilised for the biggest impact. In most cases, development work will start in 2014/15 and inform progress into 2015/16; we will use this approach to ‘learn as we go’.
It is widely recognised that there is a lack of robust evidence available nationally on the impact of shifting the balance from acute to preventative services and a lack of health economics expertise to model this. As a Pioneer, we will take risks and accept our BCF, as part of our wider Transformation programme, will be an iterative process. However, the rigorous process of testing and evaluation we have put in place will enable us to be confident that we are investing in what works locally – and to contribute to growing the evidence base nationally.
The complete list of schemes and initiatives is included in the supplementary information to this submission. Schemes are split into those that will be recurrently funded and those that will be achieved through non-recurrent funding housed within the BCF scheme. In total there are over 20 schemes, and the appendix gives detail about aims, objectives, required investment and anticipated savings. Specific schemes have been proposed to support patients more at risk of emergency admissions, e.g. the frail elderly and those with dementia in order to achieve national and local BCF targets. Furthermore, since the first draft was submitted, the two schemes to support patients with dementia have been further developed and are intended to enhance mental health services in this regard. This reflects our dedication to maintaining parity of esteem between physical and mental health services
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The BCF and all related plans and activity are aligned to the Leeds Joint Health and Wellbeing Strategy. The priorities of the strategy were developed following the robust work to compile the city’s Joint Strategic Needs Assessment, which sets out the challenge to the health and social care system of a growing older population and associated need to support people with long-terms conditions.
It should also be noted that whilst the BCF represents £54.9m of expenditure, the whole health and social care commissioning budgets amount to approximately £1.5bn and therefore it is recognised across the whole health and social care system that the BCF alone will not address the city’s financial challenge.
We will ensure that we will maintain alignment of plans through the reporting mechanisms and governance structures agreed, or developed during our shadow year.
d) Implications for the acute sector Set out the implications of the plan on the delivery of NHS services including clearly identifying where any NHS savings will be realised and the risk of the savings not being realised. You must clearly quantify the impact on NHS service delivery targets including in the scenario of the required savings not materialising. The details of this response must be developed with the relevant NHS providers. The Leeds health and social care economy is facing a financial challenge of over £100m a year. Leeds Teaching Hospitals NHS Trust is looking at around a £250m deficit over the next 5 years; 2015/16 is the year presenting the biggest challenge. Savings need to be identified not only to plug this gap, but also to free up monies to allow investment in more joined up community based services.
A reduction in emergency acute activity is the main driver for commissioners in Leeds to generate savings for both the health and social care commissioners and provider in the city. Leeds Teaching Hospitals NHS Trust is currently consulting on its 5 year strategy. Since submission of the first draft of the BCF, organisations in the city have provided comments on this strategy, linking it back to the content of BCF plans. LTHT, in its draft strategy, has stated its intention to deliver seamless integrated care across organisation boundaries, with a reduction in urgent admissions for frail elderly patients and those with long term conditions by 20%. In order to realise these savings, there is a need to also invest in preventative measures through better integrated working and more joined up care in the community.
Realising savings through reductions in hospital activity is a big risk for the city - the most obvious implication is that the NHS in the city becomes financially unsustainable and service delivery targets fail to be met. The targets most at risk include: Failure to meet the RTT 18 weeks elective care target – due to increased pressure on beds from acute admissions Failure to meet the A&E 4 hour waiting time target
Increasing community capacity should act not only to promote the integration agenda, but also to support the delivery of these key performance targets.
Changes in finance and commissioning arrangements are also key to generating savings. Leeds is a Year of Care pilot and recent work, carried out by the Year of Care tariff working group, has looked to identify patients who have remained in hospital
11 beyond the point at which they were medically fit for discharge. The work found that over a third of patients were staying in hospital beds longer than was clinically necessary, but these patients attract the same tariff as a patient who goes home earlier. Commissioners in Leeds are looking at more intelligent commissioning and contracting models that will incentivise timely discharge, and tariff arrangements that reflect the actual cost as well as the amount of time someone stays in hospital - thus potentially generating further savings for the Leeds pound.
Health and social care commissioners in the city are also mindful that hospital-based care must be sustainable. Given the scale of specialised activity at Leeds Teaching Hospital it is imperative the development of the acute strategy for Leeds is cognisant of the approach of NHS England to specialised services commissioning. It is crucial that as less money and activity is delivered in the acute sector as a result of the BCF initiatives, costs in that sector either reduce or are refocused on specialist activity. Therefore, it is essential to develop a citywide plan which factors in the commissioning intentions for specialised services, working closely with NHS England and the local area team under the auspices of the Health and Wellbeing Board. Savings in the health and social care sector need to be generated by shifting activity into the community, and making the entire sector more focussed on prevention.
The hospital itself also needs to become more efficient to ensure that it remains sustainable. Leeds Teaching Hospital NHS Trust’s goal is financial stability, with a recognition that efficiency savings of 18 – 20% must be made over the next three years. This will be achieved through: treating patients differently who do not need to be in hospital length of stay, purchasing and the innovative use of information technology. At the same time, we need to ensure that acute services in Leeds continue to provide excellent patient care, develop an effective and caring workforce and lead on research, innovation and education.
As a consequence of moving to a more prevention focussed agenda, there are implications for the workforce size and skill mix and thus workforce redesign is a priority. Modelling need and developing a future workforce strategy with provider organisations to support the shift in skill base from acute to community care for Leeds is one of our proposals within the BCF plan and will be supported through the Pioneer programme, working with Health Education England and Skills for Care to shape this. As non-elective activity starts to reduce, and community activity rises, re-training the workforce will become increasingly important and workforce development to meet changing needs is part of our wider transformation programme. Roles that were once only available in the hospital will still be required, but in a different setting.
In the longer term, the BCF workforce development scheme will focus on strategy implementation, e.g. training to ensure we have the correctly qualified staff working in the right places and with the right patients to create the integrated health and social care system patients, service users and their families deserve. e) Governance Please provide details of the arrangements are in place for oversight and governance for progress and outcomes Leeds has established robust partnership structures and excellent relationships between senior leadership teams from health and social care organisations across the city. There is a real commitment to working together to make the best use of our collective resources
12 to get the best outcomes for Leeds.
Governance for the BCF and associated transformation plans is established; in preparation for the BCF, the Terms of Reference for the Health and Wellbeing Board have been reviewed by Leeds City Council’s legal services department. The Health and Wellbeing Board has been closely involved in the BCF process and will retain overall accountability following sign off of the plan. The day-to-day executive leadership and steer for the BCF will be through the Integrated Commissioning Executive, which is the executive arm of the Health and Wellbeing Board. The Transformation Board provides a forum for all commissioning and provider organisations to actively agree and oversee the delivery of the schemes within the BCF.
The following is the agreed process for developing all Transformational Changes in the city.
The development of proposals to transform health and social care services will not stop once the BCF has been submitted. The process above will allow the system to make on- going, evidence-based decisions for the best use of pooled budgets for integrated care going forwards. Together with on-going monitoring arrangements, we believe this will ensure that the necessary clinical and financial benefits are realised.
2) NATIONAL CONDITIONS a) Protecting social care services
At a time when we are planning to make significant investments in community-based, person-centred health and care services, we are seeing rising demand on our health and care services as a result of changing demography and as we get better at keeping people alive longer. Against this backdrop, local authority social care budgets are facing a prolonged period of real-term reduction, increasing the risk that individual care needs will not be met.
Our BCF plan is about applying targeted investments to convert this potentially negative cycle into a positive one, driven by improved outcomes for individuals, communities and the health and social care system as a whole. We recognize that the BCF alone will not 13 resolve the financial challenges faced by Social Care, but we are confident that as part of the overarching transformation plans in the city, these will be met.
This means: Supporting people to live independently and well Releasing pressure on our acute and social services Investing in high-quality, joined-up care in and around the home
Protecting social care services in Leeds means ensuring that those with eligible needs within our local communities continue to receive support, despite growing demand and budgetary pressures.
Our primary focus is on continuing to develop new forms of joined up care which help to ensure that individuals remain healthy and well, and have maximum independence, with benefits to both themselves and their communities, and the local health and social care economy as a whole. By proactively intervening to support people at the earliest opportunity and ensuring that they remain well, are engaged in the management of their own wellbeing, and wherever possible enabled to stay within their own homes, our focus is on protecting and enhancing the quality of care by tackling the causes of ill-health and poor quality of life, rather than simply focusing on the supply of services.
This is illustrated by Adult Social Care’s ‘Better Lives for People in Leeds’ strategy – our commitment to supporting people to live independently and giving them more say in how they live their lives. Our ambition is to make Leeds a place where people can be supported to have better lives than they have now. Over the next five years, we intend to continue our achievement towards this through a mixture of enterprise and integration, where the council join up with health and other service providers to create an adult social care sector that is varied, accessible to all and fit for its purpose. For more information, go to: www.leeds.gov.uk/betterlives
Underlying our vision are the nationally-accepted priorities for social care in the UK, which are: • Enhancing the quality of life for people with care and support needs • Delaying and reducing the need for care and support • Ensuring that people have a positive experience of care and support • Safeguarding adults whose circumstances make them vulnerable and protecting them from avoidable harm.
Funding currently allocated under the Social Care to Benefit Health grant has sustained the current level of eligibility criteria and ensured the continued provision of timely assessment, care management and review, together with the commissioning of services to clients who have substantial or critical needs and information and signposting to those who are not FACS eligible. As part of the BCF financial model, the proposal is to sustain and protect the current level of health funding to support social care (£11.9m-£12.5m plus £2.8m reablement) with CCG QIPP programmes used to set up the BCF to develop a recurrent investment fund to transform the social and health care system. This will be the primary mechanism to protect social care services through health spending focusing on reducing demand to services.
As part of the next stage in the development of the BCF health and social care will work
14 together to further develop the programmes of work which will result in additional schemes being developed that benefit the health and social care economy. This may well add further funding to social care to schemes to enable the transformation of the city.
This is required due to the continued financial pressures facing all partners in the BCF. Prior to the consideration of the impact of further Local Authority funding reductions on Social care, Leeds Social Care are facing unidentified CIPs of £7.2m in 15/16. To maintain essential services at current levels of eligibility, savings generated through the BCF process will be focused on addressing this shortfall as well as the future QIPP challenge facing the NHS. Potentially upwards of an additional £15m contribution to the Councils’ wider CIP programme may be required by Social Care in 15/16. Decisions have yet to be made on the level of this contribution to date, however, and further discussions will be required to identify the size of this gap. The focus on the BCF will be to demonstrate a contribution towards mitigating some of these additional pressures through the services developments proposed. However, given the size of the financial challenge faced by Social Care, the challenge will not be met by the BCF alone, but by a commitment of all partners to meet the collective financial challenge for the Health and Social Care economy, of which Social Care is one part, through the established H&SC Transformation programme in the city.
In addition, it is also recognised that, nationally, the BCF includes provision of £185m (£50m of which is capital) for ‘a range of new duties that come in from April 2015 as a result of the Care Bill.’ Although this funding is not ring fenced, the Leeds BCF includes a draft scheme which could be up to £2.7m non recurrent (£0.7m of which is capital), although further work will be required to quantify the impact of this scheme.
Adult Social Care has a very strong track record of delivering significant efficiencies and has delivered over £70m in the last 5 years to enable ongoing financial challenges to be met, whilst at the same time improving the quality of services to people. These efficiencies have been delivered through a range of measures including the significant decommissioning of in-house services, service redesign and investment in preventative services, together with the implementation of innovative, jointly commissioned and provided social care schemes including the South Leeds Independence Centre, Reablement Service, Integrated Neighbourhood Teams, the Assistive Technology Hub all as part of our ongoing ‘Better Lives’ programme.
The BCF clearly represents a further opportunity for health and social care to work together to deliver significant savings through more integrated and efficient working, while ensuring that care provided to the people of Leeds remains of the highest standard.
b) 7 day services to support discharge Please provide evidence of strategic commitment to providing seven-day health and social care services across the local health economy at a joint leadership level (Joint Health and Wellbeing Strategy). Please describe your agreed local plans for implementing seven day services in health and social care to support patients being discharged and prevent unnecessary admissions at weekends.
Moving health and social care services from five to seven days is a key commitment across the Health and Social Care system. The day of the week on which a person
15 becomes ill (or recovers from illness) should not be the determinant of the services that someone can receive, or the speed with which they can access services or return home.
Leeds already has a 24/7 community nursing and care management service. The BCF offers the city an opportunity to build on this.
A core requirement of the 14/15 contract with all main NHS providers is to work with commissioners to facilitate the delivery of seven day working requirements.
The role out of 7 day services also requires fundamental and large scale change to existing services and we see the BCF targeting seven day working, as set out in the supplementary information section – particularly in relating to the community beds and enhance integrated neighbourhood teams schemes. Operational changes would include: The community bed bureau would move to a seven day service The Homeless discharge service would be available seven days a week Leeds equipment service being available seven days a week The early discharge assessment team, based in the hospital A&E department will maintain the service that operated over winter, including seven day working Fund extra discharge facilitation roles to work on a seven day basis There will be a seven day community nursing service to support patients choosing to end their life at home and new nurse-led beds in the community Extend the home care service to deliver 24/7 support for service users
This will allow out of hospital services to better respond to the anticipated increase in transfers of care at weekend from hospitals.
Further work following submission to develop detailed implantation plans for the BCF will involve taking into account the cost of moving to seven day service and equally the potential savings from operating uniformly during the week. Additionally, current CCG contract negotiations with providers are taking account of 7 day working.
The chart below shows the result from a recent audit of patients from the hospital elderly medical wards showing the day of the week a transfer of care occurred. Working in this way increases pressure on community and social care services at the end of the week, and means that patients remain in a hospital bed (often unnecessarily) over the weekend as either the hospital is not set up to discharge or services are not available to support patients in the community over the weekend.
Day of Transfer of Care (n=285) 80 60 40 20 0 Mon Tue Wed Thu Fri Sat Sun Qty 26 43 49 65 67 21 14
As a city, our aim is to smooth out this graph by reducing the peaks and troughs seen 16 here throughout the week. Having services available consistently will reduce length of stay and reduce the pressure points on services at certain times of the week.
c) Data sharing Please confirm that you are using the NHS Number as the primary identifier for correspondence across all health and care services. As part of our Pioneer bid, we outlined our innovative practice in this area, through the development of the Leeds Care Record. This system allows all relevant practitioners within the system to see real-time data on individuals at the point of service delivery. This work has been piloted in three GP practices and would not have been possible without Leeds’ commitment to use of the NHS Number.
The NHS Number is being used as the primary identifier across health and social care (key systems across the health and social care system can handle the NHS number) and NHS numbers are ‘traced’ and added to the patient/client record as early as possible. However, the acquisition of NHS Numbers in social care is via a tactical (non- strategic) solution and further work needs to be done to use the NHS Number within social care correspondence.
Significant work has been completed to enable e-correspondence, which automatically includes the NHS number. This includes e-Discharge letters, e-Test Requesting, e- Results and Radiology reports, e-Discharge Initiation Documents. Within the proposed BCF Informatics scheme is the work to extend e-correspondence to outpatient letters and A&E attendances and then subsequently make visible all secondary care correspondence via a Leeds Care Record.
If you are not currently using the NHS Number as primary identifier for correspondence please confirm your commitment that this will be in place and when by Within the proposed BCF Informatics scheme is the work required to deliver a strategic solution to obtaining the NHS Number for social care using the national Patient Demographic Service (PDS). The strategic aim is to implement this before April 2015, as part of our work to go “further and faster” towards integration. Alongside this is resource to embed the NHS number in to social care correspondence within that time frame.
Please confirm that you are committed to adopting systems that are based upon Open APIs (Application Programming Interface) and Open Standards (i.e. secure email standards, interoperability standards (ITK)) Adopting systems that interoperate is a key part of a formal Leeds-wide Informatics strategy and progress is being made towards delivery. We have strong examples of where the ITK has been used, though there is some dependency on large national system suppliers such as TPP. Leeds is committed to work with Open APIs, however, cost is a factor and the cooperation of system suppliers is required. Open APIs support the integration of systems and data and this is a key part of the Leeds Informatics strategy. It is a strategic intention and direction of travel; a timeline and investment plan is in development.
Currently Social Care, CCGs, GPs, Community and Mental Health organisations are using secure email. The acute hospital is at the early stages of implementing NHS Mail
17 with considerable progress expected during 2014/15.
As part of its wider ambition to become a digital city, Leeds is focussed on adopting the Public Sector Network as the technical infrastructure to support health and social care integration. Together with the necessary platforms for technology to support self-care and self-management, “big data” solutions will support more accurate commissioning and service provision decisions in line with people’s experiences of care – which will lead to better outcomes for the people of Leeds. Additionally, the establishment of an ‘interconnect’ with the existing NHS network (N3) enables much of the local aspiration to be achieved.
Please confirm that you are committed to ensuring that the appropriate IG Controls will be in place. These will need to cover NHS Standard Contract requirements, IG Toolkit requirements, professional clinical practice and in particular requirements set out in Caldicott 2. We are committed to ensuring that the appropriate IG controls are in place. All individual health and social care organisations are operating at Level 2 against the IG Toolkit. We are working closely with HSCIC DSCRO to ensure that data flows are in line with Caldicott 2 and have a number of data sharing and data processing agreements in place.
However, there are acknowledged challenges around delivering IG for integrated working, especially shared data, shared systems and common care processes. Therefore, within the proposed BCF Informatics scheme (scheme 19) is the resource required to strengthen the city-wide (multi-organisational) IG expertise.
Leeds is also leading national work to develop a Public Services-wide IG Toolkit which rolls out in 2014, with a fully rationalised version completed in 2015. This work underpins health and social care transformation locally and nationally.
d) Joint assessment and accountable lead professional Please confirm that local people at high risk of hospital admission have an agreed accountable lead professional and that health and social care use a joint process to assess risk, plan care and allocate a lead professional. Please specify what proportion of the adult population are identified as at high risk of hospital admission, what approach to risk stratification you have used to identify them, and what proportion of individuals at risk have a joint care plan and accountable professional. Leeds has a well-established system of risk stratification already in place to identify patients at high risk of hospital admission. The system supports accountable lead professionals to work in a more proactive and preventative way, identifying patients before they become unwell and ensuring they have a tailored care plan in place.
The introduction of new arrangements for GP contracting next year provides an opportunity to adapt the way in which the tool is used. The tool will be used to identify the top 2% high risk patients from each practice and from that will include the development of a care plan. The plan will identify a named accountable GP within the practice who has responsibility for the creation of each patient's personalised care plan. In addition, the plan will also specify a care co-ordinator, who will be the most appropriate person within the multi-disciplinary team to be the main point of contact for the patient or their carer to discuss or amend their plan. This could be the GP or it could be another member of the
18 integrated neighbourhood team. This process will ensure MDT input into care, coupled with professional accountability.
To support risk stratification and motive further joint working, a complimentary CQUIN will come into effect in April 2014. The CQUIN will incentivise community health services to work in a more multi-disciplinary way with primary care, to deliver improved proactive care management.
In Leeds, the risk stratification tool has been rolled out across primary care, and is also available to some of the integrated neighbourhood teams. The teams that do not currently have access to the tool will be granted access over the course of 2014/15. This will ensure a common way in the city of assessing the risk of hospitalisation for patients. At the time of writing, the risk stratification tool indicates that 2.6% of people in the city are at high risk of admission to hospital.
Leeds’ innovative work on information governance and data sharing (as outlined earlier in this template) has enabled us to go so far in this regard. A Joint Gateway has been developed through to enable health and social care professionals from different organisations to work more effectively. The Leeds Care Record has already been rolled out to a number of GP practices and can be accessed by Adult Social Care staff. However, there is still more work to do and the intention is that our Pioneer status enables us to move forwards, with national support, over the lifetime of the BCF.
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RISKS Please provide details of the most important risks and your plans to mitigate them. This should include risks associated with the impact on NHS service providers
Risk Risk rating Mitigating Actions The savings and efficiencies Very high The proposals within the Better needed to fund whole system Care Fund submission have been change that meets people’s costed and likely efficiencies health and social care needs may estimated. There is very little not be delivered through the work evidence base with few examples planned. of full implementation of schemes. Progress post implementation will be closely monitored but likely impact will be based on a culmination of interventions. In order for the hospital sector to Very high Leeds Teaching Hospitals Trust release efficiencies, it will need to plans outline how beds within the close beds as activity drops. acute sector can be closed without destabilising the sector. Impact of specialist commissioning strategy key to understanding overall strategy for LTHT Work carried out under the Better High Resources are being discussed Care Fund will need to be and will be allocated from both managed and monitored. health and social care. Resources have not yet been identified to undertake this essential function. NHS facing 10% real terms budget cut in administration in 2015/16 Shifting resources to fund new High Proposals been jointly developed schemes may destabilise current by health and social care services and providers, organisations across Leeds, particularly in the acute sector. including service providers. This has enabled a holistic consideration of the benefits and dis-benefits of each proposal Work outlined may not High The Protection of Adult Social adequately ensure the Protection Care Services has been of Adult Social Care services. fundamental to the development of proposals and of Leeds’ wider ambition of a high quality and sustainable health and social care system. The focus has been on protecting existing spend whilst developing an investment pool to invest to reduce overall health and social care spend. Operational pressures and the High Proposals include investment in current high volume of business infrastructure and development to change will restrict the ability of support overall organisational our workforce to deliver the development. projects needed to make the vision of care outlined a reality. Improvements in the quality of High Proposals have been developed care and in preventative services using a wide range of available will fail to translate into the data. 2014/15 will be used to test required reductions in acute and and refine these assumptions, 20 nursing / home care activity by with a focus on developing 2015/16, impacting the overall detailed Business Cases and funding available to support care service specifications services and future schemes Leeds may suffer reputational Medium Proposals have been developed damage if the city fails to deliver through a rigorous process of the outcomes detailed, especially consultation and engagement, as there is a public perception review and scrutiny. that the BCF represents new money and will deliver additional services. The introduction of the Care Bill High The Care Bill is a fundamental may result in a significant part of Leeds’ work towards increase in the cost of care achieving the ambition of a high provision from April 2016 that it quality and sustainable health not currently fully quantifiable and and social care system. that will impact on the Specifically, a Chief Officer with sustainability of current social specific responsibility for Social care funding and plans. Care Reforms has been appointed to plan for the introduction of the Care Bill and monitor its impact. Community and social settings Medium Savings generated through work may be unable to pick up under the Better Care Fund will increased demand as care moves be used to increase capacity in away from acute settings. community and social settings. It may be impossible to realise Medium NHS England are part of ICE and plans because Leeds CCGs are Transformation Board not the primary commissioner for all primary care services and are dependent on NHS England Area Team Specialist Commissioning plans. The lack of detailed baseline data Medium Proposals are based in all and the need to rely on current available information and will be assumptions may mean that refined as work progresses. financial targets are unachievable.
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014b/2014 Board
This template is to be used for part 2 of HWB BCF plans and replaces the original template available on the NHS England BCF webpage. The new version contains more information in the metrics section and is locked in order to assist in the NHS England assurance process .
This new template should be used for submitting final BCF plans for the 4 April BCF Planning Template Finance - Summary DRAFT
Finance - Summary
For each contributing organisation, please list any spending on BCF schemes in 2014/15 and the minimum and actual contributions to the Better Care Fund pooled budget in 2015/16. It is important that these figures match those in the plan details of planning template part 1 . Please insert extra rows if necessary
Spending on Actual Holds the pooled BCF schemes in Minimum contribution (15/16) /£ contribution Organisation budget? (Y/N) 14/15 /£ (15/16) /£ Leeds South & East CCG £17,351,000 Leeds North CCG £12,665,000 Leeds West CCG £20,105,000 NHS England £2,759,000 Leeds City Council (Disability Facilities Grant, Social Care Grant) £4,802,000 BCF Total £ 2,759,000 £ 54,923,000 £ -
Approximately 25% of the BCF is paid for improving outcomes. If the planned improvements are not achieved, some of this funding may need to be used to alleviate the pressure on other services. Please outline your plan for maintaining services if planned improvements are not achieved.
The expenditure and outcomes of the BCF will be overseen by the city-wide integrated commissioning executive (ICE) board. The board is made up of each of the Directors/Chiefs of finance from the health and social care commissioning organisations in the city. Close and regular monitoring of the outcomes that BCF spend is achieving will be key. Where the group feels that trajectories are not improving, or that outcomes are not being achieved, funding will need to be shifted, most likely to the acute sector, to allieviate those pressures.
CONTINGENCY PROVISION The amount of contingency provision in the Leeds BCF will be on a risk base assessment. Scheme number 23 in the BCF fund is the contingency fund which can either be used to off set some of the scenorios set out below if they occur, or invest in schemes that at the time of writing have not got a fully worked up evidence base.
METHODOLOGY AND ASSUMPTIONS FOR CALCULATION OF CONTINGENCY PLAN Outcome 1. Assume worst case scenario - patient admitted to residential care. Cost of one year residential stay modelled at £17,250, multiplied by 20 and then divided in two to give average partial year effect for some admissions. Outcome 2. Assume worst case scenario - patient admitted to hospital and then onto residential care at combined cost of £20,000, multiplied by 208, and then divided by to to give partial year effect for some patients. Outcome 3. Average delayed transfer of care is 7 days, at excess bed day cost of £200, multiplied by 257. Outcome 4. Average elderly acute admission cost os £2,500, multiplied by 874
Contingency plan: 2015/16 Ongoing Planned savings (if targets fully 20 fewer admissions Outcome 1 - Permanent admissions of older achieved) people (aged 65 and over) to residential and Maximum support needed for other nursing care homes, per 100,000 population £172,500 services (if targets not achieved) 89.7% - in percentage terms this is a Outcome 2 - Proportion of older people (65 Planned savings (if targets fully continuation of current achievement. In and over) who were still at home 91 days achieved) real terms this represents an increase of after discharge from hospital into reablement 208 patients / rehabilitation services Maximum support needed for other £1,794,000 services (if targets not achieved) Planned savings (if targets fully 257 fewer delayed transfers of care Outcome 3 - Delayed transfers of care from achieved) hospital per 100,000 population (average per Maximum support needed for other month) £359,800 services (if targets not achieved) Planned savings (if targets fully 874 fewer avoidable admissions Outcome 4 - Avoidable emergency achieved) admissions (composite measure) per Maximum support needed for other 100,000 population (average per month) £2,185,000 services (if targets not achieved) Planned savings (if targets fully n/a - we are aiming to increase the rate of Outcome 6 - Estimated diagnosis rate for achieved) dementia diagnosis people with dementia (NHS Outcomes Framework 2.6i) Maximum support needed for other services (if targets not achieved)
DRAFT 041b.2014 Board - Leeds BCF Finance Template BCF Planning Template Finance - Schemes DRAFT
Please list the individual schemes on which you plan to spend the Better Care Fund, including any investment in 2014/15. Please add rows to the table if necessary.
BCF Investment Lead provider 2014/15 spend 2014/15 benefits 2015/16 spend 2015/16 benefits
Recurrent /£ Non-recurrent /£ Recurrent /£ Non-recurrent /£ Recurrent /£ Non-recurrent /£ Recurrent /£ Non-recurrent /£ 01 - Reablement 0 0 4,512 02 - Community beds 0 0 5,300 03 - Supporting carers 0 0 2,059 04 - Leeds equipment service 0 0 2,300 05 - 3rd sector prevention 0 0 4,609 06 - Admission avoidance 0 0 2,800 07 - Community matrons 0 0 2,683 0 0 12,500 08 - Social care to benefit health 09 - Disabilities facilities grants 0 0 2,958 10 - Social care capital grant - 0 0 0 744 Care bill 11 - Enhancing primary care 0 2,141 12 - Eldercare facilitator 188 0 565 500 (over 2 years) 13 - Medication prompting 50 0 320 TBC (dementia) 14 - Falls 50 0 500 TBC 15 - Expand community / 990 0 1,490 1,153 + TBC intermediate beds 16 - Enhancing integrated 1,216 0 3,590 6,100 + TBC neighbourhood teams 17 - Urgent care 50 0 TBC TBC 18 - Information technology 0 0 1,800 TBC (inc. social care capital grant) 19 - Care Bill 0 0 1,900 TBC 80 0 80 20 - Improved system intelligence 21 - Workforce 80 0 80 22 - Contingency 0 1,992
Total £ - £ 2,704 £ - £ - £ 39,721 £ 15,202 £ - £ -
DRAFT 041b.2014 Board - Leeds BCF Finance Template BCF Planning Template Outcomes & Metrics DRAFT
Outcomes and metrics
Please provide details of how your BCF plans will enable you to achieve the metric targets, and how you will monitor and measure achievement Please see supplementary information for full answer
For the patient experience metric, either existing or newly developed local metrics or a national metric (currently under development) can be used for October 2015 payment. Please see the technical guidance for further detail. If you are using a local metric please provide details of the expected outcomes and benefits and how these will be measured, and include the relevant details in the table below n/a - Leeds plan to use the national metric once it is fully developed.
For each metric, please provide details of the assurance process underpinning the agreement of the performance plans In Leeds, the BCF will be the responsibility of the Integrated Commissioning Executive (ICE) to assure, run and manage. This group, comprised of the Directors/Chiefs of Finance from the health and social care organisations in the city will have a direct line report into the Leeds Health & Wellbeing Board. ICE will be empowered to hold other projects and programmes of work to account for the delivery of their stated aims and milestones.
The target level of achievement against the metrics below is the same as the level of achievement quoted in the Leeds CCG plans. Any apparent discrepency is due to taking a different baseline position for both. All CCGs are committed to achieving these milestones.
If planning is being undertaken at multiple HWB level please include details of which HWBs this covers and submit a separate version of the metric template both for each HWB and for the multiple-HWB combined n/a
Please complete all pink cells: Performance underpinning Performance Metrics Baseline* April 2015 payment underpinning October 2015 payment Permanent admissions of older people (aged 65 and over) to Metric Value 684.6 636.2 residential and nursing care homes, per 100,000 population Numerator 776 756 N/A Denominator 113350 118827 ( Apr 2012 - Mar 2013 ) ( Apr 2014 - Mar 2015 ) Proportion of older people (65 and over) who were still at home 91 Metric Value 89.70 89.70 days after discharge from hospital into reablement / rehabilitation Numerator 61 269 services Denominator 68 N/A 300 NB. The metric can be entered either as a % or as a figure e.g. 75% (0.75) ( Apr 2012 - Mar 2013 ) ( Apr 2014 - Mar 2015 ) or 75.0
Delayed transfers of care (delayed days) from hospital per 100,000 Metric Value 248.2 210.1 201.0 population (average per month) Numerator 1532 1316 1275 Denominator 617176 626391 634287 NB. The numerator should either be the average monthly count or the appropriate total count for the time period ( Dec 2012 - Nov 2013) Apr - Dec 2014 Jan - Jun 2015 (9 months) (6 months)
Avoidable emergency admissions (average per month) Metric Value 168.8 150.4 156.5 Numerator 15392 7070 7448 NB. The numerator should either be the average monthly count or the Denominator 773597 783698 793041 appropriate total count for the time period ( Oct-2012 to Sep-2013 ) Apr - Sep 2014 Oct 2014 - Mar 2015 (6 months) (6 months)
Patient / service user experience For local measure, please list actual measure to be used. This does not need to be completed if the national metric (under development) is to be TBD N/A TBD used
Local measure Metric Value 0.5 0.6 66.0 'Estimated diagnosis rate for people with dementia (NHS Outcomes Numerator 4514 5046 5874 Framework 2.6i) Denominator 8500 8700 8900 End March 2013 (Census) End September 2014 (Census) End March 2013 (Census)
DRAFT 041b.2014 Board - Leeds BCF Finance Template
Supplementary Information 014c/2014 Board Leeds Better Care Fund
Introduction The total value of the Leeds Better Care Fund (BCF) is in excess of £55million. It is a fund of a size that can make a real different to patients and the people of this city and we are determined that this money makes a difference. The concept of the Leeds £ (a common currency that runs through all of health and social care services in the city – see appendix) is already well established, and the establishment of the BCF signals that this is now being brought into reality.
It is important to be clear – the BCF is not new money. Over recent years, the city has already moved many of its core health and social care services into a jointly commissioned environment. The range of jointly commissioned services has recently been expanded to include the Leeds Equipment Service. The BCF therefore, offers an opportunity to bring in new governance arrangements around this existing portfolio of jointly commissioned services and commission more services jointly.
2014/15 will be used as a shadow year to “pump prime” the Better Care Fund proposals, to help ensure that the city will benefit from and be able to maximise the opportunities from the BCF as soon as possible, in line with both its aspirations and Pioneer status to go further, faster.
Calculating the return on investment from the BCF The city has set itself a target of a reducing the number of emergency admissions to hospital by 15% over the next five years, against a backdrop of increasing demographic growth and therefore demand. This is set out in the chart below.
If the city were to continue on its current trajectory and factoring continued increases in demand, in five years time the city would be spending over £163million on emergency admissions. It is on this figure that a reduction of 15% has been modelled. If successful the city will save £24millon on where
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it should be, which is equivalent to an £11.4million real terms reduction in spending. Investments from the BCF will support the delivery of these savings.
For the purposes of the BCF, these saving reductions have not been apportioned to individual schemes. It is not possible to be definite about the individual contribution of each scheme. Therefore, the projected saving target of £24million has been divided out among all schemes.
Pre-committed spend Some of the funding listed in the tables below has already been allocated to initiatives prior to the BCF coming into effect. All of these pre-committed schemes are all focused around reducing avoidable hospital and care home admissions, reducing re-admissions and facilitating discharge.
2014/15 – The Shadow Year for the Better Care Fund The BCF does not come into being until 2015/16. 2014/15 is a shadow year for the fund. Therefore, the funding allocations for the recurrent schemes will not actually be transferred into the BCF until the following year. The figures in this document represent the CCG and local authority allocations for this work next year to work up and test out the “invest to save” opportunities, and the likely minimum values that will be allocated to these same schemes in 2015/16 that will go into the live BCF.
2014/15 also represents a shadow year for testing the governance arrangements for the BCF in Leeds. As set out in the main document, the fund will be overseen by the Integrated Commissioning Executive (ICE) which will be held accountable for delivering on BCF aims and objectives by the Health and Wellbeing Board.
Where schemes that are being worked up in 14/15 are able to demonstrate that they will generate a saving, the exact amount of funding they require will be allocated in 15/16. For those schemes that are being worked up/piloted in 14/15 that are subsequently unable to demonstrate a whole system saving, they will be withdrawn from the BCF.
How the fund has been divided In order to manage the fund we have made the decision to sub-divide the fund into a schemes that support already well established joint commissioned and/or jointly provided services, and new schemes that provide further “invest to save” opportunities. Some of this funding is recurrent and some is non-recurrent. Schemes of recurrent and non-recurrent funding have been separated below into two tables.
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Table 1. Recurrently funded schemes Investment Investment Scheme Return Name Description 2014/15 2015/16 No. £000 £000 £000 This funding supports the city’s reablement services and one of the intermediate care bed facilities. It is already matched by contributions from the city council. Funding in this scheme is Reablement designed to supports patients to return directly to their own homes following unplanned 01 4,512 services admission – be it directly from the hospital or via the use of an intermediate care bed. These facilities support patients to move through the system and reduces pressure on discharge from the acute sector, maximise independence or avoid unnecessary admission completely. This scheme is focussed on enhancing our community services to prevent acute admission and facilitate discharge. This funding supports a network of intermediate care beds and services. Community 02 The beds act to facilitate prompt discharge and reduce length of hospital stay. For some 5,300 beds patients they can also be used as a “step up” service to prevent acute admission.
Part of the existing transfer of CCG funds to social care is to support carers. This includes initiatives to support carers supporting people with dementia, those that have been recently Supporting 03 bereaved and respite care opportunities (both residential or at home). During the course of 2,059 Carers 2014/15 it is our intention to create an s256 agreement so these services can be delivered as part of our integrated care system. Leeds This is the funding for the Leeds Equipment Service. The service helps users and carers to stay 04 Equipment safe and independent at home, preventing hospitalisation. The service is jointly commissioned 2,300 Service and run by health & social care services. Health and social care services across the city are also supported by the voluntary and 3rd 3rd sector sectors. There are a range of organisations commissioned to provide support services including 05 4,609 prevention frail elderly, those with a physical disability, hearing and sight loss, dementia, stroke and advocacy services. In order to break the cycle of increasing admissions to hospital the health and social care across city recognises that it needs to invest in more pro-active and preventative care, Admission 06 especially for the frail elderly. Once someone has been admitted to hospital we need to invest 2,800 avoidance more and ensure that the follow up care arranged for patients is going to support them to remain out of hospital in future. Community Currently community matron services in the city are funded by CCGs and are part of the 07 2,683 matrons integrated neighbourhood teams. By moving this funding to the BCF will support the continued
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integration of this service into our integrated health and social care model This is the NHS England transfer from health to social care for 14/15. This fund is to be used to Social care to 08 enhance social care services that have a direct impact on health and care for Leeds people. 11,850 benefit health This will be in the range of £11.9m to £12.5m, awaiting clarification. Nationally agreed health funding to support local authorities to make modifications to homes Disabilities 09 for disabled people. Evidence shows investment in these grants supports people to live 2,958 facilities grants independently, reduces admissions to acute/community beds and facilitates discharges.
Revenue TOTAL 0 39,721
Table 2. Pump Priming – Invest to Save Schemes Investment Investment Sche Return 2015/16 2014/15 2015/16 me Name Description No. £000 £000 £000 Social care 10 capital grant - 744 Care Bill From 2014/15 the new GPs contract will incentivise GPs to take a case management approach to the top 2% high risk and vulnerable patients on their practice registers. In order to develop services around these patients this funding will be used to enhance services to support the Enhancing 11 management of this patient cohort. 0 2,141 TBC primary care
Additional schemes may include the provision of enhanced support to Care Homes and the housebound through GP visits and use of teleconferencing/telehealth/telemedicine facilities. This new role will focus on patients with dementia and other frail elderly patients with mental health illnesses. The facilitator will link to the existing neighbourhood integrated teams to meet the demand for increased diagnosis, support memory assessment and work with people Eldercare 500 12 and carers post-diagnosis to provide support and sign-posting to local services not hospitals. 188 565 Facilitator The role will also have a key coordination role with primary care, supporting memory clinics in (over 2 yrs) GP surgeries across each of the neighbourhoods. This scheme will enable GPs to plan more actively to address risk and therefore reduce the number of acute readmissions. Medication Improve medication prompting for people with memory problems to avoid hospital admission TBC 13 50 320 prompting - caused by adverse reaction and potential multiple conditions treatment/co-morbidities. (following
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Dementia Adherence to prescribed treatment to maximise clinical effectiveness and health benefit. scoping) 2014/15 – scoping, return on investment and development work including establishing the most effective way for this service to be provided. During the course of 14/15 work will be undertaken to review the existing falls services, better identify the gaps in service and recommend where investment would make the most difference. Existing service models could subsequently be developed to respond urgently to 500 TBC 14 Falls people who have had a fall who do not necessarily need acute hospital care but who cannot be 50 (TBC following (following left alone. There are several initiatives already in place in other parts of Yorkshire run by the scoping) scoping) Yorkshire Ambulance Service and the voluntary sector that would need further consideration before commissioning. This scheme has four component parts to it; a) Expand community intermediate care bed capacity by 7.5%. In order to continue to a) 600 a) 600 a + b) 900 reduce the number of acute hospital beds capacity needs to shifted into the community. This scheme will be used to increase nursing CIC beds by 12 (7.5% increase in overall provision, going from 161 to 173 beds), allowing 140 additional patient CIC stays per year. This will enable appropriate and timely discharge of patients from hospital and avoid admissions. Expand b) Move bed bureau to 7 day working. Increase in staffing ratios to support flow through b) 50 b) 50 community 15 the system and to expand the community bed bureau to 7 day working, allowing intermediate care optimum use of available community beds and to even out capacity across the week. beds c) End of Life nurse-led care beds. To provide additional capacity out of hospital, c) 0 c) 500 c) TBC increasing choice and reducing the number of people that die in hospital inappropriately. d) Homeless Accommodation Leeds Pathway (HALP). Supporting homeless people who d) 240 d) 240 d) 253 have been admitted to hospital to be discharged in a more timely manner into an intermediate care-type facility. TOTAL 990 TOTAL 1,490 TOTAL 1,153
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This scheme will look to extend and enhance the role of the existing neighbourhood teams in a range of ways, to improve their focus on reducing admission, streamlining discharge and proactively managing patients in the community. The services will complement the primary care schemes in the overarching BCF aims. Enhancement of integrated neighbourhood teams will also further expand 7 day working in health and social care: a) Leeds Equipment Service to be open and functioning 7 days a week a) 130 a) 130 a) 0 b) Extend hours for the Early Discharge Assessment Team based within A&E, including 7 b) 300 b) 300 b) 1,200 day working. This service enables patients to be diverted to appropriate community alternatives and enables a proactive response to patient needs. c) Fund additional discharge facilitation roles over 7 days, providing a link between c) 86 c) 260 c) hospital and community services to ensure smooth transfer of care. The service will (dependent Enhancing focus on end of life and frail elderly and builds on the positive outcomes to date from on tariff integrated existing EoL discharge facilitator roles. negotiations) 16 neighbourhood d) Extend the home care service to enable people to be cared for in their own home 7 d) TBC d) TBC d) TBC teams days a week and provide new packages of care at weekends and late evenings. e) Enhance Community Matron Service to provide proactive care management. This e) 450 e) 1,500 e) 3,000 service will complement the primary care schemes in reducing admission, readmission and act as a stronger “pull” in the system to safely discharge people and support their return home. f) Increase community nursing capacity to enable more people to choose End of Life f) 350 f) 1,200 f) 1,900 Care at home, have increased weekend capacity and support earlier discharge g) Retain interface geriatrician role, to provide expert advice to primary care and g) 200 g) 200 g) 0 community teams. TOTAL TOTAL TOTAL 1,216 3,590 6,100
Exploring opportunities with urgent care providers to reduce duplication and improve efficiency: a) Establish a robust, multi-agency case management approach those identified as frequent users of urgent care services (i.e. out of hours GPs, walk in centres, 999 and Urgent care A&E attendance) to improve patient outcomes and reduce emergency admissions. 17 50 TBC TBC services The “top 5” attenders account for 500 A&E attendances a month. Further work in 2014/15 to further scope and develop this piece of work. b) Utilise portable technology to provide point of care blood testing to reduce admissions, speed up discharge and enable enhanced care in community settings.
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There are a range of initiatives to enable better data sharing between health and social care, recognising the crucial role this plays in successfully integrating care. These are focussed on the following areas: a) Improving communication and access to information for clinical teams working in Information different organisations technology 18 b) Improving data quality and information to use when making commissioning decisions 0 1,800 (inc. social care c) Embedding the NHS number as the only person/patient identifier across health and capital grant) social care in the city In addition there will ongoing IT requirements around the Leeds Care Record together with IT investment requirements to support the delivery of savings from the integrated teams and their estate. Revenue implications of care bill introduction. National £135m, local would be circa £2m 19 Care Bill revenue but not ring fenced. Detail of scheme to be developed. 0 2,651
Undertake a clinical audit of a sample of patients who have been admitted to hospital. The Improved system audit will ask the question “what could have been in place in the community to prevent this 20 80 80 intelligence admission in future?” The audit results will then be used to inform more detailed, precise commissioning plans in 15/16. The city has a clear and stated aim to move activity and demand away from urgent and Workforce emergency care into the community. As patients move to different places in the system, staff 21 planning & 80 80 will need to move with them. The city needs to have a focussed recruitment, retention and re- development training strategy in place, so that staff can be deployed in city where they are needed most. This is the Leeds BCF contingency provision, arrived at following a risk base assessment. Funds Contingency 22 here will also be used to fund schemes in 15/16 that are being worked up during 14/15 that 0 1,992 Fund will deliver savings.
Pump Prime 2,704 13,358 Total Revenue Pump Prime 1,844 Total Capital
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Table 3. Grand Totals of BCF Sche Investment Investment Return me Name Description 2014/15 2015/16 No. £000 £000 £000 £000 Grand Total 2,704 53,079 Revenue Grand Total 1,844 Capital
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Measurement and metrics
National Measure 1: Permanent admissions of older people (aged 65 and over) to residential and nursing homes, per 100,000 population
The chart below presents the historic data that is currently available, together with a projected figure for FY13/14 (assuming admission rates remain flat) and a proposed target admission rate for FY14/15 (which represents a gross reduction of 7% on projected demand, and a 3.6% reduction on FY12/13 admissions). This level of ambition has been arrived at with consideration to the following factors:
1) ONS population projections point to continued growth in Leeds’s 65 plus population (by between 2 and 2.8% per year for the next few years reaching 118,827 by Mid-2015) - Therefore, to maintain performance at current levels, the actual number of permanent admissions to residential and/or nursing homes will need to increase accordingly
2) When benchmarked against the ‘core cities’ Leeds has the lowest admission rate of all of the core cities, and 11 of our 15 comparator local authorities had higher figures than Leeds in FY12/13 - This suggests Leeds as a care economy is already performing well on this measure, and the future scope for improvement is constrained by our previous good performance and the relative needs of Leeds citizens.
3) Not all admissions to residential and nursing care are undesirable, and a balance needs to be met between ensuring individuals are offered support to live independent lives in the community whist recognising some will benefit from being cared for in a care home
4) Restricting residential and nursing home provision for people with genuine needs risks negative outcomes in relation to unplanned admission to hospital and excessive home care costs. For this reason Leeds is proposing using total bed days in residential and nursing placements as an additional performance measure which is considered more sensitive to inappropriate admissions.
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Acutal Projected admissions Target admissions admissions (no change) (7% reduction)
900 900 797 800 760 775 756 800
700 700 689.6 683.7 683.7 600 635.9 600
500 500
400 400 years plus) years
300 300
funded residential and/or nursing care nursing and/or residential funded 200 200 Annual number of permanent admissions to to admissions permanent of number Annual
100 100 Rate of admissions per 100,000 popualtion (65 popualtion 100,000per admissions of Rate
0 - FY11/12 FY12/13 FY13/14 FY14/15
National Measure 2: Proportion of older people (65 and over) who were still at home 91 days after discharge from hospital into reablement/rehabilitation services
The chart below presents the historic data that is currently available, together with a projected figure of 89.7% FY14/15 (assuming current performance is maintained whilst increasing the numbers of patients being managed through the reablement service by 440%). This level of ambition has been arrived at with consideration to the following factors:
5) Performance improved between FY11/12 and FY12/13, with 89.7% of patients who received a reablement package remaining at home 91 days after discharge from hospital for FY12/13 (based on the sample used).
6) When benchmarked against the ‘core cities’ Leeds has the highest rate of all of the core cities and Leeds already performs in the top quartile both nationally and among our comparators for this indicator. - Whilst this may suggest the reablement service is highly effective, the provision of reablement services in Leeds is low compared to the other core cities, and the ‘success’ observed in part reflects a marginal affect associated with the limited places being offered to individuals that are most likely to benefit. It is therefore the ambition in Leeds to increase the numbers of people accessing the reablement service to a target of 400 by Q4 FY15/16. This should ensure the reablement service contributes to the wider agenda which is to reduce demand for urgent care services and delay admissions to permanent residential and nursing placements.
7) For Leeds, this performance measure is based on a relatively small sample (70 cases for FY12/13)
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- As a consequence monitoring this target will be subject to statistical errors that may obscure any actual change in performance. This ‘error’ represents a significant risk in terms of how Leeds is held to account on this indicator.
Target rate (89.7% + increased Projected rate through-put) Acutal rate (no change)
95
89.7 89.7 89.7 90 Leeds (Actuals) 85.7 85 Leeds (Projected) Leeds (Target)
80 Birmingham Bristol 75 Liverpool Manchester 70 Newcastle upon Tyne
Nottingham who received a reablement package of care of package reablement a received who
65 Sheffield Percentage patients at home 91 days after discharge discharge after days 91home at patients Percentage
60 FY11/12 FY12/13 FY13/14 FY14/15
National Measure 3: Delayed transfers of care from hospital per 100,000 population
The chart below presents historic delayed transfers of care of Leeds residents (up until Nov-2013) and projects forward future numbers assuming a month-on-month reduction of 1.7% from April 2014 to June 2015 (which equates to a reduction of 20% on present levels or a reducing of 10 occupied beds). This level of ambition has been arrived at with consideration to the following factors:
8) Delayed transfers of care are seasonal, with higher numbers in the winter months - This seasonality results in the average for the Jan to Jun-15 period (which is used for the Oct-2015 performance payment) being higher than that for the Apr to Dec-14 period (which is used for the Apr-2-15 performance payment), despite modelling in a month-on-month reduction
9) The long-term trend in delayed transfers of care has remained relatively flat since Apr-2012 - This supports setting a flat baseline going forward (assuming no impact)
10) When benchmarked against the ‘core cities’ Leeds is middle of the pack - If the city performed at the same level as Newcastle (the best performing core city) numbers of delayed transfers would fall by 12%
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Total bed days lost to delayed transfers of care for Leeds residents
Actual data Forecast Apr-15 Payment Oct-15 Payment (no change) Period Period
3,000
2,500
2,000
1,500
1,000
Number delayedof transfers ofcare (patients) 500 Centred moving average
- Apr-11 Oct-11 Apr-12 Oct-12 Apr-13 Oct-13 Apr-14 Oct-14 Apr-15 Oct-15 Monthly bed days lost
National Measure 4: Avoidable emergency admissions
The chart below presents historic numbers of ‘avoidable’ emergency admissions by month (up until Nov-2013) and projects uture numbers assuming a month-on-month reduction of 0.85% from April 2014 to March 2015 (which equates to a real terms reduction of 10% on the baseline position). This level of ambition has been arrived at with consideration to the following factors:
11) Despite a growing population, Leeds has seen a downward trend in ‘avoidable’ emergency admissions, which is consistent with a reduction in all emergency admissions over the last couple of years - This trend can be attributed to changes in the urgent care pathway where patients who would previously have been admitted to an inpatient ward are held in assessment areas prior to discharge. As this pathway redesign is now complete, the baseline has been set using activity for Oct-12 to Sep-13.
12) When benchmarked against the ‘core cities’ Leeds has the third lowest rate of all of the core cities and is close to the national average - This suggests scope for improvement, although as a consequence of local variations in coding practices on how assessment pathways are recorded, care must be taken when interpreting these findings.
13) ‘Avoidable’ emergency admissions are seasonal, with higher numbers in the winter months
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- This seasonality results in the average for the Oct-14 to Mar-15 period (which is used for the Oct- 2015 performance payment) being higher than that for the Apr-15 to Sep-14 period (which is used for the Apr-15 performance payment), despite modelling in a month-on-month reduction
14) The 10% reduction on baseline exceeds the level of statistically significant of 2% as derived using the ‘Better Care Fund – statistical significance calculator’ and is in line with the cities aspiration to reduce emergency admissions rate for the city by a minimum of 15% by FY18/19. Apr-15 Oct-15 payment payment Period
2,000
1,800
1,600
1,400
1,200
1,000
800
600
400
200 Number of 'avoidable' emergency admissions per month month per emergencyadmissions 'avoidable' of Number
0
2010 - 04 - 2010 10 - 2010 12 - 2010 06 - 2011 12 - 2011 06 - 2012 12 - 2012 02 - 2013 08 - 2013 02 - 2014 08 - 2014 02 - 2015 04 - 2015 2010 - 06 - 2010 08 - 2010 02 - 2011 04 - 2011 08 - 2011 10 - 2011 02 - 2012 04 - 2012 08 - 2012 10 - 2012 04 - 2013 06 - 2013 10 - 2013 12 - 2013 04 - 2014 06 - 2014 10 - 2014 12 - 2014 06 - 2015
Lower respiratory tract infections in children Asthma, diabetes and epilespy in children Chronic ambulatory care sensitive conditions Acute conditions that should not usually require hospitalisation Trajectory 1st Period (Apr-Sept)
National Measure 5: Patient/service user experience
This measure is under construction by NHS England and until this information is available Leeds is unable to set its level of ambition for this measure.
Local Metric: Estimated diagnosis rate for people with dementia
Leeds has selected the estimated diagnosis rate for people with dementia (which is within the NHS Outcomes Framework) as its local metric for the Better Care Fund. This section is based on the city’s commitment to improve the lives of people with dementia in Leeds, which to a large part will be delivered by seamlessly managing these individuals’ needs across the health and social care system.
For reporting purposes, NHS England’s Dementia Prevalence Calculator (www.primarycare.nhs.uk) has been used as the data source for the 2013 baseline data. The future prevalence of dementia in the population has been estimated by increasing the 2013 baseline figure by 2.3% annually (which
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reflect the projected growth rate of the elderly population based on the ONS 2011 Subnational Population Projections).
An improvement trajectory has been set to achieve the national ambition of having two thirds of all dementia patients on GP Practice dementia registers by March 2015 (see chart below). This trajectory accounts for the phased introduction of new services to help identify (and diagnose) individuals with dementia.
10,000 70%
9,000 60% 8,000
7,000 50%
6,000 40% 5,000 30% 4,000
3,000 20% rate diagnosis Esimtated
2,000 10%
1,000 Number of patients suffering from dementia (Leeds total) (Leeds dementiafrom suffering patients of Number 0 0% End March 2013 End September End March 2014 End September End March 2015 2013 2014
No. of patients estimated to have dementia (not on registers) No. patients on practice dementia registers Projected numbers on practice dementia registers Diagnosis rate
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NHS Leeds North Board Members Register of Interests as at May 2014
Name/Position Name of Company, Partnership, Local Nature of Interest Type of Interest Date of Date of Appointment Authority or other body/organisation Declaration /Resignation Dr Jason Broch Oakwood Lane Medical Practice Partner Direct pecuniary 10/05/2012 01/01/2006 – Ongoing (GP Chair) Jenjo Healthcare Ltd Director Direct pecuniary 10/05/2012 01/04/2009 – Ongoing Airtight International Spouse’s business Indirect pecuniary 10/05/2012 Nails 17 Ltd Spouse’s business Indirect pecuniary 10/05/2012 Donisthorpe Hall Nursing Home Trustee of charity Direct non-pecuniary 10/05/2012 01/04/2010 – Ongoing Leeds Acupuncture Clinic Father’s business Indirect non- 10/05/2012 pecuniary Leeds Jewish Free School Director Direct non-pecuniary 16/01/2014 13/07/2012 – Ongoing Chapeloak Investments Ltd Owner / Director Direct pecuniary 15/02/2013 June 2013 - Ongoing Local Authority Brodestsky Primary School LA Governor Direct non-pecuniary 01/09/2012 01/09/2012 – Ongoing Nigel Gray Bevan Healthcare Board Non-Executive Director Direct non-pecuniary 01/05/2012 (Chief Officer) Leeds Teaching Hospitals Trust Spouse employed by Indirect non- 01/05/2012 them pecuniary Leeds Community Healthcare Sister employed by them Indirect non- 18/12/2012 – Business Change pecuniary Manager Dr Manjit Purewal North Leeds Medical Practice Partner Direct pecuniary 11/05/2012 01/04/2003 – Ongoing (Clinical Director) Oakwood Surgery Partner Direct pecuniary 11/05/2012 01/09/2001 - 01/03/2003 Primary Care Training Centre Tutor Direct pecuniary 11/05/2012 01/04/2003 – Ongoing BMA Member Direct non-pecuniary 11/05/2012 01/02/1994 – Ongoing Diabetes UK Member Direct non-pecuniary 11/05/2012 01/09/2006 – Ongoing Local Care Direct Member Direct non-pecuniary 11/05/2012 2005 – Ongoing Circle Group Member Direct non-pecuniary 11/05/2012 2006 – Ongoing PWC Member Indirect pecuniary 11/05/2012 2007 – Ongoing
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Petra Morgan Street Lane Practice General Manager Direct pecuniary 18/05/2012 03/07/2000 – Ongoing (Practice Manager – (Employee) with Governing Body Enhance Primary Healthcare Ltd Director and Shareholder – Direct pecuniary 18/05/2012 14/12/2011 – Ongoing responsibilities) Services they provide: Cardiology; Dermatology; Minor surgery; General Paediatrics; Care Home – LES. Provides the wound Care & Catheter Service for the LNCCG practices. Changing Faces Member of Advisory Panel Direct non-pecuniary 26/07/2013 22/07/2013 – Ongoing Lucy Jackson Leeds City Council Employee Direct pecuniary 13/04/2013 01/04/2013 – Ongoing (Public Health Indirect pecuniary Consultant) Martin Wright South West Yorkshire partnership NHS Spouse employed as Senior Indirect pecuniary 11/05/2013 1988 – Ongoing (Chief Financial Foundation Trust Finance Manager Officer) Graham Prestwich Astra Zeneca Pension Provider Direct pecuniary 17/05/2012 1978 – Ongoing (Non-Executive Lay Pfizer Ltd Pension Provider Direct pecuniary 17/05/2012 1997 – Ongoing Member – PPI) Pfizer Ltd Shares Indirect pecuniary 01/08/2013 1997 - Ongoing Graham Prestwich Ltd Director Direct pecuniary 17/05/2012 28/03/2007 – Ongoing GalbraithWight Ltd (Global Strategic Senior Consultant Direct pecuniary 17/05/2012 14/08/2009 – 01/08/2013 Healthcare Consultancy) Nine Health Community Interest Company Director Direct pecuniary 17/05/2012 26/07/2011 – 31/05/2013 University of Leeds Member of the Consensus Direct pecuniary 11/07/2012 July 2012 - Ongoing Development Panel for ASPIRE, a 5 year £2m research project (Action to Support Practices Implementing Research Evidence) Change Member, Board of Trustees Direct non- 13/04/2013 24/04/2013 – Ongoing pecuniary Patient Information Forum Board recruitment Indirect non- 01/08/2013 01/08/2013 – December pecuniary 2013 Leeds Area Prescribing Committee Patient Representative Direct non-pecuniary 04/10/2013 04/10/2013 – Ongoing National Blood Transfusion Audit Member of the PPI Advisory Direct non-pecuniary 15/01/2014 October 2013 - Ongoing Programme promoting the use of evidence Panel based guidelines (AFFINITIE) Page 2 of 3
Leeds Institute for Quality Healthcare Lay Member of the Advisory Direct non-pecuniary 15/01/2014 January 2014 - Ongoing Board Faculty of Medical Leadership and Lay Member of the North of Direct non-pecuniary 15/01/2014 January 2014 - Ongoing Management England Steering Group Medicines Communication Charter Task Chair Direct non-pecuniary 15/01/2014 January 2014 - Ongoing and Finish Group of the Leeds Area Prescribing Committee Peter Myers Beverley Building Society Chief Executive Direct pecuniary 18/05/2012 (Aligned Non- Finance Yorkshire Ltd Director Direct pecuniary 18/05/2012 Executive Lay Member – Governance) Royal Air Force Voluntary Reserve Officer Direct pecuniary 18/05/2012 (Training) Dr Simon Robinson SACAR (Specialist Autism Services) Leasee Direct pecuniary 19/02/2013 19/02/2013 – Ongoing (GP Non- Executive Director) Assura Leeds Shareholder Direct non-pecuniary 13/06/2012 Leeds West GP Practice Federation Member Practice Direct pecuniary 17/02/2014 December 2013 – (Official name yet to be confirmed) Ongoing Dr Nick Ibbotson Wetherby Surgery GP Principal Direct pecuniary 18/06/2012 01/04/2006 – Ongoing (GP Non-Executive Director) Ellie Monkhouse LTHT Spouse is Orthopaedic Indirect non- 15/01/2013 01/11/2012 – Ongoing (Director of Nursing & Consultant at Leeds pecuniary Quality) Teaching Hospitals Ankle and Co. Spouse’s Business Indirect non- 15/01/2013 01/04/2012 – Ongoing pecuniary Dr Mark Freeman Mid Yorkshire Hospitals Consultant Physician Direct pecuniary 18/03/2013 01/08/2002 – Ongoing (Secondary Care Glycosmedia Partner Direct pecuniary 18/03/2013 01/03/2008 – Ongoing Consultant) Univadis Scientific Committee Advisor Direct pecuniary 18/03/2013 01/08/2012 – Ongoing Freemans Pharmacy Brother – Owner Indirect pecuniary 18/03/2013 01/02/2001 – Ongoing BMA Member Direct pecuniary 18/03/2013 01/08/1992 – Ongoing Liane Langdon Making Lemonade Ltd Owner and Director Direct pecuniary 17/07/2013 03/12/2007 – Ongoing (Director of Commissioning and Strategic Development)
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PATIENT ASSURANCE GROUP
Minutes – Final
Tuesday 1 April – 6.00 pm to 8.00 pm
Leafield House
Members Initials Role Present Apologies Graham Prestwich GP Chair - Lay Member PPI (LNCCG) Carol Stevens CS Member - Alwoodley Bob Stone BS Member - Roundhay Andy Morgan AM Member - Alwoodley Pat Newdall PN Member Dick Killington DK Member - Moortown Keith Reynolds KR Member - Adel/Wharfedale Savi Tyndale-Biscoe STB Member - Chapel Allerton Paul Landey PL Member - Moortown Margaret Wilkinson MW Member - Harewood Adrian Knowles AK Member - Otley/Yeadon Vacant Member- Wetherby Vacant Member- Killingbeck and Seacroft In attendance Initials Role Present Apologies Kevin Bray KB PAG member from LWCCG Rob Goodyear RG Head of Planning and Performance Irene Stockwell IS PA/Administrator
Item No Agenda Items Action LNPAG Welcome and Apologies: 2014/045 GP welcomed members to the meeting. Two apologies received and recorded above. DK apologised for not attending the meetings due to illness but looks forward to attending the meetings in the future. GP advised that Trude Silman has decided to leave the group. Group asked that a letter could be sent to thank Trudie for her contributions. IS No contact from BS. Action: IS to send letter. LNPAG Introductions: 2014/046 GP welcomed RG and KB to the meeting. RG is the Head of Planning and Performance at LNCCG and KB has been a PAG member with LWCCG for 4 months.
LNPAG Minutes from previous meeting: 2014/047 IS to e-mail the group all members contact details. All members happy for details to be shared. PAG FINAL Minutes 01.04.2014 Page 1 of 5 PL thanked IS for sending information by e-mail and post. Group happy that the attendance list was correct for the last meeting and reflected members present. GP to arrange meeting with Natasha Beardsmore regarding IFR, still GP ongoing. KB attended on behalf of LWCCG as requested by the group at the last meeting. GP shared feedback and comments from member regarding anticoagulants. (Paper copy handed to each member). Final report from NHS England released at the end of March 2014. Call to action to be included. Planning that needs to happen incorporated into other things, possible not to stand alone. NHS Call to Action and local report, not too different. AK advised that any paper should be in plain English which is RG understandable to all. RG offered to give group access to the paper. Action RG to bring paper to later meeting to share with the group.
End of Life Care PN advised she attended the first meeting regarding end of life care and felt the decision to interview patients and relatives within the first year of bereavement was too soon. PN not sure that that the generalisation that all bereaved go through the bereavement stages in 12 months is appropriate. LSECCG too have concerns regarding this. Also felt that the number of people interviewed was insufficient, if more people at different stages of bereavement had been interviewed the outcome could have been quite different. • Report to scrutiny going to 2nd stage. • The question of who is going to deliver the care was raised. • PN was unable to attend the last palliative care group meeting and not sure if near commissioning. • Leeds scored low on the needs assessment which highlighted that Leeds was poor on end of life care plan; there is a need to understand why the score was so low. • PN advised that palliative care board works very hard with the professionals. GP and district nurses are going out to the patients but it is going to take time to implement across the city. • Leeds has two computer systems – System 1 and EMIS, which does cause some problems. 70% are on System 1 and 30% on EMIS. • Group were advised that the service is out for tender – assurance role feedback to be reflected and contract will reflect this, it will be mindful of mechanisms not about figures. The worry that it is going to be a private service but advised that best provider will be used. Action: RG to come back to group with more information. GP to arrange for this topic to come back to the LNPAG for review. RG/GP
PAG FINAL Minutes 01.04.2014 Page 2 of 5 New members PG advised that introduction meetings had taken place but no members had been recruited. PG asked if members would discuss with him how to grow the group and provide continuity. GP Two year plan PL enquired if the new head of NHS England Simon Stevens will change GP the plan but was advised that probably not. GP – link to the plan to be added to minutes Congenital heart disease at Leeds The findings have been published regarding LTHT. Challenging issues. The group hope that patients are being involved and their voices are being listened to. Action: Link to the current NHS Plan GP LNPAG Matters arising: 2014/048 PN - as previously mentioned has decided not to take a place on the Health Watch Board Action: GP and AM to speak to Stuart Morrison at Health Watch to GP/AM/IS confirm. IS to amend the attendance list. Feedback on anticoagulant survey • Tony Jamieson from Medicine Optimisation expected patients who were on anti-coagulants would have been part of the survey but he didn’t advise of the number of patients involved. • Survey is nearing completion within 10 days. • LWCCG are leading but LNCCG are also involved, as it impacts on the whole city. • The present system is not as streamlined as it could be. Group agreed that survey is the best way forward. Action - GP to circulate a copy of the survey to the group when it is GP available.
LNPAG Medicine Management Projects 2014/049 The small working group met with Heather Edmonds from Medicine Optimisation. The group were unhappy with the outcome of the meeting and that no information was available on the day but received later. Group felt the facilitator didn’t know the reason for the meeting. The group didn’t feel they were listened to. Group asked GP what assurance did the group have that the patients had been involved. GP Liked:- • The presenter • Some involvement (waste – Otley) • Commitment to the future • PPI • Principles • Involvement process • Long term goals Disliked:- • Process • Pre-reading
PAG FINAL Minutes 01.04.2014 Page 3 of 5 • Question of being taken seriously • No evidence of involvement presented Do differently:- • The whole thing • The presentation
Action GP to discuss and advise the group. GP
LNPAG Update on the PPI section of the plan 2014/050 Small working group were very unhappy about the way their meeting was organised. They felt that being given Chapter 12 of the clear and credible plan at the meeting was not the way forward. The group took the paper away and another meeting was reconvened to discuss. Group were unhappy that patients and the public had not been involved. • In the paper they felt that the wording audience was not acceptable. • Small group asked if there was any evidence of involvement but advised there was not any as far as he was aware. • AM hopes the public will in future be involved in putting the plans together
GP apologised for the bad experience. Liked:-
Disliked:- • 12.6 process for involvement – for handbook • wording – audience – felt it was inappropriate Do differently:- • The whole thing GP/RG Action GP to discuss outcome of meeting with RG LNPAG Dementia 2014/051 Small working group met with Tim Sanders, the Dementia lead. • Group were happy that targets had been identified. Felt there were some shortcomings. • Positive meeting to improve the service. • Felt that carers not being supported. • Received the questionnaire that patients receive – felt it was too complicated and needed amending. Group felt the use of NHS wording needs to be understandable to all. GP asked if given any information regarding the patients been included in the presentation of the questionnaire. Liked:- • Assurance on additional staff • Leeds Dementia project – to inform the activity • Clear objective to improve services Disliked:- • No review of questionnaire • Wording of the questionnaire for dementia patients
PAG FINAL Minutes 01.04.2014 Page 4 of 5 • Very difficult to understand • Question such as pregnant – inappropriate • Fait a complis – no opportunity for input • In house wording • Old age psychiatrist – not appropriate • Elder facilitator • Seen to be addressing patient’s needs. • Patient involvement • Do differently:- • Scrutinise the questions for suitability. LNPAG Review of small work plan 2014/52 GP to contact LNCCG staff to arrange meetings. IS to book meeting GP/IS rooms and contact members. LNPAG Review of the terms of reference for the LNPAG 2014/053 To be discussed at the next meeting.
LNPAG AOB 2014/054 KR asked if there could be further meetings to cover the previous small work groups. Next Date of next meeting: meeting 6 May 2014 2014 Venue: Leafield House
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Governance, Performance & Risk Committee Thursday 3 April 2014, 10:00-12:00 Boardroom Leafield House, Leeds DRAFT Minutes
Chair: Nigel Gray Minutes: Nicola Smith
Members Initials Role Present Apologies Nigel Gray NG Chief Officer Martin Wright MW Chief Financial Officer Dr Manjit Purewal MP Clinical Director Ellie Monkhouse EM Director of Nursing and Quality Graham Prestwich GP Lay Member – PPI Rob Goodyear RG Senior Business Manager
Liane Langdon LL Director of Commissioning and Strategic Development Rabia Patel RP Interim Corporate Governance Lead Russell Hart-Davies RHD Head of Quality, LWCCG In Attendance Initials Role Present Apologies Richard Gibson RAG Head of Governance Simon Harris SH Business Intelligence Manager Nicola Smith NS Personal Assistant
Item No. Agenda Item Action
123/2014 Welcome and apologies
NG welcomed everyone to the meeting and noted apologies, as
above. The meeting was quorate.
124/2014 Declarations of Interest
There were no declarations of interest in respect of agenda items.
125/2014 Draft Minutes from 6 February 2014
These were agreed as an accurate record. Draft GPR Minutes 03.04.2014
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126/2014 Actions and Matters Arising from 6 February 2014 NG addressed the action log of the last meeting (see attached log and matters arising below).
117/2014 SR advised A&E admission rates had fallen since January 2014, particularly at LGI and were now below 30%.
SH gave a brief update on performance and will circulate paper to the GPR Committee. NG commented there were no surprises and it could have been predicted. NG’s view was that more capacity is
needed on Mondays or an increased workforce at weekends. GP felt that the whole system needs looking at, rather than just focus on A&E in isolation, and reported that currently two thirds of A&E admissions are patient-led. NG suggested that this information is fed back to the operational & strategic urgent care boards. SH
120/2014 Risk reporting – to be discussed at this meeting 03/04/2014
127/2014 Information Governance Update
AC reminded the group that we have 2 key responsibilities; to engage a SIRO (MW) and a Caldicott Guardian (MP). Information Governance is still a very active issue. There had been some negative publicity around a care.data initiative regarding selling patient data to private sector; lobby groups and twitter are encouraging people to opt out of data sharing. The Governance group met with NHS England to make sense of current guidance and discussed whether patients are being fully informed of the implications of their decision before opting out; it could be very damaging for the City, if they opt out they will be opting out of some patient care initiatives. GP reported that this issue was discussed at the patient reference group and felt there was very little support from practice staff in terms of encouraging patients and why it’s in their best interest to share their data, in fact it was almost the opposite. GP felt there was a lot of work to do with regards to giving positive messages to the public. AC commented that practices appear to take their own stance on this issue. We have distributed newsletters to practices and are working with Comms to get a clearer communication out. However, it is an NHS England initiative, and therefore quite difficult to progress on wording without their authority. Risk Stratification - is a technique whereby Primary and Secondary care data is combined and used to generate a predictive score as to how much healthcare resource an individual is likely to use over the next 12 months. Unfortunately this has been caught up in the debate Draft GPR Minutes 03.04.2014
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of who can see what data in the NHS. NHS England has agreed a new, temporary legal framework under which Risk Stratification systems can operate. This is known as a Section 251 exemption under the Data Protection Act. The exemption stipulates a number of criteria which the CCG cannot currently meet. The CSU is working to advise and address these gaps.
This shortfall is currently flagged as a risk on the CCG risk register and the Accountable Officer is aware. Asset owners – AC reported that they have now been trained. GP asked for the SIRO and Caldicott Guardian to be named in the AC report.
128/2014 Performance Report
RG briefly discussed his paper:- We have been predictively modelling performance around A&E waiting times and are confident that we will achieve the target for this year. Diagnostic test waiting times – The headline 99% was achieved in January with 4 out of 15 diagnostics tests falling below the national standard.
Cancer 2 Week Waits – Year-to-date performance is below the 93% standard, consistent over-achievement against this standard will be required in the remaining 2 months to achieve the year-end target and minimize any negative impact on the 62 day target.
Ambulance Response Times – For Leeds North, YAS is consistently not achieving the Red One 8 minute and 19 minute standards, and will need to improve performance to achieve the aggregate standard for 2013/14. Overall YAS are achieving these standards.
We still need to clarify MRSA performance, but it looks likely we will fail to meet target.
C-diff – we failed to meet target. NG commented that Harrogate performance figures need to be RG included in LNCCG. GP commented that he would like to better understand the term ‘under-trading’. RG to discuss with GP outside of this meeting. RG
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129/2014 Complaints The PALs service runs from the CSU, which is the patient’s first port of call for making a complaint. The PALS team is in a position to signpost members of the public to the most appropriate organisation if their query requires escalation to the formal NHS complaints tool. Some complaints go direct to the provider. As a cross city group we would deal with multi-city complaints. RAG gave brief explanation of various complaints.
GP asked whether we have any robust evidence of raising awareness to the public of how they can make a complaint – RAG reported that 20,000 leaflets have been distributed in the city. The LNCCG website also provides contact details for patients, in relation to a complaint or a concern that they may have. NG commented that in terms of learning points would like to know whether these are discussed at Q&S committee.
130/2014 Board Assurance Framework
RAG didn’t distribute the BAF this time. The BAF is currently being reviewed. It was presented to the Board a couple of weeks ago and an updated one will be produced for 2014/15. RP will be progressing this over next couple of months with the City wide Governance Team and will bring it to a Board workshop.
MW commented that it would be useful to include a risk movement summary on the BAF using an arrow system. This can provide debate to be focussed on the risk movement summary, particularly changes or issues.
131/2014 Risk Register
Outcome of discussion: – 2 reds risks remain: 339 and 286. Four other risks have been taken off the LNCCG Corporate Risk Register and are to be managed operationally. NG commented that the synopsis on risk 339 cancer is very out of date – referring back to Oct 2013 and should be updated. Action - Cath Foster (CF). We need to add who is the owner for LNCCG RAG (LL).
NG commented that the Outpatients risk (286) is at 16 but is not assured and felt it should go above 16. NG felt we need to go back and reassess the scoring as both red risk are 16 on the risk register RAG before and after the synopsis/action.
GP stated that risk 314 goes to amber – needs updating. NG to NG update Draft GPR Minutes 03.04.2014
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MW stated that internal audits for 2013/14 are coming to an end, and stated that the audit relating to governance and Risk MW Management will be brought to this meeting. It was agreed that Richard Gibson will become a member of this group. NS
132/2014 Policies for Approval:
HR Policies Review Summary: a) Recruitment and Selection Policy (LNHR08) – This policy absorbs 3 other policies, and is being simplified into one policy. MG asked that a change be made to Section 10 – currently states ‘procedures should’ – change to HM ‘procedures must’. GP asked about version control of the policies and suggested that it would be helpful if detail was added to show the changes in the document. GP asked whether the policies are checked independently. HM stated that they are not checked independently but they go through HR for comments. GP stated he would like them to be reviewed. GP commented that the policy states it only applies to ‘prospective employees’ and ‘employees’ and commented that it should include contracted personnel who only have a service of contract. NG agreed and asked for the policy to be amended accordingly. HM b) Acceptable Standards of Behaviour Policy (LNHR09) This policy has absorbed 2 other policies. A simplified version of standards of dress has been included. Procedures have stayed the same around behaviour.
c) Protection of Pay and Conditions of Service Policy (LNHR10) – no changes in protection, short term and long term continuous service. d) Organisational Change Policy (LNHR11) – 4 week trial period changed from 3 months for an organisational transfer. Duties need to be mainly the same when transfer into another job and in same band. e) Policy on Trade Union Recognition and Facilities and Time Off for Trade Union Representative (LNHR12) – changes to time off for employees. f) Managing Concerns with Performance Policy (LNHR13) – changes to pay progression. MW asked whether the policy was clear about whether we should go through an informal procedure first before going through a formal procedure. HM would update to make more explicit. HM
We are reviewing all HR polices; this is a second set, at final stage to be ratified now. NG felt that our policies should be very similar to the other Leeds CCGs.
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It was agreed to produce simplified flow charts of policies and present at Team Brief. GP suggested footers be added to the documents detailing the HM document file path/name.
133/2014 Any Other Business GP had read the APMG minutes included in the Exec paper and commented that he struggled to see provider management meetings addressing quality other than hospital markers - re hospital acquire infections (HCAI). GP also commented that they don’t seem to be touching on patient experience and it is not appearing as a significant chunk of provider management.
RHD stated he has taken quality reports to PMG – they focus on performance aspects and quality is managed outside of that with the providers. NG stated that there are quality groups for each section i.e. LTHT, Community and MH and asked whether these minutes go RP to Quality and Safety Subgroup of our Board? RP to chase up individual quality groups for these minutes.
GP stated that from the PMG minutes he had noted that MSK meeting had been deferred twice, and questioned whether there were any implications of this for patients.
Date of next meeting: Thursday 5 June 2014 10:00 – 12:00
Venue: Boardroom, Leafield House
Draft GPR Minutes 03.04.2014
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DRAFT MINUTES Council of Members Meeting Tuesday 8 April 2014 Leeds Seventeen, Nursery Lane, Leeds LS17 7HW
Practices Represented: Aireborough Family Foundry Lane Rutland Lodge Practice Practice Allerton Medical Centre Hilton Rd (One Medicare) Shadwell Medical Centre Avenue Surgery The Light (One Medicare) Spa Surgery Bramham Medical Centre Meanwood Group Practice St Martin’s Practice Chevin Medical Practice Moorcroft Street Lane Surgery Chapeltown Family Surgery North Leeds Practice Wetherby Surgery Charles Street Newton Surgery Westfield Surgery Crossley Street Surgery Nursery Lane Westgate Surgery Dr Gould & Partners Oakwood Lane Medical Practice Woodhouse Medical Centre Dr Lightfoot & Partners Oakwood Surgery .
Not in Attendance
LNCCG Representatives: Jason Broch (Chair) Nigel Gray, Martin Wright, Liane Langdon, Manjit Purewal, Ellie Monkhouse, Andy Irvine, Gina Davy, Simon Harris, Amelia Letima, Dawn Gunga, Vicky Doherty, Matt Langwade, Vicky Womack, Heather Edmonds, Lucy Jackson, Diane Burke, Jenny Chambers (Notes)
Primary Care Framework (see copy of slides)
Vision – Dr Jason Broch Structure – Andy Irvine What this means in practice – Gina Davy
The presentations set out a vision for the challenge ahead and how LNCCG would support the Primary Care Framework. This was an open discussion and this issue will be discussed at future Council Meetings as this is an on-going debate and working arrangements are being formulated
Locality Commissioning Scheme (see copy of slides)
Petra Morgan & Simon Harris presented a summary of the scheme and highlighted the information that had been sent to practices leading up to Council Meeting. Practices were invited to meet in potential locality groups with a facilitator to discuss the working arrangements of the scheme in more detail, which practices they might want to work with and give feedback on the data presented to practices and what else they felt they required.
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The facilitator notes will be collated and presented back to the members and taken forward in Locality meetings.
Practices interested in signing up for this scheme are required to complete the form by 30th April 2014. Strategy Discussion – Liane Langdon (see copy of slides)
Members were presented with a progress report about the strategy discussions that had taken place at the January and March Council Meetings and how the decisions made at Council have influenced commissioning and contracting decisions.
The members were asked to discuss the key elements of the 5 year plan. The ideas and comments are being collated and will be fed back to members.
Council Meeting:
Chair: Jason Broch
1. Welcome The Chair welcomed all to the meeting of Leeds North CCG Council of Members.
2. Minutes from previous It was noted that Bramham practice attended the meeting on the 4 March 2014 and the minutes were amended to record this.
With the addition of the change made above, the Council of Members accepted the minutes as an accurate record of the meeting held on 4 March 2014.
3. Matters arising There were no matters arising
4. Chief Officer’s Report – Nigel Gray Nigel welcomed Members and wished them "Happy Birthday" on the first anniversary of Leeds North CCG. He thanked them for all the hard work and support they have provided over the last 12 months.
The Chief Officer confirmed that the Annual Report and Accounts were in the final stages of completion and that input from today's Council Meeting will be incorporated into them before sign off by the Governing Body and final submission to NHS England on Friday, 6 June, 2014.
Nigel discussed new ways of working in partnership with other organisations. The NHS is now working jointly with the local authority and with third sector bodies (previously charitable organisations but now not for profit or local enterprises where any profit is reinvested back into the organisation). Work is underway on the framework to support this way of working to ensure that governance is in place to facilitate the sharing of information. Action: Nigel to share details of the work in progress with Council Members and discuss in more detail at the next Council Meeting.
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In summary, the Chief Officer confirmed that Council had received a briefing earlier in the meeting on two important pieces of work - the 5 Year Plan and the Primary Care Framework - and that the Chief Officer’s Report will be published on the LNCCG website (www.leedsnorthccg.nhs.uk).
5. Quality & Performance Update – Manjit Purewal/Ellie Monkhouse Manjit gave an update regarding the concerns expressed at the last meeting on the use of One to One Midwives (an independent company who were marketing their services to patients). Manjit informed Council that:
- The CCGs do not commission this service as they believe current provision allows for choice and there are no capacity concerns. - Pathways are not in place regarding urgent transfers as this is not a local service.
Sir David Nicholson, Chief Executive of NHS England has recently circulated a letter which supports this approach.
Manjit updated Council regarding the 16-bed J31 community ward in the Beckett Wing, St James. They are still experiencing a few teething problems which are being worked on at the moment. CQC registration status has now been confirmed. Further updates will be provided at a future meeting.
Manjit shared with Council the work on which Cath Johnson is leading on behalf of the three Lead Practice Nurses regarding the supply issues with vacuette and monovette safety equipment. The Leeds Medical Council has raised these issues with the Area Team and Cath is liaising with them and will update practices on progress.
Manjit requested Council Members to continue to encourage the use of the Quality Issues Reporting System (formerly known as Yellow Card Soft Intelligence) in their practice to help us build up a fuller picture of quality issues being experienced with our providers. Action: all
6. Requirement to produce a Member Practices Report as part of the LNCCG 2013/14 Annual Report – Petra Morgan Petra informed Council of the requirement to produce a Member Practices section of the annual report which is owned/written by Council. Petra suggested that the best approach to do this within the tight timescales would be to send out a presentation to practices for them to read and give their feedback on the content. The Locality Team will help to gather the feedback to be included in the report which will reflect the discussions and the objectives achieved in primary care throughout the year.
Richard Vautray enquired whether there would be a copy of the annual report for each practice so that they could engage with staff who do not attend Council. Gina Davy agreed to support this. Action: Petra/Locality Team to circulate the presentation. GP practices to look at the detail, provide comments/add anything they feel is missing from the report.
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7. Integrated Health and Social Care Update – George Winder George Winder presented an update in relation to integrated neighbourhood teams (INTs).
INTs are now coterminous with practice boundaries. This gives practices the opportunity to agree with their local INT the best way in which the team will work with the practice to deliver the enhanced service.
Other opportunities to promote integration include the newly-released enhanced admissions avoidance service, city-wide initiatives using the Better Care Fund and CCG monies to commission primary and community services to support older people at home. These services should be designed to complement the work being undertaken at practice level to deliver the enhanced service.
Council were asked to divide into groups and each group suggested their preferred areas for prioritising the direction of commissioning funds. Council mandated George Winder and Gina Davy to work with the Locality Teams to develop these proposals further. Volunteers were requested from GP practices to help support this piece of work. Action: Member practices to volunteer clinical representatives to help with this project Gina and George to communicate with members the outcomes following the initial scoping of the proposal
8. Ratification of Strategy Decisions/Plan – Liane Langdon Council ratified the strategic decisions made earlier in the meeting as a result of Liane’s presentation and mandated Leeds North Clinical Commissioning Group to proceed on this basis.
9. Finance Update – Martin Wright Martin gave an update on the financial year end. The Finance Team are currently pulling together the accounts, which need to be completed by 23 April, 2014. The accounts are one of three key documents needed to be produced by this date, which also includes the Annual Report and the Annual Governance Statement. Post 23 April the accounts will go to the Audit Committee for review on the 4 June. The Audit Committee will then recommend them to the Board for final sign off before being submitted to NHS England and publication on the LNCCG website on 6 June 2014.
Nigel confirmed that the Annual Report would be uploaded to the website in “Plain English” and would reflect on last year and the forward planning for the new financial year. Nigel and Jason will issue a brief summary for the website to make for easier reading.
In the new financial year work has begun in tandem on the Finance Plan 2014/15 and the 2 Year Strategy Plan.
An Annual General Meeting/Council Meeting is planned for 1 July 2014 when Council will be able to view the accounts for last year and the plan for the future.
10. PPI Update – Nigel Gray Nigel confirmed that Liane and Paul Storey were meeting on Thursday, 10 April to discuss how to take forward the Patient Reference Group. Council were asked to email them if they had any ideas they would like to put forward for this group. Action: all
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11. AOB Liane confirmed that there were complimentary places on offer for the Commissioning Show in London on 25/26 June. This would showcase commissioning and the development of thinking around commissioning. If anyone from the locality groups would like to attend, they would need to email Liane or Nigel by close of play on Wednesday, 9 April to book their place. Action: all
Date of Next Meeting: 1 July 2014 – Annual General Meeting/Council Meeting
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Quality & Safety Committee Tuesday 22 April 2014, 13:00 – 15:30 Boardroom, Leafield House DRAFT Minutes
Chair: Dr Manjit Purewal Minutes: Jenny Chambers
Members Initials Role Present Apologies Ellie Monkhouse EM Director of Nursing and Quality Graham Prestwich GPr Lay Member (Deputy Chair) Lucy Jackson LJ Public Health Consultant Dr Manjit Purewal MP Clinical Director (Chair) Mark Gallacher MG Quality Manager Dr Nick Ibbotson NI GP Non-Executive Director Rabia Patel RP Corporate Governance Lead Russell Hart-Davies RHD Head of Quality (LWCCG) Dr Simon Robinson SR GP Non-Executive Director In Attendance Initials Role Present Apologies Jenny Chambers JC Minutes Diane Addison RG Governance Support Manager (LWCCG) Norman Campbell NC Mental Health Commissioning Manager Simon Harris SH Business Intelligence Manager
Item Action Welcome and apologies 051/2014 MP welcomed all to the meeting and apologies were noted. Declaration of Interest 052/2014 There were no declarations of interest to record. Minutes from meeting 27 February 2014 053/2014 There were no changes made to the minutes from the last meeting and they were accepted and signed off as an accurate record. Actions and matters arising from 27 February 2014: Item 040/2014 – Acute Trust Quality Dashboard data: 054/2014 SH confirmed that this dashboard information will still be produced on a regular basis in an electronic format using an online toolkit called Stethoscope. https://stethoscope.methjods.co.uk
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Action: It was agreed to align the four quality dashboards in use and include the information into the Quality Report. SH/RHD were RHD / SH tasked to review the dashboards and report back.
Action: Agree with the Chief Executive the content to present to Board on the role of the Q&S Committee as opposed to the GPR MP Committee.
Item 043/2014 – PROMS / Public Health England reports, clarification re CSU involvement. RHD confirmed that these reports had ended. Discussion was underway on the value of the report and whether they should RHD commission the CSU to continue. Action: Feedback to Q&S.
Item 045a/2014 – Seek clarity from LTHT on their Testing & Equality policies and procedures. It was confirmed that Fiona Day has been appointed Public Health Consultant and would fall within her remit. LNCCG Quality Report Mark Gallagher updated on the Quality Report. MP asked if there was anything that Mark needed to highlight to the Q&S Committee from the report. The causes for concern which needed to be highlighted were noted as : Friends and Family Test: RHD confirmed that he has spoken with Clare Linley at LTHT to enquire why the net promoter scores were declining. Clare confirmed that this issue was being dealt with at the LTHT Quality Group meeting.
Action: MP requested that information from the LTHT Quality Sub- Group could be included in the Quality Report to provide assurance RHD / MG to the Q&S Committee that issues were being addressed.
It was noted that A&E statistics were also an area of concern.
055/2014 MP asked whether in the future it would be possible to compare A&E statistics with Primary Care information to obtain a comparative view.
Action: GPr asked MG to add the date/year to the items on the report. GPr also enquired whether the statistics were a mean or MG / RHD median figure. GPr also queried whether trends could be recorded in
the report rather than statistics.
Harm-Free Care: There were no specific concerns recorded with our main providers.
LTHT CQC Visit: It was noted that there were areas for improvement, but as an organisation LTHT was seen to be
improving. The full report and feedback has not yet been produced.
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Action: Mark to inform Q&S Committee on findings at a future RHD / MG meeting when the information is available.
GPr noted that it was important that the measure of clinical effectiveness should be included and fully addressed. RHD confirmed that this information was not available at this moment in time but would be included in future reports when available. Patient Safety: HCAI Action Plan Trajectories for 2014-15
MG discussed the report with the Q&S Committee. NI expressed the view that GPs needed to be clear on prescribing guidelines for C. Difficile. NI expressed concerns re community acquired C. Difficle infections and the use of certain antibiotics.
Action: MP confirmed that this question needed to be raised with the MG / NI Medicines Optimisation Team for clarification.
Patient Awareness: GPr queried whether patient groups were being 056/2014 fully involved in this piece of work. The project is being led by the
Medicines Optimisation Team and he felt that patients could be more involved in designing solutions.
Action: Communicate and invite people to become involved via GPr patient groups.
LJ noted that times/dates should be applied to the report so that the Q&S Committee could monitor when actions are being completed.
Action: MP requested that the action plan should be presented to MG Q&S Committee by the end of September.
MP noted that LNCCG have been asked to produce their own trajectories for HCAIs. EM has produced a paper for the LNCCG Board based on 65 cases for 2014/15. This trajectory was accepted by the Quality & Safety Committee.
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Patient Safety: Serious Incidents Diane Addison, Governance Support Manager, attended to take the Q&S Committee through the main parts of the Serious Incident Report. The main priorities for each incident were discussed for each of our three main providers.
Action: MP requested that going forward the report is constructed to identify and concentrate on Leeds area incidents rather than highlight York area incidents, as these were of more relevance to the DA/RG Leeds Q&S Committee.
It was recorded that LTHT had reported 8 Never Events and that work was in progress by LTHT to overcome these incidents.
MG raised the query as to whether the incident at Bootham Park regarding non-collapsible bed rails should be re-categorised as a Never Event. Action: DA undertook to check whether this incident should be re-categorised. MP confirmed that the Medical Directors DA / RG 057/2014 discussed these incidents in detail at the 3 CCG Medical Directors meeting and asked that these discussions should be incorporated into the summary of the serious incident report (Action).
To provide assurance on the number of days required to monitor STEIS incidents (currently set at 2 days), MP asked if the Committee could access information for the Harrogate area.
Action: MP requested that individual incidents be reported rather than exceptions. MP also enquired whether the system could DA/RG monitor the number of “watching briefs” being undertaken and whether these could be incorporated into the metrics.
MP also raised the question of whether Q&S Committee needs to be involved in establishing CQUINS for next year. MP stated that the newly evolving Leeds Institute for Quality Healthcare could be a good link in improving the quality of reporting.
Action: GPr noted that the Lessons Learned section of the report should highlight room for improvement (for example there are DA / RG recurrent themes in several investigation reports) and give the assurance needed that improvements in quality were being made. Patient Safety: JIP Update Norman Campbell attended to give a summary of the work underway as a result of the Winterbourne Review. There is an NHS England
058/2014 deadline of 1 June 2014 for this work to be completed. NC confirmed that the review encompassed out of area patients and patients with complex needs who could not remain in their own homes. MP enquired whether plans were in place to address the patients’ needs and NC provided assurance to the Q&S Committee that adequate care was being provided for these patients. DRAFT Q&S Minutes 2014.04.22
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MP enquired whether Dr Sam Browning, the city-wide GP Lead for learning disabilities was involved with this work. NC confirmed that it is planned that she will be visiting facilities in Leeds so that she can fully appreciate the problems involved with in-patient care.
GPr queried whether the trend for these types of problems is growing city-wide or whether the trend is flat. NC confirmed that the trend was flat and that it would hopefully be declining, but that there would always be a need for in-patient care for some people throughout the city.
NC confirmed that we were working to observe the Winterbourne view by using supported living services wherever possible. MP invited NC to share the Quarterly NHS England Audit Review at a NC future meeting (Action). Patient Safety: LYPFT CQC Inspection update and action plan MG shared the main points of the LYPFT CQC inspection with the Committee. MG noted that an action plan is being prepared and will 059/2014 be going to the LYPFT Board shortly.
Action: MP requested MG to note whether there were any areas of MG concern that would impact on Leeds and to report back on his findings at a future Q&S Meeting. Patient Safety: Safer Staffing MG updated the meeting on progress following on from the Government response to the Francis report - “Hard Truths”. Our three main providers are currently working on information which will form the first Board report in June.
060/2014 MP discussed how the Q&S Committee could utilise the information from this report to establish what effect the low staffing levels and appointment of agency staff had on quality of care. GPr stated that he would like to see this information being fed through into the dashboard so that we could see any detrimental effects and whether it was a worsening trend.
Action: MG to report back to the June Q&S meeting on whether there are any anomalies or quality issues appearing from the data. MG Patient experience: Independent Investigation NHS England has commissioned an Independent investigation into 061/2014 mental health homicides within Leeds. This is a legacy incident from several years ago. RHD tabled a summary of the report which EM had produced to give an oversight of this investigation and the role of the CCG, as this is managed by NHS England.
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The report is expected to be presented in approx. 6 months, and CCG’s will oversee the monitoring of any actions that may be recommended with the provider. This will be done through the Provider Quality meeting as a standard agenda item. Patient experience: Intermediate Care Phase 1 Report A ward at Seacroft Hospital was closed down due to environmental issues. It has now reopened at Beckett Wing, St James. This is currently a 16 bed ward, still managed and staffed by LCH.
Concern has been raised at the time taken to recruit permanent staff to reduce the levels of agency staff being used. EM is closely monitoring this situation and has recently conducted a site visit and 062/2014 obtained feedback on care from patients on the ward.
GPr queried what assurance we had that these safeguarding issues had been properly dealt with and what preventative action had been taken. RHD confirmed that a comprehensive action plan was in place which was being actively managed by the provider’s safeguarding team. Progress has been demonstrated by implementation of the actions from this report and assurance on this has been provided to the Safeguarding and Quality Team. Action: EM will feedback on progress at the next meeting EM Clinical effectiveness: CQUIN update MG updated the meeting on CQUINS for the 2014/15 contracts with our main providers of secondary services. Local CQUINS are agreed between commissioners and providers so that work can be targeted locally to improve quality. Our providers produce quarterly reports on achievement of CQUINS and their performance is monitored on a regular basis by our Provider Management Group.
A discussion took place as to whether CQUINS were a performance
063/2014 measure and whether they should fall into the remit of the Q&S Committee. It was decided that CQUINS were a good measure of clinical effectiveness and quality which Q&S needed to review during the year. The Committee also felt that they needed to be sighted on new CQUINS as they were being developed for next year.
The Q&S Committee required to see whether CQUINS had become a key performance indicator and have been embedded as a measure of quality care year on year.
Action: MG was requested to review the 2012/13 performance of CQUINS in this context and to report back to the October Q&S MG meeting.
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Provider issues / updates: GP soft intelligence Simon Harris attended and provided an update report as at 4 April 2014. He reported that there were 79 responses recorded from 13 (out of 28) practices in the LNCCG area.
Action: MP suggested that SH could raise the profile and promote the benefits of the Soft Intelligence Reporting System to GPs by SH enlisting the help of the Locality and Medicine Management Teams, 064/2014 who have direct contact with GP surgeries.
Action: GPr suggested that to improve performance and take up of the system, SH should write up some guidance for GPs on what SH needs to be recorded on the soft intelligence system.
Action: MP suggested that SH should liaise with TPP, the clinical SH system developers, to look at how the soft intelligence system could be linked to existing GP systems to maximise effect. Provider issues : 065/2014 Harrogate & District FT There were no areas of concern noted at the meeting. Provider issues: 066/2014 LCH/CHC Dashboard There were no areas of concern noted at the meeting. Any other business 067/2014 There were no items recorded under any other business.
Date of next meeting: Tuesday 24 June 14:30 – 16:30
Venue: Meeting Room 2 Leafield House
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Summary Report Meeting: LNCCG Board Date: 21 May 2014 Agenda Item: Information Only Report Title: Human Resources Policy Review Prepared by: Hannah Morris – Senior HR Associate Executive Lead: Liane Langdon – Director of Commissioning and Strategic Development Presented by: Liane Langdon Other meetings presented to: Governance, Performance & Risk Committee Purpose of Report Approval Decision Assurance Information and Comment Strategic Objectives (tick all that apply) 1. To be a successful and robust organisation that puts clinicians, patients and carers at the forefront of commissioning high quality services based on the needs of local people and within the resources available. 2. To support people to be healthy for longer by promoting better disease management, prevention and early detection and treatment. 3. To drive the transformation of urgent care across the city, improving access and promoting appropriate use of urgent care services. 4. To drive the improvement of services city-wide for people with mental health needs and learning disabilities. 5. To promote choice based on quality of care and improve access to services for people in the Leeds North Clinical Commissioning group area. Executive Summary
The below HR policies were ratified at the Governance Performance and Risk Committee on the 4 April 2014. Consultation has taken place with management, staff and trade unions. They were formally presented at the Leeds CCG Social Partnership Forum on the 20 January 2014.
Policy Reference Recruitment and Selection Policy LNHR08 Acceptable Standards of Behaviour Policy LNHR09 Protection of Pay and Conditions of Service Policy LNHR10 Organisational Change Policy LNHR11 Policy on Trade Union Recognition and Facilities LNHR12 and Time Off for Trade Union Representative Managing Concerns with Performance Policy LNHR13
Further information regarding the changes from the policies which rolled over from the PCT are outlined below.
The full policies can be requested by contacting us at [email protected] or 0113 84 32900. Key Recommendations
The policies are provided to board for information.
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Assurance Framework
The appropriate assurance route has been considered with Rabia Patel.
Next Steps
Policies published via the Workforce Intranet Communication sent via the e-bulletin “North News” advising staff of their responsibility to read the new policies
HR to produce supporting toolkits, template letters and forms where applicable and consider training requirements
Corporate Impact Assessment Regulatory implications N/A Financial implications N/A Legal implications N/A - the policies will ensure compliance with legal requirements Workforce implications N/A – the policies will ensure sound employment practice Equality impact assessment Attached at the back of each policy, with the exception of the Policy on Trade Union Recognition and Facilities and Time Off for Trade Union Representative, where E&D have advised an impact assessment is not required.
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Human Resources Policy Review
1. Introduction A staged review of all HR policies has commenced following the rollover of HR policies from Leeds PCT. It is anticipated this will be complete by the end of the financial year. The aim of the review is to ensure the CCG has a set of consistent, best practice policies.
2. Changes A summary is provided below for each policy, highlighting any significant changes from the Leeds PCT polices.
Recruitment and Selection Policy The policy has absorbed three existing policies which transferred from Leeds PCT, including Disclosure of Criminal Background Policy, Professional Registration Policy and Managing Personal Relationships in the Workplace Policy. There have been no further significant changes to the content of the policy.
Acceptable Standards of Behaviour Policy The policy has also absorbed part of the Managing Personal Relationships in the Workplace Policy and the Standards of Dress and Appearance Policy. The content around dress at work has been simplified and does not explicitly exclude jeans. There have been no further significant changes to the content of the policy.
Protection of Pay and Conditions of Service Policy The policy mirrors the Leeds PCT policy and provides further clarity around specific protection elements. For example the new policy advises where there is a reduction or increase in hours the employee will be able to work previous hours for the period of protection. This fell silent in the previous policy. An appeal process has also been included.
Organisational Change Policy The policy reflects a legal change around consultation notice periods for redundancy. Definitions are strengthened, an appeal process and reference to TUPE and early retirement is also included. In order to “slot in” to a post the duties must be mainly the same as in the previous policy. However the new policy clarifies the individual must also be at the same grade. The trial period in suitable alternative employment has been reduced to 4 weeks (opposed to a maximum of 3 months) in line with statutory rights.
Policy on Trade Union Recognition and Facilities and Time off for Trade Union Representative There was not a previous Leeds PCT policy in place. This policy outlines the partnership agreement to work with trade unions and clarifies support and time off for trade union representatives.
Managing Concerns with Performance Policy The policy mirrors the Leeds PCT policy. There have been no further significant changes to the content of the policy.
Human Resources Policy Review
Page 3 of 3 Commissioning Support Unit Proposed Merger (North Yorkshire & Humber CSU and West & South Yorkshire and Bassetlaw CSU)
28 April 2014
Dear Colleague
As you will be aware, North Yorkshire and Humber CSU and West and South Yorkshire and Bassetlaw CSU recently announced a strategic partnership in order to bid to secure a place on the Lead Provider Framework.
As this work has progressed it has become clear that both organisations have much in common and individual strengths from which the other can benefit. Therefore a decision has now been taken by both boards of directors that it is in everyone’s best interests for the organisations to work more closely together with the aim of merging into one organisation by 1 October 2014.
We strongly believe that one organisation going forward will be beneficial to our clients as it will enable us to enhance our service offers and provide you with the benefit of greater efficiencies by being able to still offer local solutions with ‘at scale’ savings. By combining our strengths we believe we can offer our clients a wider pool of talented, creative people who can deliver truly transformational change.
The process of merging is still at a very early stage. A programme management office has been established and we will keep you updated on our progress. We are absolutely committed to ensuring that service delivery for you remains our top priority; we will continue to focus on getting the fundamentals right; improving the quality, responsiveness and value for money of our services. Our programme management approach will ensure that staff remain focused on business as usual.
We appreciate that organisational change can be unsettling; however, we strongly believe that this is the best approach to create a vibrant organisation that will enable you to achieve real success in the future. It is also important for us to reassure you that there will be no immediate change to how the two organisations operate and deliver services to you. Your customer relationship manager will remain the same to ensure continuity and will arrange a meeting with you soon to go through the proposal in more detail. We have made a short video which you can watch here https://vimeo.com/93126282.
If you have any queries or concerns please do not hesitate to contact one of us directly.
Maddy Ruff Alison Hughes Managing Director – NYHCSU Managing Director – WSYBCSU
www.wsybcsu.nhs.uk West Yorkshire Office - Douglas Mill, Bowling Old Lane, Bradford, West Yorkshire BD5 7JR Sheffield Office - 722 Prince of Wales Road, Darnall, Sheffield, S9 4EU